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155 Cards in this Set
- Front
- Back
WBC differential, highest to lowest mnemonic
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Neutrophils Like Making Everything Better
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causes of eosinophilia - mnemonic
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NAACP
neoplasia, asthma, allergies, collagen vascular dz, parasites (invasive) |
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HMWK
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high molecular weight kininogen - adsorbs on biomaterials, activates intrinsic pathway (cofactor in kallekrein, hageman (xii) activation. def increases PTT
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ADP in coagulation
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binds p2y on platelet, causes exposure of many 2b3a receptors for fibrinogen binding
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gp2b/2a - what does it bind?
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fibrinogen. gp2 binds factor 1
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ticlopidine and clopidogrel vs abciximab
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t + c prevent gp2b3a receptor expression by blocking p2y receptor, abciximab directly binds gp2b3a
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warfarin vs heparin
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warfarin prevents activation of vitk (and 2,7,9,10,c,s). heparin activates AT3, which inactivates 2,7,9,10,11,12?)
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basophilic stippling mnemonic
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BASte the ox TAIL - thlassemias, anemias of chronic dz, lead poisoning (inhibition of ribonucleotide reductase)
rRNA accum in cytoplasm |
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siderblastic anemia
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inability to incorporate Fe into Hb - fe accum in mitochondria
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target cell mnemonic
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HALT said the hunter! HbC, Asplenia, Liver dz, Thalassemia
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deficiency in ALA synthase
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x linked siderblastic anemia, tx is B6
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causes of siderblastic anemia
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alcoholism, lead poisoning, heredity. cannot incorporate Fe into heme
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anemia w/ inc homocysteine and normal methylmalonic acid
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folate def
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anemia with inc homocysteine and inc methylmalonic acid
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b12 def
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hepcidin
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increased during inflammation, decreases releace of Fe from macrophages, reasulting in anemia of chronic dz. dec fe, dec tibc, inc ferritin
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Lead poisoning - enzymes effected and accum substrates
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ala dehydratase + ferrochelatase, accumulate protoporphyrin and delta ALA
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Acute Intermittent porphyria - enzymes and substrates
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porphobilinogen deaminase (aka uroporphyrinogen synthase) - accumulate porphobilinogen, delta ALA
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AIP - mnemonic
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5 Ps, painful abdomen, pink urine, polyneuropathy, psychological distrubance, precipitated by drugs, porphobilinogen accumulation
tx glucose and heme |
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Porphyria cutanea tarda - enzymes and substrates
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uroporphyrinogen decarboxylase, accumulate uroporphyrin.
blistering photosensitivity, MC porphyria |
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lead poisoning mnemonic
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LEAD - lead lines on gums and bone, encephalopathy + erythrocyte basophilic stippling, abdominal colic and siderblastic anemia, drops (wrist, foot), dimercaprol, eDta, succimer
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bernard soulier dz - defect, PC, BT, tx
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gp1b, low PC, high BT, giant platelets, give platelets, defect in formation and adhesion to collagen
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glanzmanns thormbasthenia - defect, PC, BT, tx
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gp2b/3a, normal PC, high BT, defect in aggregation
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idiopathic thrombocytopenic purpura
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anti gp2b3a antibodies, PC down, BT up, peripheral destruction, increased megakaryocytes
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thrombotic thrombocytopenic purpura
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ADAMSTS13 defect (vWF metalloproteinase), dec degradation of multimers. large vWF multimers, Inc platelet agg, schitsocytes + LDH,
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lab shows : inc fibrin split products (d dimers), dec fibrinogen, dec favtors V and VII
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DIC
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reduced increase in PTT on heparing administration. dz?
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AT3 defiency
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what increases risk of hemorrhagic skin necrosis following warfarin administration?
