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{{c1::Laryngeal papillomas}} are benign papillary squamous proliferations commonly found on the {{c1::true}} vocal cords; they are associated with HPV{{c2::6}} and HPV{{c2::11}}"- True vocal cords are made of stratified squamous epithelium - recall that HPV has a predilection to SSE - Can be transmitted vertically from mother to fetus prior to delivery - Can be described as ""finger-shaped, warty, or grapelike"" lesions Photo credit: Omland et al., CC BY 4.0, via PLOS ONE"Watch Human Papillomavirus (Papillomaviridae)Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphoma Watch associated Bootcamp video - DNA Viruses: Human Papillomavirus: Clinical Manifestations55a4efad-8002-48e9-87a3-69cca6005a1a
{{c1::Cervical intraepithelial neoplasia (CIN)}} is a dysplastic pre-cancerous lesion of the cervix that commonly manifests following the loss of the tumor suppressors {{c2::p53}} and {{c2::Rb}} following HPV infectionHigh risk HPV (16, 18, 31, 33) encode proteins E6 and E7 → knock out p53 and Rb, respectively CIN 1 (LSIL), CIN 2 (HSIL), and CIN 3 (HSIL) respectively: Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Cervical Neoplasia Watch Human Papillomavirus (Papillomaviridae)Watch associated Bootcamp video - Female Pathology: Cervical Pathology Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - DNA Viruses: Human Papillomavirus: Clinical Manifestationsa6dd91ca-4289-48ec-8593-88ed65af0af6
Where in the body are Group D Streptococci normally found? {{c1::Colon (GI) and urogenital (GU)::2}}- Therefore in instrumental procedures that involve the GI/GU tract, infection can occur Group D streptococci include: - Enterococcal (Enterococcus faecium & faecalis) - Non-enterococcal (Streptococcus gallolyticus *formerly named S. bovis)Watch Streptococcus gallolyticus (Group D Strep) Watch Enterococcus faecium & faecalisWatch associated Bootcamp video - Enterococcus and Bacillus: Enterococcus Watch associated Bootcamp video - Streptococcus : Additional Streptococci70028592-974e-41c7-aa12-4ec0302f85ec
Which toxin from Clostridium tetani causes tetanus? {{c1::Tetanospasmin}}- Travels retrograde through motor neuron, cleaving SNARE proteins involved in neurotransmission - Prevents release of GABA and glycine (inhibitory neurotransmitters) - Causes spastic paralysis, trismus, and risus sardonicusWatch Clostridium tetaniWatch associated Bootcamp video - Invasive Spinal Cord Disease: Tetanus Watch associated Bootcamp video - Clostridium: Clostridium Tetani Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junction85f12d7f-65e5-4596-90d5-d3ff9c30847f
{{c1::Pott disease}} is a possible complication of extrapulmonary tuberculosis that involves spread of infection to {{c2::vertebral bodies}}AKA tuberculous spondylitis Photo credit: Yale Rosen, CC BY-SA 2.0, via FlickrWatch Mycobacterium tuberculosis Watch Mycobacterium lepraeWatch Pneumonia SOA Watch Approach to Chronic Back Pain & Opioid UseWatch associated Bootcamp video - Mycobacteria: Pulmonary Tuberculosis Disease Variants Watch associated Bootcamp video - Spine: Vertebral Osteomyelitis Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphomab45e3dd5-3945-4995-aa9e-711e35bc44ee
Neisseria {{c1::gonorrhoeae}} has no {{c3::vaccine}} due to rapid antigenic variation of {{c2::pilus}} proteins- GoNOrrhoeae has NO vaccine - AKA fimbriaeWatch Neisseria Overview [Old Version]Watch Neisseria OverviewWatch associated Bootcamp video - Gram Negative Diplococci: Neisseria Gonorrhoeae20a1ba68-5cda-4078-a8b4-717f17f78626
{{c1::Trypanosoma cruzi}} is the etiology of {{c2::Chagas disease}}Chagas disease caused by flagellated protozoa called Trypanosoma cruzi transmitted by reduviid (kissing) bug by painless bite and defecation as it's contained within the bug fecesWatch Trypanosoma cruzi [Old Version]Watch Trypanosoma cruziWatch associated Bootcamp video - Cardiomyopathy: Chagas Disease Watch associated Bootcamp video - Systemic Protozoa: Trypanosoma Cruzi Watch associated Bootcamp video - Antiparasitics: Antiparasitics of Leishmaniasis and Trypanosomiasise4782260-6d3a-4495-b4a3-fcf0d95cffa3
"How is Chagas disease (Trypanosoma cruzi) transmitted? {{c1::Reduviid bug feces (AKA ""kissing bug"")}}"- More specifically, a Triatomine bug - Chagas disease caused by flagellated protozoa Trypanosoma cruzi transmitted by reduviid (kissing) bug by painless bite and defecation as protozoa present within the bug fecesWatch Trypanosoma cruzi [Old Version]Watch Trypanosoma cruziWatch associated Bootcamp video - Cardiomyopathy: Chagas Disease Watch associated Bootcamp video - Systemic Protozoa: Trypanosoma Cruzi Watch associated Bootcamp video - Antiparasitics: Antiparasitics of Leishmaniasis and Trypanosomiasis125b8962-5caf-435c-9df1-1281c4b04217
{{c1::Infectious mononucleosis}} due to EBV virus infection presents with fever, hepatosplenomegaly, pharyngitis, and lymphadenopathyLymphadenopathy is especially seen at the posterior cervical nodes and should ONLY last 2-3 weeksWatch Epstein-Barr Virus (Herpesviridae)Watch Infectious Mononucleosis Watch Upper Abdominal Pain DDx Watch Aseptic MeningitisWatch Epstein-Barr Virus (Herpesviridae)Watch associated Bootcamp video - DNA Viruses: Herpesvirus Family Overview Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Clinical Manifestations3c317502-cf41-4baf-9710-be7fea18f71b
{{c1::Epstein-Barr nuclear antigen (EBNA)}} is a serological antigen from EBV that contributes to Hodgkin or Burkitt lymphomaFound in latent cellsWatch Epstein-Barr Virus (Herpesviridae)Watch Epstein-Barr Virus (Herpesviridae)Review Burkitt Lymphoma Review Hodgkin LymphomaWatch associated Bootcamp video - Leukemias and Lymphomas: Hodgkin Lymphoma Watch associated Bootcamp video - Burkitt Lymphoma Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Clinical Manifestations516dd710-5fbf-42fa-b3ed-420330dd5f76
{{c1::Cytomegalovirus (CMV)}} is a herpesvirus that causes interstitial pneumonia in patients with HIVAssociated with owl eye inclusions Photo credit: See page for author, Public domain, via Wikimedia Commons; Tony Hisgett from Birmingham, UK, CC BY 2.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)Watch Cytomegalovirus (Herpesviridae)Watch HIV SOAPWatch associated Bootcamp video - Cardiorespiratory Infections: Atypical Pneumonia Pathogens Watch associated Bootcamp video - Opportunistic Infections: Cytomegalovirus, Disseminated Mycobacterial Non-Tuberculous Disease Watch associated Bootcamp video - DNA Viruses: Cytomegalovirus: Pathogenesis and Clinical Manifestationsebaf94f4-057a-4227-bb70-4c02eea486cd
{{c1::Streptococcus agalactiae (GBS)}}, {{c2::Escherichia coli}}, and {{c3::Listeria monocytogenes}} are bacteria that all cause meningitis in neonatesIn order GBS > E. coli > Listeria Bacterial Meningitis - Most Common CausesAgeBacteriaNeonatesGroup B streptococci > Escherichia coli > Listeria monocytogenesChildrenStreptococcus pneumoniaeAdolescentsNeisseria meningitidisAdultsStreptococcus pneumoniaeElderlyStreptococcus pneumoniae > Listeria monocytogenesWatch Listeria monocytogenesNeonatal Meningitis SOAP - Lesson - SketchyWatch associated Bootcamp video - Non-Spore Forming Gram Positive Bacilli: Listeria Monocytogenes Watch associated Bootcamp video - Infectious Neuropathology: Neonatal Meningoencephalitis Watch associated Bootcamp video - Streptococcus: Streptococcus Agalactiae3e08fc01-1d3d-4fc0-9ccc-a4c0fabc20f0
{{c1::Foscarnet}} is an antiviral agent that acts as a viral {{c3::DNA/RNA polymerase}} inhibitor by binding to the {{c2::pyrophosphate}}-binding site of the enzyme- e.g., organ transplant or AIDS patients - Also inhibits HIV reverse transcriptaseWatch Acyclovir, Valacyclovir, FamciclovirWatch associated Bootcamp video - Antivirals: Additional Herpetic Antiviral Therapy67fd45e3-0406-4c08-a95f-6348180f0e2f
What is the likely diagnosis & next step in management? Diagnosis: {{c1::Scabies}} Best next step: {{c1::Scrape skin and view under light microscopy}}Dx: Scabies Photo credit: Amintoosad, CC BY-SA 4.0, via Wikimedia Commons Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Scabies, Lice, CrabsWatch Scabies & Lice Watch Approach to Rashes1305be67-e8d3-46fd-ab12-fac1fed4b00b
The H2 receptor antagonist {{c2::cimetidine}} is a potent {{c3::inhibitor}} of {{c1::cytochrome P-450}} and therefore has multiple drug interactionsCimetidine can also cross the blood-brain barrier (causing confusion, dizziness, and headaches) and placentaWatch H2 Receptor Blockers & PPIsWatch associated Bootcamp video - Pharmacology: Histamine-2 Blockers Watch associated Bootcamp video - Pharmacokinetics: Cytochrome P450 Interactions95cc2cd1-e582-4b3c-b59b-efb08750c67d
{{c1::Rifaximin and neomycin::2}} are poorly absorbed antibiotics that eradicate ammonia-producing intestinal bacteria and thus treat {{c2::hepatic encephalopathy}}Watch Laxatives & Antidiarrheal Agents [Old Version] Watch Cirrhosis Pathogenesis & Clinical Manifestations Watch Cahill Cori CyclesWatch Cirrhosis Complications & ManagementWatch LaxativesWatch associated Bootcamp video - Hepatic Pathology: Cirrhosis Watch associated Bootcamp video - Antibiotics: Rifamycins2745ff6d-9a9e-4039-a16e-8ff04247f33b
{{c1::Loperamide}} is a(n) {{c2::μ-opioid}} agonist that does not cross the BBB, therefore there is no analgesia and low potential for addiction- At high doses, loperamide may cross the BBB & produce symptoms of opioid intoxication! - Diphenoxylate is another μ-opioid agonist that crosses the BBB (& combined with atropine to prevent drug abuse)Watch Laxatives & Antidiarrheal Agents [Old Version]Watch Antidiarrheal AgentsWatch associated Bootcamp video - Substance Misuse: Opioid Classification Watch associated Bootcamp video - Pharmacology: Loperamide2e1fb6b7-9f8c-4d29-89fd-6e2633228acd
{{c1::Octreotide (a somatostatin analog)}} may be used to treat the secretory diarrhea caused by VIPoma and carcinoid syndromeMay also be used for acute variceal bleeds and other causes of secretory diarrhea, including chemotherapy and HIV-induced diarrhea, and short bowel syndromeWatch Growth hormone, mecasermin, octreotide, pegvisomant Watch Laxatives & Antidiarrheal Agents [Old Version]Watch Antidiarrheal AgentsWatch associated Bootcamp video - Pharmacology : Octreotide Watch associated Bootcamp video - Intestinal Pathology : Carcinoid Tumors7c88d065-eb1b-479a-b6d8-d5a8a9cf00ce
Amine hormones include {{c1::thyroid}} hormones and {{c1::catecholamines}} (epinephrine, norepinephrine, and dopamine)7b36ce64-1954-4def-86c3-17192126f00e
In the adenylyl cyclase mechanism of cellular signaling, the {{c2::αs-GTP}} complex activates adenylyl cyclase, which then catalyzes the conversion of {{c1::ATP}} to {{c1::cAMP}}Intrinsic GTPase activity in the G protein converts GTP back to GDP and the αs subunit returns to its inactive state Photo credit: Kitra101 (talk) (Uploads), Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Energy Production: Regulation of Phosphofructokinase Watch associated Bootcamp video - Pharmacodynamics: Membrane Proteins9ae601e3-6655-4b51-a1f2-7bf38ccabca0
What hormone/chemical acts through a cytosolic guanylyl cyclase? {{c1::Nitric oxide}}Watch associated Bootcamp video - Vasodilation and Vasoconstriction: Endothelial Regulated Vasodilation7905b17d-a95f-42b4-8e25-d0a99fb19e07
Once nitric oxide diffuses into muscle cells, it activates soluble (cytosolic) guanylyl cyclase, which converts {{c1::GTP}} to {{c1::cGMP}}- cGMP then acts to relax smooth muscle; same mechanism as ANP but with a soluble guanylyl cyclase receptor - Agents that mimic nitric oxide (e.g., riociguat) are useful in treating pulmonary arterial hypertensionWatch associated Bootcamp video - Vasodilation and Vasoconstriction: Endothelial Regulated Vasodilationfe126767-e0b6-47d5-aac9-6d38ca11b2f5
What is the difference between the binding sites of atrial natriuretic peptide (ANP) and nitric oxide (NO) to guanylyl cyclase receptors? {{c1::- ANP binds to a receptor guanylyl cyclase - NO binds to a cytoplasmic guanylyl cyclase}}756dac24-d5c6-45a9-a981-e63bdb4151f3
The pituitary gland, also called the {{c1::hypophysis}}, consists of an anterior and posterior lobeAnatomic Relationships of the Hypothalamic-Pituitary Axis Watch Anterior Lobe of the PituitaryWatch associated Bootcamp video - Endocrine Pituitary EmbryologyAtlas:8d895404-d295-403b-9fea-7dabcea89159
One direct action of growth hormone is {{c1::decreased}} glucose uptake into cells, producing a(n) {{c1::increase}} in glucose blood concentration- Diabetogenic effect; growth hormone causes insulin resistance which mimics the effects of diabetes mellitus - Also increases gluconeogenesisWatch Hyperpituitarism Watch Anterior Lobe of the PituitaryWatch associated Bootcamp video - Anterior and Posterior Pituitary : Anterior Pituitary Function9b6311cf-e4ef-44b7-b8ff-8710303efcbe
The major action of ADH (vasopressin) is to increase {{c1::water permeability (and thus reabsorption)}} of the principal cells in the {{c2::late distal convoluted tubule}} and {{c2::collecting duct}}Watch Diabetes Insipidus & SIADH Watch Renin-Angiotensin II-Aldosterone System Watch Regulation of Body Fluid Osmolarity Watch Production of Hyperosmotic Urine Watch Production of Hypoosmotic Urine Watch Free Water Clearance Watch Cardiovascular Response to HemorrhageWatch associated Bootcamp video - Cardiology RAAS Regulation Watch associated Bootcamp video - Endocrine RAAS/ADH Review Watch associated Bootcamp video - Endocrine : Posterior Pituitary Function Watch associated Bootcamp video - Nephron Transporters : Collecting Duct0bfcdf2b-dc66-433c-8a22-d2e817a02667
In syndrome of {{c1::inappropriate ADH (SIADH)}}, excess ADH is secreted from an autonomous sitee.g., small cell carcinoma of the lungWatch Diabetes Insipidus & SIADHWatch SIADH Watch Lung CancerWatch associated Bootcamp video - Hypothalamus : SIADH Watch associated Bootcamp video - Electrolytes : Sodium Watch associated Bootcamp video - Lung Cancer : Small Cell Carcinoma4b9e1cb5-893e-47b3-b9cb-1cf6a4a97b20
What is the main thyroid hormone that is secreted? {{c1::T4::T3 or T4}}The coupling reaction for T4 is much fasterWatch associated Bootcamp video - Thyroid : T3, T4 Synthesis and Pharmacologyc1f1e081-e22b-460b-ab11-374cc89a0cc6
Why is much more T4 produced compared to T3? {{c1::The coupling reaction for T4 is much faster}}Despite this, T3 is still the more active compound Photo credit: Mikael Häggström, CC0, via Wikimedia CommonsWatch associated Bootcamp video - Thyroid : T3, T4 Synthesis and Pharmacology0318ec5b-b3d6-444d-b563-7848e39da68d
After T3 binds its nuclear receptor, the T3-receptor complex binds to a thyroid-regulatory element on DNA, where it stimulates {{c1::DNA transcription}}This ultimately leads to synthesis of new proteins that are responsible for the multiple actions of thyroid hormone Photo credit: Talhada et al., CC BY 4.0, via Frontiers in NeurologyWatch associated Bootcamp video - Thyroid : Thyroid Anatomy and Function Watch associated Bootcamp video - Pharmacodynamics: Receptor Physiology368c6027-ab09-4026-a5fd-824912ef7453
Hypothyroidism may be treated with {{c1::thyroid hormone replacement therapy (e.g., levothyroxine, liothyronine)}}- Levothyroxine is the synthetic form of T4 - Liothyronine is the synthetic form of T3Watch Hypothyroidism Overview & Hashimotos Thyroiditis Watch Pathophysiology of Thyroid HormonesWatch Hypothyroidism SOAPWatch Propylthiouracil, Methimazole, LevothyroxineWatch associated Bootcamp video - Thyroid : Hyper/Hypothyroidism: Hashimoto's and Postpartum ThyroiditisTitrate the dose until TSH levels are normal, indicating right amount of (-) feedback from T4/T3aaadbd1e-af24-4ade-b08a-e5422368b929
Glucocorticoids may have anti-inflammatory effects by inducing the synthesis of {{c1::lipocortin-1}}, an inhibitor of {{c2::phospholipase A2}}Phospholipase A2 provides the precursor (arachidonic acid) for the synthesis of prostaglandins and leukotrienes, which mediate the immune responseWatch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways Watch associated Bootcamp video - Pharmacology : Gout Medications623dbc06-b4b7-482f-8b30-8a06e250e68e
What is the level of ACTH in Addison disease? Why? {{c1::Increased}}Low cortisol levels stimulate ACTH secretion by decreased negative feedbackWatch Adrenal InsufficiencyWatch Adrenal Insufficiency SOAPWatch associated Bootcamp video - Adrenal Glands : Primary Adrenal Insufficiency72936f0e-c459-4efd-9a11-70a87b7541d6
Increased intracellular Ca2+ in the pancreatic β cell causes {{c1::exocytosis}} of insulin-containing granulesGranules also contain C-peptide, which is excreted in the urine Photo credit: Aydintay, Public domain, via Wikimedia CommonsWatch Insulin, Sulfonylureas, Meglitinides, GLP-1 Agonists, DPP-4 InhibitorsWatch associated Bootcamp video - Pancreas : Insulin Physiology00555192-014e-4a8a-a94f-a0a7e2e9e4cc
Does glucose cross the placenta? What about insulin? {{c1::Glucose does; insulin does not}}Review Insulin Overviewf975a9de-3eef-42f0-a3aa-6a0a0898ecc7
What is the cause of metabolic acidosis in a patient with diabetes mellitus? {{c1::Increased production of ketoacids}}May cause increased ventilation rate to compensateWatch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS) Watch Acid/Base Disorders Watch Ketone BodiesWatch Vomiting in Older Children & Adolescents DDxWatch associated Bootcamp video - Lipid Metabolism : Ketones: Ketone Synthesis Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketoacidosis Review and Ketogenolysis Watch associated Bootcamp video - Pancreas : Diabetic Ketoacidosis1148501c-1c92-4541-bc74-a5fe2c5b2f8d
Through which secondary messenger(s) does glucagon exert its actions on liver and adipose tissue? {{c1::cAMP}}"""FLAT ChAMP's CHuGG"""Watch Hormonal Regulation Glycogen Insulin Glucagon EpinephrineWatch associated Bootcamp video - Energy Production: Regulation of Phosphofructokinase54ba6503-2113-4938-85b9-af3e74a46c8c
How does PTH increase intestinal Ca2+ absorption? {{c1::Indirectly, by stimulating production of 1,25-(OH)2D3 in the kidney}}Increases production by stimulating 1-α-hydroxylase in the proximal tubuleWatch Parathyroid Hormone (PTH)Review Vitamin D BiochemistryWatch associated Bootcamp video -Parathyroid : Parathyroid Location and Function7ec1aad5-2906-439c-895b-d7a43b7fc916
{{c1::Primary hyperparathyroidism}} is characterized by hypercalcemia, hypophosphatemia, and increased circulating levels of PTH- Hypercalcemia and hypophosphatemia are results of elevated PTH levels - Will also see increased 1,25-dihydroxyvitamin D (PTH-induced renal conversion) despite low or normal 25-hydroxyvitamin D levels - May have high-normal or high 24-hour urinary calcium excretion* NOTE: Raised Calci-yum ice cream held by professor (sketchy wrong) Watch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Electrolytes: Phosphateccfede9f-9a37-4e89-89f9-b31d6c9c1281
What is a possible complication of increased Ca2+ in the urine (e.g., due to primary hyperparathyroidism)? {{c1::Calcium-oxalate kidney stones}}Watch Parathyroid Gland DisordersWatch Types of Kidney StonesWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Electrolytes : Calcium Watch associated Bootcamp video - Nephrolithiasis : Calcium Stones5b3b2b76-0b44-41e8-b0f0-88ba0b348bcd
"Which parathyroid disorder is characterized by ""stones, bones, groans, thrones, and psychiatric overtones""? {{c1::Primary hyperparathyroidism}}"- Stones from hypercalciuria - Bones from increased bone resorption - Groans from constipation - Thrones from polyuria - Psychiatric overtones from depressionWatch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Electrolytes : Calcium Watch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Fibrosis Cystica42cfe766-0a3c-4858-87aa-baff7fd930ee
Humoral hypercalcemia of malignancy is treated with IV fluids, calcitonin, and either {{c1::zoledronic acid::specific}} (preferred) or {{c1::pamidronate::specific}}"Zoledronic acid (Zoledronate) is preferred over pamidronate because of its superior efficacy, longer duration of action, and ease of administration (shorter infusion, 15 minutes vs. 2 hours) Per UpToDate: ""The inconvenience of prolonged IV treatment and the relatively weak potency of etidronate (which this card previously said) have diminished its utility, and it is not generally recommended unless other bisphosphonates are not available"""Watch Bisphosphonates, Raloxifene, Denosumab, CalcitoninWatch associated Bootcamp video - Parathyroids : Hyperparathyroidisminhibits osteoclasts9080c2ec-4781-4310-9f48-3987f2f1ff24
In {{c2::chronic kidney disease (CKD)}}, the combination of elevated PTH and decreased 1,25-(OH)2D3 causes {{c1::renal osteodystrophy::pathology}}, in which there is increased bone resorption and osteomalacia- Due to secondary hyperparathyroidism, patient presents with bone pain, painful nodules / skin necrosis (due to tissue calcifications), electrolyte abnormalities - If left untreated / develops further, constant stimulation of parathyroid leads to tertiary hyperparathyroidism (osteitis fibrosa cystica — bone pain and fractures due to bone cysts and brown tumors) - Patients have hypocalcemia, hyperphosphatemia, and a failure to hydroxylate vitamin D, leading to a secondary hyperparathyroidism Photo Credit: Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Chronic Kidney Disease (CKD) Watch Parathyroid Gland DisordersWatch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Calcification Watch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Fibrosis Cystica Watch associated Bootcamp video - Cellular Injury and Neoplasia: Calcification73127a02-51c5-4607-9081-f3b7ba9d9343
One source of vitamin D3 (cholecalciferol) is through synthesis from 7-dehydrocholesterol in the presence of {{c1::UV light}}Photo credit: Frontiersin [Frontiers | Vitamin-D Deficiency As a Potential Environmental Risk Factor in Multiple Sclerosis, Schizophrenia, and Autism (frontiersin.org)]Watch Osteomalacia & RicketsReview Vitamin D BiochemistryWatch associated Bootcamp video - Parathyroids : Vitamin D Deficiency Watch associated Bootcamp video - Physiology: Vitamins Watch associated Bootcamp video - Vitamins: Vitamin D: Synthetic Pathway7ddabd34-29fb-4ce8-9e73-1c9436e86e18
Cholecalciferol is converted to {{c1::25-hydroxycholecalciferol}} in the {{c2::liver}}; this compound is chemically {{c3::inactive}}- AKA 25-OH-cholecalciferol or calcidiol - Importantly, this is done by liver CYP450 enzymes, thus patients taking cytochrome p450 inducers / inhibitors should adjust their intake of vitamin D accordingly Photo credit: frontiersin [Frontiers | Role of Vitamin D in the Hygiene Hypothesis: The Interplay between Vitamin D, Vitamin D Receptors, Gut Microbiota, and Immune Response (frontiersin.org)]Watch Vitamin D & CalcitoninReview Vitamin D BiochemistryWatch associated Bootcamp video - Parathyroids : Vitamin D Deficiency Watch associated Bootcamp video - Physiology: Vitamins Watch associated Bootcamp video - Pharmacokinetics: Cytochrome P450 Interactions Watch associated Bootcamp video - Vitamins: Vitamin D: Synthetic Pathway375eeb7a-de13-4af7-a1f8-9ba918b56439
Pituitary adenoma may present with {{c1::bitemporal hemianopsia}} due to compression of the {{c2::optic chiasm}}- Tumor sits in sella turcica, which is adjacent to optic chiasm - These patients will present with a history of clumsiness and visual changes Photo credit: OpenStax, CC BY 4.0 Photo credit: Miquel Perello Nieto, CC BY-SA 4.0, via Wikimedia CommonsWatch Hypothalamic & Pituitary Dysfunction EtiologiesWatch Primary Brain Tumors in AdultsReview Pituitary AdenomaWatch associated Bootcamp video - Vision: Optic Chiasm Lesion Watch associated Bootcamp video - Endocrine Pituitary EmbryologyAtlas:d9762847-5f73-4e4f-8a92-2079f8970239
Acromegaly is associated with increased {{c1::insulin}} resistanceThus contributing to secondary diabetes mellitusWatch HyperpituitarismWatch associated Bootcamp video - Anterior and Posterior Pituitary : Gigantism and Acromegaly39f028de-1f67-4dc2-b8eb-3c60f22c2a08
Treatment for central diabetes insipidus includes hydration and {{c1::desmopressin}}, which is an ADH analogNote: Central diabetes insipidus has been renamed arginine vasopressin deficiency (AVP-D)Watch Diabetes Insipidus & SIADHWatch Diabetes Insipidus Watch Moderate & Severe Traumatic Brain Injury: ManagementWatch associated Bootcamp video - Hypothalamus : Diabetes Insipidus Watch associated Bootcamp video - Electrolytes : Sodiumbda337c9-bdfe-445d-882b-c9a49880d072
A(n) {{c2::thyroglossal duct}} cyst presents as a(n) {{c1::anterior, midline::location}} {{c3::neck}} mass that moves with swallowing or protrusion of the tongue"- vs. branchial cleft cyst in the lateral neck; may contain thyroid cells - The thyroglossal duct may persist and result in a thyroglossal duct cyst (occurring in midline near hyoid bone or at the base of the tongue), thus will classically move up with swallowing or tongue protrusion Photo credit: Baghaffar et al., CC BY 4.0, via Cureus , via Wikimedia Commons""> Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: wikimedia [File:Thyreoglossal duct cyst.jpg - Wikimedia Commons]"Watch associated Bootcamp video - Thyroid : Thyroid and Parathyroid DevelopmentAtlas:ebf27967-aaaf-4d24-a031-59f58d006165
The thyroid develops at the base of the tongue (primitive pharynx) and then travels along the {{c1::thyroglossal}} duct to the anterior neck Bonus: forms from which arch?- Thyroid diverticulum develops in floor of embryonic pharynx (1st arch) at 3-4 weeks of gestation - Thyroglossal duct progenitor migrates caudally and thyroid gland eventually assumes its normal position below larynx (unless interrupted)Watch associated Bootcamp video - Thyroid : Thyroid and Parathyroid DevelopmentAtlas:fa598fe7-00b7-402b-ad28-d5300761375e
The {{c1::foramen cecum}} (of the tongue) is the normal remnant of the thyroglossal ductSite of thyroid primordium Photo credit: Mikael Haggstrom, Public Domain, via WikipediaWatch associated Bootcamp video - Thyroid : Thyroid and Parathyroid Development Watch associated Bootcamp video - Non-Visceral Anatomy : Oral Cavity, Mastication and SwallowingAtlas: Netters:b0f8e5dd-1e82-4ca7-879b-e83aa760d39d
A partially involuted thyroglossal duct may present as a(n) {{c1::pyramidal}} lobe on the thyroidPhoto credit: Laboratoires Servier, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Thyroid : Thyroid and Parathyroid DevelopmentAtlas:70d464b5-ec40-42bd-8215-a308ec87d8ad
Graves disease is associated with {{c1::exophthalmos}}, which occurs due to activation of retro-orbital {{c2::fibroblasts}}"- Activated T cells release cytokines (TNF-α, IFN-γ) which activate fibroblasts (along with TRAb to a lesser degree), causing increased secretions of glycosaminoglycans - GAG deposition leads to osmotic muscle swelling, muscle inflammation, and increased adipocyte count → eyes being pushed out, dysfunction of extraocular muscles causes restricted extraocular movements and diplopia - Visible appearance causes appearance of a ""stare"" Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ"* activated T cells release cytokines which activate fibroblasts, causing increased secretions of glycosaminoglycans, which are osmotic Watch Hyperthyroidism Overview & Graves Disease Watch Pathophysiology of Thyroid HormonesWatch Hyperthyroidism SOAPWatch associated Bootcamp video - Thyroid : Hyperthyroidism: Graves DiseaseAtlas: e.g. lid lag, diplopia, proptosis, ocular irritation, impaired/painful EOM0e5dae79-6628-40ca-b412-9a5d17d748e5
A pot-bellied, pale, puffy-faced child with protruding umbilicus, protuberant tongue, and poor brain development is characteristic of {{c1::congenital hypothyroidism}}Congenital hypothyroidism was historically known as cretinismWatch Hypothyroidism Overview & Hashimotos ThyroiditisWatch associated Bootcamp video - Thyroid : Hypothyroidism: Other Causes Watch associated Bootcamp video - Thyroid : Thyroid and Parathyroid Development78031c2c-4589-4d39-ab2e-8fd94d5f2b63
Does subacute granulomatous thyroiditis (de Quervain) present with a tender or nontender thyroid? {{c1::**Very tender**}}- May also have jaw pain, pain that radiates to ears, and elevated ESR / CRP - de QuerVAIN is associated with PAINWatch Hypothyroidism Other CausesWatch Hypothyroidism SOAPWatch associated Bootcamp video -Thyroid : Hyper/Hypothyroidism: De Quervain and Riedel ThyroiditisAtlas:b7bc170e-9c96-4825-b349-0f9437a9c75a
Subacute granulomatous thyroiditis (de Quervain) may initially present with {{c1::hyperthyroidism}}, which typically is followed by a brief {{c1::hypothyroid}} state- Thyroid symptoms usually mild; this is permanent in ~15% of cases - During the transient hyperthyroid phase, radioiodine uptake is decreased due to low TSH levels - Typical pattern of thyroiditis (initially hyper spilling out T3/T4, then transitioning to burnout hypo)Watch Hypothyroidism Other CausesWatch Hyperthyroidism SOAP Watch Hypothyroidism SOAPWatch associated Bootcamp video -Thyroid : Hyper/Hypothyroidism: De Quervain and Riedel Thyroiditis Watch associated Bootcamp video - Thyroid : Hyperthyroidism: Other CausesAtlas:66a26c8f-265c-4ce7-98fb-5233bbde8129
What is the most common cause of primary hyperparathyroidism? {{c1::Parathyroid adenoma (>80%)}}- Other causes include sporadic hyperplasia and parathyroid carcinoma - Extends via local invasion or metastasisWatch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Thyroid : Thyroid MalignanciesAtlas:6519e8c0-76f5-41cc-9cdf-8cc2c8eb26ab
What is the serum calcium level in primary hyperparathyroidism? {{c1::Increased (due to increased PTH)}}* NOTE: Raised Calci-yum ice cream held by professor (sketchy wrong) Watch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Electrolytes : Calcium Watch associated Bootcamp video - Non-Rheumatologic Diseases: Diagnostics of Bone Disorders20d20115-382c-4540-a943-8e7f50e93416
As a result of hypercalcemia, patients with primary hyperparathyroidism are at increased risk for {{c1::calcium oxalate}} kidney stones- Despite calcium being absorbed by the kidney, the high calcium levels are unable to be completely absorbed leading to high urine calcium - Calcium oxalate stones > Calcium phosphate stonesWatch Parathyroid Gland DisordersWatch Types of Kidney StonesWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Calcium Stones46157edb-2041-4b51-8962-7884b47ac8b0
Is a patient with hyperparathyroidism more likely to present with constipation or diarrhea? {{c1::Constipation}}"""Stones, bones, groans, thrones, and psychiatric overtones"""Watch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Fibrosis Cysticaa0cfc9fc-43fd-4117-bfd0-ff1f7e000b0c
What is the serum level of calcium in secondary hyperparathyroidism? {{c1::Decreased (hypocalcemia)}}- Decreased calcium is the defect causing the increased PTH - CKD → decreased calcitriol → decreased calcium absorption from GI tractWatch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Electrolytes : Calcium Watch associated Bootcamp video - Non-Rheumatologic Diseases: Diagnostics of Bone Disordersffbf6f94-6da5-4841-915e-83d9ea293827
What is the most common cause of secondary hyperparathyroidism? {{c1::Chronic kidney disease (CKD)}}Phosphate builds up in the blood and binds free calciumWatch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism08b9591d-6e27-41c1-874a-3bc353eef119
How does renal insufficiency cause secondary hyperparathyroidism? {{c1::↓ phosphate excretion}} → {{c1::↑ serum phosphate binds to calcium}} → {{c1::↓ free calcium}} → {{c1::↑ PTH release}}In CKD ↓ synthesis of active vitamin D and subsequently ↓ intestinal calcium absorption may also cause or contribute to secondary hyperparathyroidismWatch Parathyroid Gland DisordersWatch associated Bootcamp video - Parathyroids : Hyperparathyroidism Watch associated Bootcamp video - Electrolytes: Phosphatey0c41174b-e22b-4785-b139-23f58a10a4e0
Chronic {{c1::kidney}} disease can cause a secondary hyperparathyroidism syndrome known as {{c1::renal osteodystrophy}}, which is characterized by bone lesions due to increased bone resorption (from elevated PTH)Duplicate card! If you have already unsuspended this card which is now marked for deletion, please use nid:1462140837741i as replacement. If you have not unsuspended this card, you can simply delete :) Patients have hypocalcemia, hyperphosphatemia, and a failure to hydroxylate vitamin D, leading to a secondary hyperparathyroidismWatch Parathyroid Gland Disorders Watch Chronic Kidney Disease (CKD)Watch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Osteitis Fibrosis Cystica Watch associated Bootcamp video - Parathyroids : Hyperparathyroidism
One of the most feared complications of type 1 diabetes is {{c1::diabetic ketoacidosis (DKA)}}"- No insulin to inhibit lipolysis to make ketones; type 2 can also develop following pancreas exhaustion → no insulin - DKA is a state of low insulin, which is a ""starving"" state because glucose is stuck in the blood and can't get into cells, so the liver makes ketone bodies from fatty acids as an alternative source of energy Photo credit: ProfBethRN, CC0, via Wikimedia Commons Photo credit: Mahatef, CC BY 3.0, via Wikimedia Commons""*#1 car with broken BETAscotch candie wheels= type I diabetes is the result of autoimmune destruction of pancreatic beta cells Watch Diabetes Mellitus Pathogenesis & Acute Clinical Manifestations"Watch Acute Diabetes Complications SOAPWatch associated Bootcamp video - Energy Production : Tricarboxylic Acid Cycle: Key Enzymes Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketone Synthesis Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketoacidosis Review and Ketogenolysis Watch associated Bootcamp video - Pancreas : Diabetes Types I and II Watch associated Bootcamp video - Pancreas : Diabetic Ketoacidosis6f97b1f6-4030-4320-a7e0-3b0684dbd4d4
In T1DM, increased {{c2::lipolysis}} leads to an increase in free fatty acids, which the liver consumes to secrete {{c1::ketone bodies}}Lack of insulin → no inhibition of HSL → lipolysisWatch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS)Watch associated Bootcamp video - Energy Production : Tricarboxylic Acid Cycle: Key Enzymes Watch associated Bootcamp video - Lipid Metabolism : Adipocytes and Lipolysis Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketone Synthesis Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketone Synthesis Watch associated Bootcamp video - Pancreas : Diabetes Types I and II Watch associated Bootcamp video - Pancreas : Diabetic Ketoacidosis2ca8f4fc-6c26-4725-b788-582ae3e58e05
Diabetic ketoacidosis is associated with a(n) {{c1::fruity}} breath odor due to exhaled {{c2::acetone}}Watch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS)Watch Acute Diabetes Complications SOAPWatch associated Bootcamp video - Energy Production : Tricarboxylic Acid Cycle: Key Enzymes Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketone Synthesis Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketoacidosis Review and Ketogenolysis Watch associated Bootcamp video - Pancreas : Diabetic Ketoacidosise7f7ad8b-9c8f-4d40-84a2-d4cb8a30d6dd
Symptomatic patients with insulinoma have {{c1::low::high/low}} blood glucose and {{c1::high::high/low}} C-peptide levelsAlso have high insulin levelsWatch Pancreatic Cancer & Islet Cell Tumorsd0e37c73-143e-4d93-84ac-a9e821115884
Elevated levels of {{c1::5-HIAA}}, a metabolite of serotonin, in the urine is indicative of a(n) {{c2::carcinoid}} syndrome- Abbreviation for 5-hydroxyindoleacetic acid - For this reason, 5-HIAA levels are the best initial test for carcinoid syndromeWatch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Intestinal Pathology : Carcinoid Tumors Watch associated Bootcamp video - Protein Metabolism : Tryptophan Niacin and Serotonin: Serotonin Pathway and AADC DeficiencyOther:738ad0a5-7621-46cf-84c5-1964cb90bf03
Carcinoid syndrome may occur if an intestinal carcinoid tumor metastasizes to the {{c1::liver}}- Bypasses liver metabolism and releases serotonin systemic circulation - Extraintestinal carcinoid tumors can cause carcinoid syndrome without metastasis to the liverWatch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Intestinal Pathology : Carcinoid TumorsOther:3aa65231-9cb9-4dfa-9cbd-9ee60c4d64b6
{{c1::VIPoma}} is a non-α, non-β, non-δ islet cell pancreatic tumor that secretes VIP (also known as WDHA syndrome)Vasoactive intestinal peptide (VIP)Watch Pancreatic Cancer & Islet Cell TumorsWatch associated Bootcamp video - Physiology : Secondary Digestive HormonesOther:887e219b-026b-42da-aecc-7ee1c773f23d
One clinical feature of Cushing syndrome is muscle weakness with {{c1::thin::appearance}} extremitiesDue to increased lipolysis/proteolysisWatch Cushings Syndrome Watch GlucocorticoidsWatch Cushing Syndrome SOAPWatch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome)60b7289c-8518-484c-8ad2-f34ec2155711
One clinical feature of Cushing syndrome is {{c1::hypertension}}, which is a result of an upregulation of {{c2::α1-adrenergic}} receptors, causing increased sensitivity of blood vessels to catecholaminesCortisol mediates the upregulation of α1 receptors on arteriolesWatch Cushings SyndromeWatch Hypertension SOA Watch Cushing Syndrome SOAPWatch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome) Watch associated Bootcamp video - Hypertension: Secondary Hypertensionb3fa292b-8c06-4660-9753-9d6cfb475cf2
What is the most common tumor that produces ectopic ACTH? {{c1::Small cell lung carcinoma (SCLC)}}Also may produce ADH causing SIADH*cushion is in front of the table → anterior pituitary Watch Lung Carcinoma Watch Cushings SyndromeWatch Lung Cancer Watch Cushing Syndrome SOAPWatch associated Bootcamp video - Pulmonary Small Cell Carcinoma Watch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome)Other:b6ac2fd1-d45b-43d8-999d-bfa56428cc6e
Congenital adrenal {{c1::hyperplasia}} occurs due to loss of one of the four enzymes needed for cortisol synthesis- Most commonly 21-hydroxylase deficiency (90%), most rarely 3β-hydroxysteroid dehydrogenase deficiency - Because there is a loss of cortisol, ACTH is released; whatever enzyme is blocked, precursors will be shunted elsewhereWatch Congenital Adrenal Hyperplasia (CAH)Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video- Adrenal Glands: Adrenal Cortex Pathways Overviewf677b14a-8132-4832-a16a-3d329e208dfc
"Waterhouse-Friderichsen syndrome is the bilateral {{c1::hemorrhagic}} necrosis of the {{c2::adrenal glands}}, resulting in a ""sack of blood"" appearance"Photo credit: Amadalvarez, CC BY-SA 4.0, via Wikimedia CommonsWatch Adrenal Insufficiency Watch Neisseria meningitidis [Old Version]Watch Adrenal Insufficiency SOAPWatch Neisseria meningitidisWatch associated Bootcamp video - Gram Negative Diplococci: Neisseria Meningitidis Watch associated Bootcamp video - Infectious Neuropathology: Bacterial MeningoencephalitisAtlas:14606211-a234-440b-b72f-fe39a8c2aaa9
Waterhouse-Friderichsen syndrome classically follows after disseminated intravascular coagulation (DIC) in young children with {{c1::N. meningitidis}} infectionLack of cortisol exacerbates hypotension, often leading to deathWatch Adrenal InsufficiencyWatch Adrenal Insufficiency SOAPWatch Neisseria meningitidisWatch associated Bootcamp video - Gram Negative Diplococci: Neisseria Meningitidis Watch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitis Watch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular CoagulationAtlas:ecb65c2e-adb1-4a3f-b879-307f6032a31f
Which anterior pituitary hormones are basophilic on histological preparation? {{c1::FSH, LH, ACTH, TSH}}- B-FLAT: Basophilic for FSH, LH, ACTH, and TSH - A-PiG: Acidophilic for prolactin and GHd5fb3e05-7743-4579-916a-c05fe22f8514
What surgical approach is used in the removal of a pituitary adenoma? {{c1::Transsphenoidal resection}}Watch Cushing Syndrome SOAPAtlas:1d3d2646-b7fa-49e3-90ed-e95127ca8d05
MEN {{c2::2A}} and {{c2::2B}} are associated with {{c1::medullary thyroid carcinoma::thyroid}}- Neoplasm of parafollicular cells, which secrete calcitonin - Requires prophylactic thyroidectomy TypeMEN 1MEN 2AMEN 2BGeneMeninRETRETChromosome111010Principal findingsPrimary hyperparathyroidism (adenoma)Medullary thyroid carcinoma (calcitonin)Medullary thyroid carcinoma (calcitonin)Additional findingsPituitary tumors (Prolactin or GH)PheochromocytomaPheochromocytomaPancreatic tumors (Zollinger-Ellison, insulinomas, VIPomas, glucagonomas)Primary hyperparathyroidism (hyperplasia)Mucosal neuroma/Marfanoid habitusWatch Thyroid Nodules & Cancer Watch Multiple Endocrine Neoplasia (MEN)Review MEN 297bb57ba-9dc8-4391-b64b-d52a260dbb52
{{c1::Sulfonylureas}} and {{c1::meglitinides}} bind the ATP-dependent {{c2::K+}} channels on pancreatic β cells, causing release of endogenous insulinCauses depolarization of the membrane leading to endogenous insulin release, therefore C peptide is released as well Photo credit: Aydintay, Public domain, via Wikimedia CommonsWatch Insulin, Sulfonylureas, Meglitinides, GLP-1 Agonists, DPP-4 InhibitorsReview SulfonylureasWatch associated Bootcamp video - Diabetes Type 2 Managementba5cf99b-f2fc-4cc4-85a0-c5302a646a6d
Metformin modulates enzyme function to decrease hepatic {{c1::gluconeogenesis}}Watch Diabetes ManagementWatch Metformin, Thiazolidinediones, Pramlintide, SGLT2 InhibitorsReview MetforminWatch associated Bootcamp video - Diabetes Type 2 Managementd4c03ae1-98e3-4281-a268-a89debc2b3b1
Metformin causes increased insulin {{c1::sensitivity}}, therefore enhancing glucose uptake in peripheral tissuesTherefore does not provoke hypoglycemia b/c it does not bypass glucose dependent insulin releaseWatch Diabetes ManagementWatch Metformin, Thiazolidinediones, Pramlintide, SGLT2 InhibitorsReview MetforminWatch associated Bootcamp video - Diabetes Type 2 Managementb799f30b-0db2-4bdd-b2c2-56b84e62b9e5
In {{c1::androgen insensitivity}} syndrome a person is genotypically XY but has {{c2::female}} external genitalia, {{c2::present::present/absent}} undescended testes, and breasts- i.e., the presence of the lower vagina, clitoris, and labia, as well as testes - Testes are often cryptorchid, other male internal genitalia are missing - Looks like 5α-reductase, but breasts are present due to lack of androgen receptors causing elevated testosterone - Elevated testosterone is unable to inhibit breast development and is aromatized to estrogenWatch OBGYN Primary Amenorrhea DDx Watch Pediatric Primary Amenorrhea DDxWatch associated Bootcamp video - Fetal Development: Disorders of Sexual Development Part 1 Watch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders29d3148d-cd47-4499-bddd-9468569b522b
The primary event that initiates puberty is the onset of {{c2::pulsatile}} secretion of {{c1::GnRH}} from the hypothalamus- Pulsatile pattern is necessary for the onset of puberty - Delayed onset of pulsatile nighttime GnRH release leads to constitutional delay of growth and puberty (CDGP)Watch Repro Hormones Overview & Polycystic Ovary Syndrome (PCOS)Watch LHRH Agonists/GnRH AnalogsWatch associated Bootcamp video - Hypothalamus <Watch associated Bootcamp video - Pharmacology: GnRH Modulatorsdcbee772-629f-49fe-b338-71a7b71c30f4
{{c3::Sertoli}} cells (males) secrete {{c1::inhibin B::specific}}, which serves to inhibit {{c2::FSH}}Review Klinefelter SyndromeWatch associated Bootcamp video - Fetal Devlopment: Chromosomal Disorders Watch associated Bootcamp video - Fetal Development : Sexual Differentiation9b0f0bb3-0538-41f2-a87c-23e56594e596
{{c2::Sertoli}} cells secrete {{c1::androgen-binding protein}} which serves to maintain local levels of testosteroneBinds testosterone and DHT, making these hormones less lipophilic and reducing diffusion out of the luminal fluidReview Klinefelter SyndromeWatch associated Bootcamp video - Fetal Devlopment: Chromosomal Disordersa45f658a-e40c-4564-b333-2d679e88a3dd
{{c1::Tight junctions}} between adjacent {{c3::Sertoli}} cells form the {{c2::blood-testis}} barrier, which isolates gametes from autoimmune attack163999ff-933b-4f0f-b9cb-ae8e82acca75
In some tissues, such as the prostate, {{c1::dihydrotestosterone (DHT)}} is the active androgenNot testosterone because these tissues contain 5α-reductaseWatch Benign Prostatic Hyperplasia (BPH) & Prostate CancerWatch associated Bootcamp video - Adrenal Glands: 5-α-reductase deficiencyacb0f49f-3400-4e0f-9e2f-b2a6429d3e2c
Testosterone is converted to dihydrotestosterone (DHT) via the enzyme {{c1::5α-reductase}}Watch Benign Prostatic Hyperplasia (BPH) & Prostate CancerWatch associated Bootcamp video - Fetal Development: Disorders of Sexual Development Part 1 Watch associated Bootcamp video - Adrenal Glands: 5-α-reductase deficiencyb4e81104-0660-4407-91b4-23f4cd43ba63
The Sertoli cells release a substance called {{c1::inhibin B::specific}} which causes decreased secretion of {{c2::FSH}} (negative feedback)Review Klinefelter SyndromeWatch associated Bootcamp video - Fetal Development : Sexual Differentiation
Which androgen is responsible for differentiation of the prostate? {{c1::Dihydrotestosterone (DHT)}}Watch Benign Prostatic Hyperplasia (BPH) & Prostate Cancer3f9b75f3-a83b-4c7f-bf49-db4674d4bcc7
Which androgen is associated with male hair patterns and balding? {{c1::Dihydrotestosterone (DHT)}}Photo credit: Keministi, CC0, via Wikimedia Commons2829b8a4-8bf5-4c08-ae17-12afd0e6870c
Ovarian granulosa cells may produce {{c1::inhibin}}, which inhibits FSH secretion from the anterior pituitary- Analogous to the testes - Lack of inhibin after menopause is why FSH levels are very high573d7c8c-d034-4c53-8ae6-8d25fc581e34
Where are estrogen receptors expressed (cell membrane, cytoplasm, nucleus)? {{c1::Cytoplasm; translocate to nucleus when bound by estrogen}}Watch Breast CancerWatch associated Bootcamp video - Pregnancy and Menstruation : Hormones of Pregnancy317c18d3-ba62-48f0-962b-69fd039d1fbe
The corpus luteum synthesizes {{c1::progesterone}} and {{c1::estrogen}}Progesterone > EstrogenWatch Repro Hormones Overview & Polycystic Ovary Syndrome (PCOS)Watch Intro to Obstetrics Watch Physiology Menstrual Cycle Watch OBGYN Normal Menstrual CycleWatch associated Bootcamp video - Pregnancy and Menstruation : Gametogenesis Watch associated Bootcamp video - Pregnancy and Menstruation : Hormones of Pregnancy Watch associated Bootcamp video - Pregnancy and Menstruation : Menstrual Cycle Watch associated Bootcamp video - Pharmacology : Hormone Replacement Therapy10cc1712-c8ba-4edd-812f-40ea375cee15
What lymph nodes do the vulva, scrotum, distal anus, and distal vagina drain into? {{c1::Superficial inguinal nodes}}Remember that the scrotum and vulva are superficial on the body → drained by superficial inguinal lymph nodesWatch associated Bootcamp video - Fetal Development : Female Anatomy Watch associated Bootcamp video - Fetal Development : Male Anatomya205c53b-1e44-44b1-9f1c-b1ea2da9ac80
In Tanner stage {{c1::I}}, a person is pre-pubertal (childhood) with no pubic hair and a flat chestWatch associated Bootcamp video - Pregnancy and Menstruation: Childhood Developmentf0970ebf-204e-42fd-a1e8-eb4772d4ac88
In Tanner stage {{c1::II}}, pubic hair appears (pubarche), breast buds form (thelarche), and testicular enlargement occursWatch associated Bootcamp video - Pregnancy and Menstruation: Childhood Development1a6f0e8a-3a78-4ba3-b3da-a2e1e25d038c
In Tanner stage {{c1::III}}, the pubic hair coarsens, the penis size increases, and the breasts enlargeWatch associated Bootcamp video - Pregnancy and Menstruation: Childhood Development7c9a4c9e-5686-4118-b86d-1212b4a0133b
In Tanner stage {{c1::IV}}, the penis width and glans increases and the breasts enlarge with raised areolasWatch associated Bootcamp video - Pregnancy and Menstruation: Childhood Developmentff8f2f46-f99d-43cc-9629-2fe21cfb27fb
In Tanner stage {{c1::V (adulthood)}} the penis and testis enlarge to adult size and the areola flattensWatch associated Bootcamp video - Pregnancy and Menstruation: Childhood Development936ca2ee-27eb-4c20-a128-0c38799b2d9d
A(n) {{c1::Bartholin}} cyst presents as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canalMay develop into an abscess Photo credit: Medimage, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Nicholasolan at English Wikipedia, CC BY-SA 3.0, via Wikimedia CommonsWatch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Fetal Development: Disorders of Genital Embryology Watch associated Bootcamp video - Fetal Development: Female Anatomy Watch associated Bootcamp video - Female Pathology: Internal Vaginal Pathology7358461c-5daa-4e0b-9e81-e9909e19a156
Rhabdomyoblasts are spindle-shaped cells that sometimes exhibit cytoplasmic {{c1::cross-striations}}- Malignant rhabdomyoblasts cause embryonal rhabdomyosarcoma - Rare malignant mesenchymal proliferation of immature skeletal muscleWatch Vulvar & Vaginal LesionsWatch associated Bootcamp video - Female Pathology: Vaginal CancerSarcoma botryoides Photomicrograph of a section from a bladder tumor biopsy from a child (H&E stain; approx. 550x magnification) The spindle-shaped cell (yellow overlay) with transverse striations and two nuclei (red overlay) is a skeletal muscle cell. The surrounding hypercellular stroma and the numerous mitotic figures indicate that this tumor is malignant. Sarcoma botryoides is a type of rhabdomyosarcoma that almost exclusively affects the bladder and vagina of infants. The presence of skeletal muscle cells in a pediatric bladder tumor tissue is a common feature of sarcoma botryoides.7d2a1678-d1a1-4a20-af9e-7d8b6cab90e8
Advanced cervical carcinoma tumors often invade through the anterior uterine wall into the bladder, blocking the {{c1::ureters}}May lead to hydronephrosis and renal failure, which is a common cause of death in cervical carcinoma patientsWatch Cervical NeoplasiaWatch Post-Renal AKIWatch associated Bootcamp video - Female Pathology: Cervical Pathology582d763d-ec18-41fe-aaa4-a128b9a93768
{{c2::Hydronephrosis}} with {{c1::postrenal AKI}} is a common cause of death in females with advanced {{c3::cervical}} carcinomaInvasive cervical carcinoma tends to locally create symptoms, rather than metastasize to a different siteWatch Cervical NeoplasiaWatch Post-Renal AKIHydronephrosis and hydroureter CT scan of the abdomen and pelvis (coronal view) Renal calyces, pelvises, and ureters (to the extent visualized) are distended bilaterally (green hatched overlay), causing a compression of the renal parenchyma (grade IV hydronephrosis). The normally concave cup-shaped calyces are convex or club-shaped here (red dashed line). The bladder wall appears diffusely thickened (red hatched overlay), indicating a chronic lower urinary tract obstruction as the underlying etiology. These are the radiological features of bilateral hydronephrosis and hydroureter caused by a chronic lower urinary tract obstruction.8e3d1be3-3198-4fc3-beca-c19fe80ea94e
Endometrial hyperplasia is usually caused by unopposed {{c1::estrogen}}e.g., obesity, polycystic ovary syndrome, hormone replacement therapy, anovulatory cycles, granulosa cell tumorWatch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch Abnormal Uterine Bleeding DDx Watch Endometrial Hyperplasia & CancerWatch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndrome Watch associated Bootcamp video - Female Pathology: Adenomyosis, Endometrial Hyperplasia, and Asherman Syndrome Watch associated Bootcamp video - Pharmacology: Hormone Replacement Therapy- Unopposed estrogen without progesterone = proliferate! - Obesity (↑ fat) = ↑ androgen → estrogen conversion (aromatase) - PCOS (also fat) = ↑↑ estrone production from adipose tissue (proliferative phase) and lack of progesterone (due to ↓ FSH → no luteal phase): overall, continual proliferation without shedding!6ef8262d-92ac-42c9-b171-94591b7f39c2
In polycystic ovary syndrome (PCOS), increased {{c1::LH}} production causes excess {{c2::androgen}} production (from theca cells), resulting in {{c3::hirsutism}}PCOS is the most common cause of hirsutism in females Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Repro Hormones Overview & Polycystic Ovary Syndrome (PCOS)Watch Hirsutism & Virilization DDx Watch Abnormal Uterine Bleeding DDxWatch associated Bootcamp video - Female Pathology: Polycystic Ovarian Syndrome3a876b2f-4b74-474a-b0a1-8932430a1215
{{c2::Sertoli-Leydig}} cell tumor is a rare ovarian sex cord-stromal cell tumor that may produce androgens, thus causing {{c1::hirsutism / virilization}} in women- AKA androblastoma - Contrast with thecoma (AUB in postmenopausal females) and granulosa cell tumor (precocious puberty, endometrial hyperplasia, postmenopausal bleeding, breast tenderness) Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Ovarian Neoplasms (Germ Cell & Sex Cord Stromal Tumors)Watch Hirsutism & Virilization DDx Watch Germ Cell & Sex-Cord Stromal TumorsWatch associated Bootcamp video - Female Pathology: Ovarian Cancer Subtypesfe449744-b0c6-4112-92a3-16766028c97f
{{c1::Krukenberg}} tumor is a metastatic mucinous tumor that involves both {{c3::ovaries}}; most commonly due to metastatic {{c2::gastric carcinoma (diffuse type)::specific}}Characterized by mucin-secreting signet ring cell adenocarcinoma Photo credit: Für den Autor, siehe, Public domain, via Wikimedia CommonsWatch Ovarian Cysts & Epithelial Ovarian CancerWatch Gastric CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology : Malignant Gastric PathologyKrukenberg tumor Ovarian resection specimen The ovary appears diffusely enlarged and has a smooth surface. The heterogeneous tissue contains streaks of cystic, mucoid tissue. Krukenberg tumors are usually secondary to gastric signet ring cell carcinoma or breast cancer.40f1ffa3-3496-4637-b2b3-a6ed6f3e72c6
Spontaneous abortion is more common in patients in a(n) {{c1::hypercoagulable}} state, such as those with antiphospholipid syndromeOther risk factors include congenital infection and exposure to teratogensWatch Acquired & Inherited Thrombosis Syndromes Watch Autoimmune Disease Overview & Systemic Lupus Erythematosus (SLE)Watch Early Pregnancy Loss Watch APLS & Recurrent Pregnancy Loss Watch Systemic Lupus Erythematosus SOAPWatch associated Bootcamp video - Rheumatologic Diseases: Antiphospholipid Syndrome Watch associated Bootcamp video - Coagulation and Fibrinolysis: Thrombophilias- Thrombus forms in placenta - e.g. anti-β2 glycoprotein, anticardiolipin, and lupus anticoagulant antibodies react with platelets activating endothelial cells/platelets → thrombosis9e5dd38e-da14-4e4e-b76f-1bcd1e6cc050
Preeclampsia is caused by abnormal placental {{c1::spiral}} arteries, causing endothelial dysfunction, vasoconstriction, and ischemia- Due to release of inflammatory and anti-angiogenic factors from abnormal placentation - Histologically: fibrinoid necrosis with inflammatory cells known as atherosisWatch Gestational DisordersWatch Preeclampsia & Hypertensive Diseases of PregnancyWatch associated Bootcamp video3202eda8-7b7d-49a8-af2e-37f24fc301c0
{{c1::Peyronie}} disease is the abnormal {{c2::curvature}} of the penis due to fibrous plaque within the tunica albuginea- Most commonly on the dorsum but can form anywhere in the tunica albuginea - Usually due to repeated trauma to penis during intercourse - Can cause pain and anxiety; may be surgically repaired Photo credit: SugarMaple, CC BY-SA 3.0, & NIDDK, Public domain, both via Wikimedia CommonsWatch Bladder Cancer & Penile DisordersWatch associated Bootcamp video - Penile Pathologyfcb9007b-c092-453c-b46d-ab71a20baefb
Common bacterial causes of orchitis in {{c2::young::old/young}} adults include {{c1::Chlamydia trachomatis (D-K)}} and {{c1::Neisseria gonorrhoeae}}- Increased risk of sterility, but libido not affected because Leydig cells are spared - Whereas E. coli and Pseudomonas are associated with orchitis in older adultsWatch associated Bootcamp video - Male Pathology : Inflammatory Pathology Watch associated Bootcamp video - Gram Negative Diploccoi : Neisseria Gonorrhoeae Watch associated Bootcamp video - Atypical Bacteria : Chlamydia Trachomatis Serotypes and Disease Variantsefaa5a0d-53eb-49fc-8a3c-7ca97f55771f
What is the effect of varicocele on fertility? {{c1::Decreased}}Because the pampiniform plexus acts as a heat exchanger for the testicular artery blood, dysfunction results in increased testis temperatureWatch associated Bootcamp video - Varicocele Watch associated Bootcamp video - Testicular Fluid Collectionsb944e392-a1ab-44bf-8667-460018b7eb52
Chemotherapy of an embryonal carcinoma may result in {{c1::differentiation (e.g., may mature into a teratoma)}}Watch Testicular Disorders & CancerWatch associated Bootcamp video - Germ Cell Tumors92eede8e-8472-4034-b902-4cb52d066c10
Prostatic adenocarcinoma often has {{c1::osteoblastic::type}} metastases, which is indicated by {{c2::lower back}} pain- Via Batson (vertebral) venous plexus - Commonly spreads to lumbar spine or pelvis Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Benign Prostatic Hyperplasia (BPH) & Prostate CancerWatch Approach to Chronic Back Pain & Opioid UseWatch associated Bootcamp video - Prostate AdenocarcinomaDislocation of hip replacement and sacral scleroses Pelvic x-ray of a 78-year-old male patient with bilateral hip prosthesis, PA view The hip replacement on the right side is correctly positioned and shows no sign of loosening. In contrast, the left prosthesis is cranially displaced (white arrowheads).There are also irregularly demarcated, inhomogenous sclerotic lesions in the region of the sacroiliac joint and lumbar vertebral bodies (green overlay), as well as in proximity to the prostheses (marked with stars). These lesions might be osteoblastic metastases from prostate cancer.88a065b4-68c3-4013-8de6-ec3ed80104fa
Prostatic adenocarcinoma may be treated with {{c1::GnRH}} analogs and/or {{c1::androgen}} receptor inhibitors- e.g., leuprolide (GnRH analog) and/or flutamide (androgen receptor inhibitor) - The prostate is dependent on androgens to grow and functionWatch Benign Prostatic Hyperplasia (BPH) & Prostate CancerWatch LHRH Agonists/GnRH Analogs Watch Non-Steroidal Antiandrogens (NSAAs)Watch associated Bootcamp video - Prostate Adenocarcinoma Watch associated Bootcamp video - Pharmacology: GnRH Modulators Watch associated Bootcamp video - Pharmacology: Antiandrogenseee3d882-4cd9-439e-a315-dea69cf8d2d5
Breast cancer assessment: The following is an immunohistochemical stain for the {{c1::estrogen}} receptor, which is located in {{c2::nuclei}}Photo credit: Ed Uthman from Houston, TX, USA, CC BY 2.0, via Wikimedia Commons Estrogen receptor is present in cytoplasm but enters nucleus when bound by a ligand (or in this case, staining)* Her2/Neu receptor is located at the cell membrane. *Progesterone receptor is located in the nucleus, as well. Watch Breast Cancer9967c9ee-4275-4742-95f0-8ff1dad41f42
The {{c1::round ligament of the uterus}} connects the uterine horn (fundus) to the {{c2::labia majora}}- This ligament is the remnant of the distal (inferior) portion of the female (ovarian) gubernaculum - This ligament passes through the inguinal canal, above the artery of Sampson (anastomosis of uterine artery and ovarian artery; typically insignificant and dissected during hysterectomy, rarely causes hemoperitoneum) Photo credit: Henry Vandyke Carter, Public domain, via Wikimedia Commons Photo credit: Briceag et al., CC BY 3.0, via Journal of Medicine and Life; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)Watch associated Bootcamp video - Female Anatomy915a7c84-5dab-4d05-9205-c30aad565cbd
Which two pathologies are associated with increased temperature of the testis? - {{c1::Varicocele}} - {{c1::Cryptorchidism}}Results in ↓ sperm production and ↓ inhibin BWatch Testicular Disorders & CancerWatch associated Bootcamp video - Cryptorchidism and Testicular Torsion Watch associated Bootcamp video - Testicular Fluid Collectionsfea04ec4-070e-409f-93fd-f262d40425f2
Bisphosphonates bind to {{c1::hydroxyapatite}} in bone, inhibiting osteoclast activityWatch Bisphosphonates, Raloxifene, Denosumab, CalcitoninWatch associated Bootcamp video - Pharmacology : Bisphosphonates, Denosumab, and Teriparatide29815a32-0923-48be-bc46-5c3b1620a8ac
When bound to bisphosphonate, {{c1::osteoclasts}} are unable to adhere to the bony surface, thus decreasing their activityBisphosphonates also lead to increased apoptosis of osteoclastsWatch Bisphosphonates, Raloxifene, Denosumab, CalcitoninWatch associated Bootcamp video - Pharmacology : Bisphosphonates, Denosumab, and Teriparatide49f5ee23-2427-4205-91dc-7dd1b18263f1
Bisphosphonates decrease the development and recruitment of {{c1::osteoclast}} precursorsWatch Bisphosphonates, Raloxifene, Denosumab, CalcitoninWatch associated Bootcamp video - Pharmacology : Bisphosphonates, Denosumab, and Teriparatide541ea83b-ff20-4d4b-a07c-f0c485472957
In addition to decreasing osteoclast activity, bisphosphonates also may induce osteoclast {{c1::apoptosis}}Watch Bisphosphonates, Raloxifene, Denosumab, CalcitoninWatch associated Bootcamp video - Pharmacology : Bisphosphonates, Denosumab, and Teriparatide9cc26f6e-39df-4339-967e-11f02cca009d
Desmopressin (DDAVP) has high specificity for the ADH-activated {{c1::V2}} receptorWatch ADH, DDAVP, ADH receptor antagonistsWatch associated Bootcamp video - Autonomic System : Other Involuntary Signaling Systems Watch associated Bootcamp video - Pharmacodynamics : Membrane Proteins Watch associated Bootcamp video - Pharmacodynamics : Receptor Physiologya6c8673c-58ff-49a4-afd4-4909944d6370
What is the effect of glucocorticoids on phospholipase A2? {{c1::Inhibition}}Watch GlucocorticoidsWatch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways Watch associated Bootcamp video - Pharmacology : Gout Medicationsd673dfcd-eeff-44d6-b4aa-a0ab67b168db
Glucocorticoids prevent production of {{c1::arachidonic acid}} by inhibiting phospholipase A2Watch GlucocorticoidsWatch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways Watch associated Bootcamp video - Pharmacology : Gout Medications35ddd2e7-d7c8-4657-8c20-0da960bb1ef5
