Everyday 4

zoyogasa's version from 2016-04-14 05:32


Question Answer
RCAInferior wall of left ventricle leads II,III,aVF
LADAnteroseptal transmural ischemia lead V1-V4
LCXV5 & V6 I, aVL


Question Answer
+Lancet AdultsStrep Pneu
+Clusters Skull surgery or injuryStaphyl Aur
+Chains NeonatalStrep Agalac
+Rods Neonatal/ Immunocomp/ ElderlyListeria Monocytogenes
-Bean Shaped(2nd Adults)NeISSEria Mening


Question Answer
CocaineChestpain, Seizures
LSDVisual Hallucinations
Phencyclidine(PCP)Nystagmus, Violent
MethamphetamineTooth Decay, Violent, Diapohersis, Choreiform, Tachycardia
Marijuana↑Appetite, Impaired Time perception, Conjunctival Injection
HeroinDepressed Mental Status & Respiratory, Miosis,


Question Answer
21Hydroxylase↓Cortisol & Aldosterone ↑Tesosterone & 17hydroxyprogesterone
21HydroxylaseAmbigious Genitalia girls, Salt wasting(Vomiting,hypotension, ↓Na↑K
11b Hydroxylase↓Cortisol & Aldosterone ↑Tesosterone & 11 deoxycorticosterone
11b HydroxylaseAmbigious Genitalia girls, Fluid &Salt Retention = Hypertension
17a hydroxylase↓Cortisol & Testosterone ↑Mineralcortico & Corticosterone
17a hydroxylasePhenotypically female, Fluid &Salt retention = Hypertension

Inhibition of Enzymes

Question Answer
CompetitiveActive site
CompetitiveIncreases Km apparent
CompetitiveDoes not affect Vmax
CompetitiveOvercome by additional substrate
NoncompetitiveNonactive site
NoncompetitiveDecreases Vm
NoncompetitiveDoes not affect Km
NoncompetitiveCannot be overcome by additional substrate


Question Answer
Shrinkage of cellbodyRed Neuron
Pyknosis of the nucleusRed Neuron
loss of nissl substanceRed Neuron
Eosiniophilic CytoplasmRed Neuron
Transient Sever insult that leads to cell deathRed Neuron
Loss of axonAxonal Reaction
Enlargement of cell bodyAxonal Reaction
Eccentric NucleusAxonal Reaction
Enlargement of the nucleolusAxonal Reaction
Dispersion of Nissl SubstanceAxonal Reaction
Progressive Degenerative diseaseNeuronal Atrophy
loss of neurons and functional groups of neuronsNeuronal Atrophy
Reactive GliosisNeuronal Atrophy


Question Answer
Jugular Venous Pulses (At Carter's Xing, Vehicles, Yield) a = RA contraction, c = RV contraction (tricuspid bulges into RA), x - Mean systemic filling pressure. v = RA filling (increasing RA pressure against closed tricuspid valve). y = when blood flow from RA to RV

Breast Cancer

Question Answer
FibroadenomaSmall, mobile, firm mass with sharp edges
Most common tumor in women < 35 y/o
↑ size/tenderness with ↑ estrogen (pregnancy/menstruation)
Benign - not a precursor to breast cancer
Intraductal papillomaSmall tumor that grows in lactiferous ducts beneath areola
Serous or bloody nipple discharge
Slight (1.5-2x) ↑ risk for carcinoma
Phyllodes tumorLarge bulky mass of connective tissue and cysts w "Leaf-like" projections
Most common in pts in their '50s
Some may become malignant
Malignant breast tumors (general info)Commonly post-menopausal, arising from terminal duct lobular unit in upper-outer quadrant of breast
Overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common → affects therapy and prognosis
Single most important prognostic factor in breast cancersaxillary lymph node involvement indicating metastasis
Ductal carcinoma in situ (DCIS)Fills ductal lumen - arises from ductal hyperplasia, calcifications
Early malignancy without basement membrane penetration
Comedocarcinomanon-invasive ductal, caseous necrosis
Subtype of DCIS
Invasive ductalWorst and most invasive breast cancer
Firm, fibrous, "rock-hard" mass with sharp margins and small, glandular, duct-like cells
Classic "stellate" morphology
Most common (76% of all breast cancers)
Invasive lobularOrderly row of cells ("Indian file")
Bilateral with multiple lesions in the same location

MedullaryFleshy, cellular, lymphocytic infiltrate
Good prognosis
InflammatoryDermal lymphatic invasion by breast carcinoma
Peau d'orange (breast skin resembles orange peel)
Neoplastic cells block lymphatic drainage
50% survival at 5 years
Paget's diseaseEczematous patches on nipple
Paget cells = large cells in epidermis with clear halo
Suggests underlying DCIS
Also seen on vulva


