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USMLE Step 1

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1. Serum TSH thyrotoxicosis, hypopituitarism, hypothalamic dysfunction


2. 1 -adrenal adenoma (Conn syndrome) or idiopathic adrenal hyperplasia
Aldosteronism -hypertension, hypernatremia, hypokalemia, metabolic alkalosis *** no edema bc of the Aldosterone escape mech =
increased RBF, GFR, and ANP
- increased aldosterone, decreased renin
3. 2 -renovascular hypertension, juxtaglomerular cell tumor
Aldosteronism -compensates for cardiac output; activates RAA system
-increased aldosterone, increased renin
4. 5alpha- -SRD5A deficiency, AR
reductase def -Sex limited to genetic males (46,XY)
-Inability to convert testosterone to DHT
-Ambiguous genitalia until puberty, when increased testosterone causes masculinization/ increased growth of
external genitalia
-Testosterone/estrogen levels are normal; LH is normal or increased
-Internal genitalia are normal
5. 5a-Reductase -Normal karyotype
deficiency -Insufficient conversion of testosterone to active dihydrotestosterone form
-Female develops internal male genitalia
-Ambiguous external then male external during puberty
6. 123-I = used to evaluate synthetic activity of thyroid gland
(radioactive)
uptake -123-I uptake: synthesis of thyroid hormone= Graves disease
-123-I uptake: thyroiditis, patient taking excess thyroid hormone
-Cold nodule: 123-I uptake
-Hot nodule: 123-I uptake
7. Abruptio -premature seperation (partial or complete) of placenta from uterine wall before delivery of infant
placentae -retroplacental clot, MCC of late pregnancy bleeding
-hypertension is greatest risk factor
-triad: painful vaginal bleeding, tetanic contractions, fetal compromise
- no pelvic exam; dx with US
-possible DIC, maternal shock, fetal distress
-life threatening for mom and baby
8. Acanthosis -Obesity/ insulin resistance
Nigracans -Malignancy of GI or Lungs
9. Acute kidney Often results in hyperkalemia
injury
10. Acute -endemic in dev countries
Rheumatic -molecular mimicry: anti group a strep ab attack host antigens on cardiac and neuronal tissue approx 2-4 weeks post
fever acute pharyngitis (aka cross reactivity of ab against bacterial and host antigens)
-acute/subacute: migratory arthritis, pancarditis, Sydenham chorea
-Chr: mitral regurg/ stenosis
-tx: PCN
11. Acute -thyrotoxicosis
thyroiditis -bacterial infection
-123-I uptake
-fever
-tender gland with painful cervical adenopathy
-initial thyrotoxicosis from gland destruction-- increased serum T4, decreased serum TSH
-permanent hypothyroidism uncommon
12. Acute Tubular Necrosis -MCC: acute renal failure-- which results when hypotension (ischemia, hypoxemia) or tubular toxins
damage renal tubular epithelial cells
-Dysfunction of these cells--> sodium and water reabsorption in the proximal tubule is impaired
-Large amounts of NaCl and water are therefore presented to the macula densa-- via
tubuloglomerular feedback, this decreases renal blood flow and GFR by stimulating
vasoconstriction of the afferent arteriole
-The subsequent decrease in GFR may play a role in limiting potentially life- threatening losses of
sodium and water that might otherwise occur in ATN
13. Addison disease Chronic adrenal insufficiency
-diffuse hyperpigmentation; hypotension, weakness
-serum sodium, cortisol, bicarbonate
-serum potassium, ACTH
-hypoglycemia, eosinophilia, lymphocytosis, neutropenia
14. Adrenal Cushing syndrome -Primary adrenal adenoma, hyperplasia, or carcinomas
-ACTH, cortisol
-atrophy of the uninvolved adrenal gland
-can present as primary aldosteronism (Conn synd)
15. Anatomic Shunt -Blood flow bypasses lungs
-Increased perfusion of bronchial arteries in chronic inflammatory lung disease
16. Androgen insensitivity -XY karyotype
syndrome (male -Androgen receptor defect
pseudohermaphroditism) -Male internal genitalia but incompletely virilized, ambiguous, or female external genitalia
-These individuals do not have male internal genitalia (no epididymis, seminal vesicles, vas deferens,
prostate), and most have normal female-looking external genitalia with a blind-ending vaginal
pouch
-Increased testosterone, estrogen and LH
-Primary amenorrhea
17. Aortic Regurg -Decreased effective SV, *widened pulse pressure
-Increased SV (b/c increased preload) and decreased diastolic pressure --> Water Hammer pulse on
exam (hyperdynamic circulation)
-Decreased CO
-LVH and dilation
-Austin Flint murmur= blood hits the anterior leaflet of of aortic valve
-Aortic valve is incompetent= high-pitched diastolic blowing murmur --early diastole; decreases in
intensity throughout diastole (decrescendo)
-Turbulent flow back into left ventricle from the high-pressure aorta
-Can cause Pul HTN
-Causes: Syphillis (3) induced aortic aneurysm, CT disorders, endocarditis
-sx: fatigue, syncope, SOB, palpitations
18. Aortic Stenosis -Increase afterload, decrease stroke volume, pulsus parvus et tardus
-Pre-stenotic dilation and concentric LVH (pressure overload)
-Systolic ejection murmur- best at snd Rt. ICS
-Increased amplitude of PMI- closer to the sternum near the 5th ICS
-Decreased pulse and pulse pressure
-angina/ syncope with exercise- caused by increased O2 demand
-Increased velocity of flow across narrowed aortic valve
-Throughout systole + ejection click (crescendo decrescendo)
-Causes: Age related stenosis, calcification of valve (CAD RF), bicuspid aortic valve, rheumatic fever
-sx: S.A.D= syncope, angina, dyspnea
19. ARDS

Characterized by the development of hypoxemia and bilateral pulmonary infiltrates in the absence of heart
failure
-begins with initial injury of pul alveoli (smoke inhal) or pul endothelium (sepsis) which leads to the
recruitment of neutrophils- this worsens the situation and leads to intraalveolar accumulation and hyaline
membrane formation