Glucocorticoids inhibit production of inflammatory {{c1::prostaglandins}} by cyclooxygenaseWatch GlucocorticoidsWatch associated Bootcamp video - Adrenals : Adrenal Insufficiency Overview Watch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways179ed7bf-e11e-4382-bf68-a2d1d5219fa1
Glucocorticoids inhibit production of inflammatory {{c1::leukotrienes}} by lipoxygenaseWatch GlucocorticoidsWatch associated Bootcamp video - Adrenals : Adrenal Insufficiency Overview Watch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways7cf7f593-07c0-4255-b92e-4b7fcee3a3e9
What is the result of 50% increased plasma volume vs. 30% increased RBC volume during pregnancy? {{c1::Anemia}}Watch Maternal Physiology Watch Multifetal GestationsWatch associated Bootcamp video - Pregnancy and Menstruation : Menstrual Cycle Watch associated Bootcamp video - Pregnancy and Menstruation : Pregnancy Physiology Watch associated Bootcamp video - Microcytic Anemia: Iron Deficiency Anemia3aa31879-816f-49d6-9d07-1b6318babf54
What is a possible complication of monochorionic twins as a result of anastomosis? {{c1::Twin-to-twin transfusion syndrome (TTTS)}}Photo Credit: Kevin Dufendach, CC BY 3.0, via Wikimedia CommonsWatch Multifetal GestationsWatch associated Bootcamp videof65a6851-c0ed-4018-8cf3-a92c7af74b4c
{{c1::Gynecomastia}} is defined as breast enlargement in males due to increased estrogen compared with androgen activityPhoto credit: David Andrew Copeland, Dr. Mordcai Blau www.gynecomastia-md.com, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Female Pathology: Benign Breast Conditions Watch associated Bootcamp video - Anterior and Posterior Pituitary: Hyperprolactinemiad79d22be-5984-4a24-8ec0-daad8e1faa15
What is a possible off-label use of the thyroid hormone replacement therapy (e.g., levothyroxine and liothyronine)? {{c1::Weight loss supplement}}- Levothyroxine is the synthetic form of T4 - Liothyronine is the synthetic form of T3First Aid Pharmacology: EndocrineWatch Propylthiouracil, Methimazole, Levothyroxine44b9774c-6c39-4941-8ac4-8bf90c3e30d1
Which pituitary hormone is useful for stimulating labor via the induction of uterine contractions? {{c1::Oxytocin}}- Acts via Gq-Coupled receptors - Uterine contraction may also be used to help control uterine hemorrhage (e.g., postpartum bleeding)Watch Posterior Lobe of the PituitaryWatch Normal & Abnormal LaborWatch associated Bootcamp video - Endocrine : Posterior Pituitary Function Watch associated Bootcamp video - Fundamental Principles of Endocrinology: Feedback Loops26d01d6d-df6b-45d6-b3f3-338a71d6cad9
What is the clinical use for orlistat? {{c1::Weight loss}}First Aid Pharmacology: GI (Weight Loss)Watch associated Bootcamp video - Pharmacology: Orlistatc1eca645-7a42-4c80-807b-9e458064ceef
{{c2::Orlistat}} is an inhibitor of gastric and pancreatic {{c1::lipase}}, thus leading to decreased breakdown and absorption of dietary {{c1::fats}}First Aid Pharmacology: GI (Weight Loss)Watch associated Bootcamp video - Pharmacology: Orlistat6cc3d505-c679-486a-8473-6863da4916f7
Ursodeoxycholic acid (ursodiol) acts via increasing {{c1::bile}} secretion and decreasing {{c1::cholesterol}} secretion/reabsorptionFirst Aid Pharmacology: GIWatch Cholelithiasis & Acute Calculous Cholecystitis Watch Cystic Fibrosis Managemen252c5d3d-2fc1-4ea5-b0c4-c192021c4b02
Lac Operon: What is the expression level of the Lac genes in the presence of low glucose and lactose available? {{c1::Strong expression}}Photo credit: G3pro, CC BY 2.0, via Wikipedia Commonsallolactose binds repressor so it doesn't bind to operator region low glucose means increased CAMP→CAP binds to CAP binding site (guy with CAP has no candy so he pushes push-to-talk button) CAP binds to CAP binding site and repressor protein does not bind to operator region→high expression of lac genes (music!) Watch Lac OperonWatch associated Bootcamp video- DNA Replication, Transcription, Translation: Lac Operon66f964b3-3767-400e-8c53-33f7e576a913
Lac Operon: What is the expression level of the Lac genes in the presence of high glucose and lactose available? {{c1::Low (basal) expression}}Photo credit: G3pro, CC BY 2.0, via Wikipedia Commonshigh glucose means no CAMP to bind to CAP, which means CAP doesn't bind to CAP binding site (guy with CAP has candy so he sits on the ground and does not push the push-to-talk button) lactose available means allolactose is available to bind the repressor protein so the repressor protein doesn't bind to the operator region (Ally is grabbing the record pres to stop him from interfering with the operator) this means that a little bit of music gets made Watch Lac OperonWatch associated Bootcamp video- DNA Replication, Transcription, Translation: Lac Operon629ab291-998b-405e-8a76-036f6948d2fd
What form of DNA repair fixes mutations induced by UV radiation? {{c1::Nucleotide excision repair}}Photo credit: OpenStax, CC BY 4.0Watch DNA Repair MechanismsReview Xeroderma PigmentosumWatch associated Bootcamp video - DNA Mutations, Damage, and Repair : Single Stranded Repair44180e37-46c0-4cff-aa91-fc4d0ed49ab7
Xeroderma pigmentosum is an inherited pathology due to a defective {{c1::nucleotide excision repair}} pathway- This is inherited in an autosomal recessive manner - Can diagnose by measurement of repair mechanisms in WBCs Photo credit: James Halpern, Bryan Hopping and Joshua M Brostoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell Carcinoma Watch DNA Repair MechanismsReview Xeroderma PigmentosumWatch associated Bootcamp video - DNA Mutations, Damage, and Repair : Single Stranded Repair4789211e-1733-4936-8c2c-28e5f3db3f89
Recognition and facilitation of excision of {{c2::mismatched nucleotides}} occur via enzymes found on two genes: {{c1::MSH2 (MutS)}} or {{c1::MLH1 (MutL)}}- MutS recognizes the mismatch on the newly-created daughter strand (distinguished from parent strand by occasional nicks in the daughter strand phosphodiester bonds) - MutL is then recruited, and the complex slides along the DNA until 1 of the daughter strand nicks is encountered - Exonuclease 1 is then loaded onto the repair complex and activated, which then excises the mismatch - Mutations in these genes account for 90% of cases of Lynch syndromeWatch Colorectal Polyps & CancerReview Lynch SyndromeWatch associated Bootcamp video - Colorectal Pathology : Colorectal Cancer Watch associated Bootcamp video - DNA Mutations, Damage, and Repair : Single Stranded Repair2255bc06-9ff6-44cf-8ad6-32d67cacea07
Does reverse transcriptase require a primer? {{c1::Yes! Because it is a DNA polymerase (RNA-dependent DNA polymerase)}}Watch associated Bootcamp video- DNA Replication, Transcription, Translation: DNA replication0d535178-156c-4d7b-8976-bc5bcd019a02
What protein receptor motif is common to all steroid hormones, thyroid hormones, and vitamins A/D? {{c1::Zinc finger}}These hormones and vitamins are lipid-soluble and bind to intracellular receptorsReview ZincWatch associated Bootcamp video - Pharmacodynamics: Receptor Physiologya05aff14-5f42-484e-a3e0-dbd5769116a9
The genes that are responsible for the generation of homeodomain proteins are the {{c1::homeobox (HOX)}} gene and {{c1::PAX}} gene11a94a04-a57b-408e-b844-d579cfb26cf4
What pathology is associated with a defective PAX gene? {{c1::Klein Waardenburg Syndrome}}- Defect in the differentiation of neural crest cells in the skin, hair, irises, and cochlea - Patients typically present with a white forelock and eyelashes, depigmented skin patches, limb abnormalities, iridic heterochromia, and sensorineural hearing loss - Autosomal dominant inheritance pattern Photo credit: Jin et al., CC BY 4.0, via Frontiers in Genetics, modified by cropping4c1f2052-2f6c-4bfb-a155-226444d30863
One post-transcriptional modification of mRNA is the addition of a(n) {{c1::poly-A tail}} at the 3' end- Synthesized by poly-A polymerase in the nucleus - Protects mRNA from degradation within the cytoplasm after it exits the nucleus Photo credit: OpenStax, CC BY 4.0Watch Transcription and RNA ProcessingWatch associated Bootcamp video - DNA Replication, Transcription, and Translation : DNA Transcription9e0a256e-203c-462f-9fb1-9824acea380e
What sequence of bases represents a polyadenylation signal? {{c1::AAUAAA::6}}This sequence is recognized by endonucleases, which leads to cleavage of RNA at that site; Poly(A) polymerase then binds to this cleavage site and adds ~50-250 nucleotides Telomeres are TTAGGGWatch associated Bootcamp video - DNA Replication, Transcription, and Translation : Organization of a Gene Watch associated Bootcamp video - DNA Replication, Transcription, and Translation : DNA Transcription Watch associated Bootcamp video- DNA Mutations, Damage, and Repair: DNA Mutations and Damage19843872-0f54-4c86-ae40-2d9f0e7185b0
In the first step of alternative splicing, the primary transcript (hnRNA) combines with {{c1::small nuclear ribonucleoproteins (snRNPs)}} and other proteins to form the {{c2::spliceosome}}- Anti-snRNP antibodies are known as anti-Smith antibodies (SLE) - Defective snRNP assembly can lead to spinal muscular atrophy (SMA) due to decreased SMN protein Photo credit: OpenStax, CC BY 4.0Watch Transcription and RNA Processingae6cb7a2-08fc-469c-9706-7999ae49de64
In the Golgi apparatus, {{c1::mannose-6-phosphate}} is added to proteins for trafficking to {{c2::lysosomes}}Review I-Cell DiseaseWatch associated Bootcamp video - Cell Trafficking Watch associated Bootcamp video - I-Cell Disease1bc7fe75-4c9c-4a08-8b5b-90eb902e92c1
What pathology is associated with a defect in the enzyme N-acetylglucosaminyl-1-phosphotransferase? {{c1::I-cell disease (inclusion cell disease / mucolipidosis type II)}}Failure of the Golgi to phosphorylate mannose residues (i.e., mannose-6-phosphate) on glycoproteinsReview I-Cell DiseaseWatch associated Bootcamp video - I-Cell Diseased3ae6b19-9369-46ef-8df7-e7f0755e0a27
{{c1::Endosomes}} are sorting centers for material from outside the cell or from the Golgi, sending it to lysosomes for destruction or back to the membrane/Golgi for further useWatch associated Bootcamp video - Cell Trafficking2fffc300-0513-4f07-a3ef-0f54c16ec72a
Which inherited lysosomal storage disorder is characterized by coarse facial features, clouded corneas, and restricted joint movement with high serum levels of multiple lysosomal enzymes? {{c1::I-cell disease}}Often fatal in childhood (typically due to severe dilated cardiomyopathy)Review I-Cell DiseaseWatch associated Bootcamp video - I-Cell Disease450b144e-30b2-4c8b-a6a2-3bd1e31742f1
I-cell disease is characterized by high plasma levels of {{c1::lysosomal}} enzymesProteins are secreted extracellularly rather than delivered to lysosomesReview I-Cell DiseaseWatch associated Bootcamp video - I-Cell Diseasece6f49d5-8161-4b83-a0f2-c695a2bdc862
What type of filament are cytokeratin and desmin? {{c1::Intermediate filaments}}Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Cell Biology: Cytoskeleton3c0291e5-0faa-4264-a186-97dd8bc55447
What type of collagen is decreased in osteogenesis imperfecta type I? {{c1::Type I}}- Collagen is normal but production is decreased - Type I collagen is the predominant collagen in osteoid (organic portion of bone matrix) - Autosomal dominant mutations in the genes that encode the α1 and α2 chains of type I collagen - These defects cause misfolding of the mutated collagen polypeptides, and they interfere with the proper assembly of wild-type collagen chains (a dominant negative loss of function)Watch Congenital Bone Disorders Osteogenesis Imperfecta, Achondroplasia & Osteopetrosis Watch Collagen (Overview and Synthesis)Review Osteogenesis Imperfecta (Brittle Bone Disease)Watch associated Bootcamp video - Connective Tissue: Osteogenesis Imperfecta5f7b2f2d-4163-4345-9292-a02abe21afbd
Collagen Synthesis: After the collagen alpha chains are synthesized, specific residues of the amino acids {{c1::proline}} and {{c1::lysine}} are {{c2::hydroxylated}}This step requires vitamin C (deficient in scurvy) and occurs in the RER Image licensed by Physeo and used with permission. Purchase full access here.Watch Collagen (Overview and Synthesis)Review Vitamin C (Ascorbic Acid) Biochemistry Review Collagen SynthesisWatch associated Bootcamp video - Connective Tissue: Collagen Structure Mutations and Wound Health Watch associated Bootcamp video - Connective Tissue: Collagen Synthesis1690d8a7-34e1-462d-96fe-3125d54bf137
Collagen Synthesis: Hydroxylation of selected prolines and lysines during collagen synthesis requires vitamin {{c1::C}}- Deficiency of vitamin C causes scurvy - These patients will have defective pro-alpha chains that can't form a triple helix, resulting in collagen being degraded instead of secreted Image licensed by Physeo and used with permission. Purchase full access here.Watch Collagen (Overview and Synthesis)Review Vitamin C (Ascorbic Acid) Biochemistry Review Collagen SynthesisWatch associated Bootcamp video - Connective Tissue: Collagen Synthesis Watch associated Bootcamp video - Physiology: Vitaminsbebc8d35-0b5b-4c68-95e7-5b8bd469da4c
{{c1::Polymerase chain reaction (PCR)}} is a powerful diagnostic tool used to amplify a desired fragment of DNAvs RT-PCR which is used for the detection and quantification of mRNA Photo credit: OpenStax, CC BY 4.0Watch Recombinant DNA (Overview) Molecular Cloning & PCRWatch associated Bootcamp video - Laboratory Techniques : Polymerase Chain Reactiond94cc19e-e11f-4579-af41-1133dad0b391
What two types of variations in DNA are detected when using microarrays? (DNA markers) {{c1:: - Single nucleotide polymorphisms (SNPs) - Copy number variations (CNVs)}}Disadvantage: cannot detect translocation or inversions, only can detect gain or loss of materialWatch associated Bootcamp video - Laboratory Techniques: Microarray, GWAS, Karyotype, FISHdcd5a112-4513-4fc0-9ac9-e117be32cc32
If a disease has an autosomal dominant inheritance pattern, it usually {{c1::doesn't}} skip generationsVertical appearance Photo credit: Hydra2114, via Wikimedia Commons0352d14c-ab22-4505-bc73-42cc2db7bf04
Autosomal {{c1::dominant}} diseases are often pleiotropic with variable expressivityMay demonstrate incomplete penetranceWatch associated Bootcamp video - Basics of Clinical Genetics: Pedigrees and Modes of Inheritance Watch associated Bootcamp video - Basics of Clinical Genetics: Genetics Concepts84bad7b3-7928-4004-bb29-3e2c94be4e3c
If a male has an X-linked recessive disease, all of his daughters will be {{c1::carriers}}Assuming the mother is homozygous normalWatch associated Bootcamp video - Basics of Clinical Genetics: Punnett Squaresb7e6e337-5833-4e13-a639-551306d0f306
"Muscle biopsies of patients with {{c2::mitochondrial}} myopathies often show ""{{c1::ragged red}}"" fibers"Appearance is due to accumulation of abnormal mitochondria under the sarcolemma Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Modified_Gomori_trichrome_stain_showing_several_ragged_red_fibers_.jpg: Abu-Amero KK, Al-Dhalaan H, Bohlega S, Hellani A, Taylor RW.derivative work: CopperKettle, CC BY 2.0, via Wikimedia CommonsWatch Mitochondrial Inheritance DisordersReview Mitochondrial MyopathiesWatch associated Bootcamp video - Antivirals: Antiretroviral Nucleoside Reverse Transcriptase Inhibitors3c0265b7-602b-4840-ba73-114d9819e20b
{{c1::Variable expressivity}} describes phenotypic variation among individuals with the same genotypeThey all have some phenotypic expression; e.g., neurofibromatosis IWatch associated Bootcamp video - Basics of Clinical Genetics: Genetics Conceptsfd17950c-1980-4858-ad12-22a00910d750
What equation is used to calculate allele frequency when using Hardy-Weinberg population genetics? {{c1::p + q = 1}}Watch Hardy Weinberg Population GeneticsWatch associated Bootcamp video - Basics of Clinical Genetics: Hardy-Weinbergc807da1a-f2b1-494f-8123-43ec3abe0167
What equation is used to calculate genotypic frequency when using Hardy-Weinberg population genetics? {{c1::p2 + 2pq + q2 = 1}}\(p^{2} + 2pq + q^{2}\) \(p^{2}\) = homozygous dominant \(2pq\) = heterozygous \(q^{2}\) = homozygous recessiveWatch Hardy Weinberg Population GeneticsWatch associated Bootcamp video - Basics of Clinical Genetics: Hardy-Weinberg848fd755-97dc-4385-9b0f-db59502a9deb
When using Hardy-Weinberg population genetics, the frequency of a carrier of a recessive disease is equal to {{c1::2pq}}\(p^{2} + 2pq + q^{2}\) \(p^{2}\) = homozygous dominant \(2pq\) = heterozygous \(q^{2}\) = homozygous recessiveWatch Hardy Weinberg Population GeneticsWatch associated Bootcamp video - Basics of Clinical Genetics: Hardy-Weinberg088f23de-9c3d-48cd-a075-e305fc3bad08
Down syndrome may present with {{c1::in}}creased nuchal translucency on prenatal ultrasound- Also may present with a hypoplastic nasal bone - Increased depth of nuchal transluency seen below (green overlay) Photo credit: Wolfgang Moroder., CC BY-SA 3.0, via Wikimedia Commons (photo 1), AMBOSS, CC BY-SA 3.0 (photo 2)Watch Prenatal Screening & DiagnosisReview Down Syndrome (Trisomy 21)Watch associated Bootcamp video - High Yield Genetic Disorders: Autosomal Trisomies Watch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Meiosis ErrorsAtlas:ee21c024-b19b-4dac-a0a4-505865496b37
The resistance of the entire systemic vasculature is called the {{c1::total peripheral resistance (TPR)}}May also be referred to as systemic vascular resistance (SVR)Watch Cardiovascular Response to HemorrhageWatch associated Bootcamp video - Cardiac Parameters of Physiologic Function: Mean Arterial Pressure562136ca-5380-485e-a261-3bda5a614445
The {{c1::AV}} node is located in the posteroinferior part of the interatrial septumPhoto credit: biologists [The formation and function of the cardiac conduction system | Development | The Company of Biologists]Watch Chambers of the Heart & Pulmonary CirculationWatch associated Bootcamp video - Anatomy: Cardiac Conductive Physiology : Cardiac Conduction System053ff047-f852-4447-accb-2d88e22345ac
The heart sound {{c1::S2}} is due to {{c2::aortic}} and {{c2::pulmonic}} valve closureNormally, A2 is earlier than P2 because the left sided system has higher pressure than right; P2 can be earlier than A2 in pulmonary hypertension Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Cardiac Cycle : Heart Sounds7dd32cdc-9050-4f01-93d3-9af311380e59
The heart sound {{c1::S4}} can be associated with ventricular {{c2::noncompliance}}e.g., hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy, restrictive heart diseasesWatch Aortic Stenosis & RegurgitationWatch Hypertension SOA Watch Aortic Stenosis SOAP Watch Pulmonary HypertensionWatch associated Bootcamp video - Cardiac Cycle : Heart Sounds Watch associated Bootcamp video - Valvular Disease: Aortic Stenosis Watch associated Bootcamp video - Heart Failure : Diastolic Heart Failure390dd9b0-848f-4ba7-b232-a53a76f109b2
A decreased TPR causes the cardiac output to {{c1::increase}} and venous return to {{c1::increase}}- E.g., vasodilators / sepsis, exercise, AV shunt / fistula - Changing the TPR (primarily determined by arterioles) only changes the slope (venous tone and volume have not changed), thus RA pressure is mostly unchanged - When peripheral resistance to the LV decreases (CW rotation), it makes it easier to push blood out (thus CO rises, and thus there is more VR)Watch Cardiovascular Response to HemorrhageWatch associated Bootcamp video - Combined Cardiac Function & Venous Return Curvesa0632caa-3419-4369-a8ee-f7eb19b037d1
What effect does decreased stretch (e.g., hemorrhage) have on the afferent firing rate of a baroreceptor? {{c1::Decreased firing rate}}Photo credit: OpenStax College, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Pressure and Flow Physiology : Sensory Receptors of Vasculaturede086b73-3469-484d-81a9-00943af029d8
A decrease in renal perfusion pressure causes the {{c2::juxtaglomerular}} cells of the afferent arterioles to secrete {{c1::renin}}Photo credit: OpenStax, CC BY 4.0Watch Renin-Angiotensin II-Aldosterone SystemWatch associated Bootcamp video - Cardiology RAAS Regulation Watch associated Bootcamp video - Endocrine RAAS/ADH Review Watch associated Bootcamp video - Nephrology RAAS Overview0637e944-f73e-47a1-b7d4-3fbfc86ab277
In which organ does angiotensin-converting enzyme (ACE) catalyze conversion of angiotensin I to angiotensin II? {{c1::Lungs (primarily)}}Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Cardiology RAAS Regulation Watch associated Bootcamp video - Endocrine RAAS/ADH Review Watch associated Bootcamp video - Nephrology RAAS Overviewebe9708b-692e-4052-827a-8c680c6ffed9
Pyrogens induce fever via increased production of {{c1::IL-1}}, which acts on the anterior hypothalamus to increase local production of {{c2::prostaglandins}}Prostaglandins increase the set-point temperatureReview IL-1Watch associated Bootcamp video - Cytokines: Proinflammatory CytokinesOther:f7f9a2ab-2e92-4a50-8357-670f2684c47f
Where is a murmur due to mitral regurgitation the loudest? {{c1::Apex (mitral area) - left 5th ICS at the midclavicular line}}Holosystolic murmur (vs. mitral stenosis which presents as a diastolic murmur in this area)Watch Mitral Valve Regurgitation & Prolapse Watch Aortic Stenosis & RegurgitationWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Valvular Disease: Mitral Regurgitation Watch associated Bootcamp video - Cardiac Cycle : Auscultation Watch associated Bootcamp video - Cardiorespiratory Infections: Infective Endocarditis Diagnostics096fd35c-03bd-4529-beef-ad5bfee66410
Does mitral valve prolapse (MVP) cause a systolic or diastolic murmur? {{c1::Late systolic (with midsystolic click)::Specific}}Watch Mitral Valve Regurgitation & ProlapseWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Valvular Disease: Mitral Valve Prolapsef9e7f087-c760-42b3-b065-cecbb47d10fb
Where is a murmur due to mitral valve prolapse the loudest? {{c1::Apex (mitral area)}}Most commonly left 5th ICS in the midclavicular lineWatch Mitral Valve Regurgitation & ProlapseWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Valvular Disease: Mitral Valve Prolapse Watch associated Bootcamp video - Cardiac Cycle : Auscultation572796db-bd1b-4fae-8d20-455300b33e1b
What is the likely cause of this murmur? {{c1::Mitral valve prolapse}}If you want to be the MVP, your team has to CLICKWatch Mitral Valve Regurgitation & ProlapseWatch Mitral Regurgitation & Mitral Valve Prolapse SOAPWatch associated Bootcamp video - Valvular Disease: Mitral Valve Prolapseaec8f81d-a766-4636-a799-0327b3fe9fd4
{{c2::Takayasu}} arteritis is a granulomatous thickening and narrowing of the {{c1::aortic arch}} and proximal great vesselsPhoto credit: Raman et al., CC BY 2.0, via BMCWatch Large & Medium Vessel VasculitidesWatch Surgery Aortic Dissection Watch Internal Medicine Aortic DissectionWatch associated Bootcamp video - Vasculitides: Takayasu ArteritisAtlas: Clinical Features Initial signs and symptoms usually are nonspecific, including fatigue, weight loss, and fever. With progression, vascular signs and symptoms appear and dominate the clinical picture. These include reduced upper-extremity blood pressure and pulse strength; neurologic deficits; and ocular disturbances, including visual field defects, retinal hemorrhages, and total blindness. Distal aorta disease can manifest as leg claudication, and pulmonary artery involvement can cause pulmonary hypertension.40c7724a-aaa8-4ed1-a44d-c610c172e1ce
Takayasu arteritis may present with {{c1::visual}} and {{c1::neurologic}} symptoms- Can range from headache to acute ischemic stroke - Also presents with constitutional symptoms including fever, night sweats, arthritis, myalgias, and skin nodulesWatch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Vasculitides: Takayasu ArteritisAtlas:aba9b3ae-e243-4d1d-82f0-465ff324efe6
{{c1::Takayasu}} arteritis is associated with a(n) {{c2::weak or absent}} pulse in the upper extremity"Thus it is sometimes called ""pulseless disease"""Watch Large & Medium Vessel VasculitidesWatch associated Bootcamp video - Vasculitides: Takayasu ArteritisAtlas:8573ee25-d695-405a-ba47-6e263bb8d0b1
"The symptoms of {{c1::Kawasaki}} disease may be remembered with the mnemonic ""CRASH and burn"": {{c1::Conjunctivitis (bilateral)::C}} {{c1::Rash (polymorphous → desquamating)::R}} {{c1::Adenopathy (unilateral; cervical lymph nodes)::A}} {{c1::Strawberry tongue (oral mucositis)::S}} {{c1::Hand-foot erythema and edema::H}} & {{c1::Fever ≥ 5 days::Burn}}"- Kawasaki disease criteria: fever ≥ 5 days with ≥ 4 of the CRASH symptoms above - Classic manifestations typically include labs indicative of systemic inflammation (i.e., thrombocytosis, leukocytosis, and sterile pyuria) Photo credit: Dong Soo Kim, CC BY-SA 4.0, via Wikimedia CommonsWatch Large & Medium Vessel VasculitidesWatch Kawasaki DiseaseWatch associated Bootcamp video - Vasculitides: Kawasaki Diseasey88ab271d-90d5-48bb-9d00-3f6b15757d05
The symptoms of Kawasaki disease may be remembered with the mnemonic {{c1::CRASH and Burn}}Conjunctivitis (bilateral) Rash (polymorphous → desquamating) Adenopathy (unilateral; cervical lymph nodes) Strawberry tongue (oral mucositis) Hand-foot erythema and edema& Burn: Fever ≥ 5 days Kawasaki disease criteria: fever ≥ 5 days with ≥ 4 of the CRASH symptoms above - Classic manifestations typically include labs indicative of systemic inflammation (i.e. thrombocytosis, leukocytosis, and sterile pyuria) Photo credit: Dong Soo Kim, CC BY-SA 4.0, via Wikimedia CommonsWatch Large & Medium Vessel VasculitidesWatch Kawasaki DiseaseWatch associated Bootcamp video - Vasculitides: Kawasaki Disease9296e348-21ea-4475-8f2d-c5a8a6e12055
{{c2::Granulomatosis with polyangiitis (GPA)}} is a form of necrotizing, granulomatous vasculitis that classically involves the {{c1::nasopharynx}}, {{c1::lungs}}, and {{c1::kidneys}}GPA was formerly known as Wegener granulomatosis Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Small Vessel VasculitidesWatch Other High-Yield DPLD/ILD Watch Glomerulonephritis SOAPWatch associated Bootcamp video - Vasculitides: Granulomatosis with Polyangiitis (GPA)30792fd6-c073-4271-8cb8-e94ba4a5a63f
Granulomatosis with polyangiitis (GPA) often presents with upper respiratory tract symptoms, such as {{c1::sinusitis}} or {{c2::nasopharyngeal ulceration}}- Nasal mucosal ulcerations are most characteristic of GPA - GPA was formerly known as Wegener granulomatosisWatch Small Vessel VasculitidesWatch Glomerulonephritis SOAPWatch associated Bootcamp video - Vasculitides: Granulomatosis with Polyangiitis (GPA)bc4c5332-13f6-424a-8a60-1307559008ff
Granulomatosis with polyangiitis (GPA) often presents with kidney-related symptoms, such as {{c1::hematuria}}, red cell casts, and rapidly progressive glomerulonephritis (RPGN)GPA was formerly known as Wegener granulomatosisWatch Small Vessel VasculitidesWatch Other High-Yield DPLD/ILD Watch Glomerulonephritis SOAP Watch Approach to HematuriaWatch associated Bootcamp video - Vasculitides: Granulomatosis with Polyangiitis (GPA) Watch associated Bootcamp video - Rapidly Progressive Glomerulonephritis8f04d8d0-8671-48c3-831a-99e7ceff301f
Which vasculitis is characterized by a triad of: (1) Focal necrotizing vasculitis (2) Necrotizing granulomas in the lung and upper airway (3) Necrotizing glomerulonephritis {{c1::Granulomatosis with polyangiitis (GPA)}}GPA was formerly known as Wegener granulomatosisWatch Small Vessel VasculitidesWatch Other High-Yield DPLD/ILD Watch Glomerulonephritis SOAPWatch associated Bootcamp video - Vasculitides: Granulomatosis with Polyangiitis (GPA)20b857b7-0d89-4463-ade6-2cf5d0e97665
What significant laboratory finding is associated with granulomatosis with polyangiitis (GPA)? {{c1::Positive c-ANCA}}- c-ANCA stands for cytoplasmic anti-neutrophil cytoplasmic antibody; also known as PR3-ANCA and anti-proteinase 3 - GPA was formerly known as Wegener granulomatosisWatch Small Vessel VasculitidesWatch Other High-Yield DPLD/ILDWatch associated Bootcamp video - Vasculitides: Granulomatosis with Polyangiitis (GPA)6e41b4c2-fed9-4855-b6bf-d72ed83f3034
What condition can cause secondary hypertension in young females? {{c1::Fibromuscular dysplasia::not OCPs}}Developmental defect of the blood vessel wall → irregular thickening of large/medium sized arteries, especially the renal artery → renal artery stenosis Photo credit: See page for author, CC BY 2.0, via Wikimedia CommonsFA 2019 changes this to >130/80Watch HypertensionWatch HTN SOAWatch associated Bootcamp video - Hypertension: Secondary HypertensionAtlas:e7bb8f3d-70fa-40b7-9316-6fac4912e194
"Fibromuscular dysplasia results in the irregular thickening of small- and medium-sized muscular arteries which may manifest as a(n) ""{{c1::string of beads}}"" appearance on imaging"- Associated with secondary hypertension due to renal artery stenosis - Pathology typically demonstrates alternating fibromuscular webs and aneurysmal dilations with absent internal elastic lamina Photo credit: See page for author, CC BY 2.0, via Wikimedia CommonsFA 2019 changes this to >130/80Watch HypertensionWatch associated Bootcamp video - Hypertension: Secondary Hypertension08ed8800-a4d0-4b17-a85b-f55a8d86eb59
The intimal plaque that causes atherosclerosis often undergoes dystrophic {{c1::calcification}}Watch Atherosclerosis PathophysiologyWatch Chronic Diabetes Complications SOAPWatch associated Bootcamp video - Atherosclerosis Watch associated Bootcamp video - Cellular Injury and Neoplasia: Calcification Watch associated Bootcamp video - Principles of Oncology and Therapeutics: CalcificationAtlas:4a4f59bd-9578-4888-95c6-f04c9b372773
Chest X-ray of a patient with aortic {{c2::dissection}} shows a widened {{c1::mediastinum}}Widened mediastinum also seen with thoracic aortic aneurysm and traumatic aortic rupture Photo credit: J. Heuser JHeuser, CC BY-SA 3.0, via Wikimedia CommonsWatch Aortic DissectionWatch Shock: Cardiogenic & Obstructive SOAPs Watch Surgery Aortic Dissection Watch Internal Medicine Aortic Dissection Watch Initial Trauma Assessment: Secondary SurveyWatch associated Bootcamp video - Aortic Disease: Aortic DissectionAortic dissection Chest x-ray (PA view): widened mediastinum (1) and aortic arch (2); increased cardiothoracic ratio Additional imaging (CT with contrast, TEE, or MRA) is necessary for treatment planning. Atlas:feadcb0f-5860-421f-9c52-05fabb6da10d
The two underlying pathological processes that are associated with abdominal aortic aneurysm are {{c1::chronic transmural inflammation}} and {{c2::atherosclerosis}}- In response to chronic transmural inflammation, inflammatory cells (particularly macrophages) release MMPs and elastases that lead to weakening and progressive expansion of aortic wall; precipitated by conditions that lead to this (age > 60, smoking, HTN) - Additionally, atherosclerosis leads to decreased O2 diffusion through the aortic wall to the media, resulting in atrophy and weakness of the vessel wall; and ischemia of the tunica media plays a role as the infrarenal abdominal aorta has a tenuous vasa vasorum - UWorld emphasizes chronic transmural inflammation, whereas Pathoma emphasizes atherosclerosisWatch Aortic AneurysmWatch associated Bootcamp video - Aortic Disease: Aortic Aneurysmeb28d702-8d09-4e84-9842-5bea5b602e48
What drug may be used to relieve symptoms due to unstable angina? {{c1::Nitroglycerin}}Watch Stable Angina, Vasospastic Angina, & Acute Coronary Syndromes (UA, NSTEMI, STEMI)Watch NitratesWatch associated Bootcamp video - Stable Angina and Atherosclerosis: Anti-Anginal Therapyc6bd321d-4b12-43f1-8ef7-81eaf5b793fc
What gross changes occur 10 - 14 days post-MI? Emergence of the {{c1::red border}} due to {{c2::granulation tissue}} entering from the edge of the {{c2::infarct}}UWorld / Medbullets has this as being predominantly 10-14 daysWatch Acute Myocardial Infarction & Post MI TimelineWatch associated Bootcamp video - Myocardial Infarction: Post-Myocardial Infarction Timelinebd258de9-7b57-447e-b4ed-e4ee31abd4ab
What microscopic changes occur from 3 - 14 days post-MI? {{c1::Granulation tissue*}}*According to UWorldWatch Acute Myocardial Infarction & Post MI TimelineWatch associated Bootcamp video - Myocardial Infarction: Post-Myocardial Infarction Timeline9c59d99a-6f3d-4eb8-a4c2-a5ce98010457
{{c1::Chronic ischemic heart disease}} is the progressive onset of heart failure over many years due to chronic ischemic myocardial damageWatch Myocardial Response To IschemiaWatch associated Bootcamp video - Heart Failure : Pathology Heart Failure Overview11989753-af6e-49ad-aac0-422a7176a85c
Which artery is typically associated with inferior myocardial infarction? {{c1::Right coronary artery (RCA)}}- Assuming right-dominant circulation where PDA arises off right coronary artery - Rarely due to distal LCX infarction, therefore confirm diagnosis with right-sided precordial ECG - Leads II, III, avF Photo credits: Coronary.pdf: Patrick J. Lynch, medical illustrator, CC BY-SA 3.0, via Wikimedia CommonsWatch Coronary Circulation: Clinical CorrelatesWatch associated Bootcamp video - Myocardial Infarction: Myocardial Infarction Watch associated Bootcamp video - Myocardial Infarction: ECG Localization in STEMI20317673-26f6-437e-a55b-f64d607bd409
Which leads show ST elevations or Q waves in an inferior myocardial infarction? {{c1::II, III, aVF::3}}- 3 bottommost - aVF for inFerior MI - Right coronary artery (RCA)Watch Acute Myocardial Infarction & Post MI Timeline Watch Coronary Circulation: Clinical CorrelatesWatch Ischemia & Infarction on ECGWatch associated Bootcamp video - Myocardial Infarction: ECG Localization in STEMI3 bottom most791a23b3-4bdc-4127-95f8-b75b10d9e034
How does ejection fraction change in heart failure with systolic dysfunction? {{c1::Reduced EF}}Watch Congestive Heart Failure PathophysiologyWatch Chronic Heart Failure SOA Part 1Watch associated Bootcamp video - Heart Failure : Systolic Heart Failure Watch associated Bootcamp video - Pressure-Volume Loops: Advanced Pathophysiology3d6e5715-670b-4452-91ae-78bf1623fec9
What sound on respiratory exam may be associated with heart failure? {{c1::Crackles}}AKA ralesWatch Congestive Heart Failure Clinical ManifestationsWatch Chronic Heart Failure: Physical ExamWatch associated Bootcamp video - Lung Pathology Fundamentals : Lung Physical Exam609395d2-dfcf-435a-9d50-68532a2dd36b
What is the most common congenital heart defect? {{c1::Ventricular septal defect (VSD)}}VSD > ASD > PDA Isolated condition in 12/10000 births Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia Commons Photo credit: Kjetil Jones, Public Domain, via Wikimedia Commons, The original uploader was Drickey at English Wikipedia., CC BY-SA 2.5, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 2.5Watch Left to Right ShuntsWatch Acyanotic Congenital Heart Disease DDxWatch associated Bootcamp video - Acyanotic Congenital Heart Defects: Ventricular Septal DefectAtlas:4fcfc962-aadb-4bbf-a59c-97dd7284f4e5
Ventricular septal defect (VSD) results in a(n) {{c1::left}}-to-{{c1::right}} shunt- Size of defect determines extent of shunting and age at presentation - Can cause late cyanosis → polycythemia Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia Commons Photo credit: Kjetil Jones, Public Domain, via Wikimedia Commons, The original uploader was Drickey at English Wikipedia., CC BY-SA 2.5, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 2.5Watch Left to Right ShuntsWatch Acyanotic Congenital Heart Disease DDxWatch associated Bootcamp video - Acyanotic Congenital Heart Defects: Ventricular Septal Defect Watch associated Bootcamp video - Cyanotic Congenital Heart Defects: Cyanotic Congenital Heart Defects Overview Watch associated Bootcamp video - Acyanotic Congenital Heart Defects: Acyanotic Congenital Heart Defects OverviewAtlas:2b0b45c9-21b0-4885-8e7b-55cc54c212e6
The major criteria for the diagnosis of rheumatic fever are the {{c2::J♥NES}} criteriaWatch Streptococcus pyogenes (Group A Strep) Watch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Acute Rheumatic Fever Watch Strep Pharyngitis Watch Mitral Stenosis SOAPWatch associated Bootcamp video - Cardiorespiratory Infections: Acute Rheumatic Fever Diagnostics and Management Watch associated Bootcamp video - Valvular Disease: Mitral Stenosis Watch associated Bootcamp video - Streptococcus: Streptococcus Pyogenes4cb20af2-f6ef-481c-b3b6-d717399b31f9
{{c2::Endocarditis}}, secondary to rheumatic fever, is characterized by small vegetations along valvular lines of closure, which cause {{c1::regurgitation}}- This is often mitral regurgitation (but can be aortic or tricuspid) - Endocarditis will often present as a new systolic heart sound - Note: the vegetations are much smaller in this case Photo credit: See page for author, Public domain, via Wikimedia CommonsWatch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Acute Rheumatic Fever Watch Endocarditis SOAP Watch Aortic Regurgitation SOAP Watch Tricuspid Regurgitation SOAPWatch associated Bootcamp video - Cardiorespiratory Infections: Infective Endocarditis Diagnostics Watch associated Bootcamp video - Valvular Disease: Aortic Regurgitation Watch associated Bootcamp video - Valvular Disease: Mitral Regurgitationbc3013b1-5d99-48bd-942b-a677c16982be
Early (acute) lesions of rheumatic heart disease cause mitral {{c1::regurgitation}}ARCS (Acute - Regurgitation) This is seen within the first few decades of lifeWatch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart DiseaseWatch Mitral Regurgitation & Mitral Valve Prolapse SOAP Watch Acute Rheumatic FeverWatch associated Bootcamp video - Cardiorespiratory Infections: Acute Rheumatic Fever Diagnostics and Management Watch associated Bootcamp video - Valvular Disease: Mitral Regurgitation2f3f349f-d639-40f8-a147-24c3fa72cecf
"The most common cause of aortic stenosis is {{c1::degenerative calcification}} from ""wear and tear"""- Specifically in those > 70 - Pathogenesis includes fibroblasts differentiation into osteoblast-like cells, leading to aberrant bone matrix deposition - Severely calcified aortic valves can cause Heyde syndrome by increasing the shear stress on vWF Photo credit: www.MedicalGraphics.de (CC BY-ND 4.0 EN)Watch Aortic Stenosis & RegurgitationWatch Aortic Stenosis SOAPWatch associated Bootcamp video - Valvular Disease: Aortic Stenosis50b47c7b-d692-4092-ae22-663786eeb31a
Mitral valve prolapse (MVP) complications are rare but include infective {{c1::endocarditis}}, arrhythmia, and severe mitral regurgitation- Mitral valve prolapse is the most common underlying valvular disease predisposing to development of infective endocarditis in developed countries (rheumatic heart disease in non-developed countries) - Strep viridans loves to infect MVP valves, as they produce dextrans which bind to fibrin accumulated on damaged valvesWatch Mitral Valve Regurgitation & Prolapse Watch Aortic Stenosis & RegurgitationWatch Mitral Regurgitation & Mitral Valve Prolapse SOAP Watch Endocarditis SOAPWatch associated Bootcamp video - Valvular Disease: Mitral Valve Prolapse Watch associated Bootcamp video - Cardiorespiratory Infections: Principles of Infective Endocarditisb662e472-7533-431b-b630-2b21382be89d
What anti-neoplastic agents are associated with dilated cardiomyopathy? {{c1::Anthracyclines (doxorubicin, daunorubicin, idarubicin)}}- Doxorubicin AKA adriamycin - Anthracyclines = dilAtedWatch Cytotoxic Antibiotics Watch Dilated & Restrictive CardiomyopathyWatch Dilated Cardiomyopathy Watch Dilated & Restrictive Cardiomyopathy SOAPsWatch associated Bootcamp video - Cardiomyopathy: Dilated Cardiomyopathy Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Independent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Independent Drug Targetsd4dd0534-50fa-4a0f-ad4e-dc349dadc414
"{{c1::Dilated}} cardiomyopathy may be seen during the last month of pregnancy or within five months of childbirth (""peripartum cardiomyopathy"")"- Most women return to baseline LV function within 6 months and can get pregnant again with close supervision - Counsel those who don't recover LV function against getting pregnant again until they have LVEF ≥ 0.5 for at least 6 monthsWatch Dilated & Restrictive CardiomyopathyWatch Dilated Cardiomyopathy Watch Dilated & Restrictive Cardiomyopathy SOAPsWatch associated Bootcamp video - Cardiomyopathy: Dilated Cardiomyopathysx. of dyspnea, lower extremity edema, S3 - signs of decompensated HF.1ebf44f3-5d8a-43ea-9c88-e01740e38beb
What pathologic heart sound may be heard with dilated cardiomyopathy? {{c1::S3}}- Di-la-ted → 3 syllables → S3 heart sound - Hy-per-tro-phic → 4 syllables → S4 heart sound - May also have systolic murmur (mitral or tricuspid regurgitation)Watch Dilated & Restrictive CardiomyopathyWatch Dilated Cardiomyopathy Watch Dilated & Restrictive Cardiomyopathy SOAPs Watch Chronic Heart Failure SOA Part 2 Watch Tricuspid Regurgitation SOAPWatch associated Bootcamp video - Cardiomyopathy: Dilated Cardiomyopathy Watch associated Bootcamp video - Cardiac Cycle : Heart Soundsb1529c3f-15db-4208-921d-0a8af3ba7fa2
Hypertrophic cardiomyopathy causes {{c1::diastolic::systolic or diastolic}} dysfunctionVentricle cannot fill due to decreased compliance Photo credit: BruceBlaus, CC BY 3.0, via Wikimedia CommonsWatch Hypertrophic Cardiomyopathy Watch Congestive Heart Failure PathophysiologyWatch Hypertrophic Cardiomyopathy SOAPWatch associated Bootcamp video - Cardiomyopathy: Hypertropic Obstructive Cardiomyopathy Watch associated Bootcamp video - Heart Failure : Diastolic Heart Failure4645bade-0321-4863-8837-77c054c0980a
What pathologic heart sound may be heard with hypertrophic cardiomyopathy? {{c1::S4}}- Di-la-ted → 3 syllables → S3 heart sound - Hy-per-tro-phic → 4 syllables → S4 heart soundWatch Hypertrophic CardiomyopathyWatch Hypertrophic Cardiomyopathy SOAPWatch associated Bootcamp video - Cardiomyopathy: Hypertropic Obstructive Cardiomyopathy Watch associated Bootcamp video - Cardiac Cycle : Heart Soundse9322547-59fa-4f17-bcb0-b98bf2b6c46e
What is the most common primary cardiac tumor in children? {{c1::Rhabdomyoma}}118fb0da-6da2-4507-8ca9-f1c620dcbb03
{{c2::Cardiac rhabdomyoma}} is a cardiac tumor associated with {{c1::tuberous sclerosis}}Benign tumor HAMAARTOMASWatch Sturge Weber & Tuberous SclerosisReview Tuberous SclerosisAtlas:802a77a2-8c99-4bc5-bbe4-fdbf3e4784f9
{{c1::Intravenous::Mode of delivery}} class II antiarrhythmics, such as {{c2::esmolol}}, can be used for intra-operative or other acute supraventricular arrhythmias (very short-acting)Esmolol is the fastest-acting agent but has a short half-lifeWatch Class II AntiarrhythmicsWatch Class 2 AntiarrhythmicsWatch associated Bootcamp video - Antiarrhythmics : Class II Antiarrhythmics Watch associated Bootcamp video - Autonomic System : Beta Adrenergic Antagonistsb7c10da1-fb78-4226-b9d3-3301391f89cb
Which phase of the cardiac cycle is preferentially shortened with increased heart rate? {{c1::Diastole::Systole or Diastole}}Leads to a decreased filling time therefore less cardiac outputWatch associated Bootcamp video - Cardiac Cycle3a7dbcf7-9c7a-47d6-8b1f-3fef95bcae64
{{c1::3rd}} degree AV block is characterized by independent beating of the atria and ventricles (P waves and QRS complexes are not rhythmically associated)"- Atrial rate > ventricular rate - ""Complete"" block between the SA and AV node, resulting in the AV node becoming the pacemaker"Watch Bradycardia ECG Interpretation Watch Shock: Cardiogenic & Obstructive SOAPsWatch associated Bootcamp video - Conduction Blocks : Atrioventricular Blocks433abe44-7abf-40f8-b0fe-91315df276b2
What pathology is indicated on the ECG below? {{c1::3rd-degree AV block}}- Constant P-P interval - Constant R-R interval - Wide QRSWatch Bradycardia ECG Interpretation Watch Shock: Cardiogenic & Obstructive SOAPsWatch associated Bootcamp video - Conduction Blocks : Atrioventricular Blocks9c5d2f76-4c1e-441e-9a7f-1f7b69703c66
Hypovolemic shock is characterized by skin that is {{c1::cold}} and {{c1::clammy}}1) Cold skin: ↑ TPR and ↓ CO (low output and fingers not perfusing due to arterioles clamping down) 2) Warm skin: ↓ TPR and ↑ CO (distributive shock - lots of blood can go to the fingers)Watch Shock: Undifferentiated Shock SOAP Watch Shock: Hypovolemic & Distributive SOAPs Watch Hemorrhage & Hypovolemic Shock Watch Acute Upper GI Bleed: Non-Variceal BleedingWatch associated Bootcamp video - Shock: Hypovolemic Shockf8644096-afec-4807-b0de-aba5028b9f7d
How do SVR and afterload change during hypovolemic shock? {{c1::Increased}}- The drop in effective circulating volume in the circulation is detected which leads to increased SNS activity, driving constriction of arterioles in the vasculature in an attempt to return BP to normal (increasing SVR) - Because there is increased SNS activity, there will also be an increase in pulmonary vascular resistance (some alpha-1 receptors in pulmonary vessels)Watch Shock: Undifferentiated Shock SOAP Watch Shock: Hypovolemic & Distributive SOAPsWatch associated Bootcamp video - Shock: Hypovolemic Shock93edbdd5-e1f1-442d-b009-f751d469ce50
How do SVR and afterload change during cardiogenic and obstructive shock? {{c1::Increased}}SVR stands for systemic vascular resistance (formerly known as TPR)Watch Shock: Undifferentiated Shock SOAP Watch Shock: Cardiogenic & Obstructive SOAPs Watch Cardiac Tamponade & Obstructive Shock Part 2Watch associated Bootcamp video - Shock: Obstructive Shock Watch associated Bootcamp video - Shock: Cardiogenic Shock4c8150d8-0d54-42e4-a195-5de976c968ca
Acute {{c1::pericarditis}} is defined as inflammation of the pericardiumCauses include: - Idiopathic (most common; presumed viral) - Confirmed infection (e.g., Coxsackievirus) - Neoplasia - Autoimmune (e.g., SLE, rheumatoid arthritis) - Uremia - Cardiovascular (acute STEMI or Dressler syndrome) - Radiation therapy Photo credit: BruceBlaus, Public domain, via Wikimedia CommonsWatch Pericarditis & Constrictive PericarditisWatch Acute Pericarditis SOAPWatch associated Bootcamp video - Constrictive Pericarditis Watch associated Bootcamp video - Pericardial Disease: Acute Pericarditis4da3868d-cc97-4357-a36e-8987934aae58
Acute {{c3::pericarditis}} commonly presents with sharp chest pain that is aggravated by {{c1::inspiration}} and relieved by {{c2::sitting up and leaning forward}}Sitting up/forward reduces pressure on the parietal pericardiumWatch Pericarditis & Constrictive PericarditisWatch Acute Pericarditis SOAPWatch associated Bootcamp video - Constrictive Pericarditis Watch associated Bootcamp video - Pericardial Disease: Acute PericarditisHIGH YIELD!!! Step Up to Medicine:7346c1a5-428c-4fbc-810b-8b2a41605d05
ECG changes associated with acute {{c4::pericarditis}} include widespread, diffuse {{c1::ST}} {{c2::elevation}} and/or {{c1::PR}} {{c2::depression}}i.e., ECG changes are present in all leads Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons, overlay by AMBOSS, CC BY-SA 3.0Watch Pericarditis & Constrictive PericarditisWatch Acute Pericarditis SOAPWatch associated Bootcamp video - Pericardial Disease: Acute Pericarditise008a154-464f-43c0-b0f2-20b9302e9abd
One ECG change associated with cardiac tamponade is a(n) {{c1::low-voltage}} QRS complex- Low-voltage ECG is also associated with restrictive cardiomyopathy - Alternans seen below as well Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Pericarditis & Constrictive PericarditisWatch Pericardial Effusion, Cardiac Tamponade, and Constrictive Pericarditis SOAP Part 1 Watch Cardiac Tamponade & Obstructive Shock Part 1Watch associated Bootcamp video - Pericardial Disease: Cardiac Tamponade4d02b864-8005-4518-be00-e24cd715f8b1
"One ECG change associated with cardiac tamponade is {{c1::electrical alternans}}, which occurs due to ""swinging"" movement of the heart in a large effusion"- Electrical alternans is alternation of QRS complex amplitude or axis between beats and a possible wandering base-line - Not the same as pulsus alternans (which refers to the beat-to-beat variation in pulse amplitude due to a change in systolic blood pressure) Photo credit: Jer5150, CC BY-SA 3.0, via Wikimedia CommonsWatch Pericarditis & Constrictive PericarditisWatch Pericardial Effusion, Cardiac Tamponade, and Constrictive Pericarditis SOAP Part 1 Watch Cardiac Tamponade & Obstructive Shock Part 1 Watch Shock: Cardiogenic & Obstructive SOAPsWatch associated Bootcamp video - Pericardial Disease: Cardiac Tamponade2bd4c0f2-772c-454e-90b2-868e3d699d8f
Outflow tracts from the heart are formed by migrations of {{c1::neural crest}} and {{c2::endocardial}} cells, which spiral and fuse to form the {{c3::aorticopulmonary}} septumConotruncal abnormalities with failure of neural crest cells to migrate include: - Transposition of great vessels - Tetralogy of Fallot - Persistent truncus arteriosus Image licensed by Physeo and used with permission. Purchase full textbook here.Watch associated Bootcamp video - Embryology: Truncus Arteriosus107e8291-bd23-4d92-9607-935c28a61e00
When the {{c1::posterior descending artery (PDA)}} arises from the {{c2::left circumflex}} artery, it is referred to as left-dominant circulation (8%)- The PDA supplies the inferior surface of the left ventricle - When MIs are shown to affect the inferior wall of the heart, they are caused by the occlusion of the dominant coronary artery (right or left, depending on dominance) Photo credit: OpenStax, CC BY 4.0Watch Coronary CirculationWatch associated Bootcamp video - Anatomy: Coronary Artery AnatomyNetters:6ea4de4c-7a08-44e2-9d37-a23b3e998e8a
Enlargement of the heart can cause {{c1::dysphagia}} due to compression of the esophagusEnlargement of the left atrium can compress the left recurrent laryngeal nerve and cause hoarseness (Ortner syndrome - recurrent laryngeal nerve palsy due to cardiovascular disease)Watch Chambers of the Heart & Pulmonary CirculationWatch Mitral Stenosis SOAP Watch Approach to DysphagiaWatch associated Bootcamp video - Valvular Disease: Mitral Stenosis Watch associated Bootcamp video - Pressure-Volume Loops: Valvular Diseasec41040d6-34fa-4acf-a3ff-b7155734ad12
What effect do dihydropyridine CCBs have on afterload? {{c1::Decreased afterload (via peripheral vasodilation)}}Watch Calcium Channel BlockersReview DihydropyridinesWatch associated Bootcamp video - Vasodilation and Vasoconstriction : Pharmacologic Targets5fb2a2b6-3619-40be-8e6a-958e7e731881
Nitroprusside is associated with {{c1::cyanide}} poisoning, which may present as - {{c2::Lactic acidosis}} - {{c2::Seizures}} - Altered mental statusRisk factors for cyanide toxicity due to nitroprusside include prolonged infusion (> 24 hours) and high rates (5–10 μg/kg/min), as well as chronic kidney diseaseWatch Primary Hypertension & Hypertensive EmergencyWatch Hypertensive Emergency SOAP Watch Approach to Altered Mental StatusReview Cyanide Poisoning Review NitroprussideWatch associated Bootcamp video - Hypertension: Antihypertensives Watch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels1da35c51-800d-4b36-aea6-ac8e146cf76e
Statins indirectly cause {{c1::increased}} LDL receptor expression on hepatocytesOccurs in response to decreased cholesterol synthesis → results in ↑ LDL clearance from circulation (via receptor-mediated endocytosis)Watch StatinsWatch StatinsWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology4f6925ca-69e1-4b90-9064-278fc401315e
{{c1::Statins}} significantly reduce {{c2::LDL}} levels (30-60% reductions)Watch StatinsWatch StatinsWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology Watch associated Bootcamp video - Myocardial Infarction: Management084d7c88-2209-45f0-a050-32fab662d7c2
What effect do statins have on triglyceride levels? {{c1::Mild decrease}}Watch StatinsWatch StatinsWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacologyfda5f9f4-bf6f-4b72-b4d4-0b0247698423
What effect do statins have on HDL levels? {{c1::Mild increase}}Watch StatinsWatch StatinsWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacologyc8c2ba41-967a-46fa-a5a5-892cdfccde64
The most common side effect of statins is {{c1::myopathy}}, which occurs weeks to months after starting therapy- e.g., muscle weakness, soreness - Exacerbated by fibrate usage - For patients who are intolerant of one statin due to myopathy, discontinue statin therapy for 2–4 weeks, then restart treatment with a different statin (e.g., pravastatin or fluvastatin) at low-dose once symptoms have resolvedWatch StatinsWatch StatinsWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacologyda8aa731-065e-4807-b473-50380a1f8a77
Statins can cause elevations in serum {{c1::creatine kinase (CK)}}, which may indicate myopathyCK-MM (skeletal), CK-MB (cardiac), CK-BB (brain)Watch StatinsWatch StatinsWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology40cd4042-84c8-4e0e-88b3-2e66a1970c62
Bile acid resins indirectly cause {{c1::increased}} LDL receptor expressionLiver needs more cholesterol to synthesize bile acidsWatch Cholestyramine & EzetimibeReview Bile Acid ResinsWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacologyaffd611c-c7ad-4459-9102-c338edfa9812
What drug class do gemfibrozil and fenofibrate belong to? {{c1::Fibrates}}Watch Fibrates & NiacinWatch FibratesWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology79ffa6cc-05d4-42f1-b47f-8b10f698224c
Fibrates significantly decrease serum {{c1::triglycerides}} by increasing their {{c2::hydrolysis}} in VLDLs and chylomicronsIncreased LPL activity via PPAR-α stimulation leads to increased triglyceride clearanceWatch Fibrates & NiacinWatch FibratesWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacologyba12ffb1-a15b-47a2-9593-4d54b5dd9a15
{{c1::Fibrates}} are the most effective drugs for decreasing serum {{c2::triglycerides}}First Aid Pharmacology: Blood & Inflammation (Dyslipidemia drugs)Watch Fibrates & NiacinWatch FibratesWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacologyec7351e5-e3e7-4853-a239-979335a85a62
Niacin (vitamin B3) {{c1::mildly}} decreases serum triglycerides by decreasing hepatic {{c1::VLDL}} secretionAlso inhibits lipolysis in adipose tissue (via hormone-sensitive lipase) Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Fibrates & NiacinWatch Niacin Review Vitamin B3 (Niacin) BiochemistryWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology Watch associated Bootcamp video - Vitamins: Vitamin B3 (Niacin)b62d12aa-83b7-4919-9138-4ffcf0048f9f
Niacin leads to {{c1::moderately decreased}} serum LDL by reducing {{c2::VLDL}} synthesisNiacin also inhibits lipolysis via inhibition of hormone-sensitive lipaseWatch Fibrates & NiacinWatch Niacin Review Vitamin B3 (Niacin) BiochemistryWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology Watch associated Bootcamp video - Vitamins: Vitamin B3 (Niacin)67acea36-ff47-4835-b2f8-42d18af76b05
Organic nitrates are metabolized and release {{c1::nitric oxide (NO)}}Watch NitratesWatch NitratesWatch associated Bootcamp video - Vasodilation and Vasoconstriction: Endothelial Regulated Vasodilation9f66e876-3d10-4115-933c-6f0a25845f75
Nitrates may provide symptomatic relief of chronic, stable {{c1::angina}}Watch NitratesWatch NitratesWatch associated Bootcamp video - Stable Angina and Atherosclerosis: Anti-Anginal Therapy6fb749ac-70fb-4801-8690-f01a39c55a1e
{{c1::Sublingual}} administration of nitroglycerin avoids first pass metabolism, which is useful for immediate relief of anginaWatch NitratesWatch NitratesWatch associated Bootcamp video - Stable Angina and Atherosclerosis: Anti-Anginal Therapy346dbe99-f30d-479b-9a91-0f28b68d6c0a
Nitrates are useful in treatment of acute {{c1::coronary}} syndromese.g., unstable angina, NSTEMI, and STEMIWatch NitratesWatch NitratesWatch associated Bootcamp video - Stable Angina and Atherosclerosis: Anti-Anginal Therapy Watch associated Bootcamp video - Hypertension: Hypertension Variants9a2cfe0f-1a0b-4625-8972-e2f5bc4b47a4
What hematological complication is associated with nitrates? {{c1::Methemoglobinemia}}- Due to nitrites, which may oxidize Fe2+ to Fe3+ - Nitrites may also come from dietary intake or polluted / high altitude H2OWatch NitratesWatch NitratesWatch associated Bootcamp video - Hypertension: Antihypertensives Watch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels Watch associated Bootcamp video - Side Effects and Toxins: Environmental Toxins and their Treatmentsnitrites may also come from dietary intake or polluted/high altitude H2O, which may oxidize Fe2+ to Fe3+0212118a-c067-49f4-86ba-f0ae8faf9b99
"Industrial workers may develop ""{{c3::Monday}} disease"" due to excessive {{c4::nitrate}} exposure, which presents with {{c1::headache}}, {{c2::dizziness}}, and tachycardia"Develop a tolerance during the work week and lose tolerance over the weekendWatch Approach to DizzinessWatch NitratesWatch NitratesWatch associated Bootcamp video - Stable Angina and Atherosclerosis: Anti-Anginal Therapy Watch associated Bootcamp video - Hypertension: Antihypertensives50e156af-5dfa-4032-bbe9-89bcf330d809
The alveolar walls are lined with epithelial cells called {{c1::type I}} and {{c1::type II pneumocytes}}Connections between alveoli are known as pores of KohnWatch Acute Respiratory Distress Syndrome (ARDS)Watch associated Bootcamp video - Pulmonology System Function, Anatomy, and Histology7fff7fcd-7daa-451e-b5c8-707dc94bce46
Type {{c1::II}} pneumocytes have regenerative capacity for both type I and type II pneumocytesWatch Acute Respiratory Distress Syndrome (ARDS)Watch associated Bootcamp video - Pulmonology System Function, Anatomy, and Histology31918db4-0c7a-46aa-a852-1146da916b48
Lung compliance may be calculated by the equation C = {{c1::ΔV/ΔP}}ΔV = change in lung volume ΔP = change in lung pressureWatch Compliance of the Respiratory System: Part 1Watch associated Bootcamp video - Air Physiology : Compliancec7e96def-cefb-421d-a93e-4d7eadb1cd1d
What is the effect of surfactant on lung compliance? {{c1::Increased compliance}}Watch Compliance of the Respiratory System: Part 1 Watch Surfactant & Surface Tension of AlveoliWatch Lung Diseases of Prematurity: Respiratory Distress Syndrome and Apnea of PrematurityWatch associated Bootcamp video - Air Physiology: Surfactant Watch associated Bootcamp video - Air Physiology : Compliance Watch associated Bootcamp video - Lung Pathology Special Topics (Pulmonary Edema)364956d8-744f-4b79-bebc-64571c1aa643
In the developing fetus, mature levels of surfactant are not achieved until around week {{c1::35}}Infants born between week 24 and 35 will have uncertain surfactant statusWatch associated Bootcamp video - Pulmonology System Function, Anatomy, and Histology Watch associated Bootcamp video - ARDS and NRDS8b5fc5cd-e513-4be5-845d-008a55b51008
The Po2 in dry inspired air is normally approximately {{c1::160}} mmHgVia 760 mmHg * 0.21 = 160 mmHgWatch associated Bootcamp video - Blood Physiology: Oxygen Content5a657d27-3800-49d0-a76b-a059aae96535
If hemoglobin contains iron in the {{c1::ferric (Fe3+)}} state, it is called {{c2::methemoglobin}}Watch O2 TransportWatch associated Bootcamp video - Blood Physiology: Hemoglobin Watch associated Bootcamp video - Side Effects and Toxins: Environmental Toxins and their Treatments1d56cc10-9449-43f9-8196-2b92a2e001fa
Methemoglobin (Fe3+) binds O2 much {{c1::less::more/less}} readily than hemoglobin (Fe2+)Thus oxygen saturation is decreased and often fixed ∼ 85%Watch O2 TransportWatch associated Bootcamp video - Blood Physiology: Abnormal Oxygen Levels Watch associated Bootcamp video - Side Effects and Toxins: Environmental Toxins and their Treatments Watch associated Bootcamp video - Antibiotics: Pyrazinamide, Ethambutol, Dapsone, and Clofazimine992aea02-9cee-40c8-b134-98850b928a5c
{{c1::Methemoglobinemia}} may present with {{c3::cyanosis::skin}} and {{c2::chocolate}}-colored bloodPhoto credit: Biggs et al., CC BY 4.0, via Journal of Education & Teaching - Emergency Medicine; Thomas M. Nappe, Anthony M. Pacelli, and Kenneth Katz, CC BY-SA 4.0, via Wikimedia Commons (modified by cropping)Watch O2 TransportWatch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels Watch associated Bootcamp video - Side Effects and Toxins: Environmental Toxins and their Treatments Watch associated Bootcamp video - Antibiotics: Pyrazinamide, Ethambutol, Dapsone, and Clofazimine08852fce-4563-4144-9518-fe157894a09d
Methemoglobinemia is associated with the following parameters: - {{c1::decreased (typically to 85%)}} SaO2 - {{c1::decreased}} O2 content - {{c1::normal}} PaO2 - {{c1::decreased}} PaCO2"- Standard pulse oximetry is unable to detect methemoglobin, thus creating a falsely low oxygen saturation (vs. CO-oximetry, which can detect hemoglobin, methemoglobin, and carboxyhemoglobin) - Unbound O2 (PaO2) is still normal - the oxygen simply cannot bind to Fe3+ and cannot be released to tissues once bound to MetHb (thus causing cyanosis) - O2 saturation typically at 85% due to a ""saturation gap"" → caused by absorption wavelength - PaCO2 is decreased due to hyperventilation"Watch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels Watch associated Bootcamp video - Side Effects and Toxins: Environmental Toxins and their Treatments Watch associated Bootcamp video - Antibiotics: Pyrazinamide, Ethambutol, Dapsone, and Clofaziminey8358a037-e5c2-42d9-a991-3f0fbbbb97d7
The {{c2::sigmoidal}} shape of the oxygen-hemoglobin dissociation curve is due to {{c1::positive cooperativity}} (increased affinity for each successive O2 bound)Watch Oxygen-Hemoglobin Dissociation CurveWatch associated Bootcamp video - Blood Physiology: Hemoglobinc0ddeccc-809b-4cc7-b863-de4fe85b4147
The majority of CO2 transported in blood is in the form of {{c1::HCO3- (bicarbonate)}} (70%)Watch CO2 TransportWatch associated Bootcamp video - Blood Physiology : Carbon Dioxideffd8186f-d7a1-4901-a92d-c44757730a68
Fetal pulmonary vascular resistance is very {{c1::high}} because of generalized hypoxic vaso{{c1::constriction}}Watch Pulmonary Blood FlowWatch associated Bootcamp video - Blood Physiology : Pulmonary Vascular Resistance3994abe1-ed69-4687-bcbe-81a36f95aa41
