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103 Cards in this Set
- Front
- Back
what immunosuppresant matches the following:
Derivative of 6-MP: Nephrotoxic in 75% of pts: Inhibits dihydrofolate reductase: |
Derivative of 6-MP: Azathropine
Nephrotoxic in 75% of pts: Cyclosporine (prevent with mannitol) Inhibits dihydrofolate reductase: MTX |
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what enzyme is deficient in the following dz's?
Fructose intolerance: essential fructosuria: classic galactosemia: |
Fructose intolerance: aldolase B
essential fructosuria: fructokinase classic galactosemia: galactose-1-phosphate uridyltransferase |
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what might you see in a first trimester ultrasound of a fetus with Downs
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increased nucal translucency
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which protozoa fits the following:
Ixodes tick is the vector: Sodium stibogluconate is the tx: Maltese cross seen in RBC: severe diarrhea in AIDS: |
Ixodes tick is the vector: bebesia
Sodium stibogluconate is the tx: Leschmania Maltese cross seen in RBC: Babesia severe diarrhea in AIDS: cryptosporidium note: babesia is often a co-infection of Lyme and gives malaria like sx |
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what is the result of a glycolytic enzyme def? What is the result of a def in pyruvate dehydrogenase
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RBC hemolysis
Neurologic defects |
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what is responsible for the release of renin?
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JG apparatus, specifically the JG cells secrete it, while the macula densa senses the amount of Na
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give the breakdown of your % body water
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60% total body water
40% ICF 20% ECF |
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what is the water under the bridge idea?
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ureters pass under the uterine artery or ductus deferens
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CL=
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UV/P
u-urine conc of X p=plasma conc of X v=urine flow rate |
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FF=?
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GFR/RPF
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GFR can be estimated with?
RPF? |
GFR--creatinine
RPF--PAH |
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what segment of the renal tubule matches the following statement
reabsorbs 67% of fluid and electrolytes filtered by the glomerulus: segment responsible for concentrating urine: site of secretion of organic anions and cations: always impermeable to water permeable to water only in the presence of ADH |
reabsorbs 67% of fluid and electrolytes filtered by the glomerulus: Prox tub
segment responsible for concentrating urine: Collecting duct site of secretion of organic anions and cations: Prox always impermeable to water: ascending loop permeable to water only in the presence of ADH: collecting duct |
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what segment of the renal tubule matches the following statement
site of Na/2Cl/K cotransport: site of isotonic fluid reabsorption: site responsible for diluting urine: only site where glucose and amino acids are reabsorbed: water reabsorption in the loop of henle: |
site of Na/2Cl/K cotransport: ascending loop
site of isotonic fluid reabsorption: prox tub site responsible for diluting urine: thick ascending only site where glucose and amino acids are reabsorbed: prox tub water reabsorption in the loop of henle: thin descending |
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where are Ca and Mg reabsorbed? What happens with water here
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Thick ascending limb
water cannot get in |
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where in the kidney does PTH have its effect on Ca?
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leads to calcium reabsorption in the early distal tubule
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what is the role of principle cells and intercalated cells? where does this occur
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Principle: reabsorb H2O/Na, secrete K
Intercalated cells: secrete H/HCO3, reabsorb K collecting duct |
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What are the 2 types of intercalated cells
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Alpha: secrete Acid
Beta: secrete bicarb |
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what affect does aldosterone have on the intercalated cells and principle cells of the collecting duct?
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intercalated: stimulates H secretion
principle: Na reabsorption and K secretion |
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tx for hyperkalemia?
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Insulin to shift K into cells
must also give glucose to prevent hypoglycemia |
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what diuretic would you use for a woman with HTN and osteoporosis?
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Thiazide
saves Ca |
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what is the acid base disorder
pH: 7.42 HCO3: : 32 pCO2: 64 |
Mixed
normal pH: 7.35-7.4 normal pCO2: 35-45 normal HCO3: 22 |
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what is the acid base disorder
pH: 7.66 HCO3: 36 pCO2: 30 |
combined alk
normal pH: 7.35-7.4 normal pCO2: 35-45 normal HCO3: 22 |
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what is the acid base disorder
pH: 7.10 HCO3: : 15 pCO2: 50 |
Combined acidosis
normal pH: 7.35-7.4 normal pCO2: 35-45 normal HCO3: 22 |
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what is the acid base disorder
pH: 7.34 HCO3: : 31 pCO2: 62 |
resp acid with compensation
normal pH: 7.35-7.4 normal pCO2: 35-45 normal HCO3: 22 |
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what is the acid base disorder
pH: 7.39 HCO3: : 12 pCO2: 22 |
mixed
normal pH: 7.35-7.4 normal pCO2: 35-45 normal HCO3: 22 |
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what is the equation of anion gap?