-decreased lung compliance, increased work of breathing, worsened V/Q mismatch, and normal PCWP
20. Asthma Dec FEV1/ FVC
Exp wheeze
Caused by env and genetics
Chr Eosinophil Bronch: IL-5 by TH2 cells
MPB= bronch epith dmg- mc in exercise induced asthma
21. Asymptomatic heart -nonstenotic bicuspid aortic valve
defect in turner's -early systolic , high frequency click over right second IC space
synd
22. Avoid Nitrates in Nitrates decrease preload, which will increase the LV outflow tract... BUT since the ventricle is abnormally
Hypertrophic shaped, there is an outflow obstruction
Cardiomyopathy bc...
23. Beta Blocker S/E bronchospasm, bradycardia, fatigue, sexual dysfunction
24. Bicuspid Aortic Commonly presents in young, asymptomatic patient with soft systolic ejection at right 2nd ICS
Valve -can cause aortic regurg
25. Bone Marrow Stem CD34
Cells
26. Breast Milk -milk letdown is stim by oxytocin
-ideal infant nutrition when <6mo, exclusive breastfed infants require vit D supplementation
-contains: IgA, macrophages, lymphocytes
-reduces infant infections and is associated with the decreased risk of child dev asthma, allergies, DM, and
obesity
-breastfeeding decreases maternal risk of breast and ovarian cancer, and facilitates mother-child bonding
27. Caplan syndrome pneumoconiosis + cavitating rheumatoid nodules
28. Cardiac Changes w/ - decreased left ventricular chamber size
Normal Aging - shortened base- to- apex dimension
- ventricular septum becomes sigmoid and shape, with basilar portion bulging into LV outflow tract
- atrophy of myocardium causes increased interstitial connective tissue, often with concomitant extracellular
amyloid deposition
- lipofucin pigment accumulation within cardiomyocytes
29. Cause of LVHF Impaired diastolic return of Pul v. because high end diastolic pressure causes an increase in hydrostatic
shortness of breath pressure and transudate leaks out into the interstitium--> causes affected tissue to swell and increased
resistance of movement due to decreased lung compliance
= the neg pressure generated normally from inspiration isnt enough to distend the lungs, causing poor gas
exchange and sob
30. Causes of pelvic pain= E.C.T.O.P.I.C. Ectopic (mcc), Endometriosis
Cyst rupture (corpus leutium cyst rupture)
Torsion of ovary (compromise ovarian bl flow) or cyst
Ovulation (mittelschmerz)
PID, salpingitis, tubo-ovarian abscess
Incomplete abortion
Cystitis/pyelonephritis
31. Causes of Spontaneous Depol Hypokalemia, Hypermagnesemia, or prolonged QT interval
causing Tachyarrhythmias = all cause spontaneous depol of ventricles in phase 3 or 4 and it will cause an extra AP in
heart
32. CCB (diphenhydropine) S/E periph edema, dizziness/ lightheadedness
33. Chorioamnionitis -infection in fetal membranes
-danger of neonatal sepsis/ meningitis
34. Chronic Alcoholism --> Cerebellar - atrophy to the ant lobes and cerebellar vermis
Vermis effects - resulting in gait ataxia, truncal instability, intention tremor, and rhythmic "Parkinsonism" tremor
of the fingers and hands
35. Chronic diarrhea may cause a metabolic alkalosis because of volume contraction
36. Clozapine Treatment Guidelines - specific for treatment-resistant schizo and schizo assoc with suicidality
- A/E: agranulocytosis, seizures, myocarditis, and metab syndrome
37. Common S/E of ACE-Inhib cough, angioedema, inc K+
38. Common S/E of Thiazide Diuretics acute kidney injury, decreased Na+ and K+, hyperuricemia/ acute gout, elevated glu and
cholesterol levels
39. Compromised airways in -Residual volume increases because inspiratory volumes are always slightly greater than
Obstructive Airway Diseases expiratory volumes, leading to an increase in the AP diameter or the chest
-This explains the "barrel-chested" appearance of patients with emphysema
-Dynamic air trapping during exercise is a major limitation to rigorous activity in patients with
chronic obstructive pulmonary disease (COPD)
-Air trapping results in an elevated FRC at which tidal breaths occur--> airways are more
patent, which reduces airflow resistance particularly during expiration; this decreases the work
of breathing
40. Concentric LVH = pressure overload

-chr htn
-aortic stenosis
41. Congenital Cardiac Anomaly assoc COARCATION OF THE AORTA! (also assoc with Berry aneurysms)
with Ruptured Cerebral = ruptures d/t HTN of branches of aortic arch proximal to the coarct--> subarachnoid
Aneurysms... hemorrhage
42. Congenital Deficiency of -prevents conversion of propionyl CoA to methylmalonyl CoA
Propionyl CoA Carboxylase -propionyl CoA derived from= val, ile, met, thr, odd # FA, cholesterol side chains
-Propionic Acidemia: poor feeding, vomiting, hypotonia, lethargy, dehydration, anion gap
acidosis
43. Congenital Pyloric Stenosis -thickening of stomach wall, hypertrophy of smooth muscle pyloric stenosis
-palpable olive mass- epigastric region
-nonbilious projectile vomiting at 2-6 weeks of age
-assoc w/ Macrolides
-hypokalemia, hypochloremic, metab alkalosis
44. CO Poisoning Normal PO2 (dissolved O2)
Decreased %sat of Hb
Decreased total O2 content

= makes Fe2+ into Fe3+(ferric), leading to the formation of methemoglobin which cannot bind to O2- this
causes a left shift on the saturation curve- methemoglobin will present with cyanosis

causes dusky discoloration in skin


45. Coronary Blood Flow -at Early Diastole
Peak -coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
46. Corticosteroids cause -Neutrophilia, despite causing eosinopenia and lymphopenia
... -Corticosteroids activation of neutrophil adhesion molecules, impairing migration out of the vasculature to
sites of in ammation
- BUT, sequester eosinophils in lymph nodes and cause apoptosis of lymphocytes
47. Cryptorchidism - incomplete or improper descent of testis into scrotal sac= seminiferous tubule dmg
-normal testosterone and when unilateral but decreased levels when bilateral
-increased FSH and, low sperm count and inhibin
-risk for seminoma + infertility of cryptorchid testis and normally descended testis
48. Cushing disease -Pituitary Cushing syndrome
-Due to a pituitary adenoma
-ACTH, cortisol
-bilat adrenal hyperplasia
49. Decreased Alv -falls to a level too low to provide sufficient oxygen to the tissue, patients must compensate by increasing
Ventilation the rate of breathing (tachypnea) or by taking larger-volume tidal breaths
-taking larger tidal breaths would be better because it minimizes the effect of dead space on alveolar
ventilation
50. Decreased EPO -Polycythemia Vera (neg feedback)
-Anemia of Chr Disease
-Chr Kidney Disease
51. Decreased Pulse aortic stenosis, cardiogenic shock, cardiac tamponade, advanced heart failure (HF)
Pressure
52. Diastolic heart failure impaired ventricular filling during diastole due to stiff ventricle or obstruction to ventricular filling (e.g.,
mitral stenosis)
53. Diffusion-limited gas -diffusion continues as long as pressure gradient exists across pulmonary membrane
exchange -examples: O2 during vigorous exercise at high altitude and CO
54. Direct alpha 1 agonist - vasc smooth muscle contraction= increased afterload and venous return= increased DBP + SBP causes
mediated effects reflexive increase in vagal tone= dec HR and slowed AV conduction
- mydriasis
- increased internal urethral sphincter tone and prostate contraction
55. Direct alpha 2 agonist - CNS med decrease in BP
mediated effects - decreased intraocular pressure
- decreased lipolysis
- decreased presyn NE release
- increased platelet aggregation
56. Diuretics become less -With the exception of spironolactone, an aldosterone receptor antagonist, diuretics must gain access to
effective in individuals the tubular lumen to reach their site of action
with renal failure -Because they are highly protein bound, they are not filtered through the glomerulus-- Instead, they are
transported into the tubular lumen through the organic ion transporters located in the basolateral
membrane of the proximal tubular epithelial cells
-Renal Failure= This diminished efficacy occurs in part because other organic ions accumulate in renal
failure and compete with diuretics for transport into the tubular lumen
-Large doses of diuretics, particularly loop diuretics, are given in renal failure to overcome this
competition for tubular secretion
57. DNA Laddering (Gel - DNA fragments in multiples of 180 bp each
Electrophoresis) - sensitive indicator of APOPTOSIS
- laddering done by specific endonucleases during haryorrhexis, cleaving DNA at interucleosomal linker
regions
- this is not seen in cancer cells, since they evade apoptosis
58. Dopamine beta- -impaired sympathetic adrenergic activity with normal PSNS and sweating
hydroxylase deficiency -infant sx: may dev hypotension, ptosis, and hypothermia
-adult sx: postural hypotension, exercise intolerance, nasal congestion, and ejaculatory difficulties
-impaired synth of epi and NE
59. Down Synd Neuro: MR, early onset Alzheimer's
Comorbidities Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
Rheumatology: atlantoaxial stability
60. Drug causes of SIADH -Carbamazepine
-Cyclophosphamide
-SSRI
61. Drugs that cause = inability of potassium to be moved intracellularly
hyperkalemia -digitalis
-insulin
-abuterol
62. Eccentric LVH =volume overload