If there is a(n) {{c1::airway}} obstruction, the V/Q ratio = {{c2::0 (shunt)}}Image licensed by Physeo and used with permission. Purchase full textbook here.Watch Ventilation/Perfusion (V/Q) Ratios & DefectsWatch associated Bootcamp video - Blood Physiology : Pathological V/Q Mismatch615a5610-c396-472d-97f5-3ad4b04d2ddd
Allergic rhinitis is characterized by an inflammatory infiltrate with {{c1::eosinophils::WBC type}}Watch Cells of the Immune SystemReview Eosinophils5eb7a064-04ad-4e15-9839-3c76145c932e
{{c1::Aspirin-exacerbated respiratory disease (AERD)}} is characterized by a triad of: Asthma Chronic/recurrent rhinosinusitis Nasal polyps- Also known as the Samter triad - Seen in 10% of adults with asthma; due to shunting of the arachidonic acid pathway toward the leukotriene pathway - Previously referred to as aspirin-induced or intolerant asthma, but UWorld has changed the name - FA 2023 states COX-inhibitor sensitivity instead of chronic/recurrent rhinosinusitis - Mnemonic: RAN (Rhinosinusitis (chronic/recurrent), Asthma, Nasal polyps)Watch Asthma & BronchiectasisWatch Chronic Asthma SOAWatch associated Bootcamp video - Asthma Watch associated Bootcamp video - Pharmacology : Aspirin & CelecoxibShunting of the arachidonic acid pathway toward the leukotriene (LOX) pathway; treat with leukotriene antagonists (montelukast, zafirlukast); diagnose with aspirin challenge780cd42d-8f67-4bc7-a402-50c1d2224d09
Nasopharyngeal carcinoma often presents with involvement of {{c1::cervical}} lymph nodesAlso see nasal congestion with epistaxis, headache, facial numbness (para-cavernous sinus tumor invasion), and/or serous otitis media (eustachian tube obstruction)Watch Infectious Mononucleosisf665ba44-7c7c-4dbb-9ddf-dd2893a855c9
{{c1::Cytomegalovirus (CMV)}} is a common cause of atypical pneumonia in post-transplant patients on immunosuppressive therapyWatch Cytomegalovirus (Herpesviridae)Watch associated Bootcamp video - Cardiorespiratory Infections: Atypical Pneumonia Pathogens Watch associated Bootcamp video - DNA Viruses: Cytomegalovirus: Pathogenesis and Clinical Manifestations8c902c23-a2bc-4931-8204-b5a43ddba3ba
Lung abscesses may present with {{c1::air-fluid levels}} on CXR, which suggests {{c2::cavitation}}Thick walled cavity (blue overlay); air-fluid level (red line) Photo credit: Yale Rosen, CC BY-SA 2.0, via Flickr (left); AMBOSS, CC BY-SA 2.0 (right)Watch associated Bootcamp video - Lung Pathology Fundamentals : Introduction to Respiratory Infections86b69c4f-b35f-45d2-890b-c41002975ff5
Lung abscess secondary to aspiration is most commonly found in the {{c1::right::left/right}} lung- Often in the right lower lobe - The right primary bronchus is wider, shorter, and more vertical than the left Photo credit: BruceBlaus. DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0, via Wikimedia Commons Thick walled cavity (blue overlay); air-fluid level (red line) Photo credit: Yale Rosen, CC BY-SA 2.0, via Flickr (left); AMBOSS, CC BY-SA 2.0 (right)Watch associated Bootcamp video - Lung Pathology Fundamentals : Introduction to Respiratory Infectionsf9740bc7-a636-422e-a082-bd690ec138c4
If a patient is {{c2::upright}} during aspiration, an abscess is most likely to form in the {{c1::basal}} segments of the right lower lobe of the lungWatch LungsWatch associated Bootcamp video - Lung Pathology Fundamentals : Introduction to Respiratory Infections288bb3c4-9d27-4f56-bc4d-dfd343563454
Chronic bronchitis is highly associated with {{c1::smoking::risk factor}}* Chronic irritation by other inhaled air pollutants such as grain, cotton, silica dusts, sulfur dioxide and nitrogen dioxide may contribute to development of chronic bronchitis * CF → thick mucus secretions → chronic bronchitis Watch COPD & EmphysemaWatch COPD Subtypes Watch COPD Presentation Watch Chronic Dyspnea DDx Part 1 Watch Cough DDxWatch associated Bootcamp video - COPD55e043cb-31fa-4b3b-ba42-4bcd34a3c657
Chronic bronchitis is characterized by hypertrophy/hyperplasia of bronchial {{c1::mucinous}} glandsSmoking brings in excess foreign particles, leading to a compensatory hypertrophic response from the mucinous glands; may also have squamous metaplasia and lymphocytic infiltrateWatch COPD & EmphysemaWatch associated Bootcamp video - COPD87c688a6-618c-402b-aa1b-9a9dab1af094
What effect may chronic bronchitis secondarily have on RBC levels? {{c1::Increased (polycythemia)}}In response to hypoxemiaWatch COPD & EmphysemaWatch associated Bootcamp video - COPD64d594f6-9308-435b-9f4f-186762fac3c9
{{c1::Idiopathic pulmonary fibrosis}} is fibrosis of the lung interstitium with unknown cause- The pathologic presentation of IPF is known as usual interstitial pneumonitis; disease is also called chronic inflammatory interstitial pneumonitis - Secondary causes of interstitial fibrosis such as drugs (e.g., bleomycin and amiodarone) and radiation therapy must be excluded Histopathological Slide of Fibrotic Changes Photo Credit: Histopathological Slide of Fibrotic Changes Yale Rosen from USA [CC BY-SA]Watch Idiopathic Pulmonary FibrosisWatch associated Bootcamp video - Pulmonary Fibrosis9a3a475b-00cc-413d-8469-006c5c783e37
{{c1::Idiopathic pulmonary fibrosis}} is likely related to cyclical lung injury, with {{c2::TGF-β}} released from injured pneumocytes inducing increased collagen deposition and fibrosis- Normally in lung injury, type I pneumocytes are destroyed, type II pneumocytes undergo hyperplasia to make cells that differentiate into and replace the type I, then remaining type II die - In IPF, chronic injury of type II pneumocytes leads to constant hyperplasia of type II pneumocytes (increased), which produce TGF-β that stimulates activity / proliferation of fibroblasts (increased); while type I pneumocytes die off (decrease) / are replaced by fibrotic tissueWatch Idiopathic Pulmonary FibrosisWatch associated Bootcamp video - Pulmonary FibrosisIPF seen on PATHOLOGY may also be referred to as usual interstitial pneumonia (UIP) - normally in lung injury, type I pneumocytes are destroyed, type II pneumocytes undergo hyperplasia to make cells that differentiate into and replace the type I, then remaining type II die - in IPF, chronic injury of type II pneumocytes leads to constant hyperplasia of type II pneumocytes (increased), which produce TGF-B that stimulates activity / proliferation of fibroblasts (increased); while type I pneumocytes die off (decrease) / are replaced by fibrotic tissue881f0c1c-3ce0-48f3-80d8-c019b83d2999
Idiopathic pulmonary fibrosis presents clinically with progressive {{c1::dyspnea}}, cough, and digital {{c2::clubbing}}Idiopathic pulmonary fibrosis (IPF) is the most common respiratory cause of digital clubbing in developed countriesWatch Restrictive Lung Disease (Overview) Watch Idiopathic Pulmonary FibrosisWatch Intro to DPLD/ILD Watch Cough DDxWatch associated Bootcamp video - Pulmonary Fibrosis8f0e385f-c4cd-4286-80ac-2291dcf765bb
Idiopathic pulmonary fibrosis is initially seen on CT in {{c1::subpleural::location}} patchesDue to retraction of scars along the interlobar septaWatch Idiopathic Pulmonary FibrosisWatch associated Bootcamp video - Pulmonary Fibrosis7adedf88-fc59-4dd8-88d7-9f3c13ee4ec1
Sarcoidosis may be visualized on CXR as {{c1::bilateral hilar lymphadenopathy}} and coarse reticular opacitiesPhoto credit: Mikael Häggström, CC0, via Wikimedia CommonsWatch Sarcoidosis & BerylliosisWatch SarcoidosisWatch associated Bootcamp video - Rheumatologic Diseases: Sarcoidosis46bd7adb-f0cc-466d-9746-1019e0a352d5
Hypersensitivity pneumonitis is often seen in {{c1::farmers::demographic}} and those exposed to {{c2::birds}}DiseasesCausative AgentSourceHot tub lungMycobacterium avium complexMist from hot tubsSuberosisPenicillum glabrumMoldy cork dustBird fancier's (pigeon breeders) lungAvian proteinsFeathers / bird droppingsBagassosisThermophilic ActinomycetesPressed sugarcaneCheese washer's lungP. roquefortiCheese casingsFarmer's lungThermophilic Actinomycetes, Aspergillus, Saccharopolyspora rectivirgulaMoldy hayHumidifier lungBacillus subtilus / cereus, Naegleria gruberiMist generated by a machine from standing waterWatch associated Bootcamp video - Hypersensitivity Pneumonitisd56a42c6-b341-4f5b-be64-919058a2adec
Hypersensitivity pneumonitis presents with {{c1::fever}}, cough, and dyspnea hours after exposure; resolves with removal of exposure- May also present with chest tightness and headache - CXR shows bilateral, scattered, micronodular interstitial opacities due to patchy interstitial inflammation DiseasesCausative AgentSourceHot tub lungMycobacterium avium complexMist from hot tubsSuberosisPenicillum glabrumMoldy cork dustBird fancier's (pigeon breeders) lungAvian proteinsFeathers / bird droppingsBagassosisThermophilic ActinomycetesPressed sugarcaneCheese washer's lungP. roquefortiCheese casingsFarmer's lungThermophilic Actinomycetes, Aspergillus, Saccharopolyspora rectivirgulaMoldy hayHumidifier lungBacillus subtilus / cereus, Naegleria gruberiMist generated by a machine from standing waterWatch Other High-Yield DPLD/ILD Watch Approach to CoughWatch associated Bootcamp video - Hypersensitivity Pneumonitisbff86015-a0c9-46fc-8014-53b24f5ec647
{{c2::Neonatal respiratory distress}} syndrome is respiratory distress due to inadequate {{c1::surfactant}} levels- Surfactant deficiency → diffuse atelectasis → V/Q mismatch (R-L intrapulmonary shunting) - V/Q mismatch responsive to supplemental O2Watch Surfactant & Surface Tension of AlveoliWatch Lung Diseases of Prematurity: Respiratory Distress Syndrome and Apnea of PrematurityWatch associated Bootcamp video - Air Physiology: Surfactant Watch associated Bootcamp video - ARDS and NRDSa6d9c34e-d598-4a42-893c-80f9a0354144
Neonatal respiratory distress syndrome (NRDS) is associated with {{c1::premature}} birth- Surfactant production doesn't begin until at least week 20 - Surfactant levels are insufficient until around week 35Watch Lung Diseases of Prematurity: Respiratory Distress Syndrome and Apnea of PrematurityWatch associated Bootcamp video - ARDS and NRDSe0d28e5b-b981-4f6e-8e35-93e9ac7e8535
Neonatal respiratory distress syndrome (NRDS) presents with {{c1::increased}} respiratory effort after birthMust use more energy to open lung due to collapsed air sacsWatch Surfactant & Surface Tension of AlveoliWatch Lung Diseases of Prematurity: Respiratory Distress Syndrome and Apnea of PrematurityWatch associated Bootcamp video - ARDS and NRDSae411d88-ef56-41d8-965b-68ff38de3cf3
Neonatal respiratory distress syndrome (NRDS) may present with {{c1::tachypnea::respiratory rate}} with use of accessory muscles and grunting- Eventually leads to hypoxemia and cyanosis - Grunting creates PEEP (positive end-expiratory pressure) Retractions in respiratory distress: Video credit: JETem, CC BY 4.0, via Journal of Education and Teaching - Emergency Medicine DiagnosisTransient tachypnea of the newborn (TTN)Respiratory distress syndromePersistent pulmonary hypertensionPathophysiologyAlveolar fluid not cleared properly at birthAlveolar collapse and atelectasis due to lack of surfactantRight to left shunting due to high pulmonary vascular resistance resulting in hypoxiaClinical featuresTachypnea resolves by day 2Respiratory distress (premature birth)Tachypnea and cyanosisChest x-rayPerihilar linear streaking bilaterallyGround glass (reticulogranular), air bronchograms, decreased lung volumesClear lung fields, decreased pulmonary vascularityWatch Surfactant & Surface Tension of AlveoliWatch Lung Diseases of Prematurity: Respiratory Distress Syndrome and Apnea of PrematurityWatch associated Bootcamp video - ARDS and NRDS8314fda0-82b9-4f9a-9abb-3f7a47b2c5cd
The key risk factors for lung cancer are {{c1::cigarette smoke}}, {{c2::radon::not arsenic}}, and {{c3::asbestos}}; family history is also a risk factorBoth smoking AND secondhand smokeWatch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Lung Cancer Basics626bad6c-af0d-4319-92b3-5def2a8ac686
{{c1::Radon}} exposure is the 2nd most frequent cause of lung carcinoma in the U.S.Watch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Lung Cancer Basicsf559d857-fdb4-4053-832a-40dabece99e4
One benign cause of a 'coin-lesion' on CXR is {{c1::bronchial hamartoma}}, which is a benign tumor of {{c2::lung tissue}} and {{c2::cartilage}}Often calcified on imaging Photo credit: Lange123, CC BY-SA 3.0, via Wikimedia CommonsWatch Sturge Weber & Tuberous SclerosisWatch associated Bootcamp video - Lung Cancer Basics206498a5-c683-4aa7-b76c-514f39d1b17d
{{c2::Small cell}} lung carcinoma may produce the anterior pituitary hormone {{c1::ACTH}} leading to {{c1::Cushing syndrome}}"""Small cell, Smokers, Central, paraneoplastic Syndromes"" - Small cell lung cancer may also produce the posterior pituitary hormone ADH, leading to SIADH - ACTH leads to activation of the adrenal cortex which leads to increased cortisol which decreases activation of the anterior pituitary and hypothalamus Type of tumorIncidenceLocationAssociationsHistologyAdenocarcinomaMost common primary lung cancer > Women > NonsmokersPeripheralBetter prognosis EGFR gene & ALK gene ClubbingGlandular Mucin positive Lepidic → alveolar thickeningSmall cell carcinoma> SmokersCentralAggressive Early metastases L-myc oncogene Paraneoplastic syndromes (Cushing syndrome, SIADH, Lambert-Eaton)Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolaseSquamous cell carcinoma> Smokers (91% of SCC occurs in smokers)Central (hilar)PTHrP: HypercalcemiaEpithelial Desmosomes Keratin pearlsLarge cell carcinoma> SmokersPeripheralEarly metastasis Poor prognosisUndifferentiated Large cellBronchial carcinoid tumorMost common primary lung cancer in children and adolescentsVariableGood prognosis Rare metastases Carcinoid syndrome Mass effectSame as small cell (Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolase)"*cushion is in front of the table → anterior pituitary Watch Lung Carcinoma Watch Cushings SyndromeWatch Cushing Syndrome SOAP Watch Lung CancerWatch associated Bootcamp video - Pulmonary Small Cell Carcinoma Watch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome)55e9a688-5225-45e0-a362-66c12da5a196
{{c2::Small cell}} lung carcinoma may produce the posterior pituitary hormone {{c1::ADH}} leading to {{c1::SIADH}}"- May also produce anterior pituitary hormone ACTH leading to Cushing syndrome - ""Small cell, Smokers, ""S""entral, paraneoplastic Syndromes"" Type of tumorIncidenceLocationAssociationsHistologyAdenocarcinomaMost common primary lung cancer > Women > NonsmokersPeripheralBetter prognosis EGFR gene & ALK gene ClubbingGlandular Mucin positive Lepidic → alveolar thickeningSmall cell carcinoma> SmokersCentralAggressive Early metastases L-myc oncogene Paraneoplastic syndromes (Cushing syndrome, SIADH, Lambert-Eaton)Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolaseSquamous cell carcinoma> Smokers (91% of SCC occurs in smokers)Central (hilar)PTHrP: HypercalcemiaEpithelial Desmosomes Keratin pearlsLarge cell carcinoma> SmokersPeripheralEarly metastasis Poor prognosisUndifferentiated Large cellBronchial carcinoid tumorMost common primary lung cancer in children and adolescentsVariableGood prognosis Rare metastases Carcinoid syndrome Mass effectSame as small cell (Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolase)"ADH is behind the table → posterior pituitary Watch Lung Carcinoma Watch Diabetes Insipidus & SIADHWatch SIADH Watch Lung CancerWatch associated Bootcamp video - Pulmonary Small Cell Carcinoma Watch associated Bootcamp video - Endocrine SIADHPresents with euvolemic hyponatremia other common findings include low serum osmolality (< 275 mOsm/kg) and high urine osmolality (> 100 mOsm/kg due to ADH sucking back water)83e740c7-cb48-4808-8611-7e72d3b2e16a
{{c3::Small cell}} lung carcinoma may produce antibodies against {{c1::presynaptic Ca2+ channels}}, causing {{c2::Lambert-Eaton myasthenic}} syndrome"""Small cell, Smokers, Central, paraneoplastic Syndromes"""Watch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Pulmonary Small Cell Carcinoma Watch associated Bootcamp video - Neuromuscular Junction (NMJ): Lambert-Eaton Syndromefab1ec0b-1229-42f7-b0b0-21dce162e9f0
Squamous cell carcinoma of the lung is usually (60-80%) {{c1::centrally}} locatedPhoto Credit:Yale Rosen from USA, CC BY-SA 2.0, via Wikimedia Commons Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission) Type of tumorIncidenceLocationAssociationsHistologyAdenocarcinomaMost common primary lung cancer > Women > NonsmokersPeripheralBetter prognosis EGFR gene & ALK gene ClubbingGlandular Mucin positive Lepidic → alveolar thickeningSmall cell carcinoma> SmokersCentralAggressive Early metastases L-myc oncogene Paraneoplastic syndromes (Cushing syndrome, SIADH, Lambert-Eaton)Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolaseSquamous cell carcinoma> Smokers (91% of SCC occurs in smokers)Central (hilar)PTHrP: HypercalcemiaEpithelial Desmosomes Keratin pearlsLarge cell carcinoma> SmokersPeripheralEarly metastasis Poor prognosisUndifferentiated Large cellBronchial carcinoid tumorMost common primary lung cancer in children and adolescentsVariableGood prognosis Rare metastases Carcinoid syndrome Mass effectSame as small cell (Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolase)Watch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Pulmonary Non-Small Cell Carcinomaf1db274d-04c9-4e77-bb11-1fdc092a961f
{{c3::Squamous cell}} carcinoma of the lung is characterized histologically by {{c2::keratin pearls}} and {{c1::intercellular bridges}}- Keratin pseudocysts are seen in seborrheic keratosis - SCC of the lungs exogenously produces keratin filaments which generates keratin pearls - Intercellular bridges are desmosomes (which use keratin to link cells via cadherins) Keratin pearls: Photo credit: Ed Uthman, CC BY 2.0, via Flickr; photo credit: Dr. Yale Rosen, CC BY-SA 2.0, via Flickr Intercellular bridging (blue overlay): Photo credit: Yale Rosen from USA, CC BY-SA 2.0, via Wikimedia Commons. The supplementary image with added overlays was taken from the source above, licensed under CC BY-SA 2.0 Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Lung Cancer : Non-Small Cell Carcinomaa28198f0-2943-4a16-a344-874c24342520
Squamous cell carcinoma of the lung commonly presents as a hilar mass arising from the {{c1::bronchus}}Cavitations may be present as well Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Pulmonary Non-Small Cell Carcinomad4cc7a8a-e710-447f-bd13-91a92cf131a0
Adenocarcinoma of the lung is {{c1::peripherally}} locatedPhoto credit: Adenocarcinoma Atlas of Pulmonary Pathology via Flicker https://flic.kr/p/6YCpQ4 Type of tumorIncidenceLocationAssociationsHistologyAdenocarcinomaMost common primary lung cancer > Women > NonsmokersPeripheralBetter prognosis EGFR gene & ALK gene ClubbingGlandular Mucin positive Lepidic → alveolar thickeningSmall cell carcinoma> SmokersCentralAggressive Early metastases L-myc oncogene Paraneoplastic syndromes (Cushing syndrome, SIADH, Lambert-Eaton)Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolaseSquamous cell carcinoma> Smokers (91% of SCC occurs in smokers)Central (hilar)PTHrP: HypercalcemiaEpithelial Desmosomes Keratin pearlsLarge cell carcinoma> SmokersPeripheralEarly metastasis Poor prognosisUndifferentiated Large cellBronchial carcinoid tumorMost common primary lung cancer in children and adolescentsVariableGood prognosis Rare metastases Carcinoid syndrome Mass effectSame as small cell (Neuroendocrine Kulchitsky Cells Chromogranin A Synaptophysin Neuron-specific enolase)courtyard = peripheral; prison cells = central Watch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Pulmonary Non-Small Cell Carcinoma597b3655-c5ea-4edd-8824-429d59060272
Which is more common, primary lung tumors or metastasis to the lung? {{c1::Metastasis}}Watch Lung Carcinoma34b0f78c-4343-47be-bd15-1817deb9758d
{{c1::Pneumothorax}} is defined as the accumulation of air in the pleural space- Results in collapse of a portion of the lung - Hemopneumothorax = air AND blood Photo credit: James Heilman, MD, CC BY 3.0, via Wikimedia Commons Photo credit: Stead et al., CC BY 4.0, via CureusWatch Pneumothorax Watch Pleura Watch Compliance of the Respiratory System: Part 1Watch Pneumothorax & Tension Pneumothorax SOAP Watch Pneumothorax Watch Initial Trauma Assessment: Secondary SurveyWatch associated Bootcamp video - Pneumothorax91065ce5-f941-4331-824d-4bc523047cef
In {{c2::tension}} pneumothorax, the trachea ± mediastinum shifts {{c1::away from}} the side of collapse- Tracheal deviation is a clinical sign indicating unequal intrathoracic pressure within chest cavity, displacing trachea in direction of less pressure; mediastinal contents may be displaced also to the side of less pressure - In a PTX, affected side comes to atmospheric pressure, causing that side to have relatively more pressure (causing the trachea to shift to the opposite side) Photo credit: Tritsch et al., CC BY 4.0, via Journal of Education & Teaching - Emergency Medicine Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons* due to air & pressure in the pleural cavity pushing the trachea ± mediastinum Watch PneumothoraxWatch Chest Pain Assessment & Plan Watch Pneumothorax & Tension Pneumothorax SOAP Watch Pneumothorax Watch Shock: Cardiogenic & Obstructive SOAPs Watch Penetrating Thoracic & Abdominal TraumaWatch Chest X-Ray InterpretationWatch associated Bootcamp video - Lung Pathology Fundamentals : Lung Physical Exam Watch associated Bootcamp video - Pneumothorax264110b3-b87e-4aa5-a8b1-5a76b7e83e89
{{c1::Primary}} hemostasis forms a weak platelet plugSecondary hemostasis stabilizes the weak platelet plug into a thrombus via formation of a cross linked fibrin meshReview Platelet Plug FormationWatch associated Bootcamp video - Platelets: Primary Hemostasis Watch associated Bootcamp video - Coagulation and Fibrinolysis: Coagulation Cascadea0ea7fb0-e481-40c1-9f70-d826c1a95239
When a blood vessel is injured, {{c1::von Willebrand factor (vWF)}} binds exposed {{c2::subendothelial collagen}}- In sites of endothelial damage (high shear stress); the vWF protein (a large multimer) uncoils to a relaxed state, which can bind to subendothelial collagen and platelets - Thus, patients with vWF disease or collagen synthesis deficiencies will be susceptible to bleedingWatch Inherited Coagulation Defects Watch Antiplatelet AgentsReview Platelet Plug FormationWatch associated Bootcamp video - Platelets: Primary Hemostasis Watch associated Bootcamp video - Coagulation and Fibrinolysis : Von Willebrand Disease Watch associated Bootcamp video - Coagulation and Fibrinolysis: Coagulation Cascade9b390828-0668-47d7-b539-ee9cee852aa9
Following platelet adhesion (primary hemostasis), there is platelet {{c1::degranulation::not aggregation}}Platelets release: - Alpha-granules (Fibrinogen, vWF, PF4) - Dense-granules (ADP, Ca2+, Serotonin) - TXA2Watch Antiplatelet AgentsReview Platelet Plug FormationWatch associated Bootcamp video - Platelets: Primary Hemostasisd566fffb-924e-47fd-831e-45c8cc1575c9
Binding of ADP to the P2Y12 receptor promotes optimal exposure of the {{c1::GPIIb/IIIa}} receptor on platelets- Induces conformational change of the receptor to increase affinity for fibrinogen - Upregulates more GpIIb/IIIa receptors to the cell surface - This is the basis for P2Y12 inhibitors (ticlopidine, clopidogrel)Watch Antiplatelet AgentsReview Platelet Plug FormationWatch associated Bootcamp video - Platelets: Primary Hemostasis10427ce7-0ced-4ac8-be5f-9060539cb0dc
Quantitative disorders of primary hemostasis present with symptoms of skin bleeding, such as {{c1::petechiae}} (1-2 mm)Petechiae are a sign of thrombocytopenia; not usually seen with qualitative disorders of primary hemostasis Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons LesionSizePetechiae1-2 mmPurpura3 mm - 1 cmEcchymoses> 1 cmWatch Quantitative Platelet DisordersWatch associated Bootcamp video - Platelets: Platelet DisordersAtlas:952564f0-630e-49b0-9298-5edf5312177f
Petechiae are often a sign of {{c1::thrombocytopenia}} and are NOT usually seen with {{c1::qualitative::quantitative/qualitative}} platelet disordersWatch Quantitative Platelet DisordersWatch associated Bootcamp video - Thrombotic Microangiopathies Watch associated Bootcamp video - Platelets: Platelet Disorders5a4491b5-2ac2-4e46-9b16-3285d87612ac
{{c1::Immune thrombocytopenia (ITP)}} is the most common cause of thrombocytopenia in children and adultsFormerly known as idiopathic thrombocytopenic purpuraWatch Quantitative Platelet DisordersWatch Bleeding Disorders: Platelet Disorders DDxReview Immune Thrombocytopenic Purpura (ITP)Watch associated Bootcamp video - Platelets: Platelet Disordersdda8607f-11e0-47f9-8bd1-1139f9b66305
Immune thrombocytopenia (ITP) commonly follows {{c1::viral infection}}Formerly known as idiopathic thrombocytopenic purpuraWatch Quantitative Platelet DisordersWatch Bleeding Disorders: Platelet Disorders DDxReview Immune Thrombocytopenic Purpura (ITP)Watch associated Bootcamp video - Platelets: Platelet Disorders0eb6ad37-e0c8-4f63-acbe-8003359abc15
What demographic is associated with the chronic form of immune thrombocytopenia (ITP)? {{c1::Females > 55 years of age::Sex and age}}- Formerly known as idiopathic thrombocytopenic purpura - May be primary or secondary (e.g., SLE) - Adult females are also at risk of TTPSketchy is wrong according to AMBOSS Watch Quantitative Platelet DisordersWatch associated Bootcamp video - Platelets: Platelet Disordersd1ea7807-bdde-4af0-9df2-f46dd8b72e3d
Immune thrombocytopenia (ITP) presents with {{c1::decreased}} platelet count- Formerly known as idiopathic thrombocytopenic purpura - Often < 50K/μLWatch Quantitative Platelet Disorders Watch Qualitative Platelet DisordersWatch Bleeding Disorders: Platelet Disorders DDxReview Immune Thrombocytopenic Purpura (ITP)Watch associated Bootcamp video - Platelets: Platelet Disorders4ad337e6-f0ff-452b-90f3-b497db597369
Immune thrombocytopenia (ITP) presents with increased {{c1::megakaryocytes}} on bone marrow biopsyFormerly known as idiopathic thrombocytopenic purpuraWatch Quantitative Platelet DisordersReview Immune Thrombocytopenic Purpura (ITP)Watch associated Bootcamp video - Platelets: Platelet Disordersd7d00892-5ae9-4ac2-b5ca-30275430a861
In thrombotic thrombocytopenic purpura (TTP), large, uncleaved vWF multimers lead to increased platelet {{c1::adhesion}} with consequent {{c2::microthrombi}} formationWatch Quantitative Platelet DisordersWatch associated Bootcamp video - Platelets: Thrombotic Microangiopathiese00e9038-37b4-4873-a953-2f5abd05779f
What demographic is associated with thrombotic thrombocytopenic purpura (TTP)? {{c1::Adult females}}Watch Quantitative Platelet DisordersReview Thrombotic Thrombocytopenic Purpura (TTP)Watch associated Bootcamp video - Platelets: Thrombotic Microangiopathies1b5c1ef3-2fff-4fd6-8044-953fc48edb06
"The pentad of classical symptoms seen in {{c1::thrombotic thrombocytopenic purpura (TTP)}} may be remembered with the mnemonic ""FAT RN"": {{c1::Fever::F}} {{c1::Anemia (microangiopathic hemolytic Anemia)*::A*}} {{c1::Thrombocytopenia*::T*}} {{c1::Renal symptoms::R}} {{c1::Neurologic symptoms::N}}"- *However, only MAHA and thrombocytopenia are required for diagnosis - Fever in 20% of patients - Renal symptoms in 50% of patients, more common in HUS - Neurologic symptoms in 67% of patients, more common in TTP - HUS presents with similar symptoms, almost always characterized by normal PT / PTT - Fever due to inflammation from small vessel occlusion and tissue damage - Patients can have Burr cells due to kidney damage - TTP can occur during pregnancy or in the postpartum periodWatch Quantitative Platelet DisordersWatch Bleeding Disorders: Platelet Disorders DDx Watch Intravascular Hemolytic Anemia: Intro & MAHA DDxReview Thrombotic Thrombocytopenic Purpura (TTP)Watch associated Bootcamp video - Platelets: Thrombotic Microangiopathiesperipheral blood smear helps aid in diagnosis (e.g. schistocytes suggestive of intravascular hemolysis)y50214777-a288-4ef8-bf67-42694a6125f3
The pentad of classical symptoms seen in thrombotic thrombocytopenic purpura (TTP) may be remembered with the mnemonic {{c1::FAT RN}}Fever Anemia (microangiopathic hemolytic Anemia)* Thrombocytopenia* Renal symptoms Neurologic symptoms - Fever in 20% of patients - Renal symptoms in 50% of patients, more common in HUS - Neurologic symptoms in 67% of patients, more common in TTP - *However, only MAHA and thrombocytopenia are required for diagnosis; HUS presents with similar symptoms, almost always characterized by normal PT / PTT - Fever due to inflammation from small vessel occlusion and tissue damage - Patients can have Burr cells due to kidney damage - TTP can occur during pregnancy or in the postpartum periodWatch Quantitative Platelet DisordersWatch Bleeding Disorders: Platelet Disorders DDx Watch Intravascular Hemolytic Anemia: Intro & MAHA DDxReview Thrombotic Thrombocytopenic Purpura (TTP)Watch associated Bootcamp video - Platelets: Thrombotic Microangiopathies62081631-0188-4a81-b1aa-16837c36e8c8
TTP and HUS typically present with {{c1::normal}} PT and {{c1::normal}} PTTCoagulation factors are not affectedWatch Quantitative Platelet DisordersWatch Hemolytic Uremic SyndromeWatch associated Bootcamp video - Platelets: Thrombotic Microangiopathiesc0621dd6-a0ec-4494-a0c1-60ce00105e84
Aspirin irreversibly inactivates the enzyme {{c1::cyclooxygenase}}, thus decreasing synthesis of {{c2::thromboxane A2 (TXA2)}}, leading to impaired platelet {{c3::aggregation}}Aspirin is non-selective and irreversibly inhibits both forms (but is weakly more selective for COX-1)Watch Antiplatelet AgentsWatch associated Bootcamp video - Platelets: Antiplatelet Medications Watch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways Watch associated Bootcamp video - Pharmacology : NASIDs Watch associated Bootcamp video - Pharmacology : Aspirin & Celecoxib Watch associated Bootcamp video - Myocardial Infarction: Management Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response0c6b8605-ce0f-4c06-89ee-eb0798398085
Von Willebrand disease presents with {{c1::increased}} bleeding timeImportant distinguishing feature from factor VIII deficiency - ↑ Bleeding time - Normal platelet count - Normal PT & normal or ↑ PTTWatch Inherited Coagulation DefectsWatch Abnormal Uterine Bleeding DDxReview Von Willebrand DiseaseWatch associated Bootcamp video - Hemophilia Watch associated Bootcamp video - Coagulation Cascade Watch associated Bootcamp video - Coagulation and Fibrinolysis : Von Willebrand Disease7bd4f3ea-f572-43b1-8eae-66794618b702
Von Willebrand disease presents with {{c1::normal}} platelet count- ↑ bleeding time - Normal platelet count - Normal PT & normal or ↑ PTT* b/c it is a defect in platelet plug formation (secondary hemostasis) Watch Inherited Coagulation DefectsReview Von Willebrand DiseaseWatch associated Bootcamp video - Hemophilia Watch associated Bootcamp video - Coagulation Cascade Watch associated Bootcamp video - Coagulation and Fibrinolysis : Von Willebrand Disease5133e460-5a92-427d-9efa-e6212a341738
Von Willebrand disease presents with {{c1::normal}} PT and {{c1::normal or increased}} PTT- Despite elevated PTT, usually does not cause problems with coagulation cascade - ↑ bleeding time - Normal platelet count - Normal PT & normal or ↑ PTTWatch Inherited Coagulation DefectsReview Von Willebrand DiseaseWatch associated Bootcamp video - Hemophilia Watch associated Bootcamp video - Coagulation Cascade Watch associated Bootcamp video - Coagulation and Fibrinolysis : Von Willebrand Disease Watch associated Bootcamp video - Coagulation and Fibrinolysis: Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Timebcedede1-87d9-4224-b94f-098f626266bd
Vitamin K is necessary for {{c1::gamma carboxylation}} of factors II, VII, IX, X, and proteins C and S- Gives coagulation factors a Ca2+ binding site - Example of post-translational modification - Protein C/S are anticoagulants / also have shorter half lives than factorsWatch Warfarin Watch Acquired Coagulation Defects Watch Vitamin K Watch Coagulation CascadeReview Vitamin K Deficiency Review Vitamin K Biochemistry Review WarfarinWatch associated Bootcamp video - Coagulation and Fibrinolysis: Vitamin K Dependent Coagulation Factors Watch associated Bootcamp video - Vitamins: Vitamin K: Vitamin K Cycle Watch associated Bootcamp video - Coagulation and Fibrinolysis: Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Timeca27459a-597b-46c0-8ff9-8911d8ccc71f
Heparin-induced thrombocytopenia (HIT) is a disorder that results in platelet {{c1::activation}} secondary to heparin therapy- Formerly known as HIT type 2 - Activated platelets form plugs causing thrombosis; platelets are also opsonized and thus are consumed by spleen (and activation) - Activated platelets release more PF4 (positive feedback loop) - Occurs in 0.2 - 5% of patients - There are 2 types of HIT, type I is clinically insignificant, while type II requires treatment Image licensed by Physeo and used with permission. Purchase full access here.Watch Quantitative Platelet DisordersWatch DVT SOAPWatch associated Bootcamp video - Coagulation and Fibrinolysis: Anticoagulation1bc1a37b-1a36-496b-a45e-174e61e0a941
Heparin-induced thrombocytopenia (HIT) occurs due to production of Ig{{c1::G}} antibodies against {{c2::heparin-platelet factor IV}} complexesFormerly known as heparin-induced thrombocytopenia type 2 (HIT type 2)* also attach directly to the Fc portion of platelets Watch Quantitative Platelet DisordersWatch DVT SOAPWatch associated Bootcamp video - Coagulation and Fibrinolysis: Anticoagulationeccd5673-eb76-47e3-b024-bb1e48657c0d
The antibody-heparin-PF4 complex may activate {{c1::platelets}}, leading to thrombosis and thrombocytopenia- i.e., heparin-induced thrombocytopenia - Fragments of destroyed platelets activate remaining platelets, leading to thrombosisWatch Quantitative Platelet DisordersWatch DVT SOAPWatch associated Bootcamp video - Coagulation and Fibrinolysis: Anticoagulation7c3941db-4847-40ee-a176-edfb00109bca
In disseminated intravascular coagulation (DIC), consumption of platelets and factors results in {{c1::bleeding}}Bleeding due to activation of the fibrinolytic systemWatch Acquired Coagulation DefectsWatch Bleeding Disorders: Coagulation Factor Disorders DDxWatch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular Coagulationf36d34d4-7ebd-4488-89a5-aa6c6589df05
Disseminated intravascular coagulation (DIC) is associated with bleeding, especially from {{c1::IV}} sites and {{c2::mucosal}} surfacesWatch Acquired Coagulation DefectsWatch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular Coagulation0afdeede-c6be-415f-a828-52f9dfaa78bb
Disseminated intravascular coagulation (DIC) typically presents with {{c1::increased}} PT and {{c1::increased}} PTTDue to consumption of coagulation factors in the intrinsic and extrinsic pathwayWatch Acquired Coagulation DefectsWatch Bleeding Disorders: Coagulation Factor Disorders DDxWatch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular Coagulation67fdcb5b-080e-42c4-9934-f06f92efd0ee
Disseminated intravascular coagulation (DIC) typically presents with {{c1::decreased}} platelet count- Due to excessive clotting - Important distinguishing feature from fibrinolysisWatch Acquired Coagulation DefectsWatch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular Coagulation92477559-7c17-4bc8-884a-8cb721a7f060
Disseminated intravascular coagulation (DIC) typically presents with increased {{c1::fibrin}} split products, particularly {{c2::D-dimer}}Watch Acquired Coagulation DefectsWatch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular Coagulation Watch associated Bootcamp video - Coagulation and Fibrinolysis: Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Timebcd37d91-8820-48a7-8196-d136336d9c6a
What is the best screening test for disseminated intravascular coagulation (DIC)? {{c1::Elevated D-dimer}}Watch Acquired Coagulation DefectsWatch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular Coagulation Watch associated Bootcamp video - Coagulation and Fibrinolysis: Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Time35302edb-47bc-48ea-a393-8e843aabd458
Which organs phosphorylate glucose using glucokinase? {{c1::Liver, β cells of the pancreas::2}}Watch Glycogen Synthesis & GlycogenolysisReview Hexokinase vs Glucokinase Review Glycogenesis Review GlycolysisWatch associated Bootcamp video - Glycogen: Glycogenesis Watch associated Bootcamp video - Glycogen: Glycogenolysis Watch associated Bootcamp video - Energy Production: Glycolysis: Key Enzymes and Aerobic vs. Anaerobic Glycolysisd9e78261-9cfb-4584-a9f7-dea3fc752ec6
Is glucokinase activity induced by insulin? {{c1::Yes}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycogen Synthesis & GlycogenolysisReview Hexokinase vs Glucokinase Review Glycogenesis Review GlycolysisWatch associated Bootcamp video - Glycogen: Glycogenesis Watch associated Bootcamp video - Glycogen: Glycogenolysis Watch associated Bootcamp video - Energy Production: Glycolysis: Key Enzymes and Aerobic vs. Anaerobic GlycolysisOther:2080a2a4-a4c2-420a-ae54-82f3a13c7594
Is a glucokinase gene mutation associated with maturity-onset diabetes of the young (MODY)? {{c1::Yes}}- Heterozygous mutations of this cause a decrease in β cell metabolism; mild, nonprogressive hyperglycemia that often worsens with pregnancy induced insulin resistance - Homozygous mutations lead to fetal growth retardation and severe hyperglycemia at birthWatch Diabetes Mellitus Pathogenesis & Acute Clinical ManifestationsReview Hexokinase vs. GlucokinaseWatch associated Bootcamp video - Glycolysis: Key Enzymes and Aerobic vs. Anaerobic GlycolysisOther:701d09f0-53bd-4e71-9652-6212cc3574b5
{{c1::Fructose-6-phosphate}} is converted to {{c2::fructose-2,6-bisphosphate}} via the enzyme {{c3::phosphofructokinase-2 (PFK-2)}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Regulation of GlycolysisReview GlycolysisWatch associated Bootcamp video -Carbohydrates: Gluconeogenesis: Pathway Watch associated Bootcamp video - Carbohydrates: Fructose Metabolism: Pathway Watch associated Bootcamp video - Energy Production: Glycolysis: Key Substrates Watch associated Bootcamp video - Energy Production: Regulation of Phosphofructokinase54680d09-7ebc-4a7c-9084-dc1b1d049013
Increased glucagon (fasting) leads to increased cAMP and protein kinase A, thus {{c1::increasing}} activity of fructose bisphosphatase-2 and {{c1::decreasing}} activity of phosphofructokinase-2Image licensed by Physeo and used with permission. Purchase full access here.Watch Regulation of GlycolysisReview GlycolysisWatch associated Bootcamp video - Energy Production: Regulation of PhosphofructokinaseOther:8b20269d-e66e-41e1-b5ce-114a3e6529e4
{{c1::Lactose}} is converted into {{c2::galactose}} and {{c2::glucose}} by the enzyme {{c1::lactase}} (intestinal brush border)Watch Lactase DeficiencyWatch associated Bootcamp video - Physiology : Intestinal Absorption Watch associated Bootcamp video - Intestinal Pathology : Lactose Intolerance Watch associated Bootcamp video - Carbohydrates: Galactose Metabolism : Pathway4d3a9ad2-0b3b-48ce-83da-546d7a13e9bd
What molecule overrides inhibition of the enzyme phosphofructokinase-1 by ATP in the liver? {{c1::Fructose-2,6-bisphosphate}}Allows for glycolysis to continue in the liver following a high carbohydrate meal Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycolysis pt1Review GlycolysisWatch associated Bootcamp video -Carbohydrates: Gluconeogenesis: Pathway Watch associated Bootcamp video - Carbohydrates: Fructose Metabolism: Pathway Watch associated Bootcamp video - Energy Production: Regulation of PhosphofructokinaseOther:295feda4-b06f-4ea7-8da5-da375dd38a18
{{c2::McArdle}} disease is caused by a deficiency of the enzyme {{c1::muscle glycogen phosphorylase (myophosphorylase)}}M for Muscle Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycogen Storage DiseasesReview McArdle Disease (Type V)Watch associated Bootcamp video - Glycogen: McArdle DiseaseAtlas:8606d47f-7679-41c2-beaf-84d81586642c
McArdle disease is associated with painful {{c1::muscle cramps}} that occur with {{c2::strenuous exercise}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Glycogen Storage DiseasesReview McArdle Disease (Type V)Watch associated Bootcamp video - Glycogen: McArdle DiseaseAtlas:855af9f2-645f-4a7a-aad8-dd899e0ed7d0
{{c3::Oxaloacetate}} may be converted to {{c1::phosphoenolpyruvate}} via the enzyme {{c2::PEP carboxykinase (PEPCK)}}Image licensed by Physeo and used with permission. Purchase full access here.Watch GluconeogenesisWatch associated Bootcamp video -Carbohydrates: Gluconeogenesis: PathwayOther:19623a3d-eb76-49f8-8fdc-a812de129e98
Fructose-1,6-bisphosphatase is regulated via negative feedback by {{c1::fructose-2,6-bisphosphate}} and {{c1::AMP}}Opposite of phosphofructokinase-1; thus there is decreased conversion of alanine and other gluconeogenic (e.g., glycerol) substances to glucose Image licensed by Physeo and used with permission. Purchase full access here.Watch Gluconeogenesis Watch Regulation of GlycolysisReview GlycolysisWatch associated Bootcamp video -Carbohydrates: Gluconeogenesis: Pathway Watch associated Bootcamp video - Energy Production: Regulation of PhosphofructokinaseOther:21c3973d-88ed-447e-8576-fd4386700f49
Ethanol may be converted to {{c1::acetaldehyde}} via the enzyme {{c2::alcohol dehydrogenase}}- occurs in the cytosol Watch Alcoholic & Non alcoholic Fatty Liver Disease Watch Alcohol MetabolismReview Ethanol MetabolismWatch associated Bootcamp video - One-Carbon Metabolism: Uses of One-Carbon Groups Watch associated Bootcamp video - Ethanol Metabolism: Pathway Watch associated Bootcamp video - Side Effects and Toxins: Environmental Toxins and their Treatments Watch associated Bootcamp video - Antifungals: Additional Antifungals Watch associated Bootcamp video - Antibiotics: Introduction to Cephalosporins12679d18-78ab-4420-8a31-c58919982135
Acetaldehyde may be converted to {{c1::acetate}} via the enzyme {{c2::acetaldehyde dehydrogenase}}Watch Alcoholic & Non alcoholic Fatty Liver Disease Watch Alcohol MetabolismReview Ethanol MetabolismWatch associated Bootcamp video - Oxidative Stress: Ethanol Metabolism: Pathway Watch associated Bootcamp video - Antifungals: Additional Antifungals Watch associated Bootcamp video - Antibiotics: Introduction to Cephalosporins5a26e2d8-1f06-458c-8025-20cd7beca775
Ethanol metabolism increases the ratio of {{c1::NADH}}:{{c1::NAD+}} in the liverWatch Alcohol MetabolismReview Ethanol MetabolismWatch associated Bootcamp video - Oxidative Stress: Ethanol Metabolism: Pathway Watch associated Bootcamp video - Heme Synthesis Regulation32869230-ea5b-4ea2-8510-a7bc407d1f70
Many {{c2::Asians::ethnicity}} are deficient of the ethanol metabolism enzyme {{c1::acetaldehyde dehydrogenase}}Watch associated Bootcamp video - Oxidative Stress: Ethanol Metabolism: Pathwayc3498edd-9535-40c1-add8-2624dbe26b22
Increased NADH/NAD+ (e.g., due to ethanol) causes increased conversion of {{c2::oxaloacetate}} → {{c2::malate}}, thus preventing {{c1::gluconeogenesis}}Watch Alcohol MetabolismFasting Hypoglycemia (low sugar)Increased NADH/NAD+ ratio favors oxaloacetate → malate, which inhibits gluconeogenesis. Review Ethanol MetabolismWatch associated Bootcamp video - Oxidative Stress: Ethanol Metabolism: Pathway Watch associated Bootcamp video -Carbohydrates: Malate-Aspartate Shuttleab183771-2f32-4463-b391-514cffef43dc
Protein C and protein S normally {{c2::inactivate}} factor {{c1::Va}} and factor {{c1::VIIIa}}Thus, deficiency in protein C and S lead to increased risk of venous thrombosisWatch Acquired & Inherited Thrombosis SyndromesReview Intrinsic Pathway of CoagulationWatch associated Bootcamp video - Mixing Studies, Ristocetin, and D-dimer Watch associated Bootcamp video - Coagulation and Fibrinolysis: Coagulation Cascade Watch associated Bootcamp video - Thrombophilias Watch associated Bootcamp video - Coagulation and Fibrinolysis: Fibrinolysis and Inhibitors of Hemostasis8ba42ebb-a57e-4ab1-8ae2-91440b51ce26
The maxillary sinus drains into the {{c1::middle}} meatusDrainage into the middle meatus: FAM Frontal sinus Anterior (and middle) ethmoidal sinus Maxillary sinusWatch Nasal Cavity & Paranasal Sinusesd0d12813-38d0-4879-a00a-8bdcbf95576d
{{c1::Obesity hypoventilation}} syndrome is a condition in which severely overweight people fail to breathe rapidly or deeply enough- Also known as Pickwickian syndrome - Characterized by increased awake CO2 with a normal A-a gradientWatch Restrictive Lung Disease (Overview)Watch Hypoxemia DDxWatch associated Bootcamp video - Sleep Apnea Watch associated Bootcamp video - Blood Physiology : A-a Gradienta40d58e0-92e4-41b6-bf67-9b46af7bc7f6
Obesity hypoventilation (Pickwickian) syndrome is characterized by {{c1::increased}} PaCO2 during waking hours- Often > 45 mmHg while awake; important distinguishing feature from obstructive sleep apnea (PaCO2 increased during sleep only) - Also present with low PaO2Watch Restrictive Lung Disease (Overview)Watch associated Bootcamp video - Sleep Apnea7f2be1e6-1fab-4d2e-b06d-6d6952b1212e
{{c2::Transudative}} pleural effusion may be caused by increased {{c1::hydrostatic}} pressure (e.g., heart failure)e.g., hypoalbuminemia, CHF Light's CriteriaTransudative pleural effusionExudative pleural effusionProtein (pleural / serum)≤ 0.5> 0.5LDH (pleural / serum)≤ 0.6> 0.6Common causes- Cirrhosis (low albumin) - Nephrotic syndrome (low albumin) - Congestive heart failure- Infection (TB, fungal, empyema, parapneumonic) - Malignancy - Pulmonary embolismWatch Acute Respiratory Distress Syndrome (ARDS)Watch Pleural Effusion Classification & Light's Criteria Watch Transudative Pleural Effusions DDxWatch associated Bootcamp video - Pleural Effusione.g. hypoalbuminemia, CHF6d712360-7ada-4fdb-b26b-38a311c638fd
Consolidation (lobar pneumonia, pulmonary edema) presents with {{c1::increased}} fremitusIncrease in lung tissue density / inflammation of tissue → increased tactile fremitusWatch associated Bootcamp video - Lung Pathology Fundamentals : Lung Physical Exam Watch associated Bootcamp video - Pleural Effusion Watch associated Bootcamp video - Lung Pathology Special Topics (Pulmonary Edema) Watch associated Bootcamp video - Cardiorespiratory Infections: Principles of Pneumonia1ed5a1fb-7183-4695-8c6f-d138a8e9c5fa
Type {{c1::II}} pneumocytes proliferate during lung damageWatch Acute Respiratory Distress Syndrome (ARDS)Watch associated Bootcamp video - Pulmonology System Function, Anatomy, and Histology Watch associated Bootcamp video - Pulmonary Fibrosis809b4cfc-0f6a-46a2-af1f-cf4d5a2c995a
Activation of the {{c1::H1}} histamine receptor may cause pain, pruritus, and vasodilationWatch AntihistaminesWatch associated Bootcamp video - Autonomic System : Other Involuntary Signaling Systems Watch associated Bootcamp video - Pharmacodynamics : Membrane Proteins Watch associated Bootcamp video - Pharmacodynamics : Receptor Physiology0693044e-cee1-44bd-b1d4-da86be6abb64
{{c1::Corticosteroids}} treat asthma by blocking {{c2::inflammation}} and {{c3::cellular infiltration}}Watch Asthma TherapyWatch associated Bootcamp video - Asthma Treatments64972a49-76d9-4143-b7b0-028e3be2489a
Leukotriene {{c1::B4}} and 5-HPETE are potent chemoattractants for numerous inflammatory cells (particularly neutrophils)Watch Asthma TherapyWatch associated Bootcamp video - Blood Cells: Neutrophila7719966-6afc-49c2-b7a5-f947d4261428
Leukotrienes {{c1::C4}}, {{c1::D4}}, and {{c1::E4}} increase airway vascular permeability, mucus production, and bronchoconstriction (bronchospasm)Especially C4 and D4Watch Asthma Therapy7a5ab614-eaa5-4ea9-a6b4-9ce4bd2ed438
Leukotriene D4 exerts its effects by binding to the {{c1::Cysteinyl leukotrienes 1 (CysLT1)}} receptorIt is a GPCRWatch Asthma Therapy5fd54b59-9bbe-4fcf-bf09-44be610c529e
What is the effect of COX inhibition (e.g., aspirin) on production of leukotrienes? {{c1::Increased}}Due to shunting of arachidonic acid pathway towards leukotriene productionWatch Asthma TherapyWatch associated Bootcamp video - Asthma Watch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways3370951e-53b2-4890-b11a-715c0c354e7e
Adverse effects of long-acting β2 agonists (e.g., salmeterol, formoterol) include {{c1::tremor}} and {{c2::arrhythmia}}Also tachycardiaFirst Aid Pharmacology: Respiratory (Asthma)Watch Asthma TherapyWatch Albuterol vs SalmeterolWatch associated Bootcamp video - Obstructive Lung Disease : Asthma Treatments665f1bf1-f272-488f-a8fc-ca87188db033
{{c4::Bosentan}} is a competitive {{c1::endothelin-1 receptor}} {{c2::antagonist}} used to treat {{c3::pulmonary hypertension}}First Aid Pharmacology: RespiratoryWatch Prostaglandins, Prostacyclin, Bosentan, PDE5 InhibitorsWatch Pulmonary HypertensionWatch Endothelin Receptor Antagonists (Bosentan)Watch associated Bootcamp video - Pulmonary HypertensionPulmonary hypertension (1/2) Chest x-ray (PA) Regular diaphragm; enlarged left auricle and atrium (LAA) leading to the loss of the cardiac silhouette; Dilation of the left pulmonary artery (P; shaded area represents the dilation); Extensively enlarged pulmonary arteries at the lung hilus (marked area); Vascular rarefaction in the peripheral lungs with sudden change in diameter between central and peripheral pulmonary arteries. Here, the possible cause of pulmonary hypertension is mitral valve disease. Pulmonary hypertension (2/2) Lateral chest x-ray: decreased retrosternal spay due to hypertrophy of the right ventricle as well as decreased retrocardiac space due to left atrial enlargement .22c0d1b4-3e38-42f0-b55a-481a022d94c0
Bosentan antagonizes endothelin-1 receptors, causing {{c1::decreased}} pulmonary vascular resistanceSpecifically endothelin AFirst Aid Pharmacology: RespiratoryWatch Prostaglandins, Prostacyclin, Bosentan, PDE5 InhibitorsWatch Pulmonary HypertensionWatch Endothelin Receptor Antagonists (Bosentan)Watch associated Bootcamp video - Pulmonary Hypertension461aa661-dd39-470a-9e78-e0af8be1da94
What is the mode of inheritance of cystic fibrosis? {{c1::Autosomal recessive}}Watch Autosomal Recessive DiseasesWatch Cystic Fibrosis SOA Watch Cystic Fibrosis Management Watch Prenatal Screening & DiagnosisReview Cystic Fibrosis OverviewWatch associated Bootcamp video - Cystic Fibrosis Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia Watch associated Bootcamp video - Basics of Clinical Genetics: Pedigrees and Modes of Inheritance3c857180-2083-4608-a326-dd09b2a688cd
ACE inhibitors and ARBs are contraindicated during {{c1::pregnancy}} due to possible {{c1::teratogenic}} effectse.g., fetal renal malformationsFA2020 UPDATE: ACE inhibitors dilate the efferent arteriole, not constrict as the image below states:Watch ACE Inhibitors, ARBs, AliskirenWatch associated Bootcamp video - RAAS Pharmacologic Targets Watch associated Bootcamp video - Renal Pharmacology : ACEi, ARBs, Direct Renin Inhibitors Watch associated Bootcamp video - Fetal Development : Teratogenic Medications18c73fc0-5c34-469c-be58-be0c001da405
NSAIDs decrease prostaglandins, which normally {{c1::dilate}} the {{c2::afferent}} arterioles of the kidneyThus NSAIDs lead to constriction of afferent arterioles and decreased GFRFA2020 UPDATE: ACE inhibitors dilate the efferent arteriole, not constrict as the image below states:Watch ACE Inhibitors, ARBs, Aliskirenbbb32b03-5987-4dda-85da-51a153fa416f
What effect may NSAIDs have on GFR? {{c1::Decreased GFR}}Prostaglandins dilate the afferent arteriole, and NSAIDs inhibit prostaglandin synthesisFA2020 UPDATE: ACE inhibitors dilate the efferent arteriole, not constrict as the image below states:Watch ACE Inhibitors, ARBs, AliskirenWatch Pre-Renal AKIb33ae7c1-7d30-4055-be92-623549bafce6
Gynecologic procedures, such as ligation of uterine or ovarian vessels, may damage the {{c1::ureter}}May cause ureteral obstruction or leakWatch Hydronephrosis & Urinary Tract ObstructionWatch associated Bootcamp video - Anatomy and Embryology : AnatomyAtlas:439f0f67-4f66-4807-ab5a-bcb281f91b5c
Which sex is associated with a greater % total body water? {{c1::Males (due to less adipose tissue)}}Watch associated Bootcamp video - Fluid and Filtration Physiology : Fluid Physiology74dc808b-a566-4b5b-9e5e-13be8c6145dd
{{c1::Renal clearance}} is the volume of {{c2::plasma}} completely cleared of a substance by the kidneys per unit timeWatch associated Bootcamp video - Fluid and Filtration Physiology : Clearance, Renal Plasma & Blood Flow Watch associated Bootcamp video - Pharmacokinetics : Drug Elimination533e4c00-56a8-402f-87b4-0bdc4620b72f
The kidneys receive approximately {{c1::25}}% of the cardiac outputHighest of all the organ systemsWatch associated Bootcamp video - Fluid and Filtration Physiology : Clearance, Renal Plasma & Blood Flow5fa85090-caad-4118-b792-24a6ed4f37c5
The dilatory effect of ANP on afferent arterioles is {{c1::greater}} than the constrictor effect on efferent arteriolesThus decreasing renal vascular resistance → increased RBF (or RPF)Watch associated Bootcamp video - Nephrology Natriuretic Peptidesc3c8e92f-0755-4e82-850f-0c8e486ddfa2
What effect does efferent arteriolar constriction have on GFR? {{c1::Increased}}Causes increased PGC; e.g., low levels of angiotensin II Constriction of efferent arteriole leads to: decreased RPF, increased PGC leads to increased GFR Effect Renal Plasma Flow Glomerular Filtration Rate Filtration Fraction Constriction of afferent arteriole Decrease Decrease No different Constriction of efferent arteriole Decrease Increase Increase Constriction of ureter No different Decrease Decrease Increased plasma protein concentration No different Decrease Decrease Decreased plasma protein concentration No different Increase Increase Dehydration Decrease Decrease IncreaseWatch associated Bootcamp video - Cardiology RAAS Regulation Watch associated Bootcamp video - Fluid and Filtration Physiology : Filtration Physiology Overview60cd5e9a-ffcf-4597-af0f-1563f39db2f1
What effect does efferent arteriolar constriction have on filtration fraction? {{c1::Increased FF}}However, because efferent arteriolar constriction also reduces renal blood flow, filtration fraction and glomerular colloid osmotic pressure increase as efferent arteriolar resistance increases. Therefore, if constriction of efferent arterioles is severe (more than about a threefold increase in efferent arteriolar resistance), the rise in colloid osmotic pressure exceeds the increase in glomerular capillary hydrostatic pressure caused by efferent arteriolar constriction. Effect Renal Plasma Flow Glomerular Filtration Rate Filtration Fraction Constriction of afferent arteriole Decrease Decrease No different Constriction of efferent arteriole Decrease Increase Increase Constriction of ureter No different Decrease Decrease Increased plasma protein concentration No different Decrease Decrease Decreased plasma protein concentration No different Increase Increase Dehydration Decrease Decrease IncreaseWatch associated Bootcamp video - Fluid and Filtration Physiology : Filtration Physiology Overview7d183552-e86f-4040-9c92-e97aff6a7fad
The amount of a specific substance filtered in Bowman's space per unit time is called the {{c1::filtered load}}Filtered load is mg/min; GFR is mL/min Photo Credit: Madhero88, CC BY 3.0, via Wikimedia Commons102ae2b7-afb9-4471-a34f-66f1cea203ac
Aldosterone leads to {{c1::increased}} epithelial Na+ channel (ENaC) activityImage licensed by Physeo and used with permission. Purchase full access here.Watch K+ Sparing DiureticsWatch associated Bootcamp video - Cardiology RAAS Regulation Watch associated Bootcamp video - Nephrology RAAS Effects2572b6f9-d0b3-42bf-bf03-ee7d7a30624f
Increased Na+ delivery to principal cells (e.g., thiazide and loop diuretics) causes {{c1::increased}} K+ secretionIncreased activity of Na+-K+ ATPase → increased intracellular K+ → increased driving force for secretion → hypokalemiaWatch associated Bootcamp video - Nephron Transporters : Collecting Duct Watch associated Bootcamp video - Electrolytes : Potassium Watch associated Bootcamp video - Renal Pharmacology: Loop Diuretics751743d1-246a-4b4a-a4e6-64632ce75de1
Thiazide and loop diuretics {{c1::increase}} flow rate through the late DCT and collecting duct, thus {{c2::decreasing}} luminal K+ concentrationDecreased luminal K+ concentration → increased driving force for secretion → hypokalemiaWatch Loop Diuretics Watch ThiazidesWatch associated Bootcamp video - Heart Failure : Pharmacologic Targets Watch associated Bootcamp video - Electrolytes : Potassium Watch associated Bootcamp video - Renal Pharmacology : Loop Diuretics Watch associated Bootcamp video - Renal Pharmacology : Thiazide Diuretics7173fb99-9940-4429-805e-2374fc6fd9ce
{{c2::Loop}} diuretics indirectly inhibit {{c1::Ca2+}} and {{c1::Mg2+}} reabsorption in the thick ascending limb (loop of Henle)e.g., furosemide; inhibition of the Na+-K+-2Cl- transporter → decreased lumen positive potential difference Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Loop Diuretics Watch Calcium DisordersWatch associated Bootcamp video - Electrolytes: Magnesium Watch associated Bootcamp video - Renal Pharmacology: Loop Diureticsc4247980-14b9-4579-9931-196a3e4e7abf
What effect do loop diuretics have on serum Ca2+ levels? {{c1::Decreased (hypocalcemia)}}- e.g., furosemide; may be useful in the treatment of hypercalcemia - Due to increased Ca2+ excretion (rare due to PTH response to feedback) Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Loop Diuretics Watch Calcium DisordersWatch associated Bootcamp video - Renal Pharmacology: Loop Diureticscc1afc2f-cdd8-4e6d-b449-e1037ce4ca91
{{c2::Thiazide}} diuretics stimulate {{c1::Ca2+}} reabsorption in the distal tubuleUseful in the treatment of idiopathic hypercalciuria Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Calcium Disorders Watch ThiazidesWatch associated Bootcamp video - Renal Pharmacology : Thiazide Diuretics6aeececa-bdfe-4474-bac9-203254ac9eb4
ADH {{c1::enhances}} urea recyclingPhoto credit: OpenStax College, CC BY 3.0, via Wikimedia Commons78c76e53-1cfc-4116-96b0-6da0e74daa4d
In the proximal tubule, [TF/P]osm {{c1::=}} 1Isosmotic reabsorption Image licensed by Physeo and used with permission. Purchase full access here.c53937ce-4ab0-4bae-a778-a511cef56626
Varenicline is a(n) {{c1::nicotinic}} receptor {{c3::partial agonist}} used for {{c2::smoking}} cessation- Reduces withdrawal and cravings and reduces the rewarding effects of nicotine - May cause sleep disturbances and depressed mood as adverse effectsWatch CholinomimeticsWatch VareniclineWatch associated Bootcamp video - Pharmacology : Varenicline- Fills the receptor and causes partial downstream release of doapmine (vs. nicotine full agonist) = ↓ reward pathway stimulation2904c872-9070-4b1d-ab28-55574a6eb6cb
The plasma anion gap represents unmeasured ions in serum and is equal to {{c1::[Na+] - ([HCO3-] + [Cl-])::formula}}- Na+, HCO3-, and Cl- are measured; non-measured anions must exist to maintain electroneutrality - Average ~ 11-12 mEq/L Photo Credit: Dr. Agnibho Mondal, CC BY-SA 4.0, via Wikimedia CommonsWatch Acid/Base Disorders Watch Metabolic AcidosisWatch associated Bootcamp video - Acid-Base Physiology : Acid-Base Physiology Overviewshould be calculated in all patients with metabolic acidosis to narrow the differential; normal is 6-1244801425-ada8-487a-bfaf-ce4c11b9152c
The primary disturbance in metabolic acidosis is a(n) {{c2::decrease}} in {{c1::HCO3-}}Watch Acid/Base Disorders Watch Basics of Acid-Base Disorders Watch Metabolic AcidosisWatch associated Bootcamp video - Acid-Base Physiology : Metabolic Acidosis9822ae81-1909-417e-9d51-de67830df8f8
Decreased arterial pH (metabolic acidosis) causes compensatory {{c1::hyper}}ventilation with consequent {{c1::decreased}} PCO2Watch Acid/Base Disorders Watch Metabolic AcidosisWatch associated Bootcamp video - Acid-Base Physiology : Metabolic Acidosisdb5b2b52-e24f-446b-ab69-995848ba9334
The arterial blood profile seen in compensated metabolic acidosis is: pH: {{c1::decreased}} [HCO3-]: {{c1::decreased}} PCO2: {{c1::decreased}}Watch Acid/Base Disorders Watch Metabolic AcidosisWatch associated Bootcamp video - Acid-Base Physiology : Metabolic Acidosisy12185c11-c5a8-4c69-9dbc-0a36c2e100c7
Respiratory compensation in response to metabolic acidosis or alkalosis is {{c1::immediate::delayed/immediate}}Watch Acid/Base Disorders Watch Metabolic Acidosis Watch Metabolic AlkalosisWatch associated Bootcamp video - Acid-Base Physiology : Metabolic Acidosisa110f9aa-216e-4642-958c-c4e8c4b17334
If metabolic alkalosis is accompanied by ECF volume {{c1::contraction}}, the reabsorption of HCO3- increases, worsening the metabolic alkalosisi.e. contraction alkalosis ECF volume contraction leads to activation of the RAAS, which stimulates the reabsorption of bicarbonate in the kidneys through the action of carbonic anhydrase. This helps maintain the acid-base balance of the body and compensate for the decrease in ECF volumeWatch Acid/Base Disorders Watch Metabolic AlkalosisWatch associated Bootcamp video - Metabolic Alkalosise485a91c-e3ba-46ac-b130-58572359d9b9
In Potter sequence, oligohydramnios leads to pulmonary {{c1::hypoplasia}}- Most common cause of death in infants with Potter sequence - Due to the lack of normal alveolar distention by aspirated amniotic fluidWatch Congenital & Cystic Kidney Disease Watch Polyhydramnios & OligohydramniosWatch Amniotic Fluid Disorders Watch PROM & PPROM Watch Posterior Urethral Valve & UPJ Obstruction SOAPsWatch associated Bootcamp video - Anatomy and Embryology : Developmental Anomalies Watch associated Bootcamp video - Introduction to the Respiratory System : Embryologic DefectsAtlas:0280fe3b-b917-4418-b40f-99f263857650
What is the cause of death in Potter sequence? {{c1::Pulmonary hypoplasia}}Watch Congenital & Cystic Kidney Disease Watch Polyhydramnios & OligohydramniosWatch Amniotic Fluid Disorders Watch PROM & PPROM Watch Posterior Urethral Valve & UPJ Obstruction SOAPsWatch associated Bootcamp video - Anatomy and Embryology : Developmental Anomalies Watch associated Bootcamp video - Introduction to the Respiratory System : Embryologic DefectsAtlas:e355e41c-30f7-40e7-9e56-9901040cc49f
