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Glossary of USMLE Step 1 from Goljan Notes

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Learn about Question , What is the most common malaria? , What is the fever pattern for P. vivax? , Which malaria is the most lethal? , Which malaria is associated with nephrotic syndrome? , What is the fever pattern for P. falsiparirum? , What is the fever pattern for P. malariae? , What do you find in the lab work? , Prophylaxis Tx for malaria? , What drug do you use for resistant falciparum?

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Question: Answer

What is the most common malaria?: Vivax (Viva! It's the MC)

What is the fever pattern for P. vivax?: 48 hours (Viva the 48 hr party!!!)

Which malaria is the most lethal?: Falciparum (make one false step and you are dead)

Which malaria is associated with nephrotic syndrome?: P. malariae

What is the fever pattern for P. falsiparirum?: No pattern, it is so false that it doesn't have one

What is the fever pattern for P. malariae?: 72 hours

What do you find in the lab work?: Blood smears with organisms inside RBC, falciparum ring form and gametocytes (banana shape)

Prophylaxis Tx for malaria?: Chloroquine

What drug do you use for resistant falciparum?: Mefloquine

ME FLOr resistant Falciparum

What is the Tx for all except falciparum?: Chloroquine plus primaquine

What is the specific Tx for falciparum?: IV quinidine or quinine plus doxycycline

Falciparum is the FALSE QUEEN (quinidine)

What leukemia has translocation t(15;17): Acute Promyelocytic Leukemia (M3)

In which leukemia do you find DIC?: Acute Promyelocytic Leukemia (M3)

What leukemia has gum infiltration?: Acute Monocytic Leukemia (M5)

What leukemia has auer rods?: Acute Myelogenous Leukemia (M2/M3)

What are auer rods?: fused azurophilic granules on cytosol of blast cells

What leukemia is cured/reverse with Vitamin A (Retinol)?: Acute Promyelocytic Leukemia (M3)

What is the age distribution of all leukemias?: ALL (0-14) AML (15-39) AML (40-60) CML (40-60) CLL (>60 years old)

Which leukemia has translocation t9;22?: Chronic Myelogenous Leukemia (CML)

What is the frequency of acute leukemias ?: Acute Myelogenous Leukemia (M2) 30-40% Acute Promyelocytic (M3) 5-10%, Acute Monocytic (M5) 10%

What leukemia is associated with ABL protooncogene?: Chronic Myelogenous Leukemia (CML)

What is the translocation of ABL protooncogene?: t9;22

What chromosome is CML found in? What is the name of the chromosome?: Chromosome 22; Philadelphia Chromosome

What is afected in chromosome 22 for CML?: bcr (break cluster region) bcr-ABL fusion gene

What is the most specific test for CML?: decrease LAP (Leukocyte Alkaline Phosphatase)

What are other positive tests for CML?: philadephia chromosome and bcr-ABL fusion gene

What is the most common cancer and leukemia in children?: ALL

What is the most common subtype?: pre-B (80%)

What is a positive marker for ALL?: CALLA; CD10
Common ALL Antigen and TdT (terminal deoxynucleotidyl transferase)

You are Caller No. 10!!!

Where do B cells metastasize in ALL?: CNS and testicles

think B is for Brain and Balls!

Where do T cells metastasize in ALL?: Anterior Mediastinal mass or acute leukemia

Which ALL type has best prognosis?: t(12;21)

Gout or Pseudogout? How do you tell?: Positively Birefringement (Blue color) Pseudogout

Negatively Birefringement (Yellow color) Gout

What crystal is negatively birefringent?: Negative is Yellow in color so it's Monosodium Urate for Gout

What crystals are positively birefringent?: Positively Blue in color so it is Calcium Pyrophosphate Crystals (CPPC) for Pseudogout

Blue Crystals?: Pseudublue
Pseudogout
- Blue is Calcium pyrophosphate

Yellow Crystals?: Gout Monosodium urate

What joints are involved in Osteoarthritis?: DIP + PIP

What joints are involved in Rheumatoid Arthritis?: MCP + PIP

What are PIP joints inflamed called?: Bouchard Node

Pouchard

What is a Heberden Node?: Inflamation of DIP

What is rheumatoid factor? (RF): IgM Ab against IgG

Where is rhematoid factor found?: In synovial fluid

What is the synovial tissue that grows over the articulate cartilage called?: Pannus

Not to be confused with Tophus that is found in Gout

Which on is symmetrical? Rheumatoid or Osteoarthritis?: 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

Dz with degenerative arthritis in vertebral columns, pee turns black? cartilage is turns black: Alkaptonuria