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Na - (Cl + HCO3)
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what are the causes of increased anion gap
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MUDPILES
Methanol (formic acid) Uremia Diabetic ketoacidosis Paraldehyde/phenformin Iron tablets or INH Lactic acidosis Ethylene glycol (oxalic acid) Salicylates |
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where do type 1, 2, and 4 RTA occur? what are K levels like
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1: distal (collecting tubule can't excrete H); hypokalemia
Type 2: proximal (defect in prox tubule HCO3 reabsorption); hypokalemia type 3: hypoaldosteronism or lack of collecting tubule response to aldosterone, hyperkalemic |
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what effect will a renal stone that obstructs the ureter have on GFR and FF?
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decrease both
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what is the maximal serum glucose conc at which glucose can be absorbed in the tubules
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350micro grams/dL
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what change in the metabolic panel might you see in a young pt on a B-agonist for status asthmaticus?
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B-agonists will lead to hypokalemia
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What diuretic can be used in the following situations:
Edema a/w nephrotic syndrome: Increased intracranial pressure: |
Edema a/w nephrotic syndrome: Loop
Increased intracranial pressure: Mannitol |
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what type of diuretic are the following
Bumetanide: Metolazone: |
Bumetanide: Loop
Metolazone: Thiazide |
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if you have casts in the urine what does this tell you in general
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that the problem is in the kidney
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most common glomerular dz in HIV pts
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FSGS
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EM shows tram-track. what is this and what is it associated with?
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type I MPGN--associated with HBV and HCV
(also: SLE, subacute bacterial endocardititis, mixed cryoglobulinemia) |
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EM shows dense deposits. What is this an what is it associated with?
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MPGN type II
C3 nephritic factor |
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what 3 things can lead to using up complement?
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Post strep
MPGN type II SLE |
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which glomerular dz causes the following:
IF: granular pattern of immune complex deposition; LM: hyperceullar glomeruli: LM: Segmental sclerosis and hyalinosis: |
IF: granular pattern of immune complex deposition; LM: hyperceullar glomeruli: Acute post strep
LM: Segmental sclerosis and hyalinosis: FSGS |
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GLomerular histology reveals multiple mesangial nodules. What is this indicactive of?
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Diabetic glomerulonephropathy
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4 yo with facial edema and proteinuria. Tx?
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this is MC
Corticosteroids |
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proteus causes stag horn calculi, what is the content of these stones
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Ammonium magnesium phosphate
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pt with gout or leukemia is likely to get what kind of kidney stone
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uric acid
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what happens in acute interstitial nephritis? what will you see? what is it due to?
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acute renal failure
will see eosinophillia due to drugs (1-2 weeks after administration kids: ABX adults: NSAIDs tx: 2 weeks corticosteroids |
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+4 blood in urine, no RBC on urine cell count...
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Rhabdomyolysis / myoglobinuria
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what causes prerenal azotemia? what will BUN/Cr be like?
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decreased RBF (hypotension: dehydration,shock,renal vasoconstriction, hepatorenal syndrome)
BUN/Cr >20 (BUN is really high because you are trying to hang on to everything) |
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what causes intrinsic renal failure? BUN/cr lvls?
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acture tubular necrosis or ischemia/toxins
<15 |
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what causes post renal azotemia? what is BUN/Cr like?
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outflow obstruction (stones, BPH, neoplasia, congenital anomalies)
>15 (10-20, this is in a normal range) |
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sorry, i couldn't help myself...
what are the 2 most common causes of chronic kidney dz |
HTN
Diabetes |
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ADPKD vs ARPKD
leads to potters: hepatic fibrosis: polycystic liver dz: Berry aneurysms: death can be due to malignant HTN: |
leads to potters: AR
hepatic fibrosis: AR polycystic liver dz: AD Berry aneurysms: AD death can be due to malignant HTN: (i had a question on this, it was an adult, and this is what killed him, so I am saying AD for now) |
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U waves on ECG is due to what
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Low K
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disoreintation stupor, or coma is assoc with what ion?