Potter sequence may be caused by {{c1::bladder outlet obstruction}} (e.g., posterior urethral valves)- Posterior urethral valves are a membrane remnant in the posterior urethra (only occurs in males) - This causes high bladder pressure and vesicoureteral reflux - AKA obstructive uropathyWatch Congenital & Cystic Kidney Disease Watch Polyhydramnios & OligohydramniosWatch Amniotic Fluid DisordersWatch associated Bootcamp video - Anatomy and Embryology : Developmental Anomalies"- A posterior urethral valve is an obstructing membrane at the end of the bladder - It is the most common cause of bladder outlet obstruction in male newborns (can't pee out amniotic fluid → oligohydramnios → Potter sequence) - Potter sequence (oligohydramnios, limb/facial deformities, and pulmonary hypoplasia) due to lack of amniotic ""cushion"""2520421f-d176-4f09-b5f0-9ebe8b9b2ff1
Which form of polycystic kidney disease (PKD) is associated with hepatic cysts? {{c1::Both :)::Autosomal dominant or Autosomal recessive}}These cysts usually do not cause loss of liver function but may cause pain if they are large Photo credit: Sb2207, CC BY-SA 3.0, via Wikimedia CommonsWatch Congenital & Cystic Kidney DiseaseWatch Surgery Benign Hepatic Cysts Watch Internal Medicine Benign Hepatic CystsReview ADPKDWatch associated Bootcamp video - Autosomal Dominant Polycystic Kidney Disease Watch associated Bootcamp video - Autosomal Recessive Polycystic Kidney Diseaseacd31153-37ae-422f-a156-ec41db67afd8
The {{c2::autosomal dominant}} form of polycystic kidney disease typically presents in patients aged {{c1::30}} - {{c1::50}} years old"- Autosomal recessive polycystic kidney disease typically presents in infancy; may present sometimes in young adulthood - Renal cysts can usually be seen on imaging in someone's 20s or 30s - Note that ADPKD displays complete penetrance but variable expressivity - This card used to say ""4th or 5th decade,"" which roughly spans the ages of 30 - 50 years old (Jan 2025) Photo credit: Sb2207, CC BY-SA 3.0, via Wikimedia Commons Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)"Watch Congenital & Cystic Kidney DiseaseReview ADPKDWatch associated Bootcamp video - Autosomal Dominant Polycystic Kidney DiseaseAtlas:2d65988e-be87-411c-a388-b3d87b0f21da
Autosomal dominant and recessive PKD are associated with {{c1::hepatic}} cysts in addition to renal cysts (benign)Photo credit: Sb2207, CC BY-SA 3.0, via Wikimedia CommonsWatch Congenital & Cystic Kidney DiseaseWatch Benign Hepatic CystsReview ADPKDWatch associated Bootcamp video - Autosomal Dominant Polycystic Kidney Disease Watch associated Bootcamp video - Autosomal Recessive Polycystic Kidney DiseaseAtlas:054e0e47-dad6-4610-930a-0c96502ed736
Acute tubular necrosis is caused by {{c1::ischemic}} or {{c2::nephrotoxic}} injuryWatch Acute Tubular Necrosis (ATN)Watch Intra-Renal AKIWatch associated Bootcamp video - Acute Tubular Necrosis97019297-ff6d-4425-b677-7546b67d84bb
During the recovery phase of acute tubular necrosis, BUN and serum creatinine levels {{c1::decrease}}Watch Acute Tubular Necrosis (ATN)Watch associated Bootcamp video - Acute Tubular NecrosisAtlas: Step Up to Medicine:59d7af7f-265c-4a53-b557-15afba2e1a0e
"Causes of {{c1::renal papillary necrosis}} may be remembered with the mnemonic ""SAND"": {{c1::Sickle cell disease/trait::S}} {{c1::Acute pyelonephritis::A}} {{c1::NSAIDs::N}} {{c1::Diabetes mellitus::D}}"S: results in gross hematuria and proteinuria A: the edematous interstitium of the pyelonephritic kidney compresses the medullary vasculature, leading to ischemia N: e.g., long-term aspirin or phenacetin D: diabetesWatch Tubulointerstitial Nephritis Watch Sickle Cell Disease Watch NSAIDsWatch Intra-Renal AKIWatch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia Watch associated Bootcamp video - Renal Papillary Necrosis Watch associated Bootcamp video - Acute PyelonephritisAtlas:yba839301-79b8-4fca-a2f7-cf94f16283a1
Causes of renal papillary necrosis may be remembered with the mnemonic {{c1::SAND}}Sickle cell disease/trait Acute pyelonephritis NSAIDs Diabetes mellitus - S: Results in gross hematuria and proteinuria - A: The edematous interstitium of the pyelonephritic kidney compresses the medullary vasculature, leading to ischemia - N: e.g., long-term aspirin or phenacetin - D: DiabetesWatch Tubulointerstitial Nephritis Watch Sickle Cell Disease Watch NSAIDsWatch Intra-Renal AKIWatch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia Watch associated Bootcamp video - Renal Papillary Necrosis Watch associated Bootcamp video - Acute Pyelonephritis618a0198-2e77-4031-8cd2-369c0902b0a1
{{c3::Nephrotic}} syndrome is a group of glomerular disorders characterized by {{c2::protein}}uria {{c1::> 3.5}} g/dayWatch Nephrotic SyndromeWatch Nephrotic Syndrome SOAP Watch Pleural Effusion DDxWatch associated Bootcamp video - Urinalysis Basics Watch associated Bootcamp video - Glomerular Disease OverviewStep Up to Medicine:094f5f59-71b1-46c2-8e80-3284d1569b25
Nephrotic syndrome results in {{c1::hypogammaglobulinemia}}, which increases risk of {{c2::infection}}Patients should receive pneumococcal vaccine to reduce risk of recurrent pneumonia/sepsisWatch Nephrotic SyndromeWatch Nephrotic Syndrome SOAPWatch associated Bootcamp video - Glomerular Disease OverviewStep Up to Medicine:7b2d35a3-ea98-46db-92a0-4a0c892d48fc
The hyperfiltration in diabetic glomerulonephropathy can lead to eosinophilic nodular glomerulosclerosis, known as {{c1::Kimmelstiel-Wilson}} nodulesHyperfiltration leads to glomerular hypertrophy and scarring (glomerulosclerosis) Photo credit: Doc.mari, CC BY-SA 3.0, via Wikimedia Commons, modifications from AMBOSS under CC BY-SA 3.0 Photo credit: Wikipedia, Creative Commons CC0 LicenseWatch Nephrotic SyndromeWatch Chronic Diabetes Complications SOAP Watch Nephrotic Syndrome SOAPWatch associated Bootcamp video - Diabetic GlomerulonephropathyAtlas:a91f2110-a26c-4721-8269-611b44ee0fe9
What is the most common cause of glomerulonephritis in adults? {{c1::IgA nephropathy (Berger disease)}}Watch Nephritic SyndromeWatch Glomerulonephritis SOAPWatch associated Bootcamp video - IgA NephropathyAtlas:baa0ce8a-12dd-4f86-a6bb-c5d21f3a6a9a
IgA nephropathy typically presents during young adulthood with episodic gross or microscopic {{c1::hemat}}uria or {{c1::RBC}} casts​​​​​​​​​​​​​​- Due to the weak complement-fixing activity of IgA, serum complement levels are normal - May also present with mild proteinuria (< 5% of patients have nephrotic range proteinuria) Photo credit: Mohsenin V., CC BY 4.0, via Wikimedia Commons, modified by enhancing resolution via AI and croppingWatch Nephritic SyndromeWatch Glomerulonephritis SOAP Watch Approach to HematuriaWatch associated Bootcamp video - IgA NephropathyAtlas:2e969f56-e5d5-4f7e-aefa-d83040099580
IgA nephropathy typically follows a(n) {{c1::respiratory}} or {{c2::GI tract}} infection- IgA production is increased during mucosal infections - AKA Berger diseaseWatch Nephritic Syndrome Watch Small Vessel VasculitidesWatch Glomerulonephritis SOAPWatch associated Bootcamp video - IgA NephropathyAtlas:2e5c4c46-0dca-46b7-8506-e9e9071b1b25
IgA nephropathy is characterized by {{c1::mesangial::specific}} proliferation on light microscopyWatch Nephritic SyndromeWatch Glomerulonephritis SOAPWatch associated Bootcamp video - IgA NephropathyAtlas:65e898ec-dda1-4d40-a1c1-3072aaab858b
IgA nephropathy is characterized by {{c1::mesangial::location}} immune complex deposits on electron microscopyWatch Nephritic SyndromeWatch associated Bootcamp video - IgA NephropathyAtlas:58389614-e91e-4dd7-b282-4e0e11bec24b
Berger disease is characterized by Ig{{c1::A}}-based immune complex deposits in the {{c2::mesangium}} (seen with immunofluorescence)Photo credit: Emmanuelm at en.wikipedia, CC BY 3.0, via Wikimedia CommonsWatch Nephritic SyndromeWatch associated Bootcamp video - IgA NephropathyAtlas:caef0d6b-1de8-4f8e-8a7b-34362ac71fb1
IgA nephropathy (Berger disease) may slowly progress to {{c1::end-stage renal disease (ESRD)}}- Elevated serum creatinine - Hypertension (> 140/90 mmHg) - Persistent proteinuria (> 1 g/day)Watch Nephritic SyndromeWatch associated Bootcamp video - IgA NephropathyAtlas:bf0c249b-957e-4292-ab3f-17e25262a0e2
Which bacteria is associated with endocarditis, biliary tree infection, and UTI? {{c1::Enterococci (E. faecalis and E. faecium)}}e.g., cystitis, pyelonephritisWatch Enterococcus faecium & faecalisWatch Cystitis, Pyelonephritis & Prostatitis SOA Watch Endocarditis SOAP Watch Approach to DysuriaWatch associated Bootcamp video - Enterococcus and Bacillus: Enterococcus Watch associated Bootcamp video - Cardiorespiratory Infections: Typical Endocarditis Pathogense1c072db-568f-46d9-9a49-4102ebf835b2
Chronic pyelonephritis typically requires predisposition to infection, such as {{c1::vesicoureteral reflux}} (children) or {{c2::obstruction}}Photo credit: Tomograph, CC BY-SA 3.0, via Wikimedia CommonsWatch Hydronephrosis & Urinary Tract ObstructionWatch Vesicoureteral Reflux Watch Approach to DysuriaWatch associated Bootcamp video - Chronic PyelonephritisAtlas: UWorld:b71153b1-079d-4a30-8b96-fde737d65c06
Chronic pyelonephritis with scarring at the upper and lower poles is characteristic of {{c1::vesicoureteral reflux}}- The location of scarring at the upper and lower poles of the kidney in reflux nephropathy is because their compound papillae always remain open. This makes them susceptible to dilation and subsequent injury - Scarring does not happen much at the mid-kidney, as simple papillae are concentrated there, and they are not always open Photo credit: Tomograph, CC BY-SA 3.0, via Wikimedia CommonsWatch Hydronephrosis & Urinary Tract ObstructionWatch Vesicoureteral RefluxWatch associated Bootcamp video - Chronic PyelonephritisAtlas: Robbins: UWorld:a398dd76-fefb-47aa-8f69-0d22375ca009
An obstructed kidney stone may present with unilateral {{c1::flank}} tenderness that radiates to the {{c2::groin}}"- ""Loin to groin"" - Pain associated with kidney stones only arises when a stone obstructs any part of the ureter or the ureteropelvic/ureterovesical junction - The location of pain referral varies based on the stone's position, shifting closer to the groin and away from the flank as the stone travels from the kidney down the ureters Photo Credit: NIH, Public domain, via Wikimedia Commons"Watch Hydronephrosis & Urinary Tract ObstructionWatch Approach to Abdominal PainWatch associated Bootcamp video - Nephrolithiasis Overviewb3455c48-31ba-4b8e-824c-682194d52dda
{{c2::Calcium}} kidney stones may be treated with {{c1::thiazide}} diuretics- Ca2+-sparing diuretic - Treats both calcium oxalate and calcium phosphate stones Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here. Kidney stonesClinical presentationDiagnosisManagementFollow up- Flank pain - Radiates to groin - Hematuria- U/A (if negative, rules out Stone) - Non-Con CT (all) → Hydro - U/S abdomen(pregnant) → Hydro- Size - < 5mm = Fluids and Pain control - Between = Lithotripsy - > 3cm = Nephrostomy - Tamsulosin & CCB to facilitate passage- Strain the urine, bring the stone inWatch Thiazides Watch Calcium Oxalate Stones & Calcium Phosphate Stones Watch Calcium DisordersWatch Types of Kidney StonesWatch associated Bootcamp video - Calcium Stones Watch associated Bootcamp video - Renal Pharmacology : Thiazide Diuretics52584a31-2250-4c26-839a-811014f26656
The third most common type of kidney stone (5%) is a(n) {{c1::uric acid}} stoneCalcium (80%) > magnesium ammonium phosphate (struvite) (15%) > uric acid (5%)Watch Magnesium Ammonium Phosphate (MAP) Stones, Uric Acid Stones, & Cystine StonesWatch Types of Kidney StonesWatch associated Bootcamp video - Uric Acid Stoneseb613e34-7e1e-46ce-9237-3c0456424542
One clinical feature of renal failure is {{c1::uremia}}, which is a symptomatic clinical syndrome marked by increased nitrogenous waste products in the blood (azotemia)Essentially a more severe, symptomatic form of azotemiaWatch Chronic Kidney Disease (CKD)Watch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Kidney Injury Overview Watch associated Bootcamp video - Chronic Kidney Diseasefbcbe9d8-7657-467c-8737-364498892392
What acid-base disorder is a consequence of renal failure? {{c1::Metabolic acidosis}}Watch Chronic Kidney Disease (CKD) Watch Metabolic AcidosisWatch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Acid-Base Physiology : Metabolic Acidosis Watch associated Bootcamp video - Kidney Injury : Chronic Kidney Diseasec3c2577b-9aff-4066-ac5b-2ce9fd9450c8
One consequence of renal failure is {{c1::anemia}} due to decreased {{c2::erythropoietin}} productionWatch Chronic Kidney Disease (CKD) Watch ErythropoietinWatch Chronic Kidney Disease (CKD): Complications & Management Watch Normocytic Anemia DDxWatch associated Bootcamp video - Normocytic Anemia: Additional Normocytic Anemias Watch associated Bootcamp video - Chronic Kidney Disease Watch associated Bootcamp video - Blood Cells: Erythrocytef494b4c5-bc01-4c58-a062-b021513fb30e
What is the most common primary renal malignancy? {{c1::Renal cell carcinoma}}Photo credit: User:Emmanuelm, CC BY 3.0, via Wikimedia CommonsWatch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Inflammatory Conditions and Malignancy: Renal Cell CarcinomaAtlas:20edcdec-8bdb-42ce-972b-8b8dbf768d5f
Gross examination of a renal cell carcinoma reveals a(n) {{c1::golden-yellow::color}} massPhoto credit: User:Emmanuelm, CC BY 3.0, via Wikimedia CommonsWatch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Inflammatory Conditions and Malignancy: Renal Cell CarcinomaAtlas:2d5d6e4b-dfb6-4337-aadb-46466bf30d9b
{{c3::Beckwith-Wiedemann}} syndrome is associated with a(n) {{c1::WT2}} gene {{c2::mutation}}Relaxation of IGF2 imprinting on maternal alleleWatch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Inflammatory Conditions and Malignancy: Wilm's TumorAtlas:26e4acec-1583-4503-b6f4-c00ac6e0cbe1
Which urinary tract cancer is associated with naphthylamine? {{c1::Urothelial carcinoma}}Watch Bladder Cancer & Penile DisordersWatch associated Bootcamp video - Inflammatory Conditions and Malignancy: Urothelial CarcinomaAtlas:2f602802-1ef2-45ed-ad58-0a049f699a6f
If a patient is {{c2::supine}} during aspiration, an abscess may form in the {{c1::posterior}} segment of the right {{c3::upper}} lobe or the {{c1::superior}} segment of the right {{c3::lower}} lobe of the lungPULSe = Posterior Upper, Lower Superior - While supine, usually enters right lower lobe - While lying on right side, usually enters right upper lobe - While upright, usually enters right lower lobeWatch LungsWatch associated Bootcamp video - Introduction to Respiratory Infections89369c1e-3e9f-40e0-9c9e-2c64d3830725
Acetazolamide primarily prevents reabsorption of {{c1::HCO3-}}Loss of HCO3- in urine results in alkalinization of urineWatch Acetazolamide & Mannitol Watch Pulmonary Response to High AltitudeWatch associated Bootcamp video - Renal Pharmacology: Carbonic Anhydrase Inhibitors4e2072c9-2d62-40e4-80e9-e531151e98b6
In addition to HCO3-, acetazolamide also prevents the reabsorption of {{c1::Na+}} and H2Oi.e., natriuresisWatch Acetazolamide & MannitolWatch associated Bootcamp video - Renal Pharmacology: Carbonic Anhydrase Inhibitors336c141f-d803-470d-9a5e-5393d002ddba
What acid-base disorder may be treated with acetazolamide? {{c1::Metabolic alkalosis}}First Aid Pharmacology: Renal (Diuretics)Watch Acetazolamide & MannitolWatch associated Bootcamp video - Renal Pharmacology: Carbonic Anhydrase Inhibitors4baff986-5fba-43fa-b37c-faafee7bb238
Synthetic erythropoietin (e.g., epoetin) is often supplemented in chronic {{c1::kidney::organ}} diseaseWatch ErythropoietinWatch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Normocytic Anemia: Additional Normocytic Anemias Watch associated Bootcamp video - Chronic Kidney Disease Watch associated Bootcamp video - Blood Cells: Erythrocytebdaeaffa-3aaf-461b-be9e-214aa61e34fb
Loop diuretics may be used to treat the symptoms of pulmonary {{c1::edema}} in an acute heart failure exacerbationWatch Loop DiureticsWatch Chronic Heart Failure Management Part 2 Watch Hypertension ManagementWatch associated Bootcamp video - Renal Pharmacology: Loop Diuretics Watch associated Bootcamp video - Lung Pathology Special Topics (Pulmonary Edema)83fd7aad-386f-4ca6-b822-2a6f4562c68c
What acid-base disorder may be caused by loop diuretics? {{c1::Metabolic alkalosis}}e.g., contraction alkalosisWatch Loop DiureticsWatch Hypertension ManagementWatch associated Bootcamp video - Metabolic Alkalosis Watch associated Bootcamp video - Renal Pharmacology: Loop Diuretics0c28b57a-2469-49ab-bfcb-622b89010049
Thiazide diuretics may cause {{c1::hyper}}calcemia as an adverse effect"- Due to increased reabsorption- Mild (usually < 12 mg/dL) ""hyperGLUC: hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia"""Watch Thiazides Watch Calcium DisordersWatch Hypercalcemia: Workup & DDx Watch Hypertension ManagementWatch associated Bootcamp video - Renal Pharmacology : Thiazide Diuretics Watch associated Bootcamp video - Hypertension: Antihypertensives8c75b614-44d9-414e-9592-d587bc04be35
What effect may thiazide diuretics have on serum K+ levels? {{c1::Decreased (hypokalemia)}}Increased Na+ delivery to the collecting ducts → increased Na+ reabsorption, which is exchanged for K+ (potassium wasting)Watch ThiazidesWatch Hypokalemia: Clinical Presentation & DDx Watch Hypertension ManagementWatch associated Bootcamp video - Electrolytes : Potassium Watch associated Bootcamp video - Renal Pharmacology : Thiazide Diuretics5a9e5178-93f8-48a1-9ce5-b4abc6043397
{{c2::Spironolactone}}, a K+ sparing diuretic, may be used in the treatment of hepatic {{c1::ascites}}Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsFirst Aid Pharmacology: Renal (Diuretics)Watch K+ Sparing DiureticsWatch associated Bootcamp video - Renal Pharmacology: Potassium-Sparing Diureticsae2fe57a-d0cb-4373-a595-026d9506f496
What classes of diuretics are characterized by decreased blood pH (acidemia)? {{c1::Carbonic anhydrase inhibitors, K+ sparing diuretics::2}}- ↓ pH (acidemia) - Carbonic anhydrase inhibitors: ↓ HCO3- reabsorption - K+sparing: aldosterone blockade prevents K+ secretion and H+ secretion - Additionally, hyperkalemia leads to K+ entering all cells (via H+/K+ exchanger) in exchange for H+ exiting cellsFirst Aid Pharmacology: Renal (Diuretics)Watch K+ Sparing DiureticsWatch associated Bootcamp video - Renal Pharmacology: Carbonic Anhydrase Inhibitors Watch associated Bootcamp video - Renal Pharmacology: Potassium-Sparing Diuretics4ab28e28-dee0-4d33-9cdf-7810584bea10
Which lipid transport enzyme is responsible for the degradation of triglycerides stored in adipocytes? {{c1::Hormone-sensitive lipase}}Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Triglyceride Catabolism & Beta-Oxidation of Even-Chain Fatty AcidsWatch associated Bootcamp video - Lipid Metabolism : Introduction to Lipid Transport Proteins and Enzymes: Enzymes and Apolipoproteins Watch associated Bootcamp video - Lipid Metabolism : Adipocytes and Lipolysis51a66572-d39c-4471-b2ef-0c58b26bb452
Following binding of LDL to its LDL receptor, the ligand-receptor complex is endocytosed in {{c1::clathrin}}-coated pitsPhoto credit: Grant, B. D. and Sato, M, CC BY 2.5, via Wikimedia CommonsReview COP I & II and Clathrin9343e33e-b1ed-4f8c-8931-6a3bb610bcf3
The LDL-containing clathrin-coated pits fuse with {{c1::lysosomes}}, which break down cholesteryl esters into cholesterolVia the enzyme lysosomal esterase Photo Credit: Katzmann JL, Gouni-Berthold I and Laufs U (2020) PCSK9 Inhibition: Insights From Clinical Trials and Future Prospects. Front. Physiol. 11:595819. doi: 10.3389/fphys.2020.595819, CC BY 4.0Watch Lysosomes & PeroxisomesReview COP I & II and ClathrinWatch associated Bootcamp video - Lipid Metabolism : Lipid Transport: Lipoprotein Export from Liver82228ce8-e7df-48c1-a388-d140024d263e
Type {{c3::I}} lipoproteinemia is due to a(n) {{c1::LPL}} or {{c1::apo C-II}} deficiency- Chylomicrons use LPL (lipoprotein lipase) to release FFAs from their TAGs to adipocytes, generating chylomicron remnants - Apo C-II is used to activate LPLReview Familial HyperchylomicronemiaWatch associated Bootcamp video - Lipid Metabolism : Familial Dyslipidemias3898b195-de73-4f50-8328-92e2fd6d567f
Fatty acids, from triglyceride breakdown, are broken down into acetyl-CoA via the process of {{c1::β-oxidation}}Acetyl-CoA is then used for the Kreb's cycle or to produce ketone bodies Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Diabetic Ketoacidosis (DKA) & Hyperosmolar Hyperglycemic State (HHS) Watch Triglyceride Catabolism & Beta-Oxidation of Even-Chain Fatty AcidsReview Fatty Acid Breakdown (Carnitine Shuttle)Watch associated Bootcamp video - Cell Biology : Peroxisome Watch associated Bootcamp video - Energy Production : Introduction to Energy Production Watch associated Bootcamp video - Lipid Metabolism : Introduction to Energy Production Watch associated Bootcamp video - Lipid Metabolism : Introduction to Lipids Watch associated Bootcamp video - Lipid Metabolism : Adipocytes and Lipolysis Watch associated Bootcamp video - Lipid Metabolism : Fatty Acid Degradation: Carnitine Shuttle Watch associated Bootcamp video - Lipid Metabolism : Fatty Acid Degradation : β-Oxidationfb702d54-7dab-4da4-8b19-8390da7abf28
What is the rate-limiting enzyme of fatty acid β-oxidation? {{c1::Carnitine palmitoyl transferase-1 (CPT-1)}}Carnitine acyltransferase-1 Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Triglyceride Catabolism & Beta-Oxidation of Even-Chain Fatty AcidsWatch associated Bootcamp video - Lipid Metabolism : Fatty Acid Degradation: Carnitine Shuttle Watch associated Bootcamp video - Lipid Metabolism: Fatty Acid Degradation: β-Oxidation670bedc3-2d57-40b1-806d-e7cfe9414faf
Fatty acyl-carnitine is transported from the intermembrane space into the mitochondrial matrix via the {{c1::carnitine}} transporterPhoto Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Triglyceride Catabolism & Beta-Oxidation of Even-Chain Fatty AcidsReview Fatty Acid Breakdown (Carnitine Shuttle) Review Systemic Primary Carnitine DeficiencyWatch associated Bootcamp video - Lipid Metabolism : Fatty Acid Degradation: Carnitine Shuttle Watch associated Bootcamp video - Lipid Metabolism : Disorders of Fatty Acid Metabolism Watch associated Bootcamp video - Lipid Metabolism: Fatty Acid Degradation: β-Oxidation5f7c9926-d48c-4f4e-96f0-86ca0b821692
The acetyl-CoA generated through β-oxidation is used for {{c1::ketogenesis}} (liver) or the {{c2::TCA cycle}}Ketogenesis occurs when the TCA cycle cannot (e.g., excess acetyl-CoA or limited intermediates, such as oxaloacetate) Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Triglyceride Catabolism & Beta-Oxidation of Even-Chain Fatty AcidsReview Fatty Acid Breakdown (Carnitine Shuttle)Watch associated Bootcamp video - Energy Production : Introduction to Energy Production Watch associated Bootcamp video - Lipid Metabolism : Fatty Acid Degradation: Carnitine Shuttle Watch associated Bootcamp video - Lipid Metabolism : Fatty Acid Degradation: β-Oxidation4831740b-258a-41db-9958-1a789eb3d0bb
Medium chain acyl-CoA dehydrogenase (MCAD) and primary carnitine deficiency are characterized by {{c1::hypo}}ketotic, {{c1::hypo}}glycemia- Due to impaired β-oxidation (ATP is needed for gluconeogenesis; acetyl-CoA is needed for ketogenesis) - Occurs during periods of fasting (treatment is to avoid fasting)Review MCAD Deficiency Review Systemic Primary Carnitine DeficiencyWatch associated Bootcamp video - Lipid Metabolism : Disorders of Fatty Acid Metabolism5cc02f75-7056-486b-bc38-6ca0cd39935c
{{c1::Medium chain acyl-CoA dehydrogenase (MCAD)}} deficiency may cause {{c2::dicarboxylic}} acidemia/aciduria due to omega oxidation of fatty acidsReview MCAD DeficiencyWatch associated Bootcamp video - Lipid Metabolism : Disorders of Fatty Acid Metabolismd4f59337-d638-432f-b725-2468e9ad865e
Ketogenesis occurs in both prolonged starvation and ketoacidosis due to depletion of {{c1::oxaloacetate}}, thus preventing gluconeogenesisOxaloacetate cannot be combined with acetyl-CoA to form citrate, thus acetyl-CoA accumulatesWatch Ketone BodiesWatch associated Bootcamp video - Lipid Metabolism : Ketones: Ketone Synthesis Watch associated Bootcamp video - Lipid Metabolism : Ketones: Ketoacidosis Review and Ketogenolysis6c040e21-b62b-4391-8ca2-0db6b9c168de
{{c2::Hurler}} syndrome was formerly known as {{c1::gargoylism}} due to the physical appearance of those afflicted by this diseaseSkeletal abnormalities are known as dysostosis multiplex Photo credit: Sydney S. Gellis and Murray Feingold, Public domain, via Wikimedia Commons, modified by croppingWatch Biochemistry Mucopolysaccharidoses: Hurler & Hunter Syndromes Watch Pediatrics Mucopolysaccharidoses: Hurler & Hunter SyndromesReview Hurler and Hunter SyndromesWatch associated Bootcamp video - Lysosomal Storage Diseases: Mucopolysaccharidosesbef030b9-51cf-41d0-8b00-b03839a6eb92
Propionyl-CoA may be generated via the {{c1::VOMIT::acronym}} pathwayValine Odd-carbon fatty acids Methionine Isoleucine Threonine Image licensed by Physeo and used with permission. Purchase full access here.Review Propionic Acid Pathway Review Propionic AcidemiaWatch associated Bootcamp video - Carbohydrates: Gluconeogenesis: Starting Substrates Watch associated Bootcamp video - One-Carbon Metabolism: Homocysteine Metabolism Watch associated Bootcamp video - Cystinuria and Organic Acidemias: Organic Acidemias9d85d503-e5fa-4c79-ad22-6fa61cd21675
Propionyl-CoA is converted to {{c1::methylmalonyl-CoA}} via the enzyme {{c2::propionyl-CoA carboxylase}}Deficiency of propionyl-CoA carboxylase causes propionic acidemia Image licensed by Physeo and used with permission. Purchase full access here.Watch Beta Oxidation Odd Chain Fatty Acids (VOMIT Pathway) Watch Organic AcidemiasReview Propionic Acid Pathway Review Propionic AcidemiaWatch associated Bootcamp video - Carbohydrates: Gluconeogenesis: Starting Substrates Watch associated Bootcamp video - One-Carbon Metabolism: Homocysteine Metabolism Watch associated Bootcamp video - Cystinuria and Organic Acidemias: Organic Acidemias Watch associated Bootcamp video - Lipid Metabolism: Fatty Acid Degradation: β-Oxidation354cd5f7-850c-41e3-9e52-7521f400631d
If methylmalonyl-CoA mutase is dysfunctional, {{c1::methylmalonic acid}} accumulates in the blood and urinee.g., vitamin B12 deficiency, mutase defect, etc. Image licensed by Physeo and used with permission. Purchase full access here.Watch Organic AcidemiasWatch associated Bootcamp video - Macrocytic Anemia: Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Cystinuria and Organic Acidemias: Organic Acidemias Watch associated Bootcamp video - Vitamins: Vitamin B12 (Cobalamin)84293133-150f-422c-ba03-f9fd22d4269d
{{c4::Homocysteine}} may be converted to {{c1::methionine}} via the enzyme {{c2::methionine synthase}} (with {{c3::methyl-THF}} as a substrate & {{c3::vitamin B12}} as a cofactor)Methionine synthase AKA homocysteine methyl transferase Image licensed by Physeo and used with permission. Purchase full access here.Watch Homocystinuria Watch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyReview Vitamin B9 and B12 Deficiencies Review Homocysteine Metabolism Review Vitamin B12 (Cobalamin) BiochemistryWatch associated Bootcamp video - One-Carbon Metabolism: Activated Methyl Group Cycle: Pathway Watch associated Bootcamp video - Macrocytic Anemia: Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Vitamins: Vitamin B12 (Cobalamin) Watch associated Bootcamp video - Macrocytic Anemia: Folate (Vitamin B9) Deficiencydda7c8c9-020c-4060-94bf-6a9f93c6d78d
Aortic {{c1::dissection}} may present with markedly unequal blood pressure and asymmetrical pulse between limbsHypertension is the major risk factor; may present with equal BP and symmetric pulse Aortic dissection may advance along branch vessel(s) in any direction and lead to occlusion causing asymmetrical BP and pulse readings between limbs - Subclavian artery = left arm - Brachiocephalic artery = right arm - Femoral artery = left or right legWatch Aortic DissectionWatch Cardiac Chest Pain DDx Watch Surgery Aortic Dissection Watch Internal Medicine Aortic DissectionWatch associated Bootcamp video - Aortic Disease: Aortic DissectionAtlas:ceb5431a-50bc-44a1-9d05-b17534273b3b
What is the breakdown product of dopamine? {{c1::Homovanillic acid (HVA)}}Watch Catecholamine Synthesis DegradationReview Catecholamine Synthesis & BreakdownWatch associated Bootcamp video - Phenylalanine, Tyrosine, and Catecholamines9feb7fc7-0f5f-4e7b-a220-ee40fb465d23
Adenosine deaminase deficiency is one of the major causes of autosomal recessive {{c1::severe combined immunodeficiency (SCID)}}Watch Combined B & T Cell Disorders Watch Purine Salvage Deficiencies (Adenosine Deaminase Deficiency & Lesch-Nyhan Syndrome)Watch associated Bootcamp video - Immunodeficiency Syndromes: SCID Watch associated Bootcamp video - DNA Structure: Clinical Applications of the Purine Pathway79957295-41b9-4882-b740-815f24b6adc5
The enzyme {{c1::HGPRT}} is deficient in {{c2::Lesch-Nyhan}} syndrome- This prevents purines from being salvaged, with purines instead shunting into the uric acid pathway - HGPRT = Hypoxanthine-guanine phosphoribosyltransferase Image licensed by Physeo and used with permission. Purchase full access here.Watch Purine Salvage Deficiencies (Adenosine Deaminase Deficiency & Lesch-Nyhan Syndrome)Review Lesch-Nyhan Syndrome Review Purine SalvageWatch associated Bootcamp video - DNA Structure: Clinical Applications of the Purine Pathwaya7c4c4b4-ea42-4ba9-91cc-dc69caf75fec
"The symptoms of {{c1::Lesch-Nyhan}} syndrome may be remembered with the mnemonic ""HGPRT"": {{c1::Hyperuricemia::H}} {{c1::Gout::G}} {{c1::Pissed off (aggression, self-mutilation)::P}} {{c1::Red/orange sodium urate crystals (in diaper)::R}} {{c1::Tense muscles (dystonia)::T}}"- HGPRT is the enzyme that patients with Lesch-Nyhan are deficient in - Intellectual disability is also common with Lesch-Nyhan syndromeWatch Purine Salvage Deficiencies (Adenosine Deaminase Deficiency & Lesch-Nyhan Syndrome)Review Lesch-Nyhan SyndromeWatch associated Bootcamp video - DNA Structure: Clinical Applications of the Purine Pathwayyb523ad2e-7919-423f-be19-6c459abe7e47
The symptoms of Lesch-Nyhan syndrome may be remembered with the mnemonic {{c1::HGPRT}}Hyperuricemia Gout Pissed off (aggression, self-mutilation) Red/orange crystals Tense muscles (dystonia) HGPRT is the enzyme that patients with Lesch-Nyhan are deficient inWatch Purine Salvage Deficiencies (Adenosine Deaminase Deficiency & Lesch-Nyhan Syndrome)Review Lesch-Nyhan SyndromeWatch associated Bootcamp video - DNA Structure: Clinical Applications of the Purine Pathway7c0b2d8d-0a92-4085-bd01-46b3915b895b
How much energy (kcal) can be produced from 1g of fat? {{c1::9 kcal}}0.9 kg of fat contains approximately 7000 kcalWatch associated Bootcamp video - Energy Production : ATP Export and Phosphocreatine Watch associated Bootcamp video - Lipid Metabolism : Fed vs. Fasting State9cd2d84c-f2cd-4fb2-ab74-4f627e43fb68
What is the major source of energy while fasting between meals? {{c1::Hepatic glycogenolysis}}Minor sources include hepatic gluconeogenesis and adipose release of free fatty acidsWatch associated Bootcamp video - Energy Production : ATP Export and Phosphocreatine Watch associated Bootcamp video - Glycogen : Glycogenolysis Watch associated Bootcamp video - Lipid Metabolism : Fed vs. Fasting Statebedb74e5-fa5c-4cfd-a0b0-4b7a078a0dc4
Which vitamins are fat-soluble? {{c1::A, D, E, K::4}}Watch associated Bootcamp video - Physiology: Vitamins Watch associated Bootcamp video - Vitamins: Introduction to Vitaminsca972e26-f75c-4623-81f7-5fe964d994e4
Which vitamin may be contraindicated during pregnancy due to its teratogenic effects? {{c1::Vitamin A (isotretinoin)}}Watch Vitamin AReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Fetal Development : Teratogenic Medications Watch associated Bootcamp video - Vitamins : Vitamin A5270bff2-1694-479a-ab1a-26e03310691c
Teratogenic effects of excess vitamin A include {{c1::cardiac}} abnormalities and {{c2::cleft palate}}Also may have: - Fetal microcephaly - Early epiphyseal closure - Growth retardation - Spontaneous abortion Photo credit: CDC, Public domain, via Wikimedia CommonsWatch Early Pregnancy LossReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitamins: Vitamin Afa9c05e4-44d2-44f0-9e30-f59045f89be6
Vitamin A exerts its teratogenic effects by interfering with {{c1::homeobox}} genesGenes responsible for morphogenesis (e.g., limb positioning, proper development of skin)Review Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Vitamins : Vitamin A35f0ff4e-ff1a-466a-bc18-8638d06a3fa3
Vitamin B3 (niacin) is used to treat pellagra and {{c1::dyslipidemia}}- Lowers levels of VLDL - Raises levels of HDLWatch Fibrates & NiacinWatch Niacin Review Vitamin B3 (Niacin) BiochemistryWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology Watch associated Bootcamp video - Vitamins: Vitamin B3 (Niacin)262d55f1-3b20-4cef-997e-5fbf5017ace8
Vitamin B9 (folate) deficiency is characterized by {{c1::normal}} methylmalonic acid levelsImportant distinguishing feature from B12 deficiency (B12 helps convert methylmalonic acid to succinyl-CoA)Watch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyWatch Macrocytic Anemia DDxReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - One-Carbon Metabolism: Homocysteine Metabolism Watch associated Bootcamp video - Macrocytic Anemia: Folate (Vitamin B9) Deficiency Watch associated Bootcamp video - Vitamins: Vitamin B9 (Folate) Watch associated Bootcamp video - Physiology: VitaminsMMA levels in B12 deficiency are highf78ce716-7868-404c-8fa3-fd2d201122c9
Vitamin B9 (folate) deficiency is characterized by {{c1::increased}} homocysteine levelsWatch Megaloblastic Anemia Folate Deficiency & Vitamin B Deficiency Watch HomocystinuriaReview Vitamin B9 and B12 Deficiencies Review Homocysteine MetabolismWatch associated Bootcamp video - One-Carbon Metabolism: Homocysteine Metabolism Watch associated Bootcamp video - Physiology: Vitamins Watch associated Bootcamp video - Macrocytic Anemia: Folate (Vitamin B9) Deficiency Watch associated Bootcamp video - Vitamins: Vitamin B9 (Folate)f5b9a8a6-6289-4f69-899e-a773d4fc9887
Vitamin B12 (cobalamin) is a cofactor for {{c1::methionine synthase}} and {{c2::methylmalonyl-CoA mutase}}Transfers CH3 groups as methylcobalamin Photo credit: Lyon et al., CC BY 4.0, via MDPI Nutrients Image licensed by Physeo and used with permission. Purchase full access here.Watch Megaloblastic Anemia: Folate Deficiency & Vitamin B Deficiency Watch Beta-Oxidation of Odd-Chain Fatty Acids (VOMIT Pathway) Watch Vitamin B12 (Cobalamin) Watch HomocystinuriaReview Vitamin B9 and B12 Deficiencies Review Vitamin B12 (Cobalamin) Biochemistry Review Homocysteine MetabolismWatch associated Bootcamp video - One-Carbon Metabolism: Activated Methyl Group Cycle: Pathway Watch associated Bootcamp video - One-Carbon Metabolism: Homocysteine Metabolism Watch associated Bootcamp video - Macrocytic Anemia: Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Vitamins: Vitamin B9 (Folate)3d107813-7ce2-433f-8ee6-78af018348b1
Vitamin {{c2::C}} is necessary for {{c1::hydroxylation}} of proline and lysine in collagen synthesisVia prolyl & lysyl hydroxylases (vitamin C dependent) Image licensed by Physeo and used with permission. Purchase full access here.Watch Vitamin C Watch Collagen (Overview and Synthesis)Review Vitamin C (Ascorbic Acid) Biochemistry Review Collagen SynthesisWatch associated Bootcamp video - Vitamins: Vitamin C3b7a744d-4c0c-472e-825c-ff1a918c1f68
Vitamin C is found in {{c1::fruits}} and {{c1::vegetables}}Watch Vitamin CReview Vitamin C (Ascorbic Acid) BiochemistryWatch associated Bootcamp video - Physiology: Vitamins Watch associated Bootcamp video - Vitamins: Vitamin C494ddd4d-917a-479c-b89c-c45ceb4ace40
Scurvy (vitamin C deficiency) is associated with poor {{c1::wound}} healingWound healing requires proper collagen synthesisWatch Vitamin CWatch Nausea & Vomiting in PregnancyReview Vitamin C (Ascorbic Acid) Deficiency and ExcessWatch associated Bootcamp video - Physiology: Vitamins Watch associated Bootcamp video - Vitamins: Vitamin C8f796761-1d16-495b-b790-85448ac466f6
Vitamin D {{c2::increases}} intestinal absorption of {{c1::calcium}} and {{c1::phosphate}}- Decreased levels of these minerals stimulates calcitriol production - It increases absorption by binding to the vitamin D transcription factor and promoting transcription of new things Photo Credit: OpenStax College, CC BY 3.0 , via Wikimedia CommonsWatch Teriparatide, Vitamin D, Cinacalcet, SevelamerReview Vitamin D Deficiency and Excess Review Vitamin D BiochemistryWatch associated Bootcamp video - Parathyroids : Vitamin D Deficiency Watch associated Bootcamp video - Vitamins: Vitamin D: Synthetic Pathway Watch associated Bootcamp video -Parathyroid : Parathyroid Location and Functionacf06124-5578-402f-9b3f-3243ae40da4e
{{c1::Marasmus}} is a malnutrition disorder that results from a(n) {{c2::calorie}}-deficient dietNot enough protein eitherReview Kwashiorkor and Marasmusf56597ee-b74c-4291-90ad-5bd80b5c2d98
Subacute combined degeneration in vitamin B12 deficiency affects the {{c3::spinocerebellar tracts}}, {{c2::lateral corticospinal tracts}}, and {{c1::dorsal columns}}"- ""SCD"" = Spinocerebellar tracts, lateral Corticospinal tracts, Dorsal columns - Also seen in vitamin E and copper (Menkes) deficiencies"Watch Megaloblastic Anemia: Folate Deficiency & Vitamin B Deficiency Watch Vitamin B12 (Cobalamin)Review Vitamin E (Tocopherol/Tocotrienol) Review Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Macrocytic Anemia: Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Vitamins: Vitamin B12 (Cobalamin) Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junctionab6544dd-bbed-485b-b4d8-03c8d8f11499
Cystine is made of two {{c1::cysteine}} amino acids connected by a disulfide bondWatch Amino Acids (Overview)Watch associated Bootcamp video - Cystine Stones Watch associated Bootcamp video - Pharmacodynamics: Protein Structure and Functione9b0ac15-5bce-4651-9fa5-3ad33ed4727b
{{c3::Lead (Pb)}} poisoning leads to inhibition of the enzymes {{c1::δ-aminolevulinic acid dehydratase}} and {{c2::ferrochelatase}} (heme synthesis)"- ""FerrocheLeadase"" - δ-aminolevulinic acid dehydratase = ALAD = ""ALeaD"""Watch Heme SynthesisReview Heme SynthesisWatch associated Bootcamp video - Porphyrias : Heme Synthesis Watch associated Bootcamp video - Microcytic Anemia : Iron Homeostasis Watch associated Bootcamp video - Microcytic Anemia : Lead Toxicity6acbb5eb-3960-459a-ada0-4e509affaa55
The effects of cholinergic toxicity may be remembered with the mnemonic {{c1::DUMBBELSS}}Diarrhea Urination Miosis Bronchospasm Bradycardia/Bradypnea Emesis Lacrimation Salivation Sweating Often due to organophosphatesWatch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDx Watch Acute Dyspnea DDx: Non-Respiratory EtiologiesWatch Organophosphate Exposure Watch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning Watch associated Bootcamp video - Side Effects and Toxins : Pharmacological Toxicity and Treatment Watch associated Bootcamp video - Neuromuscular Junction (NMJ): Medications Targeting the NMJ1858b306-d470-45df-adad-3b76b2137bf7
"The effects of {{c1::cholinergic}} toxicity may be remembered with the mnemonic ""DUMBBELSS"": {{c1::Diarrhea::D}} {{c1::Urination::U}} {{c1::Miosis::M}} {{c1::Bronchospasm::B}} {{c1::Bradycardia/Bradypnea::B}} {{c1::Emesis::E}} {{c1::Lacrimation::L}} {{c1::Salivation::S}} {{c1::Sweating::S}}"- Often due to organophosphates - These are all muscarinic effects that can be reversed by atropine - Nicotinic effects include neuromuscular blockade and require pralidoxime for reversalWatch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDx Watch Acute Dyspnea DDx: Non-Respiratory EtiologiesWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning Watch associated Bootcamp video - Side Effects and Toxins : Pharmacological Toxicity and Treatment Watch associated Bootcamp video - Neuromuscular Junction (NMJ): Medications Targeting the NMJy131a8cc2-ca95-4fcd-9202-95545bf4a912
What effect do antimuscarinics have on heart rate? {{c1::Increased HR}}- Via blockage of parasympathetic activity of M2 receptors - May be useful for treatment of bradycardiaWatch Muscarinic AntagonistsWatch Bradycardia Workup & ManagementWatch associated Bootcamp video - Autonomic System : Muscarinic Antagonists74cb6e1a-6c01-4ccc-bc32-01b908b8140d
What effect do antimuscarinics have on AV conduction velocity? {{c1::Increased conduction velocity}}Via blockage of parasympathetic activity of M2 receptors; may be useful for treatment of AV blockWatch Muscarinic AntagonistsWatch associated Bootcamp video - Autonomic System : Muscarinic Antagonistsec63833b-9b27-4825-b339-623e24c662a5
Activation of {{c2::β}} adrenergic receptors causes {{c1::increased}} levels of intracellular cAMPThus, increases intracellular Ca2+ as well; both β1 and β2 exert similar effectsWatch Sympathomimetics Watch Adrenergic Receptors (Adrenoreceptors)Watch associated Bootcamp video - Autonomic Secondary Messengers Watch associated Bootcamp video - Pharmacodynamics: Receptor Physiology Watch associated Bootcamp video - Pharmacodynamics: Membrane Proteinsbbb64c9a-5b47-4db1-8e6f-f1517c242dcf
Phenylephrine may be used to treat nasal {{c1::congestion}}α1-mediated vasoconstriction decreases edema *Oral phenylephrine is not effective for nasal decongestion at the recommended dosages (FDA 2023)Watch SympathomimeticsReview Phenylephrine Watch Phenylephrine and PseudoephedrineWatch associated Bootcamp video - Autonomic System : Direct Sympathomimetics04992e6a-1e5c-4f16-adcb-3a523041123f
At {{c2::low}} doses, epinephrine primarily activates {{c1::β}} adrenergic receptorsWatch SympathomimeticsReview EpinephrineWatch associated Bootcamp video - Autonomic System : Endogenous Adrenergic Agonists Watch associated Bootcamp video - Autonomic System : Physiological Effects of Sympathomimeticscc48f486-6d00-4cb4-8bc8-0273142d00d8
At {{c2::high}} doses, epinephrine primarily activates {{c1::α}} adrenergic receptorsWatch SympathomimeticsReview EpinephrineWatch associated Bootcamp video - Autonomic System : Endogenous Adrenergic Agonists Watch associated Bootcamp video - Autonomic System : Physiological Effects of Sympathomimetics1534e6d1-cfcb-4f1a-b57f-1ab8ef2a60ca
Epinephrine causes {{c1::increased}} mean arterial pressureVia α1-mediated vasoconstrictionWatch SympathomimeticsReview EpinephrineWatch associated Bootcamp video - Autonomic System : Endogenous Adrenergic Agonists Watch associated Bootcamp video - Autonomic System : Physiological Effects of Sympathomimetics4da07308-8247-4925-8070-594b720b03ac
Epinephrine causes {{c1::increased}} systolic pressureVia α1-mediated vasoconstrictionWatch SympathomimeticsReview EpinephrineWatch associated Bootcamp video - Autonomic System : Endogenous Adrenergic Agonists Watch associated Bootcamp video - Autonomic System : Physiological Effects of Sympathomimetics7aced850-4a75-4531-b7ac-7ea5cad8b7b9
Low-dose epinephrine causes {{c1::decreased}} diastolic pressure- Via β2-mediated vasodilation - At high-doses, α1 activation will predominateWatch SympathomimeticsReview EpinephrineWatch associated Bootcamp video - Autonomic System : Endogenous Adrenergic Agonists Watch associated Bootcamp video - Autonomic System : Physiological Effects of Sympathomimeticsa0d5b47b-cf41-4fac-af6a-07cf4cf8a2bb
Epinephrine causes {{c1::increased}} pulse pressureVia β1-mediated increases in contractilityWatch SympathomimeticsReview EpinephrineWatch associated Bootcamp video - Autonomic System : Endogenous Adrenergic Agonists Watch associated Bootcamp video - Autonomic System : Physiological Effects of Sympathomimetics9bd59427-5443-46f8-8bf7-3c2be7a1ef0a
Cocaine exerts its effects via inhibition of the {{c1::NET}} and {{c1::DAT}} transporters (reuptake inhibitor)Watch Indirect SympathomimeticsWatch associated Bootcamp video - Substance Misuse : Benzodiazepines Watch associated Bootcamp video - Autonomic System : Indirect Sympathomimetics Watch associated Bootcamp video - Substance Misuse: Cocaineecef8504-297c-4cbe-af60-dffcaca5000c
Atomoxetine is a(n) {{c2::selective norepinephrine reuptake}} inhibitor used to treat {{c1::ADHD}}- AKA NRI, NET inhibitor - Non-stimulant alternative for ADHD (does not act on nucleus accumbens) - Prevents reuptake by blocking norepinephrine transporterWatch Indirect SympathomimeticsWatch associated Bootcamp video - Developmental Disorders : ADHDe923dd6c-35a3-4f9a-b8d2-0a4a44eb531e
Amphetamines exert their effects by {{c1::displacing}} catecholamines (NE, dopamine) into the synapseAmphetamines enter the presynaptic terminal via NET → utilize VMAT to enter neurosecretory vesicles → displace catecholamines from the vesiclesWatch Indirect SympathomimeticsWatch Amphetamine, Dexamphetamine, Lisdexamfetamine, MethylphenidateWatch associated Bootcamp video - Substance Misuse : Benzodiazepines Watch associated Bootcamp video - Autonomic System : Indirect Sympathomimetics Watch associated Bootcamp video - Substance Misuse : Amphetamines9573e1d9-1069-459a-ad60-d4a6dbd929d9
"What drug class do prazosin, terazosin, doxazosin, and tamsulosin belong to? {{c1::Selective α1 antagonists (""-osin"")}}"Watch Alpha DrugsWatch Hypertension ManagementReview -osin DrugsWatch associated Bootcamp video - Pharmacology : Tamsulosin, Minoxidil, Tocolytics Watch associated Bootcamp video - Urinary Incontinence : Micturition Overview Watch associated Bootcamp video - Autonomic System : Alpha Adrenergic Antagonists02b1057f-5428-4a96-90c2-072c54aaff1b
What hookworms are associated with iron deficiency anemia? {{c1::Ancylostoma duodenale and Necator americanus::2}}Photo credit: Ed Uthman, CC BY 2.0, via Flickr, modified by cropping; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)Watch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and Trichinella Watch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Microcytic Anemia: Iron Deficiency Anemia Watch associated Bootcamp video -Nematodes: HookwormOther:2404799c-5f6d-4114-945f-c2ae21bfeb00
Anemia of chronic disease is characterized by {{c1::increased}} ferritinImportant distinguishing feature from iron deficiency anemiaWatch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch Anemia Intro: Microcytic Anemia DDxWatch associated Bootcamp video - Microcytic Anemia: Anemia of Chronic DiseaseOther:261ca518-86b4-4dab-8686-d2375e72e92d
Anemia of chronic disease is characterized by {{c1::decreased}} TIBC- Important distinguishing feature from iron deficiency anemia - TIBC always changes in the opposite direction of ferritinWatch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Microcytic Anemia: Anemia of Chronic DiseaseOther:5138ddf7-69d0-44fd-bf91-a058ffa334ff
Anemia of chronic disease is characterized by {{c1::decreased}} serum iron* inflammation leads to inhibition of iron release from ferritin Watch Iron Deficiency Anemia & Anemia of Chronic DiseaseWatch associated Bootcamp video - Microcytic Anemia: Anemia of Chronic DiseaseOther:f7950084-6766-4db5-8ea0-34c62cca750a
{{c2::α}}-thalassemia is usually due to gene {{c1::deletions}}- aLpha = deLetion - beTA = muTAtions As compared to β-thalassemia which is due to gene mutationWatch Microcytic Anemia: Overview & ThalassemiasWatch Prenatal Screening & DiagnosisWatch associated Bootcamp video - Microcytic Anemia: ⍺-ThalassemiaAtlas: Other:8dc80248-7548-4e32-874d-a3bea3a0a20e
How does α-thalassemia with one gene deleted present? {{c1::Asymptomatic}}- α-thalassemia minima - They are silent carriers as they have no anemiaWatch Microcytic Anemia: Overview & ThalassemiasWatch Prenatal Screening & DiagnosisWatch associated Bootcamp video - Microcytic Anemia: ⍺-ThalassemiaAtlas: Other:66f36619-ad7d-4c1a-9a29-fc4b226918b4
α-thalassemia due to a two gene deletion presents with mild {{c1::anemia}} with a(n) {{c2::increased}} RBC count- β-thalassemia minor may also cause an increased RBC count - Also known as α-thalassemia minor OR α-thalassemia traitWatch Microcytic Anemia: Overview & ThalassemiasWatch Prenatal Screening & DiagnosisWatch associated Bootcamp video - Microcytic Anemia: ⍺-ThalassemiaAtlas: Other:8f3550e9-1517-4269-be07-5f392416774e
Impaired division and enlargement of RBC precursors leads to {{c1::megaloblastic}}, macrocytic anemia- Usually due to folate or vitamin B12 deficiency - Mild thrombocytopenia and leukopenia are possible findings, due to increased apoptosisWatch Megaloblastic Anemia Folate Deficiency & Vitamin B DeficiencyWatch Macrocytic Anemia DDxReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Macrocytic Anemia: Folate (Vitamin B9) DeficiencyAtlas: Other:0b7159b4-1091-4d2b-bbfd-c3a2af18a7da
Vitamin B12 deficiency is characterized by {{c1::increased}} methylmalonic acid levelsImportant distinguishing feature from folate deficiency Image licensed by Physeo and used with permission. Purchase full access here.Watch Megaloblastic Anemia: Folate Deficiency & Vitamin B Deficiency Watch Organic Acidemias Watch Vitamin B12 (Cobalamin)Watch Macrocytic Anemia DDxReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Macrocytic Anemia: Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Cystinuria and Organic Acidemias: Organic Acidemias Watch associated Bootcamp video - Vitamins: Vitamin B12 (Cobalamin) Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junction Watch associated Bootcamp video - Physiology: VitaminsOther: elevated methylmalonic acid level is more sensitive in detecting B12 deficiency than serum vitamin levels alone8192df46-0b0d-47e8-9e2d-5d0959484782
Vitamin {{c3::B12}} deficiency may result in poor {{c1::proprioception}} and {{c2::vibratory}} sense due to damage to the dorsal (posterior) column of the spinal cordUnlike vitamin E deficiency, B12 deficiency does not cause muscle weaknessWatch Megaloblastic Anemia: Folate Deficiency & Vitamin B Deficiency Watch Vitamin B12 (Cobalamin)Watch Chronic Diabetes Complications SOAPReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Macrocytic Anemia: Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Vitamins: Vitamin B12 (Cobalamin) Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular JunctionOther:0c6f1cef-2896-49fb-b67f-47a4b0fbc434
A normal reticulocyte count is between {{c1::1}} to {{c1::2}}%RBC lifespan is 120 days; each day ~ 1-2% of RBCs are removed from circulation and replaced by reticulocytesWatch Normocytic Anemia DDxWatch associated Bootcamp video - Hemolysis Watch associated Bootcamp video - Embryology: Embryology OverviewOther:f2ce7d91-bdf8-4694-903d-960ce84a1954
Hereditary spherocytosis most commonly involves defects in {{c1::ankyrin}}, {{c2::spectrin}}, {{c3::band 3}}, or protein 4.2These include: - Ankyrin (mediates the attachment of spectrin to actin) - Spectrin (forms hexagonal scaffold to maintain the plasma membrane) - Band 3 (HCO3-/Cl- antiporter) Photo Credit: Gensurg22, CC BY-SA 4.0, via Wikimedia CommonsWatch Extravascular Hemolysis Overview & RBC Membrane DefectsReview Hereditary SpherocytosisWatch associated Bootcamp video - Normocytic Anemia: Hereditary SpherocytosisAtlas: Other:bdd9ec54-0d07-42b3-ab2d-9c458b836ba6
The high prevalence of the sickle cell allele in Africans is likely due to its protective role against {{c1::Plasmodium falciparum}} malariaThis process is known as heterozygote advantageWatch Sickle Cell DiseaseWatch Plasmodium: Infection & LifecycleWatch associated Bootcamp video - Normocytic Anemia: Sickle Cell Anemia Watch associated Bootcamp video - Systemic Protozoa: Plasmodium Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell AnemiaOther:f2dd2b7d-2362-4f1c-b8db-160611eff0a8
What cancer is associated with IgG-mediated immune hemolytic anemia? {{c1::Chronic lymphocytic leukemia (CLL)}}- Classically associated with warm AIHA per UWorld - May also be seen with IgM-mediated IHAWatch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell Leukemia Watch G6PD Deficiency & Autoimmune Hemolytic Anemia (AIHA)Watch Extravascular Hemolytic Anemia: Intro & Extrinsic DDxReview Chronic Lymphocytic Leukemia (CLL)Watch associated Bootcamp video - Normocytic Anemia: Autoimmune Hemolytic Anemia Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Lymphocytic Leukemia7aa8d180-64dd-4110-a7f8-9970c37e0ca6
What cancer may be associated with IgM-mediated immune hemolytic anemia? {{c1::Chronic lymphocytic leukemia (CLL)}}More commonly associated with IgG-mediated AIHA* more commonly associated with IgG-mediated IHA * mainly seen with IgM-mediated IHA Watch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell Leukemia Watch G6PD Deficiency & Autoimmune Hemolytic Anemia (AIHA)Review Chronic Lymphocytic Leukemia (CLL)Watch associated Bootcamp video - Normocytic Anemia: Autoimmune Hemolytic Anemia Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Lymphocytic LeukemiaOther:249639d6-3493-4bbc-8d32-b44048f8e6ed
{{c3::Macroangiopathic hemolytic}} anemia may be seen with prosthetic {{c1::heart valves}} and aortic {{c2::stenosis}}- Due to mechanical destruction of RBCs (waring blender syndrome); RBCs are exposed to excessive shear and turbulence while passing the valve, resulting in mechanical damage - LVAD devices can also cause thisWatch Aortic Stenosis & Regurgitation Watch Quantitative Platelet DisordersWatch Intravascular Hemolytic Anemia: Intro & MAHA DDxWatch associated Bootcamp video - Normocytic Anemia: Additional Normocytic AnemiasOther:409afbd7-7c87-4638-890b-c1aa40b2fbfc
{{c1::Malaria}} is due to infection of RBCs and the liver with {{c2::Plasmodium}} spp.Malarial organisms may be seen within RBCs Photo Credit: The original uploader was TimVickers at English Wikipedia., Public domain, via Wikimedia CommonsWatch Plasmodium: Infection & LifecycleWatch associated Bootcamp video - Normocytic Anemia: Additional Normocytic Anemias Watch associated Bootcamp video - Systemic Protozoa: Plasmodium Watch associated Bootcamp video - Antiparasitics: Malarial Pharmacology and ChloroquineAtlas: Other:7f328f94-abed-4baf-ac74-d58325412ce7
The levels of thyroid-binding globulin (TBG) and total thyroid hormone are {{c1::increased}} with {{c2::pregnancy}} and {{c3::oral contraceptive}} use- Due to decreased TBG breakdown by the liver (secondary to increased estrogen, which modifies TBG molecules and thus slows clearance from plasma) - Increased TBG is detected via decreased resin uptake (T3 resin uptake test) - This results in increased total T3/T4; free T4 is initially mildly elevated but then decreasesWatch Maternal PhysiologyWatch associated Bootcamp video - Thyroid : T3, T4 Synthesis and Pharmacology- ↑ TBG = ↑ Total T4 - Free T3/T4 and TSH remains normal (the HPP axis is normal, so the thyroid has less negative feedback due to less free T3/T4 and produces more T3/T4)760e8d97-9c2d-4be1-a688-01923ebc5afa
What skin finding is associated with thrombocytopenia and/or decreased platelet function? {{c1::Petechiae}}Watch Quantitative Platelet DisordersWatch Bleeding Disorders: Coagulation Factor Disorders DDxae014008-bdbb-43d9-896e-ed62a36aeda9
What is the most common type of leukocyte (54 - 62%)? {{c1::Neutrophils}}Photo credit: Dr Graham Beards, CC BY-SA 3.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 3.0Watch Cells of the Immune SystemReview Neutrophils-OverviewWatch associated Bootcamp video - Blood Cells: Neutrophil71f04517-274b-4fdc-b25f-6f8b8f00f7cf
Neutrophils are increased in response to {{c1::bacterial}} infectionsPhoto credit: Dr Graham Beards, CC BY-SA 3.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 3.0Watch NeutrophilsReview Neutrophils-OverviewWatch associated Bootcamp video - Blood Cells: Neutrophil3efae2fc-c71a-4120-b613-b2a9f8236838
Macrophages {{c1::phagocytose}} bacteria, cellular debris, and RBCsWatch Cells of the Immune System Watch MacrophagesReview Monocytes / MacrophagesWatch associated Bootcamp video - Blood Cells: Monocyte and Macrophage Watch associated Bootcamp video - Acute Inflammatory Response Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology)11f6a144-d11c-4551-9896-130977aca508
The {{c3::forebrain/prosencephalon}} (primary vesicle) matures into the {{c1::telencephalon}} and {{c2::diencephalon}} (secondary vesicles)Tell Dad Me Met My (wife) Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Origins of Nervous Tissuef0001a8b-2a9f-47b4-ac20-e559fb933348
What is the adult derivative of the wall of the telencephalon? {{c1::Cerebral hemispheres}}Also basal ganglia Structure Wall Cavity Telencephalon Cerebral hemispheres Lateral ventricles Diencephalon Thalamus and hypothalamus 3rd ventricle Mesencephalon Midbrain Cerebral aqueduct Metencephalon Cerebellum and pons Upper part of 4th ventricle Myelencephalon Medulla Lower part of 4th ventricle Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Origins of Nervous Tissuedd1a2d7e-31fd-4e2e-9a40-9528266628d5
What is the adult derivative of the cavity of the telencephalon? {{c1::Lateral ventricles}}Structure Wall Cavity Telencephalon Cerebral hemispheres Lateral ventricles Diencephalon Thalamus and hypothalamus 3rd ventricle Mesencephalon Midbrain Cerebral aqueduct Metencephalon Cerebellum and pons Upper part of 4th ventricle Myelencephalon Medulla Lower part of 4th ventricle Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Origins of Nervous Tissuea835bb59-8b6e-49ca-94a1-c9d1fe10c3f1
What are the adult derivatives of the wall of the diencephalon? {{c1::Thalamus}} and {{c1::hypothalamus}} Bonus (2)?**Also the optic cup/nerves (retina) and epithalamus Structure Wall Cavity Telencephalon Cerebral hemispheres Lateral ventricles Diencephalon Thalamus and hypothalamus 3rd ventricle Mesencephalon Midbrain Cerebral aqueduct Metencephalon Cerebellum and pons Upper part of 4th ventricle Myelencephalon Medulla Lower part of 4th ventricle Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Neurology, Origins of Nervous Tissue Watch associated Bootcamp video - Hypothalamus5590c919-62ae-4eba-8ac1-62f304fc847a
What are the adult derivatives of the wall of the metencephalon? {{c1::Pons}} and {{c1::cerebellum}}Structure Wall Cavity Telencephalon Cerebral hemispheres Lateral ventricles Diencephalon Thalamus and hypothalamus 3rd ventricle Mesencephalon Midbrain Cerebral aqueduct Metencephalon Cerebellum and pons Upper part of 4th ventricle Myelencephalon Medulla Lower part of 4th ventricle Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Origins of Nervous Tissue918c5b78-410e-4b48-a943-6092b9deb98c
What is the adult derivative of the cavity of the metencephalon? {{c1::Upper part of 4th ventricle}}Remember, the metencephalon → pons + cerebellum Structure Wall Cavity Telencephalon Cerebral hemispheres Lateral ventricles Diencephalon Thalamus and hypothalamus 3rd ventricle Mesencephalon Midbrain Cerebral aqueduct Metencephalon Cerebellum and pons Upper part of 4th ventricle Myelencephalon Medulla Lower part of 4th ventricle Photo credit: Christian R. Linder, CC BY-SA 3.0, via Wikipedia Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Origins of Nervous Tissuea1307aa3-39c0-47a4-80d6-b56400b7b592
{{c1::Microglia}} fuse to form multinucleated giant cells in the CNS when infected by {{c2::HIV}}- Initially, HIV-infected monocytes cross BBB and become perivascular macrophages that release HIV-derived proteins / inflammatory cytokines - Microglia form nodules around these macrophages and fuse to form giant cells and nodules - Chronic HIV encephalitis is due to nodules of these multinucleated microgliaWatch Alzheimer Disease & DementiaWatch associated Bootcamp video - Positive-sense RNA Viruses : Primary HIV Disease Watch associated Bootcamp video - Cellular Function : Cell Types Watch associated Bootcamp video - Dementia : Additional Causes of Dementiab13184f5-ec07-4aba-97a2-2672f9cd6b9a
Axons that are myelinated by {{c1::oligodendrocytes}} do not have the potential to regenerate following injuryOligodendrocytes do NOT have a robust system of removing axonal (myelin debris): - BBB results in slow recruitment of phagocytic macrophages / microglia - Myelin-producing oligodendrocytes become inactive or undergo apoptosis and do not assist with phagocytosis - These inactive oligodendrocytes produce myelin-associated inhibitory factors and myelin debris is not removed Astrocytes also proliferate to form a glial scar, blocking axonal growth and releasing myelin inhibitory factors Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Wallerian Degeneration Watch associated Bootcamp video - Cell Typesf419062b-b112-4451-96a4-615a92523fd0
Most (80-90%) of the corticospinal tract fibers decussate just below the {{c2::caudal medulla}} at the {{c1::pyramidal}} decussationThe decussation happens at the caudal medulla-spinal cord junction Photo credit: OpenStax, CC BY 4.0 Image licensed by Physeo and used with permission. Purchase full access hereWatch Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis (ALS) & Friedreich AtaxiaReview Corticospinal TractWatch associated Bootcamp video - Descending Tractsbc334b82-dd8e-43d8-af99-a9d26f3eed05
The {{c2::2nd}}-order neuron of the dorsal column - medial lemniscus tract decussates in the {{c1::caudal medulla}}Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscusaf213254-c3bb-45a6-9067-d62648671217
The {{c2::2nd}}-order neuron of the dorsal column - medial lemniscus tract ascends {{c1::contra}}laterally in the medial lemniscus (brainstem and above)Photo Credit: Anatomy & Physiology, via Oregon State UniversityReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus8983e265-f2ab-4b90-8b15-c73118eff618