-aortic or mitral regurg


-MI
-dilated cardiomyopathy
63. Ectopic Cushing -paraneoplastic: small cell carcinoma of lung; less commonly thymus, thyroid
syndrome -ACTH, cortisol
-bilat adrenal hyperplasia
64. Electrolyte Changes in -increases extracell K+ conc bc of non-fxn'l Na+/K+/ATPase due to lack of ATP which causes K+ to leak
Ischemia out of cell
-may reduce extracell Na+, Ca2+, and Bicarb concentrations
-cytoplasmic accumulation of Ca2+ ***HALLMARK OF ISCHEMIC INJURY
65. Elevated Alveolar- -Pulmonary fibrosis
Arterial Gradient: -Emphysema
Diffusion defects -Asbestosis
66. Elevated Alveolar- - Intracardiac Shunt (VSD)
Arterial Gradient: Shunt - Intrapulmonary Shunt (pulmonary AVM, pneumonia, CHF)
- Atelectasis
67. Elevated Alveolar- -Pulmonary embolism
Arterial Gradient: V/Q -Airway obstruction
Mismatch -Interstitial lung disease
68. Embolic Phenomena -Simultaneous dev of stroke, intestinal/ foot ischemia, and renal infarct (wedge shaped) should raise
suspicion of an embolic phenomena
-These emboli commonly arise from LA or LV clots (common with A-fib) or valvular veg
69. Empty sella syndrome -radiologic studies show an empty sella turcica
-subarachnoid space extends into sella
-CSF pressure compresses gland-- increase in pressure on the pituitary gland causes it to flatten out and
undergo
atrophy
-obese with hypertension
70. Enlarged placenta Rh Hemolytic Disease of Newborn, congenital syphilis, DM
71. Eosinopenia Cushing syndrome, corticosteroids
72. Essential tremor -worsens when maintaining particular postures
-improve/ subside with etoh
-tx: propranolol
-AD inheritance= Familial tremor
73. Estrogen-containing oral -Inhibiting the LH surge that is responsible for ovulation
contraceptives -Estrogen-containing contraceptives provide a constant level of estrogen that maintains a continual
negative feedback on pituitary gonadotropin secretion, thereby stabilizing FSH and LH secretion
74. Estrogen Effects on TBG Changes in TBG: alter total serum T4; no effect on FT4 and TSH
and Thyroid Hormones
-TBG total serum T4 but not FT4
-Estrogen: pregnancy, OCPs, hormone replacement
-TBG: total serum T4 but not FT4
-TBG: anabolic steroids, nephrotic syndrome
75. Exogenous -Cushing syndrome: MCC
Corticosteriods -Decreased ACTH
-bilateral adrenal atrophy
76. Failure of endocardial -ostium primum ASD + VSD + single AV valve = sig L to R shunting and AV valve regurg leads to excessive
cushion fusion pulmonary bl flow and sx of heart failure (tachypnea, poor feeding, etc) in a neonate
-hear an AV valve regurg on auscultation (holosystolic, best at the apex) and increased pulmonary VR
(mid-systolic rumble)
77. Fasting Hypoglycemia glycogen stores
when EtOH excess gluconeogenesis (pyruvate converted to lactate)
78. Female -46,XX karyotype
pseudohermaphroditism -Gonads are ovaries, but virilization of external genitalia
-Congenital adrenal hyperplasia (21-hydroxylase deficiency)
79. Follicular adenoma - MC benign thyroid tumor
-surrounded by complete capsule
-solitary "cold" nodule
80. Follicular carcinoma -mc thyroid cancer presenting as solitary cold nodule
-encapsulated or invasive
-hematogenous rather than lymphatic spread
-mets: lung, bone
81. Germline mosaicism -involved in oocytes or spermatocytes
-genetic mutation when not present in parents but only in offspring
-prob of passing it on to further offpspring depends on the ratio of wt to mut alleles in mosaic parent

(diff than somatic mutations which can't be passed on)


