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68 Cards in this Set
- Front
- Back
type of polyp that occurs in the rectum and rectosigmoid colon. Very high risk for malignant transformation and may present with rectal bleeding, hypokalemia, and hypoproteinemia
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villous adenoma
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Form of FAP with mandilbe and skull tumors, epidermal cytsts, and a very high risk for abnormal dentition (messed up teeth)
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Gardner's syndrome
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Serious form of cancer d/t DNA mismatch repair genes. Increased risk for colon cancer with NO polyps. Pt is at huge risk for MULTIPLE CARCINOMAS especially the endometrium and ovary
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HNPCC
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GN recognized clinically by slow, chronic progression. LM shows double-layered basement membrane seen best with silver stain. Decreased serum C3
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membranoproliferative GN
tram-tracking |
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Classical physical finding is Muehrcke's nails, paired narrow horizontal white bands on fingernails
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Most often seen with hypoalbuminemia associated with nephrotic syndrome
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pathognomonic is increased mesangial matrix either diffusely or in nodules
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this is the definition of "Kimmelstiel-Wilson nodules"
Diabetic GN |
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Immune complex deposition along the glomerular basement membrane, leading to a typical granular appearance in immunofluorescence testing. This is PN for which GN?
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Type 4 Lupus GN
1 - no renal 2 - mesangial disease with focal segmental glomerular pattern 3 - focal segmental proliferative disease 5 - simply membranous GN |
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Name of condition when calcium is reabsorbed from from bone d/t renal failure and PTH is increased 2nd to high levels of P++
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Osteitis fibrosa cystica
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Type of GN, labs show urine red cells and casts, decreased C3, and increased titers. EM shows subEPIthelial 'humps" and immunoflorescence shows granular IgG/ C3 deposits
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poststreptococcal GN
ASO titer pt typically recovers |
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type of GN, deposition of fibrin and proliferation of epithelial cells and monocytes, hemoptysis late in disease, rapidly progressive. Classic EM shows immunofluorescent linear deposition of IgG
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Crescentic (RP) GN
nephritis progresses to renal failure in about a month Goodpasture's falls into this category |
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Hereditary nephritis d/t collagen abnormality, sx: renal disease, deafness, lens dislocation and cataracts, EM shows GBM splitting
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Alport's syndrome
X-linked so Dad can't pass to son |
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Most common world-wide nephropathy, presents concurrently or within DAYS after infection (PSGN/PIGN = weeks after infection), IgA deposits in mesangium, sx: hematuria with low-grade proteinuria
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Berger's disease (IgA nephropathy)
Eat a burger with my mouth |
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Child presents with abdominal pain, vomiting, hematuria and GI bleeding post respiratory infection. PE findings raised bumps on on butt and legs
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Henoch-Schonlein purpura
also an IgA nephropathy |
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GN with increased production of light chains, myleoma cells can directly invade kidney. If MM is suspected, chronic infections d/t what type of bacteria is the pt susceptible to?
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encapsulated bacteria
e. coli-->chronic RF |
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Idiopathic disorder that presents in young women d/t narrowing at various points along various arteries that look like a "string of beads"
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fibromuscular dysplasia
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What is a DOC for testicular cancer and what is primary AE?
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bleomycin
pulmonary fibrosis |
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Chemptheraputic alkylating agent that has an ADR to induce secondary cancers such as leukemia. Effective against hematologic malignancies like leukemia and lymphoma
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mechlorethamine
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ADR for all chemo drugs that are alkylating agents
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generating secondary malignancies
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DOC prostate cancer, synthetic analog of GnRH, which causes suppression of sex hormone synthesis, but not before a slight surge of LH and FSH. ADR is hot flashes
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leuprolide
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DOC prostate cancer, testosterone receptor blocker, ADR is gynecomastia
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flutamide
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Chemo agent that inhibits ribonucleotide reductase, key in the synthesis of WBCs-->tx leukemia. Also induces fetal Hb (HbF)-->reduces number of sickle cell crisis
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hydroxyurea
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Version of Vit A used as a chemo agent that only binds to receptors found on cells of AML. ADR is DIC
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ATRA (all-trans-retinoic-acid)
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estrogen receptor modulator that works on breast tissue. ADR are increased risk of DVT, PE and increased risk for endometrial cancer
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tamoxifen
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Chemo drug that inhibits microtubule disassembly resulting in apoptosis. Used in breast, lung, and ovarian cancers. ADR are dose-limiting bone marrow supression
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taxanes
paclitaxel and docetaxel |
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ADR of NSAID that are GI ulcers, that may perforate and bleed, pancreatitis, fatal hepatitis, and aplastic anemia
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Indomethacin
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Possible causes of necrosis of the cortex of kidney with the medulla spared
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kids: abruptio placentae, sepsis, shock, HUS
Adult: pregnancy accidents, bacterial sepsis, end organ spasm, DIC |
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What are two organisms that can alkanize the urine and precipitate struvite stones?
