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5028 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is the major function of the D1 receptor?
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relax renal vascular smooth muscle
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What is the major function of the D2 receptor?
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modulate transmitter release, esp. in brain
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What is the major function of the H1 receptor (4)?
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-pain
-pruritis -produce mucous -contract bronchioles |
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What is the major function of the H2 receptor (4)?
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increase gastric acid secretion
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What is the major function of the a1 receptor?
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increase vascular smooth muscle contraction
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What is the major function of the a2 receptor (2)?
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-decrease sympathetic outflow
-decrease insulin release |
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What is the major function of the M1 receptor?
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CNS
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What is the major function of the B1 receptor (5)?
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increase HR,
-inc. contractility, -inc. renin release, -inc. lipolysis, -inc. aq. Humor formation |
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What is the major function of the M2 receptor?
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decrease heart rate
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Draw the brachial plexus
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-
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Nerve(s) associated with longus colli and scalene muscles
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Nerve roots C5,6,7,8
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What is the major function of the B2 receptor (3)?
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vasodilation, bronchodilation, inc. glucagon release
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What is the major function of the M3 receptor?
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increase exocrine gland secretions
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Nerve roots associated with median nerve
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C6,7,8,T1
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What is the major function of the V1 receptor?
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increase vascular smooth muscle contraction
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Nerve roots associated with ulnar nerve
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C8,T1
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Nerve roots associated with axillary nerve
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C5,6
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Nerve roots associated with radial nerve
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C5,6,7,8
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What is the major function of the V2 receptor?
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increase water permeability and reabsorption in the renal collecting tubules
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Nerve roots associated with medial antebrachial cutaneous nerve
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C8,T1
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Nerve roots associated with subclavius
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C5,6
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What second messenger system does Gi work through?
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adenylcyclase reduces cAMP levels and protein kinase A is reduced
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Nerve roots associated with medial brachial cutaneous nerve
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T1
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What second messenger system does Gq work through?
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Lipids
phospholipase C--> I PIP2 to IP3 + DAG DAG inc. protein kinase C IP3 inc. Intracellular Ca2+ |
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Nerve roots associated with lateral pectoral nerve
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C5,6,7
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Nerve roots associated with 1st intercostal nerve
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T1
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What second messenger system does Gs work through?
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adenylcyclase converts ATP to cAMP to phosphorylate protein kinase A
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Nerve roots associated with medial pectoral nerve
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C8,T1
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Nerve roots associated with musculocutaneous nerve
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C5,6,7
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Nerve roots associated with suprascapular nerve
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C5,6
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Nerve roots associated with upper and lower subscapular nerve
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C5,6
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Nerve roots associated with dorsal scapular nerve
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C5
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Nerve roots and muscle associated with long thoracic nerve
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C5,6,7
innervates serratus anterior muscle |
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Nerve roots associated with thoracodorsal nerve
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C7,8
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Autosomal recessive diseases (12)
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-Alpha 1 antitrypsin deficiency
-infant polycystic kidney disease -CF -Albinism -Phenylketonuria -Thalassemias -Sickle cell anemia -hemochromatosis -Glycogen storage diseases: Von Gierke's, Pompe's, Cori's, McArdle's -Mucopolysaccharidoses (except Hunter's): Hurler's -lysosomal storage dz / Sphingolipidoses (except Fabry's): Niemann Pick, Tay Sachs /Sandhoff's, Gaucher's, metachromatic leukodystrophy, Krabbe's. |
most enzyme deficiency dz's with 6 exceptions (XR) plus -3 blood dz's -Infant poly cystic kidney and alpha 1 antitryp |
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_____are associated with low folic acid intake during pregnancy.
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Neural tube defects
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90% of adult polycystic kidney disease cases are due to mutation in _____(gene and chromosome).
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APKD1 (on chromosome 16)
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95% of Down's syndrome cases are due to what?
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meiotic nondisjunction of homologous chromosomes (4% due to Robertsonian translocation and 1% due to Down mosaicism)
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A patent ductus arteriosus is maintained by what 2 things?
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PGE synthesis +
low oxygen tension |
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Abnormalities associated with Marfan's syndrome:
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Skeletal:
-tall -long extremities, -hyperextendible joints, -long tapering fingers/toes Cardiovascular: -cystic medial necrosis of aorta, -aortic incompetence, -aortic dissection, -aortic aneurysm, -floppy mitral valve Ocular: subluxation of lenses |
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Adult polycystic kidney disease is associated with what other diseases or disorders?
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polycystic liver disease
BERRY ANEURYSMS mitral valve prolapse |
what in liver and what in heart |
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Baby with Fetal Alcohol Syndrome.
At risk for -limb dislocation -heart fistulas and -lung fistulas |
developmental retardation microcephaly
thin upper lip indistinct philtrum flat midface short palpabral fissures This child at risk for what other problems? |
heart lung and limb |
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Becker's muscular dystrophy is due to____.
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dystrophin gene mutations (not deletions) Becker's is less severe.
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Besides pulmonary infections, what are some other consequences of CF?
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infertility in males
malabsorption leading to fat-soluable vitamin deficiencies (A,D,E,K) |
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Causes of female pseudohermaphroditism:
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congenital adrenal hyperplasia
or exogenous administration of androgens during pregnancy i.e. excessive and inappropriate exposure to androgenic steroids during early gestation |
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Characteristic murmur with a patent ductus arteriosus.
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continuous, 'machine-like'
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Adult polycystic kidney disease:
Signs and Sx's |
Signs- bilateral massive enlargement of kidneys due to multiple large cysts
Sx's- pain, hematuria, HTN, and progressive renal failure |
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Characteristics of Duchenne's MD:
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onset before age 5
weakness begins in pelvic girdle progresses superiorly pseudohypertrophied calf (fibrofatty replacement of muscle) cardiac myopathy Gower's maneuver (arms to get up) |
progression of symptoms hear probl |
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Characteristics of female pseudohermaphroditism:
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ovaries present but external genitalia are virilized or ambiguous
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Characteristics of Fragile X syndrome:
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macro-orchidism (enlarged testes),
long face with a large jaw, large everted ears, and autism |
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Characteristics of Hereditary Spherocytosis:
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-spheroid erythrocytes
-hemolytic anemia -increased MCHC -splenectomy is curative |
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Characteristics of male pseudohermaphroditism:
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testes present, but external genitalia are female or ambiguous.
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Children may do this to increase venous return with R-to-L shunt.
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squat
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Compare the cholesterol levels of heterozygores and homozygotes with familial hyperchlosterolemia:
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Heterozygotes (1 : 500) cholest. levels around 300mg/dL Homozygotes (very rare) cholest. levels over 700 mg/dL.
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Complications associated with homozygous familial hypercholesterolemia:
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severe atherosclerotic disease early in life
tendon xanthomas (classically in the Achilles tendon) Myocardial Infarction before age 20 |
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Congenital heart defects are often due to which infection?
|
rubella
|
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|
short arm of chromosome 5 46 XX or XY, 5p-
5 yr- Cry when you start preschool |
Cri-du-chat syndrome results from a congenital deletion on which chromosome?
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Define Meningocele:
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meninges herniate through spinal canal defect picture on p. 229
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Define Meningomyelocele:
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meninges and spinal cord herniate through spinal canal defect picture on p.229
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Define pseudohermaphroditism:
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disagreement between the phenotypic (external genitalia) and gonadal (testes vs. ovaries) sex.
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Define Spina bifida occulta:
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failure of bony spinal canal to close, but no structural herniation. (usually seen at lower vertebral levels)
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Describe a true hermaphrodite:
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46 XX or 47 XXY both ovary and testicular tissue present; ambiguous genitalia
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Describe Eisenmenger's syndrome:
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Uncorrected VSD, ASD, or PDA leads to progressive pulm. HTN. As pulm. resistance increases, the shunt changes from L to R to R to L, which causes late cyanosis (clubbing and polycythemia).
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Does coarctation of the aorta affect males or females most commonly?
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3:1 males to females
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Down's syndrome is associated with increased or decreased levels of AFP?
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decreased
AFP goes DOWN, with Down's Syndrome |
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what change in amniotic fluid AFP is evidence of a neural tube defect.
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Elevated AFP
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Explain the adult type of coarctation of the aorta and give some associated symptoms.
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aortic stenosis distal to ductus arteriosus (postductal)
aDult is Distal to Ductus notching of the ribs, hypertension in upper extremities, weak pulses in lower extermities (check femoral pulse) |
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Explain the infantile type of coarctation of the aorta. What is it commonly associated with?
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aortic stenosis proximal to insertion of ductus arteriosus (preductal)
'INantile, IN close to the heart.' associated with Turner's syndrome |
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Explain the pathogenesis of eisenmeinger's syndrome
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In fetal period, shunt is R to L (normal). In neonatal period, lung resistance decreases and shunt becomes L to R with subsequent RV hypertrophy and failure (abnormal).
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Explain the transposition of the great vessels.
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Aorta leaves RV (anterior) and pulmonaryt trunk leaves LV (posterior) this leads to separation of systemic and pulmonary circulations.
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Familial Adenomatous Polyposis features:
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Colon becomes covered with adenomatous polyps after puberty
'FAP' F= five (deletion on chromosome 5) A= autosomal dominant inheritance P= positively will get colon cancer (100% without resection) |
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Findings in Von Recklinghausen's disease:
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-cafe-au-lait spots,
-neural tumors, -Lisch nodules (pigmented iris hamartomas), -skeletal disorders (scoliosis), and -increased tumor susceptibility |
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Findings of Cri-du-chat syndrome:
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-microcephaly,
-severe Mental Retardation, -high pitched crying/mewing -cardiac abnormalities |
(Cri-du-chat is French for cry of the cat) |
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Findings with Huntington's disease:
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depression
progressive dementia choreiform movements caudate atrophy dec. GABA and Ach |
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list type of L-to-R shunt Frequency:
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VSD>ASD>PDA
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Gender identity is based on what two things?
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1. external genitalia 2. sex of upbringing
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Genetic anticipation of Fragile X syndrome may be shown by what?
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Triplet repeat (CGG)n
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Highest risk of development of fetal alcohol syndrome at __ to ___ weeks.
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3 to 8
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How does CF present in infancy?
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Failure to thrive
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How is CF diagnosed?
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increased concentration of Cl- ions in sweat test
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How is Muscular dystrophy diagnosed?
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muscle biopsy
increased serum CPK |
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Huntington's disease manifests between the ages of :
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20 and 50
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Incidence and characteristics and Turner's syndrome:
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1 in 3000 births
-short stature, -ovarian dysgenesis, -webbed neck, -coarction of the aorta -shield chest -streak ovaries |
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Incidence and characteristics of double Y males:
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1 in 1000 births
-phenotypically normal, -very tall, severe acne, -antisocial behavior(1-2%) |
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Incidence and characteristics of Edward's syndrome:
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1 in 8000 births
Trisomy 18 clenched hands (flexion of fingers) low-set ears, micrognathia, prominent occiput congenital heart disease, rocker bottom feet, severe MR, Death within 1 year of birth. |
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Incidence and characteristics of Klinefelter's syndrome:
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1 in 850 births testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution
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Incidence and characteristics of Patau's syndrome:
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1 in 6000 births
trisomy 13 cleft lip/palate, microphthalmia, microcephaly, polydactly, abnormal forebrain structures, congenital heart disease severe MR Death within 1 year of birth. |
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What is the genetic problem in Marfan's?
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fibrillin gene mutation
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Mechanism of Fetal Alcohol Syndrome may be :
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inhibition of cell migration
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Most common form of male pseudohermaphroditism is ____.
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testicular feminization (androgen insensitivity) results from a mutation in the androgen receptor gene (X linked recessive); blind-end vagina
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Name 3 examples of L-to-R shunts. (late cyanosis) 'blue kids'
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1. VSD (ventricular septal defect)
2. ASD (atrial septal defect 3. PDA (patent ductus arteriosus) |
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Name 3 examples of R-to-L shunts. (early cyanosis) 'blue babies'
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The 3 T's'
1. Tetralogy of Fallot 2. Transposition of great vessels 3. Truncus arteriosus |
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Name 7 common congenital malformations
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1. heart defects
2. Hypospadias (when the urethral canal is open on the undersurface of the penis or on the perineum) 3. Cleft lip w/ or w/out cleft palate 4. congenital hip dislocation 5. Spina Bifida 6. Anencephaly 7. Pyloric stenosis |
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Name 11 autosomal-dominant diseases:
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1. Adult polycystic kidney disease
2. Familial hyperchloresterolemia (type IIA) 3. Marfan's syndrome 4. Von Hippel-Lindau disease 5. Huntington's disease 6. Familial Adenomatous Polyposis 7. Hereditary Spherocytosis 8. Achondroplasia 9. Von Recklinghausen's disease (NF1) 10. NF2 11. Tuberous Sclerosis FAMiNe is DOMINANT on Hunger TV |
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Name an X-linked recessive muscular disease that leads to accelerated muscle breakdown.
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Duchenne's Muscular Dystrophy
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Name the 4 components of Tetralogy of Fallot.
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PROVe
1. Pulmonary Stenosis 2. RVH (right ventricular hypertrophy) 3. Overriding aorta (overrides the VSD) 4. VSD (ventricular septal defect) |
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Neural tube defects (spina bifida and anencephaly) are associated with increased levels of ___ in the amniotic fluid and maternal serum.
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AFP (alpha fetal protein)
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Newborns of mothers who consumed significant amounts of alcohol (teratogen) during pregnancy are at risk for _______.
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fetal alcohol syndrome
(the number one cause of congenital malformations in the U.S.) |
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Patau's syndrome = trisomy ___
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13 (hint: Puberty - 13)
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Pathogenesis of Cystic Fibrosis:
|
defective Cl- channel -->
secretion of abnormally thick mucus--> plugs lungs, pancreas, and liver --> recurrent pulmonary infections (Pseudomonas & Staph aureus), chronic bronchitis, bronchiectasis, pancreatic insufficiency (malabsorption and steatorrhea), meconium ileus in newborns. |
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cyanotic spells occur with what?
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Tetralogy of Fallot
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Pyloric stenosis is associated with______.
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polyhydramnios; projectile vomiting
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T/F: Trisomy 21 is associated with advanced maternal age.
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True (from 1 in 1500 births in women<20 to 1 in 25 births in women>45)
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Tetralogy of Fallot leads to early cyanosis from a R-to-L shunt across the ____.
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VSD
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The defect in Von Recklinghausen's disease is found on which chromosome?
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17 (hint: 17 letters in Recklinghausen's)
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The gene responsible for Huntington's disease is located on chromosome__.
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4 ; triplet repeat disorder
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The incidence of neural tube defects is decreased by maternal ingestion of what?
|
folate
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Transposition of great vessels is a common congenital heart disease in offspring of _____ mothers.
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diabetic
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Transposition of great vessels is not compatible with life unless what is present?
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a shunt that allows adequate mixing of blood (VSD, PDA, or patent foramen ovale)
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Trisomy 18 is also known as______.
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Edward's syndrome (hint: Election age = 18)
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Turner's syndrome is the most common cause of what?
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primary amenorrhea
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Von Hippel-Lindau disease characteristics:
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hemangioblastomas of:
-retina -medulla -cerebellum 1/2 develop multiple bilateral renal cell carcinomas and other tumors |
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Von Hippel-Lindau disease is associated with the deletion of what gene?
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VHL gene (tumor suppressor) on chromosome 3 (3p)
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What are some findings of Down's syndrome?
|
mental retardation
flat facial profile prominent epicanthal folds simian crease duodenal atresia congenital heart disease (MC endocardial cushion defect->ASD) Alzheimer's disease in individuals over 35 increased risk of ALL |
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What does a heart with Tetralogy of Fallot look like on x-ray?
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boot-shaped due to RVH
|
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What gender genetic disorder has been observed with increases frequency among inmates of penal institutions?
|
Double Y males (XYY)
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What is different about the juvenile form of polycystic kidney disease?
|
it is recessive
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What is Gower's maneuver?
|
requiring assistance of the upper extermities to stand up (indicates proximal lower limb weakness)
|
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What is the cause of Duchenne's MD?
|
a deleted dystrophin gene (hint: 'D' for deletion)
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What is the cause of Tetralogy of Fallot?
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anterosuperior displacement of the infundibular septum
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What is the incidence of Down's syndrome?
|
1 in 700 births
|
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What is the most common cause of early cyanosis?
|
Tetralogy of Fallot
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What is the most common chromosomal disorder and cause od congenital mental retardation?
|
Down's syndrome (trisomy 21)
|
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What is the most common congenital cardiac anomaly?
|
VSD
|
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What is the most common lethal genetic disease of Caucasians?
|
Cystic Fibrosis
|
|
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What is the second most common cause of mental retardation?
|
Fragile X syndrome
|
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What is the underlying cause of Cystic Fibrosis incl. chromosome?
|
Autosomal - recessive defect in CFTR gene on chromosome 7
|
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What is the underlying cause of Familial hypercholesterolemia?
|
defective or absent LDL receptor leading to elevated LDL
|
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1. What is used to close a patent ductus arteriosus?
2. What is used to keep it open? |
1. Indomethacin
2. PGE (may be necessary to sustain life in conditions such as transposition of the great vessels) |
|
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Which gene is affected in Fragile X?
|
methylation and expression of the Fragile X Mental Retardation 1 gene (FMR 1 gene)
|
|
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Which genetic gender disorder has an inactivated X chromosome (Barr body)?
|
Klinefelter's syndrome
|
|
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Why are female carriers of X-linked recessive disorders rarely affected?
|
because of random inactivation of X chromosomes in each cell
|
|
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X-linked recessive disorders (10)
|
Bruton's agammaglobulinemia
Ocular albinism Wiscott-Aldrich syndrome Fragile X Fabry's G6PD deficiency Hemophilia A and B Hunter's syndrome Lesch-Nyhan syndrome Duchenne's MD BOW to the Fair queen w/ Good X genes and dont' lose HOLD of your head. |
BOW to the FFair queen w/ Good X genes and dont' lose HHOLD of your head. |
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XO =
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Turner's syndrome (think: 'hugs and kisses' -XO- from Tina Turner)
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XXY =
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Klinefelter's syndrome one of the most common causes of hypogonadism in males
|
|
|
Approximately what percentage of brain tumors arise from metastasis?
|
0.5
|
|
|
Are basal cell carcinomas invasive?
|
Locally invasive but rarely metastasize
|
|
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Are Ewing's sarcomas likely to metastasize?
|
Yes. They are extremely aggressive with early metastasis. However, they are responsive to chemotherapy.
|
|
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Are meningiomas resectable?
|
Yes
|
|
|
Are squamous cell carcinomas of the skin invasive?
|
Locally invasive but rarely metastasize
|
|
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Are the majority of adult tumors supratentorial or infratentorial?
|
Supratentorial
|
|
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Are the majority of childhood tumors supratentorial or infratentorial?
|
Infratentorial
|
|
|
Common histopathology often seen in squamous cell carcinomas of the skin?
|
Keratin pearls
|
|
|
Define anaplasia
|
Abnormal cells lacking differentiation; like primitive cells of the same tissue. Often equated with undifferentiated malignant neoplasms. Tumor giant cells may be formed.
|
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Define dysplasia
|
Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation. It is reversible but is often a preneoplastic sign.
|
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Define hyperplasia
|
Increase in the number of cells (reversible)
|
|
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Define metaplasia
|
One adult cell type is replaced by another (reversible). It is often secondary to irritation and/or environmental exposure (e.g. squamous metaplasia in the trachea and bronchi of smokers)
|
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Define neoplasia
|
Clonal proliferation of cells that is uncontrolled and excessive
|
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Do oncogenes cause a gain or loss of function?
|
Gain of function
|
|
|
Do tumor suppressor genes cause a gain or loss of function?
|
Loss of function. Both alleles must be lost for expression of disease
|
|
|
Does a melanoma have a significant risk of metastasis?
|
Very significant risk! The depth of the tumor often correlates with the risk of metastasis.
|
|
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From what cells do meningiomas most commonly arise?
|
Arachnoid cells external to the brain
|
|
|
benign tumors of epithelial origin are called?
|
1. Adenoma 2. Papilloma
|
|
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2 Names for a malignant tumor of mucosal epithelial origin.
|
1. Adenocarcinoma 2. Papillary carcinoma
|
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Give 2 examples of malignant tumors of blood cell (mesenchymal) origin.
|
1. Leukemia 2. Lymphoma
|
|
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Give Name for a benign tumor of blood vessel origin.
|
Hemangioma
|
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Name for a benign tumor of bone origin.
|
Osteoma
|
|
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Give name for benign tumor of more than one cell type.
|
Mature teratoma
|
|
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Give name for a benign tumor of skeletal muscle (mesenchymal) origin.
|
Rhabdomyoma
|
|
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Give an name for a benign tumor of smooth muscle origin.
|
Leiomyoma
|
|
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Name for malignant tumor of blood vessel origin.
|
Angiosarcoma
(mesenchymal) |
|
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Give an example of a malignant tumor of bone origin.
|
Osteosarcoma
(mesenchymal) |
|
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Give an example of a malignant tumor of more than one cell type.
|
Immature teratoma
|
|
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Give an example of a malignant tumor of skeletal muscle origin.
|
Rhabdomyosarcoma
(mesenchymal) |
|
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Give an example of a malignant tumor of smooth muscle (mesenchymal) origin.
|
Leiomyosarcoma
|
|
|
Give an example of a neoplasm associated with Down's Syndrome.
|
Acute Lymphoblastic Leukemia (ALL)
we ALL fall DOWN |
We ALL fall DOWN |
|
How are tumor markers used?
|
Tumor markers are used to confirm diagnosis, to monitor for tumor recurrence, and to monitor the response to therapy. They should not be used as a primary tool for diagnosis.
|
|
|
How is prostatic adenocarcinoma most commonly diagnosed?
|
Digital rectal exam (detect hard nodule) or by prostate biopsy
|
|
|
How often do primary brain tumors undergo metastasis?
|
Very rarely
|
|
|
In what population is osteochondroma most often found?
|
Usually men under the age of 25
|
|
|
In which age group is prostatic adenocarcinoma most common?
|
Men over the age of 50
|
|
|
Is malignant transformation in osteochondroma common?
|
Malignant transformation to chondrosarcoma is rare
|
|
|
Name 1 common tumor staging system.
|
TNM system T= size of tumor, N=node involvement, and M=metastases
|
|
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Name 3 herniation syndromes that can cause either coma or death when the herniations compress the brainstem
|
1. Downward transtentorial (central) herniation 2. Uncal herniation 3. Cerebellar tonsillar herniation into the foramen magnum
|
|
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Name 4 factors that predispose a person to osteosarcoma.
|
1. Paget's disease of bone
2. Bone infarcts 3. Radiation 4. Familial retinoblastoma |
|
|
Name 4 possible routes of herniation in the brain
|
1. Cingulate herniation under the falx cerebri 2. Downward transtentorial (central) herniation 3. Uncal herniation 4. Cerebellar tonsillar herniation into the foramen magnum
|
|
|
Name 5 primary brain tumors with peak incidence in adulthood.
|
1. Meningioma
2. Glioblastoma multiforme 3. Oligodendroglioma 4. Schwannoma 5. Pituitary adenoma |
|
|
Name 5 primary brain tumors with peak incidence in childhood.
|
1. Medulloblastoma
2. Hemangioblastoma 3. Ependymomas 4. Low-grade astrocytoma 5. Craniopharyngioma Brain tumors get Children at the HELM |
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Name 5 sites from which tumor cells metastasize to the brain.
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1. Lung
2. Breast 3. Skin (melanoma) 4. Kidney (renal cell carcinoma) 5. GI |
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Name a common histopathological sign of basal cell carcinoma nuclei
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The nuclei of basal cell tumors have 'palisading' nuclei
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Name a population at a greater risk for melanoma.
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Fair-skinned people (blue eyes and red hair have also been considered as factors)
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Name the 5 primary tumors that metastasize to the liver
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1. Colon
2. Stomach 3. Pancreas 4. Breast 5. Lung |
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Name two of the most common sites of metastasis after the regional lymph nodes
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The liver and the lung
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Name two presenting sequelae of a pituitary adenoma.
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1. Bitemporal hemianopsia (due to pressure on the optic chiasm) 2. Hypopituitarism
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On which chromosome is the p53 gene located?
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17p
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On which chromosome is the Rb gene located?
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13q
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On which chromosomes are the BRCA genes located?
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BRCA 1 is on 17q and BRCA 2 is on 13q
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Out of the 6 primary tumors that metastasize to bone, which two are the most common?
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Metastasis from the breast and prostate are the most common
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What 2 cancers are associated with EBV?
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1. Burkitt's lymphoma 2. Nasopharyngeal carcinoma
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What 2 neoplasms are associated with AIDS?
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1. Aggressive malignant lymphomas (non-Hodgkins) 2. Kaposi's sarcoma
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What 2 tumors are associated with Autoimmune disease (e.g. Hashimoto's thyroiditis, myasthenia gravis, etc.)?
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Benign and malignant thymomas
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What 2 neoplasms are associated with Paget's disease of bone?
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1. Secondary osteosarcoma 2. Fibrosarcoma
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What 2 neoplasms are associated with facial angiofibroma, seizures, and mental retardation?
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Tuberous sclerosis
1. Astrocytoma 2. Cardiac rhabdomyoma |
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What are 2 characteristic findings in carcinoma in situ?
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1. Neoplastic cells have not invaded the basement membrane 2. High nuclear:cytoplasmic ratio and clumped chromatin
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What are 2 characteristic findings of an invasive carcinoma?
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1. Cells have invaded the basement membrane using collagenases and hydrolases 2. Able to metastasize if they reach blood or lymphatic vessels.
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What are 2 neoplasms associated with Xeroderma pigmentosum?
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1. Squamous cell carcinoma of the skin 2. Basal cell carcinoma of the skin
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What are 3 disease findings associated with Alkaline Phosphatase?
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1. Metastases to bone 2. Obstructive biliary disease 3. Paget's disease of bone
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What are 6 primary tumors that metastasize to bone?
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1. Breast
2. Prostate 3. Kidney 4. Lung 5. Testes 6. Thyroid |
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What are a common histopathological finding of meningiomas?
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Psammoma bodies. These are spindle cells concentrically arranged in a whorled pattern.
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What are ependymomas?
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Ependymal cell tumors most commonly found in the 4th ventricle. May cause hydrocephalus
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What are the steps in the progression of neoplasia?
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1. Normal
2. Hyperplasia 3. Carcinoma In Situ/Preinvasive 4. Invasion |
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What are two signs of bone metastases in prostatic adenocarcinoma?
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Alkaline phosphatase &
PSA (prostate-specific antigen) Elevations in serum |
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What are two useful tumor markers in prostatic adenocarcinoma?
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Prostatic acid phosphatase and prostate-specific antigen (PSA)
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What can be associated with the risk of melanoma?
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Sun exposure
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What cancer is associated with HBV and HCV (Hep B and C viruses)?
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Hepatocellular carcinoma
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What cancer is associated with HHV-8?
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Kaposi's carcinoma
Kaposi's sarcoma-associated herpes virus KSHV |
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What cancer is associated with the HTLV-1 virus?
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Adult T-cell leukemia
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What cancers are commonly associated with HPV (human papilloma virus)?
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Cervical carcinoma, penile, and anal carcinoma
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What causes the local effect of a mass?
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Tissue lump or tumor
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What causes the local effect of a nonhealing ulcer?
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Destruction of epithelial surfaces (e.g. stomach, colon, mouth, bronchus)
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What causes the local effect of a space-occupying lesion?
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-Raised ICP w/ brain neoplasms.
-Anemia w/ bone marrow replacement. -CN deficits w/ compression |
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What causes the local effect of bone destruction?
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Pathologic fracture or collapse of bone
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What causes the local effect of edema?
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Venous or lymphatic obstruction
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What causes the local effect of hemorrhage?
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Caused by ulcerated area or eroded vessel
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What causes the local effect of inflammation of a serosal surface?
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Pleural effusion, pericardial effusion, or ascites
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What causes the local effect of obstruction in the biliary tree?
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Jaundice
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What causes the local effect of obstruction in the bronchus?
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Pneumonia
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What causes the local effect of obstruction in the left colon?
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Constipation
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What causes the local effect of pain?
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Any site with sensory nerve endings. Remember that tumors in the brain are usually painless.
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What causes the local effect of perforation of an ulcer in the viscera?
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Peritonitis or free air
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What causes the local effect of seizures?
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Tumor mass in the brain.
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What causes the localized loss of sensory or motor function?
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Compression or destruction of nerve (e.g. recurrent laryngeal nerve by lung or thyroid cancer causes hoarseness)
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What causes the paraneoplastic effect gout?
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Hyperuricemia due excess nucleic acid turnover (secondary to cytotoxic therapy of various neoplasms)
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What causes the paraneoplastic effect of Cushing's disease?
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ACTH or ACTH-like peptide (secondary to small cell lung carcinoma)
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What causes the paraneoplastic effect of hypercalcemia?
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PTH-related peptide, TGF-a, TNF-a, IL-2 (secondary to squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, multiple myeloma, and bone metastasis)
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What causes the paraneoplastic effect of Lambert-Eaton syndrome?
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Antibodies against presynaptic Ca2+ channels at NMJ (Thymoma, bronchogenic carcinoma)
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What causes the paraneoplastic effect of Polycythemia?
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Erythropoietin (secondary to renal cell carcinoma)
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What causes the paraneoplastic effect of SIADH?
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ADH or ANP (secondary to small cell lung carcinoma and intracranial neoplasms)
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What chemical carcinogen is commonly associated with the centrilobar necrosis and fatty acid change?
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CCL4
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What chemical carcinogen is commonly associated with the esophagus and stomach?
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Nitrosamines
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What chemical carcinogen is commonly associated with the lungs?
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Asbestos (Causes mesothelioma and bronchogenic carcinoma)
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What chemical carcinogen is commonly associated with the skin (squamous cell)?
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Arsenic
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What chemical carcinogen(s) are commonly associated with the liver?
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Aflatoxins and vinyl chloride
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What is a chondrosarcoma?
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Malignant cartilaginous tumor.
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What is a common genetic finding in Ewing's sarcoma?
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11;22 translocation
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What is a common gross pathological sign seen in Ewing's sarcoma?
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Characteristic 'onion-skin' appearance of bone
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What is a common origin of a chondrosarcoma?
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May be of primary origin or from osteochondroma
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What is a common sign found on the x-ray of a person with osteosarcoma?
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Codman's triangle (from elevation of periosteum)
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What is a craniopharyngioma?
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Benign childhood tumor. Often confused with pituitary adenoma because both can cause bitemporal hemianopsia. Calcification of the tumor is common.
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What is a Ewing's sarcoma?
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Anaplastic small cell malignant tumor.
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What is a giant cell tumor?
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Locally aggressive benign tumor around the distal femur, proximal tibial region.
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What is a gross pathological sign of basal cell carcinoma?
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Pearly papules
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What is a helpful mnemonic to remember the neoplasm associated with Down's Syndrome?
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We ALL go DOWN together.
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What is a helpful mnemonic to remember the site of metastasis to the brain?
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Lots of Bad Stuff Kills Glia
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What is a helpful mnemonic to remember the types of cancer that metastasize to the liver?
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Cancer Sometimes Penetrates Benign Liver
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What is a helpful mnemonic to remember what tumors metastasize to bone?
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BLT with a Kosher Pickle
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What is a Hemangioblastoma?
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Most often a cerebellar tumor. Associated with von Hippel Lindau syndrome when found with retinoblastoma.
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What is a low-grade astrocytoma?
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Diffusely infiltrating glioma. In children, it is most commonly found in the posterior fossa.
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What is a medulloblastoma?
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Highly malignant cerebellar tumor. A form of primitive neuroectodermal tumor (PNET). Can compress 4th ventricle causing hydrocephalus
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What is a neoplasm associated with actinic keratosis?
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Squamous cell carcinoma of the skin
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What is a neoplasm associated with Barrett's esophagus (chronic GI reflux)?
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Esophageal adenocarcinoma
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What is a neoplasm commonly associated with chronic atrophic gastritis, pernicious anemia, and postsurgical gastric remnants?
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Gastric adenocarcinoma
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What is an oligodendroglioma?
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A relatively rare, slow growing, benign tumor.
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What is CEA (carcinoembryonic antigen)?
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Very nonspecific antigen produced by 70% of colorectal and pancreatic cancers and by gastric and breast carcinoma
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What is considered a precursor to squamous cell carcinoma?
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Actinic keratosis
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What is considered to be a precursor to malignant melanoma?
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Dysplastic nevus
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What is meant by the term tumor grade?
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Histologic appearance of the tumor. Usually graded I-IV based on degree of differentiation and number of mitoses per high-power field.
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What is meant by the term tumor stage?
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Based on site an size of primary lesion, spread to regional lymph nodes, and presence of metastases.
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What is the characteristic appearance of a giant cell tumor on an x-ray?
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Characteristic 'double bubble' or 'soap bubble' appearance
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What is the common histopathology associated with Ependymomas?
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Characteristic perivascular rosettes. Rod-shaped blepharoblasts (basal ciliary bodies) found near the nucleus.
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What is the common histopathology associated with Hemangioblastoma?
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Foamy cells and high vascularity are characteristic. Can produce EPO and lead to polycythemia.
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What is the common histopathology associated with medulloblastomas?
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Rosettes or perivascular pseudorosette pattern of cells
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What is the common histopathology associated with oligodendrogliomas?
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Fried egg' appearance of cells in tumor. Often calcified.
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What is the common histopathology associated with schwannoma?
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Antoni A=compact palisading nuclei; Antoni B=loose pattern
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What is the common histopathology found in Glioblastoma multiforme?
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Pseudopalisading' tumor cells border central areas of necrosis and hemorrhage
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What is the differentiation pattern of normal cells?
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Basal to apical differentiation
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What is the histopathology commonly associate with giant cell tumors?
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Spindle-shaped cells with multi-nucleated giant cells.
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What is the most common benign bone tumor?
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Osteochondroma
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What is the most common location of basal cell carcinoma of the skin?
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Usually found in sun-exposed areas of the body.
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What is the most common location of osteosarcoma?
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Commonly found in the metaphysis of long bones
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What is the most common organ to 'send' metastases?
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The lung is the most common origin of metastases. The breast and stomach are also big sources.
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What is the most common organ to receive metastases?
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Adrenal glands. This is due to their rich blood supply. The medulla usually receives metastases first and then the rest of the gland.
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What is the most common population to have chondrosarcoma?
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Men age 30-60 years old
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What is the most common primary brain tumor?
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Glioblastoma multiforme (grade IV astrocytoma)
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What is the most common primary malignant tumor of bone?
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Osteosarcoma
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What is the most common type of pituitary adenoma?
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Prolactin secreting
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What is the most likely population to have Ewing's sarcoma?
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Boys under 15 years old.
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What is the origin of a craniopharyngioma?
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Derived from the remnants of Rathke's pouch
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What is the origin of a Pituitary adenoma?
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Rathke's pouch
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What is the origin of the Schwannoma?
|
Schwann cell origin. Often localized to the 8th cranial nerve (acoustic schwannoma). Bilateral schwannoma found in NF2.
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What is the peak incidence of giant cell tumor?
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20-40 years old
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What is the peak incidence of osteosarcoma?
|
Men 10-20 years old
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What is the prognosis for Glioblastoma multiforme?
|
Prognosis is grave. Usually only have a year life expectancy.
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What is the second most common primary brain tumor?
|
Meningioma
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What is the third most common primary brain tumor?
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Schwannomas
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What neoplasias are associated with a-fetoprotein?
|
Hepatocellular carcinoma and nonseminomatous germ cell tumors of the testis(eg. yolk sac tumor).
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What neoplasias are associated with B-hCG?
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Hydatidiform moles, Choriocarcinomas, and Gestational trophoblastic tumors.
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What neoplasias are associated with CA-125?
|
Ovarian and malignant epithelial tumors
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What neoplasias are associated with S-100?
|
Melanoma, neural tumors, and astrocytomas
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What neoplasm is associated with Cirrhosis (due to alcoholism, Hep B, or Hep C)
|
Hepatocellular carcinoma
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What neoplasm is associated with Dysplastic nevi?
|
Malignant melanoma
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What neoplasm is associated with Immunodeficiency states?
|
Malignant lymphomas
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What neoplasm is associated with Plummer-Vinson syndrome (atrophic glossitis, esophageal webs, and anemia; all due to iron deficiency)
|
Squamous cell carcinoma of the esophagus
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What neoplasm is associated with ulcerative colitis?
|
Colonic adenocarcinoma
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What oncogene is associated with breast, ovarian, and gastric carcinomas?
|
erb-B2
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What oncogene is associated with Burkitt's lymphoma?
|
c-myc
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What oncogene is associated with colon carcinoma?
|
ras
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What oncogene is associated with Follicular and undifferentiated lymphomas (inhibits apoptosis)?
|
bcl-2
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What tumor marker is associated with Prostatic carcinoma?
|
PSA (Prostatic acid phosphatase)
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What tumor suppressor gene is associated with Retinoblastoma and osteosarcoma?
|
Rb gene
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What type of metastases are common in the late stages of prostatic adenocarcinoma?
|
Osteoblastic metastases in bone
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What type of neoplasm is associated with Acanthosis nigricans (hyperpigmentation and epidermal thickening)
|
Visceral malignancies (stomach, lung, breast, and uterus)
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What type of skin cancer is associated with excessive exposure to sunlight or arsenic exposure?
|
Squamous cell carcinoma
|
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|
Where are chondrosarcomas usually located?
|
Pelvis, spine, scapula, humerus, tibia, or femur.