Question Answer
TGF-aEpithelial & Fibroblast growth factor
TGF-bImportant fibroblast growth factor
PDGFEndothelium, Smooth muscle, fibroblast growth factor
*FGFAngiogenesis, Skeletal Development
MyofibroblastContract wound & decrease granulation
KeloidOut of proporition Type 3
Hypertrophic scarType 1


Question Answer
Monosodium urateNeedle Shaped
Monosodium urateNegatively Birefringent "Grumpy"
Monosodium urateYellow crystals Parallel
Monosodium urateBlue perpendicular
Monosodium urateGout
Calcium PyrophosphateRhomboid Crystals
Calcium PyrophosphateWeakly Positively Birefringent "Fake Happy"
Calcium PyrophosphateYellow when Perpendicular
Calcium PyrophosphateBlue when parallel
Calcium PyrophosphatePseudogout


Question Answer
Coccidioides (spherules filled with endospores)Southwestern
Histoplasma (Macrophage filled with Histoplasma)Missisipi and Ohio
Blastomycosis (Broadbase budding)East of Missisipi and Central America
Para-coccidiomycosis(budding yeast with captains wheels)Latin America

Heart Valve

Question Answer
AorticSecond Right intercostal Space at the right sternal border
PulmonicSecond Left intercostal space at the left sternal border
TricuspidFourth Left intercostal space at the lower left sternal border
MitralFifth Left intercostal space, medial to the mid clavicular line

Lobar Stages

Question Answer Column 3
Congestion<24hrsRed,heavy,BoggyVascular Dilation, Alveolar Exudate with bacteria
Red Hepatization2-3daysRed, Firm liver like lobeAlveolar Exudate contains RBC, Neutrophils, fibrin
Gray Hepatization4-6daysGray Firm LobeRBC disintegrates leaving Neutrophils and Fibrin
ResolutionRestoration of Normal ArchitectureEnzymatic Digestion of Exudate


Question Answer
Lymphoid Follicle(Cortex)B Cell (Brutons- Germina/hiv/RA)
Lymphoid MedullaCords - Lymphocytes & Plasma
Lymphoid ParacortexT Cell & Dendritic (DiGeorge/Viral)
ThymusT cells
Cortex of ThymusImmature T, + Selection
Medulla of ThymusMature T, - Selection
BonemarrowB cells
Spleen RedpulpMacrophages
Spleen White PulpB cells
Spleen periarterial (white pulp)T cell


Question Answer
-RBC,-SaO2, -EPO, ↓PlasmaRelative HCT>52%
Dehydration,Excess DiureissRelative HCT >52%
↑RBC, -SaO2, ↓EPO, ↑PlasmaPrimary Polycythemia
↑RBC, ↓SaO2, ↑EPO, -PlasmaSecondary Polycythemia Physiologic Hypoxia
↑RBC, -SaO2, ↑EPO, -PlasmaSecondary Polycythemia EPO tumors

Ulcerative vs Crohns

Question Answer
Perianal FistulaCrohns
Non Caseating GranulomasCrohns
Rectal Sparing(Skip)Crohns
String sign, creeping fat, linear ulcers, fissuresCrohns
Diarrhea bloody or NOTCrohns
Migratory Polyartheritis, Erythema Nodusm, Kidney StoneCrohns
Th2Ulcerative Colitis
AutoimmuneUlcerative Colitis
Rectum InvolvedUlcerative Colitis
Continous DamageUlcerative Colitis
Mucosa and submucousaUlcerative Colitis
Bloody diarrhea with or without painUlcerative Colitis
Adenocarcinoma, MegacolonUlcerative Colitis

Pemphigus Vs Bullous

Question Answer
IgG antibody against desmosomesPemphigus
Netlike PatternPemphigus
SKIN & ORALPemphigus
IgG antibody agianst hemidesmosomesBullous
Eosinophls tense blistersBullous

Osteoarthri VS Rheum

Question Answer
Wear & TearOsteoarthritis
Ivory PolishedOsteoarthritis
Pain end of the dayOsteoarthritis
Improving with restOsteoarthritis
Articular cartilageOsteoarthritis
No Systemic SymptomsOsteoarthritis
Age, ObesityOsteoarthritis
Synovial JointRheum
Ulnar deviationRheum
Morning Sitfness >30minsRheum
Improving with useRheum