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protein C and S defiency, cannot inactivate V and VII
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nodular sclerosing hodgkins lymphoma
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collagen banding around lacunar cells creates nodules of neoplastic cells. low number of RS cells, MC hodgkins
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mantle cell lymphoma
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NHL, older men, t(11:14), poor prognosis, CD5+
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follicular lymphoma
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t(14:18), 40% of NHL, bcl2 expression inhibits apoptosis, indolent waxing / waning lymphoma
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diffuse large B-cell lymphoma
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MC (50%) adult NHL, EBV / AIDS association
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Mycosis fungiodes
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indolent, adults w/ cutaneous nodules- CD4 cells, called sezary if leukemic phase occurs
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Multiple myeloma vs waldenstorms macroglobulinemia
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MM- CRAB, hypercalcemia, lytic bone lesions, back pain, anemia, renal failure, IgG and IgM
WM- IgM only, macroglobulinemia, no lytic lesions no sx of lymphoma = MGUS |
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age groups for leukemias: CML, AML, CLL, ALL
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ALL <15
CML 30-60 AML ~60 median onset CLL > 60 |
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leukemoid rxn
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inc wbc w/ left shift (80% bands), inc leukocyte alp, no inc in alp is specific for CML
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t(11:14)
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man11e cell lymphoma
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t(15:17)
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acute promyelocytic, auer rods, DIC, isotretinoin
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t(14,18)
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follicular lymphoma, indolent, waxing / waning
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t(11,22)
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ewing sarcoma, malignant round cells in diaphysis of bone
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t(9,22)
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CML, philadelphia chromosome, imatanib
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t(8,14)
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burkitt's lymphoma, starry sky
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S100 + CD1a
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langerhans histiocytosis X - letterer siwe (baby), hands schuller christian (DI, lytic, exopthalmos), eosinophilic granuloma
birbeck tennis rackets |
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RBC up, WBC up, platelets up, philly neg, JAK2 pos
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polycythemia vera
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RBC normal, WBC normal, platelets up, philly neg, JAK2 pos
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essential thrombocytosis
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RBC down, WBC var, platelets var, philly neg, JAK2 pos
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myelofibrosis
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RBC down, WBC up, platelets up, philly pos, JAK2 neg
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CML
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hirudin, lepirudin, bivalrudin
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directly inhibit thrombin, alternative to heparin for pts w/ HIT
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aminocaproic acid
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anti fibronolytic, treats OD of streptokinase, urokinase, tPA (ansteplase), anistreplase
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thrombolytics - mechanism
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aid directly or indirectly in cleavage of plasminogen to plasmin
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ticlopidine vs clopidogrel:
which ones causes serious side effect? |
ticlopidine (neutropenia) - both are irrev inhibitors of gp2b3a
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etoposide
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inhibits topoisomerase 2, blocking dna synth, myelosuppression, GI hair problems
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6mp vs 6thioguanine
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both activated by HGPRTase, but 6mp is degraded by XO, so cannot be given w/ allopurinol while 6TG can
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hodgkin lymphoma tx (mnemonic)
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ABVD - adriamycin (doxo), bleomycin, vincritine, dacarbazine
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doxorubicin (adriamycin)
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noncovalently intercalates DNA, breaks it. cardiotoxic, myelosuppression (give w/ molgramostim gmcsf)
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bleomycin
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G2 phase free radicates breaks DNA strands, pulm fibrosis, minimal myelosuppression
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cyclophosphamide
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covalently x-link DNA at guanine, hemorrhagic cystitis (mesna)
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nitrosureas (-mustines)
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alkylating agent for brain tumors including GBM, CNS toxicity
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busulfan
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alkylating agent, for CML, pulm fibrosis
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antimetabolite drugs
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good for leukemias - methotrexate, 5FU, 6MP, 5TG, Cytarabine
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how to rescue bone marrow w/ mtx or 5FU
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mtx - leucovorin (folinic acid)
5fu - thymidine - 5fu = photosenstivity |
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vincristine
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binds / blocks microtubules - neurotoxic effects
vinblastine BLASTS bone marrow |
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paclitaxel
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sTAX microtubules, doesnt let them collapse - ovarian and breast CA
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cisplatin carboplatin
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cross linker, nephro / ototoxic
amofostine prevents nephrotoxicity |
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hydroxyurea
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ribonucleotide reductase inhibitor
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tamoxifen vs raloxifene
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both are anti ER, agonists in bone, tamox is partial agonist in endometrium, may cause cancer / hot flashes, ralox is endo antagonist
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falciform ligament - contents
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ligamentum teres, derived from fetal umbilical vein
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hepatoduodenal ligament - contents
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portal triad: hepatic artery, portal vein, common bile duct
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gastrohepatic ligament - contents
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gastric arteries (l gastric off celiac, r gastric off common hepatic)
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gastrocolic ligament - contents
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gastroepiploic arteries
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gastrosplenic ligament - contents
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short gastrics
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spenorenal ligament - contents
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splenic a. and v.
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gi histo: brunners glands and crypts of lieberkuhn
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deuodenum
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gi histo: most goblet cells in small intestine
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jejunum (its got jujubees)
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gi histo: peyers patches and crypts of lieberkuhn
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ileum, keeps you from gettin ill
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gi histo: crypts but no villi
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colon
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circulation above pectinate line
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portal - IMA, sup rectal a + v, IMV, portal system
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circulation below pectinate line
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caval, all I's - internal iliac, internal pudendal a, inf rectal a + v, int pudendal v, int iliac v, IVC
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layers around spermatic cord
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3 layers of fascia, 1 muscle. transversalis fascia (int spermatic fascia), cremaster m and fascia (int oblique), int and ext oblique fascia (ext spermatic)
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contents of femoral triangle
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to find your NAVEL, go lateral to medial
nerve artery vein empty lymph |
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indirect vs direct hernia - mnemonic
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MDs dont LIe
Medial direct, lateral indirect |
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where do IgA secreting cells reside?