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Where are Ewing's sarcomas most commonly found?
|
Diaphysis of long bones, pelvis, scapula, and ribs
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Where are Glioblastoma multiformes found?
|
Cerebral hemispheres
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Where do giant cell tumors most commonly occur?
|
At epiphyseal end of long bones
|
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|
Where do meningiomas most commonly occur?
|
Convexities of hemispheres and parasagital region
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|
Where do oligodendrogliomas most often occur?
|
Most often found in the frontal lobes
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|
Where do osteochondromas commonly originate?
|
Long metaphysis
|
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|
Where do squamous cell carcinomas most commonly occur?
|
Hands and face
|
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|
Where does prostatic adenocarcinoma most commonly arise?
|
From the posterior lobe (peripheral zone) of the prostate gland
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|
Which has more prognostic value: tumor stage or grade?
|
Stage
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Which is more common: metastasis to bone or primary tumors of bone?
|
Metastatic bone tumors are far more common than primary tumors
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Which is more common: metastasis to the liver or primary tumors of the liver?
|
Metastasis to the liver is more common
|
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|
Which tumor suppressor gene is associated with most human cancers and the Li-Fraumeni syndrome?
|
p53
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Which tumor suppressor genes are associated with breast and ovarian cancer?
|
BRCA 1 and 2
|
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|
___% of African-Americans carry the HbS trait, and ___% have the disease.
|
8%; 0.2
|
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________ = defect of platelet aggregation
|
Glanzmann's thrombasthenia
|
|
|
________ disease = defect of platelet adhesion
|
Bernard-Soulier
|
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|
_____= activation of coagulation cascade leading to microthrombi and global consumption of platelets, fibrin, and coagulation factors.
|
DIC (Disseminated intravascular coagulation)
|
|
|
2 therapies for sickle cell anemia:
|
1. Hydroxyurea (increased HbF) 2. bone marrow transplantation
|
|
|
50% of Hodgkin's cases are associated with which virus?
|
EBV
|
|
|
7 causes of normocytic normochromic anemia:
|
1. hemorrhage
2. enzyme defects (G6PD & PK deficiency) 3. RBC membrane defects (hereditary spherocytosis) 4. Bone Marrow disorders (aplastic anemia, leukemia) 5. Hemoglobinopathies (sickle cell) 6. Autoimmune hemolytic anemia 7. Anemia of chronic disease |
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Antiplatelet antibodies and increased megakaryocytes are seen in ____.
|
ITP
|
|
|
Auer rods, myeloblasts, adults =
|
AML
|
|
|
bcl-2 activation is associated with which translocation and which lymphomas?
|
t(14;18) - Follicular lymphomas
|
|
|
bcr-abl hybrid is associated with which translocation and which leukemia?
|
t(9;22) - CML
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|
Blood smear of a Multiple Myeloma patient would show what?
|
RBCs stacked like poker chips (rouleau formation)
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|
|
Burkitt's lymphoma: '______' appearance associated with what virus? endemic where?
|
starry sky' EBV Africa
|
|
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c-myc activation is associated with which translocation and which lymphoma?
|
t(8;14) - Burkitt's
|
|
|
Causes of aplastic anemia:
|
alkylating agents, antimetabolites,
benzene, chloramphenicol, Faconi's anemia, radiation, viral (HCV,CMV,EBV, herpes zoster-varicella), idiopathic (immune-mediated, primary stem cell defect) |
|
|
Causes of platelet abnormalities:
|
ITP, TTP, drugs, DIC
|
|
|
CFU-GM (colony forming unit-granulocyte-monocyte) gives rise to which cells?
|
monocytes, neutrophils and basophils
|
|
|
CLL is very similar to what lymphoma?
|
SLL (small lymphocytic lymphoma)
|
|
|
Coagulation factor defects cause: (3)
|
(macrohemorrage)
1. Hemarthroses (bleeding into joints) 2. easy bruising 3. prolonged PT and/or PTT |
|
|
Common cause of macrocytic megalobalstic anemia:
|
Vit. B12/folate deficiency
|
|
|
common in children, lymphoblasts, most responsive to therapy =
|
ALL
|
|
|
Compare Multiple Myeloma with Waldenstrom's macroglobinemia:
|
Waldenstrom's also has an M spike, but large amounts of IgM are produced (not IgA or IgG), no lytic lesions
|
|
|
Complications often seen in homozygotes (sickle cell disease) include:
|
-inc. risk of encapsulated org. infection
-Salmonella osteomyelitis -painful crisis (vaso-occlusive) -aplastic crisis w/ B19 parvovirus -splenic sequestration crisis -autosplenectomy |
|
|
Describe the RBCs of a parient with Hereditary spherocytosis.
|
RBCs are small, round, with no central pallor less membrane therefore increased MCHC
|
|
|
FAB classification L1:
|
ALL-null, ALL-common
|
|
|
FAB classification L2:
|
ALL- T
|
|
|
FAB classification L3:
|
ALL- B
|
|
|
FAB classification M1:
|
AML (without maturation)
|
|
|
FAB classification M2:
|
AML (with maturation)
|
|
|
FAB classification M3:
|
acute promyelocytic leukemia
|
|
|
FAB classification M4:
|
acute myelomonocytic leukemia
|
|
|
FAB classification M5:
|
acute monocytic leukemia
|
|
|
FAB classification M6:
|
acute erythroleukemia
|
|
|
FAB classification M7:
|
acute megakaryocytic leukemia
|
|
|
General considerations of leukemias:
|
-inc # leukocytes in blood & bone marrow
-leukemic cell infiltrates in liver, spleen, and lymph nodes |
|
|
Genetics associated with Burkitt's lymphoma:
|
t(8;14) c-myc gene moves next to heavy chain Ig gene (14)
|
|
|
Hb Barts =
|
Gamma 4 tetramers, lacks all 4 alpha globin genes
|
|
|
Hb Barts results in what?
|
hydrops fetalis and intrauterine fetal death
|
|
|
Hb H =
|
Beta 4 tetramers, lacks 3 alpha globin genes
|
|
|
Hereditary spherocytosis causes intrinsic, extravascular hemolysis due to a _____ defect.
|
spectrin
|
|
|
Hereditary spherocytosis is associated with what other problems?
|
gallstones, splenomegaly, anemia and jaundice
|
|
|
Hereditary spherocytosis is distinguished from warm antibody hemolysis by what test?
|
Direct Coomb's test (Hereditary spherocytosis is Coomb's negative)
|
|
|
Hodgkin's or NHL: which is associated with HIV &amp; immunosuppression?
|
NHL
|
|
|
Hodgkin's or NHL: which is associated with mediastinal lymphadenopathy?
|
Hodgkin's
|
|
|
Hodgkin's or NHL: which one displays a bimodal distribution?
|
Hodgkin's (young and old)
|
|
|
How does Multiple Myeloma affect calcium levels?
|
destructive bone lesions cause hypercalcemia (punched-out lytic bone lesions can be seen on x-ray)
|
|
|
In _____, the alpha globin chain is underproduced.
|
alpha thalassemia
|
|
|
In _____, the beta chain is underproduced.
|
Beta-minor thalassemia (heterozygote)
|
|
|
In ______, the beta chain is absent.
|
Beta-major thalassemia (homozygote)
|
|
|
In anemia of chronic disease, are these values increased or decreased? 1. TIBC 2. ferritin 3. serum iron 4. storage iron in marrow macrophages 5. % sat.
|
1. TIBC-dec.
2. ferritin-inc. 3. serum iron-dec. 4. storage iron in marrow macrophages-inc. 5. % sat-normal |
|
|
In Beta Thalassemia, cardiac failure is often due to what?
|
secondary hemochromatosis (due to transfusions)
|
|
|
In which hemorrhagic disorder is PT increased?
|
DIC
|
|
|
In which hemorrhagic disorders is PTT increased? (4)
|
1. Hemophilia A 2. Hemophilia B 3. von Willibrand's disease 4. DIC
|
|
|
increased or decreased in iron deficiency anemia? 1. TIBC 2. ferritin 3. serum iron
|
1. increased 2. decreased 3. decreased
|
|
|
Is Hodgkin's more common in men or women?
|
men (except nodular sclerosing type)
|
|
|
Lab findings of DIC:
|
increased PT and PTT, increased fibrin split products (D-dimers), decreased platelet count
|
|
|
Lymphoblastic lymphoma commonly presents with what?
|
ALL and mediastinal mass
|
|
|
Lymphomas derived from the B cell lineage:
|
ALL (B cell) Lymphoblastic lymphoma,
CLL (B) Lymphocytic lymphoma, Follicular center cell lymphoma, Immunoblastic lymphoma (B), Plasmacytoid lymphocytic lymphoma and myeloma |
|
|
Lymphomas derived from the T cell lineage:
|
ALL (T cell) Lymphoblastic lymphoma, CLL (T) Lymphocytic lymphoma, Immunoblastic lymphoma (T), Sezary syndrome and mycosis fungoides
|
|
|
Macrocytic anemia is defined as MCV&gt;____.
|
100
|
|
|
Marrow failure due to leukemia can lead to (3)
|
1. anemia (dec. RBCs) 2. infections (dec. WBCs) 3. hemorrhage (decreased platelets)
|
|
|
Microcytic, hypochromic anemia = MCV&lt;____.
|
80
|
|
|
most commonly associated with Philadelphis chromosome, myeloid stem cell proliferation, may accelerate to AML =
|
CML
|
|
|
Name 3 coagulopathies:
|
1. Hemophilia A 2. Hemophilia B 3. von Willibrand's disease
|
|
|
Name 3 etiologies of microcytic, hypochromic anemia:
|
1. iron deficiency 2. Thalassemias 3. lead poisoning
|
|
|
Name 5 hemorrhagic disorders that exhibit increased bleeding time.
|
1. Qualitative platelet defects 2. Vascular bleeding 3. Thrombocytopenia 4. Von Willibrand's disease 5. DIC
|
|
|
Name 5 types of NHL:
|
1. Small lymphocytic lymphoma
2. Follicular lymphoma (small cleaved cell) 3. Diffuse large cell 4. Lymphoblastic lymphoma 5. Burkitt's lymphoma |
|
|
Name 9 chronic myeloid leukemias:
|
CML, Polycythemia rubra vera, CML, Myelofibrosis, idiopathic thrombocythemia, (chronic monocytic, chronic myelomonocytic, eosinophilic, chronic erythroid) *last 4 are rare*
|
|
|
Nodal involvement and spread of Hodgkin's vs. NHL:
|
Hodgkin's: localized, single group of nodes, extranodal rare, contiguous spread NHL: multiple, peripheral nodes, extranodal involvement common, noncontiguous spread
|
|
|
Normal values: 1. TIBC 2. Serum iron 3. % sat.
|
1. TIBC 250-400 micro grams/ dl 2. 50-150 3. 20-50 %
|
|
|
older adults, lymphadenopathy, hepatosplenomegaly, few symptoms, indolent course, increased smudge cells in peripheral blood smear, warm Ab autoimmune hemolytic anemia =
|
CLL
|
|
|
Other causes of macrocytic anemia (2)
|
1. drugs that block DNA synthesis (e.g., sulfa drugs, AZT) 2. marked reticulocytosis
|
|
|
Pathologic features of aplastic anemia:
|
pancytopenia with normal cell morphology, hypocellular bone marrow with fatty infiltration
|
|
|
Peak incidence of NHL between what ages?
|
20-40
|
|
|
Philadelphia chromosome=
|
t(9;22), bcr-abl
|
|
|
Plasma cells in Multiple Myeloma produce large amounts of what?
|
IgG (55%) and IgA (25%)
|
|
|
Platelet abnormalities (microhemorrage) lead to: (4)
|
1. mucous membrane bleeding 2. petechiae 3. purpura 4. prolonged bleeding time
|
|
|
PMNs are hypersegmented in ____ .
|
Vit. B 12 and folate deficiencies
|
|
|
PT and PTT: which one measures the intrinsic and which one measures the extrinsic path?
|
PT (extrinsic) PTT (intrinsic)
|
|
|
Rank the prognoses of the different types of Hodgkin's:
|
Nodular Sclerosing and Lymphocyte Predominant= excellent
Mixed Cellularity= intermediate Lymphocyte Depletion= poor |
|
|
Schistocytes are characteristic of ___.
|
Mechanical damage
-DIC -Traumatic hemolysis |
|
|
Sickle cell heterozygotes (sickle cell trait) are relatively ____-resistant.
|
malaria; (balanced polymorphism)
|
|
|
Symptoms of aplastic anemia:
|
fatigue, malaise, pallor, purpura, mucosal bleeding, petechiae, infection
|
|
|
Thalassemia is prevalent in which populations?
|
Mediterranean (hint: thalassa=sea. Think, thalaSEAmia)
|
|
|
The lymphoid stem cell gives rise to: (2)
|
T cells and B cells
|
|
|
The majority of NHL involve T cells or B cells?
|
B cells (except lymphoblastic T cell origin)
|
|
|
Treatment of aplastic anemia:
|
withdrawal of offending agent, allogenic bone marrow transplantation, RBC and platelet transfusion, G-CSF or GM-CSF
|
|
|
What are 2 indications of hemolysis?
|
1. decreased serum haptoglobin 2. increased serum LDH
|
|
|
What are constitutional signs/symptoms?
|
(mostly seen in Hodgkin's) low grade fever, night sweats, weight loss
|
|
|
What are some other causes of DIC?
|
gram-negative sepsis, transfusion, trauma, malignancy, acute pancreatitis, and nephrotic syndrome
|
|
|
What genetics are involved with follicular lymphoma (small cleaved cell)?
|
t(14;18) bcl-2 expression
|
|
|
What is another Beta chain mutation in which patients have a milder disease than Hb SS patients?
|
HbC defect. patients can be HbC or HbSC (1 of each mutant gene)
|
|
|
What is aplastic anemia?
|
pancytopenia characterized by severe anemia, neutropenia, and thrombocytopenia caused by destruction of multipotent myeloid stem cells, with inadequate production or release of differentiated cell lines.
|
|
|
What is compensatorily increased in both forms of Beta Thalassemia?
|
fetal hemoglobin (it is inadequate, however)
|
|
|
What is found in the urine of patients with Multiple Myeloma?
|
Ig light chains (Bence Jones protein)
|
|
|
What is it called when CML
--> AML? |
blast crisis
|
|
|
What is the characteristic cell of Hodgkin's lymphoma?
|
Reed-Sternberg cell (decreased numbers of RS cells indicates a better prognosis)
|
|
|
What is the M spike?
|
the monoclonal immunoglobin spike on serum electrophoresis
|
|
|
What is the most common bleeding disorder?
|
von Willibrand's disease
|
|
|
What is the most common cause of DIC?
|
obstetric complications
|
|
|
What is the most common primary tumor arising within bone in adults?
|
Multiple Myeloma
|
|
|
What is the name of a chronic T cell leukemia?
|
Sezary syndrome
|
|
|
What mutation causes sickle cell anemia?
|
a single AA replacement in the Beta chain (normal glutamic acid with valine)
|
|
|
What other problems result from Multiple Myeloma?
|
renal insufficiency, increased susceptibility to infections, anemia, and amyloidosis
|
|
|
What precipitates sickling of cells?
|
low oxygen or dehydration
|
|
|
What test is used to confirm Hereditary spherocytosis?
|
osmotic fragility test
|
|
|
What test is used to distinguish between immune vs. non-immune RBC hemolysis?
|
Direct Coomb's test
|
|
|
What type of cell is cancerous in Multiple Myeloma and what does it resemble?
|
Monoclonal plasma cell, 'fried egg' appearance
|
|
|
Which 2 hemorrhagic disorders have decreased platelet counts?
|
1. thrombocytopenia 2. DIC
|
|
|
Which 2 types of NHL occur in children?
|
lymphoblastic lymphoma, and Burkitt's lymphoma (20% of diffuse large cell type too)
|
|
|
Which Beta Thalassemia results in severe anemia?
|
Beta Thal. major, (requires blood transfusions)
|
|
|
Which coagulation factors are a part of the intrinsic and which are a part of the extrinsic path?
|
(extrinsic) = Factors II, V, VII, and X (intrinsic) = all factors except VII and XIII
|
|
|
Which coagulation factors are deficient in each of the Hemophilias?
|
Hemophilia A (factor VIII deficiency) Hemophilia B (factor IX deficiency)
|
|
|
Which one is associated with neurological problems, folate deficiency or Vit. B12 deficiency?
|
Vit. B12
|
|
|
Which type of Hodgkin's accounts for 6% of cases and which type is the most rare.
|
LP (lymphocyte predominant) - 6%
LD (lymphocyte depleted) - rare |
|
|
Which type of Hodgkin's commonly affects males under 35?
|
LP
|
|
|
Which type of Hodgkin's commonly affects older males and is associated with disseminated disease?
|
LD
|
|
|
Which type of Hodgkin's has the most Reed Sternberg cells?
|
Mixed Cellularity
|
|
|
Which type of Hodgkin's is characterized by collagen banding?
|
NS (nodular sclerosing)
|
|
|
Which type of Hodgkin's is the most common? (65-75%)
|
NS (nodular sclerosing)
|
|
|
Which type of Hodgkin's is the second most common? (25%)
|
MC (mixed cellularity)
|
|
|
Which type of Hodgkin's primarily affects young adults, women>men?
|
NS
|
|
|
Which type of NHL clinically presents like CLL?
|
small lymphocytic lymphoma
|
|
|
Which type of NHL is difficult to cure?
|
follicular lymphoma
|
|
|
Which type of NHL is most common in children?
|
Lymphoblastic lymphoma (very aggressive)
|
|
|
Which type of NHL is the most common type in adults?
|
follicular lymphoma (small cleaved cell)
|
|
|
Which types of NHL involve T cells?
|
Lymphoblastic lymphoma (immature T cells) 20% of Diffuse large cell NHL (mature T cells)
|
|
|
With iron overload (hemosiderosis) are values increased or decreased? 1. TIBC 2. serum iron 3. %sat.
|
1. TIBC normal 2. Serum iron increased 3. % sat. increased (100%)
|
|
|
A patient with gallstones may present with Charcot's triad. What comprises the triad?
|
(1)epigastric/RUQ pain (2)fever (3)jaundice
|
|
|
Failure of copper to circulate in what form causes Wilson's disease?
|
ceruloplasmin
|
|
|
How can one distinguish between Dubin-Johnson syndrome and Rotor's syndrome?
|
Rotor's syndrome presents similarly, except less severely and no black liver(as seen in Dubin-Johnson)
|
|
|
How does Budd-Chiari syndrome progress(in the liver)?
|
Congestive liver disease
|
|
|
How does cirrhosis/portal hypertension(HTN) affect liver histology?
|
diffuse fibrosis, destroying normal structure, with nodular regeneration
|
|
|
How does Hirschsprung's disease first present?
|
Chronic constipation early in life
|
|
|
How does one diagnose gallstones?
|
ultrasound
|
|
|
How does one differentiate liver nodules, in the case of cirrhosis?
|
micronodular(<3mm and uniform)
macronodular(>3mm and varied) |
|
|
How does one treat gallstones?
|
cholecystectomy
|
|
|
How is achalasia evidenced on a Barium swallow?
|
Bird beak'--dilated esophagus with an area of distal stenosis.
|
|
|
How is hepatocellular carcinoma spread?
|
like renal cell carcinoma, hematogenously
|
|
|
How is the hyperbilirubinemia in Dubin-Johnson syndrome different than in the other 2 hyperbilirubinemias(Gilbert's or Crigler-Najjar(type 1))?
|
Dubin-Johnson syndrome-- conjugated hyperbilirubinemia (due to defective liver excretion)
|
|
|
How would you expect a Gilbert's syndrome patient to present?
|
Asymptomatically, with an elevated unconjugated bilirubin
|
|
|
In PUD, how can H.pylori be treated?
|
triple therapy (metronidazole, bismuth salicylate, amoxicillin or tetracycline with or without a proton pump inhibitor
|
|
|
In what fatal childhood hepatoencephalopathy is there an association with viral infections(VZV,influ.B) or
salicylates? |
Reye's syndrome
|
|
|
In Wilson's disease, where does copper accumulate(3)?
|
(1)Liver (2)Brain (3)cornea
|
|
|
Is chronic pancreatitis strongly associated with alcoholism?
|
YES
|
|
|
Is the dilation proximal, at, or distal to the aganglionic segment?
|
Proximal (results in a 'transition zone')
|
|
|
Low-fiber diets are associated with which of the following?
|
diverticulosis
|
|
|
To what cancer is a chronic gastritic patient predisposed?
|
Gastric carcinoma
|
|
|
What 3 common findings are evident in a Reye's patient?
|
(1)fatty liver (2)hypoglycemia (3)coma
|
|
|
What are 2 anti-androgen effects of liver cell failure?
|
gynecomastia loss of sexual hair
|
|
|
What are 2 extraintestinal manifestations of Crohn's?
|
migratory polyarthritis
erythema nodosum |
|
|
What are 2 main symptoms and a histological sign of Duodenal ulcers?
|
(1)pain Decreases with meals, (2)weight gain, hypertrophy of Brunner's glands
|
|
|
What are 2 main symptoms of Gastric ulcers?
|
pain Greater with meals, weight loss
|
|
|
What are 2 signs of Crigler-Najjar syndrome(other than hyperbilirubinemia)?
|
jaundice
kernicterus(bilirubin deposition in the brain) |
|
|
What are 2 types of Inflammatory Bowel Disease?
|
Crohn's disease Ulcerative colitis
|
|
|
What are 2 types of peptic ulcer disease(PUD)?
|
gastric ulcer duodenal ulcer
|
|
|
What are 3 associations of Budd-Chiari Syndrome?
|
(1)pregnancy (2)polycythemia rubra vera (3)hepatocellular carcinoma
|
|
|
What are 3 neuro effects of liver cell failure?
|
(1)asterixis, (2)scleral icterus, (3)coma
|
|
|
What are 3 types of gallstones?
|
(1)Cholesterol stones (2)Mixed stones (3)Pigment stones
|
|
|
What are 4 potential complications of PUD?
|
(1)bleeding, (2)penetration, (3)perforation, (4)obstruction
|
|
|
What are 4 signs of congestive liver disease?
|
(1)hepatomegaly (2)ascites (3)abdominal pain (4)eventual liver failure
|
|
|
What are 5 GI and 2 GU effects of portal HTN?
|
(1)esophageal varices(->hematemesis),
(2)melena, (3)splenomegaly, (4)caput medusae, (5)ascites and (1)testicular atrophy, (2)hemorrhoids |
|
|
What are 5 possible consequences of acute pancreatitis?
|
(1)DIC
(2)ARDS (3)Diffuse fat necrosis (4)hypocalcemia (5)pseudocyst formation |
|
|
What are possible causes of acute pancreatitis?
|
GET SMASHeD
Gallstones Ethanol Trauma Steroids Mumps Autoimmune disease Scorpion sting Hyperlipidemia Drugs |
|
|
What are possible etiologies of hemochromatosis?
|
primary(autos. Recessive) secondary to chronic transfusion therapy
|
|
|
What are risk factors for esophageal cancer(ABCDEF)?
|
Achalasia, Barrett's esophagus, Corrosive esophagitis, Diverticuli, Esophageal web, Familial
|
|
|
What are some complications of Crohn's(4)?
|
(1)strictures, (2)fistulas, (3)perianal disease, (4)malabsorption-nutritional depletion
|
|
|
What are some complications of ulcerative colitis(3)?
|
(1)severe stenosis, (2)toxic megacolon, (3)colorectal carcinoma
|
|
|
What are the 2 types of chronic gastritis?
|
Type A(fundal) Type B(antral)
|
|
|
What are the 3 forms of Diverticular disease?
|
(1)diverticulum, (2)diverticulosis, (3)diverticulitis
|
|
|
What are the 4 risk factors for gallstone development?
|
(1)Female (2)Fat (3)Fertile (4)Forty
|
|
|
What are the ABCD characteristics of Wilson's?
|
Asterixis Basal ganglia degeneration Cirrhosis, Ceruloplasmin decrease, Corneal deposits(Kayser-Fleischer rings), Carcinoma(hepatocell.), Choreiform movements Dementia
|
|
|
What are the characteristic 4 A's of type A gastritis?
|
Autoimmune disorder characterized by Autoantibodies to parietal cells, pernicious Anemia, Achlorhydria
|
|
|
What are the respective etiologies of Crohn's and Ulcerative colitis(UC)?
|
infectious(Crohn's) autoimmune(UC)
|
|
|
What can achalasia arise from and lead to?
|
A secondary form can arise from Chagas' disease; can lead to progressive dysphagia.
|
|
|
What can hemochromatosis lead to(2)?
|
(1)CHF (2)hepatocellular carcinoma
|
|
|
What cell tumor marker is elevated in hepatocellular carcinoma?
|
Alpha FetoProtein(AFP)
|
|
|
What disorder is characterized by increased iron deposition in many organs(up to 50g)?
|
hemochromatosis
|
|
|
What happens to hepatocytes as a result of alcoholic hepatitis?
|
they become swollen and necrotic
|
|
|
What happens when cholesterol and bilirubin overwhelm solubilizing bile acids and lecithin?
|
Gallstones
|
|
|
What histological changes, other than to hepatocytes, does one see in liver hepatitis?
|
neutrophil infiltration, Mallory bodies(hyaline), increased fat, and sclerosis around the central vein
|
|
|
What is a mnemonic for Barrett's esophagus?
|
BARRett's = Becomes Adenocarcinoma, Results from Reflux.
|
|
|
What is Barrett's esophagus?
|
The replacement of glandular stratified squamous with gastric columnar epithelium in distal esophagus.
|
|
|
What is failure of lower esophageal sphincter relaxation due to?
|
Achalasia is due to the loss of the myenteric plexus.
|
|
|
What is hepatic vein or IVC occlusion with centrilobular congestion and necrosis?
|
Budd-Chiari syndrome
|
|
|
What is recommended for patients over 50, in terms of CRC screening?
|
screen these patients over 50 with stool occult blood test
|
|
|
What is the cause of diverticulosis?
|
increased intraluminal pressure and focal weakness in the colonic wall
|
|
|
What is the classic triad of hemochromatosis?
|
(1)micronodular pigment cirrhosis (2)'bronze' diabetes (3)skin pigmentation
|
|
|
What is the discerning characteristic for type B gastritis?
|
Type B is caused by a Bug(H. pylori)
|
|
|
What is the embryonic cause of Hirschsprung's disease?
|
failure of neural crest migration
|
|
|
What is the etiology of duodenal ulcers?
|
H.pylori(100%)--lower mucosal protection or increased gastric acid secretion
|
|
|
What is the etiology of gastric ulcers?
|
H.pylori(70%), NSAIDS both lower mucosal protection vs. gastric acid
|
|
|
What is the gross morphology of Crohn's?
|
transmural inflamm. COBBLESTONE mucosa, creeping FAT, bowel wall thickening(string sign on x-ray), linear ulcers, fissures
|
|
|
What is the gross morphology of ulcerative colitis?
|
mucosal inflamm. Friable mucosal pseudopolyps with freely hanging mesentery
|
|
|
What is the incidence of diverticulosis in the elderly?
|
over 60y/o, 50%
|
|
|
What is the microscopic morphology of Crohn's?
|
noncaseating granulomas
|
|
|
What is the microscopic morphology of ulcerative colitis?
|
crypt abscesses and ulcers
|
|
|
What is the mnemonic for Crohn's?
|
For Crohn's, think of a FAT old CRONE SKIPping down a COBBLESTONE road.
|
|
|
What is the most common clinical sign of acute pancreatitis?
|
epigastric abdominal pain radiating to the back
|
|
|
What is the most common primary malignant tumor of the liver in adults?
|
hepatocellular carcinoma
|
|
|
What is the most common type of gallstone?
|
mixed stones
|
|
|
What is the primary cause of macronodules in the liver?
|
significant liver injury leading to hepatic necrosis(e.g. Infections, drug-induced)
|
|
|
What is the primary cause of micronodules in the liver?
|
metabolic(e.g. Alcohol)
|
|
|
What is the prognosis for pancreatic adenocarcinoma?
|
~6months (very aggressive--often already spread at presentation)
|
|
|
What is the term for inflamm. of diverticula?
|
diverticulitis
|
|
|
What is the term used for congenital megacolon characterized by loss of parasympathetic ganglion cells?
|
Hirschsprung's disease
|
|
|
What is the term used to describe breath that smells like a freshly opened corpse, as seen in liver cell failure?
|
fetor hepaticus
|
|
|
What is the term used to describe having many diverticula?
|
diverticulosis
|
|
|
What is the treatment for Crigler-Najjar syndrome?
|
plasmaphoresis phototherapy
|
|
|
What is the treatment of hemochromatosis?
|
repeated phlebotomy deferoxamine
|
|
|
What is the treatment of Wilson's disease(1 drug)?
|
penicillamine
|
|
|
What is the typical presentation of a patient with pancreatic adenocarcinoma(5 signs)?
|
(1)Abdominal pain radiating to the back (2)Weight loss (3)Anorexia (4)Migratory thrombophlebitis(Trousseau's Sd) (5)Pancreatic duct obstruction(palpable gallbladder)
|
|
|
What is the usual location of Crohn's?
|
Terminal ileum, small intestine, colon (but any part can be affected)-- often SKIP lesions, rectal sparing
|
|
|
What is the usual location of ulcerative colitis?
|
colon (with continuous lesions and rectal involvement)
|
|
|
What lab values are characteristic in alcoholic hepatitis?
|
SGOT(AST)/SGPT(ALT) &gt; 1.5,usually (A Scotch and Tonic=AST elevation)
|
|
|
What lab values are characteristic in hemochromatosis?
|
increased ferritin and transferrin saturation
|
|
|
What labs are elevated in acute pancreatitis?
|
amylase lipase(higher specificity)
|
|
|
What part of the GI tract is most frequently involved in diverticulosis?
|
sigmoid colon
|
|
|
What risk group has an increased incidence of PUD by 2X?
|
smoking
|
|
|
What type of stones are seen in patients with RBC hemolysis,alcoholic cirrhosis,biliary infection?
|
pigment stones
|
|
|
When do patients with Crigler-Najjar syndrome(type I) usually present?
|
early in life(often die within a few years)
|
|
|
Where are pancreatic tumors most often located?
|
pancreatic head (with obstructive jaundice)
|
|
|
Where is the pain associated with diverticulitis?
|
left lower quadrant
|
|
|
Which of the following are effects of liver cell failure? Anemia, hypercoagulation,spider nevi, jaundice, gynecomastia,bleeding tendency, ankle edema
|
all, except hyper coagulation
|
|
|
Which of the following are risk factors for colorectal cancer(CRC): age,smoking,personal and family history of colon cancer, low-fiber diet, hereditary non-polyposis CRC?
|
all, except for smoking
|
|
|
Which of the following are risk factors for colorectal cancer: colorectal villous adenomas, chronic inflamm.bowel disease, familial adenomatous polyposis,Peutz-Jeghers?
|
all, except for Peutz-Jeghers
|
|
|
Which of the following is a blind pouch leading off the GI tract lined by mucosa, muscularis, serosa? Diverticulosis, diverticulum, diverticulitis
|
diverticulum
|
|
|
Which of the following is a common association between cholesterol stones and pigment stones: obesity,Crohn's,cystic fibrosis,age,clofibrate, estrogens,multiparity,rapid weight loss?
|
advanced age
|
|
|
Which of the following is associated with perforation, peritonitis, abscesses, or bowel stenosis?
|
Diverticulitis
|
|
|
Which of the following is associated with stress:Gilbert's, Dubin-Johnson syndrome, or Crigler-Najjar(type 1)?
|
Gilbert's
|
|
|
Which of the following syndromes have a mildly decreased UDP-glucuronyl transferase: Gilbert's or Crigler-Najjar(type 1)?
|
Gilbert's(Crigler-Najjar has an absence of UDP-glucuronyl transferase)
|
|
|
Which type of liver nodule is associated with an increased risk of hepatocellular carcinoma?
|
macronodules
|
|
|
With what 6 diseases does hepatocellular carcinoma have an association?
|
(1)Hepatitis B (2)Hepatitis C (3)Wilson's (4)Hemochromatosis (5)alpha 1 antitrypsin deficiency (6)alcoholic cirrhosis
|
|
|
With what cancer is achalasia associated?
|
Increased risk for esophageal cancer.
|
|
|
An FEV1/FVC ratio greater than 80% indicates what form of pulmonary disease?
|
Restrictive lung disease
|
|
|
Are bronchogenic carcinoma metastases common?
|
Yes, very common
|
|
|
Decreased FEV1/FVC ratio are the hallmark of what kind of pulmonary disease?
|
COPD
|
|
|
How does interstitial fibrosis create a restrictive lung disease?
|
It causes increased recoil (decreased compliance), thereby limiting alveolar expansion.
|
|
|
How does lung cancer commonly present? (5)
|
- Cough - Hemoptysis - Bronchial obstruction - Wheezing - Pneumonic 'coin' lesion on x-ray
|
|
|
How does surfactant deficiency cause NRDS?
|
It leads to an increase in surface tension, resulting in alveolar collapse
|
|
|
How to you treat NRDS?
|
- Maternal steroids before birth - Artificial surfactant for infant
|
|
|
Identify: ivory-white pleural plaques in the lung.
|
Ferruginous bodies
|
|
|
In COPD, are lung volumes increased, decreased, or normal?
|
Increased (increasedTLC, increased FRC, increased RV)
|
|
|
In restrictive lung disease, are lung volumes increased, decreased, or normal?
|
Decreased
|
|
|
In what occupations is asbestosis most commonly seen? (2)
|
Shipbuilders and plumbers
|
|
|
Name three 'triggers' of asthma.
|
- Viral URIs - Allergens - Stress
|
|
|
Name three characteristics of Horner's syndrome?
|
- Ptosis - Miosis - Anhidrosis
|
|
|
Name two extrapulmonary (poor breathing mechanics) causes of restrictive lung disease.
|
Poor muscular effort: polio, myasthenia gravis
Poor apparatus: scoliosis, severe kyphosis, obesity |
|
|
Name two pulmonary causes of restrictive lung disease.
|
-pneumonia, ARDS, pulmonary edema
- Interstitial fibrosis |
|
|
Patients with asbestosis are at increased risk for what? (2)
|
Pleural mesothelioma and bronchogenic carcinoma
|
|
|
T/F Bronchiectasis is associated with bronchial obstruction, cystic fibrosis, and poor ciliary motility.
|
TRUE
|
|
|
T/F Only in obstructive and not restrictive lung disease, FEV1 and FVC are reduced.
|
False, FEV1 and FVC are reduced in both
|
|
|
T/F Restricted lung expansion causes decreased total lung capacity and increased vital capacity.
|
False, decreased VC and TLC
|
|
|
T/F Smokers with asbestosis have a decreased risk of developing cancer.
|
False, it increases synergistically for bronchogenic carcinoma but has no effect on mesothelioma development
|
|
|
What are asbestos fibers coated with hemosiderin in the lung?
|
Ferruginous bodies
|
|
|
What are the characteristics and common organism of lobar pneumonia?
|
Sx: rusty colored sputum
Signs: egophony, dullness to percussion, inc. fremitus Consolidation(Intra-alveolar exudate) Organism: strep pneumonia |
|
|
What are the hx and clinical findings of chronic bronchitis? (3)
|
Hx: >3mo. consecutive prod. cough for >2yrs. typically smoker
Signs: -Wheezing, Crackles, Cyanosis -Reid index >50% -bronchial mucus glands hypertrophied BLUE BLOATER |
|
|
What are the clinical findings of emphysema? (4)
|
- Dyspnea - Decreased breath sounds - Tachycardia - Decreased I/E ratio
|
|
|
What are the symptoms and complications of interstitial lung fibrosis?
|
- Symptoms: gradual progressive dyspnea and cough - Complications include cor pulmonale (can be seen in diffuse interstitial pulmonary fibrosis and bleomycin toxicity)
|
|
|
What bronchogenic carcinoma is associated with ectopic hormone production (ADH, ACTH) and may lead to Lambert-Eaton syndrome?
|
Small cell carcinoma
|
|
|
What bronchogenic carcinoma is associated with ectopic PTH-related peptide production?
|
Squamous cell carcinoma
|
|
|
What bronchogenic carcinoma is most common?
|
Adenocarcinoma
|
|
|
What bronchogenic carcinoma is thought not to be related to smoking?
|
Bronchioalveolar carcinoma
|
|
|
What bronchogenic carcinomas are clearly linked to SSmoking?
|
SSquamous cell carcinoma and SSmall cell carcinoma
|
|
|
What bronchogenic carcinomas usually express tumors that arise centrally? (2)
|
- Squamous cell carcinoma - Small cell carcinoma
|
|
|
What bronchogenic carcinomas usually express tumors that arise peripherally? (3)
|
- Adenocarcinoma - Bronchioalveolar carcinoma - Large cell carcinoma--undifferentiated
|
|
|
What carcinoma occurs in the apex of the lung and may affect the cervical sympathetic, causing Horner's syndrome?
|
Pancoast's tumor
|
|
|
What causes bronchiectasis?
|
Chronic necrotizing infection of bronchi
|
|
|
What causes neonatal respiratory distress syndrome (NRDS)?
|
Surfactant deficiency
|
|
|
What cells make surfactant and when is it made most abundantly in fetuses?
|
Type II pneumocytes most abundantly after 35th week of gestation
|
|
|
What COPD has a productive cough for greater than three months in two years and hypertrophy of mucus-secreting glands in the bronchioles (Reid index greater than 50%)?
|
Chronic bronchitis
|
|
|
What COPD is characterized by dilated airways, purulent sputum, recurrent infections, and hemoptysis?
|
Bronchiectasis
|
|
|
What COPD is due to an enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls?
|
Emphysema
|
|
|
What COPD is due to bronchial hyperresponsiveness which causes reversible bronchoconstriction?
|
Asthma
|
|
|
What does inhaled asbestos do to the lungs?
|
It causes diffuse pulmonary interstitial fibrosis
|
|
|
What is the composition of surfactant:
|
Dipalmitoyl phosphatidylcholine
|
|
|
What is the difference in FEV1/FVC ratios between obstructive and restrictive lungs diseases?
|
FEV1 and FVC are reduced in both, but in obstructive the FEV1 is more dramatically reduced, resulting in a decreased FEV1/FVC ratio
|
|
|
What is the leading cause of cancer death?
|
Lung cancer
|
|
|
What is the SPHERE (acronym) of complications associated with lung cancer?
|
Superior vena caval syndrome Pancoast's tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (hoarseness) Effusions (pleural or pericardial)
|
|
|
What kind of pulmonary diseases are caused by a inhibition of air flow resulting in air trapping in the lungs?
|
Obstructive lung diseases (COPD)
|
|
|
What organisms are is the most frequent cause of lobar pnuemonia?
|
Pneumococcus
|
|
|
What organisms are the most frequent cause of bronchopnuemonia? (4)
|
- S. aureus - H. flu - Klebsiella - S. pyogenes
|
|
|
What organisms are the most frequent cause of interstitial (atypical) pnuemonia? (3)
|
- Viruses (RSV, adenoviruses) - Mycoplasma - Legionella
|
|
|
What specific type of emphysema is caused by alpha-1-antitrypsin deficiency?
|
Panacinar emphysema (and liver cirrhosis)
|
|
|
What specific type of emphysema is caused by smoking?
|
Centriacinar emphysema
|
|
|
What test is used to measure in utero lung maturity?
|
The lecithin-to-sphingomyelin ratio in the amniotic fluid, usually less than 1.5 in neonatal respiratory distress syndrome
|
|
|
What type of lung cancer can cause carcinoid syndrome?
|
Carcinoid tumor
|
|
|
What type of pneumonia is characterized by acute inflammatory infiltrates from bronchioles into adjacent alveoli with a patchy distribution affecting more than one lobe?
|
Bronchopneumonia
|
|
|
What type of pneumonia is characterized by diffuse patchy inflammation localized to interstial areas at alveolar walls and involves more than one lobe?
|
Interstitial (atypical) pneumonia
|
|
|
Where does bronchogenic carcinoma commonly metastasize and how does it present? (3)
|
- Brain (epilepsy) - Bone (pathologic fracture) - Liver (jaundice, hepatomegaly)
|
|
|
Why does alpha-1-antitrypsin deficiency cause emphysema?
|
Increased elastase activity
|
|
|
Define epilepsy.
|
Epilepsy is a disorder of recurrent seizures.
|
|
|
Define syrinx.
|
Tube, as in syringe
|
|
|
Describe a myoclonic seizure.
|
Quick,repetitive jerks
|
|
|
Describe a tonic-clonic seizure.
|
Alternating stiffening and movement (grand mal)
|
|
|
Describe a tonic seizure.
|
Stiffening
|
|
|
Describe an absence seizure.
|
A blank stare (petit mal- it's in 1st aid this way!!)
|
|
|
Describe an atonic seizure.
|
drop' seizures
|
|
|
Describe Broca's aphasia.
|
Broca's is nonfluent aphasia with intact comprehension. BROca's is BROken speech.
|
|
|
Describe Horner's syndrome.
|
Sympathectomy of face (lesion above T1). Interruption of the 3-neuron oculosympathetic pathway.
|
|
|
Describe Wernicke's aphasia.
|
Wernicke's is fluent aphasia with impaired comprehension. Wernicke's is Wordy but makes no sense.
|
|
|
How do patients present with a subarachnoid hemorrhage?
|
Worst headache of my life'
|
|
|
How do pts present with MS?
|
-Optic neuritis (sudden loss of vision) - MLF syndrome (internuclear ophthalmoplegia) -Hemiparesis -Hemisensory symptoms -Bladder/bowel incontinence
|
|
|
How does it spread?
|
Through the bloodstream to the CNS
|
|
|
How does Werdnig-Hoffman disease present?
|
At birth as a 'floppy baby'
|
|
|
How is Huntington's disease inherited?
|
Autosomal dominant
|
|
|
How is the polio virus transmitted?
|
Fecal-oral route
|
|
|
How is the prevalence of MS geographically distributed?
|
Higher prevalence with greater distance from the Equator
|
|
|
In what persons is subdural hemorrhage often seen?
|
Elderly individuals, alcoholics, and blunt trauma
|
|
|
T/F. Partial seizures can not generalize.
|
False- Partial seizures can generalize.
|
|
|
What are 2 common organisms that target the brain in AIDS pts?
|
1. Toxo!Toxo!Toxo! 2. Cryptococcus
|
|
|
What are 2 degenerative diseases of the cerebral cortex?
|
1. Alzheimer's 2. Pick's disease
|
|
|
What are 2 degenerative diseases that affect the basal ganglia and brain stem?
|
1. Huntington's disease 2. Parkinson's disease
|
|
|
What are 3 degenerative disorders of the motor neuron?
|
1. Amyotrophic lateral sclerosis (ALS) 2. Werdnig-Hoffman disease 3. Polio
|
|
|
What are associated with Guillain-Barre?
|
1. Infections (herpesvirus or C. jejuni) 2. Inoculations 3. Stress
|
|
|
What are neurofibrillary tangles?
|
Abnormally phosphorylated tau protein
|
|
|
What are some demyelinating and dysmyelinating diseases?
|
1. Multiple sclerosis (MS) 2. Progressive multifocal leukoencephalopathy (PML) 3. Postinfectious encephalomyelitis 4. Metachromatic Leukodystrophy 5. Guillain-Barre syndrome
|
|
|
What are the 4 types of intracranial hemorrhages?
|
1. Epidural hematoma 2. Subdural Hematoma 3. Subarachnoid hemorrhage 4. Parenchymal hematoma
|
|
|
What are the 5 types of generalized seizures?
|
1. Absence 2. Myoclonic 3. Tonic-clonic 4. Tonic 5. Atonic
|
|
|
What are the clinical symptoms of Huntington's disease?
|
Dementia, chorea
|
|
|
What are the clinical symptoms of Parkinson's disease?
|
TRAP= Tremor (at rest) cogwheel Rigidity Akinesia Postural instability (you are TRAPped in your body)
|
|
|
What are the clinical symptoms of Tabes dorsalis?
|
-Charcot joints -Shooting pain -Argyll-Robertson Pupils -Absence of deep tendon reflexes
|
|
|
What are the common causes of seizures in adults?
|
-Tumors -Trauma -Stroke -Infection
|
|
|
What are the common causes of seizures in children?
|
-Genetic -Infection -Trauma -Congenital -Metabolic
|
|
|
What are the common causes of seizures in the elderly?
|
-Stroke -Tumor -Trauma -Metabolic -Infection
|
|
|
What are the lab findings in Guillain-Barre syndrome?
|
Elevated CSF protein with normal cell count ('albumino-cytologic dissociation')
|
|
|
What are the lab findings in poliomyelitis?
|
-CSF with lymphocytic pleocytosis with slight elevation of protein -Virus recovered from stool or throat
|
|
|
What are the pathological signs of glioblastoma multiforme (GBM)?
|
-Necrosis -Hemorrhage -Pseudo-palisading
|
|
|
What are the signs of LMN lesions seen in poliomyelitis?
|
-Muscle weakness and atrophy -Fasciculations -Fibrillation -Hyporeflexia
|
|
|
What are the symptoms of Horner's?
|
1. Ptosis 2. Miosis 3. Anhidrosis and flushing of affected side of face
|
|
|
What are the symptoms of poliomyelitis?
|
-Malaise -Headache -Fever -Nausea -Abdominal pain -sore throat
|
|
|
What area of the brain is affected by generalized seizures?
|
Diffuse area
|
|
|
What artery is compromised in an epidural hematoma?
|
Middle meningeal artery
|
|
|
What blood vessels are affected in subdural hemorrhages?
|
Rupture of bridging veins
|
|
|
What causes a parenchymal hematoma?
|
-HTN -Amyloid angiopathy -Diabetes Mellitus -Tumor
|
|
|
What causes poliomyelitis?
|
Poliovirus
|
|
|
What chemical can Parkinson's disease be linked to?
|
MPTP, a contaminant in illicit street drugs
|
|
|
What clinical symptoms are present with syringomyelia?
|
Bilateral pain and temperature loss in the upper extremities with preservation of touch sensation
|
|
|
What clinical symptoms are present?
|
-Symmetric ascending muscle weakness beginning in the distal lower extremities -Facial diplegia in 50% of cases -Autonomic fx may be severely affected
|
|
|
What congenital malformation is often associated with syringomyelia?
|
Arnold Chiari Malformation
|
|
|
What damage does cryptococcus cause in the brain?
|
Periventricular calcifications
|
|
|
What damage does toxoplasma cause in the brain?
|
Diffuse (intracerebral) calcifications
|
|
|
What diseases are berry aneurysms associated with?
|
-Adult polycystic kidney disease -Ehlers-Danlos syndrome -Marfan's syndrome
|
|
|
What do partial seizures affect?
|
One area of the brain
|
|
|
What does rupture of a berry aneurysm lead to?
|
Stroke
|
|
|
What does the spinal tap show in a subarachnoid hemorrhage?
|
Bloody or xanthochromic
|
|
|
What event is the rupture of the middle meningeal artery secondary to?
|
Temporal bone fracture
|
|
|
What genes is the familial form of Alzheimer's associated with?
|
Genes are chromosomes 1, 14, 19 and 21
|
|
|
What is a complex partial seizure?
|
Impaired awareness
|
|
|
What is a degenerative disorder of the Spinocerebellar tract?
|
Friedrich's ataxia (olivopontocerebellar atrophy)
|
|
|
What is anhidrosis?
|
Absence of sweating
|
|
|
What is another name for Guillain-Barre syndrome?
|
Acute idiopathic polyneuritis
|
|
|
What is another symptom of Werdnig-Hoffman disease?
|
Tongue fasciculations
|
|
|
What is another term for Broca's aphasia?
|
Expressive aphasia
|
|
|
What is another term for Wernicke's aphasia?
|
Receptive aphasia
|
|
|
What is miosis?
|
Pupil constriction
|
|
|
What is PML associated with?
|
JC virus
|
|
|
What is ptosis?
|
Slight drooping of the eyelids
|
|
|
What is the classic triad of MS?
|
SIN 1. Scanning speech 2. Intention Tremor 3. Nystagmus
|
|
|
What is the common name for ALS?
|
Lou Gehrig's disease
|
|
|
What is the course of a subdural hemorrhage?
