mlinnie's version from 2017-09-11 07:19

Diagnosing Cushing Syndrome

Question Answer
Check firstACTH Levels
Normal or Elevated ACTH levels DO WHAT?High Dose dexamethasone test
After Dexamethsone Test -> Suppresed ACTH & Cortisol LevelsPituitary Adenoma
After Dexamethasone Test -> Unchanged ACTH & Cortisol LevelsEctopic ACTH production
Low ACTH levels TO BEGIN WITHAdrenal Adenoma,Adrenal Malignancy, Exogenous Glucocorticosteroid intake


Question Answer
Pt with cat presents with MRI 2.5 CENTIMETER Cyst within left fissureTaenia Solium-> ~Exposure to infected stool!
Conjugate vaccine is betterInduces a more robust immune response through B & T cell activation
Mysthaniea gravis VS Lambort eaton cancerThymoma VS Small Cell lung carinoma
S.Aureus virulence factorProtein A -> Binds to Fc portion IgG
Increase in SV or EF depicted on LVP curveWidening of the isovolumic relaxation line to the left side
Left ventricle/Pressure loopstart from right -> MAAM - COCO
Brown stone in gall bladderHelminth infection induced gall stone due to beta-glucoronidase (Hepatocyte damage)
Obesity Lung function testFEV, FVC,ERV, TLC - DOWN, Residual volume - NORMAL
Sideroblastic anemia congenitalALAS deficiency
Sideroblastic anemia acquiredAlcoholism, B6, Lead posioning
How to differentiate between direct & indirect herniaInferior epigastric vessels
confusion,progressive headache, nausea, vomitingHypertensive Encephalopathy
Mri after stroke lesions shows 4 weeks laterHypertensive arteriolar sclerosis
Metapyrone testBlocks cortisol synthesis by 11b-hydroxylase leading to stimulation of Hypothalamus to release ACTH
Calcium sensing receptorsG-protein coupled receptors with regulates secretion of PTH
Arginase deficiencyHigh arginine levels, LOW Urea & Ornithine -> Tx low protein diet
Multiple sclerosis MOAReduced Saltatory conduction
Mysthania Gravis MOAImpaired Neuromuscular transmission
Blood flow to the ovariesInfundiblopelvic Ligament
Anti-thrombin deficiencyWhen you give heparin to pt -> PTT does not rise -> Because heparin usually binds to anti-thrombin. Tx-Warfarin
Protein C & S deficiency leads toHypercoagulable state because C&S inhibits factors -> Worst in pts with warfarin because C & S runs out first
Causes for Homocystinethrombosis levels increasedB12, FOLATE, Cystathionine beta synthase, B6
DIC VS TPA activatorProlonged PT,PTT & Low platelets/High D-dimers VS Prolonged PT,PTT & NORMAL platelet count/NORMAL D-dimers
Best estimate for DICIncreased D-dimer
Hypovolemia or Renal injuryLow RPF & GFR, High FF
Mucor VS AspergilliosisNon-Septate VS Septate
Lumacaftor & IvacaftorHelps CF pts get the CFTR protein
Father died of colorectal cancer, sister had endometrial cancer, son adenocarcinomaMSH 2 LYNCH SYNDROME(HNPCC)
In 21-OH deficency directly suppress which hormone for the treatment?ACTH
Prosectomy -> Injury to Prostatic plexusErectyline Dysfunction
Liver Failure causesLack of Coagulative Factors & Lack of activation due to lack of epoxide reductase
ITP major complication isSLE tx-> Give IV IgG to fool spleen from eating platelets
ITP is IgG mediatedThrombocytopenia in babies of pregnant women
TTP MOAADAM TS13 deficiency
FF = GFR/RPF -> FF->Check GFR on flow rate / 1-hematocrit
Trigeminal V3 mandibular branch responsibleforMastication -> Foramen Ovale
Tricuspid valveS.Aureus -> Needle stick marks
Meningoma grows of theMeninges
Glioblastoma grows in theMiddle of the brain
Homocystinuria treat withPyridoxine B6
Macula dense of distal arteriole senseLow blood flow & Na
Macula dense stimulate Juxtaglomerular cells of afferent arterioleRelease renin
Initiation of appendicitsObstruction of lumensmooth modified muscle cells~ by fecal