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protease and S. saprohyticus
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What is the gross change in the kidney in hydronephrosis and possible causes?
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dilation of renal pelvis and calyces with blunting of the renal pyramids
stones, BPH, preg, neurogenic bladder |
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Pt complains of lumbar pain, hematuria, recurrent infection, kidney stones, and labs show uremia. Differentiate btw chronic renal failure and ADPCKD
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CRF - small kidneys
ADPCKD - large, moth eaten kidneys done by ultrasound |
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Child with ARPCKD will present early or late with what sxs?
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early - renal symptoms, poor prognosis
late - hepatic sxs, better prognosis |
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Child presents with acute onset uremia outa nowhere, complains of excessive thirst and frequent urination. You notice he is small for his age. On ultrasound he has small kidneys and multiple bone lesions. He does not receive a kidney transplant in time and dies. Autopsy would show what?
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medullary cysts with tubular atrophy and interstitial fibrosis
small kidneys this is medullary cystic disease |
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Pt complains that he can never seem to fully empty his bladder and has frequent kidney stones with some hematuria. If you suspect medullary sponge disease, what is the pathology?
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tubular dilation of collecting ducts only
good prognosis |
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Child with unknown cause of MR presents with mom with seizures, multiple facial lesion composed of blood vessels. Recent dx of cardiac rhabdomyoma. What is the renal component and what other condition is this associated with?
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Angiomyolipoma (benign)
tuberous sclerosis - multi-system genetic disease that causes non-malignant tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. Defect is in TSC1 and TSC2, which encode for the proteins hamartin and tuberin respectively. |
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von hippel lindau disease
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autosomal dominant genetic hemangioblastomas found in the cerebellum, spinal cord, kidney and retina. Associated with renal angioma, renal cell carcinoma and pheochromocytoma.
Mutation in the von Hippel–Lindau tumor suppressor gene on chromosome 3p25.3 |
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How will renal cell carcinoma present?
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50-70 y/o male smoker
hematuria, palpable mass, flank pain, fever, 2ndary polycythemia (ectopic EPO) |
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What is the most common renal malignancy of childhood and how will it present?
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Wilm's tumor
peak 2-4 years palpable flank mass biopsy shows immature stroma, primitive tubules and glomeruli, possible striated mm deletion of WT-1 suppressor gene on CHM 11 **associated with hemihypertrophy of the body (Beckwith–Wiedemann syndrome)** |
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What modulates the following:
UES LES primary peristalsis secondary peristalsis |
UES - excitation via recurrent laryngreal nerves
LES - myenteric plexus swallowing inhibitory signals to LES from vagus nerve |
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PN no peristalsis, increased LES tone, no LES relaxation
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achalasia
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pt presents with dysphagia, chest pain, pt is convinced he's having a heart attack, symptoms are intermittent and occur spontaneously
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diffuse esophageal spasm
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What is the upper GI manifestations of neuromuscular disorders?
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decreased pharnygeal contraction
decreased UES relaxation |
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What mm are involved in Zenker's diverticulum?
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cricopharyngeus
inferior constrictor mm |
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What is the likely cause of congenital esophageal atresia
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polyhydraminos - too much fluid, bc fetus is not swallowing the fluid
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What cancer is likely to develop from Barret's esophagus?
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adenocarcinoma
squamous cell carcinoma - booze and cigs |
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What is a Schatzki ring and where is it likely to develop?
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mucosal indentation at GE junction
greater than 12 mm = food lodging |
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esophagitis is most likely d/t infection from?
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CMV, herpes, candia
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pulsion (inflammation of esophagus outward) and traction tend to occur where in the esophagus?
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pulsion - upper and lower (herniation of the mucosa only = false diverticula)
traction - middle |
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patch of excess muscosa and submucosa, spoon nail, and iron deficiency anemia. Webs disappear with iron treatment
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Plummer-vinson sd
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What cells are located at the gastric fundus and antrum respectively?
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fundus - parietal and chief cells
antrum - mucosa and goblet cells |
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Condition that develops postvagotomy with sxs of vomiting after meals, sweating, palpitations, and diarrhea. MOA? Why do patients develop reactive hypoglycemia? tx?
