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Rheumatoid
What is it called when you get a patient with rheumatoid arthritis
that expresses dry mouth and dry eyes?
Schoegrem Sx
Syndrome with rheumatoid arthritis with nodes in the lungs?
Kaplan Sx
What is the Tx of Rheumatoid Arthritis?
Methotrexate
What are some effects of long teng methotrexate tx?
i.e. Arhtritis Tx
Macrocytic Anemia
Hypersegmented Neutrophils
Also causes:
Intersitial Fibrosis of the Lung
Tx for Gout?
Indomethacine
What drug do you give for underexcretion of uric acid?
Probenecid
Sulfanpirizone
Overproducer of uric acid?
Allopurinol
What is the mech. of Allopurinol?
Block Xanthine Oxidase
What is the mechanism of uric acid accumulation/gout in
alcoholics?
Patients with alcoholism are under metabolic acidosis
-All the acids compete in the excrition of proximal tubule
Alcoholics contain b-hydroxybutiric acid, lactic acid so they
compete with uric acid to be excreted
nothing
just like new borns and old people
What blood group has greatest incidence of gastric carcinoma?
group A
What is associated w/ duodenal ulcer?
group O blood
Who is the universal donor?
Group O
Who is the universal acceptor?
AB no antibodies to attack those cells
What Protoconcogene (POC) is associated w/ osteogenic
sarcoma?
SIS
What POC is associated w/ Leukemia?
RAS
What POC is associated w/ Breast CA?
ERB-B2
What POC is associated w/ Astrocytoma?
SIS
What POC is associated w/ Neuroblastoma?
N-MYC
What POC is associated w/ lung CA?
RAS
What POC is associated w/ CML?
ABL
What POC is associated w/ Burkitt's Lymphoma?
c-MYC
MYC
What POC is associated w/ colon CA?
RAS
What POC is associated w/ MEN IIa/IIb Syndromes?
RET
WhatPOC is associated w/ pancreatic CA?
RAS
What function does SIS have?
GF synthesis
(Growth Factor)
What fx does ERB-B2 has?
Receptor Synthesis
What fx does ABL has?
Non-receptor TK activity
WHat fx does RET have?
Receptor Synthesis
What fx does MYC have?
Nuclear Transcription
What fx does N-MYC have?
Nuclear transcription
WHat fx does RAS has?
GTP signal transduction
What two POC have the same function of Receptor Synthesis?
ERB-B2 and RET
What two POC have the same fx of nuclear transcription?
c-MYC and N-MYC
What does SIS activate?
Overexpression
What does ERB-B2 activate?
Amplification
What does RET Activate?
Point Mutation
What does RAS activate?
Point Mutation
What does ABL activate?
translocation
t(9;22)
What does MYC activate?
c-MYC translocation t(8;14)
What does N-MYC activate?
Amplification
What two POC amplify?
ERB-B2 and N-MYC
What two POC activate point mutation?
RET and RAS
What two POC activate translocation?
ABL and c-MYC
What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
EBV
What POC amplifies breasts??? imagine that...
ERB-B2
Breast bigger two!
What are the inactivation of suppressor genes?
TP53, RB, APC and BRCA1/2
Hyponatremia
What SG is associated w/ familial polyposis: color cancer?
APC
What suppressor gene is asscoiated w/ retinoblastoma,
osteogenic sarcoma and breast CA?
RB
What is the function of TP53?
G1 to S phase inhibitor
What is the function of BRCA 1/2 gene?
Regulates DNA repair
What is the APC gene function?
Prevents nuclear transcription
- degrades catenin; an activator of nuclear transcription
What SG is associated w/ familial polyposis: color cancer?
APC
What suppressor gene is asscoiated w/ retinoblastoma,
osteogenic sarcoma and breast CA?
RB
What is the function of TP53?
G1 to S phase inhibitor
What is the function of BRCA 1/2 gene?
Regulates DNA repair
What is the APC gene function?
Prevents nuclear transcription
- degrades catenin; an activator of nuclear transcription
What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
EBV
angiosacroma?
Arsenic
What carcinogen is impilcated with TCC of bladder? (2)
cyclophosphamide
b-naphthylamine (dye and rubber indus.)
What carcinogen is impilcated with acute leukemia?
benzene
What carcinogen is impilcated with SCC of penis?
Smegma in uncircumcised male
What carcinogen is impilcated with SCC of scrotum?
tar, soot, oil (chimney sweeper)
What carcinogen is impilcated with malignant lymphoma?
Alkylating agents
What is the mos common risk factor for BCC, SCC, melanoma?
UVB light
What is the mos common risk factor for Kaposi's Sacroma?
HHV-8
What is the mos common risk factor for Nasopharyngela CA?
EBV
What is the mos common risk factor for larynx CA?
polycyclic HOC (hydrocarbons)
What is the mos common risk factor for distal esophagus?
barret's disease
What is the mos common risk factor for Stomach AdenoCA?
Helicobacter pylori
What is the mos common risk factor for Colon adenoCA?
preexisting polyps
tubular and villous adenoma
a=95
Normal A-a grad= 5-30
When is A-a gradient indicative of pulmonary pathology?
when A-a grad = >30
Where is ventilation most prominent in the lungs?
Apex
What is more prominent at the base of the lungs? Vent. or Perf.
Perfusion
Where do infactions of the lung occur?
Lower lobes
i.e. more perfusion
What is the diagnosis of a child w/ Nasal Polyps? Test for?