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Na
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pt is getting an infusion with substance X. Later the pt has decreased DTRs, delirium, and cardiopulmonary arrest. What was substance X
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Mg
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most common tumor of the urinary tract system?
histological appearance of renal cell ca? histological appearance of chronic pyelonehpritis? can assoc with schistosoma haematobium? |
most common tumor of the urinary tract system: TCC
histological appearance of renal cell ca: Polygomal Clear Cell histological appearance of chronic pyelonehpritis: Thyroidsim can assoc with schistosoma haematobium: Bladder SCC |
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IF granular pattern of immune complex deposition; LM: diffuse capillary thickening
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Membranous
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IF granular pattern of immune complex deposition; LM: hypercellular glomeruli
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Post strep glomerulinephritis
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HYQ: CT scan reveals massively enlarged kidneys bilaterally. Diagnosis?
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ADPCKD
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what is responsible for the biconcave shape and flexibility of RBCs
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spectrin
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Anisocytos=
Poikilocytosis= |
Anisocytos= varying RBC size
Poikilocytosis= varying RBC shape |
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survival time of RBCs?
platelets? |
RBC=120
Platelets=8-10 days |
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what is the DNAAACP for eosinophils
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Drugs
Neoplasm Asthma Allergic process Addisons Collagen vascular dz Parasites |
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what type of cell are barr bodies in?
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Neutrophils
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What are the phagocytes for the following locations:
Brain: Liver: Joint: Lung: |
Brain: microglia
Liver: kupffer cell Joint: A cells Lung: Dust cells |
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what cell traditionally has memory and plays a role in immunizations
* |
B lymphocyte
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what is the bridge btw coagulation and complement pathway
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factor XII
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why do you get purple toes etc with starting Warfarin
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while warfarin will eventually inhibit 10,9,7,2, they accutely inhibit C and S leading to hypercoaguability
give Heparin for first few days to prevent this |
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MOA of heparin
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inhibits thrombin (factor II)
co factor of antithrombin ACTIVATES ANTITHROMBIN WHICH IN TURN INHIBITS THROMBIN |
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warfarin or heparin
which if either can be used in pregnancy |
Heparin
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pt is on anticoagulant and develops thrombocytopenia which was it?
Tx? MOA? |
heparin- Heparin induced thrombocytopenia (causes hypercoaguable state)
Lepiruidn or bivalirudin--directly inhibit thrombin |
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what drug inhibits ADP induced expression of GpIIb/IIIa
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Clopidogrel
Ticlopidine |
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what are the following RBCs seen in
Basophilic stippling: Bite Cells: Schistocyte/helmet cell: Target Cells: Heinz bodies: Howell-Jolly bodies: |
Basophilic stippling: Lead
Bite Cells: G6PD Schistocyte/helmet cell: DIC/TTP/HUS/traumatic hemolysis Target Cells: HbC dz, Asplenia, liver dz, thalassemia (THAL) Heinz bodies: G6PD def Howell-Jolly bodies: asplenia (sickle cell, ITP, splenic trauma) |
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what is the change in the Hb of sickle cell
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Glu-->Val in B chain
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4 causes of microcytic hypochromic anemia...what is the MCV
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MCV<80
Iron def Thalassemia Lead poisoning sideroblastic CKD -apparently starts normocytic |
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marrow hyperplasia leading to chipmunk facies and crew cut xray
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B-thal major
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tx for lead poisoning in adults/kid
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adult: dimercaprol
kid: succimer |
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hypocellular bone marrow with fatty infiltration....
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Aplastic anemia
(pancytopenia--anemia, neutropenia, and thrombocytopenia) |
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if you have sickle cell or hereditary spherocytosis, what can lead to aplastic crisis?
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parvo B19
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what can you use in the treatment of sickle cell anemia?
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Hydroxyurea to increase HbF
bone marrow transplant is curative |
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what are the 5 causes of megaloblastic anemia
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Methotrexate
AZT Phenytoin Liver dz Ethanol MAPLE |
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what is the cause of anemia given the following statement:
Microcytic anemia reversible with B6: HIV positive pt with macrocytic anemia: normocytic anemia and elevated creatinine : |
Microcytic anemia reversible with B6: sideroblastic anemia
HIV positive pt with macrocytic anemia: Zidovudine normocytic anemia and elevated creatinine : kidney failure |
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pt presents with painful abdomen, port red urine, polyneuropathy, and psychological disturbances. What is this and what drug might they be on? enzyme affected
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Acture intermittent porphyria
Barbiturates porphobilinogen deaminase |
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man presents with blisters on sun exposed areas of his body and he has darkening of his face with a large amount of hair. What does he have? affected enzyme?