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this is Dumping syndrome (stop giggling)
vagotomy - rapid fluid transfer to duodenum, rapid caloric uptake (increased insulin = reactive hypoglycemia), solid emptying is delayed pyloric sphincterotomy metroclopramide |
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Curler's ulcer in seen in which pts?
Cushing's ulcers? Likely first + sign? |
Burn patients
post brain injury d/t increased acid levels 2nd to increased steroid levels/intracranial pressure blood in NG tube post trauma ICU |
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What are the two types of chronic gastritis and where in the stomach are each seen?
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Type A - fundal - autoimmune (pernicious anemia)
Type B - antral - H. pylori, NSAIDS, herpes, and CMV |
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Define the following physical finding in GI metastatic carcinoma:
Virchow's node Krukenberg tumor Sister Mary Joseph sign Blumer's shelf |
rock hard supraclavicular node
mucinous, signet ring cells from GI carcinoma to bilateral ovaries nodule palpated around the umbilicus nodule in rectum |
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Most deadly of GI cancers, defined by infiltrating , diffuse carcinoma, stomach looks likes a "leather bottle"
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Linitis plastica
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How does carcinoid syndrome and thyrotoxicosis cause diarrhea?
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prolong the migrating motor complex of course
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Remnant of embrionic vitelline duct, may present with bloody diarrhea, peptic ulcers, intussusception causing obstruction
rules of 2 |
Meckel's diverticulum
2% of population, 2 ft from ileocecal valve, 2 inches long, 2 years of life |
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Two conditions that show PAS + macrophages
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Whipples disease
mycobacterium avium intracellulare in AIDS |
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Enterochromaffin (EC) cells (Kulchitsky cells) are a type of enteroendocrine cell occurring in the epithelia lining the lumen of the digestive tract and the respiratory tract.
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Carcinoid syndrome
Small cell carcinoma (oat cell) |
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SO YOU NEVER FORGET, LEUKEMIAS:
ALL - kids, excess lymphoblasts, crowd bone marrow, spread to other organs AML - any age, rapid growth of abnormal white blood cells in BM, Auer rods in myeloblasts (needles), swollen spleen and lymph nodes CML - young adult, proliferation of myeloid cells in the bone marrow and the accumulation of these cells in the blood, splenomegaly, Philadelphia chro. CLL - elderly, B cells grow out of control and accumulate in the bone marrow and blood, low Ig levels, infections Hairy cell leukemia - "hairy cells" (malignant B lymphocytes) accumulate in the bone marrow, hepato/splenomegaly, pancytopenia HODGKINS DISEASE - originates from WBCs spread of disease from one lymph node group to another and by the development of systemic symptoms NON-HODGKINS LYMPHOMA - any kind of lymphoma EXCEPT Hodgkin's: -small lymphocytic -large cell lymphoma -Burkitt - cancer of the lymphatic system (in particular, B lymphocytes), translocation of c-myc gene |
x
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What are some acceptable drug regiments for Whipple's disease and how long must treatment be administered for?
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TMP/SMX (1st line)
penicillin, ampicillin, tetracycline 4-6 months, 1 year is preferable |
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What type of bacteria causes Whipple's disease?
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gram-positive actinomyces
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Liver, bile duct, kidney, bone, and the placenta have high concentrations of alkaline phosphatase, might help narrow down a path question or two.
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you're welcome
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Alcoholic cirrhosis, also known as Laennec's cirrhosis, is irreversible, MCC cirrhosis, end stage of alcoholic hepatitis.
Laennec also invented the stethoscope |
Kudos, René Laennec.
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Middle aged male presents with sxs of cirrhosis, new-onset type duce diabetis, and a lovely tan. DX?
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hemochromatosis
cardiomyopathy is a common outcome |
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What do the following bacteria have in common?
staph pseudo candida aspergillus enterobacteriaceae |
all are catalase-positive
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organism produces disease after consuming raw oysters, sx gastroentritis + cellulitis. tx?
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vibrio vunificus
gram-negative, comma-shaped, oxidase positive rod, sensitive to acid tetracycline or 3rd gen ceph |
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More lab tests:
cold agglutinins dieterle silver stain quellung reaction requires cystine factors X and V |
IgM - mycoplasma pneumonia
legionella strep pneumo francisella, legionella, brucella, pasturella haemophilus |
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Coxsackie A - hand, foot, mouth, and butt disease + disseminated multi-organ involvement. Usually resolves without issue
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kaplan
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parotitis, pancreatitis, orchitis
paramyxovirus produces multinucleated giant cells (syncytia) cell mediated immunity is necessary |
Mumps
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