What is the inheritance of alkaptonuria?: autosomal recessive

What enzyme is absent and what accumulates?: Homgentisic Acid builds up

homogentisic oxidase

Patien w/ disuria, sterile piuria?: Non-specific urethritis chlamydia

No culture in urine

Same patient develops pain on Achilles Tendon? Conjunctivitis: Reiter's Sx

HLA-27 (+) patient

Chlamydia triggered HLA-B27?: Yes, it made Reiter become active

- Ulcerative colitis can also be an environmental factor
- psoriasis
- shigella

Patient with hot joint, pustule on palm aspirated and found gram neg. dipplococci?: Disseminated Gonococchemia

STD?: Sinovitis
Tinosinovitis (hands)
Dermititis (pustules hand and feet)

What components do you need to kill Gonorrhea?: C5-C9

Septic arthritis?: MC gonorrhea (GC) Gonoccocus...

Any patient with bilateral bell-spalsy?: Lyme Dz until proven otherwise

MC cranial nerve involved with Lyme Dz?: VIIth nerve

Hemolytic Anemia? What do you see in this patient?: Babesia Micro

Ticks carry both dz?: Lyme and Babesia

What percent of lyme infected have babeiosis?: 20% of patients have babeiosis

What is babesia microti?: intracellular erythrocytic parasite

similar to ring falciparum

Tx for chronic?: Ceftriaxone

Tx for acute?: Tetracycline

Mechanism of blue sclera?: Color of veins is blue
Seein the coroidal veins
that give the color to the sclera since there is very little collagen I

What is osteopetrosis?: Brittle bone Dz
Defect in osteoclasts
no marrow, severa anemia

Where are B cells located in lymph nodes?: Germinal Follicles; Peripheral areas of spleen (white pulp)

Where are T cells located?: ParacorTex; periarteriolar sheat in spleen

What are histiocytes and where are they located?: Part of the Lymphatic system in sinuses; skin (Langherhan's Cells); Red Pulp in Spleen

What is associated with Left Supraclavicular Nodes?: Abdominal and Pancreatic CA

What is associated with Right Supraclavicular Nodes?: Lung Mets and Esophageal CA; Hodgkin's lymphoma

What is the left supraclavicular node called?: Virchow's Node

What CA diseminates to para-aortic nodes?: Testicular CA and Burkitt's Lymphoma

What gene is associated with Follicular Lymphoma?: Translocation t14;18
overexpression of bcl-2

Follicular Think Fourteen
Fo Fo

What gene association is found in Burkitt's?: EBV translocation t8;14

African Jaw

What does the African variant involve? (Burkitt's): Jaw

What does the American variant involve? (Burkitt's): GI, ovaries and retroperitoneum

What do you see in Burkitt's?: Starry Sky Apparence

What is the Starry Sky?: macrophages w/ phagocytosed apoptotic bodies

What are the characteristic cells in Hodgkin's Lymjphoma?: association w/ EBV; cutaneous anergy to common antigens

What are the cells of Hogkin's L. called?: Reed-Sternberg Cells

What are Reed-Sternberg Cells?: transformed germinal center B cells

What CD maker's do you use to detect RS cells?: CD15 and CD30; you got to be able to REED by 15 and 30

What does a classic RS cell look like?: two mirror image nuclei w/ eosinophilic nucleolus surrounded by a clear halo

What is elevated in vWF disease?: Elevated Bleeding Time (platelet adh. problem)
aPTT increased

What is elevated on hemophilia A?: VIII deficient
aPTT increased
(intrinsic pathway)

What is elevated in a person taking aspirin?: Bleeding Time elevated

What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?: Bleeding Time increased
platelets decreased

What are two other diseases that has Bleed Time increased and decreased platelets?: Thrombotic Thrombocytopenic Purpura
Hemolytic Uremic Syndrome

What factor involved in extrinsic pathway?: VII

What factor involved in intrinsic pathway?: XII, XI, IX, VIII

What is the best test for vWF diases?: ristocetin cofactor assay

What anti bodies does blood group O have?: anti A-IgM
anti B-IgM

anti AB- IgG

What anti bodies have blood A?: anti B

What does group B has?: anti A-IgM

What does group AB has?: 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

What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?: TP53

What SG is assciated w/ breast, ovary and prostate CA?: BRCA 1
BRCA 2

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 is the function of RB gene?: G1 to S phase inhibitor

What are the genes fo anti-apoptosis?: BCL-2 genes

What is the function of BCL-2 genes?: prevents the leakage of cytochrome c (signal for apoptosis)

What disease is associated with BCL-2?: b-cell lymphoma
B C L -2

Follicular Lymphoma t14;18

What is another disease that involves TP53?: Ataxia Telangiectasia
syceptibility to malignant lymphoma

What virus is associated w/ TP53?: HBV and

HTLV-1(T cell leukemia and lymphoma)