Dobutamine MOAB agonist-> Gs protein adenylate cyclase activation
Mitral valveS.epidermis(no history)
Parinaud syndromelimitation of upward gaze with downward gaze perference, bilateral eyelid retractionMidbrain
Pontine hemorrhagelocked in syndrome, paralysis with eye movements onlyPons below midbrain
Baby with jaundice, dark urine, palecolored stool, with elevated blirubin directBiliary atresia -> Extrahepatic obstruction of bile ducts
Maple syrup urine disease improve condtion with supplementation ofB1, Lipoate, Coenzyme A, B2, B3 (TENDER LOVING CARE FOR NANCY) -> a-ketoacid dehydrogenase requires b1 to work
CGD TestsDHR Flow cytometery -> Green Fluoresence shows normal neutrophils / NBT Test -> Normal makes neutrophils yellow to dark blue
Temporal lobe visual defectAffects meyers loop -> Superior Quandrantanopia Pie in the sky
C-myc Burkitt lymphoma function ->T8,14Transcription Activator
Low pyruvate kinase activity what would you see in spenomegaly?Red Pulp hyperplasia -> Increased work to remove deformed erythrocytes
Pt with stroke history and increased lactate dehydrogenase & wedge shaped kidney lesion is significant diagnosis forThrombomebolic disease -> A-fib
20% has 45X & 80% HAS 46XXPresence of multiple cell lines -> Mosacism
Condensed body composed of heavily methylated DNA at the periphery of the nucleusHeterochromation -> ~Low transcription activity
HCM pts avoid what medication?Isosorbide dinitrate, Amlodipine, Nifedipine, Nitroglycerine, ACE inhibitors, Diuretics
Amlodipine SXBilateral leg swelling with 2+ edema Peripheral edema NOT Angioedema
HypothyroidismIncreased TSH
Minimal change disease why albumin in urine?Increased selective filtration of proteins due to dysfunctional podocytes
Traztuzumab targetsTyrosine Kinase receptor
Net Filtration FractionHydrostatic pressures - Oncotic pressures ->(Pc-Pi) - (Nc-Ni)
In acute intermitent porphyria heme or glucose(dextrose) is given to inhibit what enzyme?ALA Synthase
Empyshema, Pulmonary fibrosisDiffusion limited gas exchange
Hypertensive medication that increases arteriloar dilation, improves renal perfusion, increased natiruresisFenoldopam -> D1agonist
Acquired Lactase deficiency leads to a decrease ofStool pH(Acidic)
Wilson Vs HemochromatosisBasalganglia atrophy VS Liver cirrhosis or hepatocellular carcinoma
DVT -> Acute onset shortness of breathPoor alveolar perfusion
MAO inhibitorsInhibit MAO enzymes in liver and GI -> Cant degrade dietary tyramine -> DELI and wine leads to hypertensive crisis
JanewaylesionsMicroemboli to skin vessels
Extended spectrum beta lactamase E.CholiCarbapenems Plasmid with drug resistance gene
Most Anti-depressants target both serotonin and norepinephrine in NMJ but primary MOA of SSRI is byInhibition of serotonin reuptake transporter
Displacement and dispersion of nissl substanceAxonal reaction NOT Irreversible injury~
Hypothyroidism(Hashimoto thyroiditis)Mononuclear infiltrate consisting of lymphocytes and plasma cells often with germinal centers
Ewing sarcoma affect most commonlyDiaphysis of femur
KEY for lymph node malignancyMonoclonal T cell receptor gene rearrangements NOT Abundant mitotic figures within the lymph node
Osteomyelitis affects most commonlyMetaphysis of long bones due to lack of blood supply
Lower trunk responsible forMedian and ulnar nerve -> Fine finger movement
Antibody agianst neutrophil-myeloperoxidase ?Churg Strauss -> Eosinophilic granulomatosis with polyangitis
3YR old boy with HIGH fever & malaise, limping yesterday and refraining from using right lower extremity No joint effusionHeamotgenous Osteomyelitis
Most common bone cancer in childrenOsteosarcoma then Ewing sarcoma
Osler nodes tenderImmune complex mediated vascular lesions