|
Venous bleeding (less pressure) with delayed onset of symptoms
|
|
|
What is the course of MS?
|
In most pts, the course is remitting and relapsing
|
|
|
What is the incidence of brain tumors in adults?
|
Metastases&gt; Astrocytoma (including glioblastoma)&gt; Meningioma
|
|
|
What is the incidence of brain tumors in children?
|
Astrocytoma&gt; Medulloblastoma&gt; Ependymoma
|
|
|
What is the most common cause of dementia in the elderly?
|
Alzheimer's disease
|
|
|
What is the most common complication of a berry aneurysm?
|
Rupture of the aneurysm
|
|
|
What is the most common site for a berry aneurysm?
|
The bifurcation of the anterior communicating artery
|
|
|
What is the pathogenesis of Guillain-Barre syndrome?
|
Inflammation and demyelination of peripheral nerves and motor fibers of ventral roots (sensory effect less severe than motor)
|
|
|
What is the pathogenesis of Tabes dorsalis?
|
Degeneration of the dorsal columns and dorsal roots due to tertiary syphilis.
|
|
|
What is the pathology of Alzheimer's?
|
Associated with senile plaques (beta-amyloid core) and neurofibrillary tangles
|
|
|
What is the pathology of Huntington's disease?
|
Atrophy of the caudate nucleus
|
|
|
What is the pathology of MS?
|
-Periventricular plaques -Preservation of axons -Loss of oligodendrocytes -Reactive astrocytic gliosis -Increased protein (IgA) in CSF
|
|
|
What is the pathology of Parkinson's disease?
|
Associated with Lewy bodies and depigmentation of the substantia nigra
|
|
|
What is the pathology of Pick's disease?
|
Associated with Pick bodies, intracytoplasmic inclusion bodies
|
|
|
What is the pathology of poliomyelitis?
|
Destruction of anterior horn cells, leading to LMN destruction
|
|
|
What is the pathology of syringomyelia?
|
Softening and cavitation around the central canal of the spinal cord.
|
|
|
What is the prognosis for a pts diagnosed with a GBM?
|
Very poor
|
|
|
What is the second most common cause of dementia in the elderly?
|
Multi-infarct dementia
|
|
|
What is the shape of GBMs?
|
Butterfly' glioma
|
|
|
What neural deficits are present in Tabes dorsalis?
|
Impaired proprioception and locomotor ataxia
|
|
|
What neural tracts are damaged?
|
Crossing fibers of the spinothalamic tract
|
|
|
What neurons are affected in ALS?
|
Both the upper and lower motor neurons
|
|
|
What neurons are affected in Polio?
|
Lower motor neurons only
|
|
|
What seizures are categorized as simple partial?
|
Awareness intact -Motor -Sensory -Autonomic -Psychic
|
|
|
What tumor is Horner's syndrome associated with?
|
Pancoast's tumor
|
|
|
Where are most brain tumors located in adults?
|
70% are supratentorial (cerebral hemispheres)
|
|
|
Where are most childhood brain tumors located?
|
70% below tentorium (cerebellum)
|
|
|
Where do berry aneurysms occur?
|
At the bifurcations in the Circle of Willis
|
|
|
Where does it initially replicate?
|
The oropharynx and small intestine
|
|
|
Where does the 3 neuron oculosympathetic pathway project from?
|
The hypothalamus
|
|
|
Where does the 3 neuron oculosympathetic pathway project to?
|
1. Interomediolateral column of the spinal cord 2. Superior cervical (sympathetic) ganglion 3. To the pupil, smooth muscles of the eyelids and the sweat glands
|
|
|
Where is Broca's area located?
|
Inferior frontal gyrus
|
|
|
Where is Pick's disease specific for?
|
The frontal and temporal lobes
|
|
|
Where is the aopE-4 allele located?
|
Chromosome 19
|
|
|
Where is the most common site of syringomyelia?
|
C8-T1
|
|
|
Where is the p-App gene located?
|
21
|
|
|
Where is Wernicke's area located?
|
Superior Temporal Gyrus
|
|
|
Which demyelinating disease is seen in 2-4% of AIDS patients?
|
PML
|
|
|
Define Ankylosing spondylitis?
|
Chronic inflammatory disease of spine &amp; large joints, sacroilitis, uveitis, &amp; aortic regurgitation
|
|
|
Define Ankylosing spondylitis?
|
Chronic inflammatory disease of spine &amp; large joints, sacroilitis, uveitis, &amp; aortic regurgitation
|
|
|
Define Celiac sprue
|
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
|
|
|
Define Celiac sprue
|
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
|
|
|
Define Gout.
|
Precipitation of monosodium urate crystals into joints due to hyperuricemia.
|
|
|
Define Gout.
|
Precipitation of monosodium urate crystals into joints due to hyperuricemia.
|
|
|
Define Scleroderma
|
Excessive fibrosis &amp; collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV &amp; GI systems &amp; kidney
|
|
|
Define Scleroderma
|
Excessive fibrosis &amp; collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV &amp; GI systems &amp; kidney
|
|
|
Define Sicca syndrome.
|
dry eyes, dry mouth, nasal &amp; vaginal dryness, chronic bronchitis, reflux esophagitis
|
|
|
Define Sicca syndrome.
|
dry eyes, dry mouth, nasal &amp; vaginal dryness, chronic bronchitis, reflux esophagitis
|
|
|
In what population is ankylosing sponsylitis more commonly found?
|
males (10-30 year old)
|
|
|
In what population is ankylosing sponsylitis more commonly found?
|
males (10-30 year old)
|
|
|
In what population is Celiac sprue more commonly found?
|
Assoc. w/ people of northern European descent
|
|
|
In what population is Celiac sprue more commonly found?
|
Assoc. w/ people of northern European descent
|
|
|
In what population is Goodpasture's syndrome more commonly found?
|
Men 20-40 y/o
|
|
|
In what population is Goodpasture's syndrome more commonly found?
|
Men 20-40 y/o
|
|
|
In what population is gout more commonly found?
|
Men
|
|
|
In what population is gout more commonly found?
|
Men
|
|
|
In what population is Osteoarthritis more commonly found?
|
Common in older patients
|
|
|
In what population is Osteoarthritis more commonly found?
|
Common in older patients
|
|
|
In what population is pseudogout more commonly found?
|
&gt; 50 y/o, both sexes equally
|
|
|
In what population is pseudogout more commonly found?
|
&gt; 50 y/o, both sexes equally
|
|
|
In what population is Reiter's syndrome more commonly found?
|
Strong predilection for males
|
|
|
In what population is Reiter's syndrome more commonly found?
|
Strong predilection for males
|
|
|
In what population is Rheumatoid arthritis more commonly found &amp; what the common autoimmune factor present?
|
- Common in females - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
|
|
|
In what population is Rheumatoid arthritis more commonly found &amp; what the common autoimmune factor present?
|
- Common in females - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
|
|
|
In what population is sarcoidosis more commonly found?
|
black females
|
|
|
In what population is sarcoidosis more commonly found?
|
black females
|
|
|
In what population is scleroderma more commonly found?
|
75% female
|
|
|
In what population is scleroderma more commonly found?
|
75% female
|
|
|
In what population is Sjogren's syndrome more commonly found?
|
females between the ages of 40 &amp; 60
|
|
|
In what population is Sjogren's syndrome more commonly found?
|
females between the ages of 40 &amp; 60
|
|
|
In what population is SLE more commonly found?
|
90% are female &amp; between ages 14 &amp; 45. More common &amp; severe in black females
|
|
|
In what population is SLE more commonly found?
|
90% are female &amp; between ages 14 &amp; 45. More common &amp; severe in black females
|
|
|
What are the 2 major categories of scleroderma &amp; what findings are they assoc w/?
|
Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab CREST syndrome: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly &amp; Telangiectasia; limited skin involvement, often confined to fingers &amp; face. More benign clinical course - assoc w/ anticentromere Ab
|
|
|
What are the 2 major categories of scleroderma &amp; what findings are they assoc w/?
|
Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab CREST syndrome: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly &amp; Telangiectasia; limited skin involvement, often confined to fingers &amp; face. More benign clinical course - assoc w/ anticentromere Ab
|
|
|
What are the associated sx's &amp; risks for Sjogren's syndrome?
|
- Parotid enlargement - incr risk of B-cell lymphoma - Assoc. w/ RA
|
|
|
What are the associated sx's &amp; risks for Sjogren's syndrome?
|
- Parotid enlargement - incr risk of B-cell lymphoma - Assoc. w/ RA
|
|
|
What are the characteristic findings in Celiac sprue?
|
Blunting of villi, lymphocytes in the lamina propria, &amp; abnormal D-xylose test
|
|
|
What are the characteristic findings in Celiac sprue?
|
Blunting of villi, lymphocytes in the lamina propria, &amp; abnormal D-xylose test
|
|
|
What are the common characteristics of Sarcoidosis?
|
immune-mediated, widespread noncaseating granulomas &amp; elevated serum ACE levels
|
|
|
What are the common characteristics of Sarcoidosis?
|
immune-mediated, widespread noncaseating granulomas &amp; elevated serum ACE levels
|
|
|
What are the common gross findings in Goodpasture's syndrome?
|
pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
|
|
|
What are the common gross findings in Goodpasture's syndrome?
|
pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
|
|
|
What can cause gout?
|
Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
|
|
|
What can cause gout?
|
Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
|
|
|
What causes pseudogout?
|
deposition of calcium pyrophosphate crystals w/in the joint space
|
|
|
What causes pseudogout?
|
deposition of calcium pyrophosphate crystals w/in the joint space
|
|
|
What CV disease state can be caused by SLE?
|
SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) &amp; do not embolize
|
|
|
What CV disease state can be caused by SLE?
|
SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) &amp; do not embolize
|
|
|
What drugs can induce a commonly reversible SLE-like syndrome?
|
- procainamide - INH - phenytoin - hydralazine
|
|
|
What drugs can induce a commonly reversible SLE-like syndrome?
|
- procainamide - INH - phenytoin - hydralazine
|
|
|
What immune marker aids in dx?
|
90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
|
|
|
What immune marker aids in dx?
|
90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
|
|
|
What is characteristic about gout crystals?
|
needle-shaped &amp; negatively berefringent.
|
|
|
What is characteristic about gout crystals?
|
needle-shaped &amp; negatively berefringent.
|
|
|
What is characteristic about pseudogout crystals?
|
basophilic, rhomboid crystals
|
|
|
What is characteristic about pseudogout crystals?
|
basophilic, rhomboid crystals
|
|
|
What is Reiter's syndrome?
|
a seronegative spondyloarthropath w/ a HLA-B27 link
|
|
|
What is Reiter's syndrome?
|
a seronegative spondyloarthropath w/ a HLA-B27 link
|
|
|
What is the 'classic triad' for Reiter's syndrome?
|
1. Urethritis (Can't pee) 2. Conjunctivities &amp; ant. uveitis (Can't see) 3. Arthritis (Can't climb a tree)
|
|
|
What is the 'classic triad' for Reiter's syndrome?
|
1. Urethritis (Can't pee) 2. Conjunctivities &amp; ant. uveitis (Can't see) 3. Arthritis (Can't climb a tree)
|
|
|
What is the 'classic triad' for Sjogren's syndrome?
|
1. dry eyes (conjunctivitis, xerophthalmia) 2. dry mouth (dysphagia, xerostomia) 3. arthritis
|
|
|
What is the 'classic triad' for Sjogren's syndrome?
|
1. dry eyes (conjunctivitis, xerophthalmia) 2. dry mouth (dysphagia, xerostomia) 3. arthritis
|
|
|
What is the classic pathology for Osteoarthritis?
|
Mechanical: wear &amp; tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, &amp; Heberden's nodes (DIP)
|
|
|
What is the classic pathology for Osteoarthritis?
|
Mechanical: wear &amp; tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, &amp; Heberden's nodes (DIP)
|
|
|
What is the classic pathology for Rheumatoid arthritis?
|
Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
|
|
|
What is the classic pathology for Rheumatoid arthritis?
|
Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
|
|
|
What is the Classic presentation for Osteoarthritis?
|
pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
|
|
|
What is the Classic presentation for Osteoarthritis?
|
pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
|
|
|
What is the classic presentation for Rheumatoid arthritis?
|
morning stiffness improving w/ use, symmetric joint involvement &amp; systemic symptoms: fever, fatigue, pleuritis, pericarditis
|
|
|
What is the classic presentation for Rheumatoid arthritis?
|
morning stiffness improving w/ use, symmetric joint involvement &amp; systemic symptoms: fever, fatigue, pleuritis, pericarditis
|
|
|
What is the common immunologic finding for Goodpasture's syndrome?
|
Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
|
|
|
What is the common immunologic finding for Goodpasture's syndrome?
|
Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
|
|
|
What is the common tx for gout?
|
allopurinol, probenecid, colchicine, &amp; NSAID's.
|
|
|
What is the common tx for gout?
|
allopurinol, probenecid, colchicine, &amp; NSAID's.
|
|
|
What is the common tx for pseudogout?
|
no tx
|
|
|
What is the common tx for pseudogout?
|
no tx
|
|
|
What is the descriptive acrynym for Sarcoidosis?
|
GRAIN Gammaglobulinemia Rheumatoid arthritis ACE incr. Interstitial fibrosis Noncaseating granulomas
|
|
|
What is the descriptive acrynym for Sarcoidosis?
|
GRAIN Gammaglobulinemia Rheumatoid arthritis ACE incr. Interstitial fibrosis Noncaseating granulomas
|
|
|
What is the useful memory tool for Goodpasture's syndrome?
|
there are TWO Good Pastures for this disease: Glomerulus &amp; Pulmonary. Also, a type II (TWO) hypersensitivity disease
|
|
|
What is the useful memory tool for Goodpasture's syndrome?
|
there are TWO Good Pastures for this disease: Glomerulus &amp; Pulmonary. Also, a type II (TWO) hypersensitivity disease
|
|
|
What sx's is sarcoidosis commonly associated w/?
|
restrictive lung disease, bilateral hilar lypmphadenopathy, erythema nodosum, Bell's palsy, epithelial granulomas containing microscopic Schaumann &amp; asteroid mobies, uveoparotitis, &amp; hypercalcemia (due to elevated conversion of vit. D to its active form in epithelioid macrophages)
|
|
|
What sx's is sarcoidosis commonly associated w/?
|
restrictive lung disease, bilateral hilar lypmphadenopathy, erythema nodosum, Bell's palsy, epithelial granulomas containing microscopic Schaumann &amp; asteroid mobies, uveoparotitis, &amp; hypercalcemia (due to elevated conversion of vit. D to its active form in epithelioid macrophages)
|
|
|
What the common pattern of psudogout presentation?
|
Usually affects large joints (classically the knee)
|
|
|
What the common pattern of psudogout presentation?
|
Usually affects large joints (classically the knee)
|
|
|
Where is gout commonly manifested?
|
Asymmetric joint distribution. Favored manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon)
|
|
|
Where is gout commonly manifested?
|
Asymmetric joint distribution. Favored manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon)
|
|
|
Addison's disease is characterized by what (remember 4 A's)?
|
Adrenal Atrophy and Absence of hormone production; involves All three cortical divisions
|
|
|
All MEN syndromes have what mode of inheritance?
|
Autosomal Dominant
|
|
|
An increased risk of carcinoma with atypical cells is seen in which type of fibrocystic breast disease?
|
Epithelial hyperplasia
|
|
|
Blood filled, 'chocolate cysts' are seen in what condition?
|
Endometriosis
|
|
|
Carcinoid tumors result in what recurrent symptoms? (4)
|
- diarrhea - cutaneous flushing - asthmatic wheezing - right-sided valvular disease
|
|
|
Cretin means 'Christ-like,' why is that name used?
|
Those affected were considered so mentally retarded as to be incapable of sinning.
|
|
|
Diabetic ketoacidosis (DKA) is caused by what?
|
Excess fat breakdown (usually due to an increase in insulin requirements) and increased ketogenesis from the increase in free fatty acids, which are then made into ketone bodies
|
|
|
Do leiomyosarcomas derive from other known tumors?
|
No, they usually arise de novo
|
|
|
From where do leiomyosarcomas often protrude?
|
Cervix
|
|
|
How do you treat carcinoid syndrome?
|
Treat with octreotide
|
|
|
How do you treat postmenopausal osteoporosis?
|
Estrogen replacement therapy
|
|
|
Hydatiform moles result in an increase in what hormone?
|
Beta-HCG
|
|
|
Increase in what substance is seen in the urine due to carcinoid tumors?
|
5-HIAA
|
|
|
Is ACTH increased or decreased when increased cortisol is due to a primary adrenal hyperplasia or neoplasia?
|
Decreased
|
|
|
Is ACTH increased or decreased when increased cortisol is due to an iatrogenic etiology?
|
Decreased
|
|
|
Is ACTH increased or decreased when increased cortisol is due to Cushing's disease?
|
Increased
|
|
|
Is ACTH increased or decreased when increased cortisol is due to ectopic ACTH production (e.g., carcinoid)?
|
Increased
|
|
|
Is plasma renin low or high in primary hyperaldosteronism?
|
Low
|
|
|
Is plasma renin low or high in secondary hyperaldosteronism?
|
High
|
|
|
Leiomyomas are sensitive to what?
|
Estrogen
|
|
|
Name 3 common tests for evaluating DM?
|
- Fasting serum glucose - Glucose tolerance test - HbA1c
|
|
|
Name 3 specific example of large vessel atherosclerosis due to DM?
|
- Coronary artery disease - Peripheral vascular occlusive disease and gangrene - Cerebrovascular disease
|
|
|
Name five possible causes of secondary hyperaldosteronism?
|
1. Renal artery stenosis 2. Chronic renal failure 3. CHF 4. Cirrhosis 5. Nephritic syndrome
|
|
|
Name four causes of SIADH.
|
Ectopic ADH CNS disorders/head trauma Pulmonary disease Drugs
|
|
|
Name four common presenting symptoms of benign prostatic hyperplasia.
|
1. Increased frequency of urination 2. Nocturia 3. Difficulty starting and stopping the stream of urine 4. Dysuria
|
|
|
Name four important chronic manifestations of DM.
|
- Small vessel disease - Large vessel atherosclerosis - Neuropathy - Cataracts, glaucoma
|
|
|
Name four risk factors of endometrial carcinoma.
|
1. Prolonged estrogen use 2. Obesity 3. Diabetes 4. HTN
|
|
|
Name four treatment modalities for polycystic ovarian syndrome.
|
- Weight loss - OCPs - Gonadotropin analogs - Surgery
|
|
|
Name six risk factors of breast disease.
|
1. Gender 2. Age 3. Early first menarche (under 12) 4. delayed first pregnancy (over 30) 5. Late menopause (over 50) 6. Family history of first degree relative with breast cancer at a young age.
|
|
|
Name some of the acute manifestations of Diabetes Mellitus (DM)? (7)
|
- Polydipsia - Polyuria - Polyphagia - Weight loss - DKA (type1) - Hyperosmolar coma (type 2) - Unopposed secretion of GH and Epi (exacerbating hyperglycemia)
|
|
|
Name syndrome: increased LH due to peripheral estrogen production leads to anovulation and may manifest in amenorrhea, infertility, obesity, and hirsutism.
|
Polycystic ovarian syndrome
|
|
|
Name the autoimmune hyperthyroidism with TSH receptor antibodies, opthalmopathy, pretibial myxedema, and diffuse goiter.
|
Graves' disease
|
|
|
Name the benign breast tumor: most common tumor under 25 years; small, mobile, firm mass with sharp edges.
|
Fibroadenoma
|
|
|
Name the benign breast tumor: tumor of lactiferous ducts; presents with nipple discharge.
|
Intraductal papilloma
|
|
|
Name the benign breast tumor: large, bulky mass of connective tissue and cysts; breast surface has 'leaflike' appearance.
|
Cystosarcoma phyllodes
|
|
|
Name the disease caused by primary deficiency of aldosterone and cortisol due to adrenal atrophy?
|
Addison's disease
|
|
|
Name the histologic type of fibrocystic breast disease: fluid-filled.
|
Cystic
|
|
|
Name the histologic type of fibrocystic breast disease: hyperplasia of breast stroma.
|
Fibrosis
|
|
|
Name the histologic type of fibrocystic breast disease: increase in number of epithelial cell layers in terminal duct lobule.
|
Epithelial hyperplasia
|
|
|
Name the histologic type of fibrocystic breast disease: increased acini and intralobular fibrosis.
|
Sclerosing
|
|
|
Name the histologic type of malignant breast disease: cheesy consistency of tumor tissue due to central necrosis.
|
Comedocarcinoma
|
|
|
Name the histologic type of malignant breast disease: eczematous patches on nipple.
|
Paget's disease
|
|
|
Name the histologic type of malignant breast disease: lymphatic involvement; poor prognosis.
|
Inflammatory
|
|
|
Name the histologic type of malignant breast disease: most common carcinoma; firm, fibrous mass.
|
Infiltrating ductal
|
|
|
Name three characteristics of inappropriate ADH secretion (SIADH).
|
1. Excessive water retention 2. Hyponatremia 3. Serum hypo-osmolarity with urine osmolarity &gt; serum osmolarity
|
|
|
Name three fractures commonly seen due to osteoporosis.
|
1. Vertebral crush fractures 2. Distal radius (Colle's) fractures 3. Vertebral wedge fractures
|
|
|
Pheochromocytomas may be associated with what 3 diseases?
|
1. Neurofibromatosis 2. MEN type II 3. MEN type III
|
|
|
T/F A partial hydatiform mole is commonly triploid or tetraploid.
|
TRUE
|
|
|
T/F DKA is common in Type 1 DM.
|
TRUE
|
|
|
T/F DKA is common in Type 2 DM.
|
False, rare
|
|
|
T/F Endometriosis often manifests with severe menstrual-related pain and often with infertility?
|
TRUE
|
|
|
T/F Fibrocystic breast disease usually does not indicate increased risk of carcinoma.
|
TRUE
|
|
|
T/F Genotype of a complete hydatiform mole is 46, XX and is purely maternal in origin.
|
False, it is 46, XX and Purely Paternal in origin
|
|
|
T/F Glucose intolerance in Type 1 DM is severe.
|
TRUE
|
|
|
T/F Insulin is always necessary to treat Type 1 DM.
|
TRUE
|
|
|
T/F Insulin is always necessary to treat Type 2 DM.
|
False, sometimes
|
|
|
T/F Leiomyomas often present with multiple tumors.
|
TRUE
|
|
|
T/F Leiomyomas often transform into malignant tumors.
|
False, it is rare
|
|
|
T/F Leiomyomas progress to leiomyosarcomas.
|
FALSE
|
|
|
T/F Leiomyosarcomas: highly aggressive, have a tendancy to recur, and have an increased incidence in blacks.
|
TRUE
|
|
|
T/F Risk of breast disease is increased by fibroadenoma and nonhyperplastic cysts.
|
FALSE
|
|
|
T/F Type 1 diabetes is often associated with obesity.
|
FALSE
|
|
|
T/F Type 1 diabetes is polygenic and strongly due to genetic disposition?
|
False. It is polygenic and only weakly associated with genetic disposition, whereas Type 2 is strongly associated.
|
|
|
T/F Women with endometrial hyperplasia are at increased risk for endometrial carcinoma which tends to manifest with vaginal bleeding?
|
TRUE
|
|
|
Urinary VMA levels and plasma catecholamines are elevated due to what neoplasms?
|
Pheochromocytoma
|
|
|
What are the clinical effects of increased cortisol? (9)
|
- hypertension - weight gain - moon facies - truncal obesity - buffalo hump - hyperglycemia (insulin resistance) - skin changes (thinning striae) - osteoporosis - immune suppression
|
|
|
What are the clinical effects of primary hyperaldosteronism? (4)
|
- Hypertension - Hypokalemia - Metabolic alkalosis - Low plasma renin
|
|
|
What are the episodic hyperadrenergic symptoms (5 P's) due to pheochromocytomas?
|
- Pressure - Pain (headache) - Perspiration - Palpitations - Pallor/diaphoresis
|
|
|
What are the primary hormonal causes of DM?
|
Insulin deficiency (or inefficiency) and glucagon excess
|
|
|
What are the six 'Rule of 10's' associated with pheochromocytomas?
|
- 10% Malignant - 10% bilateral - 10% extraadrenal - 10% calcify - 10% kids - 10% familial
|
|
|
What are theorized causes for Types 1 and 2 DM?
|
Type 1 - viral or immune destruction of pancreatic beta cells Type 2 - Increased resistance to insulin
|
|
|
What benign breast tumor increases in size and tenderness with pregnancy?
|
Fibroadenoma
|
|
|
What breast disease is common in postmenopausal women and arises from mammary duct epithilium or lobular glands?
|
Malignant tumors (carcinoma)
|
|
|
What causes Cushing's Syndrome?
|
Increased cortisol
|
|
|
What causes sporadic cretinism?
|
Defect in T4 formation or developmental failure in thyroid formation.
|
|
|
What condition can produce all these symptoms: cold intolerance, hypoactivity, weight gain, fatigue, lethargy, decreased appetite, constipation, weakness, decreased reflexes, myxedema (facial/periorbital), dry, cool skin, and coarse, brittle hair?
|
Hypothyroidism
|
|
|
What condition can produce all these symptoms: heat intolerance, hyperactivity, weight loss, chest pain/palpitations, arrhythmias, diarrhea, increased reflexes, warm, moist skin, and fine hair?
|
Hyperthyroidism
|
|
|
What condition is associated with the expressions 'honeycombed uterus' and 'cluster of grapes' appearance?
|
Hydatiform mole
|
|
|
What condition is caused by increased bone resorption due to decreased estrogen levels (seen postmenopausal by 10-15 years)?
|
Type 1 Osteoporosis
|
|
|
What condition is characterized by non-neoplastic endometrial glands/stroma in abnormal locations outside the uterus?
|
Endometriosis
|
|
|
-Intense thirst and polyuria --Inability to concentrate urine with fluid restriction
-lack ADH or renal response to ADH. -SE of lithium demeclocycline. |
diabetes insipidus
|
|
|
What disease may be due to an age-related increase in estradiol with sensitization of the prostate to the growth promoting effects of DHT? It is characterized by nodular enlargement of the periurethral lobes of the prostate gland compressing the urethra into a vertical slit?
|
Benign prostatic hyperplasia
|
|
|
What diuretic acts as an aldosterone antagonist used to treat primary hyperaldosteronism?
|
Spironolactone
|
|
|
What endocrine pathology may produce these findings: pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue?
|
Cretinism
|
|
|
What fractures cause acute back pain, loss of height, and kyphosis?
|
Vertebral crush fractures
|
|
|
What gynecologic tumor is often bulky with areas of necrosis and hemorrhage?
|
Leiomyosarcoma
|
|
|
What is a pathologic ovum resulting in cystic swelling of chorionic villi and proliferation of chorionic epithelium?
|
Hydatiform mole
|
|
|
What is an abnormal endometrial gland proliferation usually caused by excess estrogen stimulation?
|
Endometrial hyperplasia
|
|
|
What is the 'Rule of 1/3s' for carcinoid tumors?
|
1/3 metastasize 1/3 present with second malignancy 1/3 multiple
|
|
|
What is the etiology of Cushing's Syndrome caused by Cushing's disease?
|
Primary pituitary adenoma
|
|
|
What is the etiology of primary hyperaldosteronism (Conn's syndrome)?
|
An aldosterone-secreting tumor
|
|
|
What is the etiology of small vessel disease due to DM?
|
Diffuse thickening of the basement membrane
|
|
|
What is the most common gynecologic malignancy, with a peak age of 55-65 y/o?
|
Endometrial carcinoma
|
|
|
What is the most common of all tumors in females?
|
Leiomyoma
|
|
|
What is the most common site of ectopic endometrial tissue?
|
Ovary
|
|
|
What is the most common tumor of the adrenal medulla in adults?
|
Pheochromocytoma
|
|
|
What is the most common tumor of the adrenal medulla in children?
|
Neuroblastoma
|
|
|
What is the most common tumor of the appendix?
|
Carcinoid tumor
|
|
|
What is the pathophysiology of secondary hyperaldosteronism?
|
Kidney perception of low intravascular volume results in an overactive renin-angiotensin system.
|
|
|
What metabolic reaction is responsible for the chronic manifestations of DM?
|
Nonenzymatic glycosylation
|
|
|
What neoplasms secrete high levels of serotonin (5HT) that does not get metabolized by the liver due to liver metastases?
|
Carcinoid tumors (neuroendocrine cells) especially of the small bowel
|
|
|
What non-selective, irreversible alpha blocker is used to treat pts with pheochromocytomas?
|
Phenoxybenzamine
|
|
|
What phenotypic difference can distinguish between primary and secondary causes of Addison's disease?
|
Primary insufficiency results in hyperpigmentation due to increased MSH.
|
|
|
What substance causes cataract formation in DM patients?
|
Sorbitol accumulation
|
|
|
What syndrome is caused by a gastrin-secreting tumor that is usually located in the pancreas, causes recurrent ulcers, and may be associated with MEN type 1?
|
Zollinger-Ellison syndrome
|
|
|
What three organs (3 P's) are involved in MEN type I?
|
- Pancreas - Pituitary - Parathyroid
|
|
|
What type of respirations are seen in diabetic ketoacidosis?
|
Kussmaul respiration
|
|
|
Where (and in what forms) is small vessel disease from DM seen most prominently?
|
- Retinopathy - hemorrhage, exudates, and microaneurysms - Nephropathy - nodular sclerosis, progressive proteinuria, chronic renal failure, arteriosclerosis leading to HTN
|
|
|
Where does endemic cretinism occur?
|
Wherever endemic goiter is prevalent (lack of dietary iodine).
|
|
|
Whether the complications of diabetes Q. as it does is
|
life threatening mucormycosis, Rhizopus infection, cerebral edema, cardiac arrhythmias, heart failure
|
|
|
Which type of Multiple Endocrine Neoplasia (MEN) is associated with medullary carcinoma of the thyroid, pheochromocytoma, and oral and intestinal ganglioneuromatosis (mucosal neuromas)?
|
Type III (formerly MEN IIb)
|
|
|
Which type of Multiple Endocrine Neoplasia (MEN) is associated with medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor, or adenoma?
|
Type II (Sipple's syndrome)
|
|
|
Which type of Multiple Endocrine Neoplasia (MEN) is associated with pancreas (e.g. ZE syndrome, insulinomas, VIPomas), parathyroid and pituitary tumors?
|
Type I (Wermer's syndrome)
|
|
|
Which type of osteoporosis affects men and women over 70 y/o?
|
Type 2 (Senile) Osteoporosis
|
|
|
Why is intracellular myoinositol depleted in DM?
|
Hyperglycemia increases intracellular sorbitol (which is associated with depletion) and may also directly inhibit myoinositol uptake
|
|
|
Will total T4, free T4, and T3 uptake be increased or decreased (respectively) in primary hyperthyroidism?
|
All increased - Increased total T4 - Increased free T4 - Increased T3 uptake
|
|
|
Will total T4, free T4, and T3 uptake be increased or decreased (respectively) in primary hypothyroidism?
|
All decreased (remember: TSH is increased) - Decreased total T4 - Decreased free T4 - Decreased T3 uptake
|
|
|
Will TSH be increased or decreased in primary hyperthyroidism?
|
Increased
|
|
|
Will TSH be increased or decreased in primary hypothyroidism?
|
Increased
|
|
|
Are most pericardial effusions serous or hemorrhagic?
|
serous
|
|
|
Bacterial endocarditis of which valve is associated with IV drug abuse?
|
Tricuspid
|
|
|
Characterize EKG changes in an MI
|
ST elevation (transmural ischemia) and Q waves (transmural infarct)
|
|
|
characterize the AST levels in an MI
|
elevated 1-3 days post MI. Nonspecific enzyme found in heart, liver, and skeletal muscle
|
|
|
Characterize the cardiac troponin I levels in an MI.
|
Elevated between 4 hrs. and 7-10 days post MI most specific protein marker for MI
|
|
|
Characterize the CK-MB levels in an MI
|
elevated in the first 24 hrs. post MI
|
|
|
Characterize the LDH1 levels in an MI
|
elevated from 2 to 7 days post MI
|
|
|
Describe a mitral prolapse murmur?
|
Most frequent valvular lesion, esp. in young women. Late systolic murmur ending with 2nd heart sound
|
|
|
Describe a mitral regurgitation murmur?
|
High pitched holosystolic (continuous sound throughout systole)
|
|
|
Describe a mitral stenosis murmur
|
Rumbling late diastolic murmur when LA&gt;&gt;LV during diastole. Begins in late diastole
|
|
|
Describe a vent. Septal defect (VSD) murmur.
|
holosystolic murmur (continuous throughout systole)
|
|
|
Describe an aortic regurgitation murmur
|
high-pitched 'blowing' murmur, beginning immediately in diastole. Wide pulse pressure
|
|
|
Describe an aortic stenosis murmur
|
Crescendo-decrescendo systolic murmur, with LV&gt;&gt;aortic pressure during systole. Follows an 'ejection click,' and ends before 2nd heart sound
|
|
|
Describe an patent ductus arteriosus (PDA) murmur.
|
Continuous machine-like murmur. Loudest at the time of 2nd heart sound
|
|
|
Describe the bacterial growths in subacute bact. Endocarditis.
|
Small vegetations on congentially abnormal valves
|
|
|
Describe the bacterial growths of acute bact. endocarditis?
|
Large vegetations on previously normal valves
|
|
|
Describe the onset of Staph. Aureus endocarditis.
|
rapid, acute onset
|
|
|
Describe the onset of Streptoccus viridans endocarditis.
|
Insidious, subacute onset
|
|
|
During what weeks of pregnancy does preeclampsia present?
|
20 weeks gestation to 6 weeks postpartum
|
|
|
How can pericarditis progress?
|
It can resolve without scarring or it can lead to chronic adhesive or chronic constrictive pericarditis
|
|
|
How does atherosclerosis progress?
|
1. Fatty streaks in arteries 2. Proliferative plaques 3. Complex atheromas
|
|
|
How does Prinzmental's variant angina present?
|
chest pain at rest
|
|
|
How does stable angina present?
|
chest pain with exertion
|
|
|
How does syphilis change the aorta?
|
Causes dilation of the aorta and valve ring. Can result in aortic aneurysm or aortic valve incompetence
|
|
|
How does unstable/crescendo angina present?
|
Worsening chest pain
|
|
|
To what does HTN predispose one?(5)
|
Coronary heart dz, CVA, CHF, renal dz, and aortic dissection
|
|
|
What are associations of preeclampsia?(3)
|
1. Hemolysis 2. Elevated LFT (liver fxn test) 3. Low platelets
|
|
|
What are clinical features of preeclampsia?(6)
|
1. Headache 2. Blurred vision 3. Abdominal pain 4. Edema of face and extremities 5. Altered mentation 6. Hyperreflexia
|
|
|
What are complications from an MI?(7)
|
1. Card. Arrhythmia(90%) 2. LV failure and pul. Edema (60%) 3. Thromboembolism: mural thrombus 4. Cardiogenic shock 5. Physical trauma 6. Fibrinous pericarditis 7. Dressler's syndrome
|
|
|
What are complications of bacterial endocarditis?(4)
|
1. Chordae rupture 2. Glomerulonephritis 3. Suppurative pericarditis 4. Emboli
|
|
|
What are examples traumatic MI complications?(4)
|
1. Vent wall rupture 2. Interventricular. Septum rupture 3. Papillary muscle rupture (4-10 days post-MI) 4. Cardiac tamponade (heart compression)
|
|
|
What are fat emboli associated with?(2)
|
Long bone fractures and liposuction
|
|
|
What are Janeway lesions?
|
Small erythematous lesions on palms or soles
|
|
|
What are nonbacterial causes of endocarditis?(2)
|
Secondary to metastasis or renal failure (marantic/thrombotic endocarditis)
|
|
|
What are olser nodes?
|
tender raised lesions on finger or toe pads
|
|
|
What are possible manifestations of ischemic heart disease?(4)
|
1. Angina(CAD narrowing&gt; 75%) 2. Myocardial infarction 3. Sudden cardiac death 4. Chronic ischemic heart disease
|
|
|
What are risk factors for hypertension?(6)
|
Increased age, obesity, diabetes, smoking, genetics, race (black&gt;white&gt;asian)
|
|
|
What are Roth's spots?
|
round white spots on retina surrounded by hemorrhage
|
|
|
What are some atherosclerosis symptoms?
|
Agina and claudication. Can be asymptomatic
|
|
|
What are some risk factors for preecalmpsia?(4)
|
1. Preexisting HTN 2. Diabetes 3. Chronic renal dz 4. Autoimmune dz
|
|
|
What are the 2 major causes of HTN?
|
1.Primary (essential) HTN, related to ?CO and ?TPR 2. Secondary HTN, usually related to renal dz
|
|
|
What are the 3 most common sites of an MI?
|
LAD&gt;RCA&gt;circumflex
|
|
|
What are the 3 types of angina in ischemic heart dz?
|
stable angina, prinzmetal's variant, and unstable/crescendo
|
|
|
What are the 7 types of heart murmurs?
|
1. Aortic stenosis 2. Aortic regurgitation 3. Mitral stenosis 4. Mitral regurgitation 5. Mitral prolapse 6. Vent. Septal defect 7. Patent ductus arteriosus
|
|
|
What are the causes/associations of cardiogenic shock?
|
A large infarct with a high incidence of mortality
|
|
|
What are the complications of atherosclerosis?(6)
|
aneurisms, ischemia, infarcts, peripheral vasc dz thrombus, and emboli
|
|
|
What are the etiologies of dilated cardiomyopthy? (6)
|
1. Chronic alcohol abuse 2. Beriberi (wet) 3. Coxacke virus B postviral myocarditis 4. Cocaine use 5. Chagas dz. 6. Doxirubicin toxicity
|
|
|
What are the finding in temporal arteritis?
|
1. Unilateral headache 2. Jaw claudication 3. Impaired vision 4. Systemic involvement with polymyalgia rheumatica (in 50% of patients)
|
|
|
What are the findings in Buerger's dz?
|
Intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynauld's phenom.), severe pain in affected part; may lead to gangrene.
|
|
|
What are the findings in pericarditis?(4)
|
1. Pericardial pain 2. Friction rub 3. EKG changes 4. Pulsus paradoxicus
|
|
|
What are the findings of Wegener's granulomatosis?(3)
|
1. C-ANCA positive 2. CXR reveals large nodular lesions 3. Hematuria and red cell casts
|
|
|
What are the major causes of restrictive/obliterative cardiomyopathy?(4)
|
1. Sarcoidosis 2. Amyloidosis 3. Endocardial fibroelastosis 4. Endomyocardial fibrosis (Loffler's)
|
|
|
What are the possible lab findings in preeclampsia?(2)
|
thrombocytopenia and hyperuricemia
|
|
|
What are the risk factors of atherosclerosis?(4)
|
smoking, HTN, diabetes mellitus, and hyperlipidemia
|
|
|
What are the signs and symp of rheumatic fever or rheumatic heart dz?(7)
|
1. Fever 2. Erythema marginatum 3. Valvular damage 4. ESR increase 5. Polyarthritis 6. Subcutaneous nodules 7. Chorea
|
|
|
What are the signs and symp. of bacterial endocarditis?(8)
|
JR= NO FAME 1. Janeway lesions 2. Roth's spots 3. Nail bed hemorrhages 4. Osler nodes 5. Fever 6. Anemia 7. Murmur 8. Emobli
|
|
|
What are the signs of polyarteritis nodosa?(7)
|
1. Cotton wool spots 2. Microaneurysms 3. Pericarditis 4. Myocarditis 5. Palpable purpura 6. Elevated ESR 7. P-ANCA positive serum
|
|
|
What are the symptoms of a pulmonary embolus? (3)
|
Chest pain, tachypnea, and dyspnea
|
|
|
What are the symptoms of an MI?(5)
|
Severe retrosternal pain, pain in left arm or jaw, shortness of breath, fatigue, and adrenergic symptoms
|
|
|
What are the symptoms of polyarteritis nodosa?(6)
|
fever, weight loss, malaise, abdominal pain, myalgia, and HTN
|
|
|
What are the symptoms of Takaysu's arteritis?(6)
|
Fever, arthritis, night sweats, myalgia, and skin nodules
|
|
|
What are the symptoms of Wegeners granulomatosis? (7)
|
1. Perforation of nasal septum 2. Chronic sinusitis 3. Otitis media 4. Mastoiditis 5. Cough 6. Dyspnea 7. Hemoptysis
|
|
|
What are the types of emboli?(6)
|
1. Fat 2. Air 3. Thrombus 4. Bacteria 5. Amniotic fluid 6. Tumor
|
|
|
What can cause pericarditis?(4)
|
1. Infection 2. Ischemic heart dz 3. Chronic renal failure leading to uremia 4. Connective tissue dz
|
|
|
What causes acute bact. Endocarditis?
|
Staphyloccus aureus
|
|
|
What causes cardiac dilation in CHF?
|
greater ventricle end-diastolic volume
|
|
|
What causes dyspnea on exertion in CHF?
|
failure of LV output to increase during exercise
|
|
|
What causes hepatomegaly in CHF?
|
increased central venous press.?increased resistance to portal flow. Rarely leads to 'cardiac cirrhosis.'
|
|
|
What causes othopenea (dyspnea when supine) in CHF?
|
Pooling of blood in lungs when supine adds volume to congested pul. Vasculature system; increased venous return not put out by left ventricle.
|
|
|
What causes Paroxysmal nocturnal dyspnea and pulmonary edema in CHF?
|
Failure of left heart to keep up with rt. Heart output ?acute rise pul. Venous and capillary press. ? transudation of fluid
|
|
|
What causes prinzmental's variant angina?
|
coronary artery spasm
|
|
|
What causes pulmonary congestion in CHF?
|
LV failure?increased pul. Venous press.? pul. Venous distention and transudation of fluid. Presence of hemosiderin-laden macrophages (heart failure cells).
|
|
|
What causes pulmonary emboli?
|
95% of pulmonary emboli arise from deep leg veins
|
|
|
What causes rheumatic fever?
|
Pharyngeal infection with group A, ? hemolytic streptococci leads to cross reactivity with self (not due to direct effects of bacteria)
|
|
|
What causes stable angina?
|
atherosclerosis
|
|
|
What causes sudden cardiac death?
|
Most commonly from lethal arrhythmia
|
|
|
What causes the edema seen in CHF?
|
RV failure?increased venous press.? fluid transudation
|
|
|
What causes unstable/crescendo angina?
|
thrombosis in a branch of the coronary artery
|
|
|
What happens 2-4 days after an MI?(5)
|
1. Infarct appears pale 2. Tissue surrounding infarct shows acute inflammation 3. Dilated vessels (hyperemia) in infarct 4. Neutrophil emigration 5. Extensive coagulative necrosis
|
|
|
What happens 5-10 days after an MI?(4)
|
1. A hyperemic boarder forms around the infarct 2. The infarct shows central softening with brown/yellow color 3. An outer zone (ingrowth of granulation tissue) forms around infarct 4. Neutrophils and macrophages infiltrate infarcted tissue
|
|
|
What happens by 7 weeks post-MI?(3)
|
1. The Occluded artery causing the MI is recanalized 2. The infarct area is gray/white 3. The infarcted tissue shows contracted, complete scarring
|
|
|
What happens to contractility, cardiac output, and effective atrial blood volume in CHF?