Lesions of the dorsal column - medial lemniscus tract in the spinal cord present on the {{c1::ipsi}}lateral side below the lesion- Loss of position, vibratory, and pressure sensations, and 2-point discrimination - May also lose ability to identify the characteristics of an object using the sense of touch (astereognosis)Watch Spinal Cord Syndromes DDxReview Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscus0e2f36d9-be80-4f36-8d5b-40a9db0627bb
Lesions of the dorsal column - medial lemniscus tract in the thalamus and cerebral cortex present on the {{c1::contra}}lateral side below the lesion- Loss of position, vibratory, and pressure sensations, and 2-point discrimination - May also lose ability to identify the characteristics of an object using the sense of touch (astereognosis)Review Dorsal Column (Medial Lemniscus)Watch associated Bootcamp video - Dorsal Column - Medial Lemniscusc0aedfb4-fe8b-487f-a299-3a9e838eb1de
The {{c1::cuneo}}cerebellar tract carries unconscious proprioceptive input from the upper extremities/trunkWatch associated Bootcamp video - Spinocerebellar Tract1fcf2540-33eb-45ea-bba9-c7e60e57776e
{{c2::Subacute combined degeneration}} is a spinal cord lesion most commonly seen with vitamin {{c1::B12}} deficiency- Causes ataxic gait, paresthesia, impaired position / vibration sense - Copper deficiency (e.g., Menkes) presents similarly Vitamin E deficiencyVitamin B12 deficiencyAnemiaHemolyticMegaloblasticMuscle weakness+-Methylmalonic aciduria-+Hypersegmented neutrophils-+Spinocerebellar involvement++Dorsal column involvement++Lateral corticospinal tract involvement-+Watch Megaloblastic Anemia: Folate Deficiency & Vitamin B Deficiency Watch Vitamin B12 (Cobalamin)Watch Macrocytic Anemia DDx Watch Spinal Cord Syndromes DDxReview Vitamin B9 and B12 DeficienciesWatch associated Bootcamp video - Macrocytic Anemia: Cobalamin (Vitamin B12) Deficiency Watch associated Bootcamp video - Vitamins: Vitamin B12 (Cobalamin) Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junction Watch associated Bootcamp video - Physiology: VitaminsAtlas: Other:d37821ce-e26d-42fe-8b03-7f4a023adfc1
{{c1::Holoprosencephaly}} is due to failure of the forebrain to divide into 2 cerebral hemispheresExample of malformation Photo credit: Pallangyo et al., CC BY 4.0, via Journal of Medical Case Reports, modified by removing arrowsWatch Neural Tube Defects, Holoprosencephaly, Chiari Malformation & SyringomyeliaAtlas:69a0951a-e3f8-449a-8cb3-347500196162
What treatments are used to boost granulocyte production and thus decrease risk of infection in neutropenic patients? {{c1::GM-CSF or G-CSF::2}}Severe infections typically occur when < 500 cells/mm3Watch associated Bootcamp video - Blood Cells: Neutrophil8dd79bba-b699-4603-b0cb-6f1781e04538
EBV infection results in lymphocytosis comprised of reactive CD{{c1::8}}+ T cellsPhoto credit: Ed Uthman, CC BY 2.0, via Flickr, No machine-readable author provided. NicolasGrandjean assumed (based on copyright claims)., CC BY-SA 3.0, via Wikimedia Commons, איתן פרמן, CC BY-SA 3.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 3.0Watch Epstein-Barr Virus (Herpesviridae)Watch Infectious MononucleosisWatch Epstein-Barr Virus (Herpesviridae)Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Clinical ManifestationsAtlas:e515a667-f683-488b-828d-fc9e69ad912a
Epstein-Barr virus (EBV) remains dormant in {{c1::B}} cells, which increases risk for {{c2::lymphoma}}, especially if immunodeficiency develops (e.g., HIV)EBV infects B cellsWatch Epstein-Barr Virus (Herpesviridae)Watch Primary Brain Tumors in Adults Watch Infectious MononucleosisWatch Epstein-Barr Virus (Herpesviridae)Watch associated Bootcamp video - Adult Primary Brain Tumors : Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Positive-sense RNA Viruses : Secondary HIV-Associated Diseases Watch associated Bootcamp video - DNA Viruses: Herpesvirus Family Overview Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Clinical ManifestationsAtlas:1e2ec4aa-ee65-4ce2-b565-917079e61a6b
AML is a neoplastic accumulation of {{c1::myeloblasts}} (>20%) in the bone marrow- i.e., acute myelogenous leukemia - Can be seen on peripheral blood smearWatch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML) Watch Myeloproliferative Neoplasms & Myelodysplastic SyndromesWatch Acute Leukemias SOAPReview Acute Myelogenous Leukemia (AML)Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Myeloid LeukemiaOther:0406b168-d828-486d-be37-77f712372a60
Myeloblasts may have crystal aggregates of {{c2::myeloperoxidase (MPO)}}, which are seen on blood smear as {{c1::Auer rods}}"Described as ""azurophilic, needle-shaped cytoplasmic inclusions"" Photo credit: Ed Uthman, CC BY 2.0, via Flickr; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC) Photo Credit: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: None Mikael Häggström, M.D., CC0, via Wikimedia Commons"Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Watch Acute Leukemias SOAPReview Acute Promyelocytic Leukemia (APL)Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Myeloid LeukemiaOther:7b07e0ce-e978-4abe-95ce-dfbaefa65f9e
One subtype of AML is {{c1::acute promyelocytic leukemia (APL)}}, which is characterized by t({{c2::15}};{{c2::17}})- Formerly known as M3 AML - Translocation creates a PML/RARalpha fusion protein (an abnormal retinoic acid receptor; stops myeloid differentiation at the promyelocytic phase)Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Watch Acute Leukemias SOAPReview Acute Promyelocytic Leukemia (APL)Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Myeloid Leukemia Watch associated Bootcamp video - Vitamins: Vitamin Afff6c91d-a902-42c9-8ebb-e8a5830f77f7
Risk factors for acute myeloid leukemia include prior exposure to {{c1::alkylating}} chemotherapy and {{c2::ionizing radiation}}Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Watch Acute Leukemias SOAPReview Acute Myelogenous Leukemia (AML)Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Myeloid LeukemiaOther:0a0854c2-7398-4f59-a5da-ab399368fb88
ID Cranial Nerve: {{c1::Abducens (CN VI)}}Photo credit: Modified, Image licensed by Physeo and used with permission. Purchase full access here. This nerve exits the brainstem from the pontomedullary junction medial to the facial nerve Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Midbrain, Pons, and Medulla8788c3d0-1618-43ca-81df-6a5a58819d14
The lateral rectus muscle is responsible for eye {{c1::abduction}}Photo credit: OpenStax, CC BY 4.0Watch Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens)Watch associated Bootcamp video - Cranial Nerves 1-6: Cranial Nerve VI47a3f0d8-2ffa-4ed1-80f7-d5c462f53e9b
One complication of chronic lymphocytic leukemia is {{c1::autoimmune hemolytic (AIHA)::specific}} anemiaMore commonly associated with IgG-mediated AIHA, but can also be IgM-mediated AIHA* uworld says warm, not cold Watch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell Leukemia Watch G6PD Deficiency & Autoimmune Hemolytic Anemia (AIHA)Review Chronic Lymphocytic Leukemia (CLL)Watch associated Bootcamp video - Normocytic Anemia: Autoimmune Hemolytic Anemia Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Lymphocytic Leukemiadue to non-neoplastic cells secreting auto-Ab Other:3aca5dfb-678b-4655-93a2-46e5d62300e8
Lesions to LMNs of CN {{c2::VII (facial)}} may result in {{c1::hyperacusis::auditory complication}}Increased sensitivity to loud soundsWatch Cranial Nerve VII (Facial): Clinical CorrelatesReview Facial Nerve (CN VII)Watch associated Bootcamp video - Cranial Nerves 7-12: Cranial Nerve VII Watch associated Bootcamp video - Motor Neuron Lesions5bf53e61-7a80-4e6a-917c-f31818f5773b
ID Tract: {{c1::Lateral corticospinal tract}}Photo credit: Modified, Polarlys and Mikael Häggström, CC BY-SA 3.0, via Wikimedia Commons Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Descending Tracts Watch associated Bootcamp video - Spinal Cord Syndromes: Review of Sensory and Motor Tracts07e2556f-7cfa-471d-902c-4a271abfd289
The directional term of internuclear ophthalmoplegia (e.g., right or left) refers to which eye is {{c1::paralyzed}}e.g., right INO = right eye impaired adduction Left INO shown below Photo credit: Thebault et al., CC BY 4.0, via Cureus, modified by converting into GIFWatch associated Bootcamp video - Demyelinating Disease: Multiple Sclerosis4132f683-d833-4f1a-baaa-74aae5450a78
What artery supplies the lateral medulla? {{c1::Posterior inferior cerebellar artery (PICA)}}Photo credit: OpenStax, CC BY 4.0Review Posterior Inferior Cerebellar Artery (PICA)Watch associated Bootcamp video - Midbrain, Pons, and Medulla Watch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Medullary and Pontine Syndromesb27270a6-9425-4890-8774-333c865ea331
Lesions in the brainstem that affect the {{c1::medial longitudinal fasciculus (MLF)}} result in {{c2::ipsi}}lateral internuclear ophthalmoplegiaRules of 4 Left INO shown below Photo credit: Thebault et al., CC BY 4.0, via Cureus, modified by converting into GIFWatch associated Bootcamp video - Rule of 4s Watch associated Bootcamp video - Demyelinating Disease: Multiple Sclerosisc88c452e-27dd-406c-bed3-e3e6d0d6293f
The {{c1::raphe nucleus}} of the reticular formation is responsible for synthesis of {{c2::serotonin}}- Plays a role in mood, aggression, and the induction of non-rapid eye movement (non-REM) sleep - Located in the pons Photo credit: Marshall Strother, Patrick J. Lynch, medical illustrator, CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Neurotransmitter Activity in Psychiatric Disease: Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA804f5252-4277-42fe-85ba-7894125ce68e
Which movement disorder presents as sudden, wild flailing of 1 arm ± the leg on the same side? {{c1::Hemiballismus}}Disruption in the indirect basal ganglia overstimulates the direct basal ganglia, producing excess muscle movement; contralateral lesionWatch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Lacunar Infarction9baa67fb-d0ce-4015-9807-1e4126e38ab2
Hemiballismus results from a lesion to the {{c2::contra}}lateral {{c1::subthalamic}} nucleus (e.g., lacunar stroke)i.e., right subthalamic nucleus lesion causes hemiballismus of left sideWatch associated Bootcamp video - Disorders of the Basal Ganglia Watch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Lacunar Infarction07fb6074-1f24-432a-9c07-aebd3ed019bc
ID Structure: {{c1::Thalamus}}Photo credit: Modified, Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Basal Ganglia: Anatomical Considerations31c21d37-a43e-43fe-8082-14bacd4b6e40
"ID letter ""E"": {{c1::Thalamus}}"MRI, axial (horizontal) section through diencephalon, basal ganglia, and the cortex A) Head of caudate B) Internal capsule, genu C) Putamen D) Internal capsule, posterior limb E) ThalamusWatch associated Bootcamp video - Basal Ganglia: Anatomical Considerationsf627e128-029e-4f83-b598-aaa3c377e43d
{{c1::Marcus Gunn}} pupil is also referred to as relative afferent pupillary defect (RAPD)Swinging flashlight test: - Both pupils constrict when light is shone into normal eye - When light is rapidly transferred to affected eye, both pupils dilate - Do not confuse with Argyll Robertson pupil: Pupils accommodate but do not react to direct or indirect light RAPD in right eye: Video credit: Jonathan Trobe, CC BY 3.0, via U-M Kellogg Eye Center in Ann Arbor, modified by converting into GIFWatch Multiple SclerosisWatch Multiple Sclerosis: Clinical PresentationWatch associated Bootcamp video - Demyelinating Disease: Multiple Sclerosis Watch associated Bootcamp video - Cranial Nerves 1-6: Cranial Nerve IIc80281be-8740-4cf5-8520-a5d654dbb052
Chronic myelogenous leukemia (CML) is distinguished from a leukemoid reaction (benign neutrophilia) by a(n) {{c2::negative}} {{c1::leukocyte alkaline phosphatase (LAP)}} stain- Granulocytes in leukemoid reaction are LAP positive - *LAP is in secondary granules of granulocytes (neoplastic cells don't bother to make these)Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Watch Chronic Leukemias SOAPReview Chronic Myelogenous Leukemia (CML)Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Myeloid LeukemiaOther: helps distinguish CML from leukemoid reaction (high LAP)05636a1d-ab49-42ca-bbed-a055a3848ace
{{c1::Essential thrombocythemia (ET)}} is a neoplastic proliferation of mature myeloid cells, especially {{c2::platelets}}- RBCs and granulocytes may also be increased - Associated with JAK2 kinase mutation - While myelofibrosis is characterized by proliferation of megakaryocytes Photo credit: Ed Uthman, CC BY 2.0, via Flickr Normocellular marrow with marked proliferation of large to giant megakaryocytes: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Myeloproliferative Neoplasms & Myelodysplastic SyndromesWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Polycythemia Vera and Essential ThrombocythemiaStep 2: Other:14dc56de-8767-4422-be24-1e45ae303f99
Symptoms of essential thrombocythemia are related to an increased risk of {{c1::bleeding}} and/or {{c2::thrombosis}}Depends on whether platelets are functional or non-functional; erythromelalgia may also occurWatch Myeloproliferative Neoplasms & Myelodysplastic SyndromesWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Polycythemia Vera and Essential ThrombocythemiaOther:94122ab1-d193-4e5a-b4cf-72efc630d5e9
{{c1::Follicular}} lymphoma is a neoplastic proliferation of small B cells (CD20+) that form follicle-like nodulesPhoto credit: User:Patho, CC BY-SA 3.0, via Wikimedia Commons Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Non Hodgkin LymphomaReview Follicular LymphomaWatch associated Bootcamp video - Leukemias and Lymphomas: Follicular LymphomaOther:a12115ca-7032-4abb-809f-eb9dcf21887a
What form of non-Hodgkin lymphoma is seen in the image below? {{c1::Follicular lymphoma}}Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons Photo credit: User:Patho, CC BY-SA 3.0, via Wikimedia Commons Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Non Hodgkin LymphomaReview Follicular LymphomaWatch associated Bootcamp video - Leukemias and Lymphomas: Follicular LymphomaOther:baedfce1-5038-4be0-9555-ada86dfe1a18
The Ig heavy chain genes on chromosome 14 are {{c1::constitutively}} expressedThus when other genes are translocated next to this heavy chain region, they are overexpressedWatch Non Hodgkin LymphomaWatch associated Bootcamp video - Follicular Lymphoma Watch associated Bootcamp video - Leukemias and Lymphomas: Burkitt LymphomaOther:dd3b08a0-b5c3-4c21-849c-eafcf5ac7973
The t({{c3::14}};{{c3::18}}) translocation results in overexpression of {{c1::BCL-2}}, resulting in inhibition of {{c2::apoptosis}}BCL-2 gene is constitutively active (follicular lymphoma) Photo credit: User:Patho, CC BY-SA 3.0, via Wikimedia Commons Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Non Hodgkin LymphomaWatch Non-Hodgkin Lymphoma SOAPReview Follicular LymphomaWatch associated Bootcamp video - Leukemias and Lymphomas: Follicular Lymphoma Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Apoptotic PathwaysOther:2a8d87d0-739a-4f1f-864b-f416fc24af92
Follicular lymphoma is distinguished from reactive follicular hyperplasia by {{c1::disruption}} of normal lymph node architectureFollicles take over the entire lymph node; lymph node architecture is maintained in follicular hyperplasia LymphomaReactive LADSimilar size + shape folliclesVarying size + shape folliclesRelative absence of macrophagesTingible body (debris-laden) macrophagesPositive BCL2 StainingNegative BCL2 Staining Follicular Lymphoma (left) vs Reactive Follicular Hyperplasia (right): Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons; Smith, Benjamin; Carroll, Matthew B., CC BY 3.0, via Wikimedia CommonsWatch Non Hodgkin LymphomaReview Follicular LymphomaWatch associated Bootcamp video - Leukemias and Lymphomas: Follicular Lymphoma Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor GenesOther:b7928303-8bb0-4949-a67f-3dae8a1e5284
The {{c2::African (endemic)}} form of Burkitt lymphoma typically involves the {{c1::jaw}}Photo credit: Mike Blyth, CC BY-SA 2.5, via Wikimedia Commons, modified by censoring Photo credit: See page for author, Public domain, via Wikimedia Commons, modified by censoringWatch Non Hodgkin Lymphoma Watch Epstein-Barr Virus (Herpesviridae)Watch Non-Hodgkin Lymphoma SOAP Watch Infectious MononucleosisReview Burkitt LymphomaWatch associated Bootcamp video - Leukemias and Lymphomas: Burkitt Lymphoma Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt LymphomaOther:2e824180-141c-4177-993c-d38d70fdb244
"{{c2::Burkitt}} lymphoma is characterized by a high {{c3::mitotic index}} and ""{{c1::starry-sky}}"" appearance on microscopy""Starry-sky appearance due to: - Sheets of lymphocytes (blue sky) - Interspersion of ""tingible body"" macrophages (filled with many phagocytized, apoptotic cells in various states of degradation) [""white stars"" seen in the center] - High mitotic index is represented by high Ki-67 fraction Photo credit: National Cancer Institute (NCI), Louis M. Staudt, Public domain, via Wikimedia Commons"Watch Non Hodgkin LymphomaWatch Non-Hodgkin Lymphoma SOAPReview Burkitt LymphomaWatch associated Bootcamp video - Leukemias and Lymphomas: Burkitt Lymphoma Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphoma Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Diagnostics and ManagementOther:98aec8fa-0672-4c86-8596-1813ad3361cc
Primary CNS lymphoma is most commonly seen in patients with {{c1::AIDS::disease}}Considered an AIDS-defining illness and is the most frequent CNS tumor in immunosuppressed patientsWatch Adult CNS TumorsWatch Primary Brain Tumors in AdultsReview Primary CNS Lymphoma (PCNSL)Watch associated Bootcamp video - Leukemias and Lymphomas: Additional B-cell Non-Hodgkin Lymphomas Watch associated Bootcamp video - Adult Primary Brain Tumors : Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal Meningitis Watch associated Bootcamp video - Positive-sense RNA Viruses : Secondary HIV-Associated DiseasesAtlas: Other:59991779-e776-4a33-9b01-59892894236a
{{c1::Primary CNS}} lymphoma typically presents in adults with confusion, memory loss, and seizures (variable presentation)Usually diffuse large B-cell typeWatch Non Hodgkin LymphomaWatch Primary Brain Tumors in Adults Watch Non-Hodgkin Lymphoma SOAPWatch associated Bootcamp video - Leukemias and Lymphomas: Additional B-cell Non-Hodgkin Lymphomas Watch associated Bootcamp video - Adult Primary Brain Tumors: Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal Meningitis Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Diagnostics and ManagementAtlas: Other:4c4dad8a-e4d7-4035-8cbe-3e7216728ae5
{{c1::Primary CNS}} lymphoma typically presents as a single, solid brain lesion on MRIMay be ring-enhancing in immunocompromised patient vs. multiple ring enhancing lesions in toxoplasmosis Primary CNS Lymphoma, MRI: Photo credit: I, Tdvorak, CC BY-SA 3.0, via Wikimedia CommonsWatch Adult CNS TumorsWatch Primary Brain Tumors in Adults Watch Non-Hodgkin Lymphoma SOAPWatch associated Bootcamp video - Leukemias and Lymphomas: Additional B-cell Non-Hodgkin Lymphomas Watch associated Bootcamp video - Adult Primary Brain Tumors: Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal Meningitis Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral Lesions Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Diagnostics and ManagementAtlas: Other:79550e94-a1c5-48a0-8e49-955f9a53c6e4
Primary CNS lymphoma must be distinguished from {{c1::toxoplasmosis}} infection via CSF analysis or other lab testsSingle, solid lesion (lymphoma) vs. multiple, ring-enhancing lesions (toxoplasmosis) Ring-enhancing lesions below: Photo credit: Carnero et al., CC BY 4.0, via Insights into Imaging, modified by croppingWatch Adult CNS Tumors Watch Non Hodgkin LymphomaReview Primary CNS Lymphoma (PCNSL)Watch associated Bootcamp video - Leukemias and Lymphomas: Additional B-cell Non-Hodgkin Lymphomas Watch associated Bootcamp video - Adult Primary Brain Tumors: Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal MeningitisAtlas: Other:d939599e-2df3-4263-9439-bc3eea07e904
{{c2::Multiple myeloma}} is a malignant proliferation of {{c3::mono}}clonal {{c1::plasma}} cells in the bone marrowBone marrow particle largely replaced by sheets of neoplastic plasma cells: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission) Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org. From the case rID: 170092; modified by addition of overlays* M protein represents gamma globulins, most commonly IgG (55%) or IgA (25%) in multiple myeloma Watch Plasma Cell NeoplasmsReview Multiple MyelomaWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Multiple MyelomaAtlas: Other:1a02e867-3aee-4114-9f56-771a8dde857a
Multiple myeloma presents with {{c1::lytic (punched-out)}} bone lesions and hypercalcemiaNeoplastic plasma cells activate RANK receptor on osteoclasts; increases risk for fracture Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org. From the case rID: 170092; modified by addition of overlaysWatch Calcium Disorders Watch Plasma Cell NeoplasmsReview Multiple MyelomaWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Multiple MyelomaAtlas: Other:0c5dc6b6-9744-49b1-b4a3-1ea7f4662d95
In multiple myeloma, neoplastic plasma cells produce {{c1::IL-1}}, which stimulates {{c2::osteoclast}} maturation that will lead to bone resorption"- In this role, IL-1 is known as osteoclast activating factor - This results in lytic lesions on x-ray (""punched out"") Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org. From the case rID: 170092; modified by addition of overlays"Watch Plasma Cell NeoplasmsReview Multiple Myeloma Review IL-1 Multiple Myeloma Osteolytic LesionsWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Multiple MyelomaAtlas: Other:30451173-7970-4214-93e9-f64d1ece9aba
"The signs/symptoms of {{c1::multiple myeloma}} may be remembered with the mnemonic ""CRAB"": {{c1::hyperCalcemia::C}} {{c1::Renal insufficiency::R}} {{c1::Anemia*::A}} {{c1::Bone lytic lesions::B}} / {{c1::Back pain::B}}"*The anemia may be due to decreased bone marrow AND/OR decreased EPO from renal failure CRAB CriteriaCalcium (hypercalcemia) >11 mg/dL or >1 mg/dL above the ULNRenal insufficiency: GFR <40 mL/min or serum creatinine >2 mg/dLAnemia: Hb <10 g/dL or more than 2 g/dL below the LLNBone lesions: ≥1 osteolytic lesions on imaging Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org. From the case rID: 170092; modified by addition of overlaysWatch Plasma Cell NeoplasmsWatch Hypercalcemia: Workup & DDx Watch Plasma Cell Dyscrasias SOAP Watch Approach to Chronic Back Pain & Opioid UseReview Multiple MyelomaWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Multiple MyelomaAtlas: Other: 1) Hypercalcemia/bone lytic lesions/back pain: suck out ca from bone 2) Renal: excess light chain exceeds reabsorption ability of kidney, so light chains deposit in tissue and also cause light chains in the urine (Bence Jones; detected with SPEP); also, hypercalcemia damages kidney's ability to concentrate urine3) Anemia: replacement of bone marrow with plasma cells, so less RBCs produced. Also renal failure leads to low EPO productionya4e404d3-05e8-447f-a4d3-37e77cfe03a2
Which Langerhans cell histiocytosis presents as pathologic fracture with no skin involvement? {{c1::Eosinophilic granuloma}}Pathoma rules for Langerhans cell histiocytosis: 1. If it involves names, it is malignant 2. Malignant proliferations involve the skin 3. If two people named, affects children < 2 years old 4. If three people named, affects children > 3 years old Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Pediatric Bone Tumors DDxOther:2c29eb44-6e93-45bb-9134-30ea4e68ef9f
Which Langerhans cell histiocytosis presents as scalp rash, lytic skull lesions, diabetes insipidus, and exophthalmos? {{c1::Hand-Schüller-Christian disease}}Pathoma rules for Langerhans cell histiocytosis: 1. If it involves names, it is malignant 2. Malignant proliferations involve the skin 3. If two people named, affects children < 2 years old 4. If three people named, affects children > 3 years oldWatch Pediatric Bone Tumors DDxOther:a8112db2-4968-45a1-85d0-c8f657f43f78
{{c1::Thalamic}} pain syndrome is caused by a(n) {{c1::thalamic}} stroke that manifests with pure {{c2::contralateral::ipsilateral or contralateral}} sensory loss and initial paresthesias followed in weeks to months by: - Abnormal, unpleasant sense of touch ({{c3::dysesthesia}}) - Hypersensitivity to pain ({{c4::allodynia/hyperalgesia}})- AKA central post-stroke pain syndrome or Dejerine–Roussy syndrome - Occurs in 10% of stroke patients - Full loss of all sensory modalities on the face, arms, and legs of the contralateral side - Pains are paroxysmal or exacerbated by touchWatch associated Bootcamp video - Diencephalon: Disorders of the Thalamusa0f9a236-bff5-42d4-ae2f-87ab7b244342
The {{c1::supraoptic}} nucleus of the hypothalamus primarily makes ADH- Lesions here cause diabetes insipidus - May also secrete oxytocin to a lesser extent - *per NBME form 30 ADH can also be released from the paraventricular nuclei SAD POX: Supraoptic = ADH, Paraventricular = oxytocinWatch Diabetes Insipidus & SIADHWatch associated Bootcamp video - Diencephalon: Hypothalamic Nuclei Watch associated Bootcamp video - Hypothalamus Watch associated Bootcamp video - Endocrine : Posterior Pituitary Function7b615181-513d-40e2-a913-c212cddac8a3
The t(9;22) translocation (BCR-ABL) is also known as the {{c1::Philadelphia}} chromosome most commonly seen in {{c1::chronic myeloid leukemia (CML)}}Rarely seen with ALLWatch Myeloproliferative Neoplasms & Myelodysplastic Syndromes Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML) Watch Kinase InhibitorsReview Chronic Myelogenous Leukemia (CML)Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Myeloid Leukemia Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor GenesOther:c43cb351-6e51-4580-81ba-1f150f838388
Strokes involving the {{c2::anterior}} cerebral artery may cause paralysis and sensory loss of the {{c3::contra}}lateral {{c1::lower}} limb- Due to damage of the sensory and motor cortices on the medial aspect of the homunculus - May also have behavioral symptoms and urinary incontinence if the frontal micturition center is involved (e.g., medial frontal lobe, cingulate gyrus) - Whereas strokes involving the middle cerebral artery may cause paralysis and sensory loss of the contralateral upper limb and faceWatch Localizing A Stroke: ACAReview Anterior Cerebral Artery (ACA)Watch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Stroke Presentation by Territory Watch associated Bootcamp video - Cerebral Cortex: Frontal Lobe1d3f3269-3509-422d-a666-908f8e66c95f
Which part of the limbic system is responsible for learning and memory? {{c1::Hippocampus}}The neurotransmitter nitric oxide is thought to participate in the formation of new memories Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Diencephalon Overview Watch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Types of Strokefc6b7c32-dc1d-4e29-b2b9-43527966fffe
Which part of the limbic system is responsible for attaching an emotional significance to a stimulus? {{c1::Amygdala}}Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Diencephalon: Overview (Hypothalamus, Thalamus, Pineal Gland, Limbic System)789ca5c8-e816-4401-b14d-83a6d2d95047
Wernicke-Korsakoff syndrome is characterized by: - Damage {{c1::bi}}laterally to the {{c1::mammillary bodies}} - Periventricular hemorrhagic lesions to the {{c1::dorsomedial}} nucleus of the {{c1::thalamus}}- Mammillary bodies are involved in recollective and spatial memory - The dorsomedial nucleus of the thalamus plays a role in memory - The anterior thalamus is part of Papez circuit; it may be damaged as well but is less commonly affected Photo credit: Jto410, CC BY-SA 3.0, via Wikimedia Commons Photo credit: SoniaM2020, CC BY-SA 4.0, via Wikimedia CommonsWatch Vitamin B1Watch associated Bootcamp video - Memory, Dissociation, and Orientation: Amnesia Watch associated Bootcamp video - Diencephalon: Hopothalamic Disorders Watch associated Bootcamp video - Ketones: Ketoacidosis Review and Ketogenolysis Watch associated Bootcamp video - Vitamins: Vitamin B1 (Thiamine)Atlas:y5f54cda2-c75f-47b8-8517-c49ab1288f95
Wernicke-Korsakoff syndrome is associated with {{c1::thiamine (B1)}} deficiency and excessive {{c2::alcohol}} useWatch Vitamin B1Watch associated Bootcamp video - Memory, Dissociation, and Orientation: Amnesia Watch associated Bootcamp video - Diencephalon: Hopothalamic Disorders Watch associated Bootcamp video - Substance Misuse: Alcohol Watch associated Bootcamp video - Ketones: Ketoacidosis Review and Ketogenolysis Watch associated Bootcamp video - Vitamins: Vitamin B1 (Thiamine)Atlas:da358ee9-bd7a-4abb-8454-7e917d9ab539
ID Vessel: {{c1::Anterior cerebral artery}}Watch associated Bootcamp video - Aneurysms and Intracranial Hemorrhage: Circle of Willisfe1709da-2dd9-422a-97c1-497e1ccb8a7f
ID Vessel: {{c1::Anterior cerebral artery}}Photo credit: Shazia Mirza and Sankalp GokhaleSee, CC BY 4.0, via Wikimedia CommonsWatch Localizing A Stroke: ACAWatch associated Bootcamp video - Aneurysms and Intracranial Hemorrhage: Circle of Willis31dac586-9f5a-4d1e-8e0e-ce18116d8c13
ID Cortical Area: {{c1::Wernicke's area (Brodmann area 22)}}Watch Aphasias OverviewWatch associated Bootcamp video - Cerebral Cortex: Temporal Lobe8d923923-efcb-48b0-88cb-37d60a306a6c
Common viral causes of meningitis include {{c1::enteroviruses (especially coxsackievirus)}} and {{c2::HSV-2}}- Other possible viral causes include HIV, West Nile virus, and VZV - HSV-1 causes encephalitis - Give acyclovir until HSV is ruled outWatch Coxsackievirus A & B (PicoRNAviridae) Watch Herpes Simplex Virus Types 1 & 2 (Herpesviridae)Watch Aseptic Meningitis SOAPWatch associated Bootcamp video - Infectious Neuropathology: Viral (Aseptic) Meningoencephalitis Watch associated Bootcamp video - Positive-sense RNA Viruses : Picornaviridae OverviewAtlas:a4091934-3d53-47fd-b6b9-3e3147192f52
One histological feature seen after an ischemic stroke is the presence of {{c1::red neurons}}, which appear between {{c2::12}} - {{c2::24}} hoursFirst 12 hours no changes, then first affected structures are neurons: - Microvacuoles (small holes) develop in neuron cytoplasm - Neurons develop an intense pink-red color (red neurons) due to the development of eosinophilic cytoplasm, and their nuclei become pyknotic Photo credit: Patho, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Maffini et al., CC BY 3.0, via Ecancer Histological features seen after an ischemic strokePresence of red neurons12 - 24 hrsPresence of neutrophils1 - 3 daysPresence of microglia3 - 5 daysReactive gliosis & vascular proliferation1 - 2 weeksGlial scar2 weeksWatch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Histologic Timeline of StrokeAtlas:334c38eb-6ba5-4179-929e-848d43d58741
{{c1::Intraparenchymal}} hemorrhage is characterized by bleeding into the brain parenchymaPhoto credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Ischemic & Hemorrhagic StrokeWatch Intraparenchymal Hemorrhage Watch Moderate & Severe Traumatic Brain Injury: Presentation & WorkupWatch associated Bootcamp video - Intraparenchymal Hemorrhage Watch associated Bootcamp video - Aneurysms and Intracranial Hemorrhage: Types of StrokesAtlas:4d48865e-99c8-408b-a8f0-aac6853bb046
{{c2::Intraparenchymal}} hemorrhage typically occurs in the {{c1::basal ganglia}} and internal capsule, but can occur in the thalamus, cerebral hemispheres, brainstem, and cerebellumImage showing basal ganglia hemorrhage Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Intraparenchymal HemorrhageWatch associated Bootcamp video - Aneurysms and Intracranial Hemorrhage: Intraparenchymal HemorrhageAtlas:caae845c-e8d2-4615-907e-c3bfcf0b3931
Uncal herniation typically compresses the {{c1::cerebral peduncle}} on the same side of the herniation resulting in a(n) {{c2::contra}}lateral paresis- Same side results in contralateral paresis because the fibers decussate below the medulla; patients initially have flaccid paralysis with hyporeflexia → spasticity / hyperreflexia in days to weeks due to (spinal shock) - Specifically, the anterior portion of the cerebral peduncle - the crus cerebri - is being compressed (contains the motor tracts)* Sketchy is showing the severe caseWatch Intracranial Hypertension (ICH)Watch Moderate & Severe Traumatic Brain Injury: ManagementWatch associated Bootcamp video - Traumatic Brain Injuries: Brain Herniatione33c301b-8cf8-44f5-9537-563c93dca4b2
Rapid correction of {{c1::hypo}}natremia results in {{c2::osmotic demyelination syndrome (ODS)}}"- Also known as Central Pontine Myelinolysis - This is caused by overly rapid intravenous correction of hyponatremia - ""from low to high, your pons will die"" - In context of chronic low plasma sodium, the brain compensates by decreasing the levels of osmolytes (inositol, betaine, glutamine, glucose) so that brain cells can remain relatively isotonic and not absorb too much fluid - With correction of hyponatremia with IV fluids, extracellular tonicity increases, followed by an increase in intracellular tonicity (by cells making more intracellular osmolytes) - If correction is too rapid, not enough time is allowed for brains cells to adjust to new tonicity - Not enough time to increase osmolytes- Therefore, the intracellular water will be pulled out to balance the extracellular tonicity - This can lead to cellular dysfunction and central pontine myelinolysis - Myelin sheaths in the pons becomes damaged"Watch Osmolality & Sodium DisordersWatch Hyponatremia: Workup & Management Watch Hypernatremia Watch IV Fluid ManagementWatch associated Bootcamp video - Hypothalamus : SIADH Watch associated Bootcamp video - Hypothalamus : Hyponatremia Watch associated Bootcamp video - Electrolytes : Sodium Watch associated Bootcamp video - Ischemic Cerebrovascular Accidents : Medullary and Pontine Syndromes Watch associated Bootcamp video - Demyelinating Disease: Additional Diseases of DemyelinationAtlas: In context of chronic low plasma sodium, the brain compensates by decreasing the levels of osmolytes (inositol, betaine, glutamine, glucose) so that brain cells can remain relatively isotonic and not absorb too much fluid With correction of hyponatremia with IV fluids, extracellular tonicity increases, followed by an increase in intracellular tonicity (by cell making more intracellular osmolytes) no more than 0.5 mEq/L/hrf091cd4a-e532-4514-8946-a8aefce02e4a
Degeneration of the neurons of the {{c1::cerebral cortex}} leads to dementia (e.g., Alzheimer)Watch Alzheimer Disease & DementiaWatch associated Bootcamp video - Dementia: Alzheimer DementiaAtlas:b0c7000a-e170-4da3-a814-e95c8ab28c6f
{{c3::Parkinson}} disease is characterized histologically by {{c1::Lewy bodies}}, which are round, eosinophilic inclusions composed of {{c2::α-synuclein}}Think of Parkinsynuclein Photo credit: Suraj Rajan, CC BY-SA 3.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Dementia: Parkinson DiseaseAtlas:effd8221-7c04-4292-b59b-4572737b4674
{{c3::Huntington}} disease is characterized by degeneration of {{c1::GABAergic}} neurons in the {{c2::caudate nucleus}} and putamen of the basal gangliaPhoto credit: Frank Gaillard, CC BY-SA 3.0, via Wikimedia CommonsWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Basal Ganglia: Disorders of the Basal Ganglia Watch associated Bootcamp video - Dementia: Additional Causes of Dementia Watch associated Bootcamp video - Neurotransmitter Activity in Psychiatric Disease: Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion DiseasesAtlas: Hunting = excited, more = lose GABA inhibitory (plus GABA goose)c97d453f-a1fc-49ee-814f-89dc143e3e1a
Which movement disorder symptom presents as sudden, jerky, purposeless movements? {{c1::Chorea}}Seen with Huntington disease and acute rheumatic fever (sydenham chorea); both pathologies damage the basal ganglia Watch 'Sydenham Chorea', NEJM, via Youtube (0:24)Watch Streptococcus pyogenes (Group A Strep) Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch Strep Pharyngitis Watch Acute Rheumatic FeverReview Huntington DiseaseWatch associated Bootcamp video - Basal Ganglia: Disorders of the Basal Ganglia Watch associated Bootcamp video - Dementia: Additional Causes of Dementia Watch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseasesa30be9ab-e1d4-4cf1-8d71-c95650f215fb
Huntington disease presents initially with chorea, and may later show {{c1::depression::cognitive}}, {{c2::dementia::cognitive}}, and/or aggression- Chorea may progress to hypo/akinesia in later stages - Symptoms may be initially mistaken for substance abuseWatch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseReview Huntington DiseaseWatch associated Bootcamp video - Basal Ganglia: Disorders of the Basal Ganglia Watch associated Bootcamp video - Dementia: Additional Causes of Dementia Watch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion DiseasesAtlas:8a6cf252-6dd7-4c6f-bc70-6140a224e006
{{c4::Normal pressure}} hydrocephalus classically presents with a triad of: {{c1::Urinary incontinence}} {{c1::Gait apraxia}} {{c1::Dementia}}"- ""Wet, wobbly, and wacky"" - Sometimes reversible - Urinary incontinence is caused by disruption of the periventricular pathways that transmit inhibitory impulses from the cortex to the sacral micturition center - Apraxia is a motor disorder caused by damage to the posterior parietal cortex, where the individual has difficulty with motor planning to perform tasks / movements (without sensory loss or paralysis)"Watch HydrocephalusWatch Normal Pressure Hydrocephalus Watch Dementias DDxWatch associated Bootcamp video - Cerebellum and Ventricles: Hydrocephalus Watch associated Bootcamp video - Dementia: Additional Causes of DementiaAtlas:8be258e5-2e99-4bc5-a2cf-52e1314ab6ae
Do meningiomas typically invade the cortex? {{c1::No (external to brain parenchyma)}}Compresses, but does not invade Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Adult CNS TumorsWatch Primary Brain Tumors in AdultsReview MeningiomaWatch associated Bootcamp video - Adult Primary Brain Tumors: MeningiomaAtlas:08e9b088-4005-4072-b32c-209d50eac0fd
Pilocytic astrocytomas are most often found in the posterior fossa, such as the {{c1::cerebellum}}; may be supratentorialPhoto credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Pediatric CNS TumorsWatch Pediatric CNS TumorsReview Pilocytic AstrocytomaWatch associated Bootcamp video - Pediatric Brain Tumors: Pilocytic AstrocytomaAtlas:d50e326c-9a7c-4ea2-8731-e2033004731a
Zollinger-Ellison syndrome is characterized by acid hypersecretion, causing recurrent {{c1::ulcers}} in the {{c2::duodenum}} and {{c2::jejunum}}Watch Pancreatic Cancer & Islet Cell TumorsWatch Gastric Cancer Watch Peptic Ulcer DiseaseWatch associated Bootcamp video - Intestinal Pathology : Zollinger Ellison Syndromeb3c5ee36-0aed-48e5-8a5b-fcb8a2518ce2
{{c4::Cholecystokinin (CCK)}} is secreted from {{c1::I}} cells in the {{c2::duodenum}} and the {{c2::jejunum}}Sketchy Physiology: Gastrointestinal PhysiologyWatch associated Bootcamp video - Visceral Anatomy : Intestines Watch associated Bootcamp video - Physiology : Primary Digestive Hormones95226eaf-4021-439e-8e67-db7945ac82ce
Cholecystokinin secretion is stimulated by {{c2::fatty acids}} and {{c2::amino acids}}Watch associated Bootcamp video - Physiology : Primary Digestive Hormonesd08e3811-b1b0-4d06-95dd-28814ad1eb28
One function of secretin is to increase secretion of pancreatic {{c1::HCO3-}}Neutralizes gastric acid in the duodenum, allowing pancreatic enzymes to functionSketchy Physiology: Gastrointestinal Physiology Sketchy Physiology: Gastrointestinal PhysiologyWatch associated Bootcamp video - Physiology : Primary Digestive Hormones Watch associated Bootcamp video - Physiology : Gastrointestinal Secretions Watch associated Bootcamp video - Physiology : Exocrine Pancreas5a842fd0-be4e-477d-be5e-66d064f2b303
{{c4::Glucose-insulinotropic peptide (GIP)}} is secreted from {{c1::K}} cells in the {{c2::duodenum}} and {{c2::jejunum}}- Also known as gastric inhibitory peptide (GIP) - GluKose-insulinotropiK peptideWatch GI Regulatory Substances Part 2Watch associated Bootcamp video - Physiology : Secondary Digestive Hormonesc26fbc4e-3426-49d0-b86f-5b9dd19d69e4
Which nutrient stimulates glucose-insulinotropic peptide secretion? {{c1::All three (Glucose, Fat, Protein) :)::Glucose, Fat, Protein}}Specifically oral glucose; somatostatin and GIP are the only GI hormones that respond to all three nutrientsSketchy Physiology: Gastrointestinal Physiology Watch InsulinWatch associated Bootcamp video - Physiology : Secondary Digestive Hormones5245785a-2d03-4b78-b768-8f31d6e4dc4f
Glucose-insulinotropic peptide causes increased release of {{c1::insulin}} in response to a(n) {{c2::oral::oral/IV}} glucose load (endocrine effect)Watch GI Regulatory Substances Part 2Watch associated Bootcamp video - Physiology : Secondary Digestive Hormones4bed7da7-e613-4be2-bc35-fd63fe4d4783
{{c2::Motilin}} is a hormone that initiates {{c1::migrating motor complexes (MMCs)}} at 90-minute intervals between mealsWatch GI Regulatory Substances Part 2Watch associated Bootcamp video - Physiology : Secondary Digestive Hormonesfc6b2f82-de8d-43e1-bcbb-85d0cb73fe5e
Ghrelin levels {{c1::decrease}} after gastric bypass surgeryWatch Bariatric Surgery OverviewWatch associated Bootcamp video - Physiology : Secondary Digestive Hormonesee28e765-9815-46aa-b462-d637347cb7ad
Which hormone provides the major stimulus for bile ejection? {{c1::Cholecystokinin (CCK)}}Via contraction of the gallbladder and relaxation of the sphincter of Oddi Photo credit: Original: Boumphreyfr Vector: Vezixig, CC BY-SA 3.0, via Wikimedia CommonsSketchy Physiology: Gastrointestinal PhysiologyWatch Cholelithiasis & Acute Calculous CholecystitisWatch associated Bootcamp video - Physiology : Primary Digestive Hormones Watch associated Bootcamp video - Physiology : Bile23ed56e2-5cb6-41ff-9e01-58c3e510e4b7
Glucose and galactose are transported from the intestinal lumen into the cells by {{c1::Na+-dependent cotransport (SGLT1)}}Watch associated Bootcamp video - Physiology: Intestinal Absorption Watch associated Bootcamp video - Carbohydrates: Galactose Metabolism: Pathwayc953a02c-22de-463f-a8fd-23a744dadc8f
Which monosaccharide(s) are absorbed from the intestinal lumen by Na+-dependent cotransport (SGLT1)? {{c1::Glucose and galactose}}Watch associated Bootcamp video - Physiology: Intestinal Absorption Watch associated Bootcamp video - Carbohydrates: Galactose Metabolism: Pathwayeba56650-b3a5-48d6-8f5c-34254e03ba33
Which monosaccharide(s) are absorbed from the intestinal lumen by GLUT-5? {{c1::Fructose}}F for Five, FructoseWatch associated Bootcamp video - Physiology: Intestinal Absorption Watch associated Bootcamp video - Carbohydrates: Fructose Metabolism: Pathwayb41afc4e-31ec-43db-a914-0e0f67b464e4
Dipeptides and tripeptides are transported from the intestinal lumen into the cells by {{c1::H+}}-mediated cotransportPhoto credit: Boumphreyfr, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Physiology : Intestinal Absorptiond6314c04-1c24-4340-a2d2-b8a6b5fb9a34
In multiple myeloma, neoplastic plasma cells produce IL-{{c1::6}} which stimulates osteoclast activating factor (IL-1)Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org. From the case rID: 170092; modified by addition of overlaysWatch Plasma Cell NeoplasmsReview Multiple MyelomaWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Multiple Myeloma354aa2bc-bd62-4e80-836b-751acab8ac5e
{{c1::Behçet}} syndrome is characterized by a triad of: - Recurrent {{c2::aphthous}} ulcers - {{c2::Uveitis}} - {{c2::Genital}} ulcers- Classically presents in a young adult of Turkish, Middle Eastern, or Asian descent - Other manifestations include thrombosis and skin lesions (e.g., erythema nodosum) - Use colchicine to prevent recurrence - Mnemonic: Turkish RUG (Recurrent aphthous ulcers, Uveitis, Genital ulcers)Watch associated Bootcamp video - Vasculitides : Behcet Diseaseclassically presents in a young adult of Turkish, Middle Eastern, and Asian descent; other manifestations include thrombosis and skin lesions (e.g. erythema nodosum)26665cbd-2e17-4a7b-9b14-ad1984695203
{{c1::Zenker}} diverticulum is an outpouching of pharyngeal mucosa through an acquired defect in the muscular wall (false diverticulum) caused by {{c2::cricopharyngeal motor}} dysfunction- Abnormal spasm or diminished relaxation of cricopharyngeal muscles → increased oropharyngeal intraluminal pressure → herniation through a weakness in Killian triangle - Treatment is cricopharyngeal myotomy Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Structural Esophageal Disorders & GERDWatch Approach to DysphagiaWatch associated Bootcamp video - Esophageal and Gastric Pathology: Swallowing PathologyAtlas:9f568ee8-eae1-4466-9266-fb39865ace06
{{c4::Zenker}} diverticulum classically arises at {{c1::Killian's triangle::landmark}}, between the {{c2::thyropharyngeal}} and {{c3::cricopharyngeal}} parts of the inferior pharyngeal constrictorThis area is above the upper esophageal sphincter (AKA the cricopharyngeal part), at the junction of the esophagus and pharynx (this area is a zone of muscle weakness) Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Structural Esophageal Disorders & GERDWatch Approach to DysphagiaWatch associated Bootcamp video - Esophageal and Gastric Pathology: Swallowing Pathology99255da9-7f8d-4c0b-8e8c-1a663a54d195
Esophageal {{c2::varices}} are a common cause of death in patients with {{c1::cirrhosis}}Liver malfunction → inability to generate coagulation factors → ruptured varice → bleed out/death Photo credit: Samir, Public domain, via Wikimedia CommonsWatch Cirrhosis Pathogenesis & Clinical ManifestationsWatch Cirrhosis SOA Watch Acute Upper GI Bleed: Esophageal VaricesWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and Hemorrhoids Watch associated Bootcamp video - Hepatic Pathology : CirrhosisAtlas:970c7fd2-13a1-44c8-adec-0afa3da53cb0
Primary achalasia is due to an autoimmune-lymphocytic destruction of ganglion cells in the {{c1::myenteric (Auerbach)}} plexusResults in loss of postganglionic inhibitory neurons that contain nitric oxide and VIP; primary is believed to be autoimmune (HLA-DQB1 / HLA-DQw1 associations)Watch Esophageal Dysmotility & CancerWatch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Swallowing Pathologyc48bc9eb-27fe-43e1-aba0-b661717b68ad
"{{c2::Achalasia}} is characterized by the ""{{c1::bird beak}}"" sign on barium swallow"Dilated esophagus with an area of distal stenosis Photo credit: Farnoosh Farrokhi, Michael F. Vaezi., CC BY 2.0, via Wikimedia Commons, Bernard DUPONT, CC BY-SA 2.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 2.0Watch Esophageal Dysmotility & CancerWatch Approach to DysphagiaWatch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology: Swallowing Pathology6276aa6c-7998-4a3a-903f-4d733380a1dc
Gastroesophageal reflux disease (GERD) often presents with {{c1::heartburn}}, which can mimic cardiac chest painWatch Structural Esophageal Disorders & GERDWatch Esophagitis & GERD Watch Upper Abdominal Pain DDx Watch Approach to Abdominal PainWatch associated Bootcamp video - Esophageal and Gastric Pathology : Benign Gastric Pathology4b9f1d58-327e-404f-9a24-b8d2874d0385
Late complications of GERD include: - {{c2::Barrett}} esophagus - Ulcerations followed by esophageal {{c1::strictures}}Odynophagia (pain with swallowing) usually indicates the progression to erosive esophagitis and the formation of an ulcer (which can be confirmed with upper endoscopy) Photo credit: melvil, CC BY-SA 4.0, via Wikimedia CommonsWatch Structural Esophageal Disorders & GERDWatch Esophagitis & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology : Malignant Esophageal Disorders Watch associated Bootcamp video - Esophageal and Gastric Pathology : Benign Gastric Pathologyd95ae090-769f-4a9b-9d76-e4ad491b1128
In Barrett esophagus, {{c1::non-keratinized stratified squamous epithelium}} is replaced with {{c2::non-ciliated columnar epithelium with goblet cells}} (metaplasia)Response of lower esophageal stem cells to acidic stress Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons (left); Maione et al., CC BY 4.0, via MDPI Diagnostics (right) Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons* Metal intestines= intestinal metaplasia; * Barrett's bear=GERD → Barrett esophagus (intestinal metaplasia of the distal esophagus); * Squamous tiles= esophagus normally lined with stratified squamous epithelium; * Scattered mucus cups= intestinal metaplasia of Barrett esophagus contains goblet cell hyperplasia Watch Structural Esophageal Disorders & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology: Malignant Esophageal Disorders Watch associated Bootcamp video - Principles of Oncology and Therapeutics: MetaplasiaRobbins:6a6f6662-77e6-454a-acbf-e876c6df348b
Which type of esophageal cancer is associated with obesity, GERD, and Barrett esophagus? {{c1::Adenocarcinoma::SCC or Adenocarcinoma}}Adenocarcinoma requires metaplasia to occur first Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons (left); Maione et al., CC BY 4.0, via MDPI Diagnostics (right)Watch Esophageal Dysmotility & CancerWatch Esophageal CancerWatch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology : Malignant Esophageal DisordersAtlas: may present with chest pain, weight loss, and dysphagiaae5a13a7-490f-4c59-a061-44b1a88e3ba0
Adenocarcinoma of the esophagus most commonly arises from pre-existing {{c1::Barrett esophagus}}Other risk factors include chronic GERD, obesity, and smoking Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons (left); Maione et al., CC BY 4.0, via MDPI Diagnostics (right)Watch Structural Esophageal Disorders & GERD Watch Esophageal Dysmotility & CancerWatch Esophageal CancerWatch Structural Esophageal Disorders & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology : Malignant Esophageal Disordersother risk factors include chronic GERD, obesity, smoking, and achalasia think of goblet cells (glands = adeno) in Barrett Atlas:92271e5d-6a75-4120-b0a4-56d30bb37e08
The most common causes of squamous cell carcinoma of the esophagus are {{c1::alcohol}} and {{c1::tobacco smoke}}Watch Esophageal Dysmotility & CancerWatch Esophageal CancerWatch Esophageal Dysmotility & CancerWatch associated Bootcamp video - Esophageal and Gastric Pathology : Malignant Esophageal Disorders Watch associated Bootcamp video - Substance Misuse: AlcoholAtlas:3b60d5e4-b4a4-477f-afd4-561e98e9fbbc
{{c1::Pyloric stenosis}} is a congenital hypertrophy of the pyloric smooth muscleNarrowing of the pylorusWatch Congenital GI DisordersWatch Pyloric Stenosis Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video - Embryology : Atresias and Pyloric StenosisAtlas:376d1867-b660-4e85-96b0-b0364845410b
What is the most common cause of gastric outlet obstruction (GOO) in infants? {{c1::Pyloric stenosis (1:600)}}Watch Congenital GI DisordersWatch Pyloric Stenosis Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video - Embryology : Atresias and Pyloric StenosisAtlas:e552d705-7ef0-4e3c-9937-fa1a7a24ef4c
What demographic is associated with pyloric stenosis? {{c1::First-born males}}Watch Congenital GI DisordersWatch Pyloric Stenosis Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video - Embryology : Atresias and Pyloric StenosisAtlas:5815b2f6-bf92-49e5-a376-81205eaa4c90
How soon after birth does pyloric stenosis typically present? {{c1::~ 2 - 6 weeks}}- 1 month ± 2 weeks, if that is easier to remember - Takes time for hypertrophy to develop; helps distinguish from intestinal atresia (bilious vomit within 1-2 days)Watch Congenital GI DisordersWatch Pyloric Stenosis Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video - Embryology : Atresias and Pyloric StenosisAtlas:70384248-7676-4f19-acff-3cbcdf3e0329
Pyloric stenosis typically presents with {{c1::nonbilious::bilious or nonbilious}}, projectile vomitingNonbilious vomiting is an important distinguishing feature from intestinal atresia (bilious)Watch Congenital GI DisordersWatch Pyloric Stenosis Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video - Embryology : Atresias and Pyloric StenosisAtlas:5ef6a81d-cb81-40f6-92d6-1609b4e4c411
"{{c2::Pyloric stenosis}} often presents with a palpable ""{{c1::olive}}-like"" mass in the epigastric region of the abdomen"Watch Congenital GI DisordersWatch Pyloric Stenosis Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video - Embryology : Atresias and Pyloric StenosisAtlas:0a6dc66e-e4b2-48eb-bd93-fe6f8efdd88d
Pyloric stenosis may present with visible {{c1::peristalsis}}Watch 'Peristaltic Waves in Pyloric Stenosis', - Mahmood Ahmad, via YouTube (0:19)Watch Pyloric StenosisWatch associated Bootcamp video - Embryology : Atresias and Pyloric StenosisAtlas:58024943-5032-424b-bfae-20d71c882ea6
What is the most common (90%) form of chronic gastritis? {{c1::Chronic H. pylori gastritis}}Ureases, proteases, and inflammation weaken mucosal defensesWatch Gastric Dysmotility & CancerWatch Upper Abdominal Pain DDxWatch associated Bootcamp video - Esophageal and Gastric Pathology : Gastritis and Peptic Ulcers Watch associated Bootcamp video - Gram Negative Curved Rods : Helicobacter PyloriAtlas:d2176db1-005e-490f-b49e-037260dbf88b
H. pylori produces {{c1::urease::enzyme}}, which alkalinizes the local environment, enabling bacterial survivalUrea → NH3 and CO2 → NH3 combines with H+→ increases the pH → stimulates gastrin release → excess acid production and ulcer formationWatch Acute & Chronic Gastritis & Peptic Ulcer Disease Watch Helicobacter pyloriWatch associated Bootcamp video - Gram Negative Curved Rods : Helicobacter Pylori Watch associated Bootcamp video - Esophageal and Gastric Pathology : Gastritis and Peptic UlcersAtlas:9372430b-d275-44f4-bc1c-d74542a50c20
Gastric ulcers are usually due to {{c1::H. pylori}} (~ 70%)Here, gastric ulcers are caused by local damage due to cytotoxic compounds (proteases / ureases) produced by H. pylori (as opposed to loss of somatostatin producing D cells which causes duodenal ulcers)Watch Acute & Chronic Gastritis & Peptic Ulcer DiseaseWatch Peptic Ulcer Disease Watch Upper Abdominal Pain DDxWatch associated Bootcamp video - Esophageal and Gastric Pathology : Gastritis and Peptic Ulcers Watch associated Bootcamp video - Gram Negative Curved Rods : Helicobacter PyloriAtlas:df27662c-360d-4a25-8485-fdb2dd52432c
Which type of duodenal ulcer is more commonly associated with perforation? {{c1::Anterior::Anterior or Posterior}}vs. posterior duodenal ulcers are more commonly associated with hemorrhage\ Watch Acute & Chronic Gastritis & Peptic Ulcer DiseaseWatch Acute Upper GI Bleed: Non-Variceal Bleeding Watch Peptic Ulcer Disease Watch Abdominal Surgical EmergenciesWatch associated Bootcamp video - Esophageal and Gastric Pathology : Gastritis and Peptic Ulcers7cbd9e98-08b7-4e8e-8e7e-6c5ef2aea63f
{{c1::Perforation}} of an anterior duodenal ulcer is characterized by free air under the diaphragm (pneumoperitoneum)"This is also known as a ""perforated viscus"" Photo credit: Cerevisae, CC BY-SA 4.0, via Wikimedia Commons"Watch Acute & Chronic Gastritis & Peptic Ulcer DiseaseWatch Acute Upper GI Bleed: Non-Variceal Bleeding Watch Peptic Ulcer Disease Watch Abdominal Surgical EmergenciesWatch Chest X-Ray InterpretationWatch associated Bootcamp video - Esophageal and Gastric Pathology : Gastritis and Peptic Ulcers168f1192-35cb-41b5-a5fd-2774958cbd52
Meckel diverticulum may contain ectopic acid-secreting {{c1::gastric mucosa}} and/or {{c2::pancreatic}} tissue- 2 types of epithelia (gastric and pancreatic) - Acid may damage the Meckel diverticulum, resulting in brisk, painless bleedingWatch Congenital GI DisordersWatch associated Bootcamp video - Colorectal Pathology : Meckel's DiverticulumMeckel diverticulum Small intestine (gross photograph) An abnormal sac (green overlay) is visible in the lower part of the small intestine near the ileocecal valve. It is located on the antimesenteric side and involves all layers of the intestinal wall (true diverticulum). Atlas:a3121d90-52e2-4dad-a652-e79284c9a4f5
Abetalipoproteinemia is a(n) {{c1::autosomal recessive}} inherited malabsorption disorder that is caused by a mutation in the {{c2::microsomal triglyceride transfer protein (MTTP)}} gene- Defect in the MTP gene; MTTP functions as a chaperone protein necessary for proper folding of apoB and helps transfer lipids to newly formed chylomicrons - Normally, chylomicrons and VLDL particles are synthesized within the ER as lipids accumulate around a single apo BWatch Autosomal Recessive DiseasesReview AbetalipoproteinemiaWatch associated Bootcamp video - Lipid Metabolism : Lipid Digestion and Absorption: Cholesterol and Clinical Implications6950b591-4abf-49c2-922a-483e64668c92
Carcinoid tumors may arise anywhere in the gut, however, they most commonly arise in the {{c1::terminal ileum}}Grows a submucosal polyp-like nodule Photo credit: See page for author, Public domain, via Wikimedia CommonsRefer to endocrine section:Watch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Intestinal Pathology : Carcinoid TumorsAtlas:8e439a2d-f278-4e2c-a423-1af97ffe5001
The serotonin released from carcinoid tumors in the small bowel is metabolized in the {{c1::liver}} by {{c2::monoamine oxidase (MAO)}}, producing {{c3::5-HIAA}}- First-pass metabolism; serotonin travels to the liver via the portal vein - Specifically MAO-ARefer to endocrine section:Watch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Intestinal Pathology : Carcinoid TumorsAtlas:699e4283-2736-4038-8513-40cbde88ddf2
"The symptoms of {{c1::carcinoid}} syndrome may be remembered with the mnemonic ""Be FDR"": {{c1::Bronchospasm::Be}} {{c1::Flushing::F}} {{c1::Diarrhea::D}} {{c1::Right-sided heart disease::R}}"- Also wheezing - Symptoms arise due to excess serotonin and kallikrein (both cause vasodilation) and tryptophan being used to make serotonin and results in niacin deficiency (pellagra) - Serotonin: causes diarrhea. May stimulate fibroblasts and lead to heart valve fibrosis - Histamine: flushing - Kallikrein: flushing - Prostaglandins: stimulate intestinal secretions - Tachykinins: flushing and diarrheaRefer to endocrine section:Watch Carcinoid Tumor & Small Bowel NeoplasmsWatch Tricuspid Regurgitation SOAPWatch associated Bootcamp video - Intestinal Pathology : Carcinoid Tumors Watch associated Bootcamp video - Valvular Disease : Tricuspid Regurgitation Watch associated Bootcamp video - Protein Metabolism : Tryptophan Niacin and Serotonin: Serotonin Pathway and AADC DeficiencyAtlas:y3ef6a2f9-9dc7-4d2f-b21e-74167eae5d66
The symptoms of carcinoid syndrome may be remembered with the mnemonic {{c1::Be FDR}}Bronchospasm Flushing Diarrhea Right-sided heart disease - Also wheezing - Symptoms arise due to excess serotonin and kallikrein (both cause vasodilation) and tryptophan being used to make serotonin and results in niacin deficiency (pellagra) - Serotonin: causes diarrhea. May stimulate fibroblasts and lead to heart valve fibrosis - Histamine: flushing - Kallikrein: flushing - Prostaglandins: stimulate intestinal secretions - Tachykinins: flushing and diarrheaWatch Carcinoid Tumor & Small Bowel NeoplasmsWatch associated Bootcamp video - Intestinal Pathology : Carcinoid Tumors Watch associated Bootcamp video - Protein Metabolism : Tryptophan Niacin and Serotonin: Serotonin Pathway and AADC Deficiencyd6bd015e-d0cc-4bb1-a6e6-54dc05e5e1a3
Appendicitis may lead to rupture, resulting in peritonitis with guarding and {{c1::rebound tenderness}} on physical examWatch 'Rebound Tenderness,' Med School Made Easy, via Youtube (0:31)Watch Appendicitis Watch Appendectomy Overview Watch Abdominal Surgical EmergenciesWatch associated Bootcamp video - Intestinal Pathology : Appendicitis61499738-d79d-4737-abe6-e818a0b0b166
{{c2::Crohn disease::IBD}} is characterized by {{c1::skip}} lesions, which can occur anywhere from the mouth to the anusImage(s) provided by www.radiologyassistant.nl. Used with permission.Watch Crohns Disease & Ulcerative ColitisWatch Inflammatory Bowel Disease: Crohn's Disease & Ulcerative ColltisWatch associated Bootcamp video - Colorectal Pathology : Crohn's DiseaseAtlas:8caab3d1-615b-425b-be20-e27d25f5a81d
{{c2::Crohn disease::IBD}} appears grossly with {{c1::cobblestone}} mucosaWatch Crohns Disease & Ulcerative ColitisWatch Inflammatory Bowel Disease: Crohn's Disease & Ulcerative ColltisWatch associated Bootcamp video - Colorectal Pathology : Crohn's DiseaseAtlas:316cc15a-8c03-488d-84ed-1090be2652ab
Crohn disease appears grossly with {{c1::strictures::lumen size}} and bowel wall thickeningThis occurs as a result of bowel wall edema, fibrosis, and hypertrophy of the muscularis mucosa (which can progress to bowel obstruction) Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Crohns Disease & Ulcerative ColitisWatch Inflammatory Bowel Disease: Crohn's Disease & Ulcerative ColltisWatch associated Bootcamp video - Colorectal Pathology : Crohn's DiseaseAtlas:ed18c547-ddbc-4637-b4a4-bf7b081a0de9
Which form of IBD is associated with fistula formation? {{c1::Crohn disease}}Fistulas occur when ulcers penetrate the entire thickness of the intestinal wall, leading to a sinus tract that communicates between multiple organs; this permits the formation of skip lesionsWatch Anorectal DisordersWatch Inflammatory Bowel Disease: Crohn's Disease & Ulcerative Colltis Watch Anorectal FistulaWatch associated Bootcamp video - Colorectal Pathology : Crohn's DiseaseAtlas:3d679186-ef88-4560-95e1-8d52a1fb17e7
What segment of the GI tract is most commonly affected by diverticulosis? {{c1::Sigmoid colon}}Photo credit: melvil, CC BY-SA 4.0, via Wikimedia CommonsWatch Large Bowel & Appendiceal DisordersWatch Diverticulosis & Acute Lower GI BleedingWatch associated Bootcamp video - Colorectal Pathology : Diverticulosis and AngiodysplasiaAtlas:715d307e-cd1d-4cb8-848b-7ea719a13e86