Sweat Test
Cystic Fibrosis (CF)
until proven otherwise
Patient w/ fibromyalgia and develops asthma, what is the cause
of this?
Aspirin induced asthma
block PG but still produce Leukotriene build up
LT C-D-E4 buildup
(potent bronchoconstrictors)
Causes of Hypoxemia w/ normal A-a gradient?
- barbiturates OD
- epiglottitis (Upper Airway Obstr.)
- Amyotrophics Lat. Sclerosis (ALS)
Newborn that turns cyanotic when breast feeding; cries and turns
back to pink. Diagnosis?
Choanal Atresia
esophagus?
polymyositis
myasthemia gravis
Why is myasthemia gravis on the upper esophagus?
Upper 1/3 of esophagus is striated muscle
What three diseases have disphagia for liquids?
really bad...
1) plummer vinson
2) esophageal CA
3) Barrett's Esophagus (ulceration and stricture)
What is associated with iron deficiency and dysphagia for solids?
Plummer-Vinson
What does it mean when you have dysphagia for solids but not
liquids?
Mechanical Obstruction
What does it mean when you have dysphagia for both solids and
liquids?
peristalisis problem
What is the MCC of odynophagia in HIV?
esophagitis caused by Candida albicans
Aids Defining
MC congenital esophageal disorder?
Tracheoesophageal fistula
What is wrong in tracheosophageal fistula? (what ends blindly?)
Proximal esophagus ends blindly
What are the common signs and symptoms of fistula in
pregnancy?
Polyhydramnios
(excess fluid)
fetus is not reabsorbing it through mouth
achalasia?
VIP (vasointestinal peptide)
What is the function of VIP?
relax the LES
What sign do we see in the X-ray of achalasia?
bird's beak in barium study
dilation of proximal esophagus
HOw are achalasia and progressive systemic sclerosis (PSS)/
CREST Sx similar?
both have relaxation of LES
absence of esophageal motility
manometry best diagnostic measure
What does CREST stand for?
Calcinosis
Raynaud's Phenomenum
Esophageal Motility Dysfunction
Sclerodactyly
Telangiectasias
What laboratory test do you use to diagnostie CREST Sx?
ANA (70-90%)
anti-SCL-70 (70%) topoisomerase I
anti-centromere antibodies (30%)
What is the problem in GERD?
relaxed LES
acid injury leads to Barrett's esophagus and then distal AdenoCA
What vein is most likely to have varices in esophagus?
left gastric coronary vein (from portal)
azygous vein
What is the MC organism causes esophagitis?
Candida
What are other causes of esophagitis?
alcohol dehydrogenase
Where is alcohol dehydrogenase found?
in cytosol and mitochondria
Why is there a build up of lactate in alcoholics?
high levels of NADH make pyruvate go into lactate (increases
anion gap)
Why does hypoglycemia occur in alcoholics?
again increase in NADH makes conversion of pyruvate to lactate
decrease in pyruvate can't go back to gluconeogenesis
Why is there steatosis?
alcohol is converted to acetaldehyde and acetate and acetyl coA
which makes free fatty acids
- increase in NADH2 favors glycerol-3-p
What is the sequence to make TG (VLDL) from 1,3 DPG?
1,3 DPG to Glyceraldehyde-3-P to DHAP to Glycerol-3-P + FA
makes TG
Why is ketoacidosis sometimes present in alcoholics?
NADH once again favors conversion of:
Acetoacetate to B-Hydroxybutyrate (ketoacids)
Why are alcoholics prone to gout?
Ketoacids and Lactic Acid compete w/ uric acid for excretion in
the kidneys
so Uric Acid Accumulates!
What is the ratio of ALT and AST in alcoholics?
You are an ASS because you drink
AST > ALT
What is seen in alcoholic hepatitis?
mallory bodies
virus
Other cause of FHF?
Reye's Sx
What is hemochromatosis?
unrestricted reabsorption of IRON (small bowel)
What is the mode of inheritance of hemochromatosis?
autosomal recessive
What are the laboratory findings of hemochromatosis?
- increase serum iron
- decrease TIBC
- increase % saturation
- increase serum ferritin
What is the best screening test?
increase serum ferritin
What are the manifestations of hemochromatosis?
- bronze skin
- pancreas (malabsorption and DM)
- restrictive cardiomyopathy
- liver anormalities including hepatocellular CA in 30%
What is the Tx of hemochromatosis?
phlebotomy
What is Wilson's Dz?
defect in Copper (Cu+) secretion into bile
- bile is Copper deficient
or
- defect in synthesis of ceruloplasmin
What is ceruloplasmin?
protein that binds to Copper
vasoconstrictors?
Angiotensin II
TXA2
What two substances are vasodilators in pre-eclampsia?
PGE1
N.O.
Tx for Eclampsia?
Magnesium Sulfate
What is the clinical presentation of pre-eclampsia?
hypertension
proteinuria
pitting edema
What is the clinical picture of eclampsia?
same as pre-eclampsia but w/ seizures or convulsions
Should BUN be increase or decreased in normal pregnancy?
decreased in normal pregnancy
Should GFR be increased or decreased in normal pregnancy?
Increased
What do we find in lab. for pre/eclampsia? BUN
Uric Acid
Serum Creatinine
GFR
transaminases
BUN increased
uric acid increased
creatinine increased
GFR decreased
transaminases increased
Schistocytes/anemia/thrombocytopenia
What kind of plancenta do Siamese twins have?
Monochorionic Monoamniotic planceta