Other breast conditions

Question Answer
MCC of "breast lumps" from 25-menopauseFibrocystic disease
Fibrocystic diseasePresentation: prementstrual breast pain and multiple lesions, often bilateral
Usually does not indicate ↑ risk of carcinoma
Fibrosis - fibrocystic diseasehyperplasia of breast stroma
Cystic fibrocystic diseasefluid filled, blue dome
Ductal dilation
Sclerosing adenosis - fibrocystic disease↑ acini and intralobular fibrosis
Assoc w calcifications
Often confused with cancer
Epithelial hyperplasia - fibrocystic disease↑ in number of epithelial cell layers in terminal duct lobule
↑ risk of carcinoma with atypical cells
Women > 30 y/o
Acute mastitisBreast abscess
During breast-feeding
↑ risk of bacterial infxn through cracks in nipple
Staph A. is the most common pathogen
Fat necrosisA benign, usually painless lump
forms as a result of injury to breast tissue
Up to 50% of patients may not report trauma
GynecomastiaHyperestrogenism in males → boobies
Non-drug causes of gynecomastiaCirrhosis, testicular tumor, puberty, old age, Klinefelter's syndrome
Drug causes of gynecomastia"Some Drugs Create Awkward Knockers"
Others: estrogen, heroin, marijuana, psychoactive drugs

Male Path

Question Answer
Prostatitisdysuria, frequency, urgency, low back pain
Cause of acute prostatitisBacterial (E. coli)
Cause of chronic prostatitsBacterial or abacterial (most common)
BPHHyperplasia (not hypertrophy) of prostate gland
Nodular enlargement of later & middle lobes (periurethral)
Not a premalignant lesion
Treatment of BPHα1- antagonists (terazosin, tamsulosin) → relacation of smooth muscle
Prostatic adenocarcinomaMost arise from posterior lobe (peripheral zone)
Dx vs ↑ PSA and subsequent needle-core biopsy
Useful tumor markers: Prostatic acid phosphatase (PAP), PSA - ↑ total PSA w ↓ fraction of free PSA
Lower back pain indicates osteoblastic mets (↑ serum alk phos and ↑ PSA)
Cryptorchidismundescended testis (one or both)
Impaired spermatogenesis due to ↑ temp
↓ inhibin, ↑ FSH, ↑ LH, ↓ testosterone (bilateral) or normal testosterone in unilateral
Assoc w ↑ risk of germ cell tumors
Prematurity increases the risk of cryptorchidism
VaricoceleDilated veins in pampiniform plexus as a result of ↑ venous pressure (MC on left side)
↑ temp → can cause infertility
MCC of scrotal enlargement in adult males
"bag of worms"
Tx: varicocelectomy, embolization by interventional radiology
Testicular mass that doesn't transilluminatecancer
Painless, homogenous testicular enlargement
MC testicular tumor
Males 15-35
Large cells in lobules with water cytoplasm and a "fried egg" appearance
↑ placental alkaline phosphatase (PLAP)
radiosensitive, late mets so excellent prognosis
Yolk sac (endodermal sinus) tumorYellow, mucinous.
Analog to ovarian yolk sac tumor
Shiller-Duval bodies resemble primitive glomeruli (↑ AFP)
↑ hCG
Disordered syncytiotrophoblastic and cytotrophoblastic elements
Hematogenous mets to lungs
Gynecomastia as hCG is an analog of LH
TeratomaOften malignant (unlike in females)
Benign in children
↑ hCG and/or AFP in 50% of cases
Embryonal carcinomaMalignant
Worse prognosis
Glandular/papillary morphology
"pure" embryonal carcinoma is rare - most commonly mixed with other tumor types
Assoc w ↑ hCG and normal AFP levels when pure (↑ AFP when mixed)
Testicular germ cell tumors (general)~95% of all testicular tumors
Most often malignant
Leydic cell testicular tumorReinke crystals
Adnrogen producing → gynecomastia in men, precocious puberty in boys
Golden brown color
Sertoli cell testicular tumorAndroblastoma from sex cord stroma
Testicular lymphomaMC testicular cancer in older men
Not a primary cancer - arises from lymphoma mets to testes
Hydrocele↑ fluid 2° to incomplete fusion of processus vaginalis
Spermatoceledilated epididymal duct (tunica vaginalis lesion)
SCC of the penisMore common in asia, africa, and south america
Assoc w HPV & lack of circumcision
Peyronie's diseaseBent penis d/t acquired fibrous tissue formation
PriapismPainful sustained erection not assoc w sexual stimulation or desire
Assoc w trauma, sickle cell disease, medications (anticoagulants, PDE5 inhibitors, antidepressants, α-blockers, cocaine)


Question Answer Column 3
9.22ABLSignal Transducer
11.14MantleCCND1(cyclin d1)
15.17AML M3Auer rods - DIC
11.22Ewings Sarcoma
12.21ALL: Good prognosis
GradingDifferentiationArchitecture & Nuclear features
StagingSize & SpreadKey prognostic Factor
TSizeOR depth
NSpread to lymph nodes2nd prognostic factor
MMetastasis1st prognostic factor