Diverticulosis is related to wall {{c1::stress (pulsion diverticulum)}} (e.g., constipation, straining, low fiber diet) and {{c2::obesity}}- Diverticulosis is due to increased intraluminal pressure; this rise in pressure causes mucosa and submucosa to herniate through areas of focal weakness in the muscularis (thus, is a false diverticula) - Diverticulosis is also related to a diet high in red meat and fatWatch Large Bowel & Appendiceal DisordersWatch Diverticulosis & Acute Lower GI Bleeding Watch Acute DiverticulitisWatch associated Bootcamp video - Colorectal Pathology : Diverticulosis and AngiodysplasiaDiverticulosis in the sigmoid colon Endoscopic view on the sigmoid colon: the opening of two small diverticula are located in the upper right corner of this image. There are no signs of inflammation.d65bc5b2-59f7-4784-9ce3-af2cad9811c7
{{c2::Hereditary hemorrhagic telangiectasia}} is a(n) {{c1::autosomal dominant::inheritance}} disorder resulting in thin-walled blood vessels, especially in the mouth and GI tract- AKA Osler-Weber-Rendu syndrome - Presents with blanching skin lesions (telangiectasias), recurrent epistaxis, skin discoloration, AV malformations, GI bleeding, and hematuria Photo credit: Herbert L. Fred, MD and Hendrik A. van Dijk, Attribution, via Wikimedia CommonsIn cardiology section:Review HHTAtlas:82024f2c-92b7-43d9-898e-a5f7eaa72fb8
{{c1::Hereditary hemorrhagic telangiectasia}} is also known as Osler-Weber-Rendu syndromePresents with blanching skin lesions (telangiectasias), recurrent epistaxis, skin discoloration, AV malformations, GI bleeding, and hematuria Photo credit: Herbert L. Fred, MD and Hendrik A. van Dijk, Attribution, via Wikimedia CommonsIn cardiology section:Review HHTAtlas:6362cd40-cf77-43e2-b913-3b8b130aebba
{{c1::Hereditary hemorrhagic telangiectasia}} presents with blanching skin lesions, AV malformations, recurrent epistaxis, skin discoloration, GI bleeding, and hematuria- AKA Osler-Weber-Rendu syndrome - Associated with widespread AV malformations - AVMs in the lung can result in right-to-left shunting with chronic hypoxemia (clubbing), reactive polycythemia, and hemoptysis Photo credit: Herbert L. Fred, MD and Hendrik A. van Dijk, Attribution, via Wikimedia CommonsWatch Hemoptysis DDxReview HHT462edd31-f98c-48f3-9c5f-af0c33463933
{{c1::Irritable bowel}} syndrome is recurrent abdominal pain ≥1 day per week for the past 3 months PLUS ≥ 2 of the following symptoms: - {{c2::Abdominal pain}} related to defecation - Change in stool {{c2::frequency}} - Change in the {{c2::appearance}} of stool- Known as the Rome IV criteria - Patients who meet criteria without any red flag symptoms / labs do not require further testing (i.e., no colonoscopy)Watch Large Bowel & Appendiceal DisordersWatch Approach to Abdominal Pain Watch Approach to DiarrheaWatch associated Bootcamp video - Intestinal Pathology : Irritable Bowel Syndrome42bee1b6-d7c7-4424-8fa1-928506a628f4
Is irritable bowel syndrome (IBS) related to structural abnormalities? {{c1::No}}Colonoscopy reveals normal colonic mucosaWatch associated Bootcamp video - Intestinal Pathology : Irritable Bowel SyndromeColonoscopy reveals normal colonic mucosa81645e38-f4d0-462f-9cc7-ebb07aa38fd3
{{c2::Familial adenomatous polyposis (FAP)}} is a(n) {{c1::autosomal dominant::inheritance}} disorder characterized by 100s to 1000s of adenomatous colonic polypsPhoto credit: Ali et al., CC BY 4.0, via Cureus Photo credit: Samir at the English-language Wikipedia, CC BY-SA 3.0, via Wikimedia CommonsWatch Colorectal Polyps & CancerWatch Colorectal Cancer: CarcinogenesisReview Familial Adenomatous Polyposis (FAP)Watch associated Bootcamp video - Colorectal Pathology: Hereditary PolyposisAtlas:b9f9a7d3-9377-4516-9c63-58386b52bc02
{{c2::Peutz-Jeghers}} syndrome is characterized by numerous {{c1::hamartomatous}} polyps WITH hyperpigmentation of the lips, mouth, hands, and genital skinPhoto credit: Masryyy, CC BY-SA 4.0, via Wikimedia Commons (1st image); Abdullah Sarhan, CC BY-SA 4.0, via Wikimedia Commons (2nd image) Photo credit: Bernshteyn et al., CC BY 4.0, via Cureus Hamartomatous colonic polyp: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Carcinoid Tumor & Small Bowel Neoplasms Watch Colorectal Polyps & CancerReview Peutz-Jeghers SyndromeWatch associated Bootcamp video - Colorectal Pathology: Hereditary Polyposisacc9a5c4-3fcd-4f29-8980-749c10812f54
Peutz-Jeghers syndrome is associated with increased risk of {{c1::breast}}, {{c2::gastrointestinal}}, and gynecologic cancers- e.g., colorectal, stomach, small bowel, pancreatic - Newly diagnosed patients should have screening esophagogastroduodenoscopy (EGD) and colonoscopy Photo credit: Masryyy, CC BY-SA 4.0, via Wikimedia Commons (1st image); Abdullah Sarhan, CC BY-SA 4.0, via Wikimedia Commons (2nd image)Watch Carcinoid Tumor & Small Bowel Neoplasms Watch Colorectal Polyps & CancerReview Peutz-Jeghers SyndromeWatch associated Bootcamp video - Colorectal Pathology: Hereditary Polyposisf1139c8f-46e2-4663-89f0-a74230934ecc
{{c1::Lynch}} syndrome is due to an inherited defect in {{c2::DNA mismatch repair}} enzymes, resulting in microsatellite instabilityMSH2, MLH1Watch Colorectal Polyps & Cancer Watch DNA Repair MechanismsWatch Colorectal Cancer: CarcinogenesisReview Lynch SyndromeWatch associated Bootcamp video - Colorectal Pathology: Hereditary Polyposis Watch associated Bootcamp video - DNA Mutations, Damage, and Repair : Single Stranded RepairColorectal carcinogenesis pathways Top: Chromosomal instability pathway (adenoma-carcinoma sequence) - Loss of the tumor suppressor gene, APC, results in hyperproliferative epithelium due to a loss of cellular adhesion and increased cellular proliferation. A mutation in KRAS results in unregulated cellular signaling and cellular proliferation, leading to the formation of an adenoma. Loss of the tumor suppressor genes TP53 and DCC results in the malignant transformation of an adenoma to carcinoma. The chromosomal instability pathway is responsible for carcinomas in FAP (loss of APC) as well as in most cases of sporadic colorectal carcinoma. Bottom: Microsatellite instability pathway - Acquired or inherited mutations in the mismatch repair genes (esp. MLH1 and MSH2) result in abnormal proliferation and the formation of adenoma and carcinoma. The microsatellite instability pathway is responsible for carcinomas in Lynch syndrome (HNPCC) and a few cases of sporadic colorectal carcinoma. Atlas:a9f04517-9b08-4384-875f-0dadbcb58994
Lynch syndrome is usually {{c1::right::left or right}}-sided and always involves the {{c1::proximal::proximal or distal}} colonWatch Colorectal Polyps & CancerWatch Colorectal Cancer: CarcinogenesisReview Lynch SyndromeWatch associated Bootcamp video - Colorectal Pathology: Hereditary Polyposisbe66199b-6dcb-49e7-a613-0bfa6744bb86
Lynch syndrome is an autosomal dominant condition associated with increased risk for {{c1::colorectal}}, {{c2::endometrial}}, {{c3::ovarian}}, and gastric cancers"- To help you memorize it ""CEO of gastric cancer"" - Prophylactic hysterectomy and bilateral oophorectomy are recommended at age 40 or after childbearing is complete (patients with a uterus should have annual endometrial biopsies beginning at age 30-35) - Minor risk for small bowel, hepatobiliary, & skin cancers"Watch Colorectal Polyps & Cancer Watch Abnormal Uterine Bleeding (AUB) & Endometriosis Watch Ovarian Cysts & Epithelial Ovarian CancerWatch Colorectal Cancer: Carcinogenesis Watch Colectomy Overview Watch Adnexal Mass DDx Watch Epithelial Ovarian Cancer Watch Endometrial Hyperplasia & CancerReview Lynch SyndromeWatch associated Bootcamp video - Colorectal Pathology: Hereditary Polyposis00809fcb-4ca2-443d-b695-017824fdfd48
In which part of the colon does colorectal carcinoma most commonly arise? {{c1::Rectosigmoid region}}Rectosigmoid > ascending > descendingWatch associated Bootcamp video - Colorectal Pathology : Colorectal Cancer5d02848f-cdb7-417a-bf56-b3f430d86dfd
{{c2::Left}}-sided colorectal carcinoma presents with decreased stool {{c1::caliber}} due to partial obstruction"- ""Right side (ascending) bleeds, left side (descending) obstructs"" - ""Pencil-stools"" due to decreased lumen size from colon cancer obstruction"Watch Colorectal Polyps & CancerWatch Colorectal Cancer: Presentation & Management Watch Approach to DiarrheaWatch associated Bootcamp video - Colorectal Pathology : Colorectal CancerAtlas:84b34c48-ea29-4891-b9eb-9d016e6b91a5
{{c1::Left}}-sided colorectal carcinoma presents with colicky pain and hematochezia (stool)Compare with melena of right-sided colorectal carcinomaWatch Colorectal Polyps & CancerWatch Colorectal Cancer: Presentation & Management Watch Approach to DiarrheaWatch associated Bootcamp video - Colorectal Pathology : Colorectal CancerAtlas:10ec6ae6-d42b-45bb-997e-016372246ab2
{{c2::Right}}-sided colorectal carcinoma presents with vague pain, weight loss, and {{c1::iron deficiency}} anemia"""Right side (ascending) bleeds, left side (descending) obstructs"" Photo credit: Ed Uthman, CC BY 2.0, via Flickr, modified by cropping; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)"Watch Colorectal Polyps & CancerWatch Anemia Intro: Microcytic Anemia DDx Watch Colorectal Cancer: Carcinogenesis Watch Colorectal Cancer: Presentation & Management Watch Surgery Hepatocellular Carcinoma Watch Internal Medcine Hepatocellular CarcinomaWatch associated Bootcamp video - Colorectal Pathology : Colorectal CancerAtlas:57d37514-5a23-4213-8c7d-9f5a688f3f7d
Intestinal {{c2::malrotation}} is a congenital anomaly of {{c1::midgut}} rotation during fetal developmentResults in the small bowel being clumped on the right side Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Congenital GI DisordersWatch Malrotation and Volvulus Watch Life-Threatening Causes of Abdominal Pain in the Neonate/Infant DDx Watch Vomiting in Neonates, Infants, and Toddlers DDx Watch Trisomy 13 & Trisomy 18Watch associated Bootcamp video - Intestinal Pathology : Small Bowel Obstruction6690d744-51f4-41b5-b2f8-3b47921aea9d
Annular pancreas may cause {{c1::duodenal}} obstruction and {{c2::bilious or non-bilious::bilious / non-bilious}} vomitingMay start clear and become bilious; may also cause obstructed pancreatic drainage (resulting in acute / chronic pancreatitis) “Image licensed by Physeo and used with permission. Purchase full access here .” Photo credit: Hellerhoff, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Pancreas : Pancreas Physiology Watch associated Bootcamp video - Embryology : Pancreatic Anomaliesea613834-8e21-4570-bc95-6b6beff73d20
Acute pancreatitis results in peripancreatic {{c1::fat}} necrosisRelease of the pancreatic enzyme lipase → autodigestion of adipose tissue → fat necrosis (visible on histology in pancreatitis)*Roasting lipid-laden pig: release of the pancreatic enzyme lipase → autodigestion of adipose tissue → fat necrosis (visible on histology in pancreatitis) Watch Acute & Chronic PancreatitisWatch Acute PancreatitisWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Acute Pancreatitis Watch associated Bootcamp video - Cellular Injury and Neoplasia : Necrosis Watch associated Bootcamp video - Principles of Oncology and Therapeutics: NecrosisAtlas:d9342641-62e0-47e3-9cf2-0d2a0bf3703e
"The causes of {{c1::acute pancreatitis}} may be remembered with the mnemonic ""I GET PP SMASHED"": {{c1::Idiopathic::I}} {{c1::Gallstones::G}} {{c1::Ethanol::E}} {{c1::Trauma (e.g., automobile accident in children - seatbelt injury)::T}} {{c1::Posterior duodenal ulcer rupture::P}} {{c1::Pancreas divisum::P}} {{c2::Steroids::S}} {{c2::Mumps::M}} {{c2::Autoimmune disease::A}} {{c2::Scorpion sting::S}} {{c2::HYPERcalcemia::H}} or {{c2::Hypertriglyceridemia / Hyperchylomicronemia::H}} {{c2::ERCP (endoscopic retrograde cholangiopancreatography)::E}} {{c2::Drugs (e.g., sulfa drugs, NRTIs, protease inhibitors, diuretics)::D}}"IdiopathicGallstonesSpecifically at the ampulla of VaterEthanolAlcohol triggers the release of pancreatic enzymes - also results in alcoholic liver disease, peripheral neuropathy, testicular atrophyTrauma (e.g., automobile accident in children - seatbelt injury)Children being restrained by seatbeltsPosterior duodenal ulcer rupturePancreas sits behind posterior duodenum - rupture perforates pancreas; pancreas divisum is an embryological causePancreas divisumOther structural abnormalities of the pancreatic duct (strictures, cancer) or the ampullary region (choledochal cyst, stenosis of sphincter of Oddi)SteroidsMumpsMumps; other infections are coxsackievirus, Mycoplasma pneumoniaeAutoimmune diseaseTypically due to IgG4 related disease (+ Riedel thyroiditis, retroperitoneal fibrosis, noninfectious aortitis)Scorpion stingScorpion stings (especially in Trinidad) + brown recluse spider + gila monster lizard; surgery (particularly of the stomach and biliary tract and after cardiac surgery)Hypercalcemia or Hypertriglyceridemia/HyperchylomicronemiaCalcium deposits in pancreas ducts and activates trypsinogen; chylomicrons obstruct pancreatic capillaries, leading to local ischemia - exposes TAGs to pancreatic lipases, leads to proinflammatory CK / free radicals → tissue injuryERCP (endoscopic retrograde cholangiopancreatography)Drugs (e.g., sulfa drugs, NRTIs, protease inhibitors, diuretics)Didanosine, corticosteroids, alcohol, valproic acid, azathioprine, furosemide, HCTZ, GLP-1 analogs, 6MP in additionWatch Acute & Chronic PancreatitisWatch Acute Pancreatitis Watch Upper Abdominal Pain DDx Watch Blunt Abdominal Trauma: Management of Retroperitoneal Injuries Watch Cholelithiasis & Acute Calculous Cholecystitis Watch Functional Biliary Disorders Watch Acute CholangitisWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Acute Pancreatitis Watch associated Bootcamp video - Pancreas : Pancreas Physiology Watch associated Bootcamp video - Negative-sense RNA Viruses : Mumpsyd4965ec8-a969-44df-a4f6-8ef50148430b
Acute {{c1::pancreatitis}} is diagnosed by 2 of 3 criteria: - Acute epigastric pain that radiates to the back - Increased serum amylase or lipase to 3× upper limit of normal - Characteristic imaging findingsWatch Acute & Chronic PancreatitisWatch Acute Pancreatitis Watch Upper Abdominal Pain DDx Watch Choledocholithiasis Watch Exudative Pleural Effusions DDxWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Acute Pancreatitis Watch associated Bootcamp video - Negative-sense RNA Viruses : Mumps472d527a-5fac-44fe-9e0a-59e1bd4616c3
One criteria for diagnosis of acute pancreatitis is increased serum {{c1::amylase}} or {{c2::lipase}}> 3x the upper limit of normalWatch Acute & Chronic PancreatitisWatch Acute Pancreatitis Watch Upper Abdominal Pain DDx Watch CholedocholithiasisWatch associated Bootcamp video - Physiology : Exocrine Pancreas Watch associated Bootcamp video - Pancreatic and Biliary Pathology : Acute Pancreatitis Watch associated Bootcamp video - Negative-sense RNA Viruses : Mumps8c245637-2aad-456e-91b4-5512f5ec1d41
Pancreatitis (acute and chronic) may present with {{c1::epigastric::location}} abdominal pain that radiates to the {{c2::back}}Watch Acute & Chronic PancreatitisWatch Acute Pancreatitis Watch Upper Abdominal Pain DDx Watch Approach to Abdominal Pain Watch Exudative Pleural Effusions DDxWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Pancreatic Insufficiency Watch associated Bootcamp video - Pancreatic and Biliary Pathology : Acute Pancreatitis Watch associated Bootcamp video - Pancreatic and Biliary Pathology : Chronic Pancreatitis0a4f8fe9-ce8b-4b00-8a52-3f1b4caa48a4
Which type of gallstone can be the result of rapid weight loss? {{c1::Cholesterol gallstone::Cholesterol or Pigment}}- Very low calorie diets with decreased caloric intake and rapid weight loss can lead to bile stasis (due to lack of CCK release from poor oral intake) and increased cholesterol mobilization - similar mechanism to that of cholecystitis occurring with a patient on TPN - e.g., patients with Roux-en-Y gastric bypass surgery (patients often receive prophylactic ursodeoxycholic acid for 6 months to reduce risk of gallstone development) - Weight loss causes body to secrete extra cholesterol into bile → ↑ risk for cholesterol stones Cholesterol gallstones: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permissionWatch Gallbladder Disease SOAP Watch Cholelithiasis & Acute Calculous Cholecystitis Watch Choledocholithiasis Watch Bariatric Surgery OverviewWatch associated Bootcamp video - Pancreatic and Biliary Pathology : GallstonesAtlas:060b18ef-2ca9-48f5-8896-e73bd607899a
{{c2::Cholecystitis}} is associated with a positive {{c1::Murphy}} sign, which is inspiratory arrest on RUQ palpation due to pain- Indicates an inflammatory process and/or cholecystitis, making the likely culprit a stone - Put your hand at the middle, inferior border of liver - Ask the patient to take a deep breath - If the patient has pain and stops short of full inspiration = positive Murphy sign Photo credit: Mikael HäggströmBackground made transparent by Frédéric Michel forThis image was improved or created by the Wikigraphists of the Graphic Lab (fr). You can propose images to clean up, improve, create or translate as well., Public domain, via Wikimedia CommonsWatch Gallbladder & Biliary Tract DiseaseWatch Acute Cholecystitis & Acute Cholangitis SOAPs Watch Cholelithiasis & Acute Calculous Cholecystitis Watch Upper Abdominal Pain DDx Watch Approach to Abdominal PainWatch associated Bootcamp video - Pancreatic and Biliary Pathology : GallstonesAtlas:a1b020a3-8cf9-40b9-beda-238dac0ac65e
What dermatome is found at the umbilicus? {{c1::T10}}"""belly butTEN"""Watch Neurogenic Shock & Cervical Spine Injuries: Presentationb821157e-d9fb-4713-ab7a-c31a12313a72
Acute inflammatory demyelinating polyneuropathy (AIDP) is the most common subtype of {{c1::Guillain-Barré}} syndrome- AIDP represents 60–80% of GBS cases - Treat with IVIG or plasmapheresisWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Demyelinating Disease: Guillain-Barre SyndromeAtlas:dc29df58-d48f-4b25-b26c-cd1b9ebbe8e6
{{c2::Guillain-Barré}} syndrome results in {{c3::symmetric::symmetric/asymmetric}} {{c1::ascending::ascending or descending}} muscle weakness/paralysis with {{c2::hypo}}reflexia- Reduced or absent reflexes - May also involve sensory abnormalitiesWatch Guillain Barre & Charcot Marie ToothWatch associated Bootcamp video - Demyelinating Disease: Guillain-Barre SyndromeAtlas:9a2a05e7-6f4b-486e-8fa8-946637ef4924
"The characteristics of {{c1::tuberous sclerosis}} may be remembered with the mnemonic ""HAMAARTOMAS"": {{c1::Hamartomas in CNS and skin::H (benign growths)}} {{c1::Angiofibromas (adenoma sebaceum)::A (face)}} {{c1::Mitral regurgitation::M (valvular pathology)}} {{c1::Ash-leaf spots (hypopigmented macule)::A (earliest cutaneous finding)}} {{c1::Astrocytomas (giant cell)::A (CNS tumor)}} {{c1::cardiac Rhabdomyoma::R (cardiac tumor)}} {{c2::Tumor suppressor genes (TSC1 and TSC2)::T (genes)}} {{c2::autosomal dOminant::O (inheritance)}} {{c2::Mental challenges (intellectual disability)::M (development)}} {{c2::renal Angiomyolipoma::A (renal mass)}} {{c2::Seizures::S (neurologic)}}, {{c2::Shagreen patches::S (lower back)}}"- Death most commonly occurs secondary to neurologic impairment (i.e., seizures, aspiration PNA, hydrocephalus) - 1st: Hypopigmented macules (Ash leaf spot), 2nd: Shagreen patch and 3rd: periungual fibroma of tuberous sclerosis Photo credit: Portocarrero et al., CC BY 4.0, via Wikimedia Commons Renal angiomyolipoma: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Sturge Weber & Tuberous SclerosisWatch Pediatric Seizure DDxReview Tuberous Sclerosisycf0aa67f-400d-456b-8bce-54107e2ab86d
The characteristics of tuberous sclerosis may be remembered with the mnemonic {{c1::HAMAARTOMAS}}Hamartomas in the CNS and skin Angiofibromas (adenoma sebaceum) Mitral regurgitation Ash-leaf spots (hypopigmented macule) Astrocytomas (giant cell) cardiac Rhabdomyoma Tumor suppressor genes (TSC1 and TSC2) autosomal dOminant Mental challenges (intellectual disability) renal Angiomyolipoma Seizures, Shagreen patches 1st: Hypopigmented macules (Ash leaf spot), 2nd: Shagreen patch and 3rd: periungual fibroma of tuberous sclerosis Photo credit: Portocarrero LKL, Quental KN, Samorano LP, Oliveira ZNP, Rivitti-Machado MCDM, CC BY 4.0, via Wikimedia Commons Renal angiomyolipoma: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Sturge Weber & Tuberous SclerosisWatch Pediatric Seizure DDxReview Tuberous Sclerosisebbfcf0a-60fe-422a-955e-44a670616d04
What is the mode of inheritance of neurofibromatosis I and II? {{c1::Autosomal dominant}}- Chromosome 17 for NF1 - Chromosome 22 for NF2Watch NeurofibromatosisReview Von Recklinghausen Disease (NF I) Review Neurofibromatosis Type II (NF II)Watch associated Bootcamp video - Basics of Clinical Genetics: Pedigrees and Modes of InheritanceAtlas:ba718c65-f2ff-4b67-ad58-708e37f2495b
What is the penetrance of neurofibromatosis I? {{c1::100%}}Also exhibits variable expressivityWatch NeurofibromatosisReview Von Recklinghausen Disease (NF I)Atlas:82471e0c-4e27-4c0b-a347-905a7ac14451
"The characteristics of {{c1::von Hippel-Lindau}} disease may be remembered with the mnemonic ""HARP"": {{c1::Hemangioblastomas in retina, brainstem, cerebellum, spine::H (4 locations)}} {{c1::Angiomatosis (e.g., cavernous hemangiomas in skin, mucosa, organs)::A}} {{c1::bilateral Renal cell carcinoma::R}} {{c1::Pheochromocytoma::P}}"Hemangioblastomas are clumps of capillaries: - High vascularity with hyperchromatic nuclei - When occurs in the retina, can lead to retinal detachment, treat with argon laser phototherapy and cryotherapy if symptomatic - Bright red on gross examination (well-circumscribed, benign, no invasion) - Renal cell carcinomas are clear cell carcinomas, patients also develop renal cysts - Pheochromocytomas manifest as excess adrenaline and tendency to be aggressive* VHL disease: mutated VHL disallows HIF1alpha to ubiquitinate and prevent angiogenesis, thus there is a proliferation of hemangioblastomas Watch Pheochromocytoma & NeuroblastomaWatch Adult CNS Tumors Watch Renal Cell Carcinoma & NephroblastomaWatch Primary Brain Tumors in AdultsReview von Hippel-Lindau (VHL)Cerebellar hemangioblastoma Cranial MRI (with contrast; axial view) A brightly enhancing, sharply delimited nodular mass (white arrow) with nonenhancing, cystic areas is visible within the right cerebellar hemisphere. These findings are consistent with cerebellar hemangioblastoma. Hemangioblastomas of the CNS in Von-Hippel-Lindau syndrome MRI imaging (contrast enhanced, T1w) in different planes Image A (cranial MRI, axial view) shows a tumor within the lateral aspect of the right cerebellum. It consists of a hyperintense part and a larger, hypointense part, the latter indicating a fluid-filled cyst. Image B (cranial MRI, sagittal view) shows a contrast-enhancing tumor between medulla oblongata and cerebellum, indicating a narrowing of foramen magnum. Image C (spine MRI, sagittal view) shows a hyperintense tumor within the spinal canal at the level of vertebra C5-C6. All of the hyperintense lesions are very likely to be vascular tumors (hemangiomas). The unusual, multiple occurrence within the CNS suggests a syndromal cause like Von-Hippel-Lindau syndrome. In this case, it can be assumed that the vascular tumors are hemangioblastomas. Hemangioblastoma Photomicrograph of cerebellar tissue (HPS stain; high magnification) Numerous polygonal neoplastic stromal cells with lipid-laden vacuoles can be seen (examples indicated by green arrowheads), resulting in the typical clear-cell appearance. Additionally, there is an abundance of small, thin-walled blood vessels, many of them densely packed together (examples indicated by green overlay). Diagnosis: cerebellar hemangioblastoma (WHO grade I) Hemangioblastoma Photomicrograph of a biopsy from a cerebellar mass (H&E stain) Numerous thin-walled capillaries (examples in yellow overlay) containing erythrocytes (red, biconcave structures) are visible throughout the image. Surrounding the capillaries are large stromal cells with multiple unstained intracytoplasmic lipid inclusions, which give them a foamy appearance (examples in blue overlay). This appearance is characteristic of hemangioblastoma. Atlas:y464e7ce1-3bb3-4751-8c81-e563079364e8
The characteristics of von Hippel-Lindau disease may be remembered with the mnemonic {{c1::HARP}}Hemangioblastomas (clumps of capillaries) - Form in the retina, brainstem, cerebellum, and/or spine - High vascularity with hyperchromatic nuclei - When occurs in the retina, can lead to retinal detachment, treat with argon laser phototherapy and cryotherapy if symptomatic - Bright red on gross examination (well-circumscribed, benign, no invasion) - Mutated VHL cannot ubiquitinate HIF1alpha for degradation and therefore cannot prevent angiogenesis → proliferation of hemangioblastomas Angiomatosis (e.g., cavernous hemangiomas in skin, mucosa, organs) Bilateral Renal cell carcinomas - Clear cell carcinomas - Patients also develop renal cysts Pheochromocytomas - Manifest as excess adrenaline and tend to be aggressiveWatch Pheochromocytoma & Neuroblastoma Watch Renal Cell Carcinoma & Nephroblastoma Watch Adult CNS TumorsReview von Hippel-Lindau (VHL)a7500201-684d-4c6e-beb2-172c38a3cf00
{{c1::Pinealoma}} is a tumor of the pineal glandWatch Pediatric CNS TumorsWatch Pediatric CNS TumorsReview PinealomaWatch associated Bootcamp video - Diencephalon: Other Disorders of the DiencephalonAtlas:b5ebdb98-f41f-4e22-9485-bffd27582e83
What virus commonly causes conjunctivitis? {{c1::Adenovirus}}Approximately 80% of cases of viral conjunctivitis are caused by adenovirusesWatch Adenovirus (Adenoviridae)Watch associated Bootcamp video - Approach to Virology: Comprehensive Virus Diagrams Watch associated Bootcamp video - DNA Viruses: AdenovirusAtlas:c78444d1-d31f-4e6f-b70b-be2de8d90666
Glaucoma is frequently associated with elevated {{c1::intraocular}} pressurevs. papilledema which occurs due to increased intracranial pressureWatch Anatomy of the EyeWatch GlaucomaAtlas:0660b699-55dc-43d0-8ad2-2324793b983a
{{c1::Countertransference}} is characterized by the doctor projecting feelings about formative or other important persons onto the patient"- e.g., patient reminds physician of younger sibling Example of transference: - When patient says ""He is short just like my dad"" Countertransference: - When doctor says ""My dad would say something like that"""Watch associated Bootcamp video04da75be-821e-4a4d-a84e-cbec9b269335
Which ego defense is defined as expressing unacceptable feelings and thoughts through actions? {{c1::Acting out (immature defense)}}- This includes attention seeking behavior and socially inappropriate behavior - e.g., tantrums, child with sick parents misbehaves at school, adolescent engages in promiscuous sex during parents' divorceWatch associated Bootcamp video4b982bb3-30b8-4e5b-b87b-731e2ebf02db
Which ego defense is defined as redirection of emotions / impulses to a neutral person or object? {{c1::Displacement (immature defense)}}e.g., a teacher is yelled at by the principal; she then goes home and criticizes her husband's dinner selection rather than confronting the principalWatch associated Bootcamp video5a262184-f1ad-4e08-82f1-d64b66e32832
Which ego defense is defined as believing that people are either all good or all bad at different times due to intolerance of ambiguity? {{c1::Splitting (immature defense)}}e.g., a patient says that all the nurses are cold and insensitive but that the doctors are warm and friendlyWatch associated Bootcamp videoc80c0460-420f-47ad-ab30-3a1f2aa6438c
ADHD is treated with {{c1::stimulants}} ± {{c2::cognitive behavioral therapy (CBT)*}}- Behavioral interventions are first-line in patients ≤ 5 years old - Complete a cardiac history and physical prior to prescribing - e.g., methylphenidate; alternative non-stimulants include atomoxetine, guanfacine, clonidineWatch Amphetamine, Dexamphetamine, Lisdexamfetamine, MethylphenidateReview Clonidine & GuanfacineWatch associated Bootcamp video - Developmental Disorders : ADHD Watch associated Bootcamp video - Substance Misuse : Amphetaminese4ed77d0-8bd9-4784-b8dd-6b928364a944
{{c2::Brief psychotic}} disorder is symptoms of schizophrenia lasting {{c1::< 1 month::duration}} with ≥ 1 {{c3::positive}} symptomWatch Schizophrenia & Related DisordersWatch associated Bootcamp video - Psychotic and Mood Disorders: Schizophrenia4c3855d6-6a15-484a-816a-41c04524ec35
Benzodiazepines exert their effects via binding to an allosteric site on the {{c1::GABAA}} receptorWatch Benzodiazepines & FlumazenilWatch associated Bootcamp video - Substance Misuse: Benzodiazepines Watch associated Bootcamp video - Seizures: Status Epilepticusda660a47-f487-4b0f-9329-7e32420eeac6
Benzodiazepines {{c1::enhance::enhance or inhibit}} the action of GABAABy increasing the frequency of chloride channel openingWatch Benzodiazepines & Flumazenil Watch Agonists, Antagonists, Allosteric ModulatorsWatch associated Bootcamp video - Substance Misuse: Benzodiazepines Watch associated Bootcamp video - Neurotransmitter Activity in Psychiatric Disease: Acetylcholine, Dopamine, Norepinephrine, Serotonin, and GABA Watch associated Bootcamp video - Seizures: Status Epilepticus Watch associated Bootcamp video - Conduction Physiology: Ion Channel Inhibitors and Activatorsf2efc110-29d5-404e-8ac3-748bb1b68cc0
{{c1::Benzodiazepines}}, {{c2::barbiturates}}, and {{c3::alcohol}} all bind different allosteric sites of the GABAA receptorWatch Benzodiazepines & FlumazenilWatch associated Bootcamp video - Substance Misuse: Benzodiazepines Watch associated Bootcamp video - Substance Misuse: Alcohol Withdrawala01a3c99-3442-4c14-bb64-098f01ea7255
{{c1::Bipolar I}} disorder is defined by presence of at least 1 manic episode ± a hypomanic episode or depressive episodeThese may be separated by any length of timeWatch Bipolar I DisorderWatch associated Bootcamp video - Psychotic and Mood Disorders : Bipolar Disorder5f732870-8c01-45eb-b1f2-14ce32c1a2c2
{{c2::Ketamine}} is an IV anesthetic that exerts its effect via inhibition of {{c1::NMDA}} receptorsWatch IV Anestheticsff875c9b-7b4b-40f5-b57a-a9cab0abd3a1
"Ketamine (an arylcyclohexylamine) is a PCP analog that causes ""{{c1::dissociative}} anesthesia"""The patient's eyes remain open with a slow nystagmic gazeWatch IV Anesthetics10e0ef75-e99d-4a7a-8c44-fe68fe9f53ec
{{c1::Ketamine}} is an IV anesthetic that can cause disorientation, hallucinations, and unpleasant dreamsWatch IV Anesthetics4d4ff7e4-7297-4daa-a27b-499101d3ebc4
Which S. aureus toxin nonspecifically binds MHC-II (on APCs) and the T-cell receptor producing cytokine storm and toxic shock? {{c1::Toxic shock syndrome toxin (TSST-1) superantigen}}Watch Staph aureusWatch associated Bootcamp video - Staphylococcus: Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Infectious Dermatologic Disease: Systemic Infectious Dermatologic Pathology (Toxic Shock Syndrome, SSSS, Necrotizing Fasciitis)2f1f24ec-8577-4e17-a94c-ae9e72f61cff
Toxic shock syndrome is commonly caused by {{c1::leaving gauze, sutures, or tampons in for too long::what objects?}}Treatment: remove the culprit, give abx, fluidsWatch Staph aureusWatch Postoperative Surgical Fevers Watch Debridement OverviewWatch associated Bootcamp video - Staphylococcus: Staphylococcus Aureus Toxins, Disease, Antibiotics Watch associated Bootcamp video - Infectious Dermatologic Disease: Systemic Infectious Dermatologic Pathology (Toxic Shock Syndrome, SSSS, Necrotizing Fasciitis)0c01097c-8b29-41cb-805b-8a19077a07f7
MRSA obtains methicillin resistance by altering {{c1::penicillin-binding proteins (PBPs)}}Methicillin-resistant Staphylococcus aureusWatch Staph aureusWatch associated Bootcamp video - Staphyloccous: Antibiotic Resistant Strains of Staph Aureus Watch associated Bootcamp video - Antibiotics: Antipseudomonal Penicillins428cb1d5-c0c8-45cc-804c-bb1837a2fde3
Most opioid analgesics cause {{c1::miosis::pupil size}}Meperidine is the opioid that causes mydriasis instead of miosisWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Substance Misuse: Opioidsff9545f4-6015-4e84-b7bd-d28bf9a9d3f9
{{c1::Methadone}} is a long-acting μ-receptor agonist used to attenuate opioid withdrawal symptoms- Also is an NMDA antagonist → makes it good for neuropathic pain - Risk of QT prolongationWatch Opioids, Naloxone, NaltrexoneWatch associated Bootcamp video - Substance Misuse: Opioid Classification730603d9-f7ae-4c79-962c-6aed515e20c4
"{{c1::Factitious}} disorders are when a patient {{c2::consciously*::consciously/unconsciously}} creates physical and/or psychological symptoms in order to assume a ""sick role"" and get medical attention and sympathy (primary/internal gain)"*The goal is to get medical attention and sympathy (primary gain) even though the motivation is unconsciousWatch associated Bootcamp video Sleep and Psychosomatic Conditions : Disorders of Deception918893d6-5e92-4559-8cff-d6a6d27929ba
Factitious disorder imposed on self is more common in {{c1::females::sex}} and {{c2::healthcare workers}}Also known as Munchausen syndromeWatch associated Bootcamp video Sleep and Psychosomatic Conditions : Disorders of Deception1ca150e6-6b16-4ca7-a534-b5cf60c7eed6
{{c1::Somatic symptom}} disorder is characterized by various medically unexplained bodily complaints lasting for months and years with persistent thoughts/anxiety about symptomsPatient complains of medical symptom that has no medical basisPatient believes there is something wrong (they are mistaken)Patient is lying and knows there is nothing wrongConversion disorder (stress leads to motor or sensory alteration)Factitious disorder (faking sick because they crave the sick role)Somatic symptom disorder (many unexplained complaints)Malingering (lies for gain)Illness anxiety disorder (mild/nonexistent symptoms cause fear of serious illness)Watch associated Bootcamp video - Sleep and Psychosomatic Conditions : Disorders of Somatization and Hypochondriasisd9364535-e325-453a-a175-105dbb00a211
What drug class do fluoxetine and paroxetine belong to? {{c1::SSRIs}}Watch SSRIs, SNRIs, CyproheptadineWatch associated Bootcamp video - Pharmacology: SSRIs67e84969-fdbc-4009-a306-e29e7ef70419
Tricyclic antidepressants (TCAs) may cause {{c1::anticholinergic}} side effects, such as tachycardia, urinary retention, dry mouth, and confusionWatch Tricyclic AntidepressantsWatch associated Bootcamp video - Pharmacology: Tricyclic Antidepressants Watch associated Bootcamp video - Side Effects and Toxins: Age Considerations for Pharmacokinetics06fecd84-12cb-400e-ac91-000e03e5e4c9
Which tricyclic antidepressant has the most anticholinergic effects? {{c1::Amitriptyline (tertiary amine)}}May be a useful side effect in Parkinson disease patients (helps to restore cholinergic-dopaminergic balance)Watch Tricyclic AntidepressantsWatch associated Bootcamp video - Pharmacology: Tricyclic Antidepressants4b2515fc-9c84-4776-ac6d-a0360b39acef
Which neurotransmitter(s) are broken down by monoamine oxidase A (MAO-A)? {{c1::Serotonin, norepinephrine, and dopamine}}MAO-B breaks down dopamine onlyWatch MAO Inhibitors Watch Catecholamine Synthesis DegradationWatch associated Bootcamp video - Pharmacology: MAOIs9c4637ed-0c45-42e9-ab9d-766cf727036d
What type of diabetes is associated with lithium use? {{c1::Nephrogenic diabetes insipidus}}- Lithium antagonizes the action of ADH in the collecting tubules - Note: Nephrogenic diabetes insipidus has been renamed arginine vasopressin resistance (AVP-R)Watch Diabetes Insipidus & SIADH Watch LithiumWatch associated Bootcamp video - Psychotic and Mood Disorders : Bipolar Disorder Watch associated Bootcamp video - Pharmacology : Lithium Watch associated Bootcamp video - Hypothalamus : Diabetes Insipidus7b72c6cb-6466-4d9c-ac0d-8560460b7097
Carbamazepine is a(n) {{c2::inducer}} of {{c1::cytochrome P450}} and thus may have many drug interactionsWatch Carbamazepine, Oxcarbazepine, Phenytoin, Tiagabine, VigabatrinWatch associated Bootcamp video - Seizures: Antiepileptic Medications Watch associated Bootcamp video - Pharmacokinetics: Cytochrome P450 Interactionsd951dd3e-316a-41cf-a6f3-37e7bfb5d873
Which personality disorder is characterized by voluntary social withdrawal with limited emotional expression? {{c1::Schizoid personality disorder (cluster A)}}Schizoid avoids relationshipsWatch Overview of Personality Disorders (WWW)Watch associated Bootcamp video Personality Disorders : Cluster A Personality Disorders605d8867-3a32-4860-abff-0fb744b50cc0
Which personality disorder is characterized by eccentric appearance, interpersonal awkwardness, and odd beliefs/magical thinking? {{c1::Schizotypal personality disorder (cluster A)}}Schizotypal has 'o'dd types of thoughtsWatch Overview of Personality Disorders (WWW)Watch associated Bootcamp video Personality Disorders : Cluster A Personality Disorders2902d07d-da92-4686-98b7-53202ae59318
Which personality disorder is characterized by impulsivity, criminality, and disregard for/violation of rights of others with lack of remorse? {{c1::Antisocial personality disorder (cluster B)}}Watch Overview of Personality Disorders (WWW)Watch associated Bootcamp video - Personality Disorders : Cluster B Personality Disorders4dd8b4b7-1aab-4c4a-8056-109ae6feccd6
Which personality disorder is characterized by unstable mood and relationships and a sense of emptiness? {{c1::Borderline personality disorder (cluster B)}}Watch Overview of Personality Disorders (WWW)Watch associated Bootcamp video - Personality Disorders : Cluster B Personality Disorders"On the ""border"" → breaking up & getting back together often"c93ada5d-c167-4fa3-b80c-f1cc74132716
Which cluster B personality disorder has a high rate of self-mutilation and suicide? {{c1::Borderline personality disorder}}Watch Overview of Personality Disorders (WWW)Watch associated Bootcamp video - Personality Disorders : Cluster B Personality Disorders110a21a6-c425-4a2f-a6b8-3ea2453aeea4
Anorexia nervosa/strenuous exercise is associated with {{c1::amenorrhea}} in females due to loss of pulsatile GnRH secretionFunctional hypothalamic amenorrheaWatch associated Bootcamp video - Anxiety, Trauma, and Stress Disorders: Eating Disorders36ae67a9-b3f0-4872-9ef8-1b1bc691cbd4
Which eating disorder is associated with functional hypothalamic amenorrhea and lanugo? {{c1::Anorexia nervosa}}- Loss of GnRH due to loss of fat (decreased leptin) leads to decreased LH/FSH → amenorrhea - Functional hypothalamic amenorrhea is also seen in competitive athletes, dancers, fashion models, others who maintain very low body weights Photo credit: Raumka, CC0, via Wikimedia CommonsWatch AmenorrheaWatch associated Bootcamp video - Anxiety, Trauma, and Stress Disorders: Eating Disorders4fd4a611-c104-4982-bf97-e60400fe8a4f
Which eating disorder is associated with bilateral parotid gland hypertrophy, enamel erosion, and normal to slightly-elevated weight? {{c1::Bulimia nervosa}}- Bulimia nervosa: presence of inappropriate compensatory behavior(s) - Binge-eating disorder: no compensatory behavior(s) Enamel erosion on the inside of the upper teeth imaged below; can increase risk for dental caries Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Anxiety, Trauma, and Stress Disorders: Eating Disorderseccce243-2a28-404c-adcd-cd42510f607f
Which stage of change is characterized by not yet acknowledging that there is a problem? {{c1::Precontemplation}}Watch associated Bootcamp video66a09283-1778-4919-b519-ba6c6b6cfd88
Which stage of change is characterized by acknowledging there's a problem, BUT not yet ready or willing to make a change? {{c1::Contemplation}}Watch associated Bootcamp videoe237f1fe-a92f-4f1c-9ff4-11fa2eebeee7
What drug intoxication presents as violence, psychomotor agitation, analgesia, and nystagmus? {{c1::Phencyclidine (PCP)}}- Patients initially may appear catatonic and rigid (PCP is a sedative hypnotic / dissociative anesthetic that generally acts as a downer), but these patients can quickly become violent and have superhuman strength - MOA: blocks NMDA receptors and inhibits reuptake of dopamine, NE, 5HT = SNS effects (like stimulants) - Also may present with impulsivity, tachycardia, hypertension, psychosis, delirium, and seizuresWatch Hypertensive Emergency SOAPWatch associated Bootcamp video -Substance Misuse: Phencyclidine442b486d-d42f-4c7a-b947-11c4541bd60f
Indirect cholinomimetics exert their effects via inhibition of the enzyme {{c1::acetylcholinesterase (AChE)}}e.g., neostigmine, pyridostigmine, physostigmine, edrophoniumWatch Acetylcholinesterase InhibitorsWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Autonomic System : Cholinomimetics - Anticholinesterasesaf4c934a-170d-45ae-a8fe-e991ea014832
{{c1::Organophosphates}} are a type of {{c3::acetylcholinesterase}} inhibitor found in many {{c2::insecticides}}- e.g., parathion, malathion, echothiophate - Malathion is also used to treat lice - Per UWorld: colorless, tasteless, fruity odor gas that has been used as a chemical weaponWatch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDxWatch Bradycardia Workup & ManagementWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Neuromuscular Junction (NMJ): Medications Targeting the NMJ Watch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning Watch associated Bootcamp video - Side Effects and Toxins : Pharmacological Toxicity and Treatmentd6d1a56d-6c20-46c3-a8a3-bf8b31941d87
Parathion, malathion, and echothiophate are all examples of {{c1::organophosphates}}Watch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDx Watch Bradycardia Workup & ManagementWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning5b14e2a5-a4c2-44f9-97dc-a158de375e18
What demographic is associated with organophosphate poisoning? {{c1::Farmers}}Migrant workers as wellWatch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDx Watch Bradycardia Workup & ManagementWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Neuromuscular Junction (NMJ): Medications Targeting the NMJ Watch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning736abd38-35eb-49e2-ba10-bfec5cf61777
Organophosphate toxicity may be treated with {{c1::atropine}}, which is a competitive inhibitor at {{c2::muscarinic}} receptors onlyTreat with atropine first because pralidoxime can cause transient inhibition of AChEWatch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDxWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Neuromuscular Junction (NMJ): Medications Targeting the NMJ Watch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning Watch associated Bootcamp video - Side Effects and Toxins : Pharmacological Toxicity and Treatment6d21d0cc-f439-4ab0-8d42-cde5c4a1502e
What drug class does donepezil belong to? {{c1::Acetylcholinesterase inhibitor}}Watch Acetylcholinesterase InhibitorsWatch Dementias DDxWatch Alzheimer's Disease Medications Watch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Autonomic System : Cholinomimetics - Anticholinesterasesc0b94aae-1ea3-40e2-b627-374abb1e91fa
What is the clinical use for galantamine, rivastigmine, and donepezil? {{c1::Alzheimer disease}}- Improves cognitive function, but doesn't alter the disease course - Side effects include nausea, dizziness, insomniaFirst Aid Pharmacology: Neuro/PsychWatch Dementias DDxWatch Alzheimer's Disease MedicationsWatch associated Bootcamp video - Dementia : Alzheimer Dementia Watch associated Bootcamp video - Autonomic System : Cholinomimetics - Anticholinesterasesf3728de5-6f7e-4fad-9698-e0f1559bcc86
Tubocurarine is a(n) {{c1::non-depolarizing::depolarizing or non-depolarizing}} neuromuscular blocking agentWatch Acetylcholinesterase InhibitorsWatch Acetylcholinesterase Inhibitors7106ca88-6ec7-467f-8fc5-9cbd6a96fddc
The non-depolarizing neuromuscular blocking agents are competitive {{c1::ACh}} receptor {{c2::antagonists}}- e.g., atracurium, tubocurarine, vecuronium, etc. - Specifically, NM receptorsWatch Acetylcholinesterase InhibitorsWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Neuromuscular Junction (NMJ): Botulinum Toxin0de2eedc-0bb1-4c22-9bde-e11bf949b7fa
Baclofen exerts its effects by {{c2::activation}} of {{c1::GABAB}} receptors at the spinal cord level, causing muscle {{c3::relaxation}}- GABAB receptors mediate their actions using G proteins unlike GABAA which are ion channels - Baclofen for GABABFirst Aid Pharmacology: Neuro/PsychWatch Skeletal Muscle RelaxantsWatch Approach to Chronic Back Pain & Opioid Use2356d555-50b9-4abe-8cbe-2393d0ef6604
Baclofen is used to treat muscle spasms (e.g., acute low back pain) and {{c1::multiple sclerosis (spasticity)}}First Aid Pharmacology: Neuro/PsychWatch Skeletal Muscle RelaxantsWatch Approach to Chronic Back Pain & Opioid Useb6c1a249-2b39-4bda-b018-4bd3ac31be99
{{c1::Cohort}} studies are observational studies that compare groups with a given exposure or risk factor to a group without such exposure- Looks to see if exposure or risk factor is associated with later development of disease or prognosis of a disease - Can be either retrospective or prospective Aim: Study of the incidence rate and whether a certain exposure is associated with the outcome of interest Study method: 1. Gather participants with common characteristics 2. Classify them into two groups: exposed and unexposed 3. Compare the incidence of the outcome of interest between the two groupsWatch Cohort StudiesWatch associated Bootcamp video - Research Study Designs: Longitudinal StudiesOther:b0da576b-78ea-45f1-8d3e-041b21de5c59
Which type of observational study can be retro- or prospective? {{c1::Cohort study}}Watch Cohort StudiesWatch associated Bootcamp video - Research Study Designs: Longitudinal StudiesOther:f2c7c6c4-6d1d-4768-b8b6-7bfb9753e46e
Phase {{c1::I}} of clinical trials uses a small number of healthy volunteers or patients with disease of interestAssesses safety, toxicity, pharmacokinetics, and pharmacodynamics Mnemonic: I SWIMWatch Clinical Trials & Drug-Approval ProcessWatch associated Bootcamp video - Research Study Designs: Experimental StudiesOther:f1befa9f-3f1e-4bc0-88d3-d465ac9dcaba
{{c1::Sensitivity}} is the probability that when the disease is present, the test is positive- i.e. the proportion of all people with disease who test positive (true-positive rate) - Sensitivity = \(\frac{True Positives}{True Positives + False Negatives}\) - PPV and NPV use the prevalence of a disease to determine the likelihood of a test diagnosing that specific disease, whereas sensitivity and specificity are independent of prevalence - SPINWatch Sensitivity & SpecificityWatch associated Bootcamp video - Diagnostic Tests: Sensitivity and Specifictyd557777c-beb6-4c35-81d9-38938c60034b
{{c1::Specificity}} is the probability that when the disease is absent, the test is negative- i.e. the proportion of all people without disease who test negative (true-negative rate) - Specificity = True Negatives/(True Negatives + False Positives) - Sensitivity = True Positives/(True Positives + False Negatives) - PPV and NPV use the prevalence of a disease to determine the likelihood of a test diagnosing that specific disease, whereas sensitivity and specificity are independent of prevalence - SPINWatch Sensitivity & SpecificityWatch associated Bootcamp video - Diagnostic Tests: Sensitivity and Specifictya358efe0-34ef-4819-bb3a-f859641af616
{{c1::Positive predictive value}} is the probability that when the test is positive, the disease is present- i.e. probability that person who has a positive test actually has the disease (if the test result is positive, what is the probability that a patient has the disease) - PPV = True Positives/(True Positives + False Positives)Watch Sensitivity & SpecificityWatch associated Bootcamp video - Diagnostic Tests: Positive and Negative Predictive Valuesf6b9366e-3ee7-4abb-8dd8-97f865379e63
{{c2::Positive::+ / -}} predictive value varies {{c1::directly::inversely / directly}} with pretest probability (prevalence)- i.e., high pretest probability (prevalence) = high PPV - Think about an 80 y.o. and 20 y.o. getting an abnormal ECG, the PPV for the 80 y.o. if the test is (+) is more likely to be true positive because prevalence of heart problems is higher in old people!Watch Sensitivity & SpecificityWatch associated Bootcamp video - Diagnostic Tests: Positive and Negative Predictive Values10ad893e-7315-4731-9ac1-eeadc2b0bc4e
When lowering the cutoff point for a disease, the {{c2::sensitivity}} and {{c2::NPV}} will {{c1::increase::increase / decrease}}"- i.e. lowering the blood glucose cutoff level for which a patient is diagnosed Raise cutoff point: Will increase things with ""p"" in the word (p for +, like raising) - Specificity and PPV increase, and the opposite is the case for Sensitivity/NPV"Watch associated Bootcamp video - Diagnostic Tests: Diagnostic Test Thresholds56a711a9-4a65-42d6-b141-7b9ccee5f55e
When lowering the cutoff point for a disease, the {{c2::specificity}} and {{c2::PPV}} will {{c1::decrease::increase or decrease}}"- i.e. lowering the blood glucose cutoff level for which a patient is diagnosed Raise cutoff point: Will increase things with ""p"" in the word (p for +, like raising) - Specificity and PPV increase, and the opposite is the case for Sensitivity/NPV"Watch associated Bootcamp video - Diagnostic Tests: Diagnostic Test Thresholdsda9eb598-d95e-43f3-8613-a48bf6f01235
When raising the cutoff point for a disease, the {{c2::sensitivity}} and {{c2::NPV}} will {{c1::decrease::increase or decrease}}"- i.e. raising the blood glucose cutoff level for which a patient is diagnosed Raise cutoff point: Will increase things with ""p"" in the word (p for +, like raising) - Specificity and PPV increase, and the opposite is the case for Sensitivity/NPV"Watch associated Bootcamp video - Diagnostic Tests: Diagnostic Test Thresholdsd91dc5ed-b13b-4a4e-821f-63ed23c39717
When raising the cutoff point for a disease, the {{c2::specificity}} and {{c2::PPV}} will {{c1::increase::increase / decrease}}"- i.e., raising the blood glucose cutoff level for which a patient is diagnosed - Raise cutoff point: Will increase things with ""p"" in the word (p for +, like raising) - Specificity and PPV increase, and the opposite is the case for Sensitivity / NPV"Watch associated Bootcamp video - Diagnostic Tests: Diagnostic Test Thresholdsa03f651b-7298-46d2-89ae-ff0f45742d36
{{c1::Absolute}} risk reduction is the difference in risk attributable to an intervention compared to a control"Also called the risk difference (RD) ARR Example: If 10% of people who receive a placebo vaccine develop flu vs 3% of people who get the real flu vaccine, ARR = 10% - 3% = 7% = 0.07 ARR = ERcontrol - ERtreatment ER = event rate = (# events / # of subjects) RRR = the proportion of risk reduction attributable to an intervention as compared to a control"Watch Relative Risk, RRR & ARRWatch associated Bootcamp video - Risk Quantification: Additional Calculations with Relative Risk468470bb-8648-408a-b140-58f98d25c91c
If 2% of patients who receive a flu shot develop the flu, while 8% of unvaccinated patients develop the flu: Absolute risk reduction = {{c1::6% (.06)}}"ARR = ERcontrol - ERtreatment ER = event rate = (# events / # of subjects)"Watch Relative Risk, RRR & ARRWatch associated Bootcamp video - Risk Quantification: Additional Calculations with Relative Riskaf121fd0-024d-4d58-9d9a-f5f41758547f
The number needed to treat (NNT) is equal to {{c1::\(\frac{1}{ARR}\)}}- i.e., the number of patients who need to be treated for 1 patient to benefit; lower number = better treatment - Absolute risk reduction is the difference in risk attributable to an intervention compared to a control (Control group event rate - Experimental group event rate) Example: If 10% of people who receive a placebo vaccine develop flu vs. 3% of people who get the real flu vaccine ARR = 10% - 3% = 7% = 0.07 NNT = 1/0.07 = 14.3Watch NNT & NNHWatch associated Bootcamp video - Risk Quantification: Additional Calculations with Relative Riskcda01cbb-3c46-4841-9e59-29490b2e8ea7
{{c1::Gilbert}} syndrome is due to {{c2::mildly low}} UDP-glucuronosyltransferase activityLeading to isolated increase in unconjugated (indirect) bilirubin Photo credit: Michlwt, CC BY-SA 4.0, via Wikimedia CommonsWatch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch Abnormal Liver Labs DDx Watch Neonatal Jaundice OverviewWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Jaundice Watch associated Bootcamp video - Pharmacokinetics : Drug Eliminationed379685-ac60-43d6-9184-7d00f28ad372
Does Gilbert syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Unconjugated}}Watch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch Abnormal Liver Labs DDx Watch Neonatal Jaundice OverviewWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Jaundice2c98b200-5979-4d84-8e6f-747b74de332a
Does biliary tract obstruction (obstructive jaundice) result in unconjugated or conjugated hyperbilirubinemia? {{c1::Conjugated}}- Bile builds up in hepatocytes and eventually leaks out - Thus, contents of bile are increased in the bloodWatch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch Abnormal Liver Labs DDx Watch Choledocholithiasis Watch Neonatal Jaundice OverviewWatch associated Bootcamp video - Physiology : Bilirubin Watch associated Bootcamp video - Pancreatic and Biliary Pathology : Jaundiced49c8614-bbc3-46e2-af66-329233f4ec3f
Obstructive jaundice is associated with dark urine due to the presence of {{c1::conjugated bilirubin}} in urineNot urobilinogen, as with hemolysis, because less bile is entering the duodenumWatch Lab Evaluation of Liver Injury & HyperbilirubinemiaWatch Pancreatic Cancer Watch Surgery Hepatocellular Carcinoma Watch Internal Medcine Hepatocellular Carcinoma Watch Choledocholithiasis Watch Abnormal Liver Labs DDxWatch associated Bootcamp video - Physiology : Bilirubin Watch associated Bootcamp video - Pancreatic and Biliary Pathology : Benign Biliary Disorders Watch associated Bootcamp video - Pancreatic and Biliary Pathology : Jaundice9c0a6cf9-fbb5-4c27-bb12-e0458732ec8e
Cirrhosis may present with peripheral edema secondary to {{c1::hypoalbuminemia}}Cirrhosis = ↓ albumin production by liver = ↓ oncotic pressure = ↑ edema (fluid out)* due to decreased synthesis of albumin (impaired synthetic function of liver) Watch Cirrhosis Pathogenesis & Clinical ManifestationsWatch Cirrhosis SOA Watch Abnormal Liver Labs DDx Watch Chronic Liver Disease DDx Watch Surgery Hepatocellular Carcinoma Watch Internal Medcine Hepatocellular CarcinomaWatch associated Bootcamp video - Hepatic Pathology : Cirrhosis Watch associated Bootcamp video - Positive-sense RNA Viruses : Hepatitis C Part 1 (Pathogenesis and Disease)da90c3e1-847e-4a72-90b7-01e118634bde
Which alcoholic liver disease is characterized by macrovesicular fatty change with a heavy, greasy liver? {{c1::Hepatic steatosis}}- This is primarily caused by a decrease in free fatty oxidation secondary to excess NADH production by alcohol dehydrogenase / aldehyde dehydrogenase; contributing factors include impaired lipoprotein assembly / increase in peripheral fat catabolism - In frozen tissue sections, lipids can be demonstrated by staining with oil red O or Sudan black Photo credit: Calicut Medical College, CC BY-SA 4.0, via Wikimedia Commons* versus Reye's syndrome, which presents with microvesicular fatty change Watch Alcoholic & Non alcoholic Fatty Liver DiseaseWatch associated Bootcamp video - Hepatic Pathology : Alcoholic Hepatitis and NASHAtlas:a043036a-f469-4745-ab1f-6d642581ad1b
{{c1::Non-alcoholic fatty}} liver disease is associated with obesity and metabolic syndromeRecently changed to metabolic dysfunction-associated steatotic liver disease (MASLD)Watch Alcoholic & Non alcoholic Fatty Liver DiseaseWatch Chronic Liver Disease DDxWatch associated Bootcamp video - Hepatic Pathology : Alcoholic Hepatitis and NASHAtlas:2103d906-b785-4a36-85fa-5cb811666287
{{c2::Primary biliary}} cholangitis is associated with {{c1::anti-mitochondrial}} antibodiesWatch Abnormal Liver Labs DDx Watch Chronic Liver Disease DDxWatch Primary Biliary Cholangitis & Primary Sclerosing CholangitisWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Benign Biliary DisordersAtlas:863f8e7e-42b6-424e-a084-422fb543fb10
{{c2::Reye}} syndrome is fulminant liver failure and encephalopathy in children with viral illness who take {{c1::aspirin}}- Thus, avoid aspirin in children, except for Kawasaki disease - Importantly, avoid bismuth subsalicylate (Pepto-Bismol) in pediatric patients which contains aspirin (salicylate) as a main ingredient!Watch Alcoholic & Non alcoholic Fatty Liver DiseaseWatch Vaccination Schedule 1 Watch Varicella InfectionsWatch Antidiarrheal AgentsWatch associated Bootcamp video - Hepatic Pathology : Drug-Induced Hepatic Pathology Watch associated Bootcamp video - Pharmacology : Acetaminophen Watch associated Bootcamp video - Pharmacology : Aspirin & Celecoxib Watch associated Bootcamp video - DNA Viruses: Varicella-Zoster Virus: Diagnostics and Management Watch associated Bootcamp video - Platelets: Antiplatelet Medications Watch associated Bootcamp video - Vasculitides: Kawasaki DiseaseAtlas:9bb40508-a0bf-4690-b851-55cb0b769ec6
"The {{c1::retroperitoneal structures}} may be remembered with the mnemonic ""SAID PUCKER"": {{c1::Suprarenal (adrenal) glands::S}} {{c1::Aorta::A}} {{c1::IVC::I}} {{c1::Duodenum (2nd through 4th part)::D}} {{c1::Pancreas (except tail)::P (except...)}} {{c1::Ureters::U}} {{c1::Colon* (ascending and descending)::C}} {{c1::Kidneys::K}} {{c1::Esophagus (thoracic portion)::E}} {{c1::Rectum (partially)::R}}"- Includes GI structures that lack a mesentery and non-GI structures- *Surgeons consider these intraperitoneal Structures become retroperitoneal two ways: - Develop without a posterior peritoneum against the posterior body wall and only have an anterior peritoneum - Develop as an intraperitoneal organ with a mesentery, and then move / are pushed back (like the pancreas (except tail), the 2nd to 4th part of the duodenum, and the ascending/descending colon) against the posterior abdominal wall and fuse with the body wall (secondarily retroperitoneal)Watch Intraperitoneal & Extraperitoneal OrgansWatch Blunt Abdominal Trauma: Management of Retroperitoneal Injuries Watch Penetrating Thoracic & Abdominal TraumaWatch associated Bootcamp video - Visceral Anatomy : Gross Anatomyyc0cad631-b0a9-4ec7-8f7e-69f4c7170ec6
The {{c2::gastrohepatic}} ligament separates the greater and lesser sacs on the {{c1::right::left or right}}Whereas the gastrosplenic ligament separates the greater and lesser sacs on the left Image licensed by Physeo and used with permission. Purchase full access here. Black arrow below Photo credit: Olek Remesz (wiki-pl: Orem, commons: Orem), CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Visceral Anatomy : Gross Anatomyae0fbf7e-aea8-496f-9b05-42afcc1f103d
The {{c2::gastrosplenic}} ligament separates the greater and lesser sacs on the {{c1::left::left or right}}Whereas the gastrohepatic ligament separates the greater and lesser sacs on the right Image licensed by Physeo and used with permission. Purchase full access hereWatch associated Bootcamp video - Visceral Anatomy : Gross Anatomy2eacec64-a385-42a4-bf29-338d9b915dea
The {{c2::chief::chief or parietal}} cells of the stomach stain {{c1::baso}}philic- CHIEFs need to report at BASe - Chief cells secrete pepsinogen (which self-cleaves to pepsin at gastric pH), pepsin helps begin digestion of proteins - Primarily found in the deeper gastric glands Photo credit: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: NoneMikael Häggström, M.D., CC0, via Wikimedia Commons Photo credit: Jpogi at English Wikipedia, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Visceral Anatomy : Esophagus and Stomach Watch associated Bootcamp video - Physiology : Gastrointestinal SecretionsAtlas: Esophagus Stomach Small intestine Colon261ff381-ed62-444d-bc38-a359fd42375e
The {{c2::parietal::chief or parietal}} cells of the stomach stain {{c1::eosino}}philicThese cells are primarily found in the upper gastric glands; these cells make a lot of intrinsic factor (thus stain eosinophilic) **eosinophilic due to lots of mitochondria Photo credit: Mikael Häggström,, CC0, via Wikimedia Commons, modified by adding arrows Photo credit: Jpogi at English Wikipedia, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Visceral Anatomy : Esophagus and Stomach Watch associated Bootcamp video - Physiology : Gastrointestinal SecretionsAtlas: Esophagus Stomach Small intestine Colon8d359519-61fa-4c58-baf3-8d7fbcaeb959
What histologic feature distinguishes the jejunum from other parts of the small intestine? {{c1::Plicae circulares}}"- AKA valves of Kerckring - Displays a ""feathery"" appearance with oral contrast due to ↑ surface area - Note: plicae circulares may also be present in the distal duodenum and proximal ileum"Watch associated Bootcamp video - Visceral Anatomy : IntestinesAtlas: Esophagus Stomach Small intestine Colon22ee175a-5617-4c87-b07f-17953a336145
Which artery supplies the regions of the midgut? {{c1::Superior mesenteric artery}}Watch Abdominal Aorta & Branches Watch Superior Mesenteric ArteryWatch Acute Mesenteric & Colonic Ischemia: Presentation & Workup Watch Colectomy OverviewWatch associated Bootcamp video - Embryology : Physiologic Embryology Watch associated Bootcamp video - Visceral Anatomy : Blood Supply17a52756-fa97-441c-8f54-866aecfdc51e
The three branches of the celiac trunk are the {{c1::common hepatic}}, {{c2::splenic}}, and {{c3::left gastric}} arteriesPhoto credit: Dennis M DePace, PhD, CC BY-SA 4.0, via Wikimedia CommonsWatch Celiac TrunkWatch associated Bootcamp video - Visceral Anatomy : Blood Supply071e78b9-7877-4391-bdc3-bf1e27b42b05
ID Artery: {{c1::Splenic}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Celiac TrunkWatch associated Bootcamp video - Visceral Anatomy : Blood Supply489f7ef1-949f-4e0c-b150-fc0248dab36b