82. Glomerulotubular balance among GFR, peritubular oncotic pressure, and proximal tubular reabsorption
balance
83. Graves hyperthyroidism serum T4/FT4, 123I uptake, serum TSH
tx: -blockers, thionamides
84. Hand- Foot-Genital HOX13 mutation
Syndrome - distal limb defects, hypoplastic first digits, and GU malform
85. Hashimoto thyroiditis -autoimmune thyroiditis; hypothyroidism common= human leukocyte antigen (HLA)-Dr3 and HLA-Dr5
associations
-type IV (mainly) and type II hypersensitivity
-helper T cells release cytokines attracting macrophages that damage tissue= (type IV HSR)
-antimicrosomal and antithyroglobulin antibodies destroy parenchyma (type II HSR)
-histo: lymphocytic infiltrate with prominent germinal follicles
-risk factor for primary B-cell malignant lymphoma of the thyroid
86. Heart Morphology of shunting of blood from LA to RA causes volume overload of RV --> RA enlarged + eccentric (dilated) RVH
ASD
87. Hereditary Orotic defect in UMP Synthase
Aciduria physical and mental retardation
megaloblastic anemia
elev urinary orotic acid
benefit from uridine supplement
88. Heterophile ab *CMV
NEGATIVE Mono-like HHV-6
syndromes HIV
Toxoplasmosis
89. Homocystinuria -downward & inward lens dislocation (down & in)
-AR, heart rarely affected
-mental retardation
-osteoporosis, recurrent thromboembolism
-characteristic laboratory features - plasma methionine and homocystine levels are elevated, homocystine
is excreted in the urine, plasma cystine levels are reduced, positive urine cyanide-nitroprusside test
-response to treatment with pyridoxine
90. HTN and at risk for THIAZIDES! increased bone mineral density b/c increase in Ca2+ abs in DCT
Osteoporosis
91. Hypomagnesemia diarrhea, aminoglycosides, diuretics, alcohol
92. Hypoparathyroidism -MCC is autoimmune hypoparathyroidism
-other causes: thyroid surgery, digeroge synd, hypomagnesemia: mc pathologic cause of hypocalcemia in
hospital
-serum calcium, PTH; serum phosphorus
-tetany, calcification of basal ganglia, cataracts, Candida infections
93. Inc RBC, WBC and polycythemia= increase hematocrit
Platelets
94. Increased Pulse hyperthyroidism, aortic regurgitation, aortic stiffening (isolated systolic hypertension in elderly),
Pressure obstructive sleep apnea ( sympathetic tone), exercise (transient)
95. Increased temperature decrease sperm production and inhibin when temperature increases
in Sertoli cells...
*seen in cryptochidism and varicocele
96. Increased tubular flow -slow flow rate is required for a countercurrent system to work effectively
rate in LOH -increased flow rate: its ability to function as a countercurrent system and maintain a hyperosmolar
interstitium will become compromised
-dilute urine will then be produced in large amounts
***This is one mechanism by which loop diuretics function in promoting diuresisby increasing the tubular
flow rate and compromising the ability of the loop of Henle to function as a countercurrent system
97. The inner medullary -permeability Increases in presence of ADH
collecting tubules are -ADH Increases urea permeability of inner medullary collecting duct --> urea exits tubular lumen to create
variably permeable more hypertonic interstitium --> Increases [urine]
to urea
98. ischemia area of Splenic flexure (watershed areas), rectum (watershed areas)
Colon
99. Ischemic area of ACA/MCA/PCA boundary areas (watershed areas*)
Brain -Neurons most vulnerable to hypoxic-ischemic insults include Purkinje cells of the cerebellum and pyramidal
cells of the hippocampus and neocortex
100. ischemic area of Straight segment of proximal tubule (medulla) + Thick ascending limb (medulla)
Kidney
101. ischemic area of Liver Area around central vein (zone III)
102. ischemic are of Heart Subendocardium (LV)
103. Jod-Basedow -Thyrotoxicosis if a patient with iodine deficiency and partially autonomous thyroid tissue (eg, autonomous
phenomenon nodule) is made iodine replete
-Opposite of Wolff-Chaikoff effect
104. Kallmann syndrome -AD, maldevelopment of the olfactory bulbs and GnRH-producing cells in the hypothalamus
-GnRH --> FSH, LH, testosterone, sperm count
- Delayed puberty, anosmia
-Low sprem count/ infertility in males/ amenorrhea in females
-Can be assoc with midline defects= cleft lip/ palate
105. Klinefelter syndrome -47,XXY karyotype
-Meiotic nondisjunction of X chroms
-Male with eunuchoid body, gynecomastia, testicular atrophy, tall, long extremities, female hair distribution,
dev delay, infertility, some psychosocial abnorm (lack of insight or judgment)
-Testicular atrophy; fibrosis seminiferous tubules/Sertoli cells; Leydig cells prominent
-Dysgenesis of seminiferous tubules --> decreased inhibin---> increased FSH
-Abnormal Leydig cell function--> decreased testosterone --> increased LH--> increased estrogen
106. Lactose Intolerence down regulation of lactase production of small enterocytes
107. Left Dom Heart -PDA comes off of LCX
- SA and AV node supplied by LCX
108. Left-to-Right Shunt -Bypasses systemic circulation
-May cause pulmonary hypertension and
eventual right-to-left shunt
-Patent ductus arteriosus, ventricular septal defect
109. Leukocyte adhesion -due to selectin or CD11a/ CD18 deficiency aka and integrin defect
defciency (LAD) - Delayed separation of the umbilical cord (usually separates and sloughs by the end of the second
postnatal week)-- Neutrophil enzymes are important in cord separation; therefore in a histologic section of
the surgically removed umbilical cord, no neutrophils would be seen adhering to venular endothelium or be
seen in the interstitial tissue
- Additional clinical findings include severe gingivitis, poor wound healing, and peripheral blood
neutrophilic leukocytosis (loss of the marginating pool)
- Recurrent bact infections without pus
110. Loop Diuretic effect -The juxtaglomerular apparatus is informed of NaCl in the tubular lumen by virtue of its transport into the
on Tubuloglomerular cells of the macula densa by the same Na+-K+-2Cl- cotransporter that is inhibited by loop diuretics
Feedback -One reason for the potency of loop diuretics is their ability to blunt tubuloglomerular feedback and
thereby maintain GFR (and urine production) despite increased NaCl traffic past the macula densa
111. Lupus related thrombosis -DVT
-hepatic v. thrombosis
-placental thrombosis (recurrent preg loss)
-stroke