|
all decrease
|
|
|
What happens to renal blood flow in CHF?
|
decreases
|
|
|
What happens to renin, angiotensin II, and aldosterone in CHF
|
all increase
|
|
|
What happens to sympathetic nervous activity in CHF?
|
increases
|
|
|
What happens to the heart 1 day after an MI?(5)
|
1. Appearance of a pale infarcted area 2. Coagulative necrosis in the infarct 3. Release of necrotic cells in the blood 4. Beginning of neutrophil emigration 5. Artery supplying infarcted tissue is occluded
|
|
|
What happens to urinary excretion of water and Na in CHF?
|
decrease
|
|
|
What happens to venous pressure in CHF?
|
increases
|
|
|
What histologic part of the aorta is affected by syphilis?
|
vasa vasorum
|
|
|
What is 'pulseless disease'?
|
Takayasu's arteritis
|
|
|
What is a red infarct?
|
A hemorrhagic infarct associated with reperfusion of infarcted tissue
|
|
|
What is an association of polyarteritis nodosa?
|
Hepatitis B infection (30% of patients)
|
|
|
What is Buerger's disease?
|
Known as smoker's disease and thromboangitis obliterans; idiopathic, segmental, thrombosing vasculitis of intermediate and small peripheral arteries and veins.
|
|
|
What is chronic ischemic heart dz?
|
Progressive onset of CHF over several years due to chronic ischemic myocardial damage
|
|
|
What is Dressler's syndrome?
|
an autoimmune phenomenon resulting in fibrinous pericarditis several weeks post-MI
|
|
|
What is eclampsia?
|
The addition of seizures to the preeclampsia triad
|
|
|
What is fibrinous pericarditis?
|
A friction rub of the pericardium usually 3-5 days post-MI
|
|
|
What is hypertrophic cardiomyopathy (formerly IHSS: idiopathic hypertrophic subaortic stenosis)?
|
Familial hypertrophy, usually asymmetric, involving the interventricular septum
|
|
|
What is polyarteritis nodosa?
|
Necrotizing immune complex inflammation of small or medium-sized muscular arteries, typically involving renal or visceral vessels.
|
|
|
What is preeclampsia?
|
A triad of HTN, protenuria, and edema that occurs in pregnancy
|
|
|
What is sudden cardiac death?
|
death from cardiac causes within 1 hr. of onset of symptoms
|
|
|
What is Takayasu's arteritis?
|
Thickening of aortic arch and proximal great vessels causing weak pulses in extremities and ocular disturbances.
|
|
|
What is temporal arteritis?
|
Vasculitis that affects medium and small arteries, usually branches of the carotid artery.
|
|
|
What is the appearance of a heart with hypertrophic cardiomyopathy?
|
Walls of LV are thickened, chamber becomes banana shaped on echocardiogram
|
|
|
What is the appearance of an aorta affected by syphilis?
|
Tree bark appearance
|
|
|
What is the incidence of preeclampsia?
|
7% of pregnant women
|
|
|
What is the inheritance pattern of hypertrophic cardiomyopathy?
|
AD
|
|
|
What is the most common cardiomyopathy?
|
Dilated (congested) cardiomyopathy (90%)
|
|
|
What is the most common heart tumor
|
metastases
|
|
|
What is the most common primary cardiac tumor in adults?
|
Myxoma
|
|
|
What is the most common primary cardiac tumor in children
|
rhabdomyoma
|
|
|
What is the most common vasculitis?
|
temporal arteritis
|
|
|
What is the treatment for Buerger's dz?
|
stop smoking
|
|
|
What is the treatment for temporal arteritis?
|
Responds well to steroids
|
|
|
What is the treatment of eclampsia?
|
IV Magnesium sulfate and diazepam This is a medical emergency
|
|
|
What is the treatment of polyarteritis nodosa?
|
Corticosteroids, azathioprine, and/or cyclophosphamide
|
|
|
What is the treatment of preeclampsia?
|
Deliver the fetus ASAP. Otherwise rest, salt restriction, treatment of HTN
|
|
|
What is the treatment of wegener's granulomatosis?
|
cyclophosphamide, corticosteroids, and/or methotrexate
|
|
|
What is the x-ray appearance of a heart with dilated myopathy?
|
Dilated: looks like a balloon
|
|
|
What is Wegner's granulomatosis?
|
Focal necrotizing vasculitis and granulomas in the lung and upper airway with necrotizing glomerulonephritis
|
|
|
What kind of effusions are found in pericarditis associated with TB or malignancy?
|
hemorrhagic
|
|
|
What kind of effusions are found in pericarditis associated with renal failure?
|
Serous of fibrinous
|
|
|
What lab finding is seen in Takayasu's arteritis or temporal arteritis?
|
elevated ESR
|
|
|
What part of the heart/vasculature can be damaged by syphilis?
|
Aortic root and ascending aorta
|
|
|
What percentage of HTN is primary?
|
0.9
|
|
|
What percentage of HTN is secondary?
|
0.1
|
|
|
What population is associated with death from hypertrophic cardiomyopathy?
|
young athletes
|
|
|
What predisposes one to deep vein thromosis?(3)
|
Virchow's triad: 1. Stasis 2. Hypercoagulability 3. Endothelial damage
|
|
|
What stage of syphilis can affect the heart?
|
tertiary
|
|
|
What symptoms are associated with CHF?(8)
|
1. Ankle and sacral edema 2. Hepatomegaly (nutmeg liver) 3. Pulmonary congestion 4. Dyspnea on exertion 5. Paroxysmal nocturnal dyspnea 6. Pulmonary edema 7. Orthopnea (dyspnea when supine) 8. Cardiac dilation
|
|
|
What tests are used to diagnose an MI?(5)
|
1. EKG (the gold standard) 2. Cardiac troponin I 3. CK-MB 4. LDH1 5. AST
|
|
|
What type of bacterial endocarditis is associated with dental procedures?
|
Subacute endocarditis from Strep. Viridans infection
|
|
|
What type of embolus is associated with DIC?
|
amniotic fluid, especially postpartum
|
|
|
What types of infections cause pericarditis?
|
Viruses, TB, pyogenic bacteria; often by direct spread from lung or mediastinal lymph node
|
|
|
What visual complication can temporal arteritis cause?
|
occlusion of ophthalmic artery leading to blindness
|
|
|
Where do myxomas occur?
|
90% occur in the atria, mostly LA. Myxomas are described as a 'ball valve' obstruction.
|
|
|
Where do pale infarcts occur?
|
Solid tissues with single blood supply: brain, heart, kidneys, and spleen
|
|
|
Where do red infarcts occur?
|
Loose tissue with collaterals: lungs or intestine
|
|
|
Where does a MI usually occur?
|
In the left anterior descending coronary artery
|
|
|
Where histologically does atherosclerosis occur?
|
The elastic arteries and medium to large muscular arteries
|
|
|
Where, anatomically, does atherosclerosis most occur?(4)
|
abdominal aorta > coronary a. > popliteal a. > carotid a.
|
|
|
Which valve is most frequently involved in bacterial endocarditis?
|
Mitral
|
|
|
Which valves are most affected by rheumatic heart dz?
|
mitral&gt;aortic&gt;&gt;tricuspid (high pressure valves most affected)
|
|
|
Who gets Takayasu's arteritis?
|
Primarily affects young Asian females
|
|
|
Who gets temporal arteritis?
|
Affects elderly females
|
|
|
Define renal failure.
|
Failure to make urine and excrete nitrogenous wastes
|
|
|
How do you calculate anion gap?
|
Na-(Cl + HCO3) = 8-12 mEq/L
|
|
|
How do you treat minimal change disease?
|
Responds well to steroids
|
|
|
How does acute poststreptococcal glomerulonephritis resolve?
|
Spontaneously
|
|
|
How does renal cell carcinoma spread metastically?
|
Invades the IVC and spreads hematogenously
|
|
|
How does transitional cell carcinoma present?
|
Hematuria
|
|
|
How does Wilms' tumor present?
|
Huge, palpable flank mass
|
|
|
In what epidemiological group is renal cell carcinoma most common?
|
Men ages 50-70
|
|
|
T/F: Ammonium magnesium phosphate kidney stones are radiopaque
|
TRUE
|
|
|
T/F: Calcium kidney stones are radiopaque.
|
TRUE
|
|
|
T/F: Calcium kidney stones do not recur.
|
FALSE
|
|
|
T/F: Cystine kidney stones are radiopaque.
|
FALSE, cystine stones are radiolucent
|
|
|
T/F: Transitional cell carcinoma is cured by surgical removal.
|
False, transitional cell carcinoma often recurs after removal
|
|
|
T/F: Uric acid kidney stones are radiopaque
|
FALSE, uric acid stones are radiolucent
|
|
|
What additional sx are seen in a pt with acute streptococcal glomerulonephritis?
|
Peripheral and periorbital edema
|
|
|
What age group is poststreptococcal glomerulonephritis most common?
|
Children
|
|
|
What are 4 causes of hypoventilation?
|
1. Acute lung disease 2. Chronic lung disease 3. Opioids, narcotics, sedatives 4. Weakening of respiratory muscles
|
|
|
What are the 2 forms of renal failure?
|
Acute and chronic
|
|
|
What are the 2 main symptoms present in Goodpasture's syndrome?
|
Hemoptysis, hematuria
|
|
|
What are the 4 major types of kidney stones?
|
1. Calcium 2. Ammonium magnesium phosphate 3. Uric acid 4. Cystine
|
|
|
What are the 5 nephritic syndromes?
|
Acute poststreptococcal glomerulonephritis Rapidly progressive (crescentic) glomerulonephritis Goodpasture's syndrome Membranoproliferative glomerulonephritis Berger's disease
|
|
|
What are the 5 nephrotic syndromes?
|
1. Membranous glomerulonephritis 2. Minimal change disease (lipoid nephrosis) 3. Focal segmental glomerular sclerosis 4. Diabetic nephropathy 5. SLE
|
|
|
What are the causes and signs of calcium ion deficiency?
|
-Kids- rickets -Adults- osteomalacia -Contributes to osteoporosis -Tetany
|
|
|
What are the causes and signs of phosphate toxicity?
|
-Low serum calcium ion -can cause bone loss -renal stones
|
|
|
What are the causes of chloride ion deficiency?
|
Secondary to emesis, diuretics, renal disease
|
|
|
What are the causes of metabolic acidosis?
|
-Diabetic ketoacidosis -Diarrhea -Lactic Acidosis -Salicylate OD -Acetazolamide OD
|
|
|
What are the causes of respiratory acidosis?
|
-COPD -Airway obstruction
|
|
|
What are the causes of respiratory alkalosis?
|
-High altitude -Hyperventilation
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with immunofluorescence?
|
Granular pattern
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the electron microscope?
|
Subepithelial humps
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the light microscope?
|
Glomeruli enlarged and hypercellular neutrophils 'lumpy-bumpy'
|
|
|
What are the characteristics of rapidly progressive (crescentic) glomerulonephritis seen on LM and IF?
|
Crescent-moon shape
|
|
|
What are the clinical features of renal cell carcinoma?
|
-Hematuria -Palpable mass -Secondary polycythemia -Flank pain -Fever
|
|
|
What are the clinical symptoms of a nephritic syndrome?
|
I' = inflammation; hematuria, hypertension, oligouria, azotemia
|
|
|
What are the clinical symptoms of nephrotic syndromes?
|
O = proteinuria Hypoalbuminuria Generalized edema Hyperlipidemia
|
|
|
What are the consequences of renal failure?
|
1. Anemia 2. Renal osteodystrophy 3. Hyperkalemia 4. Metabolic acidosis 5. Uremia 6. Sodium and water excess 7. Chronic pyelonephritis 8. HTN
|
|
|
What are the factors associated metabolic alkalosis?
|
-Increased pH -Increased PCO2 -Increased HCO3-
|
|
|
What are the factors associated with metabolic acidosis?
|
-Decreased pH -Decreased PCO2 -Decreased HCO3-
|
|
|
What are the factors associated with respiratory acidosis?
|
-Decreased pH -Increased PCO2 -Increased HCO3-
|
|
|
What are the factors associated with respiratory alkalosis?
|
-Increased pH -Decreased PCO2 -Decreased HCO3-
|
|
|
What are the functions of calcium ion?
|
-Muscle contraction -Neurotransmitter release -Bones, teeth
|
|
|
What are the functions of sodium ion?
|
-Extracellular fluid -Maintains plasma volume -Nerve/muscle function
|
|
|
What are the functions of the chloride ion?
|
-Fluid/electrolyte balance -Gastric acid -HCO3/Cl shift in RBC
|
|
|
What are the functions of the magnesium ion?
|
-Bones, teeth -Enzyme cofactor
|
|
|
What are the functions of the phosphate ion?
|
-ATP -nucleic acids -Phosphorylation -Bones, teeth
|
|
|
What are the functions of the potassium ion?
|
-Intracellular fluid -Nerve/muscle function
|
|
|
What are the signs of magnesium ion deficiency?
|
-Diarrhea -Alcoholism
|
|
|
What are the signs of magnesium ion toxicity?
|
-Decreased reflexes -Decreased respirations
|
|
|
What are the signs of phosphate deficiency?
|
-Kids- rickets -Adults- osteomalacia
|
|
|
What are the signs of potassium ion toxicity?
|
-EKG changes -Arrhythmia
|
|
|
What bugs cause ammonium magnesium phosphate kidney stones?
|
Urease-positive bugs such as Proteus vulgaris or Staphylococcus
|
|
|
What calcium molecules form calcium kidney stones?
|
Calcium oxalate or calcium phosphate or both
|
|
|
What can excess Na and water cause?
|
CHF and pulmonary edema
|
|
|
What can the hyperkalemia associated with renal failure lead to?
|
Cardiac arrhythmias
|
|
|
What causes metabolic alkalosis?
|
1. Vomiting 2. Diuretic use 3. Antacid use 4. Hyperaldosteronism
|
|
|
What causes renal osteodystrophy?
|
Failure of active vitamin D production
|
|
|
What characteristics of Berger's disease are seen with IF and EM?
|
Mesangial deposits of IgA
|
|
|
What characteristics of focal segmental glomerular sclerosis are seen with the LM?
|
Segmental sclerosis and hyalinosis
|
|
|
What characteristics of Goodpasture's syndrome are seen with IF?
|
Linear pattern Anti-glomerular basement membrane antibodies
|
|
|
What characteristics of Membranoproliferative glomerulonephritis are seen with the EM?
|
subendothelial humps 'tram track'
|
|
|
What characteristics of membranous glomerulonephritis are seen with IF?
|
Granular pattern
|
|
|
What characteristics of membranous glomerulonephritis are seen with the EM?
|
Spike and Dome'
|
|
|
What characteristics of membranous glomerulonephritis are seen with the LM?
|
Diffuse capillary and basement membrane thickening
|
|
|
What characteristics of minimal change disease are seen with the EM?
|
Foot process effacement
|
|
|
What characteristics of minimal change disease are seen with the LM?
|
Normal glomeruli
|
|
|
What characteristics of SLE are seen with the LM?
|
Wire-loop appearance with extensive granular subendothelial basement-membrane deposits in membranous glomerulonephritis pattern
|
|
|
What defines metabolic acidosis?
|
-pH less than 7.4 -PCO2 less than 40 mm Hg
|
|
|
What defines metabolic alkalosis with compensation?
|
-pH greater than 7.4 -PCO2 greater than 40 mm Hg
|
|
|
What defines respiratory acidosis?
|
-pH less than 7.4 -PCO2 greater than 40mm Hg
|
|
|
What defines respiratory alkalosis?
|
-pH greater than 7.4 -PCO2 less than 40 mm Hg
|
|
|
What diseases often cause uric acid kidney stones?
|
Diseases with increased cell proliferation and turnover, such as leukemia and myeloproliferative disorders
|
|
|
What disorders can lead to hypercalcemia and thus kidney stones?
|
1. Cancer 2. Increased PTH 3. Increased vitamin D 4. Milk-alkali syndrome
|
|
|
What disorders cause an increased anion gap?
|
1. Renal failure 2. Lactic acidosis 3. Ketoacidosis (DM) 4. Aspirin ingestion
|
|
|
What disorders cause metabolic acidosis and normal anion gap?
|
1. Diarrhea 2. Glue sniffing 3. Renal tubular acidosis 4. Hyperchloremia
|
|
|
What disorders make up the WAGR complex?
|
Wilms' tumor Aniridia Genitourinary malformation mental-motor Retardation
|
|
|
What does potassium deficiency cause?
|
-Weakness -Paralysis -Confusion
|
|
|
What factors are associated with transitional cell carcinoma?
|
Exposure to cyclophosphamide, smoking, phenacetin, and aniline dyes
|
|
|
What genetic disorder and mutation are associated with renal cell carcinoma?
|
Renal cell carcinoma is associated with von Hippel-Lindau and gene deletion in chromosome 3
|
|
|
What genetic disorder is associated with Wilms' tumor?
|
Deletion of tumor suppression gene WT-1 on chromosome 11
|
|
|
What is a common cause of adult nephrotic syndrome?
|
Membranous glomerulonephritis
|
|
|
What is acute renal failure often due to?
|
Hypoxia
|
|
|
What is Berger's disease?
|
IgA nephropathy -Mild disease -Often postinfectious
|
|
|
What is chronic failure due to?
|
HTN and diabetes
|
|
|
What is the 2nd most common type of kidney stone?
|
Ammonium magnesium phosphate
|
|
|
What is the cause of magnesium ion deficiency?
|
Secondary to malabsorption
|
|
|
What is the cause of metabolic alkalosis?
|
Vomiting
|
|
|
What is the cause of potassium ion deficiency?
|
Secondary to injury, illness or diuretics
|
|
|
What is the cause of sodium deficiency?
|
Secondary to injury or illness
|
|
|
What is the compensatory mechanism of metabolic alkalosis?
|
Hypoventilation
|
|
|
What is the compensatory mechanism of respiratory alkalosis?
|
Renal HCO3- secretion
|
|
|
What is the compensatory response to metabolic acidosis?
|
Hyperventilation
|
|
|
What is the compensatory response to respiratory acidosis?
|
Renal HCO3- reabsorption
|
|
|
What is the course of membranoproliferative glomerulonephritis?
|
Slowly progresses to renal failure
|
|
|
What is the course of rapidly progressive (crescentic) glomerulonephritis?
|
Rapid course to renal failure from one of many causes
|
|
|
What is the Henderson-Hasselbalch equation?
|
pH = pKa + log [(HCO3-)/(0.03*PCO2)]
|
|
|
What is the most common cause of childhood nephrotic syndrome?
|
Minimal change disease (lipoid nephrosis)
|
|
|
What is the most common renal malignancy of early childhood (ages 2-4)?
|
Wilms' tumor
|
|
|
What is the most common renal malignancy?
|
Renal cell carcinoma
|
|
|
What is the most common tumor of the urinary tract system?
|
Transitional cell carcinoma
|
|
|
What is the primary disturbance in respiratory acidosis?
|
Increased PCO2
|
|
|
What is the primary disturbance of metabolic acidosis?
|
HCO3- decrease
|
|
|
What is the primary disturbance of metabolic alkalosis?
|
Increased HCO3-
|
|
|
What is the primary disturbance of respiratory alkalosis?
|
Decreased PCO2
|
|
|
What is the sign of calcium ion toxicity?
|
Delirium
|
|
|
What is the sign of sodium ion toxicity?
|
Delirium
|
|
|
What lesions are seen on the LM in diabetic nephropathy?
|
Kimmelstiel-Wilson lesions
|
|
|
What might an elevated anion gap indicate?
|
MUD PILES 1. Methanol 2. Uremia (chronic renal failure) 3. Diabetic ketoacidosis 4. Paraldehyde or Phenformin 5. Iron tablets or INH 6. Lactic acidosis (CN-, CO, shock) 7. Ethanol or Ethylene glycol 8. Salicylates
|
|
|
What paraneoplastic syndromes are associated with renal cell carcinoma?
|
Ectopic EPO, ACTH, PTHrP, and prolactin
|
|
|
What severe complications may kidney stones lead to?
|
Hydronephrosis Pyelonephritis
|
|
|
What social factor increases the incidence of renal cell carcinoma?
|
Smoking
|
|
|
What type of hypersensitivity contributes to the pathogenesis of Goodpasture's syndrome?
|
Type II hypersensitivity
|
|
|
Where can transitional cell carcinoma occur?
|
-Renal calyces -Renal pelvis -Ureters -Bladder
|
|
|
Where does renal cell carcinoma originate?
|
Renal tubule cells, polygonal clear cells
|
|
|
Which kidney stone is often secondary to cystinuria?
|
Cystine
|
|
|
Which kidney stone is strongly associated with gout?
|
Uric acid kidney stones
|
|
|
Which of the nephrotic syndromes are worse in HIV pts?
|
Focal segmental glomerular sclerosis
|
|
|
Which type of kidney stones constitute the majority of kidney stones (80-85%)?
|
Calcium
|
|
|
Why are ammonium magnesium phosphate kidney stones often associated with UTIs?
|
Ammonium magnesium phosphate stones can form large struvite calculi that can be a nidus for UTIs
|
|
|
Why does renal failure cause anemia?
|
Failure of EPO production
|
|
|
Why does renal failure cause metabolic acidosis?
|
Due to decreased acid secretion and decreased generation of HCO3-
|
|
|
Define/Describe Alcoholism:
|
-Physiologic tolerance and dependence with syptoms of withdrawal when intake is interrupted. -Continued drinking despite medical and social contraindications and life disruptions.
|
|
|
In alcoholics, what causes Wernicke-Korsakoff syndrome?
|
Vitamin B1 (thiamine) deficiency
|
|
|
Is Korsakoff's syndrome reversible?
|
NO
|
|
|
Wernicke-Korsakoff syndrome is associated with periventricular hemorrage/necrosis in which part of brain?
|
Mamillary bodies
|
|
|
What are the accompanying symptomes of Alcoholic cirrhosis?
|
-Jaundice -Hypoalbuminemia -Coagulation factor deficiencies -Portal hypertension -Peripheral edema and ascites -Encephalopathy -Neurologic manifestations (e.g., asterixis, flapping tremor of the hands)
|
|
|
What are the bodily effects of ethanol? (3)
|
-Toxicity (especially in the brain) -Fatty liver -Increased NADH/HAD
|
|
|
What are the effects of increased NADH/NAD (from ethanol use)? (4)
|
-Increases lactate/pyrubate -Inhibits gluconeogenesis -Inhibits fatty acid oxidation -Inhibits glycerophosphate dehydrogenase leading to elevated glycerophosphate
|
|
|
What are the long term consequences of alcohol use?
|
-Alcoholoic hepatitis and cirrhosis -Pancreatitis -Dilated cardiomyopathy -Peripheral neuropathy -Cerebellar degeneration -Wernicke-Korsakoff syndrome -Testicular atrophy and hypertension -Mallory-Weiss syndrome
|
|
|
What are the symptoms of alcohol withdrawel?
|
-tremor -tachycardia -hypertension -malaise -nausea -delerium tremens
|
|
|
What is Korsakoff's syndrome?
|
Progression of Wernicke's encephalopathy to memory loss, confabulation, and confusion
|
|
|
What is Mallory-Weiss syndrome?
|
Longitudinal lacerations at the gastroesophageal junction caused by excessive vomitting with failure of Lower Esophageal Sphincter relaxation that could lead to fatal hematemesis.
|
|
|
What is the treatment for Wernicke-Korsakoff syndrome?
|
IV vitamin B1 (thiamine)
|
|
|
What is the triad of symptoms for Wernicke's encephalopathy?
|
1. Psychosis 2. Ophthalmoplegia 3. Ataxia
|
|
|
What supportive group has been mose successful in sustaining abstinence?
|
Alcoholics Anonymous (sorry… it was in the book :)
|
|
|
What treatment is used to condition the patient negatively against alcohol use?
|
Disulfiram
|
|
|
Actinic keratosis
|
Often precedes squamous cell carcinoma
|
|
|
Addison's
|
Autoimmune (infection is the second most common cause)
|
|
|
Albumino-cytologic dissociation
|
Guillain-Barre (increased protein in CSF with only modest increase in cell count)
|
|
|
Aneurysm, dissecting
|
HTN
|
|
|
Anti-basement membrane
|
Goodpasture's syndrome
|
|
|
Anti-centromere antibodies
|
Scleroderma (CREST)
|
|
|
Anti-double-stranded-DNA antibodies (ANA antibodies)
|
SLE (type III hypersensitivity)
|
|
|
Anti-epithelial cell
|
Pemphigus vulgaris
|
|
|
Anti-gliadin antibodies
|
Celiac disease
|
|
|
Anti-histone Antibodies
|
Drug-induced SLE (cf. SLE)
|
|
|
Anti-IgM antibodies
|
Rheumatoid arthritis
|
|
|
Anti-mitochondrial antibodies
|
Primary biliary cirrhosis
|
|
|
Anti-neutrophil antibodies
|
Vasculitis
|
|
|
Antiplatelet antibodies
|
Idiopathic thrombocytopenic purpura
|
|
|
Aortic aneurysm, abdominal &amp; descending aorta
|
Atherosclerosis
|
|
|
Aortic aneurysm, ascending
|
Tertiary syphilis
|
|
|
Arachnodactyly
|
Marfan's syndrome
|
|
|
Argyll-Robertson pupil
|
Neurosyphilis
|
|
|
Aschoff bodies
|
Rheumatic fever
|
|
|
Atrophy of the mamillary bodies
|
Wernicke's encephalopathy
|
|
|
Auer rods
|
Acute myelogenous leukemia (especially the promyelocytic type)
|
|
|
Autosplenectomy
|
Sockle cell anemia
|
|
|
Babinski sign
|
Upper motor neuron lesion
|
|
|
Bacteremia/pneumonia (IVDA)
|
Staphylococcus aureus
|
|
|
Bacteria associated with cancer
|
Helicobacter pylori
|
|
|
Bacteria found in GI tract
|
Bacteroides (second most common is Escherichia coli)
|
|
|
Bacterial meningitis (adults)
|
Neisseria meningitidis
|
|
|
Bacterial meningitis (elderly)
|
Streptococcus pneumoniae
|
|
|
Bacterial meningitis (kids)
|
Haemophilus influenza type B
|
|
|
Bacterial meningitis (newborns)
|
Escherichia coli
|
|
|
Baker's cyst in popliteal fossa
|
Rheumatoid arthritis
|
|
|
Bamboo spine' on xray
|
Ankylosing spondylitis
|
|
|
Basophilic stippling of RBC's
|
Lead poisoning
|
|
|
Bence-Jones proteins
|
Multiple myeloma (kappa or lambda Ig light chains in urine) Waldenstrom's macroglobinemia (IgM)
|
|
|
Bilateral hilar adenopathy, uveitis
|
Sarcoidosis
|
|
|
Birbeck granules on EM
|
Histiocytosis X (eosinophilic granuloma)
|
|
|
Bloody tap on LP
|
Subarachnoid hemorrhage
|
|
|
Blue-domed cysts
|
Fibrocystic change of the breast
|
|
|
Blue bloater'
|
Chronic bronchitis
|
|
|
Blue sclera
|
Osteogenesis imperfecta
|
|
|
Boot-shaped heart on x-ray
|
Tetralogy of Fallot; RV hypertrophy
|
|
|
Bouchard's nodes
|
BOP
Osteoarthritis (PIP swelling secondary to osteophytes) |
BOP |
|
Boutonniere's deformity
|
Rheumatoid arthritis
|
|
|
Brain tumor - supratentorial (kids)
|
Craniopharyngioma
|
|
|
Brain tumor (adults)
|
Glioblastoma multiforme> Mets>Meningioma>Schwannoma >Oligodendrogliomas>Pituitary adenoma
|
ADULTS are more likely to have GeMS On Pillows |
|
Brain tumor (kids)
|
Medullobastoma (cerebellum)
|
|
|
Branching rods in oral infection
|
Actinomyces israelii
|
|
|
Breast cancer
|
Infultrating ductal carcinoma (in the US, one in nine women will develop breast cancer)
|
|
|
Breast mass
|
Fibrocystic change (in post-menopausal women, carcinoma is the most common)
|
|
|
Breast tumor (benign)
|
Fibroadenoma
|
|
|
Brown tumor'of bone
|
Hemorrhage causes brown color of osteolytic cysts:
Hyperparathyroidism; Osteitis fibrosa cystica (von Recklinghausen's disease) |
|
|
White spots on iris concentrically, sligtly elevate
|
Brushfield's spots in Down syndrome more prevalent,also in nl kids
|
|
|
Bruton's lines
|
Lead poisoning
|
|
|
Bug in debilitated, hospitalized pneumonia patient
|
Klebsiella
|
|
|
C-ANCA
|
Wegerner's granulomatosis
|
|
|
Café au lait spots on skin
|
Neurofibromatosis
|
|
|
Calf pseudohypertrophy
|
Duchenne's muscular dystrophy
|
|
|
Call-Exner bodies
|
Granulosa/thecal cell tumor of the ovary
|
|
|
Cancer associated with AIDS
|
Kaposi's sarcoma
|
|
|
Cardiac primary tumor (adults)
|
Myxoma (4:1 left to right atrium; 'ball &amp; valve')
|
|
|
Cardiac primary tumor (kids)
|
Rhabdomyoma
|
|
|
Cardic tumor (adults)
|
Mets
|
|
|
Cardiomegaly with apical atrophy
|
Cagas' disease
|
|
|
Cardiomyopathy
|
Dilated cardiomyopathy
|
|
|
Cerebriform nuclei
|
Mycosis fungoides (cutaneous T-cell lymphoma)
|
|
|
Chancre
|
Primary syphilis (not painful)
|
|
|
Chancroid
|
Haemophilus ducreyi (painful)
|
|
|
Charcot's triad
|
Multiple sclerosis (nystagmus, intention tremor,scanning speech); Cholangitis (jaundice, RUQ, fever)
|
|
|
Charcot-Leyden crystals
|
Bronchial asthma (eosinophil membranes)
|
|
|
Cherry-red spot on macula
|
Tay-Sachs, Niemann-Pick disease, central retinal artery occlusion
|
|
|
Chevostek's sign
|
Hypocalcemia (facial muscle spasm upon tapping)
|
|
|
Cheyne-Stokes respirations
|
Central apnea in CHF & increased ICP
|
|
|
Chocolate cysts'
|
Endometriosis (frequently involve both ovaries)
|
|
|
Chromosomal disorder
|
Down syndrome (associated with ALL, Alzheimer's dementia, &amp; endocardial cushion defects)
|
|
|
Chronic arrhythmia
|
Atrial fibrillation (associated w/ high risk of emboli)
|
|
|
Chronic atrophic gastritis
|
Predisposition to gastric carcinoma
|
|
|
Clue cells
|
Gardnerella vaginitis
|
|
|
Codman's triangle on x-ray
|
Osteoasarcoma
|
|
|
Cold agglutinins
|
Mycoplasma pneumoniae; Infectious mononeucleosis
|
|
|
Cold intolerance
|
Myxedema
|
|
|
Condyloma lata
|
Secondary syphilis
|
|
|
Congenital adrenal hyperplasia
|
21-Hydroxylase deficiency
|
|
|
Congenital cardiac anomaly
|
VSD
|
|
|
Constrictive pericarditis
|
Tuberculosis
|
|
|
Continuous machinery murmur
|
Patent ductus arteriosus
|
|
|
Coronary artery involved in thrombosis
|
LAD > RCA > LCA
|
|
|
Cotton wool spots
|
Chronic hypertension
|
|
|
Cough, conjunctivitis, coryza + fever
|
Measles
|
|
|
Councilman bodies
|
Toxic or viral hepatitis
|
|
|
Cowdry type A bodies
|
Herpes virus
|
|
|
Crescents in Bowman's capsule
|
Rapidly progressive crescentic glomerulonephritis
|
|
|
Cretinism
|
Hypothyroidism/iodine deficit
|
|
|
Currant-jelly sputum
|
Klebsiella
|
|
|
Curschmann's spirals
|
Bronchial asthma (whorled mucous plugs)
|
|
|
Cushing's syndrome
|
Corticosteroid therapy (second most common cause is excess ACTH secretion by pituitary)
|
|
|
Cyanosis (early; less common)
|
Tetralogy of Fallot, transposition of great vessels, truncus arteriosus
|
|
|
D-dimers
|
DIC
|
|
|
Death in CML
|
Blast crisis
|
|
|
Death in SLE
|
Lupus nephropathy
|
|
|
Dementia
|
Alzheimer's (second most common is multi-infarct)
|
|
|
Demyelinating disease
|
Multiple sclerosis
|
|
|
Depigmentation of neurons in substantia nigra
|
Parkinson's disease (basal ganglia disorder -- rigidity, resting tremor, bradykinesia)
|
|
|
Dermatitis, dementia, diarrhea
|
Pellagra (Niacin, vitamin B3 deficiency)
|
|
|
Diabetes insipidus + exopthalmos + lesions of skull
|
Hand-Schuller-Christian disease
|
|
|
DIC
|
Gram-negative sepsis, obstetric complications, cancer, burns trauma
|
|
|
Dietary deficit
|
Iron
|
|
|
Dog or cat bite
|
Pasteurella multocida
|
|
|
Donovan bodies
|
Granuloma inguinale
|
|
|
Ejection click
|
Aortic/pulmonic stenosis
|
|
|
Elastic skin
|
Ehlers-Danlos syndrome
|
|
|
Epiglottitis
|
Haemophilus influenza type B
|
|
|
Erythema chronicum migrans
|
Lyme disease
|
|
|
Esophageal cancer
|
Squamous cell carcinoma
|
|
|
Fat, female, forty, &amp; fertile'
|
Acute cholecystitis
|
|
|
Fatty liver
|
Alcoholism
|
|
|
Ferruginous bodies
|
Asbestosis
|
|
|
Food poisoning
|
Staphylococcus aureus
|
|
|
Ghon complex
|
Secondary TB
|
|
|
Ghon focus
|
Primary TB
|
|
|
Glomerularnephritis (adults)
|
IgA nephropathy (Berger's disease)
|
|
|
Gower's maneuver
|
Duchenne's (use of patient's arms to help legs pick self off the floor)
|
|
|
Group affected by cystic fibrosis
|
Caucasians (fat-soluble vitamin deficiencies, mucous plugs/lung infections)
|
|
|
Gynecologic malignancy
|
Endometrial carcinoma
|
|
|
Hair on end' appearance on x-ray
|
Beta-thalassemia
& Sickle cell |
|
|
Hampton's hump on x-ray
|
Pulmonary embolism
|
|
|
HbS
|
Sickle cell anemia
|
|
|
HCG elevated
|
Choriocarcinoma; Hyadatidiform mole (occurs with &amp; without embryo)
|
|
|
Heart murmur
|
Mitral valve prolapse
|
|
|
Heart valve (rheumatic fever)
|
Mitral valve (aotric is second)
|
|
|
Heart valve in bacterial endocarditis
|
Mitral
|
|
|
Heart valve in bacterial endocarditis in IVDA
|
Tricuspid
|
|
|
Heberden's nodes
|
DOH
Osteoarthritis (DIP swelling secondary to osteophytes) |
DOH |
|
Heinz bodies
|
G6PD deficiency
|
|
|
Helminth infection (US)
|
Enterobius vermicularis (Ascaris lumbricoides is second most common)
|
|
|
Hematoma - epidural
|
Rupture of middle meningeal artery (arterial bleeding is fast)
|
|
|
Hematoma - subdural
|
Rupture of bridging veins (trauma; venous bleeding is slow)
|
|
|
Hemochromocytosis (cause and sequele)
|
Multiple blood transfusions (can result in CHF, and increases risk of hepatocellular carcinoma)
|
|
|
Hepatic cirrhosis
|
EtOH
|
|
|
Hepatocellular carcinoma
|
Cirrhotic liver (often associated with hepatitis B &amp; C)
|
|
|
Hereditary bleeding disorder
|
Von Willebrand's
|
|
|
Heterophil antibodies
|
Infectious mononucleosis (EBV)
|
|
|
Hgb F
|
Thalassemia major
|
|
|
High output cardiac failure (dilated cardiomyopathy)
|
Wet beriberi (thiamine, vitamin B1 deficiency)
|
|
|
HLA-B27
|
Reiter's syndrome, ankylosing spondylitis
|
|
|
HLA-DR3 or DR4
|
DM type 1 (caused by autoimmune destruction of beta cells)
|
|
|
Holosystolic murmur
|
VSD, tricuspid regurgitation
|
|
|
Homer-Wright rosettes
|
Neuroblastoma
|
|
|
Honeycomb lung on x-ray
|
Interstitial fibrosis
|
|
|
Howell Jolly bodies
|
Splenectomy (or non-functional spleen)
|
|
|
Hyperphagia + hypersexuality + hyperorality + hyperdocile
|
Kluver-Bucy syndrome (amygdala)
|
|
|
Hyperpigmentation of skin
|
Primary adrenal insufficiency (Addison's disease)
|
|
|
Hypersegmented neutrophils
|
Macrocytic anemia
|
|
|
Hypertension + hypokalemia
|
Cushing & Conn syndromes
|
|
|
Hypertension, secondary
|
Renal disease
|
|
|
Hypochromic microcytosis
|
Iron-deficiency anemia
|
|
|
Hypoparathyroidism
|
Thyroidectomy
|
|
|
Hypopituitarism
|
Adenoma
|
|
|
Increase alpha-fetoprotein in amniotic fluid/maternal serum
|
Anencephaly; Spina bifida
|
|
|
Increased uric acid levels
|
-Gout
-Lesch-Nyhan -Myeloproliferative disorders -Loop & thiazide diuretics |
|
|
Infection in blood transfusion
|
Hepatitis C
|
|
|
Infection in burn victims
|
Klebsiella
|
|
|
Intussesception
|
Adenovirus (cause hyperplasia of Peyer's patches)
|
|
|
Janeway lesions
|
Endocarditis
|
|
|
Jarisch-Herxheimer reaction
|
Syphilis; over-aggressive treatment of an symptomatic patient that causes symptoms due to rapid lysis
|
|
|
Kaposi's sarcoma
|
Homosexual AIDS patients (not associated with IVDA acquired HIV/AIDS)
|
|
|
Kayser-Fleischer rings
|
Wilson's disease
|
|
|
Keratin pearls
|
Squamous cell carcinoma
|
|
|
Kidney stones
|
Calcium = radiopaque (2nd most common is ammonium = radiolucent; formed by urease positive organisms like Proteus vulgaris or Staphylococcus)
|
|
|
Kimmelstiel-Wilson nodules
|
Diabetic nephropathy
|
|
|
Koilocytes
|
HPV
|
|
|
Koplik spots
|
Measles
|
|
|
Kussmaul hyperpnea
|
Diabetic ketoacidosis
|
|
|
Lens dislocation + aortic dissection + joint hyperflexibility
|
Marfan's disease (fibrillin deficit)
|
|
|
Leukemia (adults)
|
AML
|
|
|
Lewy bodies
|
Parkinson's disease
|
|
|
Lines of Zahn
|
Arterial thrombus
|
|
|
Lisch nodules
|
Neurofibromatosis I(von Recklinghausen's disease)
|
|
|
Liver disease
|
Alcoholic liver disease
|
|
|
Location of brain tumors (adults)
|
Supratentorial
|
|
|
Location of brain tumors (kids)
|
Infratentorial
|
|
|
Low serum ceruloplasmin
|
Wilson's disease
|
|
|
Lucid interval
|
Epidural hematoma
|
|
|
Lumpy Bumpy' appearance of glomeruli on immunoflourescence
|
Poststreptococal glomerulonephritis
|
|
|
Lysosomal storage disease disorder
|
Gaucher's
|
|
|
Lytic bone lesions on x-ray
|
Multiple myeloma
|
|
|
Machine-like' murmur
|
PDA
|
|
|
Male cancer
|
Prostatic carcinoma
|
|
|
Malignancy associated with infectious fever
|
Hodgkin's
|
|
|
Malignant skin tumor
|
Basal cell carcinoma (rarely metastasizes)
|
|
|
Mallory bodies
|
Alcoholic liver disease
|
|
|
McBurney's sign
|
Appendicitis
|
|
|
Mental retardation
|
Down syndrome (Fragile X is the second most common cause)
|
|
|
Mets to bone
|
Breast, lung, thyroid, testes, prostate
|
|
|
Mets to brain
|
Lung, breast, skin (melanoma), kidney (renal cell carcinoma), GI
|
|
|
Mets to liver
|
Colon, gastric, pancreatic, breast, &amp; lung carcinomas
|
|
|
MI
|
Atherosclerosis
|
|
|
Mitral valve stenosis
|
Rheumatic heart disease
|
|
|
MLF syndrome (INO) in what disease
|
Multiple sclerosis
|
|
|
Monoclonal antibody-spike
|
Multiple myeloma (called the M protein; usually IgG or IgA); MGUG; Waldenstrom's (M Protein = IgM) macroglobulinemia
|
|
|
Motor neuron disease
|
ALS
|
|
|
Myocarditis
|
Coxsackie B
|
|
|
Myxedema
|
Hypothyroidism
|
|
|
Necrotizing vasculitis (lungs) & necrotizing glomerulitis
|
Wegener's & Goodpasture's (hemoptysis & glomerular disease)
|
|
|
Needle-shaped, negatively bifringent crystals
|
Gout
|
|
|
Negri bodies
|
Rabies
|
|
|
Neoplasm (kids)
|
ALL (2nd most common is cerebellar medulloblastoma)
|
|
|
Nephritis + cataracts + hearing loss
|
Alport syndrome
|
|
|
Nephrotic syndome (kids)
|
Minimal change disease (associated with infections/vaccinations; treat with corticosteroids)
|
|
|
Nephrotic syndrome
|
Membranous glomerulonephritis
|
|
|
Nephrotic syndrome (adults)
|
Membranous glomerulonephritis
|
|
|
Neurofibrillary tangles
|
Alzheimer disease
|
|
|
No lactation postpartum
|
Sheehan's syndrome
|
|
|
Nutmeg liver
|
Congestive heart failure
|
|
|
Obstruction of male urinary tract
|
BPH
|
|
|
Occupational exposure to asbestos
|
Malignant mesothelioma
|
|
|
Oncogene involved in cancer
|
p53 Suppressor
|
|
|
Opening snap
|
Mitral stenosis
|
|
|
Opportunistic infection in AIDS
|
PCP
|
|
|
Organ receiving mets
|
Adrenal glands (due to rich blood supply)
|
|
|
Organ sending mets
|
Lung
breast, stomach |
|
|
Orphan Annie cells
|
Papillary carcinoma of the ovary
|
|
|
Osler's nodes
|
Endocarditis
|
|
|
Osteomyelitis
|
Staphylococcus aureus
|
|
|
Osteomyelitis in patients with sickle cell disease
|
Salmonella
|
|
|
Osteomyelitis with IVDA
|
Pseudomonas
|
|
|
Ovarian tumor (benign)
|
Hamartoma
|
|
|
Ovarian tumor (malignant)
|
Serous cystadenoma
|
|
|
Owl's eye
|
CMV
|
|
|
P-ANCA
|
Polyarteritis nodosa
|
|
|
Painless jaundice
|
Pancreatic cancer (head)
|
|
|
Palpable purpura on legs &amp; buttocks
|
Henoch-Schonlein purpura
|
|
|
Pancreatic tumor
|
Adenocarcinoma (head of pancreas)
|
|
|
Pancreatitus (acute)
|
EtOH and gallstones
|
|
|
Pancreatitus (chronic)
|
EtOH (adults), cystic fibrosis (kids)
|
|
|
Pannus
|
Rheumatiod arthritis
|
|
|
Patient with ALL/CLL/AML/CML
|
ALL - Child
AML - Adult over 60 CML - Adult 35-50 CLL - Adult over 60 |
|
|
Patient with Hodgkin's
|
Young male (except nodular sclerosis type - female)
|
|
|
Patient with minimal change disease
|
Young child
|
|
|
Patient with Reiter's
|
Male
|
|
|
Peau d'orange
|
Carcinoma of the breast
|
|
|
Pelvic inflammatory disease
|
Neisseria gonorrhoeae (monoarticular arthritis)
|
|
|
Periosteal elevation on x-ray
|
Pyogenic osteomyelitis
|
|
|
Philadelphia chromosome (bcr;abl)
|
CML (may sometimes be associated with AML)
|
|
|
Pick bodies
|
Pick's disease
|
|
|
Pink puffer'
|
Emphysema (centroacinar (smoking), panacinar (alpha1-antitrypsin deficiency))
|
|
|
Pituitary tumor
|
Prolactinoma (2nd - somatotropic 'acidophilic' adenoma)
|
|
|
Pneumonia, hospital-acquired
|
Klebsiella
|
|
|
Pneumonia, in CF, burn infection
|
Pseudomonas aeruginosa
|
|
|
Podagra
|
Gout (MP joint of hallux)
|
|
|
Podocyte fusion
|
Minimal change disease
|
|
|
Polyneuropathy preceded by GI or respiratory infection
|
Guillian-Barre syndrome
|
|
|
Polyneuropathy, cardiac pathology, &amp; edema
|
Dry beriberi (thiamine, vitamine B1 deficiency)
|
|
|
Port-wine stain
|
Hemangioma
|
|
|
Posterior anterior 'drawer sign'
|
Anterior cruciate ligament injury
|
|
|
Preventable blindness
|
Chlamydia
|
|
|
Preventable cancer
|
Lung cancer
|
|
|
Primary amenorrhea
|
Turner's (XO)
|
|
|
Primary bone tumor (adults)
|
Multiple myeloma
|
|
|
Primary hyperaldosteronism
|
Adenoma of adrenal cortex
|
|
|
Primary hyperparathyroidism
|
Adenomas (followed by: hyperplasia, then carcinoma)
|
|
|
Primary hyperparathyroidism
|
Adenoma
|
|
|
Primary liver tumor
|
Hepatoma
|
|
|
Psammoma bodies
|
Caused by apoptosis of tumor cells with dystrophic calcification &amp; found in: Papillary adenocarcinoma of the thyroid (most common cancer of the thyroid); Serous papillary cystadenocarcinoma of the ovary; Meningioma, Mesothelioma
|
|
|
Pseudopalisade tumor cell arrangement
|
Glioblastoma multiforme
|
|
|
Pseudorosettes
|
Ewing's sarcoma
|
|
|
Ptosis, miosis, anhidrosis
|
Horner's syndrome (Pancoast's tumor)
|
|
|
Pulmonary hypertension
|
COPD
|
|
|
Pus, empyema, abscess
|
Staphylococcus aureus
|
|
|
Rash on palms & soles
|
Secondary syphilis; Rocky Mountain Spotted Fever
|
|
|
RBC's in urine
|
Bladder carcinoma
|
|
|
RBC casts in urine
|
Glomerular inflammation (nepritic syndromes), ischemia, Malignant HTN.