{{c2::Esophageal varices}} result from portosystemic shunting between the {{c1::left gastric}} (portal) and {{c1::esophageal branch of the azygos}} (systemic) veins- Esophageal branch of azygos → azygos → IVC / SVC - Left gastric → portal vein - If ruptured, manifests as painless bleeding, can cause massive hematemesis Photo credit: Hassan et al., CC BY 4.0, via CureusWatch Portal Circulation: Clinical CorrelatesWatch Acute Upper GI Bleed: Esophageal VaricesWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and Hemorrhoids5417d88a-b781-4f84-b2e3-01f69de424bb
{{c2::Anorectal varices}} result from portosystemic shunting between the {{c1::superior rectal}} (portal) and {{c1::middle/inferior rectal}} (systemic) veinsWatch Anorectal Disorders Watch Portal Circulation: Clinical CorrelatesWatch Acute Upper GI Bleed: Esophageal Varices Watch HemorrhoidsWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and Hemorrhoids98c14bfa-7589-4f65-8a3b-136b8f5a9d63
Which lymph nodes drain the rectum above the pectinate line? {{c1::Internal iliac nodes}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Anorectal CancerWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and Hemorrhoids37837197-edca-4a7e-9a53-6723381b451c
Does the rectum ABOVE the pectinate line drain into the portal or systemic circulation? {{c1::Portal}}Superior rectal vein → inferior mesenteric vein → splenic vein → portal vein Image licensed by Physeo and used with permission. Purchase full access here.Watch Anorectal Disorders Watch Portal CirculationWatch Anorectal CancerWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and Hemorrhoidseb7e8806-440f-40ee-bb23-2a29f8049d24
Which lymph nodes drain the rectum below the pectinate line? {{c1::Superficial inguinal nodes}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Anorectal CancerWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and Hemorrhoids924e5622-ed89-4e5a-9fe9-f5d12416eb84
Which type of hemorrhoid IS painful? {{c1::External hemorrhoids}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Anorectal DisordersWatch HemorrhoidsWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and HemorrhoidsAtlas:ccb58f2b-9c35-41c5-b0b7-e407d3fcd75f
Anal fissures typically present with pain while defecating and {{c1::blood}} on toilet paperWatch Anorectal DisordersWatch Anal Fissures61f4d7f2-add8-4c6b-96e0-2e2bb3d23e59
Anal fissures are associated with constipation and {{c1::low-fiber}} dietsWatch Anorectal DisordersWatch Anal Fissures2f914fbd-1854-45a5-9ad7-8f35afdcd235
Gallstones that reach the confluence of the common bile and pancreatic ducts at the {{c1::hepatopancreatic ampulla (ampulla of Vater)}} can block both ducts (double duct sign) causing cholangitis and pancreatitisWatch Gallbladder & Biliary Tract DiseaseWatch Acute Cholecystitis & Acute Cholangitis SOAPs Watch Acute Cholangitis Watch Choledocholithiasis Watch Acute Pancreatitis Watch Pancreatic Cancer Watch Upper Abdominal Pain DDx Watch Acute PancreatitisWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Gallstones292e9f9d-5a1b-4bff-9978-effca791e5bc
The {{c2::iso}}type of an antibody is determined by the {{c1::Fc::Fc or Fab}} regionConstant region, Carboxy terminal; determines class (e.g., IgG, IgM, etc.)Watch associated Bootcamp video - Antibodies: Antibody Structureeaea28b6-7d16-446d-a4db-e7f66f67f8e1
Antigen-independent antibody diversity in {{c1::heavy}} chains is generated by {{c2::V(D)J}} gene recombinationThus, when you compare DNA of the constant region of lymphocytes from the bone marrow to different organs, there will be far fewer types of constant regions as they will have undergone VDJ recombination into one specific type Image licensed by Physeo and used with permission. Purchase full access here.Watch Antibody Structure Watch Somatic Hypermutation and Affinity MaturationWatch associated Bootcamp video - Antibodies: Antibody Properties0419eb20-5d80-482b-9a77-d558105fbd2a
Which primary lymphoid organ is the site of T-cell differentiation and maturation? {{c1::Thymus}}Watch T-Lymphocyte Maturation and SelectionReview T Cells-DifferentationWatch associated Bootcamp video - Lymphoid Tissue: Primary Lymphoid Tissue2f85eb3c-5205-4cbc-b1f1-889cc1c51d3c
Which lymph node cluster drains the head and neck? {{c1::Cervical}}Patients with URTIs, infectious mononucleosis, Kawasaki disease will have cervical lymphadenopathyc9ba09ea-6361-4a93-88fd-83e21652c918
Which lymph node cluster drains the scrotum and vulva? {{c1::Superficial inguinal}}Scrotum and vulva are superficial on the body and are drained by superficial inguinal lymph nodes
Patients undergoing splenectomy should be vaccinated against {{c1::encapsulated}} organismse.g., pneumococcal, Hib, and meningococcal vaccinesWatch Secondary Lymphoid OrgansWatch Blunt Abdominal Trauma: Management of Peritoneal Injuries Watch Vaccination Schedule 2Watch Neisseria meningitidisWatch associated Bootcamp video - Lymphoid Tissue: Spleen Watch associated Bootcamp video - Infectious Neuropathology: Bacterial MeningoencephalitisAtlas:0f2c4513-b161-4761-bda9-92501a752a66
Which MHC class is associated with the gene products of HLA-DP, HLA-DQ, and HLA-DR? {{c1::MHC II}}"""MHC 2 loci have 2 letters"" Photo Credit: סתו כסלו, CC BY-SA 4.0, via Wikimedia Commons"Review MHC IIWatch associated Bootcamp video - Major Histocompatibility Complex Watch associated Bootcamp video - Transplant Rejection: Transplantation Principles5d9b12c9-aab7-44d9-8e98-98d25825676e
Which type of selection allows survival of T cells expressing TCRs capable of binding self-MHC on cortical epithelial cells? {{c1::Positive selection}}Watch T-Lymphocyte Maturation and SelectionReview T Cells-DifferentationWatch associated Bootcamp video - T-cells: T-cell Development4dab4bb2-9e2e-4952-b79e-776646320fe7
MHC {{c2::I}} presents {{c1::endogenously}} synthesized antigens to CD8+ cytotoxic T cellsPhoto credit: סתו כסלו, CC BY-SA 4.0, via Wikimedia CommonsWatch MHC molecules Watch Antigen Processing & Presentation to T-CellsReview Cytotoxic (Killer) T Cells Review MHC I Review T Cells-ActivationWatch associated Bootcamp video - Major Histocompatibility Complex Watch associated Bootcamp video - Innate vs Adaptive Immunity: Adaptive Immunity and Antigen Presentation Watch associated Bootcamp video - Cytokines: Proinflammatory Cytokines Watch associated Bootcamp video - Hypersensitivities: Type IV Hypersensitivity Reactions78e7c0a0-84e6-42fa-b53c-4bb77485b780
Antigen loading onto MHC II occurs following release of the {{c2::invariant chain}} in a(n) {{c1::acidified endosome}}Photo Credit: סתו כסלו, CC BY-SA 4.0, via Wikimedia CommonsWatch Antigen Processing & Presentation to T-CellsReview MHC IIWatch associated Bootcamp video - T-cells: Major Histocompatibility Complexa993322a-69b3-4e9e-85eb-1a13b34a8990
The second signal for T-cell activation is a costimulatory signal via interaction between {{c1::B7}} (APC) and {{c1::CD28}} (T cell)- B7 is also known as CD80/86 - Costimulatory signal for B-cell activation involves CD40/CD40L interactionWatch Cytotoxic T-cellsReview T Cells-ActivationWatch associated Bootcamp video - T-cells: T-cell Activation Watch associated Bootcamp video - B-cell Activation0e6ce4a7-a6d6-401e-9f6b-ce273628e678
{{c2::Natural killer}} cells are induced to kill cells that have an absence of {{c1::MHC I}} on their cell surfaceOr when exposed to a non-specific activation signal on target cells Photo credit: OpenStax, CC BY 4.0Watch The Innate Immune System's Response to VirusesReview Natural Killer (NK) CellsWatch associated Bootcamp video - T-cells: Major Histocompatibility Complex Watch associated Bootcamp video - Antivirals : Hepatitis B Antiviral Therapy Watch associated Bootcamp video - Basics of Virology : Host Defense6d0a73f0-f2ba-4750-bbc1-eb1fb07d08ab
Which type of vaccine has the potential to revert to a virulent form? {{c1::Live attenuated vaccines}}Thus often contraindicated during pregnancy and in immunocompromised patientsAvoid in immunocompromised!Watch Vaccination Schedule 1Watch associated Bootcamp video - Vaccinations: Live Attenuated Vaccines1627e9c7-a423-4a57-b83f-c522e1d5c808
Live attenuated vaccines are often contraindicated in {{c1::pregnancy}} and {{c2::immunodeficiency}}Due to potential to cause significant diseaseWatch OB Early Pregnancy & Prenatal Care Watch FM Early Pregnancy & Prenatal Care Watch Vaccination Schedule 1Watch associated Bootcamp video - Vaccinations: Live Attenuated Vaccines2b6fc7e5-524e-423d-8539-97ea60964b0b
What is an advantage of inactivated vaccines compared to live attenuated? {{c1::Inactivated vaccines are safer}}Watch Vaccination Schedule 1Watch associated Bootcamp video - Vaccinations: Live Attenuated Vaccines Watch associated Bootcamp video - Vaccinations: Whole Inactivated Vaccines2c8a4aad-0f67-4c10-83ad-43dfda3dd78f
Is primary CNS lymphoma typically a B-cell or T-cell neoplasm? {{c1::B-cell}}* Antibody archer in sketch Watch Non Hodgkin Lymphoma Watch Adult CNS TumorsWatch Primary Brain Tumors in Adults Watch Non-Hodgkin Lymphoma SOAPReview Primary CNS Lymphoma (PCNSL)Watch associated Bootcamp video - Adult Primary Brain Tumors: Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal MeningitisAtlas: Other:681c4619-701c-491f-937a-1bd831781d78
The pathogenesis of primary CNS lymphoma involves {{c1::EBV}} infectionUsually diffuse large B-cell typeWatch Adult CNS Tumors Watch Non Hodgkin LymphomaWatch Primary Brain Tumors in AdultsReview Primary CNS Lymphoma (PCNSL)Watch associated Bootcamp video - Adult Primary Brain Tumors: Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Localized Kaposi Sarcoma, Oropharyngeal Candidiasis, Oral Hairy Leukoplakia Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal Meningitis Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral LesionsAtlas: Other:555b036c-4f9a-43a0-b0ba-4ab26b081c54
The immediate response of mast cell and basophil activation is release of preformed {{c1::histamine}} granules and {{c2::tryptase::marker of activation}}- Causes vasodilation of arterioles and increased vascular permeability - Other preformed granules include heparin and eosinophil chemotactic factorWatch Cells of the Immune SystemReview Mast CellsWatch associated Bootcamp video - Hypersensitivities: Type I Hypersensitivity Reactions Watch associated Bootcamp video - Blood Cells: Mast Cell Watch associated Bootcamp video - Basophil6515f24a-bfa1-4ef3-8b7a-abb0fc395fa8
The delayed response of mast cell and basophil activation involves production of {{c2::chemokines}} (e.g., to attract eosinophils) and other proinflammatory mediators from mast cellsAllows for maintenance of the acute inflammatory response and results in inflammation / tissue damageWatch associated Bootcamp video - Hypersensitivity Reactions: Type I Hypersensitivity Reactions Watch associated Bootcamp video - Basophil Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology)5a7b3561-317b-4f18-866f-d9825737ac41
What type of hypersensitivity reaction is hyperacute transplant rejection? {{c1::Type II HSR (inflammation)}}Watch Type II/III Hypersensitivity ReactionsReview Hyperacute Transplant RejectionWatch associated Bootcamp video - Hypersensitivity Reactions: Type II Hypersensitivity Reactions Watch associated Bootcamp video - Transplant Rejection: Hyperacute Rejectionf59a6719-e817-4ba2-b649-6b277d8f628a
{{c1::Serum sickness}} is an immune complex disease in which antibodies to foreign serum proteins are produced- Immune complexes form and are deposited in membranes - Where they fix complement (leads to tissue damage) - Cleared by mononuclear phagocytesWatch Monoclonal Antibody TherapyWatch associated Bootcamp video - Hypersensitivity Reactions: Type III Hypersensitivity Reactions Watch associated Bootcamp video - DNA Viruses: Hepatitis B Virus: Pathogenesis and Clinical Manifestationse03c0317-70ab-4cd1-8ddc-35c997740ac3
Serum sickness presents with fever, urticaria, arthralgia, proteinuria, and lymphadenopathy {{c1::1}} - {{c1::2}} weeks after antigen exposure- These patients have low serum C3 and C4 levels - Most commonly caused by β-lactams and sulfa drugs - Symptoms typically resolve with withdrawal of the offending agent - Serum sickness-like reaction will be nearly identical, but fever is lowerWatch Monoclonal Antibody TherapyWatch associated Bootcamp video - Hypersensitivity Reactions: Type III Hypersensitivity ReactionsAtlas: most commonly caused by β-lactams and sulfa drugs; symptoms typically resolve with withdrawal of the offending agent3752fd09-464d-4e34-814c-cf771cebd44f
What type of hypersensitivity reaction is serum sickness? {{c1::Type III HSR (immune complexes)}}Immune complexes deposit in vessels → activate complement → neutrophils → vasculitis and fibrinoid necrosisWatch associated Bootcamp video - Hypersensitivity Reactions: Type III Hypersensitivity Reactionse9fd24f5-7178-495e-a02b-48514b580897
What type of hypersensitivity reaction is allergic contact dermatitis (e.g. poison ivy, nickel allergy)? {{c1::Type IV HSR (CD4 & CD8 mediated)}}"- Poison ivy produces urushiol, which covalently binds to proteins on keratinocytes - Sensitization phase: Langerhans cells uptake haptens (random skin proteins covalently bind urushiol), travel to draining lymph nodes, and interact with CD4+ / CD8 T cells (takes 10-14 days) - Following sensitization / re-exposure to urushiol, the hapten is taken up by skin cells (e.g. keratinocytes), which are targeted by CD8 CTLs Photo credit: #4484, via CDC PHIL; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC) Photo credit: Nunyabb at English WikipediaW, Public domain, via Wikimedia Commons"Watch Type IV Hypersensitivity ReactionWatch Approach to RashesWatch associated Bootcamp video - Hypersensitivities: Type IV Hypersensitivity Reactions Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Atopic and Allergic DiseasesAtlas:c8b94937-acae-4e02-a80f-2a27020fb4c3
What type of hypersensitivity reaction is graft-versus-host disease? {{c1::Type IV HSR (delayed-type hypersensitivity)}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Blood Transfusion ComplicationsReview Graft vs Host Disease (GVHD) Review Type 4 Hypersensitivity ReactionsWatch associated Bootcamp video - Hypersensitivity Reactions:Type IV Hypersensitivity Reactions Watch associated Bootcamp video - Graft vs Host Disease195a5740-56cb-45cd-8e96-f83e1efaec77
Which type of transplant rejection occurs within minutes? {{c1::Hyperacute}}Review Hyperacute Transplant RejectionWatch associated Bootcamp video - Transplant Rejection: Hyperacute RejectionAtlas:4fffa13f-48c1-4722-89a3-5e7ab6b7da81
Which type of transplant rejection is due to pre-existing recipient antibodies to donor antigen? {{c1::Hyperacute}}"""Antibody-mediated hypersensitivity"" (type II); antibodies subsequently result in complement activation"Review Hyperacute Transplant RejectionWatch associated Bootcamp video - Transplant Rejection: Hyperacute RejectionAtlas:653bd2ba-fbe1-4d47-a8ea-954f019ab5c3
Which type of transplant rejection presents with widespread thrombosis of graft vessels, causing ischemia/necrosis? {{c1::Hyperacute}}- Often seen while operating; graft must be removed - Due to antibody response against donor HLA class I moleculesReview Hyperacute Transplant RejectionWatch associated Bootcamp video - Transplant Rejection: Hyperacute RejectionAtlas:2c1008d7-d76a-46ce-ad63-b6aecb274984
"Which type of transplant rejection presents as grafted immunocompetent T cells proliferating and rejecting host cells with ""foreign"" proteins? {{c1::Graft-versus-host-disease (GVHD)}}"- Results in severe organ dysfunction; type IV HSR - Due to recognition of host HLA antigens; compare to host attacking the donor causing rejectionWatch Blood Transfusion ComplicationsReview Graft vs Host Disease (GVHD)Watch associated Bootcamp video - Graft vs Host DiseaseAtlas:06d65d62-d23c-48a9-9584-31b92683c6c2
Which type of transplant rejection presents with maculopapular rash, jaundice, diarrhea, and hepatosplenomegaly? {{c1::Graft-versus-host disease (GVHD)}}Graft-versus-Host-Disease causes GI problems (diarrhea and jaundice), Hepatomegaly, and Derm problems (maculopapular rash)Watch Blood Transfusion ComplicationsReview Graft vs Host Disease (GVHD)Watch associated Bootcamp video - Graft vs Host DiseaseAtlas: due to recognition of host HLA-antigens by donor T-cells; think about the donor's T-cells attacking the skin, intestine and liver5cd02181-3d05-42df-8adb-17fe4baeacc9
Which transplanted organs are associated with graft-versus-host disease? {{c1::Bone marrow and liver::2}}Rich in lymphocytesWatch Blood Transfusion ComplicationsReview Graft vs Host Disease (GVHD)Watch associated Bootcamp video - Graft vs Host DiseaseAtlas:b23f55f4-b044-440a-9256-97d8f7674c6a
Atrophy via decrease in cell size may occur via {{c1::autophagy}} of cellular components- Beclin-1 core complex → generation of autophagic vacuoles → consumption of cellular organelles → combination with lysozymes whose hydrolytic enzymes break down organelles for nutrients - Cellular starvation → activation of Akt → inhibition of mTOR → autophagy Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cellular Adaptations Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cellular Adaptations237b86db-6186-42cb-b2c5-2a4cd2d63ad1
Which cellular change typically occurs after chronic exposure to an irritant, such as gastric acid or smoke? {{c1::Metaplasia}}Metaplastic cells are better able to handle the new stress: - Repeated gastric acid causes stratified squamous epithelium of lower esophagus to be replaced with columnar epithelium + goblet cells to be able to better handle stress (Barrett' esophagus) - Repeated cigarette smoke causes respiratory ciliated columnar epithelium to be replaced by stratified squamous epithelium Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia Commons (left); Maione et al., CC BY 4.0, via MDPI Diagnostics (right)Watch associated Bootcamp video - Esophageal and Gastric Pathology: Malignant Esophageal Disorders Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Metaplasia Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cellular Adaptations6f545ac4-5371-40c4-8378-51ac6d24b046
What is the hallmark of reversible cellular injury? {{c1::Swelling}}Failure of Na+-K+ pump due to loss of ATP; Na+ and H2O buildup in the cellWatch Myocardial Response To IschemiaWatch associated Bootcamp video - Cellular Injury and Neoplasia: Cellular Injury Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cellular Injury1033eb1a-b991-40ba-bfc9-6cc0124cc050
What type of infarct occurs in tissues with a single arterial blood supply (e.g., heart, kidney, spleen)? {{c1::Pale (anemic) infarct}}- Wedge-shaped infarct pointing towards the vascular occlusion - In the kidney the base of the wedge faces cortex, apex points to medulla Heart pale infarct: the infarcted area is pale whereas the rupture is hemorrhagic (dark red) Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia Commonsdceea141-49c0-42f8-a21e-8c87d3b979e7
In fat necrosis, fatty acids bind to Ca2+ via a process called {{c1::saponification}}Damaged cells release lipase to break down triglycerides, liberating fatty acidsWatch associated Bootcamp video - Cellular Injury and Neoplasia: Necrosis Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Necrosis077ed353-7434-4df6-80eb-3c0c2062fddf
Apoptosis is mediated by {{c1::caspases}}, which activate proteases and endonucleasesWatch associated Bootcamp video - Cellular Injury and Neoplasia: Apoptotic Pathways Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Apoptotic Pathways Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cellular Adaptations Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cellular Injury783e8253-8193-493d-8c29-1c33667e5456
BCL-2 normally keeps the mitochondrial outer membrane impermeable, thus preventing {{c1::cytochrome C}} release from the intermembrane spaceThus, inactivation (apoptosis) allows release of cytochrome c, which then activates caspasesWatch associated Bootcamp video - Cellular Injury and Neoplasia: Apoptotic Pathways Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Apoptotic Pathways Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Lymphocytic Leukemia Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Geneseca73355-27de-4162-96fe-09acb9b52904
The extrinsic (death receptor) pathway of apoptosis can occur via receptor binding between {{c1::Fas-L}} and its receptor CD{{c3::95}}, or {{c2::TNF-α}} and its receptor- i.e., binding of Fas (CD95) and TNF-α receptors result in caspase activation - Fas ligand binding Fas death receptor (CD95) is what mediates negative selection in the thymusReview TNF-alphaWatch associated Bootcamp video - Cellular Injury and Neoplasia: Apoptotic Pathways Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Apoptotic Pathwaysce1bd9ec-3e8f-480e-b023-8923432a2a96
DNA laddering in multiples of 180 BP is a sensitive indicator of {{c1::apoptosis}}Photo credit: Shinryuu, Public domain, via Wikimedia Commons2ccadfdc-74b2-49f8-960f-4f345b352c3a
{{c3::Primary}} amyloidosis is characterized by systemic deposition of {{c1::AL amyloid}}, which is derived from {{c2::Ig light chain}}- Associated with plasma cell dyscrasias (e.g., multiple myeloma) - AL = amyloid light chainWatch AmyloidosisWatch Nephrotic Syndrome SOAPReview Multiple MyelomaWatch associated Bootcamp video - Amyloid Nephropathy Watch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Multiple Myeloma2a4513d8-dc94-4cd0-b1d5-a8bebd1ec766
Arachidonic acids are converted to prostaglandins via the enzyme {{c1::cyclooxygenase}}Also converted to thromboxane A2 by the same enzymeWatch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology) Watch associated Bootcamp video - Pharmacology : Arachidonic Acid Pathways Watch associated Bootcamp video - Platelets: Antiplatelet Medications07e4acbf-4a45-49c2-99e3-cca5f2b5d817
Which leukotriene attracts and activates neutrophils? {{c1::Leukotriene B4}}Neutrophils are attracted by bacterial products, IL-8, C5a, and LTB4. Watch NeutrophilsReview Neutrophils-OverviewWatch associated Bootcamp video - Acute Inflammatory Response Watch associated Bootcamp video - Blood Cells: Neutrophil Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology)72ee9f28-54aa-4a9a-ba92-7cc132d8a9d3
Mast cells may be activated by tissue {{c1::trauma}}Review Mast CellsWatch associated Bootcamp video - Blood Cells: Mast Cell94948f01-fd24-4ece-9f8a-4369da305c72
Which complement protein(s) can activate mast cells (anaphylatoxins)? {{c1::C3a, C4a, and C5a}}Photo credit: Ayman Qasrawi at English Wikipedia, Public domain, via Wikimedia CommonsWatch The Complement Cascade & Other Functions of Complement Watch Complement System DisordersReview Common Complement PathwayWatch associated Bootcamp video - Complement: Complement - Overviewa7211178-25f5-4632-86ac-08c64ba20a0a
One cardinal sign of inflammation is swelling, or {{c1::tumor}}- Due to leakage of protein rich fluid from postcapillary venules into interstitial space (exudate), resulting in increased oncotic pressure that draws out fluid - Cardinal signs of inflammation: redness (rubor), heat (calor), swelling (tumor), pain (dolor), and loss of function (functio laesa)Watch associated Bootcamp video - Acute Inflammatory Response Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology)d351d4a2-1b20-4230-a6af-1ad8915d95fc
Swelling in inflammation is mediated by endothelial cell disruption (due to tissue damage) and endothelial cell contraction (caused by {{c1::leukotrienes}}, {{c2::histamine}}, and {{c3::serotonin}})Watch associated Bootcamp video - Acute Inflammatory Response Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology)011f23d9-6922-477c-a2dd-3ebdd6d0437a
Fever in inflammation is mediated by release of {{c1::IL-1}}, {{c1::IL-6}}, and {{c1::TNF}} by {{c2::macrophages}} in response to pyrogens (e.g., LPS from bacteria)Cytokines enter the OVLT and bind endothelial receptors on vessel walls (perivascular cells) of the hypothalamus or local microglia → upregulating COX-2 → PGE2 releaseWatch Postoperative Surgical FeversReview Monocytes / Macrophages Review TNF-alpha Review IL-1 Review IL-6Watch associated Bootcamp video - Acute Inflammatory Response Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology)e2327f2e-acfa-4152-9ca9-7173633584b2
{{c2::Leukocyte adhesion deficiency (type 1)::Specific type}} is due to a defect in {{c1::LFA-1 integrin (CD18)::specific}} protein on phagocytesCan present with persistent leukocytosis and neutrophilia because leukocytes cannot migrate out of the blood vesselsWatch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)UWorld:8e55be09-fce1-4979-8a7c-c0644572bd60
What is the mode of inheritance of leukocyte adhesion deficiency? {{c1::Autosomal recessive}}Watch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)UWorld:92289905-3a70-4b69-8c40-e812d9099f40
Leukocyte adhesion deficiency is characterized by {{c1::increased}} circulating neutrophilsDue to impaired adhesion of the marginated pool of leukocytes + cannot escape the blood vesselWatch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)UWorld:febd6e6e-4d36-4e34-82c2-8f6c46f1627e
Leukocyte adhesion deficiency is characterized by {{c1::absent}} neutrophils at infection sitesWatch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)UWorld:894ff73f-4ba0-4807-a059-b647bc1e3907
Leukocyte adhesion deficiency is characterized by recurrent bacterial infections (skin and mucosal) with absent {{c1::pus}} formation- Patients also have impaired wound healing and severe periodontal disease - Pus = dead neutrophils - No neutrophil out = no pusWatch Phagocytic Cell DisordersReview Leukocyte Adhesion Deficiency (LAD)Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology) Watch associated Bootcamp video - Blood Cells: NeutrophilUWorld: - patients also have impaired wound healing and severe periodontal disease - pus = dead neutrophils - no neutrophil out = no pusbaf7b4d0-70ce-4e81-9e70-44e4017e6356
Neutrophil chemotactics include {{c1::IL-8}}, {{c2::C5a}}, {{c3::leukotriene B4 (LTB4)}}, and bacterial productsOther chemotactics include kallikrein and platelet-activating factorReview Neutrophils-Overview Review Common Complement Pathway Review IL-8Watch associated Bootcamp video - Neutrophil Migration Watch associated Bootcamp video - Blood Cells: Neutrophil Watch associated Bootcamp video - Inflammatory Response: Neutrophil Migration(Pathology)UWorld:49229fef-8f36-403e-8625-7da053cd08a0
Which immunodeficiency is characterized by impaired phagolysosome formation? {{c1::Chédiak-Higashi syndrome}}Watch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)838d0a23-eff2-47fa-bfec-79382268aa45
Chédiak-Higashi syndrome is caused by a defect in the {{c2::lysosomal trafficking regulator (LYST)}} gene, resulting in impaired {{c1::phagolysosome}} formationLYST defect results in impaired protein traffickingWatch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)2313d3df-30f9-4d09-8d7b-9eff055a68b3
What cytoskeletal component is impaired in Chédiak-Higashi syndrome? {{c1::Microtubules}}Watch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)cf7eebd7-9dd4-4f15-838e-68335babfe3d
What is the mode of inheritance of Chédiak-Higashi syndrome? {{c1::Autosomal recessive}}Watch Phagocytic Cell Disorders Watch Autosomal Recessive DiseasesReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)0f02dd20-1c50-4abe-8f57-a8f7064947ef
Chédiak-Higashi syndrome is associated with defective {{c1::primary}} hemostasisDue to abnormal dense granules in plateletsWatch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)28314093-3d60-420b-8901-2ba758317e2a
Chédiak-Higashi syndrome is characterized by {{c1::decreased}} circulating neutrophilsNeutropenia due to intramedullary death of neutrophilsWatch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)db2a0cc4-81a1-4909-87a1-fc4ade07ed7e
{{c2::Chronic granulomatous}} disease is characterized by recurrent infection and granuloma formation with {{c1::catalase}}-positive organismsHigh-risk catalase positive infections in CGD: - Staph aureus - Burkholderia cepacia - Serratia marcescens - Nocardia - AspergillusWatch Phagocytic Cell DisordersReview Chronic Granulomatous Disease (CGD)Watch associated Bootcamp video - Staphylococcus: Staphylococcus Aureus Principles Watch associated Bootcamp video - Non-Spore Forming Gram Positive Bacilli: Nocardia Watch associated Bootcamp video - Oxidative Stress: Respiratory (Oxidative) Burst: Clinical Implications Watch associated Bootcamp video - Fundamentals of Bacteriology: Bacterial Morphology Watch associated Bootcamp video - Opportunistic Infections: Localized Kaposi Sarcoma, Oropharyngeal Candidiasis, Oral Hairy Leukoplakiab7c7c98e-c78b-418b-861f-cedab930b5e2
Which immunodeficiency is characterized by inability to generate HClO (hypochlorite) from H2O2? {{c1::Myeloperoxidase deficiency}}The NBT test will still turn blue (normal) with this disorderWatch Phagocytic Cell DisordersWatch associated Bootcamp video - Staphylococcus: Staphylococcus Aureus Principles Watch associated Bootcamp video - Fundamentals of Bacteriology: Bacterial Morphologyddb3fd9a-5d94-4180-896d-da5808d8ffdc
Myeloperoxidase deficiency is associated with increased risk for {{c1::Candida}} infection, however, most patients are asymptomatic- HClO is important for killing off Candida, but H2O2 and other free radicals are sufficient for killing off catalase +ve species - In contrast to chronic mucocutaneous candidiasis, where there is a defect either with Th17 response or AIREWatch Phagocytic Cell DisordersWatch associated Bootcamp video - Opportunistic Mycosis: Candida Disease Variants Watch associated Bootcamp video - Infectious Diseases of the Skin: Candida0b5eb772-2432-4057-9b8b-57b436f8b628
Granulomatous diseases are associated with {{c1::hypercalcemia}}, due to increased 1α-hydroxylase in epithelioid histiocytesWatch Sarcoidosis & BerylliosisWatch associated Bootcamp video - Inflammatory Response: Chronic Inflammatory Response Watch associated Bootcamp video - Rheumatologic Diseases: Sarcoidosis Watch associated Bootcamp video - Inflammatory Response: Chronic Inflammatory Response (Pathology) Watch associated Bootcamp video - Vitamins: Vitamin D: Clinical Implications0f74d27a-0af5-457f-b7a6-42a481d99a28
What enzyme deficiency is associated with severe combined immunodeficiency (SCID)? {{c1::Adenosine deaminase (ADA) deficiency}}Results in buildup of adenosine, which is toxic to lymphocytesWatch Combined B & T Cell Disorders Watch Purine Salvage Deficiencies (Adenosine Deaminase Deficiency & Lesch-Nyhan Syndrome)Watch associated Bootcamp video - Immunodeficiency Syndromes: SCID Watch associated Bootcamp video - DNA Structure: Clinical Applications of the Purine Pathway0d8f9dcb-6cf3-4594-b77e-09d73bf511e3
Which immunodeficiency is characterized by absent B cells in peripheral blood? {{c1::X-linked (Bruton) agammaglobulinemia}}- Due to disordered B-cell maturation; pro- and pre-B cells cannot mature - Markedly reduced CD19+ B-cells on flow cytometryWatch B Cell Disorders & DiGeorge SyndromeReview Bruton (X-linked) AgammaglobulinemiaWatch associated Bootcamp video - Immunodeficiency Syndromes: B-cell and T-cell Variants4cbf24be-2198-46a1-b100-b5888ee5288c
Which immunodeficiencies are characterized by absent / scanty lymph nodes and tonsils? {{c1::X-linked (Bruton) agammaglobulinemia}} and {{c1::severe combined immunodeficiency (SCID)}}Due to ↓ in B lymphocyte maturation; ↓ Ig of all classesWatch B Cell Disorders & DiGeorge SyndromeReview Bruton (X-linked) AgammaglobulinemiaWatch associated Bootcamp video - Immunodeficiency Syndromes: SCID Watch associated Bootcamp video - Immunodeficiency Syndromes: B-cell and T-cell Variantsf0fa9cd6-025b-474f-98b1-f56f6cd62a17
{{c2::Hyper-IgM}} syndrome is most commonly due to mutated {{c1::CD40L}} on Th cellsClass-switching defectWatch Combined B & T Cell DisordersReview Hyper-IgM SyndromeWatch associated Bootcamp video - Immunodeficiency Syndromes: Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome60a474d4-2711-4a1f-bb1c-6004471a9194
Which immunodeficiency presents with defective class switching? {{c1::Hyper-IgM syndrome}}Thus, resulting in increased IgM with decreased IgA, IgG, and IgEWatch Combined B & T Cell DisordersReview Hyper-IgM SyndromeWatch associated Bootcamp video - Immunodeficiency Syndromes: Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndrome70ef5057-7be4-4159-977a-affddac7da84
What classes of immunoglobulin are decreased in hyper-IgM syndrome? {{c1::IgA, IgG, and IgE}}IgM levels are normal or increasedWatch Combined B & T Cell DisordersReview Hyper-IgM SyndromeWatch associated Bootcamp video - Immunodeficiency Syndromes: Hyper-IgM, Hyper-IgE, and Wiskott-Aldrich Syndromeeb50394d-bf5e-46bc-9a4f-70813f664a76
Which immunodeficiency is always caused by failure to repair DNA double strand breaks? {{c1::Ataxia-telangiectasia}}- Results in unrestricted cell cycle progression (resulting in mutations accumulating) and DNA hypersensitivity to ionizing radiation - VDJ recombination requires double-strand breaks to occur; without ATM gene, these are hard to repair (resulting in a weakened immune system) - Defects in dsDNA repair are also a rare cause of SCID (due to defective Artemis enzyme)Watch Combined B & T Cell Disorders Watch DNA Repair MechanismsReview Ataxia-TelangiectasiaWatch associated Bootcamp video - Cerebellum and Ventricles: Cerebellar PathologyAtlas:473f7d03-75ac-45b1-93f1-8752db1a1a1e
Ataxia-TelangiectasiA presents with a triad of: {{c1::Ataxia (cerebellar defects)::A}} {{c1::Telangiectasia (spider angiomas)::T}} {{c1::IgA, G, and E deficiency::A}}- Lymphopenia and cerebellar atrophy - Toddlers wobble and sway when walking (almost appear drunk) - Patients also present with slurred / distorted speech, dysphagia, and oculomotor apraxia - Telangiectasias erupt on skin and eye, early aging (premature greying of hair)Watch Combined B & T Cell DisordersReview Ataxia-TelangiectasiaWatch associated Bootcamp video - Cerebellar Pathology Watch associated Bootcamp video - Cerebellum and Ventricles: Sensory vs Cerebellar Ataxiay4dc6ffe3-5e53-401a-9477-e8fb2dc09861
Ataxia-telangiectasia is associated with increased risk of {{c1::lymphoma}} and {{c2::leukemia}}- TeLLangiectasia = Leukemia and Lymphoma - Increased risk due to lack of surveillanceWatch Combined B & T Cell DisordersReview Ataxia-TelangiectasiaWatch associated Bootcamp video - Cerebellum and Ventricles: Cerebellar PathologyAtlas:8815e461-d3f3-4eb8-800e-d412c40a1647
Which complement deficiency results in an increased risk for systemic lupus erythematosus / glomerulonephritis? {{c1::Early complement deficiencies (C1-C4)}}- Immune complexes are normally cleared when they bind complement (macrophages have complement receptors) - In early complement deficiencies, patients can get a glomerulonephritis from IC deposition without clearance; other type III HSR can occurWatch Complement System Disorders Watch Nephritic SyndromeWatch associated Bootcamp video - Rheumatologic Diseases: Systemic Lupus Erythematosus1d6b2568-6ce9-4562-9b3e-f9cca2c83afd
{{c2::Lupus anticoagulant}} is an antiphospholipid antibody that results in a falsely {{c1::elevated}} {{c3::PTT}}"- Because these antibodies bind to phospholipids, they may prolong the PTT (an in vitro clotting test that requires phospholipids) - PTT will not correct when mixed with normal plasma (mixing study); prolonged PTT is an in vitro artifact - ""Falsely"" elevated because patients are in a hypercoagulable, NOT hypocoagulable state - LuPus anTicoagulanT falsely elevates PTT"Watch Acquired & Inherited Thrombosis Syndromes Watch Autoimmune Disease Overview & Systemic Lupus Erythematosus (SLE)Watch APLS & Recurrent Pregnancy Loss Watch Hypercoagulable Disorders DDxWatch associated Bootcamp video - Mixing Studies, Ristocetin, and D-dimer Watch associated Bootcamp video - Rheumatologic Diseases: Systemic Lupus Erythematosus Watch associated Bootcamp video - Rheumatologic Diseases: Antiphospholipid Syndrome Watch associated Bootcamp video - Coagulation and Fibrinolysis: Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Time Watch associated Bootcamp video - Coagulation and Fibrinolysis: ThrombophiliasAtlas: PTT will not correct when mixed with normal plasma (mixing study); prolonged PTT is an in vitro artifact29f3ac0d-9cfa-4607-806e-b4211e7723d3
Antiphospholipid syndrome is diagnosed based on clinical criteria including history of {{c1::thrombosis}} or spontaneous {{c2::abortion}} along with antiphospholipid antibodiese.g., anti-β2-glycoprotein, anticardiolipin, and lupus anticoagulant antibodiesWatch Acquired & Inherited Thrombosis Syndromes Watch Autoimmune Disease Overview & Systemic Lupus Erythematosus (SLE)Watch APLS & Recurrent Pregnancy Loss Watch Hypercoagulable Disorders DDx Watch Systemic Lupus Erythematosus SOAP Watch Early Pregnancy LossWatch associated Bootcamp video - Rheumatologic Diseases: Antiphospholipid Syndrome Watch associated Bootcamp video - Coagulation and Fibrinolysis: ThrombophiliasAtlas:db5a8ab2-d4f5-4e83-80ef-6659632f69ba
Sclerosis of what organ is the most common cause of death in scleroderma? {{c1::Lungs}}- May cause interstitial lung disease (alveolar basement membrane inflammation and fibrosis) or pulmonary arterial hypertension (vasculopathy → lumen narrowing) - ILD associated with diffuse scleroderma, PAH associated with CREST syndrome - Second most common cause is kidney involvement (sclerodermal renal crisis)Watch Sjogren's Syndrome, Systemic Sclerosis & Mixed Connective Tissue Disease Watch Idiopathic Pulmonary FibrosisWatch Pulmonary HypertensionWatch associated Bootcamp video - Rheumatologic Diseases : Scleroderma and Mixed Connective Tissue Disease Watch associated Bootcamp video - Pulmonary Hypertensiona45f4da3-67cb-45d9-9caf-1d1d6f81023e
Granulation tissue consists of type {{c1::III}} collagen, capillaries, and myofibroblastsWatch Collagen (Overview and Synthesis)Watch associated Bootcamp video - Connective Tissue: Collagen Structure Mutations and Wound Health7cb807f0-bcf3-47a2-99e4-46e5143ef6a1
What component of granulation tissue provides nutrients? {{c1::Capillaries}}b4bc0712-155b-4928-9d47-5bb0d7244b08
TGF-β is a growth factor that mediates {{c1::fibrosis}} and {{c2::angiogenesis}}, it also {{c3::inhibits}} inflammationWatch Idiopathic Pulmonary FibrosisReview TGF-betaWatch associated Bootcamp video - Inflammatory Response: Chronic Inflammatory Response (Pathology) Watch associated Bootcamp video - Cytokines: Additional Cytokines Watch associated Bootcamp video - Inflammatory Response: Chronic Inflammatory Responsebc77282f-a05e-420c-a0e6-266f72cc26b5
What is the primary role of vascular endothelial growth factor (VEGF)? {{c1::Angiogenesis / vasculogenesis}}- M2 macrophages secrete VEGF which recruits EPCs from bone marrow - VEGF causes increased vascular permeability, pericyte detachment, MMP release to break down basement membrane - EDCs migrate to area guided by fibrin strands - VEGF stimulates EDCs to form a leading tip, along with existing endothelial cells to help extend the tip - Elongating tip finally connects to an existing blood sprout, whereupon the stalk is remodeled to make a new connection - Because these are newly formed, endothelial junctions are not tight yet - Lots of fluid and plasma proteins leak out, keeps wound moist and provides a microenvironment where cells can easily moveWatch MacrophagesWatch Chronic Diabetes Complications SOAPReview Monocytes / Macrophages93739c35-e61d-43e2-b293-f6d56a4f21c0
What is another name for the c-ANCA antibody? {{c1::Proteinase 3 (PR3)-ANCA}}"""C-3PO"" c-ANCA = PR3 p-ANCA = MPO"Watch Small Vessel VasculitidesWatch associated Bootcamp video - Vasculitides: Granulomatosis with Polyangiitis (GPA)a165dcdb-ffdc-4034-b1b7-7fef1521a2a7
Rickets may present with {{c1::rachitic rosary}} due to osteoid deposition at the costochondral junction"""Bead like"" Photo Credit: Frank Gaillard, CC BY-SA 3.0, via Wikimedia Commons, FotoKatolik from Polska, CC BY-SA 2.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 3.0"Watch Osteomalacia & RicketsReview Vitamin D Deficiency and ExcessWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteomelacia/Rickets Watch associated Bootcamp video - Vitamins: Vitamin D: Clinical Implications4ae158d4-b369-47ba-95fe-dbd9233162b6
What MSK pathology is characterized by a reduction in trabecular and cortical bone mass and interconnections? {{c1::Osteoporosis}}Trabecular (spongy) bone is most affected (e.g., vertebrae, femur)Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: OsteoporosisAtlas:204b9d82-b4ae-4e1c-900b-e18039cf3718
Osteoporosis can lead to {{c1::vertebral}} compression fractures, which result in loss of height and kyphosisAlso can present with fractures of femoral neck and distal radiusWatch Osteoporosis & Paget Disease of BoneWatch Vertebral Pathology Watch Spine DisordersWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteoporosis Watch associated Bootcamp video - Spine: Vertebral FractureAtlas:d719aad7-6958-45fd-8e3a-d8ef07482678
What MSK pathology is characterized by thick, heavy bone that fractures easily due to imbalance of osteoblast and osteoclast function? {{c1::Paget disease of bone (osteitis deformans)}}Photo credit: Jmarchn, CC BY-SA 4.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 4.0 (right)Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)Atlas:ab3ac79d-a1e7-4fc5-b09f-39d7cac6d8f0
Is Paget disease of bone (osteitis deformans) a localized or diffuse process? {{c1::Localized}}Does not involve the entire skeleton Photo credit: Jmarchn, CC BY-SA 4.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 4.0 (right)Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)Atlas:b1819ca4-ca7e-41ce-90cf-e4f8eeee1288
What demographic is associated with Paget disease of bone (osteitis deformans)? {{c1::Late adulthood (age > 60)::age group}}Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)Atlas:2c295acc-e3bb-4d13-a80e-c010dcce0df1
What is the first stage of Paget disease of bone (osteitis deformans)? {{c1::Osteoclastic (lytic)}}Osteoclasts appear abnormally large with an excessive number of nuclei StageDescriptionFirstOsteoclastic (lytic)SecondMixed osteoblastic-osteoclasticThirdOsteoblastic (sclerotic)FourthQuiescent (minimal osteoclast/osteoblast activity) Photo credit: Jmarchn, CC BY-SA 4.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 4.0 (right)Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)Atlas:deced7cf-9ed1-4919-9008-cfc3c3861f6a
{{c2::Paget disease of bone (osteitis deformans)}} is the most common cause of isolated elevated {{c1::alkaline phosphatase}} in patients > 40 years oldPhoto credit: Jmarchn, CC BY-SA 4.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 4.0 (right)Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)Atlas:0283c16b-a105-402c-b2b2-653aacc2dcbf
Paget disease of bone (osteitis deformans) is characterized by {{c1::normal}} serum Ca2+Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)Atlas:8cf7cd9b-ebfd-4e0f-b278-055f5c1064a0
Paget disease of bone (osteitis deformans) is characterized by {{c1::normal}} serum PO43-Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone) Watch associated Bootcamp video - Electrolytes: PhosphateAtlas:4fe1eea5-e237-4ac8-9c3e-6e98fa92ed8c
Osteosarcoma is a malignant proliferation of {{c1::osteoblasts}}- AKA osteogenic sarcoma - These are pleomorphic osteoid producing cells Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Malignant Bone TumorsWatch Pediatric Bone Tumors DDxReview OsteosarcomaWatch associated Bootcamp video - Primary Bone Tumors: OsteosarcomaAtlas:fdc58835-c5fa-4a82-b0e0-33c74d90feb4
The peak incidence for primary osteosarcoma is in {{c1::teenagers (10-20 years old)::specific}}Due to time of adolescent growth spurtWatch Malignant Bone TumorsWatch Pediatric Bone Tumors DDxReview OsteosarcomaWatch associated Bootcamp video - Primary Bone Tumors: OsteosarcomaAtlas:52ace996-3eeb-425e-a0a6-1bf2f4f83b86
Osteosarcoma arises in the {{c1::metaphysis}} of long bones, often around the {{c2::knee::body location}}i.e. distal femur or proximal tibiaWatch Malignant Bone TumorsWatch Pediatric Bone Tumors DDxReview OsteosarcomaWatch associated Bootcamp video - Primary Bone Tumors: OsteosarcomaAtlas:f475a0c0-e3cc-42e3-8218-bb661ed8501e
Biopsy of osteosarcoma reveals pleomorphic cells that produce {{c1::osteoid}}"- Also has a ""lace-like"" appearance - Osteoid: unmineralized, organic portion of the bone matrix that forms prior to the maturation of bone tissue Photo credit: Mikael Häggström, CC0, via Wikimedia Commons Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia Commons"Watch Malignant Bone TumorsWatch associated Bootcamp video - Primary Bone Tumors: OsteosarcomaAtlas:8204253a-ae01-405d-a061-eacbfa8b2ea3
Ewing sarcoma arises in the {{c1::diaphysis}} of long bones (particularly the {{c3::femur}}); other locations include pelvic {{c2::flat bones}}, scapula, and ribsDiaphysis = midshaftWatch Malignant Bone TumorsWatch Pediatric Bone Tumors DDxWatch associated Bootcamp video - Primary Bone Tumors: Ewing SarcomaEwing sarcoma X-ray (lateral view) of a child's knee and lower leg. Zone of decreased radiodensity in the proximal tibial diaphysis (red overlay) with a lamellated periosteal reaction producing the typical onion skin appearance (blue overlay and arrow) of Ewing sarcoma. Atlas:7992caa0-69a2-48e2-bcdc-7511f8667705
{{c1::Chondrosarcoma}} is a malignant cartilage-forming tumor- This is a tumor of malignant chondrocytes - Grade determines biological behavior; Male (3): Female (1) ratioWatch Malignant Bone TumorsWatch associated Bootcamp video - Primary Bone Tumors: ChondrosarcomaAtlas:98ceaa1d-72f6-4910-ba2d-18585765ef5e
"This image is an example of a ""{{c1::swan neck}}"" deformity, which is most commonly associated with {{c2::rheumatoid arthritis}}"Photo credit: User:Phoenix119, CC BY-SA 3.0, via Wikimedia Commons, Trachemys, CC BY-SA 3.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 3.0 Image(s) provided by www.radiologyassistant.nl. Used with permission. Boutonniere deformity (MCP extension, PIP flexion, DIP hyperextension) Swan neck deformity (MCP flexion, PIP hyperextension, DIP flexion)Watch Rheumatoid Arthritis Watch Polyarticular Joint Pain DDx Watch Juvenile Idiopathic Arthritis SOAPWatch Rheumatoid ArthritisWatch associated Bootcamp video - Rheumatologic Diseases: Rheumatoid ArthritisAtlas:ef522047-0471-44a4-8180-ec14a8514ecd
Rheumatoid arthritis may present with {{c1::ulnar}} finger deviation and {{c1::radial}} wrist deviationRadial wRist Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Rheumatoid Arthritis Watch Polyarticular Joint Pain DDxWatch Rheumatoid ArthritisWatch associated Bootcamp video - Rheumatologic Diseases: Rheumatoid ArthritisAtlas:e25a38ac-045f-4524-b5c4-9c6347e1573e
Rheumatoid arthritis is associated with {{c1::rheumatoid nodules}}, which are areas of {{c2::fibrinoid necrosis::histological feature}} with palisading histiocytes in the skin and visceral organs (e.g., lung)Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Rheumatoid Arthritis Watch Polyarticular Joint Pain DDx Watch Juvenile Idiopathic Arthritis SOAPWatch Rheumatoid ArthritisWatch associated Bootcamp video - Rheumatologic Diseases: Rheumatoid Arthritis Watch associated Bootcamp video - Cellular Injury and Neoplasia: Necrosis Watch associated Bootcamp video - Principles of Oncology and Therapeutics: NecrosisAtlas:fa74f83a-8704-49b8-97bb-0d48a42af072
Septic arthritis classically presents as a single red, swollen, and painful joint; usually the {{c1::knee}}Photo credit: Tally et al., CC BY 4.0, via Journal of Education and Teaching - Emergency Medicine, modified by croppingWatch Neisseria gonorrhoeae [Old Version]Watch Septic Arthritis SOAP Watch Polyarticular Joint Pain DDx Watch Monoarticular Joint Pain DDx Watch Approach to Knee Pain Watch Debridement OverviewWatch Neisseria gonorrhoeaeWatch associated Bootcamp video - Non-Rheumatologic Diseases: Septic Arthritisd7fd0cd7-4c85-4bc0-973c-6358692b4ffb
Acute gout may occur with {{c1::alcohol}} consumption due to competition for the same excretion site in the kidney as uric acidMay also occur with red meat or seafood consumption (rich in purines)Watch Gout & PseudogoutWatch Gout & Pseudogout SOAPWatch Gout & PseudogoutWatch associated Bootcamp video - Non-Rheumatologic Diseases : Gout Watch associated Bootcamp video - Substance Misuse: AlcoholAtlas:b255a680-9591-4589-a7b4-30125e44a494
{{c2::Dermato}}myositis is associated with increased risk for occult {{c1::malignancy}}- Most commonly ovarian, lung, colorectal, or non-Hodgkin lymphoma - Occult malignancy = cancer in which the site of the primary tumor cannot be foundWatch Polymyositis & DermatomyositisWatch associated Bootcamp video - Rheumatologic Diseases: Polymyositis and Dermatomyositis9a908dc2-027b-4ed6-919f-0c842fd3bc0b
What gene is defective in X-linked muscular dystrophy (e.g., Duchenne, Becker)? {{c1::Dystrophin (DMD) gene}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Muscular DystrophiesWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular DystrophiesAtlas:ae04e479-bd22-4599-8924-ea6d68997a8b
Dystrophin normally anchors the muscle {{c1::cytoskeleton}} to the {{c2::extracellular matrix}}; primarily in skeletal and cardiac muscleSpecifically, it connects actin to the transmembrane proteins α and β-dystroglycan, which are connected to the ECM Image licensed by Physeo and used with permission. Purchase full access here.Watch Muscular DystrophiesWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular DystrophiesAtlas:fb3af295-6c88-4558-85cc-5f46a45de60b
What is the mode of inheritance of Duchenne and Becker muscular dystrophy? {{c1::X-linked recessive}}"Hence referred to as ""X-linked muscular dystrophy"""Watch Muscular DystrophiesWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular Dystrophies Watch associated Bootcamp video - Basics of Clinical Genetics: Pedigrees and Modes of InheritanceAtlas:78efd62c-e956-4c69-abba-b20077a017df
Duchenne muscular dystrophy presents with weakness in the {{c1::pelvic girdle}} muscles and progresses superiorlyCalf muscles initially hypertrophy to compensate for proximal muscle weakness, but are eventually replaced by fat, leading to pseudohypertrophyWatch Muscular DystrophiesWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular DystrophiesAtlas:733f635f-7c0b-414f-bb85-af5668b0e104
Duchenne muscular dystrophy (DMD) is associated with increased serum {{c1::creatine kinase (CK)}} and {{c2::aldolase}}Obtaining CK level is a good initial screening test (before definitive diagnosis with genetic analysis)Watch Muscular DystrophiesWatch Muscular DystrophiesReview Duchenne and Becker Muscular DystrophyWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular DystrophiesAtlas:bb363fb8-1849-4169-888d-724be6308a0b
What is the mode of inheritance of myotonic dystrophy? {{c1::Autosomal dominant}}- myOtonic = dOminant - DuchEnne muscular dystrophy, BEcker muscular dystrophy = X-linked rEcessiveWatch Muscular DystrophiesReview Myotonic DystrophyWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular Dystrophies Watch associated Bootcamp video - Basics of Clinical Genetics: Pedigrees and Modes of Inheritance Watch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion DiseasesAtlas:27849a0d-c74f-4037-a3b4-88ba77ad1702
{{c2::Lambert-Eaton myasthenic syndrome (LEMS)}} is caused by autoantibodies to {{c1::pre}}-synaptic {{c1::voltage-gated calcium channels (VGCC)}} at the NMJ- Leads to impaired ACh release - Treatment includes blocking K+ channel to get more Ca2+ influx (prolonged AP) or AChE inhibitor Photo credit: Huang K, Luo Y-B and Yang H (2019) Autoimmune Channelopathies at Neuromuscular Junction. Front. Neurol. 10:516. doi: 10.3389/fneur.2019.00516Watch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch Lung CancerWatch associated Bootcamp video - Neuromuscular Junction (NMJ): Lambert-Eaton Syndrome5eb7bdd7-6a48-41ed-8816-524807f4520e
{{c1::Rhabdomyoma}} is a benign tumor of striated muscleAtlas:029319ed-7562-4c80-8df0-92727b76b48f
Which layer of the epidermis is characterized by desmosomes between keratinocytes? {{c1::Stratum spinosum}}Photo credit: Wbensmith, CC BY 3.0, via Wikimedia Commons; OpenStax College : J. Gordon Betts, Peter Desaix, Eddie Johnson., CC BY 3.0, via Wikimedia CommonsWatch associated Bootcamp video - General Principles: Skin Structure and FunctionAtlas:0d4df0b5-fcab-41d2-935d-918cb60f72c5
Which epithelial cell junction prevents paracellular movement of solutes? {{c1::Tight junctions (zonula occludens)}}Watch associated Bootcamp video - General Principles: Skin Structure and Function8b7849c8-9eb5-4274-9b89-426d4f74b6b6
{{c1::Allergic contact}} dermatitis presents with a pruritic, oozing rash with vesicles and edema due to a type {{c2::IV}} HSR"Whereas irritant contact dermatitis is a nonimmunologic reaction and atopic dermatitis occurs due to a type I HSR Photo credit: #4484, via CDC PHIL; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC) Photo credit: Dr.khatmando, CC BY-SA 4.0, via Wikimedia Commons"Watch Approach to RashesWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Atopic and Allergic Diseases Watch associated Bootcamp video - Hypersensitivities: Type IV Hypersensitivity ReactionsAtlas:3e9530fa-d7dd-4059-8f1a-7a7f51d9cc2c
{{c1::Allergic contact}} dermatitis arises upon exposure to allergens (e.g., nickel, poison ivy, neomycin)"Lesions arise at the site of contact Photo credit: Dr.khatmando, CC BY-SA 4.0, via Wikimedia Commons Photo credit: #4484, via CDC PHIL; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)"Watch Approach to RashesWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Atopic and Allergic Diseases Watch associated Bootcamp video - Hypersensitivities: Type IV Hypersensitivity ReactionsAtlas:706fecb3-81aa-4e9f-be9e-03f8e11e6e48
Acne vulgaris is due to chronic inflammation of hair follicles and associated {{c1::sebaceous}} glands, which secrete their contents through a(n) {{c1::holocrine}} mechanism- May result in comedones (white heads, black heads), pustules (pimples), or nodules (scarring) [Holy, that’s a lot of Sebum!] [DHT increases sebum secretion] - Hair follicle keratinization with keratin plug formation - Sebaceous gland hypertrophy with increased sebum production - The gland is colonized with cutibacterium acnes (formerly propionibacterium acnes) - Hydrolysis of TAGs in sebum by bacteria and inflammatory fatty acids production Photo credit: OpenStax College, CC BY 3.0, via Wikimedia Commons Photo credit: Roshu Bangal, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Pustular Disease Watch associated Bootcamp video - Infectious Dermatologic Disease: Infectious Follicular PathologyAtlas:b2a55ced-312c-4fde-b52d-2090ce8bedff
Acne arises due to hormone-related increase in {{c1::sebum}} and blockage of hair follicles by excess {{c2::keratin}}Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Roshu Bangal, CC BY-SA 4.0, via Wikimedia Commons, modified by croppingWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Pustular Disease Watch associated Bootcamp video - Infectious Dermatologic Disease: Infectious Follicular PathologyAtlas:7d20c72c-3537-41b3-a90d-bf08e8c3b6cd
What type of hormone results in increased sebum production (and thus acne)? {{c1::Androgens}}Sebaceous glands have androgen receptors Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Roshu Bangal, CC BY-SA 4.0, via Wikimedia Commons, modified by croppingWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Pustular Disease Watch associated Bootcamp video - Infectious Dermatologic Disease: Infectious Follicular PathologyAtlas:b788d8e7-6d2c-4d1f-83d8-94906fd2b1d9
{{c2::Bullous pemphigoid}} is an autoimmune destruction of {{c1::hemidesmosomes}} between basal cells and the underlying basement membrane"In bullous pemphigoid, autoantibodies bind BP180 and BP230, stimulating complement mediated inflammation and destruction of these proteins by recruitment of neutrophils Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Tham et al., CC BY 4.0, via BMC Veterinary Research (1st image); Si et al., CC BY 2.0, via BMC Diagnostic Pathology, modified by brightening, cropping, and removing letter ""A""; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)"Watch Staph & Strep Skin InfectionsWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering ConditionsAtlas:f63a4781-f414-4453-b8f0-7ccfb00497c8
Which blistering skin disorder presents with tense blisters with eosinophils that don't rupture easily? {{c1::Bullous pemphigoid}}- vs. pemphigus vulgaris which does rupture easily - Usually occurs in the elderly Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering ConditionsAtlas:055db802-c07c-4bae-b6de-2ef1eed0ab46
Which blistering skin disorder is characterized histologically by detachment of the basal cell layer from the basement membrane? {{c1::Bullous pemphigoid}}"Bullous, Basal cell layer, Basement membrane Photo credit: Mohammad2018, CC BY-SA 4.0, via Wikimedia Commons Micrograph of bullous pemphigoid. Subepidermal blistering [solid arrows in (A,B)] and influx of inflammatory cells including eosinophils and neutrophils in the dermis [solid arrow (C)] and blister cavity [dashed arrows (C)]. In (C) also deposition of fibrin is noted (asterisks) Photo credit: Jenny Giang, Marc A. J. Seelen, Martijn B. A. van Doorn, Robert Rissmann, Errol P. Prens and Jeffrey Damman, CC BY 4.0, via Wikimedia Commons Photo credit: Tham et al., CC BY 4.0, via BMC Veterinary Research (1st image); Si et al., CC BY 2.0, via BMC Diagnostic Pathology, modified by brightening, cropping, and removing letter ""A""; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)"Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering ConditionsAtlas:a170e8e3-58eb-406f-a01e-60960f35f1f7
Does bullous pemphigoid typically involve the oral mucosa? {{c1::No}}Contrast with pemphigus vulgaris Photo credit: Mohammad2018, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering ConditionsAtlas:9130dae4-9295-499c-bdfe-b315e7a69869
Which blistering skin disorder is characterized by a linear pattern on immunofluorescence? {{c1::Bullous pemphigoid}}"Photo credit: Tham et al., CC BY 4.0, via BMC Veterinary Research (1st image); Si et al., CC BY 2.0, via BMC Diagnostic Pathology, modified by brightening, cropping, and removing letter ""A""; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC) Photo credit: Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Mohammad2018, CC BY-SA 4.0, via Wikimedia Commons"Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering ConditionsAtlas:5db340d3-f60d-4f39-bc80-8eedd83887b3
Which skin cancer typically presents as an elevated nodule with telangiectasias, rolled borders, central crusting, and/or ulcerations? {{c1::Basal cell carcinoma (nodular type)}}Photo credit: M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara, CC BY 2.0, Mikael Häggström, CC0, via Wikimedia CommonsWatch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch Approach to Neoplastic Skin LesionsWatch associated Bootcamp video - Malignant Skin Disorders: Skin CancerAtlas:c5f742c3-3c5f-4c55-af1c-3aa0d406936f
"Which skin cancer presents as a ""pink, pearl-like papule"" with telangiectasias? {{c1::Basal cell carcinoma}}"AppearanceDiagnosisTreatmentBasal Cell CarcinomaPearly pink papule, rolled border, telangiectasias, central ulcerationShave/punch/excisional biopsy including edge (nests of basophilic cells, palisading pattern)Full thickness surgical excision with 4-5 mm margin, Mohs surgerySquamous Cell CarcinomaErythematous papule or nodule, nonhealing ulcer, cauliflower lesionShave/punch/excisional biopsy including edge (atypical keratinocytes invading dermis, keratin pearls, intercellular bridges)Surgical excision, Mohs surgery Squamous cell carcinoma (ulcerated) 1st vs Basal cell carcinoma (nodular type) 2nd Photo credit: Unknown photographer/artist, Public domain, via Wikimedia Commons Photo credit: M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara, CC BY 2.0, via Wikimedia Commons 1st: SCC vs. 2nd: BCC Photo Credit (left): BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons Photo Credit (right): Klaus D. Peter, Wiehl, Germany, CC BY 3.0 DE, via Wikimedia CommonsWatch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch Approach to Neoplastic Skin LesionsWatch associated Bootcamp video - Malignant Skin Disorders: Skin CancerAtlas:e7ea92c3-0237-4a7d-b6cc-4ee8967b1708
Basal cell carcinoma is characterized histologically by nodules of basal cells with peripheral {{c1::palisading}}Photo credit: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: NoneMikael Häggström, M.D.Consent note: Consent from the patient or patient's relatives is regarded as redundant, because of absence of identifiable features (List of HIPAA identifiers) in the media and case information (See also HIPAA case reports guidance)., CC0, via Wikimedia CommonsWatch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch Approach to Neoplastic Skin LesionsWatch associated Bootcamp video - Malignant Skin Disorders: Skin CancerAtlas:2568d492-172d-442d-a9b5-bd055fb2dbb1
"Which skin disorder presents as rough, ""gritty"", hyperkeratotic, scaly plaques? {{c1::Actinic keratosis}}"Typically found in sun exposed areas (e.g., face, neck, back) Actinic keratosis of the scalp Photo credit: C.Morice, A. Acher, N. Soufir, M.Michel, F. Comoz, D. Leroy, and L. Verneuil, CC BY 4.0, via Wikimedia Commons Photo credit: Future FamDoc, CC BY-SA 4.0, via Wikimedia CommonsWatch Actinic Keratosis, Squamous Cell Carcinoma & Basal Cell CarcinomaWatch Approach to Neoplastic Skin LesionsWatch associated Bootcamp video - General Principles: Skin Lesions Watch associated Bootcamp video - Malignant Skin Disorders: Skin CancerAtlas:a500b848-2228-47d0-a58c-89c99333d139
Melanoma is associated with sunlight exposure and {{c1::dysplastic}} neviFair-skinned persons are at increased risk Photo credit: Unknown photographer, Public domain, via Wikimedia CommonsWatch Malignant MelanomaWatch Approach to Neoplastic Skin LesionsWatch associated Bootcamp video - Malignant Skin Disorders: MelanomaAtlas:e1b00670-9254-4492-a114-04416815ca7c