TX: lifelong anticoag


112. Lymphocytic hypophysitis autoimmune destruction during/after pregnancy
113. Lymphopenia HIV, DiGeorge syndrome, SCID, SLE, corticosteroids, radiation, sepsis, postoperative
114. Malignant Otitis Externa -common in elderly diabetics
-mcc: pseudomonas aeruginosa, non-lactose fermenting, oxisdase positive, G- rod
-severe ear pain and drainage
-granulation tissue seen in canal but tympanic membrane is intact
-can progress to osteomyelitis of skull and causes CN dmg
115. Marfan's -upward & outward lens dislocation (up &out)
-AD, aortic incompetence or MVP may occur
-normal intellectual dev
-flat feet, herniae, scoliosis; there is a 50% reduction in life expectancy
116. MC Ankle Sprain due to -Ant Talofibular Lig dmg
inversion of plantar- -ecchymosis at the ant-lat aspect of the ankle
flexed foot
117. MCC of Hypoglycemia in impaired clearance of insulin
advanced renal insuff
118. MCC of Hypoglycemia in Thiamine def= suppression of GNG (pyruvate DH) and TCA cyle (alpha-KG DH)
EtOH-ics
119. MCC of Vaginal 1. Abx use= reduces lactobacilli pop
Candidiasis 2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
120. MC Complication post SAH sx: thunderclap ha, confusion, fever, nuchal rigidity
Subarachnoid MC Compl: VASOSPASM!
Hemorrhage -vessels surrounding ruptured aneurysm
-cerebral ischemia and new onset confusion and/or focal neuro deficits (paresthesia, weakness, etc) 4-
12 days post SAH
-mech of vasospasm is related to impaired brain autoreg
-not seen on CT, need transcranial color doppler
-Nimodipine prescribed to prevent vasospasm post-SAH
121. Mechanically Ventilated -The amount of anatomic dead space increases considerably b/c the volume of space occupied by the
Patients respiratory apparatus from the patient's mouth to the ventilator must be considered to be anatomic
dead space
-Alveolar ventilation is altered, and care must be taken to ensure adequate oxygenation
122. Medullary carcinoma -sporadic > familial-- familial type has a better prognosis than the sporadic type
-autosomal dominant MEN IIa/IIb
-derives from C cells; calcitonin tumor marker
-calcitonin converted into amyloid
123. Meigs Syndrome ovarian fibroma, ascites, and hydrothorax
*** Fibroma= benign ovarian neoplasm
124. MEN 1 -Pituitary tumors (prolactin or GH) Pancreatic endocrine tumorsZollinger-Ellison syndrome,
insulinomas, VIPomas,glucagonomas (rare)
-Parathyroid adenomas
-Associated with mutation of MEN1 (menin, a tumor suppressor, chromosome 11)
125. MEN 2a -Parathyroid hyperplasia
-Medullary thyroid carcinomaneoplasm of
parafollicular or C cells; secretes calcitonin;
prophylactic thyroidectomy required
-Pheochromocytoma (secretes catecholamines)
-Associated with mutation in RET (codes for
receptor tyrosine kinase) in cells of neural crest origin
126. MEN 2b -Medullary thyroid carcinoma
-Pheochromocytoma
-Mucosal neuromas (oral/intestinal ganglioneuromatosis)
-Associated with marfanoid habitus; mutation in
RET gene
127. Menopause -decreased estrogen prod d/t age linked decline in the number of ovarian follicles (exhaustion of follicles)-- avg
onset is 51 yo and earlier in smokers (<35 yo: premature ovarian failure)
-increased FSH is diagnostic for menopause (d/t loss of inhibin/ neg feedback by estrogen)
-hormonal changes: decreased estrogen, increased FSH, increased LH (no surge), increased GnRH
128. Metabolic metabolic acidosis, ketonemia, hyperglycemia, hyperkalemia, hyponatremia
derangements -hyperammonemia can be observed due to muscle degradation
assoc with DKA
129. Metanephric - interacts with ureteric bud that induces differentiation and formation of glomerulus through the distal
Mesenchyme convoluted tubules
130. Methylmalonyl- -AR
CoA mutase Def -increased urine: methylmalonic acid and propionic acid
-hyperammonemia, ketotic hypoglycemia, and metab acidosis
-newborns present with lethargy, vomiting, and tachypnea
131. Mets through BM Clonal proliferation of cells can invade/ metastasize*
1. malignant cells to lose their cell-to-cell adhesion molecules (cadherins)
2. cell receptors to attach to laminin (a glycoprotein) in the basement membrane and to release
metalloproteinases (e.g., collagenases, stromelysins, gelatinases) to degrade the basement membrane and other
enzymes to degrade the interstitial connective tissue- tissue inhibitors of metalloproteinases neutralize these
tumor-produced enzymes and limit the degree of invasion
3. cell receptors to attach to bronectin and other proteins in the extracellular matrix (ECM) and to break it down
4. malignant cells to produce cytokines that stimulate locomotion, so that they can move through basement
membranes and the intracellular and extracellular matrices
132. Mineralocorticoid think volume expansion, hypertension, hypokalemia, hypernatremia, metabolic alkalosis
excess
133. Mitral Regurg -mitral valve does not form good seal--> blood flows into left atrium during early systole
-Precise symptoms of mitral regurgitation depend on temporal course of the mitral regurgitation
-acute onset--> severe symptoms
-chronic onset--> typically asymptomatic or minor symptoms
-MVP: classically gives rise to a midsystolic "click" on auscultation
-Turbulent flow into left atrium during ventricular systole
-Murmur lasts throughout systole
134. Mitral Stenosis -Associated with large diastolic pressure difference between left atrium and ventricle
- Increased left atrial pressures --> increased hydrostatic pressures in pulmonary circulation --> pulmonary
edema --> RVH and decreased CO
-Sx of pulmonary edema: dyspnea, reduced exercise capacity
-Opening snap + diastolic rumble (diastolic murmur)
-Turbulent flow across stenotic mitral valve during ventricular filling
-LA pushes on esoph
-LA hypertrophy and dilation
135. MM - Inc susceptibility to infection
- Primary amyloidosis (AL)
- Punched-out lytic bone lesions on x-ray = activated RANK-L increased osteoclast activity
- M spike on serum protein electrophoresis
- Ig light chains in urine (Bence Jones protein)
- Activated IgG prod by plasma cells by IL-6, may lead to proteasome inhib
- Rouleaux formation (RBCs stacked like poker chips in blood smear)
136. MM Symptoms -fatigue= d/t anemia
-constipation= d/t hypercalcemia
-bone pain, mostly in the back and ribs= d/t osteoclast activating factor prod by myeloma cells
-elevated serum protein= monoclonal protein
-renal failure
-"myeloma kidney"= excess excretion of free light chains (bj proteins), and when the levels exceed the reabs
capacity they will precipitate with Tamm Horsfall protein and form casts that cause tubular obstruction and
epithelial injury --> tubular dysfxn
-glassy casts stain eosinophillic
137. Most Serious REBLEED!
Compl of SAH -sudden dev of severe confusion, HA, N/V, decreased consciousness, focal neuro deficits
-seen on CT
138. Mullerian Duct -anatomical defects that may present as primary amenorrhea in females with fully developed secondary sexual
Abnormalities characteristics (indicator of fxn'l ovaries)