HPV 16,18 HPV16 inhibits TP53
RB inhibited by HPV 18

What CA is associated w/ hypercalcemia?: primary SCC of lung
Renal Adeconcarcinoma
PTH-like peptide

WHat CA is associated w/ myasthenia gravis?: Eaton-Lambert Sx
SCC of lung

What CA is associated w/ sudden appearance of seborrheic keratosis?: "Sudden"
Stomach Adenocarcinoma

What CA is associated w/ hypertrophic osteoarthropathy?: Lung CA

What CA is associated w/ superficial migratory thrombophlebitis?: pancreatic carcinoma

Troussau sign (he had it himself, self-diagnosed)

What CA manifests Nonbacterial thrombotic endocarditis? (Sterile Vegetations on Mitral Valve): Mucous-secreting pancreatic and colorectal CA

WHat CA manifests w/ ADH increase? What do you find clinically?: SCC of lung

Hyponatremia

What CA manifests w/ ACTH increase? Clinical Symptoms?: SCC of lung
Medullary CA of Thyroid

Clin: Cushing Sx

What CA manifests increase in erythropoietin? Clinical?: Renal AdenoCA
primary SCC of lung
Breast CA

hypercalcemia

What CA presents w/ inc. in B-hCG? Symp?: Choriocarcinoma (Testis)

gynecomastia

What CA presenst w/ Calcitonin increase? Symp.?: Medullary CA of Thyroid

hypocalcemia

What region of the face does BCC and SCC occur?: BCC top of the face upper lips
SCC below lower lips

WHat RNA virus is associated with TP53 suppressor?: HTLV-1 T cell leukemia and lymphoma virus!

What DNA virus is associated w/ TP53 suppersor gene?: HBV and HPV 16,18 E6 inhibits it

What two genes are knocked out by HPV 16, 18?: E6 and E7 produced by HPV

E6 inhibits TP53
E7 inhibits RB suppressor gene

What CA does EBV is associated with?: Burkitt's lymphoma
CNS lymphoma in AIDS
Mixed Cellularity Hodgkin's
Nasopharyngeal CA

What virus is associated w/ hepatocelluar CA?: HBV

What RNA virus causes hepatocellular CA?: HCV not HBV!!!

HBV is DNA virus

What deffect has opening snap during diastole?: Mitral Stenosis

Snap Stenosis

What MCC of death in rheumatic fever?: Myocarditis

What type of Hypersensitivity is Rheumatic Fever?: Type II

What organism is involved in Rheumatic Fever?: group A Strepto

Step. pyogenes

What do the antibodies react to in Group A Steptococcus?: Ab react to M proteins

What are two common findings in myocarditis?: aschoff bodies
Anitschkow Cells

the two Russians

WHat are Aschoff Bodies?: central fibrinoid necrosis surrounded by reactive histiocytes

How long after a group A step. pharyngitis does Rheumatic Fever occur?: 1-5 weeks after episode

What are five signs of Rheumatic fever?: 1) Carditis
2) Migratory polyarthritis
3) Subcutaneous Nodules
4) Erythema Marginatum
5) Sydenham's Chorea

What valve is affected with a pansystolic (holosytolic) murmur?: Mitral Regurgitation

What valve is involved in a mid-systolic click?: Mitral Valve Prolapse

it clicks half way since the chordae restrain it

What two diseases have Mitral Valve Prolapse?: Marfan's Sx
Ehlers Danlos

What pathology is associated with coarctation of the aorta?: Turner Sx

What is the MC congenital heart disease in children?: VSD
very small dudes :)

What is the MC congenital heart disease in adults?: a is for ASD

What are the three A's in ASD?: Adults
Alchohol Fetal Sx
ALL from Down Syndrome

What viral infection is involved w/ PDA?: rubella

What murmur is heard in PDA?: machine like murmur during systole and diastole

What keeps PDA open in fetus?: PGE2

What is the Tx for closure of PDA in newborn?: indomethacin

Where is the murmur best heard for PDA?: between the shoulder blades

What carcinogen is impilcated with pancreatic adenocarcinoma, SCC of oropharynx and upper/mid esophagus?: Alcohol

What carcinogen is impilcated with stomach AdenoCA?: nitrosamines and nitrosamides

What carcinogen is impilcated with colorectal cancer?: Lithocholic acid
secondary bile acid

What carcinogen is impilcated with Lung CA? (4): uranium
asbestos
chromium
nickel

What carcinogen is impilcated with pleural mesothelioma?: Asbestos

What carcinogen is impilcated with breast cancer and cervical cancer?: Oral Contraceptives

What carcinogen is impilcated with SCC of skin, lung CA, liver 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)

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