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peyers B-cells are stimulated into germinal centers, diff into IgA plasma cells that reside in lamina propria. needs secretory component
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plummer vinson syndrome triad
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fe def anemia, dysphagia (webs) and glossitis
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ABCs of esophageal cancer
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Alcohol/Achalasia
Barretts Cigarettes Diverticuli Esophageal webs / esphagitis Familial |
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whipple's dz - whats it really similar to?
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lyme dz + diarrhea - arthralgias, cardiac and neuro problems. tx w/ penicillin.
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curling vs cushing ulcers
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get burned by curling iron, low blood vol causes sloughing.
always cushion brain |
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type A chronic gastritis
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Autoimmune, antibody mediated, macrocytic Anemia, Achlorhydria, occurs in Body
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type B chronic gastritis
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Bacterial, occurs in Antrum
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Mentrier dz
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edema ascites from protein loss, brain gyri, inc adenoCA risk, low HCl high gastrin
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three signs of stomach CA
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virchows node, st mary josephs nodule, krukenberg tumor, acanthosis nigricans
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L vs R colon cancer
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distal left = obstruction
proximal right = anemia right better prognosis |
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peutz jeghers
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AD, multiple non mal. hamartomas in gi, hyperpigmented mouth lips genetalia, inc risk CRC, brca, gyny ca
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Gardners
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FAP + osseous + soft tissue tumors
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turcots
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FAP + malignant CNS tumors
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ABCDs of Wilsons
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Asterixis, Basal ganglia degeneration, Ceruloplasmin down, Cirrhosis, Corneal deposits, Copper accum, Carcinoma, Choreiform movements, Dementa, Hemolytic anemia, hepatolenticular degenration
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PBC vs PSC
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PBC - ANA+ granulomas, anti mito antibodies, inc HCC risk, women
PSC - concentric beading, intra+extrahepatic, cholangiosarcoma risk, in MEN - ass w/ UC, hyperIGM |
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charcot's triad of cholangitis
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jaundice, fever, ruq paint
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Acute pancreatitis mnemonic
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GET SMASHED - gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion sting, hypercalc/lipidemia, ERCP, drugs (sulfa)
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proton pump inhibitors - reversible or irreversible?
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irreversible
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muscarinic antagonists for acid hypersecretion
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pirenzepine + propantheline - blocks M1 on ECL, M3 on parietal cell
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ondansetron
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5ht3 antagonist, central acting antiemetic, for postoperative nausea and chemo
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metoclopramide vs domperidone
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D2 rec antagonists, increase gastric tone / motility. met has parkinsonian effects, crosses BBB, both interact w/ diabetic + digoxin agents due to K+ opening Gi
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Pituitary gland - basophils?
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B-FLAT
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Pituitary gland - acidophils?
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PG - not B-flat, remainder of PiG
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CAH - hypotension, salt wasting
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21 alpha hydroxylase
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What do all CAHs have in common?
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decreased cortisol, increased ACTH -> adrenal hyperplasia
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CAH - sexual infantilism in XX or external female w/ no internal female organs in XY
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17 alpha hydroxylase
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masculinization w/ hypertension
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11 beta hydroxylase
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masculinization w/ hypotension
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21 alpha hydroxylase
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decreased cortisol and mineralocorticoids
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21 alpha hydroxylase
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decrased cortisol, aldosterone and corticosterone, increased 11-DOC (mineralocorticoid)
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11 beta hydroxylase
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decreased serum Mg+2?
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decreases Pth secretion. less competition from Ca+2
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common causes of decreased serum Mg+2?
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diarrhea, diuretics, AG and alcohol abuse.
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sex hormone binding globulin - what does it have higher affinity for?
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testosterone, so increasing SHBG decreases free T.
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increase SHBG in men?
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gynecomastia
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decrease SHBG in women?
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hirsutism
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cortisol's effect on epinephrine?
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upregulates alpha1 receptors, raising blood pressure
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thyroxine's effect on epinephrine?
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upregulates beta1 receptors, increasing CO, HR, SV
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T3 functions - mnemonic
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4B's - brain maturation, bone growth, beta adrenergic effects, BMR up.
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what increases / decreases TBG?
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thyroid binding globulin.. increased by Estrogen/OCPs, decreased by hepatic failure
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low TBG and high T4?
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exogenous thyroid hormone - also low TSH, high T4, T3 and rT3
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normal TSH?