-agenesis because of hypoplastic or absent mullerian duct system
139. Nelson Synd enlarged existing ACTH-sec pituitary adenoma after bilat adrenalectomy for refractory Cushing's D (to remove the
cortisol feedback)
-sx: hyperpig, HA, bitemporal hemianopia
140. neonatal -mc in fragile germinal matrix
intravascular -inc freq with decreased age and birth wt
hemorrhage -mc complication would be long term neurodev impairment (alt consciousness, hypotonia, dec spont mvmnt)
-s/sx of bleed: bulging ant frontanelle, hypotension, decerebrate posturing, tonic-clonic seizures, irreg
respirations, coma
141. Neuroblastoma -malignant tumor of postganglionic sympathetic neurons-- adrenal medulla tm
-neural crest cells
-childhood tumor and cause of hypertension
-N-MYC oncogene (nuclear transcriber) amplification
-increased HVA and VMA (catecholamine metabolites) in urine
-Homer-Wright rosettes B characteristic of neuroblastoma and medulloblastoma
-bombesin and NSE
-Opsoclonus-myoclonus syndrome: paraneoplastic syndrome; myoclonic jerk; chaotic eye movements
142. Neutropenia Sepsis/postinfection, drugs (including chemotherapy), aplastic anemia, SLE, radiation
143. Obstructive -expiratory volumes are reduced because of airway narrowing and sometimes a loss of elastic recoil in the lungs
Lung Capacity -Total expiratory volumes are largely preserved, but the ability to exhale rapidly is substantially reduced
-FEV1 is reduced more than is FVC, and the FEV1/FVC ratio is reduced
-increased TLC
144. Opioid action -g-protein coupled activation of K+ efflux= hyperpol and pain transmission termination
on mu rec -inhib adenylyl cyclase
-inhib Ca2+ conductance
-inhib transmitter release
145. Opioids cause -act on mu rec to constrict sphincter of oddi=
biliary colic increased pressure of common bile duct and gallbladder
-need to discontinue drug and treat pain with other NSAIDS: ketorolac and diclofenac
146. Ovulation -estrogen surge (increase GnRH rec on ant pit) LH surge ovulation (rupture of
follicle)
-increased temp= progesterone induced
-between days 14 and 16
147. Paget's Disease associate Bone Tm OSTEOSARCOMA! arising from tibia, femur, humerus, and other bones
-pain doesnt resolve with OTC analgesics
148. Papillary adenocarcinoma -mc endocrine cancer
-radiation exposure***
-multifocal, papillary fronds intermixed with follicles, psammoma bodies, Orphan
Annie nuclei, lymph invasion
-mets: cervical nodes, lung
149. Patent Ductus Arteriosus -PDA= connection b/w pul a. and aorta that should've obliterated at birth
-continuous machine like murmur= L to R shunt
- large PDA can progress to pul htn and reversal of shunt (R to L shunt)
- can lead to heart failure= SOB, fatiguability
- Eisenmenger's Synd= cyanosis and clubbing that is more pronounced in the lower
extremities (in ToF it is whole body cyanosis)
150. Patent foramen ovale -failure of septum primum and septum secundum to fuse after birth
-can lead to paradoxical emboli
151. pathophysiologic mechanisms that reduce (1) increased thickness of the pulmonary membrane in restrictive diseases (the primary
diffusing capacity factor in silicosis and idiopathic pulmonary fibrosis)
(2) collapse of alveoli and lung segments (atelectasis), which contributes to a
decreased surface area available for gas exchange (e.g., with bed rest after surgery)
(3) poor lung compliance, resulting in insufficient ventilation (e.g., silicosis)
(4) destruction of alveolar units, which also decreases surface area (e.g., emphysema)
152. Patient with HTN and Hypokalemia = -CAH
decreased renin and decreased -Adrenal tumor
aldosterone -Cushing Synd
-Exogenous mineralocorticoid
153. Patient with HTN and Hypokalemia = PRIMARY HYPERALDOSTERONISM
decreased renin and increased -Aldosterone prod Tm
aldosterone -Bilateral adrenal hyperplasia
154. Patient with HTN and Hypokalemia = SECONDARY HYPERALDOSTERONISM
increased renin and increased aldosterone -renovasc htn ( renal a. stenosis)
-malignant HTN
-renin secreting tm (JG cell tm)
- diuretic use
155. PCT: Isosmotic reabsorption reabsorption of fluid along the proximal tubule in which there is no change in tubular
osmolality
156. Perfusion-limited gas exchange -diffusion can increase only if blood flow increases
-examples: N2O and O2 under normal conditions
157. P-Glycoprotein -Also known as multidrug resistance protein 1 (MDR1)--transmembrane ATP-dep efflux
pump protein with broad specificity for hydrophobic compounds
-Classically seen in adrenal cell carcinoma but also expressed by other cancer cells
(eg, colon, liver)
-Used to pump out toxins, including chemotherapeutic agents (one mechanism of
responsiveness or resistance to chemotherapy over time)
158. Pheochromocytoma -majority benign, unilateral, arise in adrenal medulla
-neurofibromatosis; MEN IIa/IIb (RET); von Hippel- Lindau disease; Sturge-Webber Synd
-palpitations, paroxysmal hypertension, anxiety, drenching sweats, headache, orthostatic
hypotension, chest pain, ileus
-Tm: brown, hemorrhagic, and o en necrotic
-Dx: plasma free metanephrines best screen
-Urine tests: 24-hour collection for metanephrine (best test), VMA
-lab: hyperglycemia, neutrophilic leukocytosis
159. Physiol Adaptations during -increased cardiac output= increased preload and decreased afterload
Pregnancy -increased heart rate= increased placental and adrenal perfusion
-anemia= increased plasma + increase RBCs--> increased viscosity
-hypercoag= decreased blood loss at delivery
-hypervent= eliminate fetal CO2
160. Physiological Shunts in -pneumonia or pulmonary edema
Pathological Cases (Disease -impaired ventilation may result in perfusion of unventilated alveoli
states)
161. Physiologic shunt -This occurs when blood is appropriately directed to the lungs but is not involved in gas exchange
-EX bronchial arterial circulation= The bronchial arteries supply the bronchi and supporting lung
parenchyma but
are not involved in gas exchange at the level of the alveoli
162. Pituitary apoplexy -hemorrhage into preexisting adenoma hypopituitarism
-RF: trauma, pregnancy (Sheehan postpartum necrosis, a nontumorous cause), treatment of a
prolactinoma with bromocriptine
-headache, mental status dysfunction, visual disturbances
-hormone dysfunction
163. Pituitary during pregnancy -pituitary gland doubles in size during pregnancy because of prolactin synthesis
-prolactin release is inhibited by the high levels of progesterone during pregnancy
164. Placenta accreta -placenta attaches to myometrium without penetrating it
-most common type
-Defective decidual layer= abnorm attachment and separation after delivery
-No separation of placenta after delivery postpartum bleeding (can cause Sheehan syndrome)
165. Placenta increta/ percreta implantation into muscle; danger of hemorrhage at delivery
-Placenta incretaplacenta penetrates into myometrium
-Placenta percretaplacenta penetrates ("perforates") through myometrium and into uterine
serosa (invades entire uterine wall); can result in placental attachment to rectum or bladder