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Porphyria cutanea tarda
Uroporphyrinogen decarboxylase |
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decreased Gp1b-->defect in platelet to collagen adhesions
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Bernard soulier dz
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GpIIb/IIIa antibodies-->peripheral platelet destruction
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Idiopathic thrmobocytopenic purpura (ITP)
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decreased GpIIb/IIIa -->defect in platelet to platelet aggregation
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Glanzmann's thrombasthenia
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pt has neurologic and renal sx, fever, thrombocytopenia, and microangiopathic hemolytic anemia...what does he have? what is deficient?
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Thrombotic thrombocytopenic purpura (TTP)
def of ADAMTS 13 (vWF metalloprotease)-->degrades vWF thrombosis |
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what are some of the causes of DIT
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STOP Making New Thrombi
Sepsis (G-) Trauma Obstetric Pancreatitis Malignancy Nephrotic syndrome Transfusion |
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What is the rate-limiting step in heme synthesis
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aminolevulinic acid synthase
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what are the following tests associated with:
Hams: DEB: Heinz body: D-Dimer: Basophilic stippling: Osmotic fragility test: (+) ristocetin test: |
Hams: Paroxsymal nocturnal hemoglobinuria
DEB: Fanconi's anemai Heinz body: G6PD D-Dimer: DIC Basophilic stippling: Thalassemia, ACD, Iron def, LEAD POISONING Osmotic fragility test: hereditary spherocytosis (+) ristocetin test: vWF dz |
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Hodgkin vs Non-Hodgkin
Reed-Sternberg Cells Bimodal distribution: Assoc with HIV B symptoms: Mostly involves B cells: Peripheral nodes, noncontiguous spread: Local nodes: contiguous spread: |
Reed-Sternberg Cells: H
Bimodal distribution: H Assoc with HIV: NH B symptoms: H Mostly involves B cells: NH Peripheral nodes, noncontiguous spread: NH Local nodes: contiguous spread: H |
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what is the most common type of AML and the translocation associated?
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M3 type
t(15,17) |
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Leukemia buzzwords:
Smudge cell: Children: TRAP: Philadelphia chromosome: Auer Rods: |
Smudge cell: CLL
Children: ALL TRAP: Hairy cell Philadelphia chromosome: CML Auer Rods: AML |
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What is most likely to cause progression to AML
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CML
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What drug targets the Philadelphia chromosome? what is this treating?
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Imatinib
CML |
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what leukemia/lymphoma is most likely to cause bone pain
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ALL
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Birbeck granules ("tennis rackets" on EM)
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Langerhans cell histiocytosis
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woman says she itches when she is in the shower. She says she has pain in her hands/fingers that is relieved with aspirin. what does she have
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polycythemia vera
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give the hematological dz that matches the following:
AML assoc with Downs: Leukemia with more mature cells and less than 5% blasts: PAS + acute leukemia: |
AML assoc with Downs: M7 AML (ALL is most common)
Leukemia with more mature cells and less than 5% blasts: Chronic leukemia PAS + acute leukemia: ALL |
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give the hematological dz that matches the following:
Greater than 20% blasts in marrow: myleodysplastic/proliferative disorders may progress to: numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP): |
Greater than 20% blasts in marrow: acute leukemia
myleodysplastic/proliferative disorders may progress to: AML numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP): CML |
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give the hematological dz that matches the following:
most common neonatal leukemia: associated with the BCR-ABL genes: assoc with sjogren, hashimoto's thyroiditis, and h pylori: |
most common neonatal leukemia: M7 AML
associated with the BCR-ABL genes: CML assoc with sjogren, hashimoto's thyroiditis, and h pylori: Marginal cell MALToma |
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give the hematological dz that matches the following:
acute leukemia positive for peroxidase: solid sheets of lymphoblasts in marrow: PAS (-) acute leukemia: |
give the hematological dz that matches the following:
acute leukemia positive for peroxidase: AML solid sheets of lymphoblasts in marrow: ALL PAS (-) acute leukemia: AML |
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describe the following in DIC
BT: PT: PTT: Platelet count: |
BT: increase
PT: increase PTT: increase Platelet count: decrease |
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HYQ: 11 year old child presents with a chronic non-healing ulcer on his foot and imaging shows a small calcified spleen. What drug can improve his sx?
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This is sickle cell
Hydroxyurea |