DermatomyositisGrouton pauples, hip & pelvic muscle weakness high risk forMalignant cancer of -> Lung, Ovary or Colorectal
Uric acid stone ultrasound seen onlyLymphproliferative conditions -> Increased uric acid production OR All other causes -> Increased hydrogen ion excretion in the kidney
Protein is broken down into alanine then converts to Pyruvate -> Glucose with the help ofa-Ketoglutarate
Inferior portion of the heartRight coronary artery
Ability to contract wound and make it smallerMyofibroblasts
Bone marrow stem cell hemaotpoieticCD34
SLE greatest risk for deathRenal failure -> Diffuse proliferative
SLE complicationPregnancy risk due to thrombosis -> Buddchiari -> Hepatic vein thrombosis
What does interferon released from virus infected cells do?Decrease protein synthesis by infected cells promoting apoptosis
Sjogren's syndrome -> SS-a & SS-b antbodies target areRibonucleotide protein
Sjogren's syndrome unilateral growth of parotidsB-cell lymphoma
BuspironeSlow onset of action
MILow cardiac output, PULMONARY CAPILLARY WEDGE PRESSURE, Increase Central venous pressure
Leukocyte alkaline phosphatase normal or IncreasedLeukomoid Reaction -> Basophilic oval inclusions in mature neutrophils
Poison Ivyunmaintained backyardContact Dermatitis -> Type IV hypersensitivity -> T cell lymphocytes
Copper removal from bodyHepatic excretion in bile
Organisms that undergo reassortmentOrthomyxovirus(Influenza), Rotavirus, Reovirus, Bunyaviruses, Arenavirus
CGD organismsS.Aureus, P.cepacia, S.Marcescens, Nocardia, Aspergillios -> Catalase positive Organism
Mediators of painLcE2, p substance, bradykinin
Which molecular pathways of methylprednisolone best explains this improvement?Binding to its cytoplasmic receptor, translocation to the nucleus, and activation of transcription of target genes
45 yo M has a 2-day history of severe abdominal pain. Patient admits to consuming large amounts of alcohol over the past few days. Serum amylase activity of 700, lipase of 850 and serum calcium concentration of 7 Appropriate therapy is initiated; however, the patient dies after 48 hours. Photomicrograph shows the mesenteric fat as seen at autopsy. Which explains the appearance of the fat?Action of pancreatic enzymes on adipose tissue
Systemic candida Bloodculture + for pseudohyphae producing yeast with germ tubesLow Neutrophils
Superficial candidaLow T-Lymphocytes
Pt was out in outdoor trip has fever,cough,malaise, KOH preparation shows large yeast cells with single bud when incubated in 23 C &75.2FDimorphic Blastomyces dermatitidis
CMVEnveloped Double stranded DNA Virus
RhinovirusNonenveloped single strand RNA virus
InfluenzaEnveloped single stranded RNA virus
AdenovirusNonenveloped Double stranded DNA virus
ParvovirusEnveloped single stranded DNA virus
PrimaquineKills Hypnozites & Prevents relapse
Pancreas has 2 types of necrosisFatsurrounding & LiquefactiveOriginal pancreas
Placenta in preeclampsia goes underFibrinoid necrosis
Phosphatidylcholine(Letchin) / Sphinogomyelin2 to 1 Letching higher than sphingomyelin
Orinthine transport deficiency leads to lack of urea leading toAmmonia buildup -> CNS Symptoms -> tx - Balancing Protein intake & output
Pt started on Infliximab presents 10 days later with joint pain, pruritic skin rashSerums Sickness-> Decreased serum C3 & C4 level TYPE III
HBV induced liver injuryCD8 T-lymphocyte
Left dominant circulation 20% -> Lateral left ventricular wall & posterior portion of the septumLeft main coronary artery -> Left circumflex artery -> Left anterior descending
Alcoholic pt with elevated pancreas enzymespancreatitis has bilateral lung opacitiesARDS -> Normal pulmonary wedge pressure!