-Defective decidual layer= abnorm attachment and separation after delivery


-No separation of placenta after delivery postpartum bleeding (can cause Sheehan syndrome)
166. Placental aromatase defciency -Inability to synthesize estrogens from androgens
-Masculinization of female (46,XX) infants (ambiguous genitalia), increased serum testosterone and
androstenedione
-Can present with maternal virilization during pregnancy (fetal androgens cross the placenta)
-males are normal phenotypically
167. Placenta previa -implantation over cervical os-- placenta attaches to lower uterine segment
-previous C-section risk factor
-painless vaginal bleeding
-dx by US; deliver by C-section
168. Polycystic ovary syndrome (PCOS) -incidence insulin-resistance, obesity, acanthosis nigricans
-LH/FSH ratio >3
-serum free tesosterone/ androstenedion
- serum SHBG; normal to serum FSH
-secretion LH follicular hyperthecosis (hyperplasia ovarian thecal cells) production
testosterone, androstenedione hyperandrogenicity (e.g., hirsutism)
-chronic anovulation (less aromatization of androgens to estrogen)
-follicular arrest, subcortical cysts
-conversion androstenedione to estrone endometrial hyperplasia/cancer, breast cancer
risk
- oligomenorrhea, hirsutism, obesity, infertility
- first line tx: OCPs= Induce regular menses, inhibits ovarian androgen production, increases
sex
hormone-binding globulin (SHBG) production
169. Precocious puberty -Normal karyotype
-Premature maturation of arcuate nucleus in
hypothalamus
-Treat with GnRH agonists (e.g., leuprolide)
170. Primary B-cell lymphoma -most often derives from Hashimoto thyroiditis
171. Primary hyperparathyroidism -MC nonmalignant cause of hypercalcemia
-MEN I, IIa association
-MCC of 1 HPTH: benign adenoma
-primary hyperplasia: all four glands involved-- chief cell hyperplasia
-renal stones, nephrocalcinosis; metastatic calcification, PUD, acute pancreatitis, osteitis fibrosa
cystica; subperiosteal bone resorption; osteoporosis; pseudogout, diastolic HTN, band
keratopathy, psychosis, confusion, anxiety, coma
-serum calcium/PTH; serum phosphorus/bicarbonate; chloride/phosphorus ratio >33
172. Primary hypogonadism due to testosterone, sperm count; LH; FSH
Leydig cell + seminiferous tubule
dysfunction [males]
173. Primary hypogonadism due to -alcohol, renal failure, orchitis, radiation
Leydig cell dysfunction' -testosterone, sperm count; LH; normal FSH; hypergonadotropic hypogonadism
[males]
174. Probenecid -Probenecid and penicillin use organic anion transporters for elimination into the urine
-Probenecid can be used clinically to reduce elimination of penicillin because it competes for
the anion transporter, thereby increasing plasma penicillin levels
175. Progesterone-only OCPs -50% effective in inhibiting ovulation
-work primarily by thickening the cervical mucus and altering the motility and secretions of the
fallopian tubes, as well as thinning the endometrium
- All these changes make the uterus a less hospitable environment for implantation of a
fertilized embryo
-Inhibits implantation and therefore pregnancy, it does not prevent fertilization
176. Pseudohypoparathyroidism type -Unresponsiveness of kidney to PTH hypocalcemia despite PTH levels
1A (Albright hereditary -Characterized by shortened 4th/5th digits, short stature
osteodystrophy) -Autosomal dominant
-Due to defective Gs protein -subunit causing end-organ resistance to PTH
-Defect must be inherited from mother due to imprinting
177. Pseudopseudohypoparathyroidism -physical exam features of Albright hereditary osteodystrophy but without end-organ PTH
resistance
-Occurs when defective Gs protein -subunit is inherited from father
178. Pulmonary V/Q Mismatch, causes hypoxemia that increases ventilation and HR via a chemoreceptor reflex
Embolism -hypocapnia b/c hypervent, but unable to compensate for hypoxemia
-resp alkylosis= increased ph and decreased PaCO2
179. Pulmonary -Pulmonary infarction: MC site lower lobes
infarction -Saddle embolus: sudden death
-dyspnea/tachypnea MC symptom/sign
-respiratory alkalosis; hypoxemia; D-dimers
180. Pure Red Cell -Inhib of erythroid precursors and progenitors by IgG autoantibodies or cytotoxic T cells
Aplasia - Marrow failure characterized by hypoplasia of erythroid elements but normal granulopoiesis and thrombopoiesis
(PRCA) - Assoc with thyoma, lymphocytic leukemias, and parvovirus B19 infection
181. Reduced -LV Heart Failure + Pul Congestion
pulmonary -Pul Fibrosis
compliance -Insuff Surfactant

decreased compliance= decreased FRC


182. Regulation of ***Extremely important, because modest changes in plasma levels can precipitate neuromuscular symptoms and
the lethal cardiac arrhythmias
extracellular
potassium -These occur because the resting membrane potentials of nerves and muscle are directly related to the ratio of
pool intracellular and extracellular potassium concentrations
183. Renal Artery -MCC: atherosclerosis or fibromuscular hyperplasia. In unilateral renal artery stenosis, hypertension may occur
Stenosis because decreased perfusion of the affected kidney is incorrectly "interpreted" as intravascular volume depletion,
which triggers a neurohormonal cascade response (the RAAS and ADH)--> causing fluid retention and
vasoconstriction resulting in hypertension
-When both renal arteries are affected (bilateral renal artery stenosis), renal blood flow may become so
compromised that the kidneys are unable to perform their normal recycling functions, resulting in the toxic
accumulation of metabolic byproducts
184. Renal Artery
Stenosis (histo)

medial fibroplasia, absent internal elastic lamina in areas of aneurysmal dilation


185. Resp Alkylosis -Respiratory alkalosis:increases negative charges on albumin, extra negative charges bind some of the ionized
+ Ca2+ calcium, normal total serum calcium
Homeostasis -ionized calcium, PTH
-tetany: due to a decreased ionized calcium level= thumb adducts into palm; facial twitching after tapping facial
nerve
186. Respiratory hypoventilatory capacity limited owing to resulting hypoxemia
compensation
for metabolic
alkalosis
187. Response to Decreased RPF --> Increased filtration fraction to maintain GFR --> Increased peritubular oncotic pressure -->
volume- Increased proximal tubular reabsorption --> Increased ECF volume
depleted state
188. Response to Increased RPF --> Decreased filtration fraction to maintain GFR--> Decreased peritubular oncotic pressure -->
volume- expanded Decreased proximal tubular reabsorption --> Increased urinary losses--> Decreased ECF volume
state
189. Restrictive Lung -do not have difficulty emptying their lungs, FVC typically decreases because they are unable to adequately
Disease fill their lungs during inspiration
-inspiration is limited by noncompliance of the lungs, which limits expiratory volumes
-elastic recoil of the lungs is largely preserved (if not increased), the FVC is typically reduced more than is the
FEV1, resulting in an FEV1/FVC ratio that is normal or increased
-decreased TLC
190. Riedel thyroiditis -Fibrous tissue replacement of gland and surrounding tissue
-Can obstruct the trachea
-Associated with other sclerosing conditions (ex: sclerosing mediastinitis)
-tx: corticosteroids
191. Right Dom Heart majority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
192. Right-to-left Shunt -Bypasses pulmonary circulation
-Tetralogy of Fallot, truncus arteriosus, transposition of great vessels, atrial septal defect
193. Risk Factors of -C-section delivery
Endometritis -chorioamnionitis
-group B strep colonization
-intrauterine instrumentation
-preterm delivery
-prolonged labor
-prolonged ruptured membranes
-retained products of conception

SIGNS AND SX OF POSTPARTUM ENDOMETRITIS


-fever
-leukocytosis
-uterine tenderness
-foul smelling vaginal discharge
194. SCD + Pituitary Hypopituitarism from HbSS anemia: infarction; vascular occlusion by sickled cells
195. Secondary -constitutional delay, Kallmann syndrome, hypopituitarism, prolactinoma; hypogonadotropic hypogonadism
hypogonadism -lab findings: FSH, LH, testosterone, sperm count
[males]
196. S. epidermidis - coag neg
-novobiocin sens
- infective endocarditis and infective arthritis in prosthetic pts
197. Serotonin Synd confusion, agitation,tremor, tachycardia, htn, clonus, hyperreflexia, hyperthermia, diaphoresis
TX: Cyproheptadine= 1st gen histamine antag, nonspec 5-HT1 and 5-HT2 rec antag
198. Solitary Thyroid -Solitary nodule in a woman: majority are benign--15% malignant
Nodules -Solitary nodule in a man or child: more likely to be malignant