|
|
|
Recurrent pulmonary Pseudomonas and Staphylococcus aureus infections
|
Cystic fibrosis
|
|
|
Red urine in the morning
|
Paroxysmal nocturnal hemoglobinuria
|
|
|
Reed-Sternberg cells
|
Hodgkin's lymphoma
|
|
|
Reid index (increased)
|
Chronic bronchitis
|
|
|
Reinke crystals
|
Leydig cell tumor
|
|
|
Renal cell carcinoma + cavernous hemangiomas + adenomas
|
Von Hippel - Lindau disease
|
|
|
Renal epithelial casts in urine
|
Acute toxic/viral nephrosis
|
|
|
Renal tumor
|
Renal cell carcinoma - assoc. w/ von Hippel-Lindau
polycystic kidney disease paraneoplastic syndromes (erythropoietin, renin, PTH, ACTH) |
|
|
Rhomboid crystals, positively bifringent
|
Pseudogout
|
|
|
Rib notching
|
Coarctation of aorta
|
|
|
Right-sided heart faulure
|
Left-sided heart failure
|
|
|
Right heart failure due to a pulmonary cause
|
Cor pulmonale
|
|
|
Roth spots in retina
|
Endocarditis
|
|
|
Rouleaux formation (RBC's)
|
Multiple myeloma
|
|
|
Russell bodies
|
Multiple myeloma
|
|
|
S3
|
Left to right shunt (VSD, PDA, ASD); Mitral regurgitation; LV failure (CHF)
|
|
|
S4
|
Aortic stenosis, hypertrophic subaortic stenosis
|
|
|
Schiller-Duval bodies
|
assoc. w/: Yolk sac tumor,
Look like:Characteristic structures resembling fetal glomeruli composed of a central blood vessel surrounded by embryonal cells lying within a space also lined by embryonal cells. |
|
|
Schwartzman reaction
|
Neisseria meningitidis
A vasculitis, resulting in tissue necrosis and/or hemorrhage. In pregnancy gram- septicemia during delivery or abortion may be provocative encounter. |
|
|
Secondary hyperparathyroidism
|
Hypocalcemia of chronic renal failure
|
|
|
Senile plaques
|
Alzheimer's disease
|
|
|
Sexually transmitted disease
|
Chlamydia
|
|
|
Sheehan's syndrome
|
Postpartum pituitary infarction
|
|
|
SIADH
|
Small cell carcinoma of the lung
|
|
|
Signet ring cells
|
Gastric carcinoma
|
|
|
Simian crease
|
Down syndrome
|
|
|
Site of diverticula
|
Sigmoid colon
|
|
|
Site of metastasis
|
Regional lymph nodes
|
|
|
Site of metastasis (2nd most commond)
|
Liver
|
|
|
Sites of atherosclerosis
|
1.Abdominal aorta
2.coronary 3.popliteal 4.carotid |
|
|
Skin cancer
|
Basal cell carcinoma
|
|
|
Skip lesions
|
Crohn's
|
|
|
Slapped cheeks
|
Erythema infectiosum (fifth disease)'
|
|
|
Smith antigen
|
SLE
|
|
|
Smudge' cell
|
CLL
|
|
|
Soap bubble on x-ray
|
Giant cell tumor of bone
|
|
|
Spike & dome on EM
|
Membranous glomerulonephritis
|
|
|
Splinter hemorrhages in fingernails
|
Endocarditis
|
|
|
Starry-sky pattern
|
Burkitt's lymphoma
|
|
|
Stomach cancer
|
Adenocarcinoma
|
|
|
Strawberry tongue'
|
Scarlet fever
|
|
|
Streaky ovaries
|
Turner's syndrome
|
|
|
String sign on x-ray
|
Crohn's disease
|
|
|
Subepithelial humps on EM
|
Poststreptococal glomerulonephritis
|
|
|
Suboccipital lymphadenopathy
|
Rubella
|
|
|
Sulfur granules
|
Actinomyces israelii
|
|
|
Surgical wound
|
Staphylococcus aureus
|
|
|
Swollen gums, bruising, poor wound healing, anemia
|
Scurvy (ascorbic acid, vitamin C deficiency) - vitamin C is necessary for hydroxylation of proline &amp; lysine in collagen synthesis
|
|
|
Systolic ejection murmur (crescendo-decrescendo)
|
Aortic valve stenosis
|
|
|
t(14; 18)
|
Follicular lymphomas (bcl-2 activation)
|
|
|
t(8;14)
|
Burkitt's lymphoma (c-myc activation)
|
|
|
t(9;22)
|
Philadelphia chromosome, CML (bcr-abl hybrid)
|
|
|
Tabes dorsalis
|
Tertiary syphilis
|
|
|
Target cells
|
Thalassemia
|
|
|
Tendon xanthomas (classically Achilles)
|
Familial hypercholesterolemia
|
|
|
Testicular tumor
|
Seminoma
|
|
|
Thumb sign on lateral x-ray
|
Epiglottitis
|
|
|
Thymoma
|
Myasthenia gravis (present in 20% of those with MG)
|
|
|
Thyroid cancer
|
Papillary carcinoma
|
|
|
Thyroidization of kidney
|
Chronic bacterial pyelonephritis
|
|
|
Tophi
|
Gout
|
|
|
Tracheoesophageal fistula
|
Lower esophagus joins trachea/upper esophagus - blind pouch
|
|
|
Tram-track' appearance on LM
|
Membranoproliferative glomerulonephritis
|
|
|
Traumatic open wound
|
Clostridium perfringens
|
|
|
Trousseau's sign
|
Visceral cancer; pancreatic adeneocarcinoma (migratory thrombophlebitis); Hypocalcemia (carpal spasm)
|
|
|
Tumor in men
|
Prostate carcinoma
|
|
|
Tumor in women
|
Leiomyoma (estrogen dependent)
|
|
|
Tumor of infancy
|
Hemangioma
|
|
|
Tumor of the adrenal medulla (adults)
|
Pheochromocytoma (benign)
|
|
|
Tumor of the adrenal medulla (kids)
|
Neuroblastoma (malignant)
|
|
|
Type of Hodgkin's
|
Mixed cellularity (versus: lymphocytic predominance, lymphocytic depletion, nodular sclerosis)
|
|
|
Type of non-Hodgkin's
|
Follicular, small cleaved
|
|
|
Type of pituitary adenoma
|
Prolactinoma
|
|
|
UTI
|
Escherichia coli
|
|
|
UTI (young women)
|
Staphylococcus saprophyticus
|
|
|
Vasculitis
|
Temporal arteritis (risk of ipsilateral blindness due to thrombosis of ophthalmic artery)
|
|
|
Viral encephalitis
|
HSV
|
|
|
Virchow's node
|
Left supraclavicular node enlargement from metastatic carcinoma of the stomach
|
|
|
Virchow's triad
|
Pulmonary embolism (triad = blood stasis, endothelial damage, hypercoag.)
|
|
|
Vitamin deficiency (US)
|
Folic acid (pregnant women are at high risk; body stores only 3-4 month supply)
|
|
|
Waxy casts
|
Chronic end-stage renal disease
|
|
|
WBC's in urine
|
Acute cystitis
|
|
|
WBC casts in urine
|
Acute pyelonephritis
|
|
|
Wire loop' appearance on LM
|
Lupus nephropathy
|
|
|
Worst headache of my life'
|
Berry aneurysm - associated with adult polycystic kidney disease
|
|
|
Xanthochromia (CSF)
|
Subacrachnoid hemorrhage
|
|
|
Xerostomia + arthritis + keratoconjunctivitis sicca
|
Sjogren's syndrome
|
|
|
(T/F) The outer membrane for G+ and the cell membrane for G- act as major surface antigens.
|
FALSE: they DO act a major surface antigens BUT the outer mb for G- and the cell membrane for G+
|
|
|
Are endotoxins heat stable?
|
yes, stable at 100C for 1 hr.
|
|
|
Are endotoxins secreted from cells?
|
NO
|
|
|
Are endotoxins used as antigens in vaccines?
|
no, they don\\'t produce protective immune response
|
|
|
Are exotoxins heat stable?
|
no, destroyed rapidly at 60C (exception: Staphylococcal enterotoxin)
|
|
|
Are exotoxins secreted from cells?
|
YES
|
|
|
Are exotoxins used as antigens in vaccines?
|
Yes, TOXOIDS are used as vaccines
|
|
|
Describe the chemical composition of peptidoglycan.
|
Sugar backbone with cross-linked peptide side chains.
|
|
|
Describe the major components of a G- cell wall.
|
inner and outer lipid bilayer membranes - thin layer of peptidoglycan - periplasmic space - contains lipopolysaccharide, lipoprotein and phospholipid
|
|
|
Describe the major components of a G+ cell wall.
|
one lipid bilayer membrane - thick layer of peptidoglycan - contains teichoic acid
|
|
|
Describe the process of conjugation.
|
DNA transfer from one bacterium to another.
|
|
|
Describe the process of transduction.
|
DNA transfer by a virus from one cell to another
|
|
|
Describe the process of transformation.
|
purified DNA is taken up by a cell
|
|
|
Does endotoxin induce and antigenic response?
|
no, not well
|
|
|
Does exotoxin induce and antigenic response?
|
Yes, induces high-titer antibodies called antitoxins
|
|
|
Give two general functions of peptidoglycan
|
Gives rigid support - protects against osmotic pressure
|
|
|
How are Group A and Group B Strep primarily differentiated?
|
Group A are Bacitracin sensitive - Group B are Bacitracin resistant
|
|
|
How are the pathogenic Neisseria species differentiated?
|
on the basis of sugar fermentation
|
|
|
How are the species of Streptococcus primarily differentiated?
|
on the basis of their HEMOLYTIC capabilities
|
|
|
List the four phases of the bacterial growth curve.
|
Lag phase - log (exponential) phase - stationary phase - death phase
|
|
|
Name 2 G- rods that are considered slow lactose fermenters.
|
Citrobacter and Serratia
|
|
|
Name 3 G- rods that are considered fast lactose fermenters.
|
1) Klebsiella 2) E. coli 3) Enterobacter
|
|
|
Name 3 G- rods which are lactose nonfermenters and Oxidase(-)?
|
Shigella, Salmonella, Proteus
|
|
|
Name 4 bacteria that use IgA protease to colonize mucosal surfaces.
|
1) Strep. pneumoniae 2) Neisseria meningitidis 3) Neisseria gonorrhea 4) H. flu
|
|
|
Name 4 genus of bacteria that are G- \\'coccoid\\' rods.
|
1) H. flu 2) Pasteruella 3) Brucella 4) Bordetella pertussis
|
|
|
Name 6 bacteria that don\\'t Gram\\'s stain well?
|
Treponema - Rickettsia - Mycobacteria - Mycoplasma - Legionella pneumophila - Chlamydia
|
|
|
Name four genus of bacteria that are G+ rods.
|
1) Clostridium (an anaerobe) 2) Coynebacterium 3) Listeria 4) Bacillus
|
|
|
Name seven G+ bacteria species that make exotoxins.
|
1) Corynebacterium diphtheriae 2) Clostridium tetani 3) Clostridium botulinum 4) Clostridium perfringens 5) Bacillus anthracis 6) Staph. aureus 7) Strep. pyogenes
|
|
|
Name three diseases caused by exotoxins.
|
Tetanus - botulism - diptheria
|
|
|
Name three G- bacteria species that make exotoxins.
|
1) E. coli 2) Vibrio cholerae 3) Bordetella pertussis
|
|
|
Name three Lactose-fermenting enterics.
|
Eschericia, Klebsiella, Enterobacter
|
|
|
Name two diseases caused by endotoxins.
|
Meningococcemia - sepsis by G(-) rods
|
|
|
Name two type of Strep that exhibit alpha hemolysis?
|
S. pneumoniae - Viridans strep. (e.g. S. mutans)
|
|
|
Name two types of Strep. that are non-hemolytic (gamma hemolysis).
|
Enterococcus (E. faecalis) and Peptostreptococcus (anaerobe)
|
|
|
Name two types of Strep. that exhibit beta hemolysis.
|
Group A Strep. (GAS) and Group B Strep. (GBS)
|
|
|
Teichoic acid induces what two cytokines?
|
TNF and IL-1
|
|
|
What are the effects of erythrogenic toxin?
|
it is a superantigen - it causes rash of Scarlet fever
|
|
|
What are the effects of streptolysin O?
|
it is a hemolysin - it is the antigen for ASO-antibody found in rheumatic fever
|
|
|
What are the effects of the exotoxin secreted by Bacillus anthracis? (1)
|
one toxin in the toxin complex is an adenylate cyclase
|
|
|
What are the effects of the exotoxin secreted by Bordetella pertussis? (3)
|
Stimulates adenylate cyclase by ADP ribosylation - causes whooping cough - inhibits chemokine receptor, causing lymphocytosis
|
|
|
What are the effects of the exotoxin secreted by Clostridium botulinum?
|
blocks release of acetylcholine: causes anticholenergic symptoms, CNS paralysis; can cause \\'floppy baby\\'
|
|
|
What are the effects of the exotoxin secreted by Clostridium perfringens?
|
alpha toxin is a lecithinase - causes gas gangrene - get a double zone of hemolysis on blood agar
|
|
|
What are the effects of the exotoxin secreted by Clostridium tetani?
|
blocks release of the inhibitory NT glycine; causes \\'lockjaw\\'
|
|
|
What are the effects of the exotoxin secreted by Corynebacterium diphtheria? (3)
|
1) inactivates EF-2 by ADP ribosylation 2) pharyngitis 3) \\'pseudomembrane\\' in throat
|
|
|
What are the effects of the exotoxin secreted by E. coli? (2)
|
this heat labile toxin stimulates adenylate cyclase by ADP ribosylation of G protein - causes watery diarrhea
|
|
|
What are the effects of the exotoxin secreted by Staph. aureus?
|
superantigen; induces IL-1 and IL-2 synthesis in Toxic Shock Syndrome; also causes food poisoning
|
|
|
What are the effects of the exotoxin secreted by Vibro cholerae? (3)
|
Stimulates adenylate cyclase by ADP ribosylation of G protein - increases pumping of Cl- and H2O into gut - causes voluminous rice-water diarrhea
|
|
|
What are the general clinical effects of endotoxin?(2)
|
fever, shock
|
|
|
What are three primary/general effects of endotoxin (especially lipid A)?
|
1) Acivates macrophages 2) Activates completment (alt. pathway) 3) Activates Hageman factor
|
|
|
What are two exotoxins secreted by Strep. pyogenes?
|
Erythrogenic toxin and streptolysin O
|
|
|
What are two functions of the pilus/fimbrae?
|
Mediate adherence of bacteria to the cell surface - sex pilus forms attachment b/t 2 bacteria during conjugation
|
|
|
What are two species of Gram (-) cocci and how are they differentiated?
|
1) Neisseria memingitidis: maltose fermenter 2) Neisseria gonorrhoeae: maltose NONfementer
|
|
|
What bacteria produces a blue-green pigment?
|
Pseudomonas aeruginosa
|
|
|
What bacteria produces a red pigment?
|
Serratia marcescens (\\'maraschino cherries are red\\')
|
|
|
What bacteria produces a yellow pigment?
|
Staph. aureus (Aureus= gold in Latin)
|
|
|
What culture requirements do Fungi have?
|
Sabouraud\\'s agar
|
|
|
What culture requirements do Lactose-fermenting enterics have?
|
MacConkey\\'s agar (make pink colonies)
|
|
|
What culture requirements does B. pertussis have?
|
Bordet-Gengou (potato) agar
|
|
|
What culture requirements does C. diphtheriae have?
|
Tellurite agar
|
|
|
What culture requirements does H. flu have?
|
chocolate agar with factors V (NAD) and X (hematin)
|
|
|
What culture requirements does Legionella pneumophia have?
|
Charcol yeast extract agar buffered with increased iron and cysteine
|
|
|
What culture requirements does N. gonorrhea have?
|
Thayer-Martin (VCN) media
|
|
|
What G- rod is a lactose nonfermenter and is Oxidase+ ?
|
Pseudomonas
|
|
|
What is a function of the plasma membrane in bacterial cells.
|
site of oxidative and transport enzymes
|
|
|
What is a toxoid?
|
exotoxin treated with formaldehyde (or acid or heat); retains antigeniciy but looses toxicity
|
|
|
What is an acronym for remembering 6 bacteria that don\\'t Gram\\'s stain well?
|
TRMMLC: These Rascals May Microscopically Lack Color
|
|
|
What is meant by alpha, beta, and gamma hemolysis?
|
On a Blood agar plate: alpha= complete; clear - beta= partial; green - gamma= no hemolysis; red
|
|
|
What is the chemical composition of a glycocalix?
|
polysaccharide
|
|
|
What is the chemical composition of bacterial ribosomes?
|
RNA and protein in 30S and 50S subunits
|
|
|
What is the chemical composition of endotoxin?
|
Lipopolysaccharide
|
|
|
What is the chemical composition of exotoxin?
|
polypeptide
|
|
|
What is the chemical composition of spores?
|
keratin-like coat - dipicolinic acid
|
|
|
What is the funciton and chemical composition of the flagellum?
|
for motility - made of protein
|
|
|
What is the function of a glycocalix?
|
mediates adherence to surfaces, especially foreign surfaces (i.e. catheters)
|
|
|
What is the function of spores?
|
provides resistance to dehydration, heat, and chemicals
|
|
|
What is the major chemical composition of the capsule?
|
Polysaccharide (*except Bacillus anthracis, which contains D-Glutamate)
|
|
|
What is the major function of the capsule?
|
antiphagocytic
|
|
|
What is the mode of action of endotoxin?
|
includes TNF and IL-1
|
|
|
What is the nature of the DNA transferred in conjugation?
|
Chromosomal or plasmid
|
|
|
What is the nature of the DNA transferred in transduction?
|
Any gene in generalized transduction; only certain genes in specialized transduction
|
|
|
What is the nature of the DNA transferred in transformation?
|
Any DNA
|
|
|
What is the periplasm? Where is it found?
|
the space between the inner and outer cell membranes found in G(-) bacteria.
|
|
|
What is the primary test to subcatergorize G- rods?
|
are they Lactose Fermenters?
|
|
|
What is the source of endotoxins?
|
cell wall of most G- bacteria (think N-dotoxin=gram Negative)
|
|
|
What is the source of exotoxins?
|
certain species of some G+ and G- bacteria
|
|
|
What is the unique chemical component of Gram (-) cell membranes?
|
Lipopolysaccharide
|
|
|
What is the unique chemical component of Gram + cell membranes?
|
Teichoic acid
|
|
|
What is used to stain Legionella?
|
Use silver stain.
|
|
|
What species is Group A Strep?
|
S. pyogenes
|
|
|
What species is Group B Strep?
|
S. agalactiae
|
|
|
What stain is amyloid and gives an apple-green birefringence in polarized light?
|
Congo red
|
|
|
What stain is used for acid fast bacteria?
|
Ziehl-Neelsen
|
|
|
What stain is used for Borrelia, Plasmodium, trypanosomes, and Chlamydia?
|
Giemsa\\'s
|
|
|
What stain is used for Cryptococcus neoformans?
|
India ink
|
|
|
What stains gylcogen, mucopolysaccharides and is used to diagnose Whipple\\'s disease?
|
PAS (periodic acid Schiff)
|
|
|
What test distinguishes Staph. and Strep?
|
Staph. are Catalase (+) and are in clusters - Strep. are Catalase (-) and are in chains
|
|
|
What test distinguishes Staph. aureus from Staph. epidermidis and Staph. saprophyticus?
|
S. aureus is Coagulase (+) - S. epidermidis and S. saprophyticus are Coagulase (-)
|
|
|
What two things distinguish S. pneumoniae from Viridans Strep.?
|
S. pneumoniae: have Capsule; Optochin Sensitive - Viridans strep: No capsule; Optochin Resistant
|
|
|
What type of enzymes allows certain bacteria to colonize mucosal surfaces?
|
IgA proteases
|
|
|
When endotoxin activates complement, what are the secondary effects?
|
C3a: hypotension, edema - C5a: neutrophil chemotaxis
|
|
|
When endotoxin activates Hageman, what are the secondary effects?
|
coagulation cascade: DIC
|
|
|
When endotoxin activates macrophages, what 3 cytokines are released and what are the secondary effects?
|
IL-1--fever - TNF--fever, hemmoragic tissue necrosis - Nitic oxide--hypotension, shock
|
|
|
Where are the genes for endotoxin located?
|
on the bacterial chromosome
|
|
|
Where are the genes for exotoxin located?
|
on a plasmid or in a bacteriophage
|
|
|
Where are the spores of Clostridium botulinum found?
|
canned food - honey
|
|
|
Where is LPS found?
|
in the outer membrane of G (-) cell walls
|
|
|
Which has a higher toxicity: exotoxin or endotoxin?
|
EXOTOXIN: fatal dose is ~1ug! (for endotoxin, fatal dose is hundreds of micrograms)
|
|
|
Which type of Neisseria ferment Glucose only?
|
Gonococci (Glucose= Gonococci)
|
|
|
Which type of Neisseria ferment maltose and glucose?
|
Meningococci (MaltoseGlucose= MeninGococci)
|
|
|
Which types of transfer can eukaryotic cells do?
|
only transformation
|
|
|
Which types of transfer can prokaryotic cells do?
|
all 3: conjugation, transduction, and transformation
|
|
|
Why don\\'t Mycobacteria Gram\\'s stain well?
|
high lipid content cell wall requires acid-fast stain
|
|
|
Why don\\'t Mycoplasma Gram\\'s stain well?
|
no cell wall
|
|
|
Why don\\'t Rickettsia, Chlamydia, and Legionella Gram\\'s stain well?
|
they are intracellular (Legionella is Mainly intracellular)
|
|
|
Why don\\'t Treponema Gram\\'s stain well?
|
too thin to be visualized (use darkfield microscopy and antibody staining)
|
|
|
Name 5 species of bacteria that are transmitted to humans from animals.(Acronym: BBugs From Your Pet.)
|
Borrelia burgdorferi - Brucella spp. - Francisella tularensis - Yersinia pestis - Pasteurella multocida
|
|
|
All Rickettsiae (except one genus) are transmitted by what type of vector?
|
arthropod (Coxiella is atypical: transmitted by aeresol)
|
|
|
Are G(-) bugs resistant to Pen G? to ampicillin? to vancomycin?
|
G- bugs are resistant to PenG but may be susceptible to pen. derivative like ampicillin. The G- outer mb inhibits entry of PenG and vancomycin.
|
|
|
Are Strep. pneumoniae sensitve to optochin? Are Viridans strep.?
|
Strep. pneumoniae is optochin-Sensitive - Viridans streptococci is optochin-Resistant
|
|
|
Are Strep. pyogenes Bacitracin-sensitive?
|
YES.
|
|
|
Are Viridans strep. alpha, beta, or non-hemolytic?
|
alpha
|
|
|
Because of drug resistance, what in an alternate treatment combination for leprosy?
|
rifampin with dapsone and clofazimine
|
|
|
Besides the rash, what other body systems are affected by Lyme disease? (3)
|
joints -CNS -heart
|
|
|
Describe lab-findings for Pseudomonas aeruginosa.
|
Aerobic, G(-) rod. - Non-lactose fermenting - Oxidase positive - Produces pyocyanin (blue-green pigment)
|
|
|
Describe the disease associated with M. avium-intracellulare.
|
often resistant to multiple drugs; causes disseminated disease in AIDS.
|
|
|
Describe the H. flu vaccine. When is it given?
|
contains type b capsulare polysaccharide conjugated to diphtheria toxoid or other protein. -Given b/t 2m and 18m.
|
|
|
Describe the typical findings with diarrhea caused by enterotoxigenic E. coli. (3)
|
1) Ferments lactose 2) watery diarrhea 3) no fever/leukocytosis
|
|
|
Describe the typical findings with Vibro cholerae. (3)
|
1) Comma-shaped organisms 2) rice-water stools 3) no fever/leukocytosis
|
|
|
Do Streptococcus pneumonia have catalase? Do Viridans Strep. have catalase?
|
NO. both are catalase -
|
|
|
Enterococci are hardier than nonenterococcal group D bacteria. What lab conditions can they grow in?
|
6.5% NaCl (used as lab test)
|
|
|
Following primary infection with TB, if preallergic lymphatic or hematogenous dissemination occurs, what follows?
|
-dormant tubercle bacilli form in several organs - REACTIVATION can occur in adult life
|
|
|
Following primary infection with TB, if severe bacteremia occurs, what follows?
|
Miliary tuberculosis and possibly death
|
|
|
Following primary infection with TB, if the lesion heals by fibrosis, what is the result?
|
Immunity and hypersensitivity---&gt; tuberculin positive
|
|
|
Following primary infection with TB, under what conditions would the lesion likely progress to lung disease?
|
HIV, malnutrition. This progressive lung disease can rarely lead to death.
|
|
|
Following primary infection with TB, what are 4 possible courses the disease could take?
|
1) Heals by fibrosis 2) Progressive lung disease 3) Severe bacteremia 4) Preallergic lymphatic or hematogenous dissemination
|
|
|
Give 3 examples of obligate anaerobes.
|
Clostridium - Bacteroides - Actinomyces
|
|
|
Give 3 types of infection Pseudomonas aeruginosa is commonly responsible for.
|
1) burn wound infection 2) nosocomial pneumonia 3) pneumonia with cystic fibrosis
|
|
|
Give 4 examples of encapsulated bacteria.
|
1) Strep. pneumoniae 2) Haemophilus influenza (especially b) 3) Neisseria memingitidis 4) Klebsiella pneumoniae
|
|
|
H. flu causes what? (4)
|
Epiglottitis -Meningitis -Otitis media -Pneumonia (haEMOPhilus)
|
|
|
How are Borrelia visualized?
|
using aniline dyes (Wright\\'s or Giemsa stain) in light microscopy
|
|
|
How are Mycobacteria visualized in the lab?
|
acid-fast stain =Ziehl-Neelson
|
|
|
How are Treponema visualized?
|
by dark-field microscopy
|
|
|
How can secondary tuberculosis in the lung occur?(2)
|
1) Reinfection of partially immune hypersensitized hosts (usu. adults) =exogenous source 2) Reactivation of dormant tubercle bacilli in immunocompromised or debilitated hosts =endogenous source
|
|
|
How can you remember that Viridans strep are resistant to optochin?
|
they live in the mouth and are not afraid of the (opto-)CHIN
|
|
|
How does primary syphilis present?
|
with a painless chancre (localized disease; 2-10 wks).
|
|
|
How does secondary syphilis present?
|
disseminated disease (1-3m later) with constitutional symptoms, maculopapular rash, condylomata lata (genital lesions)
|
|
|
How does tertiary syphilis present?
|
gummas (granulomas), aortitis, neurosyphilis (tabes dorsalis), Argyll-Robertson pupil
|
|
|
How does the bacterium cause the disease?
|
via exotoxin encoded by beta-prophage; exotoxin inhibits protein synthesis via ADP-ribosylation of EF-2
|
|
|
How does the rash with typhus differ from the rash with RMSF?
|
typhus: maculopapillary rash BEGINS ON TRUNCK, moves peripherally -RMSF: macules progressing to petichiae BEGIN ON HANDS &amp;FFET and move inward.
|
|
|
How is Brucellosis/Undulant fever transmitted?
|
dairy products, contact with animals
|
|
|
How is Cellulitis transmitted?
|
Animal bite; cats, dogs
|
|
|
How is H. flu transmitted?
|
aeresol
|
|
|
How is Legionnaires\\' disease diagnosed in lab?
|
use silver stain (doesn\\'t Gram stain well) -culture with charcoal yeast extract with iron and cysteine.
|
|
|
How is Legionnaires\\' disease transmitted?
|
aeresol transmission from envirnomental water source habitat (NO human-to-human transmission).
|
|
|
How is Lyme disease transmitted?
|
Tick bite; Ixodes ticks that live of deer and mice
|
|
|
How is Shigella spread?
|
food, fingers, feces, and flies\\'
|
|
|
How is the Plague transmitted?
|
Flea bite; rodents, especially prairie dogs
|
|
|
How is Tuleremia transmitted?
|
Tick bite; rabbits, deer
|
|
|
Is Bacillus anthracis G+ or G-? What is its morphology?
|
It is a G+, spore-forming rod
|
|
|
Is there an animal reservoir for leprosy?
|
Yes, armadillos in the US
|
|
|
List 5 findings associated with rheumatic fever. (Hint: PECCS)
|
Polyarthritis - Erythema marginatum -Chorea - Carditis - Subcutaneous nodules
|
|
|
List the \\'ABCDEFG\\' of diphtheria.
|
ADP ribosylation -Beta-prophage -Corynebacterium - Diphtheria - Elongation Factor 2 - Granules
|
|
|
Name 2 alpha-hemolytic bacteria.
|
Strep. pneumoniae - Viridans streptococci
|
|
|
Name 2 bugs that cause diarrhea but NOT fever and leukocytosis?
|
E. coli and Vibro cholerae
|
|
|
Name 2 disease processes that can be caused by enterococci.
|
1) UTI 2) subacute endocarditis
|
|
|
Name 2 species of enterococci.
|
Enterococcus faecalis -Enterococcus faecium
|
|
|
Name 2 symptoms of diphtheria.
|
pseudomembraneous pharyngitis (grayish white membrane) - lymphadenopathy
|
|
|
Name 3 spore forming bacteria.
|
Bacillus anthracis - Clostridium perfringens - C. tetani
|
|
|
Name 4 beta-hemolytic bacteria.
|
1) Staph. aureus 2) Strep. pyogenes (GAS) 3) Strep. agalactiae (GBS) 4) Listeria monocytogenes
|
|
|
Name 4 lactose-fermenting enteric bacteria.
|
Klebsiella -E. coli -Enterobacter Citrobacter (think Lactose is KEE for first three listed)
|
|
|
Name 4 obligate aerobic bacteria.
|
Norcardia - Pserudomonas aeruginosa - Mycobacterium tuberculosis - Bacillus
|
|
|
Name 5 bugs that cause watery diarrhea.
|
1) Vibrio cholerae 2) enterotoxigenic E. coli 3) viruses (rotavirus) 4) protozoa (Cryptosporidium and (5) Giardia)
|
|
|
Name 6 bugs that cause bloody diarrhea.
|
1) Salmonella 2) Shigella 3) Campylobacter jejuni 4) enterohemorrhagic/enteroinvasive E.coli 5) Yersinia enterocilitica 6) Entamoeba histolytica (a protozoan)
|
|
|
Name 7 faculatative intracellular bacteria.
|
1) Mycobacterium 2) Brucella 3) Francisella 4) Listeria 5) Yersinia 6) Legionella 7) Salmonella
|
|
|
Name three genera of spirochetes.
|
Borrelia (big size) - Leptospira -Treponema (think: BLT; B is big)
|
|
|
Name two lab tests used to detect syphilis?
|
VDRL and FTA-ABS
|
|
|
Name two non-lactose fermenting bacteria that invade intestinal mucosa and can cause bloody diarrhea.
|
Salmonella and Shigella
|
|
|
Name two obligate intracellular bacteria.
|
Rickettsia and Chlamydia (Hint: \\'stay inside when its Really Cold.\\')
|
|
|
RMSF is endemic to what part of the US?
|
the East Coast (in spite of the name)
|
|
|
Spore are formed by certain species of what type of bacteria?
|
Gram+ rods, usually in soil; form spores only when nutrients are limited
|
|
|
T/F Chlamydia are obligate intracellular parasites that cause mucosal infections.
|
TRUE
|
|
|
T/F Chlamys means cloak.
|
TRUE (intracellular)
|
|
|
T/F Enterobacteriaceae are oxidase negative and are glucose fermenters.
|
TRUE
|
|
|
T/F H. pylori infection is a risk factor for peptic ulcer and gastric carcinoma.
|
TRUE
|
|
|
T/F Penicillin is not an effective treatment against Mycoplasma pneumoniae.
|
TRUE Mycoplama are naturally resistant b/c they have no cell wall.
|
|
|
T/F Pseudomonas produces both endotoxin and exotoxin.
|
TRUE: endotoxin---&gt; fever, shock -exotoxin---&gt; inactivates EF-2
|
|
|
T/F Rickettsiae are obligate intracellular parasites and need CoA and NAD.
|
TRUE
|
|
|
T/F Some enterococci are resistant to PenG.
|
FALSE: ALL enterococci are naturally resistant to Pen/cephlosporins.
|
|
|
T/F Spores have no metabolic activity.
|
TRUE
|
|
|
T/F: S. aureus food poisoning is due to the ingestion of bacteria that rapidly secrete toxin once they enter the GI tract.
|
FALSE: rapid onset of S. aureus food poisoning is due to injestion of PREFORMED toxin
|
|
|
The Weil-Felix reaction usually tests positive for what two diseases? Negative for what? Cross reacts with what?
|
Positive: typhus and RMSF -Negative: Q fever -Cross-reacts: with Proteus antigen
|
|
|
Think COFFEe for Enterobacteriaceae. What does that stand for?
|
Capsular -O-antigen -Flagellar antigen -Ferment glucose -Enterobacteriaceae
|
|
|
What\\'s a pneumonic for remembering 4 obligate aerobes?
|
Nagging Pests Must Breath (=Norcardia - Pserudomonas aeruginosa - Mycobacterium tuberculosis - Bacillus
|
|
|
What (6) infections can Pseudomonas aeruginosa cause?
|
burn-wound infections -Pneumonia (esp. in cystic fibrosis) -Sepsis (black skin lesions) -External Otitis (swimmer\\'s ear) - UTI -hot tub folliculitis
|
|
|
What 2 bugs can cause bloody diarrhea, fever, and leukocytosis, but do not ferment lactose?
|
Salmonella and Shigella
|
|
|
What animals carry Lyme disease?
|
The Ixodes tick transmits it. - Deer are required for tick life cycle. - Mice are important resservoirs.
|
|
|
What anitbody class is necessary for an immune response to encapsulated bacteria?
|
IgG2.
|
|
|
What are 2 disease processes caused by Viridans strep and what species are responsible?
|
1) dental caries: Strep. mutans 2) bacterial endocarditis: Strep. sanguis
|
|
|
What are 2 options for triple thearpy treatment of H. pylori?
|
(1) bismuth (Pepto-Bismal), metronidazole, and tetracyclin or amoxicillin. OR (2) metronidazole, omeprazole, and clarithromycin (#2 is more expensive)
|
|
|
What are 3 advantages/differences between VDRL and FTA-ABS?
|
FTA-ABS is 1) more specific 2) positive earlier in disease 3) remains positive longer than VDRL
|
|
|
What are 3 disease processes caused by Strep. pyogenes?
|
1) Pyogenic--pharyngitis, cellulitis, skin infection 2) Toxigenic--scarlet fever, TSS 3) Immunologic--rheumatic fever, acute glomerulonephritis
|
|
|
What are 4 biological false positives for VDRL?
|
1) Viruses (mono, hepatitis) 2) Drugs 3) Rheumatic fever and rheumatic arthritis 4) Lupus and leprosy (=VDRL)
|
|
|
What are 4 clinical symptoms of \\'walking\\' pneumonia?
|
1) insidious onset 2) headache 3) nonproductive cough 4) diffuse interstitial infiltrate
|
|
|
What are 4 clinical symptoms of TB?
|
1) fever 2) night sweats 3) weight loss 4) hemoptysis
|
|
|
What are 5 areas that can be affected by extrapulmonary TB?
|
1) CNS (parenchmal tuberculoma or meningitis) 2) Vertebral body (Pott\\'s disease) 3) Lymphadenitis 4) Renal 5) GI
|
|
|
What are the culture requirement for H. flu?
|
culture on chocolate agar with factor V (NAD) and X (hematin). [Think: \\'Child has \\'flu\\'; mom goes to five (V) and dime (X) store to buy chocolate.\\']
|
|
|
What are the lab findings with Chlamydia?
|
cytoplasmic inclusions on Giemsa fluorescent antibody-stains smear
|
|
|
What are the symptoms of RMSF? (3)
|
1) rash on palms and soles (migrating to wrists, ankles, then trunck) 2) headache 3) fever
|
|
|
What are the three stages of Lyme disease?
|
1) erythema chronicum migrans, flu-like symptoms 2) neurologic and cardiac manefestations 3) autoimmune migratory polyarthritis
|
|
|
What are the two forms of chlamydia?
|
1) Elementary body (small, dense): Enters cell via endocytosis 2) Initial or Reticulate body: Replicates in the cell by fission
|
|
|
What are the two forms of leprosy (or Hansen\\'s disease)?
|
1) lepromatous- failed cell-mediated immunity, worse 2) tuberculoid- self-limited.
|
|
|
What are two drugs that could be used to treat \\'walking\\' pneumonia?
|
tetracycline or erythromycin
|
|
|
What are two drugs that could treat Chlmydia?
|
erythromycin or tetracycline
|
|
|
What are two lab findings associated with \\'walking\\' pneumonia?
|
1) X-ray looks worse than patient 2)High titer of cold agglutinins (IgM)
|
|
|
What are usually associated with pseudomembraneous colitis?
|
Clostridium difficile; it kills enterocytes, usu. is overgrowth secondary to antibiotic use (esp. clindamycin or ampicillin)
|
|
|
What bacteria are G+, spore-forming, anaerobic bacilli?
|
Clostridia
|
|
|
What bacteria causes a malignant pustule (painless ulcer); black skin lesions that are vesicular papules covered by a blak eschar?
|
Bacillus anthracis
|
|
|
What bacteria exhibits a \\'tumbling\\' motility, is found in unpasteurized milk, and causes meningitis in newborns?
|
Listeria monocytogenes
|
|
|
What bacteria is catalase(-) and bacitracin-resistant?
|
Strep. agalactiae
|
|
|
What bacteria is catalase(-) and bacitracin-sensitive?
|
Strep. pyogenes
|
|
|
What bacteria is catalase+ and coagulase+?
|
Staph. aureus
|
|
|
What bacteria produces alpha-toxin, a hemolytic lecithinase that causes myonecrosis or gas gangrene?
|
Clostridium perfringens
|
|
|
What bacterium causes Cellulitis?
|
Pasteurella multocida
|
|
|
What bacterium causes leprosy?
|
Mycobacterium leprae
|
|
|
What bacterium causes Lyme disease?
|
Borrelia burgdorferi
|
|
|
What bacterium causes the Plague?
|
Yersinia pestis
|
|
|
What bacterium causes Tularemia?
|
Francisella tularensis
|
|
|
What bacterium causes Undulant fever?
|
Brucella spp. (a.k.a. Brucellosis)
|
|
|
What bug causes atypical \\'walking\\' pneumonia?
|
Mycoplama pneumoniae
|
|
|
What bug causes gastroenteritis and up to 90% of duodenal ulcers?