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always euthyroid
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electrolyte imbalances:
Na+ n/c K+ down HCO3- up |
primary mineralocorticoid excess (Na+ is normal because of ANP releace w/ increased plasma volume.)
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electrolyte imbalances:
Na+ down K+ up HCO3- down |
primary adrenocortical insufficiency (addisons)
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electrolyte imbalances:
Na+ n/c K+ down HCO3- down |
renal tubular acidosis
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electrolyte imbalances:
Na+ down K+ down HCO3- up |
diuretic use (alkalosis 2/2 dec K+/H+)
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electrolyte imbalances:
Na+ down K+ n/c HCO3- n/c |
SIADH (ADH overpowers aldosterone)
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pot bellied, pale, puffy faced child w/ protruding umbilicus and protuberant tongue dx?
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cretinism aka fetal hypothyroidism
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Hypercalcemia causes?
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CHIMPANZEES
Calcium ingestion, Hyperparathyroid, Hyperthyroid, Iatrogenic (thiazides), Multiple myeloma, Paget's, Addison's, Neoplasms, Zollenger Ellison, Excess vitamin D, Excess vitamin A, Sarcoidosis |
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osteitis fibrosa cystica mnemonic
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"stones bones and groans", cystic bone spaces filled w/ brown fibrous tissue. 2/2 primary hyperparathyroidism. groans = constipation, stones = renal stones.
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pseudohypoparathyroidism
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albright's hereditary osteodystrophy. AD, kidney not responsive to PTH. Hypocalcemia, shortened 4th and 5th digits, short stature.
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hyponatremia + urine osmolarity > plasma osmolarity = ?
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SIADH
tx: demeclocycline |
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SIADH causes?
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Ectopic ADH (small cell ca)
cns disorders / head trauma pulm dz drugs (ie cyclophosphamide) |
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MEN2a and b - what do they both have?
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pheochromocytoma and medullary thyroid cancer
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MEN2a and b - how are they different?
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MEN2a aka sipple syndrome also has parathyroid tumor (normal Ca+2)
MEN2b has oral / intestinal ganglioneuromatosis / marfanoid habitus / low Ca+2 |
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which diabetic drugs dont cause hypoglycemia?
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thiazolidinediones and metformin
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biguanides / metformin toxicity
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lactic acidosis - contraindicated in renal failure
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drugs for post prandial hyperglycemia?
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short acting insulins: lispro, aspart, regular
alpha glucosidase inhibitors : acarbose and miglitol |
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exenatide MOA
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GLP-1 mimetic, inc insulin, dec glucagon - nausea vomiting pancreatitis
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pramlintide
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mimetic decreases glucagon, causes nausea, vomiting, diarrhea
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which long acting insulins require 1 and 2 shots per day?
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1 for glargine
2 for NPH total = 4 and 5 shots |
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sibutramine
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sympathomimetic serotonin and NE reuptake inhibitor - anorexiant. may cause htn and tachycardia
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propylthiouracil vs methimazole
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both inhibit organification of iodide and coupling of thyroid hormone synthesis. PTU decreases peripheral conversion of T4 to T3.
agranulocytosis / aplastic anemia |
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kallmann syndrome
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low FSH, LH from anterior pituitary, primary amenorrhea, no 2ndary sexual characters,, AD inheritance, occurs in men and women, delayed puberty (hypogonatotropic hypogonadism)
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HELLP syndrome
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hemolysis, elevated lfts, low platelets, associated w/ preeclampsia, mortality due to cerebral hemorrhage and ards
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tx for eclampsia
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iv mgso4 and diazepam.
bed rest, salt restriction, tx of htn (hydralazine) |
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PCOS
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inc LH, inc ovarian stromal stim, inc androgens, inc estrogens, inc pituitary sensitivity to LRL, inc pit LH release. LOW FSH. Tx: increase FSH to break cycle, spironolactone anti androgen
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epithelial ovarian tumors
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My Med Students Consistently Beat Exams
Mucinous, Mixed, Serous, Clear cell, Brenner, Endometrioid |
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meig's triad
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ovarian fibroma, ascites, hydrothorax (often left sided pleural effusion)
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granulosa cell tumor
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call exner bodies - small follicles filled w/ eosinophilic secretions, precocious puberty, uterine bleeding
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radial nerve innervation
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its the BEST
brachioradialis, extensors of the hand, supinator, triceps |
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radial nerve innervation
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its the BEST
brachioradialis, extensors of the hand, supinator, triceps |
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contents of thenar compartment
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OAF
opponens pollicis, abductor pollicis brevis and flexor pollicis brevis |
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contents of hypothenar compartment
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OAF
opponens digiti minimi, abductor digiti minimi, flexor digiti minimi |
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dorsal interossei
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abduct dabs
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palmar interossei
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adduct pads
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