First step in management solitary thyroid nodule: FNA


199. Spironolactone + improve survival of CHF pts with low LV ejection fraction
HF -block aldosterone's effect on heart and decrease fibrosis and ventricular remodeling
-used with ace-inhib and beta-blockers
200. Spontaneous MCC: AV malformations, ruptured cerebral aneurysms, and cocaine abuse
Intracranial
Hemorrhage
201. ST Elevation in leads II, II, RCA transmural ischemia of inf wall of LV
aVF (possible sinus node dysfxn=bradycardia and hypotension)
202. ST Elevations in leads V1 transmural ischemia of septum
and V2 infranodal (morbitz type II) 2nd degree or 3rd degree heart block is possible result as well
203. ST Elevations in leads V1- Prox LAD occlusion= anteroseptal transmural ischemia
V4
204. ST Elevations in V5, V6, I, transmural ischemia of interventricular septum and LV
and aVL
205. Subacute granulomatous - MCC painful thyroid
thyroiditis -virus induced-- preceded by URI
-no adenopathy
-granulomatous inflammation with multi-nucleated giant cells
- initial thyrotoxicosis from gland destruction-- increased serum T4, decreased serum TSH
-permanent hypothyroidism is uncommon
-decreased 123-I uptake
-self-limited; does not require treatment
206. Subacute painless -develops postpartum; progression to hypothyroidism
lymphocytic thyroiditis -abrupt onset of thyrotoxicosis due to gland destruction
-slightly enlarged and painless gland
-progresses to primary hypothyroidism
-tx: levothyroxine in the hypothyroid stage
207. Surfactant -cortisol/ thyroxine synthesis
-insulin synthesis
208. Systolic heart failure pump failure (impaired contractility, increased afterload)
209. t(8;14) Burkitt lymphoma (c-myc activation)
-cmyc is an oncogene
-very aggressive, rapid proliferation of cell growth
210. t(9;22) aka Philadelphia CML (BCR-ABL hybrid), rarely ALL
chromosome -constitutive expression of tyrosine kinase
-poor prognosis when expressed in ALL
211. t(11;14) Mantle cell lymphoma (cyclin D1 activation)
-cyclin D1 is a cell cycle regulator
-this translocation continuously allows cells to go on in cell cycle without stopping/ apoptosis
212. t(12;21) Acute lymphoblastic leukemia/lymphoma
*better prog
213. t(14;18) Follicular lymphoma (BCL-2 activation)
[Diffuse Large B-Cell Lymphoma]
-bcl-2 inhibits apoptosis normally
-in this CA, there is constant anti-apoptotic activity
214. t(15;17) APL (M3 type of AML)
-translocation of retinoic acid rec (chr 15) onto chr 17, blocks maturation and abnormal pro-
myelocytes/ blasts increase which can lead to an increase in DIC
215. TCA Effect on Cardiac Na+ BLOCKS cardiac fast Na+ channels= QT and QRS prolongation and arrhythmias
Channel -treated with Sodium Bicarb
216. Tensilon Test -Cholinergic Crisis: muscles stop responding to the bombardment of ACh, leading to flaccid paralysis, respiratory
failure, and other signs and symptoms reminiscent of organophosphate poisoning. Other symptoms include
increased sweating, salivation, bronchial secretions along with miosis.-- Flaccid paralysis resulting from
cholinergic crisis can be distinguished from myasthenia gravis by the use of the drug edrophonium (Tensilon),
which worsens the paralysis caused by cholinergic crisis, but strengthens the muscle in the case of myasthenia
gravis. (Edrophonium is an cholinesterase inhibitor hence increases the concentration of acetylcholine present).

under-tx'd MG pt presents with exaggerated MG sx, and when infused with edrophonium the sx subside it
indicates that the MG treatment (AChE inhib) need to increase in dose
217. Testis descent - transabdominal phase: descend to lower abd/ pelvic brim= Mllerian inhibitory substance (MIS) is responsible
for this phase
- inguinoscrotal phase: androgen- and hCG-dependent
218. Thyroid storm causes:
-inadequately treated patients with Graves disease undergo surgery
-infection, trauma
-iodine, pregnancy
sx:tachyarrhythmias, hyperpyrexia, coma, shock (volume depletion from vomiting)
Tx:
(1) Inhibit hormone synthesis: Propylthiouracil or Iodide
(2) Sympathetic blockade with -blockers
(3) Hydrocortisone
(4) Cooling blanket
219. Thyrotoxicosis -weight loss
-heat intolerance
-anxiety
-diarrhea
-oligomenorrhea and lid stare
-atrial fibrillation, sinus tachycardia, systolic HTN, high output failure
- brisk reflexes, osteoporosis
-glucose, calcium, lymphocytes; cholesterol
220. Toxic -one/more nodules in multinodular goiter become TSH-independent
multinodular -no exophthalmos/pretibial myxedema
goiter
221. True -46,XX karyotype, most common, followed by 46,XX/46,XY mosaicism
hermaphroditism -No sertoli cells or lack of mullerian inhibitory factor
-Presence of both ovarian and testicular tissues
-Ovulation and spermatogenesis may both occur
222. Tuberous -tuberin and harmartin mutations
Sclerosis - facial angiofibroma
- seizures
- intellectual disability
- heart defects= cardiac rhabdoyomas in ventricular walls and AV valves, cutaneous angiofibromas (adenoma
sebaceum)

assoc neoplasms:
giant cell astrocytoma -- CNS hamartoma
renal angiomyolipoma-- renal cysts
cardiac rhabdomyoma
223. Turner -45,XO karyotype with absent Barr body
syndrome -Meiotic nondisjunction
-Streaked ovaries, amenorrhea, short stature, webbed neck/ cystic hygroma (lynch defects), (preductal) aortic
coarctation, shield chest, bicuspid aortic valve, horseshoe kidney, cubitus valgus, menopause before menarche
- decreased estrogen leads to increased LH, FSH
224. Upper - Musculocutaneous and Suprascapular N.
Brachial - dystocia mc in neonates; severe trauma mc in adults
Plexus Injury - should adduction, elbow extension, and forearm pronation
225. Ureteric Bud -caudal end of mesonephric duct
-gives rise of ureter, pelvises, calyces, and collecting ducts
-canalized by 10th week
226. Ventricular -MC occurs in membranous septum
Septal Defect -Acyanotic at birth bc of L to R shunt
227. Vomiting powerfully stimulates metabolic alkalosis through direct loss of H, loss of Cl , and volume depletion
228. Warburg malignant cells undergo high rates of glycolysis to produce macromolecules necessary to sustain rapid cellular
Effect growth
229. Wernicke's -word salad: well-articulated, nonsensical speech paired with lack of lang comprehension
Aphasia -aud association cortex: post part of sup temporal gyrus
- supplied by MCA
230. Whipple triad (1) Symptoms occur: adrenergic and neurological sx
(2) Hypoglycemia
(3) Symptoms are relieved by glucose
231. Zero Order EtOH
Drugs Salicylates
Phenytoin
Lithium