|
Helicobacter pylori
|
|
|
What bug causes Legionnaire\\'s disease?
|
Legionella pneumophila
|
|
|
What bug is associated with burn wound infections?
|
Pseudomonas aeruginosa
|
|
|
What bug is comma- or S-shaped and grows at 42C, and causes bloody diarrhea with fever and leukocytosis?
|
Campylobacter jejuni
|
|
|
What bug that causes diarrhea is usually transmitted from pet feces (e.g. puppies)?
|
Yersinia enterocolitica
|
|
|
What causes tetanus? (give bacteria and disease process)
|
Clostridium tetani: exotoxin produced blocks glycine release (inhibitory NT) from Renshaw cells in spinal cord
|
|
|
What causes the flu?
|
NOT H. flu -it is caused by influenza virus
|
|
|
What chemical is found in the core of spores?
|
dipicolinic acid
|
|
|
What coccobacillus causes vaginosis: greenish vaginal discharge with a fishy smell; nonpainful?
|
Gardnerella vaginalis
|
|
|
What disease does Bordetella perussis cause? How?
|
Whooping cough: toxin permanently disables G-protein in respiratory mucosa (turns the \\'off\\' off);ciliated epithelial cells are killed; mucosal cells are overactive.
|
|
|
What disease does Vibrio cholerae cause? How?
|
Cholera: toxin permanently activates G-protein in intestinal mucosa (turns the \\'on\\' on) causing rice-water diarrhea
|
|
|
What disease is caused by Borrelia?
|
Lyme Disease
|
|
|
What disease is caused by Clostridium botulinum? What pathophys. does it cause?
|
Botulism: associated with contaminated canned food, produces a preformed, heat-labile toxin that inhibits ACh release---&gt; flaccid paralysis.
|
|
|
What diseases (2) are caused by Treponema?
|
Syphilis (T. pallidum) -yaws (T. pertenue; not and STD)
|
|
|
What diseases can be caused by Staph. aureus?
|
Inflammatory disease: skin infections, organ abcess, pneumonia - Toxin-mediated disease: Toxic Shock Syn., scalded skin syndrome (exfoliative toxin), rapid onset food poisoning (enterotoxins)
|
|
|
What do Chlamydia trachomatis serotypes A, B, and C cause?
|
chronic infection, cause blindness in Africa (ABC= Africa / Blindness / Chronic
|
|
|
What do Chlamydia trachomatis serotypes D-K cause? (3)
|
urethritis/ PID - neonatal pneumonia -neonatal conjuctivitis
|
|
|
What do Chlamydia trachomatis serotypes L1,L2, and L3 cause?
|
lymphogranuloma venereum (acute lymphadentis: positive Frei test)
|
|
|
What do RMSF, syphilis, and coxsackievirus A infection have in common?
|
rash on palm and sole is seen in each (coxasackievirus A =hand, foot, and mouth disease)
|
|
|
What does catalase do? Which bacteria have it?
|
it degrades H2O2, an antimicrobial product of PMNs. - Staphlococci make catalase; Strep. do NOT.
|
|
|
What does the H-antigen represent?
|
H: flagellar antigen, found on motile species
|
|
|
What does the K-antigen represent?
|
K: capsular, relates to virulence
|
|
|
What does the O-antigen represent?
|
O-antigen is the polysaccharide of endotoxin (found on all species)
|
|
|
What does VDRL detect? (It detects non-specific antibody that reacts with what?)
|
detects antibody that reacts with beef cardiolipin
|
|
|
What drug of choice is used to treat Norcardia? Actinomyces? (Acronym: SNAP)
|
Sulfa for Norcarida, Actinomyces gets Penicillin
|
|
|
What enteric bacterial infection may be prolonged with antibiotic treatment?
|
Salmonellosis
|
|
|
What enzyme allows H. pylori to creat an alkaline environment?
|
urease (cleaves urea to ammonia); used in urease breath test
|
|
|
What family includes E. coli, Salmonella, Klebsiella, Enterobacter, Serratia, and Proteus?
|
Enterobacteriaceae
|
|
|
What family of bacteria uses the O-, K-, and H-antigen nomenclature?
|
Enterobacteriaceae
|
|
|
What function does the capsule serve? (2: one for the bacterium, one other)
|
1) antiphagocytic 2) antigen in vaccines (Pneumovax, H. flu b, meningococcal vaccines)
|
|
|
What G+ anaerobe causes oral/facial abscesses with \\'sulfur granules\\' that may drain through sinus tracts in skin?
|
Acinomyces israelii
|
|
|
What G+ and also weakly acid fast aorobe found in soil causes pulmonary infections in immunocompromised patients?
|
Norcardia asteroides
|
|
|
What general type of bacteria are normal flora in GI tract but pathogenic elsewhere?
|
Anaerobes
|
|
|
What general type of bacteria grow pink colonies on MacConkey\\'s agar?
|
Lactose-fermenting enteric bacteria
|
|
|
What is a Ghon complex and in whom does it occur?
|
draining Hilar nodes and Ghon focus, exudative parenchymal lesion (usu. in LOWER lobes of lung)
-kids |
|
|
What is a lab diagnosis of diphtheria based on?
|
G+ rods with metachromatic granules; grows on tellurite agar. (Coryne=club shaped)
|
|
|
What is a major difference between Salmonella and Shigella observable in the lab?
|
Salmonella are motile; Shigella are nonmotile
|
|
|
What is a positive Quellung reaction?
|
if encapsulated bug is present, capsule SWELLS when specific anticapsular antisera are added.
|
|
|
What is notable about Chrmydia psittaci?
|
has an avian reservoir
|
|
|
What is one reason M. leparae infects skin and superficial nerves?
|
It likes cool temperatures
|
|
|
What is the classic symptom of Lyme Disease?
|
erythema chronicum migrans, an expanding \\'bull\\'s eys\\' red rash with central clearing.
|
|
|
What is the classic triad of symptoms associated with Rickettsiae?
|
1) headache 2) fever 3) rash (vasiculitis)
|
|
|
What is the common manifestation of secondary TB?
|
Fibrocaseous cavitary lesion usu. in APICIES of lung
|
|
|
What is the common site of infection for Mycobacterium tuberculosis?
|
the apicies of the lung (which have the highest PO2)
|
|
|
What is the D.O.C. to treat Gardnerella vaginalis?
|
Metroidazole
|
|
|
What is the DOC for treating rickettsial infections?
|
tetracycline
|
|
|
What is the DOC for treatment of most rickettsial infections?
|
tetracycline
|
|
|
What is the DOC to treat Lyme Disease?
|
tetracycline
|
|
|
What is the DOC to treat syphilis?
|
Penicillin G
|
|
|
What is the drug of choice for H. flu meningitis? What DOC for prophylaxis in close-contacts?
|
Treat meningitis with CEFTRIAXONE; Rifampin for prophylaxis.
|
|
|
What is the drug of choice for Legionaires\\' disease?
|
Erythromycin
|
|
|
What is the morphology of H. flu?
|
Small G(-) (coccobacillary) rod
|
|
|
What is the morphology of H. pylori?
|
Gram (-) rod
|
|
|
What is the primary drug used to treat leprosy?
|
dapsone (toxicity is hemolysis and methemoglobinemia)
|
|
|
What is the recommended treatment for Pseudomonas aeruginosa infection?
|
aminoglycoside plus extended-spectrum penicillin (e.g. piperacillin or ticarcillin)
|
|
|
What is the source of infection and the bacterium that causes endemic typhus?
|
R. typhi; from fleas
|
|
|
What is the source of infection and the bacterium that causes epidemic typhus?
|
R. prowazekii; from human body louse
|
|
|
What is the source of infection and the bacterium that causes Q fever?
|
Coxiella burnetii; from inhaled aersols
|
|
|
What is the source of infection and the bacterium that causes Rocky Mountain Spotted Fever?
|
Rickettsia rickettsii; from tick bite
|
|
|
What is the toxin responsible for TSS is Staph. aureus?
|
TSST-1; it is a superantigen that binds to class II MHC and T-cell receptors---&gt; polyclonal T-cell activation
|
|
|
What is the unique component found in Mycoplamsa bacterial membranes?
|
cholesterol
|
|
|
What is the unique feature of Chlamydiae cell walls?
|
its peptidoglycan wall lacks muramic acid
|
|
|
What is woolsorter\\'s disease?
|
inhalation anthrax; can cause life-threatening pneumonia
|
|
|
What lab test assays for antirickettsial antibodies?
|
Weil-Felix reaction
|
|
|
What Lancefield Antigen Group are enterococci in?
|
Group D
|
|
|
What Lancefield Antigen Group are Viridans strep in?
|
They are non-typealbe. They do not have a C-carbohydrate on their cell wall to be classified by.
|
|
|
What level of disinfection is required to kill spores?
|
autoclaving; they are highly resistant to destruction by heat and chemicals
|
|
|
What populations are most likely to get Mycoplama pneumoniae infection?
|
patients younger than age 30 - military recruits - prisons
|
|
|
What rickettsial disease is atypical in that it has no rash, no vector, negative Weil-Felix reaction, and its causative organism can survive outside for a long time?
|
Q fever (Coxiella burnetii)
|
|
|
What species are associated with food poisoning in contaminated seafood?
|
Vibrio parahaemolytica and Virbrio vulnificus
|
|
|
What species causes diphtheria?
|
Corynebacterium diptheriae
|
|
|
What species is associated with food poisoning in improperly canned foods (bulging cans)?
|
Clostridium botulinum
|
|
|
What species is associated with food poisoning in meats, mayonnaise, and custard?
|
Staphylococcus aureus (this food poisoining usu. starts quickly and ends quickly)
|
|
|
What species is associated with food poisoning in poultry, meat, and eggs?
|
Salmonella
|
|
|
What species is associated with food poisoning in reheated meat dishes?
|
Clostridium perfringens
|
|
|
What species is associated with food poisoning in reheated rice?
|
Bacillus cereus (\\'Food poisoning from reheated rice? Be serious!\\')
|
|
|
What species is associated with food poisoning in undercooked meat and unpasteurized juices?
|
E. coli 0157-H7
|
|
|
What species of Mycobacteria causes pulmonary, TB-like symptoms?
|
M. kansasii
|
|
|
What strain of Haemophilus influenza causes most invasive disease?
|
capsular type b
|
|
|
What symptoms are associated with M. scrofulaceum
|
cervical lymphadenitis in kids
|
|
|
What test differentiates Viridans from S. pneumoniae?
|
Viridans are resistant to optochin; S. pneu. are sensitive to optochin
|
|
|
What two bugs secrete exotoxins that act via ADP ribosylation of G-proteins, permanently activating adenyl cyclase (resulting in increased cAMP)?
|
Vibrio cholerae - Bordetella pertussis
|
|
|
What two genera of G+ rods form long branching filaments resembling fungi?
|
Acinomyces and Nocardia
|
|
|
What type of bacteria are difficult to culture, produce gas in tissue (CO2 and H2), and are generally foul-smelling?
|
Anaerobes
|
|
|
What type of bacteria is associated with rusty sputum, sepsis in sickle cell, and splenectomy?
|
Pneumoccocus
|
|
|
What type of E. coli are associated with bloody diarrhea?
|
enterohemmoragic/ enteroinvasive E. coli
|
|
|
What type of immunologic response is elicited by a Salmonella infection?
|
monocyte response
|
|
|
What types of infection can chlamydia cause? (4)
|
arthritis - conjunctivitis - pneumonia - nongonococcal urethritis
|
|
|
What virulence factor of Staph. aureus binds Fc-IgG, inhibiting complement fixation and phagocytosis?
|
Protein A
|
|
|
What virulence factor of Strep. pyogenes also serves as an antigen to which the host makes antibodies?
|
M-protein
|
|
|
What will likely be visible under the microscope in the case of Gardnerella vaginallis infection?
|
Clue cell, or vaginal epithelial cells covered with bacteria
|
|
|
Where are Viridans strep. found (reservoir)?
|
normal flora of oropharynx
|
|
|
Where are when is Lyme disease common?
|
common in northeast US in summer months
|
|
|
Which disease/toxin causes lymphocytosis? (Cholera or Pertussis)
|
Pertussis toxin: by inhibiting chemokine receptors
|
|
|
Which has an animal reservoir? (Salmonella or Shigella)
|
Salmonella: poultry, meat, eggs
|
|
|
Which is more specific for syphilis: VDRL or FTA-ABS?
|
FTA-ABS is more specific
|
|
|
Which is more virulent? (Salmonella or Shigella)
|
Shigella (10^1 organisms vs. Salmonella 10^5 organisms)
|
|
|
Which is motile? (Salmonella or Shigella)
|
Salmonella (think: salmon swim)
|
|
|
Which species of chlamydia causes and atypical pneumonia? How is it transmitted?
|
C. pneumonia -transmitted via aeresol
|
|
|
Which two species of chlamydia infect only humans?
|
C. trachomatis -C. pneumoniae
|
|
|
Why are anaerobes susceptible to oxygen?
|
they lack catalase and/or oxidase and are susceptible to oxidative damage
|
|
|
Why does TB usually infect the upper lobes of the lung?
|
M.tuberculosis is an aerobe; there is more oxygen at the apicies
|
|
|
Why must rickettsia and chlamydia always be intracellular?
|
they can\\'t make their own ATP
|
|
|
Are most fungal spores asexual?
|
yes
|
|
|
Are most P. Carinii infections symptomatic?
|
no, most of are asymptomatic
|
|
|
Are the above mentioned systemic mycoses dimorphic?
|
yes, except coccioidomycosis which is a spherule in tissue
|
|
|
How do the S. Schenckii yeast appear in the pus?
|
Cigar-shaped budding yeast
|
|
|
How do you diagnose cryptosporidium?
|
cysts on acid fast stain
|
|
|
How do you diagnose giardiasis?
|
Trophozoites or cysts in stool
|
|
|
How do you get P. Carinii?
|
Inhalation
|
|
|
How do you treat systemic mycoses?
|
fluconazole or ketoconazole for local infection, amphotericin B for systemic infection
|
|
|
How do you Tx S. Schenckii?
|
Itraconazole or Potassium Iodide
|
|
|
How does Aspergillus appear microscopically?
|
Mold with septate hyphae that branch at a V-shaped (45 degree angle) , they are NOT dimorphic
|
|
|
How does Mucor species appear microscopically?
|
It is a mold with irregular nonseptate hyphae branching at wide angles&gt;90 degrees
|
|
|
How does Paracocciodioidomycosis appear histologically?
|
Captain\\'s wheel\\' appearance (like on a sailboat)
|
|
|
How is Clonorchis sinensis transmitted and what disease results?
|
undercooked fish; causes inflammation of the biliary tract
|
|
|
How is Schistosoma transmitted and what disease results?
|
snails are host; cercariae penetrate skin of humans; causes granulomas, fibrosis, and inflammation of the spleen and liver
|
|
|
How is Ancylostoma Duodenale transmitted and what disease results?
|
Larvae penetrate skin of feet; intestinal infection can cause anemia
|
|
|
How is Ascaris Lumbricoides transmitted and what disease results?
|
Eggs are visible in feces; intestinal infection
|
|
|
How is cryptosporidium transmitted?
|
Cysts in Water
|
|
|
How is Dracunculus medinensis transmitted and what disease results?
|
In drinking water; sink inflammation and ulceration
|
|
|
How is E. granulosis transmitted and what disease results?
|
Eggs in dog feces cause cysts in liver; causes anaphylaxis if echinococcal antigens released from cysts
|
|
|
How is E. Histolytica transmitted?
|
Cysts in Water
|
|
|
How is Enterobius Vermicularis transmitted and what disease results?
|
food contaminated with eggs; intestinal infections; causes anal pruritus
|
|
|
How is giardia transmitted?
|
Cysts in Water
|
|
|
How is Loa loa transmitted and what disease results?
|
Transmitted by deer fly; causes swelling the in the skin (can see worm crawling in conjunctiva)
|
|
|
How is malaria dx?
|
Blood smear
|
|
|
How is malaria transmitted?
|
mosquito (Anopheles)
|
|
|
How is Onchocerca volvulus transmitted and what disease results?
|
transmitted by female blackflies; causes river blindness
|
|
|
How is Paragonimus Westermani transmitted and what disease results?
|
Undercooked crab meat; causes inflammation and secondary bacterial infection of the lung
|
|
|
How is Sporothrix schenckii appear under the scope?
|
Dimorphic fugus that lives on vegetation
|
|
|
How is Strongyloides Stercoralis transmitted and what disease results?
|
larvae in soil penetrate the skin; intestinal infection
|
|
|
How is T. Canis transmitted and what disease results?
|
food contaminated with eggs; causes granulomas (if in retina=blindness)
|
|
|
How is T. Solium transmitted and what disease results?
|
undercooked pork tapeworm; causes mass lesions in the brain, cysticercosis
|
|
|
How is T. Vaginalis transmitted?
|
sexually
|
|
|
How is Toxo transmitted?
|
cysts in meat or cat feces
|
|
|
How is Trichinella Spiralis transmitted and what disease results?
|
undercooked meat, usually pork; inflammation of muscle, periorbital edema
|
|
|
How is Wucheria transmitted and what disease results?
|
female mosquito; causes blockage of lymphatic vessels (elephantiasis)
|
|
|
In what cells do you find histoplasmosis?
|
macrophages
|
|
|
Is Pneumocystis Carinii a yeast?
|
Yes, but originally classified as a Protozoa
|
|
|
Microscopically how does Candida appear?
|
budding yeast with pseudohyphae, germ tube formation at 37 degrees C)
|
|
|
Name 3 Trematodes (Flukes) .
|
Schistosoma, Clonorchis sinensis, Paragonimus Westermani
|
|
|
Name 4 opportunistic fungal infections.
|
Candida Albicans, Aspergillus fumigatus, Cryptococcus Neoformans, Mucor and Rhizopus species
|
|
|
Name 4 systemic mycoses.
|
Coccidiomycosis, Histoplasmosis, Paracoccidioidomycosis, Blastomycosis
|
|
|
Name two asexual spores transmitted by inhalation.
|
Hisoplasmosis and Coccidiodomycosis
|
|
|
Name two Cestodes (Tapeworms) .
|
Taenia Solium, and Echinococcus Ganulosus
|
|
|
What agar is used to culture for systemic mycoses?
|
Sabouraud\\'s Agar
|
|
|
What are Conidia?
|
asexual fungal spores (ex. Blastoconidia, and arthroconidia)
|
|
|
What are some common Candida infections?
|
Thrush in Immunocompromised pts (neonates, patients on steroids, diabetics and AIDS pts) , endocarditis in IV drug users, vaginitis (high pH, Diabetes, post-antibiotic) , diaper rash, disseminated candidiasis (to any organ)
|
|
|
What are some infections caused by cryptococcus?
|
Cryptococcal meningitis, cryptococcosis
|
|
|
What are the 10 Nematodes (roundworms) we are concerned with?
|
Ancylostoma duodenale (hookworm) , Ascaris Lumbricoides, Enterobius Vermicularis (pinworm) , Strongyloides stercoralis, Trichinella Spiralis, Dracunculus Medinensis, Loa loa, Onchocerca Volvulus, Toxocara Canis, Wucheria Bancrofti
|
|
|
What are the 4 B\\'s of Blastomycosis?
|
Big, Broad-Based, Budding
|
|
|
What are the diseases caused by Cryptosporidium?
|
Severe diarrhea in AIDS, Mild disease (watery diarrhea) in non-HIV
|
|
|
What are the diseases caused by Toxoplasma?
|
Brain Abscess in HIV and birth defects
|
|
|
What are the infections caused by Aspergillus?
|
Ear fungus, Lung cavity Aspergilloma (\\'fungus ball\\') , invasive aspergillosis.
|
|
|
What can systemic mycoses mimic?
|
TB (granuloma formation)
|
|
|
What disease are caused by Entamoeba Histolytica?
|
Amebiasis: bloody diarrhea, dysentery, liver abscess, RUQ pain
|
|
|
What disease does Mucor species cause?
|
Mucormycosis
|
|
|
What disease does Pneumocystis carinii cause?
|
Pneumocystis Carinii Pneumonia
|
|
|
What disease does Sporothrix Schenckii cause?
|
Sprotricosis
|
|
|
What disease does Trypanosoma Cruzi casue?
|
Chaga\\'s Disease (heart disease)
|
|
|
What disease is caused by Giardia Lamblia?
|
Giardiasis: bloating, flatulence, foul-smelling diarrhea
|
|
|
What disease is caused by Leishmanina donovani?
|
Visceral Leishmaniasis (Kala-azar)
|
|
|
What disease is caused by P. Carinii?
|
Diffuse interstitial pneumonia in HIV
|
|
|
What disease is caused by the plasmodium species (vivax, ovale, malariae, falciparum) ?
|
Malaria: cyclic fever, headache, anemia, splenomegaly
|
|
|
What disease is caused by Trypanosma Gambiense and Rhodesiense?
|
African Sleeping sickness
|
|
|
What disesase does Trichomonas Vaginalis cause?
|
Vaginitis: foul-smeilling, greenish discharge; itching and burning
|
|
|
What do you tx P. Carinii with?
|
TMP-SMZ, or pentamidine, or dapsone
|
|
|
What do you use to culture cryptococcus?
|
Asabouraud\\'s Agar
|
|
|
What do you use to Diagnose E. Histolytica?
|
Serology and/or trophozoites or cysts in stool
|
|
|
What do you use to stain Cryptococcus?
|
India Ink
|
|
|
What do you use to tx cryptosporidium?
|
nothing
|
|
|
What do you use to Tx Giardiasis?
|
Metronidazole
|
|
|
What do you use to tx T. Vaginalis?
|
Metronidazole
|
|
|
What do you used to dx P. Carinii?
|
Lung biopsy or lavage, methenamine silver stain
|
|
|
What do you used to Tx Candida Albicans?
|
Nystatin for superficial infection, Amphotericin B for systemic
|
|
|
What does Alba mean?
|
white
|
|
|
What does dimorphic mean?
|
fungi that are mold in the soil (low temp) and yeast in tissue (higher/body temp 37 C)
|
|
|
What is diagnositic for L. donovani?
|
Macrophages containg amastigotes
|
|
|
What is diagnositic of T. Vaginalis?
|
Trophozoites on wet mount
|
|
|
What is histoplasmosis associated with?
|
bird or bat droppings
|
|
|
What is the progression of S. Schenckii infection?
|
traumatic introduction into the skin, typically by a thorn (\\'rose gardner\\'s\\' disease) , causes local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis) . Little systemic illness.
|
|
|
What is the vector for L. donovani?
|
Sandfly
|
|
|
What is the vector for T. Cruzi?
|
Reduviid Bug
|
|
|
What is the vector for T. Gambiense and Rhodesiense?
|
Tstese fly
|
|
|
What is used to dx African sleeping sickness?
|
Blood smear
|
|
|
What is used to dx T. Cruzii?
|
blood smear
|
|
|
What is used to dx toxoplasma?
|
serology and biopsy
|
|
|
What is used to treat Dracunculus Medinensis?
|
Niridazole
|
|
|
What is used to Treat E. Histolytica?
|
Metronidazole and Iodoquinol
|
|
|
What is used to tx african sleeping sickness?
|
Suramin- bloodborne disease
melaroprol- CNS penetration |
|
|
What is used to tx Ancylostoma duodenale?
|
Mebendazole/pyrantel pamoate
|
|
|
What is used to tx Ascaris Lumbricoides?
|
Mebendazole/pyrantel pamoate
|
|
|
What is used to tx Clonorhis sinensis?
|
Praziquantel
|
|
|
What is used to tx E. Granulosus?
|
Albendazole
|
|
|
What is used to tx E. Vermicularis?
|
Mebendazole/pyrantel pamoate
|
|
|
What is used to tx L. Donovani?
|
Sodium Stibogluconate
|
|
|
What is used to tx Loa loa?
|
diethylcarbamazine
|
|
|
What is used to tx malaria?
|
Chloroquine ( primaquine for vivax, ovale) , sulfadoxine + pyrimethamine, mefloquine, quinine
|
|
|
What is used to tx O. Volvulus?
|
Ivermectin
|
|
|
What is used to tx Paragonimus Wetermani?
|
Praziquantel
|
|
|
What is used to tx S. Stercoralis?
|
Ivermectin/thiabendazole
|
|
|
What is used to tx schistosoma?
|
Praziquantel
|
|
|
What is used to tx T. Canis?
|
diethylcarbamazine
|
|
|
What is used to tx T. Cruzii?
|
Nifurtimox
|
|
|
What is used to tx T. Spiralis?
|
Thiabendazole
|
|
|
What is used to tx taenia solium infection?
|
Praziquantel/niclosamide; albendazole for cysticercosis
|
|
|
What is used to tx toxoplasma?
|
sulfadiazine + pyrimethamine
|
|
|
What is used to tx W. Bancrofti?
|
diethylcarbamazine
|
|
|
What patient population is susceptible to Mucor disease?
|
Ketoacidotic patients and Leukemic patients
|
|
|
What stain do you use for lung tissue when you are detecting P. Carinii?
|
silver
|
|
|
What state predisposes you to P. Carinii infection?
|
Immunosuppression
|
|
|
What test can be used to detect polysaccharide capsular antigen of Cryptococcus?
|
latex agglutination test
|
|
|
What types of infections can Candida Albicans cause?
|
systemic or superficial fungal in fections
|
|
|
When do you start prophylaxis in HIV patients?
|
when the CD4 drops below 200 cells/mL
|
|
|
Where do the mucor and rhizopus species fungi proliferate?
|
in the walls of blood vessels and cause infarction of distal tissue
|
|
|
Where is Blastomycosis endemic?
|
States east of the Mississippi River and Central America
|
|
|
Where is Coccidioidomycosis endemic?
|
SWUS, California (San Joaquin Valley or destert (desert bumps) \\'Valley fever\\')
|
|
|
Where is Histoplasmosis endemic?
|
Mississippi and Ohio River valleys
|
|
|
Where is Paracoccioidomycosis endemic?
|
Rural Latin America
|
|
|
All viruses are haploid except _________?(1)
|
Retroviruses, which have two identical ssRNA molecules (diploid).
|
|
|
Bites from what 3 animals are more prone to rabies infection than a bite from a dog?
|
Bat, Raccoon, and Skunk
|
|
|
Define complementation?
|
When one of 2 viruses that infects the cell has a mutation that results in a nonfunctional protein. The nonmutated virus \\'complements\\' the mutated one by making a functional protein that serves both viruses.
|
|
|
Define genetic drift.
|
Minor changes based on random mutations.
|
|
|
Define genetic shift.
|
Reassorment of viral genome (such as when human flu A virus recombines with swin flu A virus.)
|
|
|
Define phenotypic mixing?
|
When virus A acquires virus B coat proteins and acts like virus B buts its progeny will have virus A genome and coat.
|
|
|
Define reassortment?
|
-When viruses with segmented genomes (eg. influenza virus) exchange segments. -High frequency recombination. Cause of worldwide pandemics.
|
|
|
Define recombination?
|
Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology.
|
|
|
Describe its incubation period and whether or not it has a carrier.
|
-Short incubation period (3 weeks) -No carriers
|
|
|
Describe its incubation period and whether or not it has a carrier.
|
-Long incubation (3 months) - has carriers
|
|
|
Describe the general concept of bacterial super infection which can occur with influenza infection?
|
A life-threatening illness where a bacterial infection is superimposed on an existing viral infection.
|
|
|
Describe the genetic and physical properties of influenza virus?
|
-Enveloped -ssRNA virus with segmented genome -prone to genetic changes
|
|
|
Describe the migration of rabies within the CNS.
|
It migrates in a retrograde fashion within the CNS up n. axons.
|
|
|
Describe the physical shape and duration of incubation for rabies.
|
-Bullet-shaped capsid (illus. in book) -long incubation period (wks. - 3 months)
|
|
|
Describe the technique and purpose for performing a Tzanck test?
|
-assay for herpes -make a smear of an opened skin vesicle to detect multinucleated giant cells
|
|
|
Describe whether or not it has a carrier.
|
has carriers
|
|
|
Does HDV have carriers?
|
Yes
|
|
|
Explain the concept of a slow virus infection.
|
Virus exists in patient for months to years before it manifests as clinical disease.
|
|
|
From the following selection which classes are considered infectious and which aren\\'t: dsDNA, ds RNA, (-)ssRNA, (+)ssRNA.
|
-Infectious: dsDNA (except poxviruses and HBV) and (+)ssRNA -Noninfectious: dsRNA and (-)ssRNA
|
|
|
HCV is a common form of hepatitis in what US population?
|
IV drug users
|
|
|
How does a Monospot test work?
|
It detects heterophil antibodies by agglutination to sheep RBC\\'s
|
|
|
How is RNA translated and processed in picornaviruses?
|
RNA is translated into one long polypeptide that is cleaved by proteases into many small proteins.
|
|
|
How many segments and what sense is the RNA genome of influenza viruses?
|
-8 segments -negative sense
|
|
|
How may serotypes do paramyxoviruses have except parainfluenza which has ___?
|
-1 -4
|
|
|
Into what class RNA or DNA to all segmented viruses fall?
|
RNA
|
|
|
Killed vaccines induce what type of immunity?
|
Humoral, with no possibility of the virus reverting to virulence
|
|
|
Live attenuated vaccines induce what type of immunity?
|
Humoral and Cellular -with a risk of the virus reverting to virulence
|
|
|
Mneumonic for rotavirus symptoms: ROTA
|
Right Out The Anus
|
|
|
Mneumonic: Hep D:
|
Defective, Dependent on HBV
|
|
|
Mneumonic: Hep E:
|
Enteric, Expectant mothers, Epidemics
|
|
|
Mneumonic: Hep A:
|
Asymptomatic (usually)
|
|
|
Mneumonic: Hep B:
|
Blood-borne
|
|
|
Mneumonic: picoRNAvirus
|
pico = \\'small\\' RNA viruses
|
|
|
Name 2 common bacterial infections in AIDS pts.
|
TB, M. avium-intracellulare complex
|
|
|
Name 2 common protozoan infections in AIDS pts.
|
Toxoplasmosis, cryptosporidiosis
|
|
|
Name 3 members of the arborvirus family.
|
Flavivirus, Togavirus, and Bunyavirus
|
|
|
Name 3 possible sequelae of measles infection?
|
-SSPE -encephalitis -giant cell pneumonia (rare;found in immunocompromised persons)
|
|
|
Name 4 common fungal infections in AIDS pts.
|
-Thrush (Candida ablicans) -cryptococcosis (cryptococcal meningitis) -histoplasmosis -Pneumocystis pneumonia
|
|
|
Name 4 common viral infections in AIDS pts.
|
-HSV -VZV -CMV -progressive multifocal leukoencephalopathy (JC virus)
|
|
|
Name 4 herpesviruses using the mneumonic: Get herpes in a CHEVrolet.
|
-CMV -HSV -EBV -VZV
|
|
|
Name 4 main segmented viruses using the mneumonic BOAR.
|
-Bunyaviruses -Orthomyxoviruses (influenza virus) -Arenaviruses -Reoviruses
|
|
|
Name eveloped DNA viruses (3). HPH
|
-Hepadna -Pox -Herpes
|
|
|
Name naked DNA viruses (3). PAP
|
-Parvo -Adeno -Papova \\'You need to be naked for a PAP smear.\\'
|
|
|
Name the 3 naked RNA viruses Naked CPR).
|
-Calcivivirus -Picornavirus -Reovirus
|
|
|
Name the characteristic cytoplasmic inclusions seen in neurons infected with rabies.
|
Negri bodies
|
|
|
Name the DNA enveloped viruses (3).
|
-Herpesviruses (herpes simplex virus types 1 and 2, VZV, CMV, EBV) -HBV -smallpox virus
|
|
|
Name the DNA nucleocapsid viruses (2).
|
Adenovirus, Papillomaviruses
|
|
|
Name the DNA viruses using the mneumonic \\'HHAPPPy viruses.\\'
|
-Hepadnavirus -Herpesviruses -Adenovirus -Parvovirus -Papovavirus -Poxvirus
|
|
|
Name the illness caused by rabies and 2 primary symptoms.
|
Encephalitis, fatal is not prevented, with seizures and hydrophobia.
|
|
|
Name the members of the PaRaMyxovirus using the letters in bold (4 viruses).
|
-Parainfluenza -RSV -Measles -Mumps
|
|
|
Name the recombinant vaccine available (1).
|
HBV (antigen = recombinant HBsAg)
|
|
|
Name the RNA enveloped viruses (9).
|
-Influenza viruses -parainfluenza viruses -RSV -measles -mumps -rubella -rabies -HTLV -HIV
|
|
|
Name the RNA nucleocapsid viruses (3).
|
-Enteroviruses (poliovirus, coxsackievirus, echovirus, hepatitis A virus) -rhinovirus -reovirus.
|
|
|
Name the vaccines that are killed (4).
|
-rabies -influenza -hepatitis A -SalK=Killed
|
|
|
Name the vaccines that are live attenuated (6).
|
-MMR -Sabin polio -VZV -yellow fever
|
|
|
Of these 3 markers (HBsAg, HBsAb, HBcAg), which ones are positive in each of the 4 phases below: (acute disease, window phase, complete recovery, chronic carrier).
|
-HBsAg, HBcAg -HBcAg -HBsAb, HBcAg -HBsAg, HBcAg
|
|
|
On HIV, what is gp41 and gp120?
|
envelope protein
|
|
|
On HIV, what is p24? (illus. p. 205)
|
rectangular nucleocapsid protein
|
|
|
Roughly, what are the time periods for acute, latent, and immunodeficient stages of HIV?
|
Acute: 1-3 months Latent: 3 months-3years Immunodefic.: 3 yrs.-death (diagram p. 205 that follows serologic course).
|
|
|
Statement: HEV resembles HAV in:
|
course, severity, and incubation,
|
|
|
Use the mneumonic PERCH to name members of the Picornavirus family.
|
-Poliovirus -Echovirus -Rhinovirus -Coxsackievirus -Hepatitis A
|
|
|
Viral nucleic acids with (choose) same/different nucleic acids as host are infective alone; others require special enzymes (contained in intact virion.)
|
same
|
|
|
What 2 antigens are used to classify influenza?
|
Neuraminadase, Hemagglutinin
|
|
|
What age group is the primary target of paramyxoviruses?
|
children
|
|
|
What antiviral treatment is approved for influenza A (especially prophylaxis) but not for influenza B &amp; C
|
Amantadine and Rimantadine
|
|
|
What antiviral treatment is approved for influenza A and B?
|
Zanamivir
|
|
|
What are Councilman bodies and what are they pathomneumonic for?
|
acidophilic inclusions seen in the liver of those with yellow fever
|
|
|
What are the 3 C\\'s of measles?
|
-Cough -Coryza -Conjunctivitis
|
|
|
What are the 4 C\\'s of HCV.
|
Chronic, Cirrhosis, Carcinoma, Carriers
|
|
|
What are the 4 most common diseases caused by prions?
|
-Creutzfeldt-Jakob disease (CJD: rapid progressive dementia) -kuru -scrapie (sheep -\\'mad cow disease\\'
|
|
|
What are the causes of SSPE and PML in immunocompromised pts.
|
-Late sequelae of measles -Reactivation of JC virus
|
|
|
What are the classic symptoms of yellow fever?
|
-high fever -black vomitous -jaundice
|
|
|
What are the common diseases (1) and routes of transmission(1) for HHV-8?
|
-Kaposi\\'s sarcoma (HIV pts.) -sexual contact
|
|
|
What are the common diseases (2) and routes of transmission(2) for EBV?
|
-infectious mono, Burkitt\\'s lymphoma -resp. secretions, saliva
|
|
|
What are the common diseases (2) and routes of transmission(2) for HSV-2?
|
-herpes genitalis, neonatal herpes -sexual contact, perinatal
|
|
|
What are the common diseases (3) and routes of transmission(1) for VZV?
|
-varicella zoster (shingles) -encephalitis -pneumonia
|
|
|
What are the common diseases (3) and routes of transmission(2) for HSV-1?
|
-gingivostomatitis keratoconjunctivitis temporal lobe encephalitis herpes labialis -respiratory secretions and saliva
|
|
|
What are the common diseases (3) and routes of transmission(6) for CMV?
|
-congenital infection, mono, pneumonia -congenital, transfusion, sexual contact, saliva, urine, transplant
|
|
|
What are the general characteristics of a prion?
|
infectious agent that does not contain RNA or DNA, consists only of protein
|
|
|
What are the major viruses of the paramyxovirus family? (4)
|
-parainfluenza (croup) -RSV -Measles -Mumps
|
|
|
What are the primary symptoms of the mumps virus? (MOP)
|
-aseptic Meningitis -Orchitis -Parotitis (mumps give you bumps = parotitis)
|
|
|
What are the primary viruses of the picornavirus family? (PERCH)
|
-Poliovirus -Echovirus -Rhinovirus -Coxsackievirus -Hepatitis A
|
|
|
What are two classic illness caused by arborviruses?
|
-dengue fever (break-bone fever) -yellow fever
|
|
|
What general form of encephalopathies do prions present as?
|
spongiform encephalopathies
|
|
|
What genetic property does segmentation afford viruses and how does this play into flu epidemics?
|
-Segmentation allows reassorment to occur in RNA viruses -this contributes to antigenic shifts which cause most flu pandemics.
|
|
|
What group has a high mortality rate from HEV?
|
pregnant women
|
|
|
What hematologic finding is characteristic of mono?
|
abnormal circulating cytotoxic T cells (atypical lymphocytes)
|
|
|
What is HBcAb, and what does it indicate?
|
Antibody to HBcAg; IgM HBcAb indicates recent disease
|
|
|
What is HBcAg?
|
Antigen associated with core of HBV
|
|
|
What is HBeAb, and what does it indicate?
|
Antibody to e antigen; indicates low transmissibility
|
|
|
What is HBeAg, and what does it indicate?
|
it is a 2nd different antigen marker of HBV core; indicates transmissibility (HBeAg=Beware)
|
|
|
What is HBsAb, and what does it do?
|
Antibody to HBsAg; provides immunity to hepatitis B
|
|
|
What is HBsAg, and what does it indicate?
|
Antigen found on surface of HBV; continued presence indicates carrier state
|
|
|
What is IgM HAVAb, and what is it used to detect?
|
IgM antibody to HAV; best test to detect active hepatitis A
|
|
|
What is meant by the \\'window period\\' in HBV infection, and what is positive in this period?
|
It is the period between disappearance of HBsAg and appearance of Anti-HBs; HBcAb is pos. during this period.
|
|
|
What is the classic vector for arborvirus?
|
Arthropods (mosquitos, ticks, etc.) ARBOR=Arthropod Borne
|
|
|
What is the function of reverse transcriptase in HIV?
|
synthesize dsDNA from RNA for integration into host genome.
|
|
|
What is the major mode of protection from influenza virus?
|
Killed viral vaccine which is reformulated each year and is given to those in high risk of infection (elderly, health-workers, etc.)
|
|
|
What is the method behind ELISA/Western blot and during what period of HIV infection are they often negative?
|
look for abs to viral proteins; false negatives common in first 1-2 months of infection
|
|
|
What is the mneumonic for remembering the Tzanck smear?
|
Tzanck heavens I don\\'t have herpes.
|
|
|
What is the only DNA virus that is not double stranded?
|
Parvoviridae (ssDNA)
|
|
|
What is the only RNA virus that has dsRNA?
|
Reoviridae [\\'repeatovirus\\' (reovirus) is dsRNA]
|
|
|
What is the viral cause of the common cold?
|
-Rhinovirus, 100+ serotypes -Rhino has a Runny nose.
|
|
|
What neurologic infection can picornaviruses (except rhinoviruses and hepatitis A viruses) cause?
|
Aseptic Meningitis
|
|
|
What physical finding is diagnostic for measles?
|
Koplik spots (bluish-gray spots on buccal mucosa)
|
|
|
What population should not receive a live vaccine?
|
Those who are immunocompromised and their close contacts.
|
|
|
What reproductive complication can mumps cause?
|
sterility; especially after puberty
|
|
|
What shape are all the DNA viruses? Which virus (1) is the exception?
|
-Icosahedral -Poxvirus (complex)
|
|
|
What test is used to make the presumptive dx of HIV, and then, which test confirms the dx?
|
ELISA (sensitive w/ high false + and low threshold); Western blot (specific, high false - rate with high threshold)
|
|
|
What tests are gaining popularity for monitoring drug tx efficacy in HIV?
|
PCR/viral load tests
|
|
|
What type of genome does HIV have?
|
diploid RNA
|
|
|
What type of nucleic acid structure does rotavirus have?
|
segmented dsRNA
|
|
|
What type of transcription occurs and what type of polymerase does it possess?
|
-Reverse transcription -the virion contains an RNA-dependent DNA polymerase
|
|
|
What type of virus is HAV and how is it transmitted?
|
-RNA picornavirus -fecal-oral route
|
|
|
What type of virus is HBV and how is it transmitted?
|
-DNA hepadnavirus -parenteral, sexual, and maternal-fetal routes
|
|
|
What type of virus is HCV and how is it transmitted?
|
-RNA flavivirus -via blood and resembles HBV in its course and severity
|
|
|
What type of virus is HDV and what is special about its envelope?
|
-delta agent, it is a defective virus -requires HBsAg as its evelope
|
|
|
What type of virus is HEV and how is it transmitted?
|
-RNA calicivirus -enteric transmission; causes water-borne epidemics
|
|
|
What variant of dengue fever is found in Southeast Asia?
|
hemorrhagic shock syndrome
|
|
|
What virus causes and what are the classic symptoms of mononucleosis?
|
-EBV -fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (esp. posterior auricular nodes)
|
|
|
What virus causes yellow (=flavi) fever, and what is its vector and reservoirs (2)?
|
-flavivirus -Aedes mosquitos -monkey or human reservoir
|
|
|
What virus is the most common global cause of infantile gastroenteritis and acute diarrhea (in the US).
|
Rotavirus
|
|
|
Where do enveloped viruses acquire their envelopes, and what virus is the exception to this rule?
|
-Plasma membrane -Herpesviruses which acquire their envelope from the nuclear membrane
|
|
|
Where in the cell do DNA viruses replicate, and which virus is the exception to this rule?
|
-Nucleus -exception: poxvirus in cytoplasm (carries DNA-dependent RNA polymerase)
|
|
|
Where in the cell do RNA viruses replicate, and what 2 viruses are the exception to this rule?
|
-Cytoplasm -exception: influenza virus and retroviruses
|
|
|
Which marker tests are appropriate for each phase of hepatitis infection: Incubation,
Prodrome/acute illness, Early Convalescence, Late Convalescence. |
Incubation -HBsAg
Prodrome/acute illness -HBsAg (Anti-HBc) Early Convalescence (Latentinfection) -Anti-HBc Late Convalescence -Anti-HBs (anti-HBc) |
|
|
Which two DNA viruses don\\'t have a linear genome? (they\\'re circular)
|
Papovaviruses and Hepadnaviruses
|
|
|
Which two hepatitis viruses follow the fecal-oral route?