NitroglycerinDecrease vascular resistance, Increase venous capacity, Decrease end diastolic pressure
Diabetic opthalomoplegia VS Aneurysm compression of CN IIINormal sized reactive pupil & Down/out VS Dilated pupil & loss of accommodation
Pt with Irritable mood, hyperactivity pacing the room, pressured speechloud,rapid,difficult to interrupt, decreased need for sleepnot slept at night for a week, grandiose delusions God true son & heal painManic Disorder -> Bipolar I disorder with psychotic symptoms
What drug works on peripheral artery disease by direct dilation of arteries & inhibiton of platelet aggregationCilostazol
Union of common illiac veins make upIVC
Invasive VS Colonizing AspergillosisInvasive in severely compromised or neutropenic pts VS Colonizing is in normal incompetent pts with prior TB
Initial injury or beginning of atheroscleorisEndothelial cells
Fibrous cap of atheroma is made fromSmooth muscle cells
What causes atherosclerosis to shoot off?Macrophages
Stopping opiod in a pt and then converting them to another drug caused withdrawal symptoms. What was the drug?Buprenorphine
Factor V leiden(Glutamine to arginine substitution) have the greatest risk forPulmonary thromboembolism
Hemophilias greatest risk forRecurrent hemarthroses
Phenylphrine a agonistIncrease BP BUT Decrease HR hence why DECREASE atrioventricular node conduction
GigantismGrowth hormone from Anterior Pituitary -> Release of Insulin Like growth factor 1 from Liver -> Promote bone and cartilage growth
Drug that decreases heart rate but NO effect on contractilityIvabradine -> Inhibit funny sodium channels during phase 4
Bluish color of red blood cells after iron supplementationReticulocytes -> blue color is Ribosomal RNA
Left-right disorientation, unable to carry out simple calculations, read or writeLesion of Dominant parietal lobe
Heavy calcification in the aortic valve of a 75 yrold who is very healthyCalcification due to Cell necrosis
Mediator of septic shockTNF-a NOT INF-y(For granuloma)
anti-EGFR DRUGSCetuximab & pantiumuanab
Power1 - B(Type II error - eg -> Study concludes no difference when there is one in reality)
NonDysjunctionFailure of chromosome pairs to separate during cell divison
Failure of homologus chromosomes happens duringMaternal Meiosis I
Failure of sister chromatids separation happens duringMaternal Meiosis II OR Mitosis
Bacteria has a shape in isotonic solution BUT disintegrate rapidly when placed on hypotonic solution due to which antibiotics?Penicillin, Cephalosporins, Vancomycin
Protein contains multiple a-helical regions with amino acid residues is a form ofTransmembrane protein -> Help other protein anchor to the cell membrane
TMP-SMX +Gancilovir increase risk forNeutropenia
DVT will have what acid disturbance?Respiratory alkalosis
Pregnant women with pain on both feetarthritis, has a baby with pleural effusion pulmonary hypoplasia, ascitesParovirus Nonenveloped single stranded DNA virus
Prostaglandin E2 mediatesFevEr & Pain
Methylation of DNA is -> Catalyze the methylation of cytosine residues in DNA using S-adenosyl-methionine(SAM) as methyl donorGenomic Imprinting -> Fragile X, Prader villi, Angelman