|
A and E; \\'The vowels hit your bowels.\\'
|
|
|
Which two hepatitis viruses predispose to hepatocellular carcinoma?
|
HBV and HCV
|
|
|
Why is mono called the \\'kissing disease?\\'
|
-Peak incidence occurs during peak kissing years 15-20 yo -(saliva transmission)
|
|
|
3 main roles of Ig binding to bacteria
|
- opsonization - neutralization - complement activation
|
|
|
A defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity or similar enzymes is indicative of what immune deficiency disease?
|
Chronic granulomatous disease
|
|
|
After exposure to what 4 things are preformed (passive) antibodies given?
|
Tetanus toxin, Botulinum toxin, HBV, or Rabies.
|
|
|
All nucleated cells have what class of MHC proteins?
|
class I MHC proteins
|
|
|
Anaphylaxis, asthma, or local wheal and flare are possible manifestations of which type of hypersensitivity?
|
Type I
|
|
|
Anti-gliadin autoantibodies are associated with what disease?
|
Celiac disease
|
|
|
Anti-Scl-70 autoantibodies are associated with what disease?
|
diffuse Scleroderma
|
|
|
Autoimmune hemolytic anemia, Rh disease (erythroblastosis fetalis), and Goodpasture\\'s syndrome are examples of what kind of hypersensitivity reaction?
|
type II hypersensitivity
|
|
|
Class I major histocompatibilty complex consists of …
|
1 polypeptide, with B2-microglobulin
|
|
|
Class II major histocompatibilty complex consists of …
|
2 polypeptides, an a and a B chain
|
|
|
Cytotoxic T cells have CD(?), which binds to class (?) MHC on virus-infected cells.
|
CD8 binds to class I MHC
|
|
|
Define acute transplant rejection.
|
Cell-mediated
due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs weeks after transplantation. |
|
|
Define adjuvant.
|
Adjuvants are nonspecific stimulators of the immune response but are not immunogenic by themselves.
|
|
|
Define chronic transplant rejection.
|
Antibody-mediated vascular damage (fibrinoid necrosis)--irreversible. Occurs months to years after transplantation.
|
|
|
Define hyperacute transplant rejection.
|
Antibody-mediated due to the presence of preormed anti-donor antibodies in the transplant recipient. Occurs within minutes after transplantation.
|
|
|
Define Ig allotype.
|
Ig epitope that differs among members of the same species (on light or heavy chain)
|
|
|
Define Ig idiotype.
|
Ig epitope determined by the antigen-binging site (specific for a given antigen-binding site)
|
|
|
Define Ig isotype.
|
Ig epitope common to a single class of Ig (5 classes, determined by the heavy chain)
|
|
|
Give 3 classic examples of bacteria with antigen variation.
|
(1) Salmonella (2 flagellar variants) (2) Borrelia (relapsing fever) (3) Neisseria gonorrhoeae (pilus protein)
|
|
|
Give 3 examples of possible SCID causes?
|
(1) failure to synthesize class II MHC antigens
(2) defective IL-2 receptors (3) adenosine deaminase deficiency |
|
|
Goodpasture\\'s syndrome is associated with what kind of autoantibodies?
|
anti-basement membrane antibodies.
|
|
|
Helper T cells have CD(?) which binds to class (?) MHC on antigen-presenting cells.
|
CD4 binds to class II MHC
|
|
|
How does Bruton\\'s agammaglobulinemia usually present?
|
as bacterial infections in boys after about 6 months of age, when levels of maternal IgG antibody decline
|
|
|
How is active immunity acquired? what is the onset and duration?
|
Active immunity is induced after exposure to foreign antigens. There is a slow onset with long-lasting protection.
|
|
|
How is passive immunity acquired? Duration? Onset?
|
by receiving preformed antibodies from another host. Antibodies have a short life span, but the immunity has a rapid onset.
|
|
|
IL-4 promotes the growth of B cells and the synthesis of what 2 immunoglobulins?
|
IgE and IgG
|
|
|
In what immune deficiency do neutrophils fail to respond to chemotactic stimuli?
|
Job\\'s syndrome
|
|
|
In what T-cell deficiency do the thymus and parathyroids fail to develop owing to failure of development of the 3rd and 4th pharyngeal pouches?
|
Thymic aplasia (DiGeorge syndrome)
|
|
|
Job\\'s syndrome is associated with high levels of what immunoglobulin?
|
IgE
|
|
|
MHC I Ag loading occurs in __(1?)__ while MHC II Ag loading occurs in __(2?)__?
|
(1) in rER (viral antigens) (2) in acidified endosomes.
|
|
|
Primary biliary cirrhosis has what kind of autoantibodies?
|
anti-mitochondrial antibodies
|
|
|
Role of TH1 cells?
|
produce IL-2 (activate Tc cells and further stimulate TH1 cell) and g-interferon (activate macrophages)
|
|
|
Role of TH2 cells?
|
produce IL-4 and IL-5 (help B cells make Ab)
|
|
|
Sensitized T lymphocytes encounter antigen and then release lymphokines which leads to macrophage activation\\' in what hypersensitivity reaction?
|
Type IV
|
|
|
TB skin test, transplant rejection, and contact dermatitis are examples of what type of hypersensitivity reaction?
|
Type IV
|
|
|
The 3 kinds of MHC class I genes are…
|
A, B, and C
|
|
|
The 3 kinds of MHC class II genes are…
|
DP, DQ, DR
|
|
|
The Fc portion of immunoglobulins are at the __?__ terminal.
|
The carboxy terminal
|
|
|
What 2 cytokines are secreted by macrophages?
|
IL-1 and TNF-a
|
|
|
What 2 kinds of autoantibodies are specific for systemic lupus?
|
Anti-dsDNA and anti-Smith
|
|
|
What 3 cytokines are classified as \\'acute phase cytokines\\'?
|
IL-1, IL-6, and TNF-a
|
|
|
What 3 ways do interferons interfere with viral protein synthesis?
|
(1) alpha and beta interferons induce production of a second protein that degrades viral mRNA (2) gamma interferons increase MHC class I expression and antigen presentation in all cells (3) activates NK cells to kill virus-infected cells.
|
|
|
What affect do the acute phase cytokines have on fat and muscle?
|
mobilization of energy reserves to raise body temperature
|
|
|
What affect do the acute phase cytokines have on the bone marrow?
|
Incr. Production of Colony stim. Factor (CS) which leads to leukocytosis
|
|
|
What affect do the acute phase cytokines have on the hypothalamus?
|
increase body temperature
|
|
|
What antibody isotype can cross the placenta?
|
IgG
|
|
|
What are 3 types of antigen-presenting cells?
|
macrophages, B cells, and dendritic cells
|
|
|
What are the maim symptoms of serum sickness an at what period of time following Ag exposure?
|
fever, urticaria, arthralgias, proteinuria, lymphadenopathy 5-10 days after Ag exposure
|
|
|
What are the major symptoms of graft-vs.-host disease?
|
maculopapular rash, jaundice, hepatosplenomegaly, and diarrhea.
|
|
|
What B- and T- cell deficiency, assoc. with IgA deficiency, presents with cerebellar problems and spider angiomas?
|
ataxia-telangiectasia
|
|
|
What causes the tissue damage associated with Serum sickness?
|
formation of immune complexes of foreign particles and Abs that deposit in membranes where they fix complement
|
|
|
What class of MHC proteins are the main determinants of organ rejection?
|
class II MHC
|
|
|
What complement components can cause anaphylaxis?
|
C3a and C5a
|
|
|
What components of the alternative complement pathway make the C3 convertase?
|
C3b, Bb
|
|
|
What components of the alternative complement pathway make the C5 convertase?
|
C3bBbC3b
|
|
|
What components of the classic complement pathway make the C3 convertase?
|
C4b, C2b
|
|
|
What components of the classic complement pathway make the C5 convertase?
|
C4b, 2b, and 3b
|
|
|
What components of the complement pathway are deficient in Neisseria sepsis?
|
The MAC complex--(C5b, C6, C7, C8, C9)
|
|
|
What cytokines attract and activate neutrophils?
|
TNF-a and B
|
|
|
What disease is associated with a X-linked defect in a tyrosine-kinase gene associated with low levels of all classes of immunoglobulins?
|
Bruton\\'s agammaglobulinemia
|
|
|
What disease is associated with anti-epithelial cell autoantibodies?
|
Pemphigus vulgaris
|
|
|
What disease is associated with anti-microsomal autoantibodies?
|
Hashimoto\\'s thyroiditis
|
|
|
What does a deficiency of C1 esterase inhibitor cause (in the complement cascade)?
|
angioedema because of overactive complement
|
|
|
What does a deficiency of C3 cause (in the complement cascade)?
|
can lead to severe, recurrent pyogenic sinus and respiratory tract infections.
|
|
|
What does deficiency of decay-accelerating factor (DAF) in the complement cascade cause?
|
leads to paroxysmal nocturnal hemoglobinuria (PNH)
|
|
|
What does Job\\'s syndrome classically present with?
|
recurrent \\'cold\\' (noninflamed) staphylococcal abscesses
|
|
|
What does TNF-a stimulate dendritic cells to do during the acute phase response?
|
TNF-a stimulates their migration to lymph nodes and their maturation for the initiation of the adaptive immune response.
|
|
|
What elements of the complement cascade made the Membrane Attack Complex (MAC)?
|
C5b, C6, C7, C8, and C9
|
|
|
What Ig is found in secretions as a monomer or a dimer?
|
IgA
|
|
|
What Ig is found in secretions as a monomer or a pentamer?
|
IgM
|
|
|
What immune deficiency disease has an autosomal-recessive defect in phagocytosis that results from microtubular and lysosomal defects of phagocytic cells?
|
Chediak-Higashi disease
|
|
|
What immune deficiency is associated with elevated IgA levels, normal IgE levels, and low IgM levels?
|
Wiskott-Aldrich syndrome
|
|
|
What immune deficiency presents with tetany owing to hypocalcemia, congenital defects of the heart and great vessels, and recurrent viral, fungal, and protozoal infections?
|
Thymic aplasia (DiGeorge syndrome)
|
|
|
What immunoglobulin isotype has the lowest concentration in serum?
|
IgE
|
|
|
What immunoglobulin isotype is involved in type-I hypersensitivity reactions?
|
IgE
|
|
|
What immunoglobulin isotype is produced in the primary response to an antigen and is on the surface of B cells?
|
IgM
|
|
|
What immunoglobulin isotype mediates immunity to worms?
|
IgE
|
|
|
What immunoglobulin isotype prevents the attachment of bacteria and viruses to mucous membranes?
|
IgA
|
|
|
What immunoglobulins bind and activate the classic complement pathway?
|
IgG and IgM (the Fc portion)
|
|
|
What interleukin induces naive helper T-cells to become TH1 cells?
|
IL-12
|
|
|
What interleukin induces naive helper T-cells to become TH2 cells?
|
IL-4
|
|
|
What interleukin stimulates the growth of both helper and cytotoxic T-cells?
|
IL-2
|
|
|
What is Chronic mucocutaneous candidiasis?
|
T-cell dysfunction specifically against Candida albicans.
|
|
|
What is important about the CD3 complex?
|
It is a cluster of polypeptides associated with a T-cell receptor and is important in signal transduction.
|
|
|
What is the cellular process that causes type I hypersensitivity?
|
Ag cross-links IgE on presensitized mast cells and basophils, triggering the release of vasoactive amines.
|
|
|
What is the cellular process that causes type II hypersensitivity?
|
IgM, IgG bind to Ag on \\'enemy\\' cell, leading to lysis (by complement) or phagocytosis (its cytotoxic).
|
|
|
What is the main antibody in the secondary immune response?
|
IgG
|
|
|
What is the most abundant immunoglobulin isotype?
|
IgG
|
|
|
What is the most common selective immunoglobulin deficiency?
|
selective IgA deficiency
|
|
|
What is the rise in temperature during the acute phase response help do (3 things?)
|
(1) increase specific immune response (2) increase antigen processing (3) decrease viral and bacterial replication
|
|
|
What is the triad of symptoms seen with Wiskott-Aldrich syndrome?
|
recurrent pyogenic infections, eczema, and thrombocytopenia
|
|
|
What kind of autoantibodies are associated with CREST/Scleroderma?
|
anti-centromere antibodies
|
|
|
What kind of autoantibodies are known as rheumatoid factor?
|
anti-IgG antibodies
|
|
|
What kind of immunity (antibody-mediated or cell mediated) is involved in autoimmunity?
|
antibody-mediated immunity (B cells)
|
|
|
What kind of immunity (antibody-mediated or cell mediated) is involved in graft and tumor rejection?
|
cell mediated immunity (T cells)
|
|
|
What kind of transplant rejection is reversible with immunosuppressants such as cyclosporin and OKT3?
|
acute transplant rejection
|
|
|
What kinds of adjuvants are included in human vaccines?
|
aluminum hydroxide or lipid
|
|
|
What kinds of cells have class II MHC proteins?
|
antigen-presenting cells (e.g. macrophages and dendritic cells)
|
|
|
What parasites have antigen variation?
|
trypanosomes (programmed rearrangement)
|
|
|
What symptoms characterize the Arthus reaction and what causes them?
|
edema, necrosis, and activation of complement due to the Ag-Ab complexes that form in the skin following intradermal injection of Ag.
|
|
|
What type of cell secretes IL-3?
|
activated T-cells
|
|
|
What type of cells does gamma interferon stimulate?
|
macrophages
|
|
|
What type of hypersensitivity reaction is the Arthus reaction?
|
type III
|
|
|
Where does the alternative complement pathway occur?
|
On microbial surfaces
|
|
|
Where does the classic complement pathway occur?
|
antigen-antibody complexes
|
|
|
Where is the defect in SCID?
|
the defect is in early stem-cell differentiation, leading to B- and T-cell deficiency
|
|
|
Which interleukin causes fever?
|
IL-1
|
|
|
Which interleukin enhances the synthesis of IgA?
|
IL-5
|
|
|
Which interleukin stimulates the production and activation of eosinophils?
|
IL-5
|
|
|
Which interleukin supports the growth and differentiation of bone marrow stem cells?
|
IL-3
|
|
|
Which is the only type of cell-mediated hypersensitivity reaction, and thus not transferable by serum?
|
Type IV
|
|
|
Wiskott-Aldrich syndrome is a defect in the ability to mount what immune response?
|
an IgM response to capsular polysaccharides of bacteria.
|
|
|
With what disease are anti-histone autoantibodies associated?
|
drug-induced lupus
|
|
|
With what disease are anti-nuclear antibodies associated?
|
systemic lupus
|
|
|
Aspiration pneumonia is usually caused by what type of organism
|
- Anaerobes
|
|
|
Atypical pneumonia is usually caused by…
|
- Mycoplasma - Legionella - Chlamydia
|
|
|
Bug Hints: Branching rods in oral infection =
|
Actinomyces israelii
|
|
|
Bug Hints: Currant jelly sputum =
|
Klebsiella
|
|
|
Bug Hints: Dog or cat bite =
|
Pasteurella multocida
|
|
|
Bug Hints: Pediatric Infection =
|
H. influenzae (including epiglottitis)
|
|
|
Bug Hints: Pneumonia in CF, burn infection =
|
P. aeruginosa
|
|
|
Bug Hints: Pus, Empyema, Abscess =
|
S. aureus
|
|
|
Bug Hints: Sepsis/Meningitis in Newborn =
|
Group B strep
|
|
|
Bug Hints: Surgical wound =
|
S. aureus
|
|
|
Bug Hints: Traumatic open wound =
|
C. perfringens
|
|
|
Incidence of what cause of mengitis has decreased with a vaccine?
|
Incidence of H. influenze meningitis has decreased greatly with introduction of H. influenzae vaccine in the last 10-15 years
|
|
|
Most osteomyelitis occurs in what age group?
|
children
|
|
|
Neonatal pneumonia is usually caused by…
|
- Group B streptococci - E. coli
|
|
|
Nosocomial pneumonia is usually caused by…
|
- Staphylococcus - gram-negative rods
|
|
|
PID includes what disorders in the body?
|
salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess
|
|
|
PID is likely caused by what two organisms? What are the characteristics of the disease caused by each organism?
|
-Chlamydia trachomatis: subacute, often undiagnosed - N. gonorrhoeae:acute, high fever
|
|
|
Pneumonia in immunocompromised patients is caused by…
|
- Staphylococcus - gram-negative rods - fungi - viruses - Pnemumocystis carinii (with HIV)
|
|
|
Pneumonia in the alcoholic/IV drug user is usually caused by…
|
- S. pneumoniae - Klebsiella - Staphylococcus
|
|
|
Postviral pneumonia is usually caused by…
|
- Staphylococcus - H. influenzae
|
|
|
Salpingitis is a risk factor for…
|
- ectopic pregnancy - infertility -chronic pelvic pain - adhesions
|
|
|
UTIs are found in men in which 2 age groups?
|
Babies with congenital defects and Elderly with enlarged prostates
|
|
|
UTIs are mostly caused how?
|
by ascending infections
|
|
|
What\\'s the likely cause of osteomyelitis in a pt where you have no other information?
|
S. aureus
|
|
|
What 2 pathogens likely cause nosocomial infections associated with urinary catherization?
|
E. coli, Proteus mirabilis
|
|
|
What 2 pathogens likely cause nosocomial infections in the newborn nursery?
|
CMV, RSV
|
|
|
What 3 UTI-causing organisms are often nosocomial and drug-resistant?
|
- Serratia marcescens - Enterobacter cloacae - Klebsiella pneumoniae - Proteus mirabilis - Pseudomonas aeruginosa
|
|
|
What 7 organisms are associated with UTIs?
|
- Serratia marcescens - Staphylococcus saprophyticus - E. coli - Enterobacter cloacae - Klebsiella pneumoniae - Proteus mirabilis - Pseudomonas aeruginosa [HINT: SEEKS PP]
|
|
|
What abnormal lab result is often seen in osteomyelitis patients?
|
elevated ESR
|
|
|
What are 4 clinical findings of Pyelonephritis?
|
- fever - chills - flank pain -CVA tenderness [c/c with UTI]
|
|
|
What are 4 clinical findings of UTIs?
|
- diysuria - frequency - urgency - suprapubic pain [c/c with pyelonephritis]
|
|
|
What are the 2 most common causes of nosocomial infections?
|
- E. coli causes UTI - S. aureus causes wound infection
|
|
|
What are the 3 most common causes of UTI in young ambulatory women?
|
1. E. coli (50-80%) 2. Staphylococcus saprophyticus (10-30%) 3. Klebsiella (8-10%)
|
|
|
What are the common causes of hospital-acquired UTIs?
|
- E. coli - Proteus - Klebsiella - Serratia - Pseudomonas
|
|
|
What are the common causes of meningitis in 6-60y/o?
|
- N. MENINGITIDIS - Enteroviruses - S. pneumoniae - HSV
|
|
|
What are the common causes of meningitis in 60+ y/o?
|
- S. PNEUMONIAE - Gram-negative rods - Listeria
|
|
|
What are the common causes of meningitis in children (6mo-6y/o)?
|
- S. pneumoniae - N. meningitidis - H. influenzae B - Enteroviruses
|
|
|
What are the common causes of meningitis in HIV pts?
|
- Cryptococcus - CMV - toxoplasmosis (brain abscess) JC virus (PML)
|
|
|
What are the common causes of meningitis in newborns (0-6mos)?
|
- GROUP B STREPTOCOCCI - E. COLI - Listeria
|
|
|
What are the common causes of osteomyelitis in those with prosthetic replacements?
|
S. aureus and S. epidermidis
|
|
|
What are the common causes of pneumonia in adults 18-40 y/o?
|
- Mycoplasma - C. pneumoniae - S. pneumoniae
|
|
|
What are the common causes of pneumonia in adults 40-65 y/o?
|
- S. pneumoniae - H. influenzae - Anaerobes - Viruses - Mycoplasma
|
|
|
What are the common causes of pneumonia in children (6wk-18y)?
|
- Viruses (RSV) - Mycoplasma - Chlamidia pneumonia S. pneumoniae
|
|
|
What are the common causes of pneumonia in the elderly?
|
- S. pneumoniae - Anaerobes - Viruses - H. influenzae - Gram-neg. rods
|
|
|
What are the CSF finings in bacterial meningitis (pressure, cell type, protein and sugar levels)?
|
- Pressure: incr. - Cell type: incr. PMNs - Protein: incr - Sugar: decr
|
|
|
What are the CSF finings in bacterial meningitis (pressure, cell type, protein and sugar levels)?
|
- Pressure: nl or incr. - Cell type: incr. lymphocytes - Protein: nl - Sugar: nl
|
|
|
What are the CSF finings in fungal/TB meningitis (pressure, cell type, protein and sugar levels)?
|
- Pressure: incr. - Cell type: incr. lymphocytes - Protein: incr - Sugar:decr.
|
|
|
What are the dominant normal florae in the colon?
|
B fragilis &gt; E. coli
|
|
|
What are the dominant normal florae in the vagina?
|
Lactobacillus, colonized by E. coli and group B strep
|
|
|
What are the predisposing factors of UTIs?
|
- flow obstruction - kidney surgery - catherization - gynecologic abnormailities - diabetes - pregnancy
|
|
|
What infections are dangerous in pregnancy?
|
- Toxoplasma - Rubella - CMV - HSV/HIV -Syphilis [HINT: ToRCHeS]
|
|
|
What is chandelier sign?
|
Cervical motion tenderness associated with PID
|
|
|
What is the 2nd leading cause of community-acquired UTI in sexually active women?
|
Staphylococcus saprophyticus
|
|
|
What is the characterisitc of Trichomonas on a slide?
|
motile on wet prep
|
|
|
What is the common cause of osteomyelitis in drug addicts?
|
Psudomonas aeruginosa
|
|
|
What is the common cause of osteomyelitis in most people?
|
S. aureus
|
|
|
What is the common cause of osteomyelitis in sickle cell pts?
|
Salmonella
|
|
|
What is the common cause of osteomyelitis in the sexually active?
|
N. gonorrhoeae
|
|
|
What is the common cause of osteomyelitis in the vertebra?
|
M. tuberculosis
|
|
|
What is the dominant normal flora contributes to dental plaque?
|
S. mutans
|
|
|
What is the dominant normal flora in the nose?
|
S. aureus
|
|
|
What is the dominant normal flora in the oropharynx?
|
viridans streptococci
|
|
|
What is the dominant normal flora on the skin?
|
S. epidermidis
|
|
|
What is the most common STD in the U.S.?
|
Chlamydia trachomatis causes 3-4 million cases per year
|
|
|
What organism can you presume is causing a nosocomial infection if respiratory equipment or burns are involved?
|
Psudomonas aeruginosa
|
|
|
What organism is the leading cause of UTI and shows a metallic sheen on EMB agar?
|
E. coli
|
|
|
What pathogen is associated with hyperalimentation?
|
Candida albicans
|
|
|
What pathogen is associated with water (ie. aerosols)?
|
Legionella
|
|
|
What pathogen likely causes nosocomial infections in the renal dialysis unit?
|
HBV
|
|
|
What population does not have any flora?
|
Neonates delivered by csarean section have no flora but are rapidly colonized after birth
|
|
|
What ratio is UTIs found more in women vs. men? Why?
|
10 to 1 because women have short urethrae more likely to be colonized by fecal flora
|
|
|
What STD is associated with Argyll-Robertson pupil?
|
3\\' Syphilis
|
|
|
What STD is associated with clue cells?
|
Garnerella
|
|
|
What STD is associated with Genital warts and loilocytes? What is the causative agent?
|
- Condylomata acuminata - HPV 6 and 11
|
|
|
What STD is associated with jaundice? What is the causative agent?
|
- Hepatitis B - HBV
|
|
|
What STD is associated with opportunistic infections, Kaposi\\'s sarcoma, lymphoma? What is the causative agent?
|
- AIDS -HIV
|
|
|
What STD is associated with painful penile, vulvar or cervical ulcers? What\\'s the causative agent?
|
-Genital Herpies - HSV-2
|
|
|
What STD is associated with painful ulcers, lymphadenopathy, rectal strictures? What is the causative agent?
|
- Lymphogranuloma venereum - Chlamydia trachomatis
|
|
|
What STD is associated with urethritis, cervicitis, conjuntivitis, Reiter\\'s syndrome PID? What is the causative agent?
|
Chlamydia - Chlamydia trachomatis
|
|
|
What STD is associated with vaginitis? What is the causative agent?
|
-Trichomoniasis - Trichomonas vaginalis
|
|
|
What STD is characterized by painful genital ulcer? What is the causative agent?
|
- chancroid - Haemophilus ducreyi
|
|
|
What STD is likely in a patient with a painless chancre? What causes it?
|
- 1\\' Syphilis - Treponema pallidum
|
|
|
What STD is likely in a patient with fever, lymphadenopathy, skin rashes, condylomata lata? What causes it?
|
- 2\\' Syphilis - Treponema pallidum
|
|
|
What STD is likely in a patient with gummas, tabes dorsalis, general paresis, aortitis, Argyll-Robertson pupil? What causes it?
|
- 3\\' Syphilis - Treponema pallidum
|
|
|
What STD is likely in a patient with urethritis, cervicitis, PID, prostatitus, epididymitis, arthritis? What organism causes it?
|
- Gonorrhea - Neisseria gonorrhoeae
|
|
|
What UTI-causing organism has a bue-green pigment, fruity odor and is usually nosocomial and drug-resistant?
|
Pseudomonas aeruginosa
|
|
|
What UTI-causing organism is characterized by a large mucoid capsule and viscous colonies?
|
Klebsiella pneumoniae
|
|
|
What UTI-causing organism is mobile, causing \\'swarming\\' on agar and also produces urease and is associated with struvite stones?
|
Proteus mirabilis
|
|
|
What UTI-causing organism sometimes produces a red pigment, is often nosocomial and drug-resistant?
|
Serratia marcescens
|
|
|
A common side effects of INF treatment is?
|
Neutropenia
|
|
|
Antimicrobial prophylaxis for a history of recurrent UTIs
|
TMP-SMZ
|
|
|
Antimicrobial prophylaxis for Gonorrhea
|
Ceftriaxone
|
|
|
Antimicrobial prophylaxis for Meningococcal infection
|
Rifampin (DOC), minocycline
|
|
|
Antimicrobial prophylaxis for PCP
|
TMP-SMZ (DOC), aerosolized pentamidine
|
|
|
Antimicrobial prophylaxis for Syphilis
|
Benzathine penicillin G
|
|
|
Are Aminoglycosides Teratogenic?
|
Yes
|
|
|
Are Ampicillin and Amoxicillin penicillinase resistant?
|
No
|
|
|
Are Carbenicillin, Piperacillin, and Ticarcillin penicillinase resistant?
|
No
|
|
|
Are Cephalosporins resistant to penicillinase?
|
No, but they are less susceptible than the other Beta lactams
|
|
|
Are Methicillin, Nafcillin, and Dicloxacillin penicillinase resistant?
|
Yes
|
|
|
Clinical use of Isoniazid (INH)?
|
Mycobacterium tuberculosis, the only agent used as solo prophylaxis against TB
|
|
|
Common side effects associated with Clindamycin include?
|
Pseudomembranous colitis (C. difficile), fever, diarrhea
|
|
|
Common toxicities associated with Fluoroquinolones?
|
GI upset, Superinfections, Skin rashes, Headache, Dizziness
|
|
|
Common toxicities associated with Griseofulvin are…...?
|
Teratogenic, Carcinogenic, Confusion, Headaches
|
|
|
Describe the MOA of Interferons (INF)
|
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
|
|
|
Do Tetracyclines penetrate the CNS?
|
Only in limited amounts
|
|
|
Does Ampicillin or Amoxicillin have a greater oral bioavailability?
|
AmOxicillin has greater Oral bioavailability
|
|
|
Does Amprotericin B cross the BBB?
|
No
|
|
|
Does Foscarnet require activation by a viral kinase?
|
No
|
|
|
Foscarnet toxicity?
|
Nephrotoxicity
|
|
|
Ganciclovir associated toxicities?
|
Leukopenia, Neutropenia, Thrombocytopenia, Renal toxicity
|
|
|
How are INFs used clinically?
|
Chronic Hepatitis A and B, Kaposi\\'s Sarcoma
|
|
|
How are Sulfonamides employed clinically?
|
Gram +, Gram -, Norcardia, Chlamydia
|
|
|
How are the HIV drugs used clinically?
|
Triple Therapy\\' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
|
|
|
How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax, P.ovale) treated?
|
Primaquine
|
|
|
How can Isoniazid (INH)-induced neurotoxicity be prevented?
|
Pyridoxine (B6) administration
|
|
|
How can the t1/2 of INH be altered?
|
Fast vs. Slow Acetylators
|
|
|
How can the toxic effects fo TMP be ameliorated?
|
With supplemental Folic Acid
|
|
|
How can Vancomycin-induced \\'Red Man Syndrome\\' be prevented?
|
Pretreat with antihistamines and a slow infusion rate
|
|
|
How do Sulfonamides act on bacteria?
|
As PABA antimetabolites that inhibit Dihydropteroate Synthase, Bacteriostatic
|
|
|
How do the Protease Inhibitors work?
|
Inhibt Assembly of new virus by Blocking Protease Enzyme
|
|
|
How does Ganciclovir\\'s toxicity relate to that of Acyclovir?
|
Ganciclovir is more toxic to host enzymes
|
|
|
How does resistance to Vancomycin occur?
|
With an amino acid change of D-ala D-ala to D-ala D-lac
|
|
|
How is Acyclovir used clinically?
|
HSV, VZV, EBV, Mucocutaneous and Genital Herpes Lesions, Prophylaxis in Immunocompromised pts
|
|
|
How is Amantadine used clinically?
|
Prophylaxis for Influenza A, Rubella ; Parkinson\\'s disease
|
|
|
How is Amphotericin B administered for fungal meningitis?
|
Intrathecally
|
|
|
How is Amphotericin B used clinically?
|
Wide spectrum of systemic mycoses: Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor
|
|
|
How is Chloramphenical used clinically?
|
Meningitis (H. influenza, N. meningitidis, S. pneumoniae), Conserative treatment due to toxicities
|
|
|
How is Foscarnet used clinically?
|
CMV Retinitis in IC pts when Ganciclovir fails
|
|
|
How is Ganciclovir activated?
|
Phosphorylation by a Viral Kinase
|
|
|
How is Ganciclovir used clinically?
|
CMV, esp in Immunocompromised patients
|
|
|
How is Griseofulvin used clinically?
|
Oral treatment of superficial infections
|
|
|
How is Leishmaniasis treated?
|
Pentavalent Antimony
|
|
|
How is Ribavirin used clinically?
|
for RSV
|
|
|
How is Rifampin used clinically?
|
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone when used of Leprosy 3. Used in combination with other drugs
|
|
|
How is Trimethoprim used clinically?
|
Used in combination therapy with SMZ to sequentially block folate synthesis
|
|
|
How is Vancomycin used clinically?
|
For serious, Gram + multidrug-resistant organisms
|
|
|
How would you treat African Trypanosomiasis (sleeping sickness)?
|
Suramin
|
|
|
In what population does Gray Baby Syndrome occur? Why?
|
Premature infants, because they lack UDP-glucuronyl transferase
|
|
|
Is Aztreonam cross-allergenic with penicillins?
|
No
|
|
|
Is Aztreonam resistant to penicillinase?
|
Yes
|
|
|
Is Aztreonam usually toxic?
|
No
|
|
|
Is Imipenem resistant to penicillinase?
|
Yes
|
|
|
Is Penicillin penicillinase resistant?
|
No - duh
|
|
|
IV Penicillin
|
G
|
|
|
Mnemonic for Foscarnet?
|
Foscarnet = pyroFosphate analog
|
|
|
MOA for Penicillin (3 answers)?
|
1)Binds penicillin-binding proteins 2) Blocks transpeptidase cross- linking of cell wall 3) Activates autolytic enzymes
|
|
|
MOA: Bactericidal antibiotics
|
Penicillin, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones, Metronidazole
|
|
|
MOA: Block cell wall synthesis by inhib. Peptidoglycan cross-linking (7)
|
Penicillin, Ampicillin, Ticarcillin, Pipercillin, Imipenem, Aztreonam, Cephalosporins
|
|
|
MOA: Block DNA topoisomerases
|
Quinolones
|
|
|
MOA: Block mRNA synthesis
|
Rifampin
|
|
|
MOA: Block nucleotide synthesis
|
Sulfonamides, Trimethoprim
|
|
|
MOA: Block peptidoglycan synthesis
|
Bacitracin, Vancomycin
|
|
|
MOA: Block protein synthesis at 30s subunit
|
Aminoglycosides, Tetracyclines
|
|
|
MOA: Block protein synthesis at 50s subunit
|
Chloramphenicol, Erythromycin/macrolides, Lincomycin, Clindamycin, Streptogramins (quinupristin, dalfopristin)
|
|
|
MOA: Disrupt bacterial/fungal cell membranes
|
Polymyxins
|
|
|
MOA: Unkown
|
Pentamidine
|
|
|
MOA:Disrupt fungal cell membranes
|
Amphotericin B, Nystatin, Fluconazole/azoles
|
|
|
Name common Polymyxins
|
Polymyxin B, Polymyxin E
|
|
|
Name several common Macrolides (3)
|
Erythromycin, Azithromycin, Clarithromycin
|
|
|
Name some common Sulfonamides (4)
|
Sulfamethoxazole (SMZ), Sulfisoxazole, Triple sulfas, Sulfadiazine
|
|
|
Name some common Tetracyclines (4)
|
Tetracycline, Doxycycline, Demeclocycline, Minocycline
|
|
|
Name the common Aminoglycosides (5)
|
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
|
|
|
Name the common Azoles
|
Fluconazole, Ketoconazole, Clotrimazole, Miconazole, Itraconazole
|
|
|
Name the common Fluoroquinolones (6)
|
Ciprofloxacin, Norfloxacin, Ofloxacin, Grepafloxacin, Enoxacin, Nalidixic acid
|
|
|
Name the common Non-Nucleoside Reverse Transcriptase Inhibitors
|
Nevirapine, Delavirdine
|
|
|
Name the common Nucleoside Reverse Transcriptase Inhibitors
|
Zidovudine (AZT), Didanosine (ddI), Zalcitabine (ddC), Stavudine (d4T), Lamivudine (3TC)
|
|
|
Name the Protease Inhibitors (4)
|
Saquinavir, Ritonavir, Indinavir, Nelfinavir
|
|
|
Name two classes of drugs for HIV therapy
|
Protease Inhibitors and Reverse Transcriptase Inhibitors
|
|
|
Name two organisms Vancomycin is commonly used for?
|
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
|
|
|
Oral Penicillin
|
V
|
|
|
Resistance mechanisms for Aminoglycosides
|
Modification via Acetylation, Adenylation, or Phosphorylation
|
|
|
Resistance mechanisms for Cephalosporins/Penicillins
|
Beta-lactamase cleavage of Beta-lactam ring
|
|
|
Resistance mechanisms for Chloramphenicol
|
Modification via Acetylation
|
|
|
Resistance mechanisms for Macrolides
|
Methylation of rRNA near Erythromycin\\'s ribosome binding site
|
|
|
Resistance mechanisms for Sulfonamides
|
Altered bacterial Dihydropteroate Synthetase, Decreased uptake, or Increased PABA synthesis
|
|
|
Resistance mechanisms for Tetracycline
|
Decreased uptake or Increased transport out of cell
|
|
|
Resistance mechanisms for Vancomycin
|
Terminal D-ala of cell wall replaced with D-lac; Decreased affinity
|
|
|
Side effects of Isoniazid (INH)?
|
Hemolysis (if G6PD deficient), Neurotoxicity, Hepatotoxicity, SLE-like syndrome
|
|
|
Specifically, how does Foscarnet inhibit viral DNA pol?
|
Binds to the Pyrophosphate Binding Site of the enzyme
|
|
|
The MOA for Chloramphenicol is ……………..?
|
Inhibition of 50S peptidyl transferase, Bacteriostatic
|
|
|
Toxic effects of TMP include………?
|
Megaloblastic anemia, Leukopenia, Granulocytopenia
|
|
|
Toxic side effects of the Azoles?
|
Hormone synthesis inhibition (Gynecomastia), Liver dysfunction (Inhibits CYP450), Fever, Chills
|
|
|
Toxicities associated with Acyclovir?
|
Delirium, Tremor, Nephrotoxicity
|
|
|
What additional side effects exist for Ampicillin?
|
Rash, Pseudomembranous colitis
|
|
|
What antimicrobial class is Aztreonam syngergestic with?
|
Aminoglycosides
|
|
|
What are Amantadine-associated side effects?
|
Ataxia, Dizziness, Slurred speech
|
|
|
What are Aminoglycosides synergistic with?
|
Beta-lactam antibiotics
|
|
|
What are Aminoglycosides used for clinically?
|
Severe Gram - rod infections.
|
|
|
What are common serious side effects of Aminoglycosides and what are these associated with?
|
Nephrotoxicity (esp. with Cephalosporins), Ototoxicity (esp. with Loop Diuretics)
|
|
|
What are common side effects of Amphotericin B?
|
Fever/Chills, Hypotension, Nephrotoxicity, Arrhythmias
|
|
|
What are common side effects of Protease Inhibitors?
|
GI intolerance (nausea, diarrhea), Hyperglycemia, Lipid abnormalities, Thrombocytopenia (Indinavir)
|
|
|
What are common side effects of RT Inhibitors?
|
BM suppression (neutropenia, anemia), Peripheral neuropathy
|
|
|
What are common toxic side effects of Sulfonamides? (5)
|
-Hypersensitivity reactions -Hemolysis -Nephrotoxicity (tubulointerstitial nephritis) -Kernicterus in infants Displace other drugs from albumin (e.g., warfarin)
|
|
|
What are common toxicities associated with Macrolides? (4)
|
GI discomfort, Acute cholestatic hepatitis, Eosinophilia, Skin rashes
|
|
|
What are common toxicities associated with Tetracyclines?
|
GI distress, Tooth discoloration and Inhibition of bone growth in children, Fanconi\\'s syndrome, Photosensitivity
|
|
|
What are common toxicities related to Vancomycin therapy?
|
Well tolerated in general but occasionally, Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing=\\'Red Man Syndrome\\'
|
|
|
What are Fluoroquinolones indicated for? (3)
|
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
|
|
|
What are major side effects of Methicillin, Nafcillin, and Dicloxacillin?
|
Hypersensitivity reactions
|
|
|
What are Methicillin, Nafcillin, and Dicloxacillin used for clinically?
|
Staphlococcus aureus
|
|
|
What are Polymyxins used for?
|
Resistant Gram - infections
|
|
|
What are the Anti-TB drugs?
|
Rifampin, Ethambutol, Streptomycin, Pyrazinamide, Isoniazid (INH)
|
|
|
What are the clinical indications for Azole therapy?
|
Systemic mycoses
|
|
|
What are the clinical uses for 1st Generation Cephalosporins?
|
Gram + cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae (PEcK)
|
|
|
What are the clinical uses for 2nd Generation Cephalosporins?
|
Gram + cocci, Haemophilus influenza, Enterobacter aerogenes, Neisseria species, P. mirabilis, E. coli, K. pneumoniae, Serratia marcescens ( HEN PEcKS )
|
|
|
What are the clinical uses for 3rd Generation Cephalosporins?
|
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
|
|
|
What are the clinical uses for Aztreonam?
|
Gram - rods: Klebsiella species, Pseudomonas species, Serratia species
|
|
|
What are the clinical uses for Imipenem/cilastatin?
|
Gram + cocci, Gram - rods, and Anerobes
|
|
|
What are the Macrolides used for clinically?
|
-Upper respiratory tract infections -pneumonias -STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) -Mycoplasma, Legionella,Chlamydia, Neisseria
|
|
|
What are the major structural differences between Penicillin and Cephalosporin?
|
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
|
|
|
What are the major toxic side effects of Imipenem/cilastatin?
|
GI distress, Skin rash, and Seizures at high plasma levels
|
|
|
What are the major toxic side effects of the Cephalosporins?
|
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram-like reaction with ethanol (those with a methylthiotetrazole group, e.g., cefamandole)
|
|
|
What are the side effects of Polymyxins?
|
Neurotoxicity, Acute renal tubular necrosis
|
|
|
What are the side effects of Rifampin?
|
Minor hepatotoxicity, Drug interactions (activates P450)
|
|
|
What are toxic side effects for Metronidazole?
|
Disulfiram-like reaction with EtOH, Headache
|
|
|
What are toxicities associated with Chloramphenicol?
|
Aplastic anemia (dose independent), Gray Baby Syndrome
|
|
|
What conditions are treated with Metronidazole?
|
Giardiasis, Amoebic dysentery (E. histolytica), Bacterial vaginitis (Gardnerella vaginalis), Trichomonas
|
|
|
What do Aminoglycosides require for uptake?
|
Oxygen
|
|
|
What do you treat Nematode/roundworm (pinworm, whipworm) infections with?
|
Mebendazole/Thiabendazole, Pyrantel Pamoate
|
|
|
What drug is given for Pneumocystis carinii prophylaxis?
|
Pentamidine
|
|
|
What drug is used during the pregnancy of an HIV + mother?, Why?
|
AZT, to reduce risk of Fetal Transmission
|
|
|
What drug is used to treat Trematode/fluke (e.g., Schistosomes, Paragonimus, Clonorchis) or Cysticercosis
|
Praziquantel
|
|
|
What is a common drug interaction associated with Griseofulvin?
|
Increases coumadin metabolism
|
|
|
What is a mnemonic to remember Amantadine\\'s function?
|
Blocks Influenza A and RubellA; causes problems with the cerebellA
|
|
|
What is a prerequisite for Acyclovir activation?
|
It must be Phosphorylated by Viral Thymidine Kinase
|
|
|
What is a Ribavirin toxicity?
|
Hemolytic anemia
|
|
|
What is an acronym to remember Anti-TB drugs?
|
RESPIre
|
|
|
What is an additional side effect of Methicillin?
|
Interstitial nephritis
|
|
|
What is an occasional side effect of Aztreonam?
|
GI upset
|
|
|
What is Clindamycin used for clinically?
|
Anaerobic infections (e.g., B. fragilis, C. perfringens)
|
|
|
What is clinical use for Carbenicillin, Piperacillin, and Ticarcillin?
|
Pseudomonas species and Gram - rods
|
|
|
What is combination TMP-SMZ used to treat?
|
Recurrent UTIs, Shigella, Salmonella, Pneumocystis carinii pneumonia
|
|
|
What is combined with Ampicillin, Amoxicillin, Carbenicillin, Piperacillin, and Ticarcillin to enhance their spectrum?
|
Clavulanic acid
|
|
|
What is Fluconazole specifically used for?
|
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
|
|
|
What is Imipenem always administered with?
|
Cilastatin
|
|
|
What is Ketoconazole specifically used for?
|
Blastomyces, Coccidioides, Histoplasma, C. albicans; Hypercortisolism
|
|
|
What is Metronidazole combined with for \\'triple therapy\\'? Against what organism?
|
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
|
|
|
What is Metronidazole used for clinically?
|
Antiprotozoal: Giardia, Gardnerella vaginalis Entamoeba, Trichomonas,
GET the METRO Anaerobes: Bacteroides, Clostridium |
|
|
What is Niclosamide used for?
|
Cestode/tapeworm (e.g., D. latum, Taenia species Except Cysticercosis
|
|
|
What is Nifurtimox administered for?
|
Chagas\\' disease, American Trypanosomiasis (Trypanosoma cruzi)
|
|
|
What is the chemical name for Ganciclovir?
|
DHPG (dihydroxy-2-propoxymethyl guanine)
|
|
|
What is the clinical use for Ampicillin and Amoxicillin?
|
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
|
|
|
What is the clinical use for Nystatin?
|
Topical and Oral, for Oral Candidiasis (Thrush)
|
|
|
What is the clinical use for Penicillin?
|
Bactericidal for: Gram + rod and cocci, Gram - cocci, and Spirochetes
|
|
|
What is the major side effect for Ampicillin and Amoxicillin?
|
Hypersensitivity reactions
|
|
|
What is the major side effect for Carbenicillin, Piperacillin, and Ticarcillin?
|
Hypersensitivity reactions
|
|
|
What is the major toxic side effect of Penicillin?
|
Hypersensitivity reactions
|
|
|
What is the memory aid for subunit distribution of ribosomal inhibitors?
|
Buy AT 30, CELL at 50\\'
|
|
|
What is the memory key for Isoniazid (INH) toxicity?
|
INH: Injures Neurons and Hepatocytes
|
|
|
What is the memory key for Metronidazole\\'s clinical uses?
|
GET on the Metro
|
|
|
What is the memory key for organisms treated with Tetracyclines?
|
VACUUM your Bed Room\\'
|
|
|
What is the memory key involving the \\'4 R\\'s of Rifampin?\\'
|
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
|
|
|
What is the MOA for Acyclovir?
|
Inhibit viral DNA polymerase
|
|
|
What is the MOA for Amphotericin B?
|
Binds Ergosterol, forms Membrane Pores that Disrupt Homeostatis
|
|
|
What is the MOA for Ampicillin and Amoxicillin?
|
Same as penicillin. Extended spectrum antibiotics
|
|
|
What is the MOA for Carbenicillin, Piperacillin, and Ticarcillin?
|
Same as penicillin. Extended spectrum antibiotics
|
|
|
What is the MOA for Clindamycin?
|
Blocks Peptide Bond formation at the 50S subunit, Bacteriostatic
|
|
|
What is the MOA for Methicillin, Nafcillin, and Dicloxacillin?
|
Same as penicillin. Act as narrow spectrum antibiotics
|
|
|
What is the MOA for Metronidazole?
|
Forms toxic metabolites in the bacterial cell, Bactericidal
|
|
|
What is the MOA for Nystatin?
|
Binds ergosterol, Disrupts fungal membranes
|
|
|
What is the MOA for Rifampin?
|
Inhibits DNA dependent RNA polymerase
|
|
|
What is the MOA for the Aminoglycosides?
|
Inhibits formation of Initiation Complex, causes misreading of mRNA, Bactericidal
|
|
|
What is the MOA for the Azoles?
|
Inhibit Ergosterol synthesis
|
|
|
What is the MOA for the Cephalosporins?
|
Beta lactams - inhibit cell wall synthesis, Bactericidal
|
|
|
What is the MOA for the Fluoroquinolones?
|
Inhibit DNA Gyrase (topoisomerase II), Bactericidal
|
|
|
What is the MOA for the Macrolides?
|
Blocks translocation, binds to the 23S rRNA of the 50S subunit, Bacteriostatic
|
|
|
What is the MOA for the Tetracyclines?
|
Binds 30S subunit and prevents attachment of aminoacyl-tRNA, Bacteriostatic
|
|
|
What is the MOA for Trimethoprim (TMP)?
|
Inhibits bacterial Dihydrofolate Reductase, Bacteriostatic
|
|
|
What is the MOA for Vancomycin?
|
Inhibits cell wall mucopeptide formation, Bactericidal
|
|
|
What is the MOA of Amantadine?
|
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
|
|
|
What is the MOA of Aztreonam?
|
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
|
|
|
What is the MOA of Foscarnet?
|
Inhibits Viral DNA polymerase
|
|
|
What is the MOA of Ganciclovir?
|
Inhibits CMV DNA polymerase
|
|
|
What is the MOA of Griseofulvin?
|
Interferes with microtubule function, disrupts mitosis, inhibits growth
|
|
|
What is the MOA of Imipenem?
|
Acts as a wide spectrum carbapenem
|
|
|
What is the MOA of Isoniazid (INH)?
|
Decreases synthesis of Mycolic Acid
|
|
|
What is the MOA of Polymyxins?
|
Bind cell membrane, disrupt osmotic properties, Are Cationc, Basic and act as detergents
|
|
|
What is the MOA of Ribavirin?
|
Inhibits IMP Dehydrogenase (competitively), and therefore blocks Guanine Nucleotide synthesis
|
|
|
What is the MOA of the RT Inhibitors?
|
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
|
|
|
What is the most common cause of Pt noncompliance with Macrolides?
|
GI discomfort
|
|
|
What is treated with Chloroquine, Quinine, Mefloquine?
|
Malaria (P. falciparum)
|
|
|
What microorganisms are Aminoglycosides ineffective against?
|
Anaerobes
|
|
|
What microorganisms are clinical indications for Tetracycline therapy?
|
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme\\'s) Rickettsia Tularemia
|
|
|
What microorganisms is Aztreonam not effective against?
|
Gram + and Anerobes
|
|
|
What musculo-skeletal side effects in Adults are associated with Floroquinolones?
|
Tendonitis and Tendon rupture
|
|
|
What neurotransmitter does Amantadine affect? How does it influence this NT?
|
Dopamine; causes its release from intact nerve terminals
|
|
|
What organism is Imipenem/cilastatin the Drug of Choice for?
|
Enterobacter
|
|
|
What organisms does Griseofulvin target?
|
Dermatophytes (tinea, ringworm)
|
|
|
What parasites are treated with Pyrantel Pamoate (more specific)?
|
Giant Roundworm (Ascaris), Hookworm (Necator/Ancylostoma), Pinworm (Enterobius)
|
|
|
What parasitic condition is treated with Ivermectin?
|
Onchocerciasis (\\'river blindness\\'--rIVER-mectin)
|
|
|
What populations are Floroquinolones contraindicated in? Why?
|
Pregnant women, Children; because animal studies show Damage to Cartilage
|
|
|
What should not be taken with Tetracyclines? / Why?
|
Milk or Antacids, because divalent cations inhibit Tetracycline absorption in the gut
|
|
|
What Sulfonamides are used for simple UTIs?
|
Triple sulfas or SMZ
|
|
|
When is HIV therapy initiated?
|
When pts have Low CD4+ (&lt; 500 cells/cubic mm) or a High Viral Load
|
|
|
When is Rifampin not used in combination with other drugs?
|
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
|
|
|
Where does Griseofulvin deposit?
|
Keratin containing tissues, e.g., nails
|
|
|
Which Aminoglycoside is used for Bowel Surgery ?
|
Neomycin
|
|
|
Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
|
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
|
|
|
Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
|
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
|
|
|
Which individuals are predisposed to Sulfonamide-induced hemolysis?
|
G6PD deficient individuals
|
|
|
Which RT inhibitor causes Megaloblastic Anemia?
|
AZT
|
|
|
Which RT inhibitors cause a Rash?
|
Non-Nucleosides
|
|
|
Which RT inhibitors cause Lactic Acidosis?
|
Nucleosides
|
|
|
Which Tetracycline is used in patients with renal failure? / Why?
|
Doxycycline, because it is fecally eliminated
|
|
|
Who rocks
|
I do!
keep studying hard you can do it! |
|
|
Why are Methicillin, Nafcillin, and Dicloxacillin penicillinase resistant?
|
Due to the presence of a bulkier R group
|
|
|
Why is Cilastatin administered with Imipenem?
|
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
|
|
|
List the mechanism, clinical use, &amp; toxicity of 5 FU.
|
-S-phase anti-metabolite Pyr analogue -Colon, solid tumors, &amp; BCC/ -Irreversible myelosuppression
|
|
|
List the mechanism, clinical use, &amp; toxicity of 6 MP.
|
-inhibits HGPRT (pur. Syn.) - Luk, Lymph,
|
|
|
List the mechanism, clinical use, &amp; toxicity of Bleomycin.
|
-DNA intercalator -testicular &amp; lymphomas -Pulmonary fibrosis mild myelosuppression.
|
|
|
List the mechanism, clinical use, &amp; toxicity of Busulfan.
|
-Alkalates DNA -CML -Pulmonary fibrosis hyperpigmentation
|
|
|
List the mechanism, clinical use, &amp; toxicity of Cisplatin.
|
-Alkalating agent -testicular,bladder,ovary,&amp;lung -Nephrotoxicity &amp; CN VIII damage.
|
|
|
List the mechanism, clinical use, &amp; toxicity of Cyclophosphamide.
|
-Alkalating agent -NHL, Breast, ovary, &amp; lung. - Myelosuppression, &amp; hemorrhagic cystitis.
|
|
|
List the mechanism, clinical use, &amp; toxicity of Doxorubicin.
|
-DNA intercalator -Hodgkin\\'s, myeloma, sarcoma, and solid tumors -Cardiotoxicity &amp; alopecia
|
|
|
List the mechanism, clinical use, &amp; toxicity of Etoposide.
|
-Topo II inhibitor(GII specific) -Oat cell of Lung &amp; prostate, &amp; testicular -Myelosuppression &amp; GI irritation.
|
|
|
List the mechanism, clinical use, &amp; toxicity of Methotrexate.
|
-S-phase anti-metabolite folate analogue -Luk, Lymp, sarc, RA, &amp;psoriasis / -Reversible myelosuppression
|
|
|
List the mechanism, clinical use, &amp; toxicity of Nitrosureas.
|
-Alkalate DNA -Brain tumors -CNS toxicity
|
|
|
List the mechanism, clinical use, &amp; toxicity of Paclitaxel.
|
-MT polymerization stabilizer -Ovarian &amp; breast CA -Myelosupperession &amp; hypersensitivity.
|
|
|
List the mechanism, clinical use, &amp; toxicity of Prednisone.
|
-Triggers apoptosis -CLL, Hodgkin\\'s in MOPP -Cushing-like syndrome
|
|
|
List the mechanism, clinical use, &amp; toxicity of Tamoxifen.
|
-Estrogen receptor antagonist -Breast CA -increased endometrial CA risk
|
|
|
List the mechanism, clinical use, &amp; toxicity of Vincristine.
|
-MT polymerization inhibitor(M phase) -MOPP, lymphoma, Willm\\'s &amp; choriocarcinoma -neurotoxicity and myelosuppression
|
|
|
Which cancer drugs effect nuclear DNA (4)?
|
-Alkalating agents+cisplatin -Doxorubicin+Dactinomycin -Bleomycin -Etoposide
|
|
|
Which cancer drugs inhibit nucleotide synthesis(3)?
|
- Methotrexate - 5 FU - 6 mercaptopurine
|
|
|
Which cancer drugs work at the level of mRNA(2)?
|
-Steroids -Tamoxifen
|
|
|
Which cancer drugs work at the level of proteins(2)?
|
-Vinca alkaloids(inhibit MT) -Paclitaxel
|
|
|
ACE inhibitors- clinical use?
|
hypertension, CHF, diabetic renal disease
|
|
|
ACE inhibitors- mechanism?
|
reduce levels of Angiotensin II, thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
|
|
|
ACE inhibitors- toxicity?
|
fetal renal damage, hyperkalemia, Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower Angiotensin II (CAPTOPRIL)
|
|
|
Acetazolamide- clinical uses?
|
glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness
|
|
|
Acetazolamide- mechanism?
|
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self-limited sodium bicarb diuresis and reduction of total body bicarb stores.
|
|
|
acetazolamide- site of action?
|
proximal convoluted tubule
|
|
|
Acetazolamide- toxicity?
|
hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
|
|
|
Acetazolamide causesÉ?
|
ACIDazolamide\\' causes acidosis
|
|
|
Adenosine- clinical use?
|
DOC in diagnosing and abolishing AV nodal arrhythmias
|
|
|
ADH antagonists- site of action?
|
collecting ducts
|
|
|
adverse effect of Nitroprusside?
|
cyanide toxicity (releases CN)
|
|
|
adverse effects of beta-blockers?
|
impotence, asthma, CV effects (bradycardia, CHF, AV block), CNS effects (sedation, sleep alterations)
|
|
|
adverse effects of Captopril?
|
fetal renal toxicity, hyperkalemia, Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower Angiotensin II (CAPTOPRIL)
|
|
|
adverse effects of Clonidine?
|
dry mouth, sedation, severe rebound hypertension
|
|
|
adverse effects of ganglionic blockers?
|
severe orthostatic hypotension, blurred vision, constipation, sexual dysfunction
|
|
|
adverse effects of Guanethidine?
|
orthostatic and exercise hypotension, sexual dysfunction, diarrhea
|
|
|
adverse effects of Hydralazine?
|
nausea, headache, lupus-like syndrome, reflex tachycardia, angina, salt retention
|
|
|
adverse effects of Hydrochlorothiazide?
|
hypokalemia, slight hyperlipidemia, hyperuricemia, lassitude, hypercalcemia, hyperglycemia
|
|
|
adverse effects of Loop Diuretics?
|
K+ wasting, metabolic alkalosis, hypotension, ototoxicity
|
|
|
adverse effects of Losartan?
|
fetal renal toxicity, hyperkalemia
|
|
|
adverse effects of Methyldopa?
|
sedation, positive Coombs\\' test
|
|
|
adverse effects of Minoxidil?
|
hypertrichosis, pericardial effusion, reflex tachycardia, angina, salt retention
|
|
|
adverse effects of Nifedipine, verapamil?
|
dizziness, flushing, constipation (verapamil), nausea
|
|
|
adverse effects of Prazosin?
|
first dose orthostatic hypotension, dizziness, headache
|
|
|
adverse effects of Reserpine?
|
sedation, depression, nasal stuffiness, diarrhea
|
|
|
Amiodarone- toxicity?
|
pulmonary fibrosis,
corneal deposits, skin deposits --> photodermatitis, hepatotoxicity, neurologic effects, constipation, CV (bradycardia, heart block, CHF) hypo- or hyperthyroidism. |
|
|
Digoxin antidote?
|
slowly normalize K+, lidocaine, cardiac pacer, and anti-Dig Fab fragments
|
|
|
Beta Blockers- CNS toxicity?
|
sedation, sleep alterations
|
|
|
Beta Blockers- CV toxicity?
|
bradycardia, AV block, CHF
|
|
|
Beta Blockers- site of action?
|
Beta adrenergic receptors and Ca2+ channels (stimulatory)
|
|
|
BP?
|
decrease
|
|
|
BP?
|
decrease
|
|
|
Bretyllium- toxicity?
|
new arrhythmias, hypotension
|
|
|
Ca2+ channel blockers- clinical use?
|
hypertension, angina, arrhythmias
|
|
|
Ca2+ channel blockers- mechanism?
|
block voltage dependent L-type Ca2+ channels of cardiac and smooth muscle- decreasing contractility
|
|
|
Ca2+ channel blockers- site of action?
|
Cell membrane Ca2+ channels of cardiac sarcomere
|
|
|
Ca2+ channel blockers- toxicity?
|
cardiac depression, peripheral edema, flushing, dizziness, constipation
|
|
|
Ca2+ sensitizers\\'- site of action?
|
troponin-tropomyosin system
|
|
|
Cautions when using Amiodarone?
|
check PFTs, LFTs, and TFTs
|
|
|
class IA effects?
|
increased AP duration, increased ERP increased QT interval. Atrial and ventricular.
|
|
|
class IB- clinical uses?
|
post MI and digitalis induced arrhythmias
|
|
|
class IB- effects?
|
decrease AP duration, affects ischemic or depolarized Purkinje and ventricular system
|
|
|
class IB- toxicity?
|
local anesthetic. CNS stimulation or depression. CV depression.
|
|
|
class IC- effects?
|
NO AP duration effect. useful in V-tach that progresses to V-fib and in intractable SVT LAST RESORT
|
|
|
class IC- toxicity?
|
proarrhythmic
|
|
|
class II- effects?
|
decrease the slope of phase 4, increase PR interval (the AV node is particularly sensitive)
|
|
|
class II- mechanism?
|
blocking the beta adrenergic receptor leads to decreased cAMP, and decreased Ca2+ flux
|
|
|
class II- toxicity?
|
impotence, exacerbation of asthma, CV effects, CNS effects, may mask hypoclycemia
|
|
|
Class III- effects?
|
increase AP duration, increase ERP, increase QT interval, for use when other arrhythmics fail
|
|
|
class IV- clinical use?
|
prevention of nodal arrhythmias (SVT)
|
|
|
class IV- effects?
|
decrease conduction velocity, increase ERP, increase PR interval
|
|
|
class IV- primary site of action?
|
AV nodal cells
|
|
|
class IV- toxicity?
|
constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression), and torsade de pointes (Bepridil)
|
|
|
classes of antihypertensive drugs?
|
diuretics, sympathoplegics, vasodilators, ACE inhibitors, Angiotensin II receptor inhibitors
|
|
|
clinical use?
|
angina, pulmonary edema (also, erection enhancer)
|
|
|
clinical use?
|
CHF, atrial fibrillation
|
|
|
contractility?
|
increase (reflex response)
|
|
|
contractility?
|
decrease
|
|
|
contraindications?
|
renal failure, hypokalemia, pt on quinidine
|
|
|
decrease Digitoxin dose in renal failure?
|
NO
|
|
|
decrease Digoxin dose in renal failure?
|
YES
|
|
|
Digitalis- site of action?
|
Na/K ATPase
|
|
|
Digoxin v. Digitoxin: bioavailability?
|
Digitoxin&gt;95% Digoxin 75%
|
|
|
Digoxin v. Digitoxin: excretion?
|
Digoxin=urinary Digitoxin=biliary
|
|
|
Digoxin v. Digitoxin: half life?
|
Digitoxin 168hrs Digoxin 40 hrs
|
|
|
Digoxin v. Digitoxin: protein binding?
|
Digitoxin 70% Digoxin 20-40%
|
|
|
Digoxin v Digitoxin ejection time?
|
?
|
|
|
ejection time?
|
increase
|
|
|
EKG results?
|
inc PR, dec QT, scooping of ST, and T wave inversion
|
|
|
Digoxin v. Digitoxin end diastolic volume?
|
decrease
|
|
|
end diastolic volume?
|
increase
|
|
|
Esmolol- short or long acting?
|
very short acting
|
|
|
Ethacrynic Acid- clinical use?
|
Diuresis in pateints with sulfa allergy
|
|
|
Ethacrynic Acid- mechanism?
|
not a sulfonamide, but action is the same as furosemide
|
|
|
Ethacrynic Acid- toxicity?
|
NO HYPERURICEMIA, NO SULFA ALLERGY; same as furosemide otherwise
|
|
|
Furosemide- class and mechanism?
|
Sulfonamide Loop Diuretic. Inhibits ion co-transport system of thick ascending loop. Abolishes hypertonicity of the medulla, thereby preventing concentration of the urine.
|
|
|
Furosemide- clinical use?
|
edematous states (CHF, cirrhosis, nephrotic syndrome, pulm edema), HTN, hypercalcemia
|
|
|
Furosemide- toxicity? (OH DANG)
|
Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout
|
|
|
Furosemide increases the excretion of what ion?
|
Ca2+ (Loops Lose calcium)
|
|
|
HDL effect?
|
no effect
|
|
|
HDL effect?
|
increase
|
|
|
HDL effect?
|
moderate increase
|
|
|
HDL effect?
|
increase
|
|
|
HDL effect?
|
DECREASE
|
|
|
how do we stop angina?
|
decrease myocardial O2 consumption by: 1-decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4-decreasing contractility 5-decreasing ejection time
|
|
|
HR?
|
increase (reflex response)
|
|
|
HR?
|
decrease
|
|
|
Hydralazine- class and mechanism?
|
vasodilator- increases cGMP to induce smooth muscle relaxation (arterioles&gt;veins; afterload reduction)
|
|
|
Hydralazine- clinical use?
|
severe hypertension, CHF
|
|
|
Hydralazine- toxicity?
|
compensatory tachycardia, fluid retention, lupus-like syndrome
|
|
|
Hydrochlorothiazide- clinical use?
|
HTN, CHF, calcium stone formation, nephrogenic DI.
|
|
|
Hydrochlorothiazide- mechanism?
|
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
|
|
|
Hydrochlorothiazide- toxicity? (hyperGLUC, plus others)
|
Hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia, sulfa allergy.
|
|
|
Ibutilide- toxicity?
|
torsade de pointes
|
|
|
K+- clinical use?
|
depresses ectopic pacemakers, especially in digoxin toxicity
|
|
|
K+ sparing diuretics- clinical use?
|
hyperaldosteronism, K+ depletion, CHF
|
|
|
K+ sparing diuretics- site of action?
|
cortical collecting tubule
|
|
|
K+ sparing diuretics- toxicity?
|
hyperkalemia, endocrine effects (gynecomastia, anti-androgen)
|
|
|
LDL effect?
|
moderate decrease
|
|
|
LDL effect?
|
large decrease
|
|
|
LDL effect?
|
moderate decrease
|
|
|
LDL effect?
|
decrease
|
|
|
LDL effect?
|
decrease
|
|
|
loop diuretics (furosemide)- site of action?
|
thick ascending limb
|
|
|
Mannitol- clinical use?
|
ARF, shock, drug overdose, decrease intracranial/intraocular pressure
|
|
|
Mannitol- contraindications?
|
anuria, CHF
|
|
|
Mannitol- mechanism?
|
osmotic diuretic- increase tubular fluid osmolarity, thereby increasing urine flow
|
|
|
mannitol- site of action?
|
proximal convoluted tubule, thin descending limb, and collecting duct
|
|
|
Mannitol- toxicity?
|
pulmonary edema, dehydration
|
|
|
nitroglycerin, isosorbide dinitrate MOA?
|
vasodilate by releasing NO in smooth muscle, causing and increase in cGMP and smooth muscle relaxation (veins>>arteries)
|
|
|
Digoxin, Digitalis mechanism?
|
Cardiac glycosides inhibit the Na/K ATPase->
inc. intracellular Na+ -> dec. the function of Na/Ca antiport -> inc. in intracellular Ca2+ |
|
|
Na+ channel blockers MOA?
|
Slow or block conduction.
Dec slope in phase 4 inc threshold for firing in abnormal pacemaker cells. |
|
|
Mg+- clinical use?
|
effective in torsade de pointes and digoxin toxicity
|
|
|
MVO2?
|
decrease
|
|
|
MVO2?
|
decrease
|
|
|
name five class II antiarhythmics?
|
timolol, esmolol, atenolol, metoprolol, propanolol
TEAM P |
|
|
name four HMG-CoA reductase inhibitors.
|
Simvastatin, Lovastatin, Atorvastatin Pravastatin,
SLAP |
|
|
name four class IA antiarrhythmics.
|
Quinidine, Amiodarone, Procainamide, Disopyramide
Queen Ann Placed Deserts |
|
|
name four class III antiarhythmics.
|
Amiodarone, Bretylium, Ibutilide, Sotalol
HooK+ fish BAItS |
|
|
name three ACE inhibitors?
|
Captopril, Enalapril, Lisinopril
|
|
|
name three calcium channel blockers?
|
Diltiazem, Verapamil, Nifedipine
DiViNe |
|
|
name three antiarrhythmics in class IB.
|
Mexiletine, Lidocaine, Tocainide
MeLT |
|
|
name three antiarrhythmics in class IC.
|
Flecainide, Encainide, Propafenone
1A. Queen Ann Placed Deserts 1B. that MeLTed 1C. before she could FEed People |
|
|
name three in class IV.
|
Verapamil, Diltiazem, Bepridil
|
|
|
name three K+ sparing diuretics?
|
Spironolactone, Triamterene, Amiloride
(the K+ TRIes to StAy) |
|
|
name two bile acid resins.
|
cholestyramine, colestipol
|
|
|
name two Lipoprotein Lipase (LPL) stimulators.
|
Gemfibrozil, Clofibrate
|
|
|
Nifedipine has similar action to?
|
Nitrates
|
|
|
preferential action of the Ca2+ channel blockers at cardiac muscle?
|
cardiac muscle: Verapamil&gt;Diltiazem&gt;Nifedipine
|
|
|
preferential action of the Ca2+ channel blockers at vascular smooth muscle?
|
vascular sm. Mus.: Nifedipine&gt;Diltiazem&gt;Verapamil
|
|
|
Procainamide- toxicity?
|
reversible SLE-like syndrome
|
|
|
Quinidine- toxicity?
|
cinchonism: HA, tinnitus, thrombocytopenia, torsade de pointes due to increased QT interval
|
|
|
Ryanodine- stie of action?
|
blocks SR Ca2+ channels
|
|
|
selectivity?
|
slectively depress tissue that is frequently depolarized (fast tachycardia)
|
|
|
side effects/problems?
|
tastes bad and causes GI discomfort
|
|
|
side effects/problems?
|
expensive, reversible increase in LFTs, and myositis
|
|
|
side effects/problems?
|
red, flushed face which is decreased by ASA or long term use
|
|
|
side effects/problems?
|
myositis, increased LFTs
|
|
|
side effects/problems?
|
DECREASED HDL
|
|
|
Sotalol- toxicity?
|
torsade de pointes, excessive Beta block
|
|
|
Spironolactone- mechanism?
|
competitive inhibirot of aldosterone in the cortical collecting tubule
|
|
|
TG effect?
|
slight increase
|
|
|
TG effect?
|
decrease
|
|
|
TG effect?
|
decrease
|
|
|
TG effect?
|
large decrease
|
|
|
TG effect?
|
no effect
|
|
|
thiazides- site of action?
|
distal convoluted tubule (early)
|
|
|
toxicity?
|
tachycardia, hypotension, headache - \\'Monday disease\\'
|
|
|
toxicity?
|
nausea, vomiting, diarrhea, blurred vision, arrhythmia
|
|
|
Triamterene and amiloride- mechanism?
|
block Na+ channels in the cortical collecting tubule
|
|
|
Verapamil has similar action to?
|
Beta Blockers
|
|
|
what two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
|
Hydralazine and Minoxidil
|
|
|
which diuretics cause acidosis?
|
carbonic anhydrase inhibitors, K+ sparing diuretics
|
|
|
which diuretics cause alkalosis?
|
loop diuretics, thiazides
|
|
|
which diuretics decrease urine Ca2+?
|
thiazides, amiloride
|
|
|
which diuretics increase urine Ca2+?
|
loop diuretics, spironolactone
|
|
|
which diuretics increase urine K+?
|
all except the K+ sparing diuretics Spironolactone, Triamterene, Amiloride
|
|
|
which diuretics increase urine NaCl?
|
all of them
|
|
|
Acetaminophen has what two clinical uses and lacks what one clinical use of the NSAIDs?
|
Acetaminophen has antipyretic and analgesic properties, but lacks anti-inflammatory properties.
|
|
|
Can Heparin be used during pregnancy?
|
Yes, it does not cross the placenta.
|
|
|
Can Warfarin be used during pregnancy?
|
No, warfarin, unlike heparin, can cross the placenta.
|
|
|
Does Heparin have a long, medium, or short half life?
|
Short.
|
|
|
Does Warfarin have a long, medium, or short half life?
|
Long.
|
|
|
For Heparin what is the 1. Structure 2. Route of administration 3. Onset of action 4. Mechanism of action 5. Duration of action 6. Ability to inhibit coagulation in vitro 7. Treatment for overdose 8. Lab value to monitor 9. Site of action
|
Heparin 1. Structure - Large anionic polymer, acidic 2. Route of administration - Paranteral (IV, SC) 3. Onset of action - Rapid (seconds) 4. Mechanism of action - Activates antithrombin III 5. Duration of action - Acute (hours) 6. Ability to inhibit coagulation in vitro - Yes 7. Treatment for overdose - Protamine sulfate 8. Lab value to monitor-aPTT (intrinsic pathway) 9. Site of action - Blood
|
|
|
For Warfarin what is the 1. Structure 2. Route of administration 3. Onset of action 4. Mechanism of action 5. Duration of action 6. Ability to inhibit coagulation in vitro 7. Treatment for overdose 8. Lab value to monitor 9. Site of action
|
Warfarin 1. Structure - Small lipid-soluble molecule 2. Route of administration -Oral 3. Onset of action - Slow, limited by half lives of clotting factors 4. Mechanism of action - Impairs the synthesis of vitamin K-dependent clotting factors 5. Duration of action - Chronic (weeks or months) 6. Ability to inhibit coagulation in vitro - No
|
|
|
For Warfarin what is the (continued):
|
7. Treatment for overdose - IV vitamin K and fresh frozen plasma 8. Lab value to monitor - PT 9. Site of action - Liver
|
|
|
Is toxicity rare or common whith Cromolyn used in Asthma prevention?
|
Rare.
|
|
|
List five common glucocorticoids.
|
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
|
|
|
Secretion of what drug is inhibited by Probenacid used to treat chronic gout?
|
Penicillin.
|
|
|
The COX-2 inhibitors (celecoxib, rofecoxib) have similar side effects to the NSAIDs with what one exception?
|
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
|
|
|
What are are the Sulfonylureas (general description) and what is their use?
|
Sulfonylureas are oral hypoglycemic agents, they are used to stimulate release of endogenous insulin in NIDDM (type-2).
|
|
|
What are five advantages of Oral Contraceptives (synthetic progestins, estrogen)?
|
1. Reliable (&lt;1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
|
|
|
What are five disadvantages of Oral Contraceptives (synthetic progestins, estrogen)?
|
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression, weight gain, nausea, HTN 5. Hypercoagulable state
|
|
|
What are five possible toxic effects of Aspirin therapy?
|
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye\\'s syndrome 5. Tinnitus (CN VIII)
|
|
|
What are five toxicities associated with Tacrolimus (FK506)?
|
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
|
|
|
What are four advantages of newer low-molecular-weight heparins (Enoxaparin)?
|
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
|
|
|
What are four clinical activities of Aspirin?
|
1. Antipyretic 2. Analgesic 3. Anti-inflammatory 4. Antiplatelet drug.
|
|
|
What are four clinical uses of glucocorticoids?
|
1. Addison\\'s disease 2. Inflammation 3. Immune suppression 4. Asthma
|
|
|
What are four conditions in which H2 Blockers are used clinically?
|
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger-Ellison syndrome
|
|
|
What are four H2 Blockers?
|
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
|
|
|
What are four Sulfonylureas?
|
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
|
|
|
What are four thrombolytics?
|
1. Streptokinase 2. Urokinase 3. tPA (alteplase), APSAC (anistreplase)
|
|
|
What are four unwanted effects of Clomiphene use?
|
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
|
|
|
What are nine findings of Iatrogenic Cushing\\'s syndrome caused by glucocorticoid therapy?
|
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
|
|
|
What are signs of Sildenafil (Viagra) toxicity?
|
Headache, flushing , dyspepsia, blue-green color vision.
|
|
|
What are the clinical uses for Ticlopidine, Clopidogrel?
|
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
|
|
|
What are the four conditions in which Omeprazole, Lansoprazole is used?
|
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger-Ellison syndrome
|
|
|
What are three clinical uses of the Leuprolide?
|
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
|
|
|
What are three clinical uses of the NSAIDs?
|
1. Antipyretic 2. Analgesic 3. Anti-inflammatory
|
|
|
What are three common NSAIDS other than Aspirin?
|
Ibuprofen, Naproxen, and Indomethacin
|
|
|
What are three complications of Warfarin usage?
|
1. Bleeding 2. Teratogenicity 3. Drug-drug interactions
|
|
|
What are three possible complications of Heparin therapy?
|
1. Bleeding 2. Thrombocytopenia 3. Drug-drug interactions
|
|
|
What are three possible toxicities of NSAID usage?
|
1. Renal damage 2. Aplastic anemia 3. GI distress
|
|
|
What are three toxicities of Leuprolied?
|
1. Antiandrogen 2. Nausea 3. Vomiting
|
|
|
What are three toxicities of Propylthiouracil?
|
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
|
|
|
What are three types of antacids and the problems that can result from their overuse?
|
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia, rebound acid increase - All may cause hypokalemia
|
|
|
What are three unwanted effects of Mifepristone?
|
1. Heavy bleeding 2. GI effects (n/v, anorexia) 3. Abdominal pain
|
|
|
What are two Alpha-glucosidase inhibitors?
|
1. Acarbose 2. Miglitol
|
|
|
What are two clinical uses of Azathioprine?
|
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
|
|
|
What are two conditions in which COX-2 inhibitors might be used?
|
Rheumatoid and osteoarthritis.
|
|
|
What are two Glitazones?
|
1. Pioglitazone 2. Rosiglitazone.
|
|
|
What are two mechanisms of action of Propythiouracil?
|
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
|
|
|
What are two processes Corticosteroids inhibit leading to decreased inflammation?
|
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
|
|
|
What are two toxicities associated with Cyclosporine?
|
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
|
|
|
What are two toxicities of the Glitazones?
|
1. Weight gain 2. Hepatotoxicity (troglitazone)
|
|
|
What are two toxicities of the Sulfonylureas?
|
1. Hypoglycemia (more common with 2nd-generation drugs: glyburide, glipizide) 2. Disulfiram-like effects (not seen with 2nd-generation drugs).
|
|
|
What are two types of drugs that interfere with the action of Sucralfate and why?
|
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
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What can result due to antacid overuse?
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Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
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What enzyme does Zileuton inhibit?
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Lipoxygenase
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What enzymes are inhibited by NSAIDs, acetaminophen and COX II inhibitors?
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Cyclooxygenases (COX I, COX II).
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What is a common side effect of Colchicine used to treat acute gout, especially when given orally?
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GI side effects. (Note: Indomethacin is less toxic, more commonly used.)
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What is a common side effect of Misoprostol?
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Diarrhea
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What is a possible result of overdose of Acetaminophen?
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Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
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What is a possible toxicity of Alpha-glucosidase inhibitors used in type-2 diabetes?
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GI disturbances.
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What is a possible toxicity of Ticlopidine, Clopidogrel usage?
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Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
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What is a sign of toxicity with the use of thrombolytics?
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Bleeding.
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What is action of insulin in the liver, in muscle, and in adipose tissue?
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1. In liver, increases storage of glucose as glycogen. 2. In muscle, stimulates glycogen and protein synthesis, and K+ uptake. 3. In adipose tissue, facilitates triglyceride storage.
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What is are two clinical uses of Cyclosporine?
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1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
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What is the category and mechanism of action of Zafirlukast in Asthma treatment?
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Antileukotriene; blocks leukotriene receptors.
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What is the category and mechanism of action of Zileuton in Asthma treatment?
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Antileukotriene; blocks synthesis by lipoxygenase.
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What is the category of drug names ending in -ane (e.g. Halothane)
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Inhalational general anesthetic.
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What is the category of drug names ending in -azepam (e.g. Diazepam)
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Benzodiazepine.
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What is the category of drug names ending in -azine (e.g. Chlorpromazine)
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Phenothiazine (neuroleptic, antiemetic).
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What is the category of drug names ending in -azol (e.g. Ketoconazole)
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Antifungal.
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What is the category of drug names ending in -barbital (e.g. Phenobarbital)
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Babiturate.
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What is the category of drug names ending in -caine (e.g. Lidocaine)
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Local anesthetic.
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What is the category of drug names ending in -cillin (e.g. Methicillin)
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Penicillin.
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What is the category of drug names ending in -cycline (e.g. Tetracycline)
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Antibiotic, protein synthesis inhibitor.
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What is the category of drug names ending in -ipramine (e.g. Imipramine)
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Tricyclic antidepressant.
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What is the category of drug names ending in -navir (e.g. Saquinavir)
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Protease inhibitor.
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What is the category of drug names ending in -olol (e.g. Propranolol)
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Beta antagonist.
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What is the category of drug names ending in -operidol (e.g. Haloperidol)
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Butyrophenone (neuroleptic).
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What is the category of drug names ending in -oxin (e.g. Digoxin)
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Cardiac glycoside (inotropic agent).
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What is the category of drug names ending in -phylline (e.g. Theophylline)
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Methylxanthine.
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What is the category of drug names ending in -pril (e.g. Captopril)
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ACE inhibitor.
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What is the category of drug names ending in -terol (e.g. Albuterol)
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Beta-2 agonist.
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What is the category of drug names ending in -tidine (e.g. Cimetidine)
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H2 antagonist
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What is the category of drug names ending in -triptyline (e.g. Amitriptyline)
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Tricyclic antidepressant.
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What is the category of drug names ending in -tropin (e.g. Somatotropin)
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Pituitary hormone.
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What is the category of drug names ending in -zosin (e.g. Prazosin)
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Alpha-1 antagonist
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What is the category, desired effect, and adverse effect of Isoproterenol in the treatment of Asthma?
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Nonspecific beta-agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
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What is the category, desired effect, and period of use of albuterol in the treatment of Asthma?
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Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
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What is the category, desired effect, and possible mechanism of Theophylline in treating Asthma?
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Methylzanthine; desired effect is bronchodilation, may cause bronchodilation by inhibiting phosphodiesterase, enzyme involved in degrading cAMP (controversial).
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What is the category, mechanism of action, and effect of Ipratroprium in Asthma treatment?
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Muscarinic antagonist; competatively blocks muscarinic receptors, preventing bronchoconstriction.
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What is the category, mechanism of action, and particular use of beclomethasone and prednisone in Asthma treatment?
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Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
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What is the category, method of use, and adverse effects of Salmeterol in Asthma treatment?
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Beta 2 agonist; used as a long-acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
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What is the clincial use for Misoprostol?
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Prevention of NSAID-induced peptic ulcers, maintains a PDA.
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What is the clinical use for Clomiphene?
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Treatment of infertility.
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What is the clinical use for Heparin?
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Immediate anticoagulation for PE, stroke, angina, MI, DVT.
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What is the clinical use for Sildenafil (Viagra)?
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Erectile dysfunction.
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What is the clinical use for Sucralfate?
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Peptic ulcer disease.
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What is the clinical use for Warfarin?
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Chronic anticoagulation.
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What is the clinical use of Mifepristone (RU486)?
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Abortifacient.
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What is the clinical use of Tacrolimus (FK506)?
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Potent immunosuppressive used in organ transplant recipients.
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What is the effect of the Glitazones in diabetes treatment?
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Increase target cell response to insulin.
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What is the enzyme inhibited, the effect of this inhibition, and the clinical use of the antiandrogren Finasteride?
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Finasteride inhibits 5 Alpha-reductase, this decreases the conversion of testosterone to dihydrotestosterone, useful in BPH
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What is the lab value used to monitor the effectiveness of Heparin therapy?
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The PTT.
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What is the lab value used to monitor the effectiveness of Warfarin therapy?
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The PT.
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What is the main clinical use for the thrombolytics?
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Early myocardial infarction.
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What is the mecanism of action of Sucralfate?
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Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid, pepsin, and bile.
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What is the mecanism of action of the COX-2 inhibitors (celecoxib, rofecoxib)?
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Selectively inhibit cyclooxygenase (COX) isoform 2, which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 which helps maintain the gastric mucosa.
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What is the mecanism of action, effective period, and ineffective period of use for Cromolyn in treating Asthma?
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Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
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What is the mechanism of action and clinical use of the antiandrogen Flutamide?
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Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor, used in prostate carcinoma.
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What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
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Inhibit steroid synthesis, used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
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What is the mechanism of action of Acetaminophen?
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Reversibly inhibits cyclooxygenase, mostly in CNS. Inactivated peripherally.
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What is the mechanism of action of Allopurinol used to treat chronic gout?
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Inhibits xanthine oxidase, decresing conversion of xanthine to uric acid.
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What is the mechanism of action of Aspirin?
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Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
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What is the mechanism of action of Clomiphene?
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Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary, which stimulates ovulation.
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What is the mechanism of action of Colchicine used to treat acute gout?
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Depolymerizes microtubules, impairing leukocyte chemotaxis and degranulation.
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What is the mechanism of action of Cyclosporine?
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Binds to cyclophilins (peptidyl proline cis-trans isomerase), blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
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What is the mechanism of action of Heparin?
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Heparin catalyzes the activation of antithrombin III.
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What is the mechanism of action of Mifepristone (RU486)?
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Competitive inibitor of progestins at progesterone receptors.
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What is the mechanism of action of Misoprostol?
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Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
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What is the mechanism of action of NSAIDs other than Aspirin?
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Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
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What is the mechanism of action of Omeprazole, Lansoprazole?
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Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
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What is the mechanism of action of Probenacid used to treat chronic gout?
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Inhibits reabsorption of uric acid.
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What is the mechanism of action of Sildenafil (Viagra)?
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Inhibits cGMP phosphodiesterase, casuing increased cGMP, smooth muscle relaxation in the corpus cavernosum, increased blood flow, and penile erection.
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What is the mechanism of action of the Alpha-glucosidase inhibitors?
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Inhibit intestinal bursh border Alpha-glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
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What is the mechanism of action of the glucocorticoids?
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Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
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What is the mechanism of action of the H2 Blockers?
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Reversible block of histamine H2 receptors
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What is the mechanism of action of the Sulfonylureas?
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Close K+ channels in Beta-cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
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What is the mechanism of action of the thrombolytics?
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Directly of indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin-bound plasminogen to plasmin.)
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What is the mechanism of action of Ticlopidine, Clopidogrel
|
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
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What is the mechanism of action of Warfarin (Coumadin)?
|
Warfarin interferes with the normal synthesis and gamma-carboxylation of vitamin K-dependent clotting factors II, VII, IX, and X, Protein C and S via vitamin K antagonism.
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What is the mechanism of Azathioprine?
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Antimetabolite derivative of 6-mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
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What is the mechanism of Leuprolide?
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GnRH analog with agonist properties when used in pulsatile fashion and antagonist properties when used in continuous fashion, causing a transient initial burst of LH and FSH
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What is the mechanism of Tacrolimus (FK506)?
|
Similar to cyclosporine; binds to FK-binding protein, inhibiting secretion of IL-2 and other cytokines.
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What is the memory key for the action of Sildenafil (Viagra)?
|
Sildenafil fills the penis
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What is the memory key for the effect of aluminum hydroxide overuse?
|
AluMINIMUM amount of feces.
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What is the memory key for the effect of magnesium hydroxide overuse?
|
Mg = Must go to the bathroom.
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What is the memory key to remember which pathway (extrinsic vs. intrinsic) and which lab value Warfarin affects?
|
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
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What is the possible mechanism and effect of Metformin in treating diabetes?
|
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
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What is the specific clinical use of |