Dysplastic nevus syndrome is a(n) {{c1::autosomal dominant::inheritance}} disorder characterized by formation of dysplastic neviAssociated with mutations on chromosome 9p21 (CDKN2A), which causes loss of p16 (tumor suppressor gene)Watch associated Bootcamp video - Malignant Skin Disorders: MelanomaAtlas:ee88e41d-eaa8-458d-9ecb-3abad51994ee
"The ABCDEs of melanoma are: {{c1::Asymmetry::A}} {{c1::Border irregularity::B}} {{c1::Color variation::C}} {{c1::Diameter ≥ 6 mm::D (≥#)}} {{c1::Evolution over time::E}}"Color variation - Red = local inflammation and vessel dilation - Brown/black = neoplastic melanocytes - White/gray = melanocyte regression (apoptosis/treatment response) - An important exception is the nodular subtype of melanoma which tends to grow vertically and therefore often presents with few of the ABCDE criteria Photo credit: Unknown photographer, Public domain, via Wikimedia Commons Photo credit: See page for author, Public domain, via Wikimedia CommonsWatch Malignant MelanomaWatch Approach to Neoplastic Skin LesionsWatch associated Bootcamp video - Malignant Skin Disorders: MelanomaAtlas:y365bff6d-b28f-446e-b161-ffe63e79467f
Which subtype of melanoma arises on the palms or soles? {{c1::Acral lentiginous melanoma}} *bonus: cause compared to other types.."Often in dark-skinned individuals; not related to UV light exposure Photo credit: Unknown photographer, Public domain, via Wikimedia Commons and Omar Bari (1st); Philip R. Cohen, CC BY 3.0, via Wikimedia Commons (2nd); 0x6adb015, CC BY 3.0, via Wikimedia Commons (3rd); Will Blake, CC BY-SA 3.0, via Wikimedia Commons (4th) Photo credit: Hindawi [https://www.hindawi.com/journals/crim/2011/670581/] Christoforos Kosmidis, Christoforos Efthimiadis, Georgios Anthimidis, Marios Grigoriou, Kalliopi Vasiliadou, Georgia Ioannidou, Fotini Makedou, Sofia Baka, ""Acral Lentiginous Melanoma: A Case Control Study and Guidelines Update"", Case Reports in Medicine, vol. 2011, Article ID 670581, 4 pages, 2011. https://doi.org/10.1155/2011/670581 (1st); Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ (2nd)"Watch Malignant MelanomaWatch associated Bootcamp video - Malignant Skin Disorders: MelanomaAtlas:a68a7a1c-5767-4d92-9efa-d88048004f89
Acral lentiginous melanoma has the highest prevalence in which two races? {{c1::African-Americans and Asians}}"Photo credit: Unknown photographer, Public domain, via Wikimedia Commons and Omar Bari (1st); Philip R. Cohen, CC BY 3.0, via Wikimedia Commons (2nd); 0x6adb015, CC BY 3.0, via Wikimedia Commons (3rd); Will Blake, CC BY-SA 3.0, via Wikimedia Commons (4th) Photo credit: Hindawi [https://www.hindawi.com/journals/crim/2011/670581/] Christoforos Kosmidis, Christoforos Efthimiadis, Georgios Anthimidis, Marios Grigoriou, Kalliopi Vasiliadou, Georgia Ioannidou, Fotini Makedou, Sofia Baka, ""Acral Lentiginous Melanoma: A Case Control Study and Guidelines Update"", Case Reports in Medicine, vol. 2011, Article ID 670581, 4 pages, 2011. https://doi.org/10.1155/2011/670581 Photo credit: Xavier-Júnior, José & Munhoz, Tania & Souza, Vinicius & Campos, Eloísa & Stolf, Hamilton & Marques, Mariângela., CC BY 4.0, via Wikimedia Commons (1st); Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ (2nd)"Watch Malignant MelanomaWatch Approach to Neoplastic Skin LesionsWatch associated Bootcamp video - Malignant Skin Disorders: MelanomaAtlas:b8932239-288e-42b2-9bad-1699c83d85aa
{{c1::Rosacea}} is an inflammatory facial skin disorder characterized by erythematous papules and pustules, but no comedonesCommonly presents in adults Photo credit: Sand et al., CC BY 2.0, via BMC Head and Face Medicine Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Approach to RashesWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Pustular DiseaseAtlas:67ea48c7-a27e-4e0c-9cac-8863928b6f42
What vascular tumor is associated with HHV-8 and HIV? {{c1::Kaposi sarcoma}}Endothelial malignancy of skin (most commonly), mouth, GI tract, and respiratory tract Photo credit: National Cancer Institute, AV-8500-3620, Public domain, via Wikimedia Commons; National Cancer Institute, Public domain, via Wikimedia CommonsWatch HHV-8 & Kaposi's Sarcoma (Herpesviridae)Watch associated Bootcamp video - Additional Dermatologic Disorders: Vascular Tumors Watch associated Bootcamp video - Infectious Dermatologic Disease: Systemic Infectious Dermatologic Pathology (Bacillary Angiomatosis, Kaposi Sarcoma, Zoster) Watch associated Bootcamp video - Opportunistic Infections: Localized Kaposi Sarcoma, Oropharyngeal Candidiasis, Oral Hairy Leukoplakia Watch associated Bootcamp video - Opportunistic Infections: Pneumocystis Pneumonia, PML, Disseminated Kaposi Sarcoma Watch associated Bootcamp video - Positive-sense RNA Viruses: Secondary HIV-Associated Diseases Watch associated Bootcamp video - DNA Viruses: Human Herpes Virus 8 (Kaposi Sarcoma)Atlas:a901dc4b-0ac9-4718-a32c-fd10a637d3f2
What vascular tumor is a cavernous lymphangioma of the neck, associated with Turner syndrome? {{c1::Cystic hygroma}}- May be present at birth or develop later in life, most commonly found on posterior neck and lateral chest wall - Light microscopy reveals large dilated vascular spaces; lymphatic cysts lined by a thin endotheliumWatch Turner SyndromeReview Turner SyndromeWatch associated Bootcamp video - Fetal Devlopment: Chromosomal Disorders Watch associated Bootcamp video - Thyroid : Thyroid and Parathyroid DevelopmentAtlas:9bc59a8e-01a7-4dee-916a-f90a73a1dbd3
Vitamin K promotes γ-carboxylation at {{c1::glutamic acid::amino acid}} residuesWatch Warfarin Watch Acquired Coagulation Defects Watch Vitamin K Watch Coagulation CascadeReview Vitamin K Biochemistry Watch WarfarinWatch associated Bootcamp video - Coagulation and Fibrinolysis: Vitamin K Dependent Coagulation Factors Watch associated Bootcamp video - Vitamins: Vitamin K: Vitamin K Cycle6be7d216-8904-4fc5-9344-823e72cdbbf0
{{c2::Warfarin}} is an anti-coagulant that interferes with {{c1::γ-carboxylation}} of vitamin K-dependent clotting factors (II, VII, IX, X)Via inhibition of epoxide reductaseWatch Warfarin Watch Vitamin KReview Vitamin K Biochemistry Review WarfarinWatch associated Bootcamp video - Coagulation and Fibrinolysis: Anticoagulation Watch associated Bootcamp video - Vitamins: Vitamin K: Clinical Implications Watch associated Bootcamp video - Coagulation and Fibrinolysis: Vitamin K Dependent Coagulation Factorsd1d09b64-0873-4f8f-b49e-d280fa6cb530
What laboratory assay is used to follow the effects of warfarin? {{c1::PT/INR}}- PT/INR measures the extrinsic pathway - Warfarin inhibits vitamin K, which produces factor X, a shared coagulation factor to both intrinsic and extrinsic pathways - INteRcom INRWatch WarfarinWatch Bleeding Disorders: Coagulation Factor Disorders DDx Watch DVT SOAP Watch Hemorrhage & Hypovolemic Shock Watch Narrow-Complex Tachycardia: AFib & AFlutter ManagementReview Coagulation Panel Review Extrinsic Pathway of Coagulation Watch WarfarinWatch associated Bootcamp video - Bleeding Time, Prothrombin Time, INR, and Partial Thromboplastin Time Watch associated Bootcamp video - Coagulation and Fibrinolysis: Vitamin K Dependent Coagulation Factors Watch associated Bootcamp video - Coagulation and Fibrinolysis: Anticoagulation Watch associated Bootcamp video - Vitamins: Vitamin K: Clinical Implications0eedcca9-9305-44f5-93bd-fb0d85c31545
"Aspirin may cause a ""pseudoallergy"" due to excess {{c1::leukotriene}} synthesis"- Associated with asthma or nasal polyps - Treat these patients with an anti-platelet inhibitor instead (e.g., clopidogrel) Samter triad: 1) Cross reactivity to other COX-1 inhibitors; general tolerance to COX-2 inhibitors 2) Chronic rhinosinusitis and nasal polyps: Hyposmia and anosmia, hyperplastic sinusitis, and recurrent nasal polyps 3) Bronchial asthma: More severe and difficult to control with increased death risk Photo credit:© MathieuMD / Wikimedia CommonsWatch Antiplatelet AgentsWatch Chronic Asthma SOAWatch associated Bootcamp video - Asthma Watch associated Bootcamp video - Pharmacology : NASIDs Watch associated Bootcamp video - Pharmacology : Aspirin & CelecoxibAspirin-Exacerbated Respiratory Disease- ↑ LOX pathway when COX blocked. - this is a non-IgE-mediated reaction (pseudo-allergic reaction); treatment includes avoidance of NSAIDs and/or administration of leukotriene receptor antagonists (e.g. montelukast)826932db-2fcd-4d04-84b7-495f49d70844
{{c1::Abciximab}} is a monoclonal IgG antibody against the GPIIb/IIIa receptorMade from monoclonal antibody Fab fragmentsWatch Antiplatelet AgentsWatch Glycoprotein IIb/IIIa InhibitorsWatch associated Bootcamp video - Platelets: Antiplatelet Medications Watch associated Bootcamp video - Myocardial Infarction: Management8f617975-7123-4f9b-92de-e8b5f7acf897
Thrombolytics exert their effects via direct or indirect conversion of plasminogen to {{c1::plasmin}}Watch ThrombolyticsWatch Thrombolytics (tPA, Streptokinase, Urokinase)Watch associated Bootcamp video - Coagulation and Fibrinolysis: Fibrinolysis and Inhibitors of Hemostasis Watch associated Bootcamp video - Myocardial Infarction: Management0aac24e4-9d64-4110-99e4-40f5478f00d6
One adverse effect of NSAIDs is {{c1::gastric ulcers::GI}} due to inhibition of COX-{{c2::1}}Watch NSAIDsWatch associated Bootcamp video - Platelets: Antiplatelet Medications Watch associated Bootcamp video - Pharmacology : NASIDsa8c9f067-1f6b-4cab-b4d7-f6c3a33fb67d
NSAIDs can cause {{c1::acute interstitial}} nephritis as an adverse effectPresents with increased creatinine, eosinophilia, castsWatch NSAIDs Watch Tubulointerstitial NephritisWatch Intra-Renal AKIWatch associated Bootcamp video - Acute Interstitial Nephritis Watch associated Bootcamp video - Pharmacology : NASIDsac266942-cc5f-42c1-866a-ec36bab4614b
Aspirin toxicity may be treated with {{c1::alkalinization}} of serum / urine- e.g., NaHCO3 - Alkalinization of serum pulls aspirin out of CNS - Alkalinization of the urine promotes salicylate excretionWatch NSAIDsWatch associated Bootcamp video - Side Effects and Toxins: Pharmacological Toxicity and Treatment836d1800-096a-4bf3-9598-89ffcee0bd0f
Acetaminophen toxicity results in depletion of hepatic {{c1::glutathione}} stores by NAPQIN-acetylcysteine restores depleted hepatic glutathione in patients with acetaminophen toxicityWatch NSAIDsWatch Acetaminophen ToxicityWatch associated Bootcamp video - Hepatic Pathology : Drug-Induced Hepatic Pathology Watch associated Bootcamp video - Side Effects and Toxins : Pharmacological Toxicity and Treatment Watch associated Bootcamp video - Pharmacology : Acetaminophen Watch associated Bootcamp video - Pharmacokinetics : Drug Elimination466a0d54-f68f-4ed9-a2fc-9a4b0cf845ae
{{c1::MRSA}} has an altered PBP target site and is thus resistant to anti-staphylococcal penicillinsRecall that the bulky R-group confers resistance of anti-staph penicillins to the penicillinase produced by staph aureus They are bulkier R-group drugs that have penicillinase resistance benefits but narrower spectrum. They are used for penicillin-resistant Staph aureus (not MRSA). Examples: - Oxacillin (instead of methicillin -withdrawn from the market) - Dicloxacillin - NafcillinWatch Nafcillin, Oxacillin, Methicillin, DicloxacillinWatch associated Bootcamp video - Staphylococcus: Antibiotic Resistant Strains of Staph Aureus Watch associated Bootcamp video - Antibiotics: Antipseudomonal Penicillins50d79dac-a452-40ec-94ce-2c7f66eba4b5
Why should tetracyclines and fluoroquinolones be avoided with milk? {{c1::Divalent cations will chelate the drug, decreasing absorption}}Ca2+, Mg2+, Fe2+Watch Tetracyclines Watch FluoroquinolonesWatch associated Bootcamp video - Antibiotics: Tetracyclines and Derivatives Watch associated Bootcamp video - Antiparasitics: Chloroquine-Resistant and Exo-Erythrocytic Antimalarials2e489d33-7a6f-4887-b1e2-a0adf71f1e67
How does the width of a 95% confidence interval change with a decreased sample size? {{c1::Increased width}}Watch associated Bootcamp video - Statistical Testing: Confidence Intervalsa9cf4964-a82f-423e-93d0-4336514284c8
What type of error is stating that there is an effect when none exists? {{c1::Type 1 error (false-positive error)}}- i.e. telling a man he's pregnant - Researchers reject the null hypothesis when the null hypothesis is really true - Represented by alpha (α) - Type 1 = false Positive; type 2 = false Negative (the letter P has 1 leg; N has 2)Watch Hypothesis Testing & Statistical Significance (p Value, Confidence Intervals) Watch Sensitivity & SpecificityWatch associated Bootcamp video - Statistical Testing: Hypothesis Testing Watch associated Bootcamp video - Testing Errors5d8a10fc-b5c1-4aed-9e4f-b724a5a28df1
What type of error is stating that there is NO effect when one DOES exist? {{c1::Type 2 error (false-negative error)}}- i.e. telling a pregnant female she is not pregnant - This is failing to reject the null hypothesis when it is truly false, causing an investigator to miss a true relationship - Denoted by beta (β) - Type 1 = false Positive; type 2 = false Negative (the letter P has 1 leg; N has 2)Watch Hypothesis Testing & Statistical Significance (p Value, Confidence Intervals) Watch Sensitivity & SpecificityWatch associated Bootcamp video - Statistical Testing: Hypothesis Testing Watch associated Bootcamp video - Testing Errors539f93ac-cb1d-4ec2-b444-b41af31066e2
The probability of making a type 1 error is represented by {{c1::alpha (α)}}- α is the 1st letter (type 1) - Typically set at 0.05; i.e. there is less than 5% chance that the data will show something that is not really there (thus if p <0.05, the result is said to be statistically significant) - Alpha is the maximum probability of making a type I error that a researcher is willing to accept - Type 1 error = false-positive errorWatch Hypothesis Testing & Statistical Significance (p Value, Confidence Intervals)Watch associated Bootcamp video - Statistical Testing: Hypothesis Testing Watch associated Bootcamp video - Testing Errorsbaa0c61f-1476-40ca-b523-f90b3e6527e8
The probability of making a type 2 error is represented by {{c1::β}}- β is the 2nd letter (type 2) - Typically set at 0.20; i.e. there is less than 20% chance that the data will NOT show something that is really there - False-negative errorWatch Hypothesis Testing & Statistical Significance (p Value, Confidence Intervals)Watch associated Bootcamp video - Statistical Testing: Hypothesis Testing Watch associated Bootcamp video - Testing Errors4aefb25f-0345-4c58-ae9b-a4f6328f14b5
The statistical power of a study is calculated by {{c1::1 - β}}- This represents a study's ability to detect a difference when one exists i.e. rejecting the null hypothesis when the alternative hypothesis is true - We want high power so we can detect a difference and reject H0 when H0 is false - β is the probability of a type 2 error (false-negative error)Watch Randomized Controlled TrialsWatch associated Bootcamp video - Statistical Testing: Testing Errorswe want this to be high so we can detect a difference and reject H0 when it is in fact false.f0cce3f1-0e1b-4c30-a008-938354bfa044
What statistical test is used to check differences between the means (quantitative) of TWO groups (qualitative)? {{c1::t-test}}- Tea is meant for two = t-test compares means of 2 groups - e.g., comparing the mean blood pressure between men and women Compared to: - Checking differences between the means of three or more groups = ANOVA - Checking differences between two categorical groups = Chi-square (χ2 ) testWatch associated Bootcamp video - Statistical Testing: Nominal Independent Variables53b4c985-87ea-44ea-baf6-37a03268e167
What statistical test is used to check differences between the means of THREE or more groups? {{c1::Analysis of variance (ANOVA)}}Analysis Of Variance = 3 words = 3 or more groups e.g., comparing the mean blood pressure between members of three different ethnic groupsWatch associated Bootcamp video - Statistical Testing: Nominal Independent Variablese111bac3-bd1c-4f28-b9a3-f053d260c575
Leuprolide, goserelin, triptorelin, and buserelin are GnRH analogues with {{c1::antagonist}} properties when used in a continuous fashionHowever, this may cause an initial surge in hormones during the first few weeks of therapy, but would then lead to GnRH receptor downregulation leading to a decrease in GnRH, FSH, and estrogen levelsWatch Benign Prostatic Hyperplasia (BPH) & Prostate CancerWatch LHRH Agonists/GnRH AnalogsWatch associated Bootcamp video - Pharmacology: GnRH Modulators826bc406-3e21-4073-93e3-993bb9208d7d
What cancer may be treated with continuous leuprolide? {{c1::Prostate carcinoma}}Other clinical uses include: - Uterine fibroids - Endometriosis - Precocious puberty - InfertilityWatch Benign Prostatic Hyperplasia (BPH) & Prostate CancerWatch LHRH Agonists/GnRH AnalogsWatch associated Bootcamp video - Pharmacology: GnRH Modulators509b8809-3578-4373-af7c-f97a8b8f911b
Clomiphene is an antagonist at {{c1::estrogen}} receptors in the hypothalamusClomiphene is a selective estrogen receptor modulator that inhibits negative feedback (by estrogen) on the release of gonadotropin-releasing hormone (GnRH) Selective Estrogen Receptor Modulators (SERMs)BreastUterusBoneTamoxifen-++Raloxifene--+Clomiphene- (in hypothalamus)ER agonist = +; ER antagonist = -Watch associated Bootcamp video - Pharmacology: Selective Estrogen Receptor Modulatorsea3361cf-0fbc-4939-9253-56004c582874
Clomiphene results in {{c1::increased::increased/decreased}} release of FSH and LH from the pituitaryPrevents normal feedback inhibition from estrogen Selective Estrogen Receptor Modulators (SERMs)BreastUterusBoneTamoxifen-++Raloxifene--+Clomiphene- (in hypothalamus)ER agonist = +; ER antagonist = -Watch SERMs & Aromatase InhibitorsWatch associated Bootcamp video - Pharmacology: Selective Estrogen Receptor Modulators81b27003-d29b-49af-a45f-34780df6a449
Which calcineurin inhibitor binds to cyclophilin? {{c1::Cyclosporine}}Watch ImmunosuppressantsReview CyclosporineWatch associated Bootcamp video - Transplant Rejection: Immunosuppressants60fb7b5c-1310-4f6d-8bdb-617598807532
Cyclosporine and tacrolimus are {{c2::calcineurin}} inhibitors that block T cell activation by preventing {{c1::IL-2}} transcriptionCalcineurin has phosphatase activity, which dephosphorylates the NFAT transcription factor, activating it and causing it to transcribe genes for IL-2Watch ImmunosuppressantsReview IL-2 Review Cyclosporine Review TacrolimusWatch associated Bootcamp video - Transplant Rejection: Immunosuppressantsde4705a0-b8b2-442f-854e-02d71ea47fe6
Epoetin alfa is a recombinant form of {{c1::erythropoietin (EPO)}} used to treat anemiasFirst Aid Pharmacology: ImmunologyWatch ErythropoietinWatch associated Bootcamp video - Normocytic Anemia: Additional Normocytic Anemias Watch associated Bootcamp video - Blood Cells: Erythrocyte5f22dbea-25da-409d-9741-bc1911b14844
Filgrastim is a recombinant form of {{c1::G-CSF}}Used for recovery of bone marrow and WBC counts by granulocyte stimulationFirst Aid Pharmacology: ImmunologyWatch associated Bootcamp video - Normocytic Anemia: Aplastic Anemia Watch associated Bootcamp video - Blood Cells: Neutrophil3adc48ef-870f-4d3e-9ea9-9915c3e612a3
Which interleukin is primarily responsible for fever and acute inflammation? {{c1::IL-1}}Watch Postoperative Surgical FeversReview IL-1Watch associated Bootcamp video - Proinflammatory Cytokines Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology) Watch associated Bootcamp video - Cytokines: Proinflammatory Cytokinesdba6bf8a-ca33-40e9-933f-7fadf6f95c05
Which cytokine is responsible for maintaining granulomas in TB infection? {{c1::TNF-α (from macrophages)}}While IFN-y stimulates macrophages to kill phagocytosed pathogens Photo credit: Ed Uthman, MD, CC BY-SA 2.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 2.0Watch Macrophages Watch TNF InhibitorsReview Monocytes / Macrophages Review TNF-alphaWatch associated Bootcamp video Watch associated Bootcamp video - Inflammatory Response: Chronic Inflammatory Response (Pathology) Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphoma Watch associated Bootcamp video - Blood Cells: Monocyte and Macrophage82a83e0c-e783-47cb-9817-8dca51fe4611
Which immune cell type has the cell surface protein B7 (CD80/86)? {{c1::APCs (B cells, macrophages, dendritic cells)}}The interaction between B7 (CD80/86 on APCs) and CD28 on T-cells is crucial for the co-stimulation required for T-cell activationWatch Cytotoxic T-cellsReview Dendritic Cells Review T Cells-ActivationWatch associated Bootcamp video - T-cells: T-cell Activationc9f96eb9-4ae2-4c8c-9edb-c190bda25f8d
Which immune cells have the cell surface protein CCR5? {{c1::Macrophages (early HIV infection), helper T cells::2}}Whereas CXCR4 is only on helper T cellsWatch HIV Overview (Retroviridae)Watch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis Watch associated Bootcamp video - Antivirals : Antiretroviral Attachment and Fusion Inhibitorsd75541d5-d5f9-40d2-8004-767c905c10bd
Which blood transfusion reaction presents with urticaria, pruritus, hypotension, and shock? {{c1::Anaphylactic transfusion reaction}}- Occurs within minutes to 2-3 hours - First stop the transfusion, then give epinephrine and antihistaminesFA2020:Watch Blood Transfusion Complications Watch Shock: Undifferentiated Shock SOAP Watch Shock: Hypovolemic & Distributive SOAPs Watch Postoperative Surgical FeversReview EpinephrineWatch associated Bootcamp video - Transfusion Reactions: Anaphylactic Transfusion ReactionsAtlas:504dcee5-5625-4465-ab40-94258628a019
Which blood transfusion reaction is a reaction against plasma proteins in transfused blood? {{c1::Allergic / anaphylactic reaction}}- Can be anaphylactic (antibodies against donor immunoglobulins) or urticarial (antibodies against donor allergen) - Anaphylaxis → stop transfusion, give epinephrine and antihistamines, treat shock if present - Urticaria → stop transfusion, give antihistamines, may resume transfusion if otherwise asymptomaticFA2020:Watch Blood Transfusion Complications Watch Shock: Hypovolemic & Distributive SOAPs Watch Postoperative Surgical FeversReview EpinephrineWatch associated Bootcamp video - Transfusion Reactions: Anaphylactic Transfusion Reactions0579c808-6ddc-4a95-9753-816700e71804
Which blood transfusion reaction presents with fever, hypotension, tachypnea, hemoglobinuria*, and jaundice? {{c1::Acute hemolytic transfusion reaction (AHTR)}}- This feared complication occurs within 1 hour; patients often have oozing from the IV site - A delayed reaction can also occur (milder fever & jaundice); due to autoantibodies against minor erythrocyte antigens - *Hemoglobinuria is a helpful clue that you're dealing with an acute hemolytic transfusion rather than an allergic reactionFA2020:Watch Blood Transfusion Complications Watch Intravascular Hemolytic Anemia: Non-MAHA DDx Watch Postoperative Surgical Fevers Watch Approach to HematuriaWatch associated Bootcamp video - Transfusion Reactions: Acute Hemolytic Transfusion Reactionf88a0f3d-e12c-4b4a-8676-c6de3822a963
Which blood transfusion reaction is caused by host antibodies against donor ABO blood groups or foreign antigen on donor RBCs? {{c1::Acute hemolytic transfusion reaction (AHTR)}}- IgM isohemagglutinins formed naturally in response to bacterial flora cause opsonization and complement activation on donor RBCs, leading to hemolysis - ABO incompatibility is mediated by the complement / IgM, whereas the foreign antigens are opsonized and cleared by the spleenFA2020:Watch Blood Transfusion Complications Watch Postoperative Surgical FeversWatch associated Bootcamp video - Transfusion Reactions: Acute Hemolytic Transfusion Reaction41096cf7-5389-4724-904a-b129d986f974
What type of hypersensitivity is acute hemolytic transfusion reaction (AHTR)? {{c1::Type II HSR}}FA2020:Watch Blood Transfusion Complications Watch Postoperative Surgical FeversWatch associated Bootcamp video - Transfusion Reactions: Acute Hemolytic Transfusion Reaction Watch associated Bootcamp video - Hypersensitivity Reactions: Type II Hypersensitivity Reactions5f34a6e7-d458-40bb-91c0-a38e04b04c44
Which blood transfusion reaction is caused by donor anti-leukocyte antibodies against recipient neutrophils and pulmonary endothelial cells? {{c1::Transfusion-related acute lung injury (TRALI)}}- Neutrophil mediated damage results in sudden onset of hypoxemia during transfusion, resulting from capillary endothelium damage and resultant exudative fluid loss - Patients will have infiltrates on CXR Photo credit: Altaf Gauhar Haji, Shekhar Sharma, DK Vijaykumar and Jerry Paul., CC BY 2.0, via Wikimedia CommonsFA2020:Watch Blood Transfusion ComplicationsWatch associated Bootcamp video - Immunology: Transfusion-Related Acute Lung Injury (TRALI)1d033a8d-c7fc-4d74-9c2a-ff76ed0ee735
What pathologic RBC finding is seen in a peripheral smear with lead poisoning, sideroblastic anemia, and myelodysplastic syndrome? {{c1::Basophilic stippling}}vs. ringed sideroblasts which are seen in bone marrow Photo Credit: Prof. Erhabor Osaro, CC BY-SA 4.0, via Wikimedia CommonsWatch Myeloproliferative Neoplasms & Myelodysplastic SyndromesWatch associated Bootcamp video - Sideroblastic Anemia Watch associated Bootcamp video - Microcytic Anemia: Lead Toxicity Watch associated Bootcamp video - Porphyrias : Sideroblastic AnemiaAtlas:39c9ddc3-ed20-41e4-8833-eb11b2cf5bad
{{c2::Porphyria cutanea tarda}} is due to deficiency of the enzyme {{c1::uroporphyrinogen decarboxylase (UROD)}}"- Results in dermatological symptoms (deficiency occurs after porphobilinogen conversion) - Can also be caused by hepatitis C (""C"" for Cutanea) - Can be worsened by alcohol and HIV"Watch Heme Synthesis Watch PorphyriasReview Heme Synthesis Review Porphyria Cutanea Tarda (PCT)Watch associated Bootcamp video - Porphyrias : Heme SynthesisUWorld:21fd72f9-2fa0-48e9-a74e-9db4b6d2bd28
Which porphyria presents with blistering cutaneous photosensitivity and hyperpigmentation? {{c1::Porphyria cutanea tarda}}"- Accumulation of uroporphyrin (oxidation product) due to build up of uroporphyrinogen III is shunted to the skin, and then on exposure to light cause blisters and hyperpigmentation - Deficiencies in enzymes post porphobilinogen conversion can result in photosensitivity issues Photo credit: Kaur Jasleen, Nidhi Sharma, Jyotika Kalsy, Mughda Sharma, ""Porphyria Cutanea Tarda with Constrictive Pericarditis: A Rare Association"", Case Reports in Dermatological Medicine, vol. 2012, Article ID 972162, 2 pages, 2012. https://doi.org/10.1155/2012/972162"Watch PorphyriasReview Porphyria Cutanea Tarda (PCT)Watch associated Bootcamp video - Porphyrias : Heme SynthesisUWorld:469baad9-ed59-4805-9403-3d5d93045a9b
In first-order kinetics, a drug infused at a constant rate takes {{c1::4}} - {{c1::5}} half-lives to reach steady stateIt takes 3.3 half-lives to reach 90% of the steady-state levelWatch associated Bootcamp video - Pharmacokinetics: Elimination Kinetics Watch associated Bootcamp video - Pharmacokinetics: Dosage Calculations7ff710f2-02ad-4f40-839f-b828d93f4714
What formula is used to calculate loading dose? {{c1::Loading dose = (Cp × Vd)/F}}- Cp = target plasma concentration at steady state - F = bioavailability - Vd = volume of distributionWatch associated Bootcamp video - Pharmacokinetics: Dosage Calculations2c88737e-f99b-432e-9da8-a2594a99953b
What is the treatment for rapid reversal of rat poison ingestion? {{c1::Fresh frozen plasma (FFP)}}Rat poison is coumadin (warfarin)Watch associated Bootcamp video - Coagulation and Fibrinolysis: Anticoagulation0f8ccdb7-1426-4075-aa36-ba899a4b79a8
Chronic alcohol use leads to {{c1::induction}} of CYP450Acute alcohol abuse inhibits CYP450, chronic alcohol abuse induces itWatch associated Bootcamp video - Pharmacokinetics: Cytochrome P450 Interactions39b0ccde-7175-443a-a559-1ac1b3db4c8f
HPV infects the {{c1::true vocal cords}} in the respiratory tract which causes {{c1::laryngeal papillomatosis}}- HPV has a tropism for stratified squamous epithelium - The true vocal cords are the only part of the URT with stratified squamous epithelium Laryngeal papillomatosis: Deenadayal, D. , Naeem, N. and Bommakanti, V. (2018) Coblation: An Alternative to CO2 Laser and Microdebrider for Laryngeal Papillomatosis. International Journal of Otolaryngology and Head & Neck Surgery, 7, 47-54. doi: 10.4236/ijohns.2018.72007.Watch Human Papillomavirus (Papillomaviridae)Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphoma Watch associated Bootcamp video - DNA Viruses: Human Papillomavirus: Clinical Manifestations7ea75447-06b4-45de-bda5-09547e780cde
Levothyroxine = {{c1::synthetic T4}} Liothyronine = {{c1::synthetic T3}}- Hence it stimulates nuclear receptors and results in increased gene expression - Note: triiodothyronine (physiologic T3) is typically reserved for severe acute hypothyroidism such as myxedema coma - Levothyroxine is the primary long-term treatment for hypothyroidismWatch Hypothyroidism SOAPWatch Propylthiouracil, Methimazole, LevothyroxineWatch associated Bootcamp video - Thyroid : Hyper/Hypothyroidism: Hashimoto's and Postpartum Thyroiditisfc2d4587-f458-48af-a4f3-ad87eba96ba8
Levothyroxine and liothyronine are {{c1::thyroid replacement::main function}} medications that are used to treat hypothyroidism and myxedema coma- Levothyroxine is the synthetic form of T4 - Liothyronine is the synthetic form of T3Watch Hypothyroidism Overview & Hashimotos ThyroiditisWatch Hypothyroidism SOAPWatch Propylthiouracil, Methimazole, LevothyroxineWatch associated Bootcamp video - Thyroid : Hyper/Hypothyroidism: Hashimoto's and Postpartum Thyroiditisbabf283b-2846-4bc6-8c9e-9069ee8adf70
Topical vitamin D can be used as an adjunct therapy for patients with {{c1::psoriasis}}- Due to its anti-keratinocyte activity - Psoriatic scales are common on the elbows, knees, lumbosacral area, and the scalpWatch Teriparatide, Vitamin D, Cinacalcet, SevelamerWatch associated Bootcamp video - Parathyroids : Vitamin D Deficiencycf4ebe64-a5dc-4db1-9546-81776f2bd2fa
Proteasome inhibitors ({{c2::-zomibs::suffix}}) are antineoplastics that inhibit cell cycle progression at the {{c1::G2-M phase}}"Includes carfilzomib and bortezomib ""Car filled with zombies and Bart the zombie"" Photo credit: Lumen learning [https://courses.lumenlearning.com/suny-osbiology2e/chapter/eukaryotic-translational-and-post-translational-gene-regulation/]"Watch Plasma Cell NeoplasmsWatch associated Bootcamp video - Cell Biology: Ubiquitin-Proteasome Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets8c9032cb-99c9-45c0-a792-10073a6994d7
Carfilzomib and bortezomib are examples of antineoplastics that work by inhibiting the {{c1::proteasome}}The proteasome is an intracellular tagging system that allows for degradation of unwanted / used up / damaged compounds (e.g., pro-apoptotic proteins) Photo credit: Lumen learning [https://courses.lumenlearning.com/suny-osbiology2e/chapter/eukaryotic-translational-and-post-translational-gene-regulation/]Watch Plasma Cell NeoplasmsWatch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targetse4be21df-854c-4cbf-b059-e8493f433501
Blinding (the cardinal feature of RCTs) is critical in reducing {{c1::measurement bias}}- Increases internal validity - Helps preserve the benefits of randomization by preventing the biased assessment of outcomes - If a clinical trial is NOT blinded, this is an open-label trialWatch Randomized Controlled TrialsWatch associated Bootcamp video - Bias and Study Errors: Performing Bias445274d3-0a4a-48a1-b36d-10f63c2842ce
What is the likely diagnosis in a young woman with alternating constipation / diarrhea and chronic abdominal pain that is relieved after a bowel movement? {{c1::Irritable bowel syndrome}}Watch Large Bowel & Appendiceal DisordersWatch Approach to Abdominal Pain Watch Approach to DiarrheaWatch associated Bootcamp video - Intestinal Pathology : Irritable Bowel Syndromefbb2a2b3-6297-43a0-8a22-b7af2178b998
Oxygenation, and thus PaO2, in mechanically ventilated patients may be improved by increasing the {{c1::FiO2}} or {{c2::PEEP}}- PEEP prevents alveolar collapse so that there's more alveoli available for oxygen - FiO2 should be limited to < 60% (oxygen → free radical damage)Watch Intro to Ventilation: Vent Management & Complications2879844c-48f6-4553-8d21-f12176c6f09e
Clonality of B lymphocytes can be determined by analysis of the {{c1::immunoglobulin light chain}} phenotypeB cells express / secrete only one of two types of immunoglobulin light chains (kappa or lambda)a60d7a8d-018d-4502-8c7e-c9817351074a
The normal kappa to lambda light chain ratio in a tissue sample is {{c1::3:1}}- Letter k = 3 lines, letter l = 1 line - In hyperplasia, which is polyclonal, this ratio is maintained - In lymphoma, which is monoclonal, this ratio increases to > 6:1 or is inverted (e.g., kappa to lambda ratio = 1:3)70ca42f7-5624-4c7d-9cab-5b9f8272d87c
In lymphoma, which is monoclonal, the kappa to lambda light chain ratio {{c1::increases to > 6:1}} or is {{c2::inverted}}Inverted = 1:3"""Can get as high as 20:1"""b102bfb1-c27b-4de2-99a6-d870251b97db
Which oncogenic microbe is associated with nasopharyngeal carcinoma, post-transplant lymphoproliferative disease, and certain lymphomas (e.g., endemic Burkitt, primary CNS)? {{c1::Epstein-Barr virus (EBV)}}African children and Chinese males are the classic demographics for EBV associated nasopharyngeal carcinoma; presents classically as a neck massWatch Epstein-Barr Virus (Herpesviridae)Watch Infectious Mononucleosis Watch Primary Brain Tumors in AdultsWatch Epstein-Barr Virus (Herpesviridae)Review Burkitt Lymphoma Review Primary CNS Lymphoma (PCNSL) Review Epstein-Barr Virus (HHV4)Watch associated Bootcamp video - Leukemias and Lymphomas: Burkitt Lymphoma Watch associated Bootcamp video - Adult Primary Brain Tumors: Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal Meningitis Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Clinical Manifestations68bbad80-121f-47ef-bfc3-2a4865fb86d6
The cell cycle is regulated by cyclins and cyclin-dependent kinases (CDKs) which when {{c2::complexed}} allow cells to bypass {{c1::checkpoints (restriction points)}}- Thus, these proteins are an important point of regulation by the cell in order to avoid tumorigenesis - Checkpoints (restriction points) occur near the end of G1, near the end of G2, and within M metaphase Photo credit: OpenStax, CC BY 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Cell Cycle Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Growth Regulation Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Growth Regulation647f6682-53d7-4b67-a235-9fbea6f86312
Cyclin-dependent kinases (CDKs) are constitutive and are normally {{c1::inactive}}- Activated when cyclins form a complex with them - They are also inhibited by cyclin-dependent kinase inhibitorsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Cell Cycle Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Growth Regulation9eb1c494-0247-40b4-8e02-cd0ae99a50ff
p53 restricts the cell cycle to G1 by leading to the inhibition of {{c2::CDK4::specific}}, maintaining the {{c1::hypo}}phosphorylated state of RbCDK4-Cyclin D1 activation: - When stimulated, CDK4 binds Cyclin D1 - This leads to hyperphosphorylation of Rb, causing it to release E2F - E2F acts as a transcription factor for genes required for the S phase Photo credit: OpenStax, CC BY 4.0Watch Cell CycleWatch associated Bootcamp video Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Growth Regulation Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Growth Regulation Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Cell Cyclea59c3f16-0f0a-4d4a-805c-7799e997f47f
Loss of p53 is seen in >{{c1::50}}% of cancerse.g., in sporadic endometrial carcinoma, Li-Fraumeni syndrome Photo credit: OpenStax, CC BY 4.0Watch Breast Cancer Watch Cell CycleWatch Colorectal Cancer: CarcinogenesisReview Li-Fraumeni Syndrome (LFS)Watch associated Bootcamp video Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Growth Regulation Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Growth Regulation11d84163-a139-4806-80a6-1341c08db4f4
A(n) {{c1::Baker cyst}} is a collection of {{c2::synovial fluid}} in the {{c3::popliteal fossa}} in the {{c4::gastrocnemius-semimembranosus}} bursa- Causes a proximal tibial nerve lesion (sensory + motor deficits), rupture mimics a DVT - Popliteal fossa is defined as the diamond shaped fossa outlined by the four muscles Image licensed by Physeo and used with permission. Purchase full access here.Watch Knee JointWatch Approach to Knee PainWarch associated Bootcamp video - Lower Extremity Nerves: Tibial Nerve6aa2231a-aa35-4798-aa5d-d233666e5d41
The {{c1::infraspinatus::rotator cuff muscle}} and {{c1::teres minor::rotator cuff muscle}} are the two main muscles that {{c2::laterally (externally) rotate::action}} the arm- See right shoulder joint below - The subscapularis (right) internally rotates the humerus, while the infraspinatus (upper left) and teres minor (lower left) externally rotate the humerus: Photo credit: Young Lae Moon, CC BY 3.0, via Wikimedia Commons Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Shoulder and Elbow: Shoulder Anatomy Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Axillary Nerved390ea3b-9bab-45e1-8b40-4be393ce8f97
The {{c1::teres minor}} (rotator cuff muscle) does the following actions: - {{c2::aDducts}} the arm - {{c2::laterally (externally) rotates}} the armPhoto credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Shoulder and Elbow: Shoulder Anatomy Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Axillary Nerve47a812fd-b099-4da9-803c-1cee7754f608
The {{c1::deltoid}} abducts the arm from {{c2::15}}° to {{c2::90}}° and is innervated by the {{c3::axillary}} nerveThe deltoid also helps flex and extend the armWatch Brachial Plexus OverviewWatch associated Bootcamp video - Shoulder and Elbow: Shoulder Anatomy Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Axillary Nerveb60afdd7-8ecf-4d0b-aca9-60a4c7fd3109
Lateral epicondylitis (AKA tennis elbow) is an elbow injury that may be due to repetitive {{c1::extension}} ({{c1::backhand}} shots) that causes microtrauma of the {{c2::extensor carpi radialis brevis (ECRB)}} tendon at its origin- Backhand strikes transmit sudden, extreme forces through the lateral epicondyle which, over time, may cause microtrauma of the extensor carpi radialis brevis (ECRB) - This microtrauma leads to excess fibroblasts and neovascularization at its origin on the lateral epicondyle - Results in pain near the lateral epicondyle and worsened pain with resisted wrist extension - HOWEVER, the pain will also be near proximal wrist extensors, and will worsen with resisted middle finger extension Photo credit: OpenStax, CC BY 4.0 Photo credit: www.scientificanimations.com, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video Watch associated Bootcamp video - Shoulder and Elbow: Epicondylitis926bc051-b6f9-4de3-b2c8-d490111be2ac
Treating an organophosphate poisoning is two fold: - {{c1::Atropine}}, which inhibits all subtypes of {{c1::muscarinic receptors}} - {{c2::Pralidoxime}}, which if given early, regenerates {{c2::acetylcholinesterase (AChE)}}- Organophosphates induce cholinergic toxicity - Per UWorld: Treat with atropine first, because pralidoxime can cause transient inhibition of AChE, which will worsen symptoms DrugMOATreatsOtherPralidoximeRegenerates AChECholinergic toxicity (e.g., organophosphate / cholinesterase inhibitor toxicity) Pyridostigmine AChE inhibitorMyasthenia gravisDoes not cross BBBPhysostigmineAChE inhibitorAnticholinergic toxicity (e.g., atropine, Jimson weed)Crosses BBBWatch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDx Watch Bradycardia Workup & ManagementWatch Acetylcholinesterase InhibitorsWatch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning Watch associated Bootcamp video - Side Effects and Toxins : Pharmacological Toxicity and Treatment Watch associated Bootcamp video - Neuromuscular Junction (NMJ): Medications Targeting the NMJabc09024-b24f-4ba8-816c-ced2837789f0
Injury to the {{c1::axillary (C5-C6)::roots}} nerve presents as: - {{c2::Flattened deltoid::appearance}} - Loss of {{c3::arm abduction at shoulder (>15°)::motor}} - Loss of sensation over {{c4::the deltoid muscle and lateral arm}}Right axillary nerve injury with flattened deltoid shown below: Photo credit: Paul Marquis,, via Ortho Eval Pal, used with permission, modified by censoring Photo credit: Picryl, Public domainWatch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Axillary Nerve977303f4-8be4-42cb-b539-216a28554cfb
{{c1::Radial}} nerve injury presents with: - {{c2::Loss of elbow, wrist, and finger extension (e.g., wrist drop)::Action}} - {{c3::Decreased grip strength (due to loss of wrist extension)::Strength}} - {{c4::Loss of sensation over posterior arm / forearm and dorsal hand::Sensation}}Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Radial Nerve23053960-b7a5-4b14-bf89-c9f8479cdbd8
In a(n) {{c1::median}} nerve injury, sensation is lost over the: 1. {{c2::Thenar eminence}} 2. {{c3::Dorsal aspects of lateral 3 1/2 fingers (with proximal lesion)}} 3. {{c4::Palmar aspects of lateral 3 1/2 fingers (with proximal lesion)}}Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Median Nerve Watch associated Bootcamp video - Wrist & Hand : Wrist and Hand Anatomy98bfa5d8-6498-4b60-aabc-0de8892e340f
Loss of muscle action in a(n) {{c1::ulnar}} nerve injury includes loss of: 1. {{c2::Wrist flexion & adduction::2}} 2. {{c3::Flexion of medial fingers (4th and 5th digits)}} 3. {{c4::Abduction AND adduction of fingers (interossei)}} 4. {{c5::Medial 2 lumbricals (4th and 5th digits)}}This is because the ulnar nerve innervates the flexor carpi ulnaris and the medial portion of the flexor digitorum profundus; once it enters the wrist (between hook of hamate and pisiform bone in Guyon's canal) it divides into superficial ulnar and deep ulnar (deep intrinsic hand muscles)Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Ulnar Nerve Watch associated Bootcamp video - Wrist & Hand : Wrist and Hand Anatomy3b74f328-2fec-4936-9d0e-1fea7d233126
"A lesion to the #{{c1::4 (posterior cord)}} would result in {{c2::wrist drop}}, paralysis of the {{c3::deltoid}}, and impairment of {{c4::internal}} rotation of the humerus""- Wrist drop can also be seen in #7: radial nerve injury - Deltoid paralysis can also be seen in #6 axillary nerve injury (posterior cord gives off both radial and axillary nerve) - IF lesion occurs at the bifurcation of the posterior cord → only deltoid paralysis + wrist drop sx, (subscapular nerves come off before the bifurcation in the lower half, so internal rotation is spared)"Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Axillary Nervef722e626-9335-46c3-925e-3fceae6a1239
{{c1::Thoracic outlet syndrome::Condition}} is due to compression of the {{c2::lower trunk}} (roots {{c2::C8-T1}}) and {{c3::subclavian}} vessels- Presents as poorly localized numbness and dysesthesia exacerbated by overhead use of the affected arm - Would also have a positive Adson test (decreased pulse intensity with abduction and external rotation of arm)Note the large thorax guy is aligned with the chairs labeled C8 and T1, just like the clumsy falling (Klumpke) guy Watch Brachial Plexus InjuriesWatch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Thoracic Outlet SyndromeKlumpke palsy (claw hand) + vascular symptoms325a9ee0-cfd0-4920-88f9-e026ca00ecf3
The {{c1::genitofemoral}} nerve ({{c2::L1-L2::nerve roots}}) provides: - Sensory innervation to the {{c3::scrotum / labia majora::genital area}} and {{c3::anteromedial proximal thigh::femoral area}} - Motor innervation to the {{c4::cremaster}}Watch Inguinal Hernia Repair OverviewWatch associated Bootcamp video - Non-visceral Anatomy : Direct Inguinal Hernias Watch associated Bootcamp video - Non-visceral Anatomy : Indirect Inguinal Hernias Watch associated Bootcamp video - Lower Extremity Nerves: Iliohypogastric, Genitofemoral and Lateral Femoral Cutaneous Nervesb927fe7d-d4e7-4230-9a3f-b752592800c8
The genitofemoral nerve is commonly injured due to laparoscopic surgeries for {{c1::inguinal hernias}} or by {{c2::retractor blades}} used in abdominal surgeryInguinal hernia surgery is often done with laparoscopic surgery, the genitofemoral nerve traverses the inguinal hernia repair operative fieldWatch Inguinal Hernia Repair Overview Watch Surgery Layers of the Anterior Abdominal WallWatch associated Bootcamp video - Lower Extremity Nerves: Iliohypogastric, Genitofemoral and Lateral Femoral Cutaneous Nerves646b1464-2ab0-497a-8674-2ca6c183c232
Injury to the {{c1::genitofemoral}} nerve presents as: - Decreased sensation of {{c2::anteromedial proximal thigh}} (as well as {{c2::labia}} and {{c2::scrotum}}) - Absent {{c3::cremasteric}} reflexBasically, the anterior thigh below the inguinal ligamentWatch Inguinal Hernia Repair OverviewWatch associated Bootcamp video - Lower Extremity Nerves: Iliohypogastric, Genitofemoral and Lateral Femoral Cutaneous Nervese9e52744-0d4c-47e6-8f5e-57804b56f5fe
The {{c1::femoral}} nerve ({{c2::L2-L4::nerve roots}}) provides: - Sensory innervation to the {{c3::anterior thigh}} and {{c3::medial leg}} - Motor innervation to the {{c4::quadriceps}}, {{c4::iliopsoas}}, {{c5::pectineus}}, and {{c5::sartorius}}Hip flexors: - Iliopsoas - Sartorius - Pectineus Quadriceps (leg extender, partial hip flexor): - Rectus femoris - Vastus lateralis - Vastus intermedius - Vastus medialisWatch Lumbosacral NervesWatch associated Bootcamp video - Lower Extremity Nerves: Femoral and Sciatic Nervea623e907-5ef8-4f51-b4cc-ee9ca2306207
The {{c1::sciatic}} nerve ({{c2::L4-S3::nerve roots}}) provides: - Sensory innervation to the {{c3::lower leg and foot}} via tibial nerve and common peroneal nerve - Motor innervation to the {{c4::semitendinosus}}, {{c4::semimembranosus}}, {{c5::biceps femoris (long head)}}, and {{c5::hamstring portion of the adductor magnus}}- Proximal sciatic nerve injury leads to weak knee flexion, dorsiflexion, plantar flexion, inversion, no ankle reflex, numbness on dorsal foot and posterolateral calf → sensation to the medial leg is spared (innervated by saphenous nerve) Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Sciatic NerveWatch associated Bootcamp video - Lower Extremity Nerves: Femoral and Sciatic Nervef3633570-dcda-4c10-8db8-c3bf3d547f42
The {{c1::sciatic}} nerve splits into the {{c2::common peroneal (fibular)}} nerve and the {{c2::tibial}} nerveWatch Sciatic Nerve Watch Common Peroneal (Fibular) NerveWatch associated Bootcamp video - Lower Extremity Nerves: Femoral and Sciatic Nerve0ad0d49a-a764-4ad2-a756-fb915c605c47
The {{c1::common peroneal}} nerve is commonly injured due to: - {{c2::Trauma}} - {{c3::Compression of the lateral leg (e.g., cast)}} - A(n) {{c4::fibular neck}} fracture- Compression at the lateral aspect of leg will compress the fibular neck - Risk for compression injury during gynecologic surgery (dorsal lithotomy with legs in stirrup boots) - AKA common fibular nerveWatch Common Peroneal (Fibular) NerveWatch associated Bootcamp video - Lower Extremity Nerves: Common, Deep and Superficial Peroneal (Fibular) Nerves9740a532-c59f-4dff-82cc-72fae790e2b7
Injury to the {{c1::common peroneal}} nerve presents as: - Loss of sensation on {{c2::the dorsum of the foot}} - {{c3::Foot drop::Motor}}- AKA common fibular nerve - Fibular causes Foot drop Photo credit: Henry Vandyke Carter , Public domain, via Wikimedia CommonsWatch Common Peroneal (Fibular) NerveWatch associated Bootcamp video - Lower Extremity Nerves: Common, Deep and Superficial Peroneal (Fibular) Nervesaf3b8aca-361c-48a8-92be-5defaa8925ea
What acid-base disorders are associated with aspirin (salicylate) toxicity? Early: {{c1::pure respiratory alkalosis}} Late (> 12 hours): {{c1::mixed respiratory alkalosis and metabolic acidosis}} with {{c1::normal}} pH- Respiratory alkalosis due to increased respiratory drive; metabolic acidosis due to increased production/decreased elimination of organic acids and anaerobic metabolism; use Winter formula to make sure there's two coexisting primary issues - Symptoms of fever, tinnitus, tachypnea Early: aspirin stimulates medullary respiratory center Medium: aspirin is an acid and dissociates and causes increased lipolysis + inhibits citric acid cycle, forming lactic acid and causing metabolic acidosis The PaCO2 will be lower than the predicted respiratory compensation by Winter formula due to concurrent respiratory alkalosisWatch Acid/Base DisordersWatch associated Bootcamp video - Pharmacology : Aspirin & Celecoxib Watch associated Bootcamp video - Side Effects and Toxins: Pharmacological Toxicity and Treatment40087cc3-6daf-42b4-adb8-a1e7371e646a
The {{c1::pudendal}} nerve ({{c2::S2-S4::nerve roots}}) provides: - Sensory innervation to the {{c3::perineum and genitalia::2}} - Motor innervation to the {{c4::external urethral}} and {{c4::anal sphincters}}S2-S4 keeps the penis off the floor!Watch Lumbosacral NervesWatch associated Bootcamp video - Urinary Incontinence: Micturition Overview Watch associated Bootcamp video - Lower Extremity Nerves: Obturator and Pudendal Nerve8969e8d5-fad7-4277-b9cf-9d34b064ce8e
Injury to the {{c1::pudendal}} nerve presents as: - Decreased sensation in the {{c2::perineal and genital area}} - {{c3::Fecal or urinary incontinence::motor}}Watch Lumbosacral NervesWatch associated Bootcamp video - Urinary Incontinence: Micturition Overview Watch associated Bootcamp video - Lower Extremity Nerves: Obturator and Pudendal Nerve4a7dc36c-219f-4245-b255-a5a244d8d6d4
An intervertebral disc herniation at the {{c1::L3-L4}} level will result in: - Weakness of {{c2::knee}} extension and {{c2::hip}} flexion (action) - Decreased {{c3::patellar}} reflex - Decreased sensation of {{c4::anterior}} / lateral thigh"- Will affect L4 spinal nerve and affect the action of the femoral nerve - ""L3 and 4, kick in the door"" (L4-5 used to drive)"Watch Lumbosacral NervesWatch associated Bootcamp video - Radiculopathy: Spinal Disc Herniation Watch associated Bootcamp video - Spine: Spinal Radiculopathy768e4b3b-711c-4e72-809b-205aa493e2f3
The {{c1::median}} nerve travels with the {{c2::brachial}} artery around the {{c3::distal humerus / cubital fossa}}- Most nerves and arteries are named together by bones / regions they are associated with; this pair is an important exception to this naming convention - Damage to this pairing can result in Volkmann's contracture Photo credit: Henry Vandyke Carter, Public domain, via Wikimedia CommonsWatch associated Bootcamp video - Shoulder and Elbow: Humerus Fractures Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Median Nerve Watch associated Bootcamp video - Wrist & Hand : Wrist and Hand Anatomy7aed43c1-7d27-4c65-9b7d-1352771fcc6a
In physiological homeostasis, {{c1::purines}} are excreted by way of metabolism to {{c2::uric acid}}Purines → hypoxanthine → xanthine → uric acidWatch Gout Drugs Watch Purine Salvage PathwayWatch Gout & Pseudogout SOAPReview Purine ExcretionWatch associated Bootcamp video - DNA Structure: Purine Synthesis and Salvage Watch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Tumor Lysis Syndromebcd2f941-78f2-4d91-b87e-031fd2cc013e
What is the likely diagnosis in a patient with a recent URI that presents with syncope, dyspnea, and the ECG findings below? {{c1::Pericardial effusion}}Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons Electrical alternans with sinus tachycardia is highly specific for large pericardial effusion, which may result in cardiac tamponade Image(s) provided by www.radiologyassistant.nl. Used with permission. Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Pericardial Effusion, Cardiac Tamponade, and Constrictive Pericarditis SOAP Part 1 Watch Shock: Cardiogenic & Obstructive SOAPsWatch associated Bootcamp video - Pericardial Disease: Pericardial Effusion0963b708-4d94-4e14-aaca-7a19afa3b7c9
The anemia in chronic kidney disease (CKD) can be treated with {{c1::epoetin alfa}}- Epoetin alfa is a synthetic form of erythropoietin (EPO) - This will effectively reverse the anemia, since the problem with anemia here is loss of interstitial fibroblasts that produce erythropoietinFirst Aid Pharmacology: ImmunologyWatch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Normocytic Anemia: Additional Normocytic Anemias Watch associated Bootcamp video - Chronic Kidney Disease Watch associated Bootcamp video - Blood Cells: Erythrocytef0cc931c-8d84-4fb5-8d2d-127ea6061c93
Tumor lysis syndrome results from the fulminant release of tumor cell contents into the plasma, resulting in the following problems - {{c1::Hyper}}kalemia - {{c1::Hyper}}phosphatemia - {{c1::Hypo}}calcemia - {{c1::Hyper}}uricemia due to increased {{c1::nucleic}} acid breakdown"Mnemonic: ""PUKE Calcium"" Phosphorus, Uric acid, potassium (K+) Elevated, Calcium decreased - Hypocalcemia is due to increased complexation/sequestration by phosphate - Hyperuricemia can lead to acute tubular necrosis which causes acute kidney injury"Watch Gout & Pseudogout Watch Gout DrugsWatch Gout & Pseudogout SOAP Watch Hypocalcemia: Clinical Presentation & DDx Watch NeuroblastomaWatch Gout & Pseudogout Watch Hypocalcemia: Clinical Presentation & DDxWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Tumor Lysis Syndromey13c5a87f-c0ad-4e2c-bdc5-9c2102be77fa
Tumor lysis syndrome can be prevented with aggressive {{c1::IV fluids}} + either {{c2::xanthine oxidase}} inhibitors OR {{c3::rasburicase::drug}}Main focus is on prophylaxis. However, if it appears clinically, monitor cardiac function and electrolytes closely and correctWatch Gout DrugsWatch Acute Leukemias SOAPReview Purine ExcretionWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Tumor Lysis Syndromeee662471-7101-4993-a28e-425767030416
By interfering with tubulin function, colchicine disrupts the {{c2::cytoskeleton::cellular element}} of {{c1::neutrophils}}Thus, colchicine interferes with neutrophil migration, phagocytosis, and degranulationWatch Gout DrugsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Pharmacology : Gout Medications2fd6bf5b-7875-468c-835e-825abb0007e4
During muscle contraction: - The {{c1::H}} and {{c1::I}} bands, and distance between Z bands, are shortened - The {{c2::A}} band remains the same length- The A band stays the sAme - A single sarcomere is defined as the distance between two Z lines - H band is the region of the sarcomere with only thick filaments and are bound to structural proteins at the M line - I band is the region of sarcomere with only thin filaments and are bound to structural proteins at the Z line - A band corresponds to the thick filaments and includes portions overlapped by thin filaments Photo credit: SlothMcCarty, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Ekaterina P. Lamber, Pascale Guicheney, and Nikos Pinotsis, CC BY 4.0, via Wikimedia CommonsWatch Muscle ContractionWatch associated Bootcamp video - Skeletal Muscle: Muscle Contraction and Relaxatione5f1011c-1b17-492d-a2be-e2dae35bf324
Osteoblastic activity is measured by which three parameters? - {{c1::Alkaline phosphatase (ALP)}} - {{c2::Osteocalcin}} - {{c3::Propeptides of type I procollagen}}- ALP: creates alkaline, favorable environment for bone mineralization - Osteocalcin: Major non-collagen protein in bone matrix **binds Ca2+ - Type I procollagen: precursor to tropocollagen and collagen found in bone553e701e-761e-4224-8d49-1b05816a0bee
How does baroreceptor sensitivity change with aging? {{c1::Decreased sensitivity}}- Predisposes to orthostatic hypotension because you can no longer effectively constrict and increase TPR - Other predisposing factors include reduced sensitivity of the myocardium to sympathetic stimulation and decreased norepinephrine content of sympathetic nerve endingsWatch Syncope DDxWatch associated Bootcamp video - Pressure and Flow Physiology : Sensory Receptors of Vasculature9dd0b926-0b7c-42da-8214-f6a10689a3a9
{{c1::Bosentan}} is an agent used to treat pulmonary hypertension that works by blocking the {{c2::endothelin-1 (ET-1)}} receptorWatch Prostaglandins, Prostacyclin, Bosentan, PDE5 InhibitorsWatch Pulmonary HypertensionWatch Endothelin Receptor Antagonists (Bosentan)Watch associated Bootcamp video - Pulmonary Hypertension8be9bb57-2abe-459a-a0e2-3244377212f0
Intestinal biopsy with flask-shaped lesions is diagnostic of {{c1::Entamoeba histolytica}}"Photo credit: #416, via CDC"Watch Entamoeba histolyticaWatch Surgery Benign Hepatic Cysts Watch Internal Medicine Benign Hepatic CystsWatch associated Bootcamp video - Parasitic Liver Disease Watch associated Bootcamp video - Gastrointestinal Protozoa: Entamoebac0efd058-a586-424d-a148-876a296d39f4
{{c1::Histoplasma capsulatum::Which fungus}} is associated with {{c2::bat}} and {{c2::bird}} droppings, therefore spelunkers who explore caves are at risk, or farmers with chicken coops- May manifest as subacute fever, malaise, dry cough - Chest x-ray: Hilar lymphadenopathy (often mimics sarcoidosis) - Liver biopsy: Granulomas with narrow-based budding yeast seenWatch Histoplasma capsulatumWatch Pneumonia SOAWatch associated Bootcamp video - Dimorphic Mycosis: Histoplasmamay manifest as subacute fever, malaise, dry cough; hilar lymphadenopathy seen on CXR (often mimics sarcoidosis) and granulomas with narrow-based budding yeast seen on biopsy8cd8bb8c-b41d-4319-8795-009a5cc38091
The fungus {{c1::Malassezia spp. (globosa, furfur)}} causes {{c2::pityriasis versicolor}}'malice seezia, pity rye asis' Photo credit: Grook Da Oger, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Malassezia furfurWatch Approach to Rashes Watch Pityriasis (Tinea) VersicolorReview MalasseziaWatch associated Bootcamp video - Tinea: Malassezia Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditions5b0d3eb1-e32f-4a00-903d-6cb3e423048e
Pityriasis versicolor is characterized by hyper or hypo{{c1::pigmented}} patches on a patient's skin- The variety of color changes that may occur led to the term “versicolor, having many colors” - Malassezia furfur results in pityriasis versicolor in healthy individuals Photo credit: Sarahrosenau on Flickr.com, CC BY-SA 2.0, via Wikimedia Commons Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Malassezia furfurWatch Approach to Rashes Watch Pityriasis (Tinea) VersicolorWatch associated Bootcamp video - Tinea: Malassezia Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditions Watch associated Bootcamp video - Localized Dermatologic Infectious Pathology Watch associated Bootcamp video - General Principles: Skin Lesionse0e32941-aa26-4da6-8cef-380c6376a57d
Hyper / hypopigmented patches of pityriasis versicolor on the skin commonly occur on the {{c1::chest}} and {{c1::back}}, especially in individuals who spend a lot of time in the {{c1::sun}}- Variety of color changes that may occur led to the term “versicolor, having many colors” - Lesions don't tan in sunlight, so they will be more prominent in the summer or after sun exposure Photo credit: Sarahrosenau on Flickr.com, CC BY-SA 2.0, via Wikimedia Commons Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Malassezia furfurWatch Approach to Rashes Watch Pityriasis (Tinea) VersicolorWatch associated Bootcamp video - Tinea: Malassezia Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditionsd023bdd0-a7ba-427c-99c0-d082c44be669
{{c1::Dermatophytes::What cutaneous fungi}} are responsible for rashes known as {{c2::tinea (ringworm)}}- Dermatophytes colonize the skin - Tinea is the disease it causes; multiple types of eachWatch Epidermophyton spp., Trichophyton spp., Microsporum spp. (Dermatophytes)Watch Tinea InfectionsWatch associated Bootcamp video - Tinea: Tinea Overview> Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditionscd66da4c-097d-4c19-b9f7-55ece6c88790
The 3 {{c1::dermatophytes}} are: 1. {{c5::Trichophyton}} 2. {{c3::Epidermophyton}} 3. {{c2::Microsporum}}Watch Epidermophyton spp., Trichophyton spp., Microsporum spp. (Dermatophytes)Watch Tinea InfectionsWatch associated Bootcamp video - Tinea: Tinea Overview Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditions Watch associated Bootcamp video - Localized Dermatologic Infectious Pathology0340eedf-119c-499f-bb49-d76dc738122f
"Tinea is commonly referred to as ""{{c1::ringworm}}"""Caused by dermatophytesWatch Epidermophyton spp., Trichophyton spp., Microsporum spp. (Dermatophytes)Watch Tinea InfectionsWatch associated Bootcamp video - Tinea: Tinea Overview Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditions Watch associated Bootcamp video - Localized Dermatologic Infectious Pathology170debd2-d68c-4505-b499-056a4fd72c10
What demographic of adults are at risk for tinea (ringworm) infections? {{c1::Athletes}}Swimmers that walk barefoot, wrestlers that have body contact with matsWatch Epidermophyton spp., Trichophyton spp., Microsporum spp. (Dermatophytes)Watch Tinea InfectionsWatch associated Bootcamp video - Tinea Overview Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditions9225974d-92f0-4443-a492-4d6a6308354a
{{c2::Hyphae}} of Tinea lesions due to {{c3::dermatophytes}} are seen with {{c1::KOH}} prep of {{c1::skin}} scrapingsPhoto credit: Microrao, CC BY-SA 4.0, via Wikimedia Commons; Juan Carlos Fonseca Mata, CC BY-SA 4.0, via Wikimedia CommonsWatch Epidermophyton spp., Trichophyton spp., Microsporum spp. (Dermatophytes)Watch Tinea InfectionsWatch associated Bootcamp video - Tinea: Tinea Diagnostics and Management Watch associated Bootcamp video - Infectious Diseases of the Skin: Fungal Infectious Conditionsa45f1875-1b27-4a26-8e70-bf13fe7eb7e5
Individuals with {{c3::chronic granulomatous}} disease are susceptible to {{c1::Candida and Aspergillus::which fungi (2)}} colonization due to them both being {{c2::catalase}}-positive organisms- CGD = lack of NADPH oxidase, therefore cannot perform respiratory burst - In these patients, phagocytes use H2O2 made by bacteria to perform respiratory burst, however the enzyme catalase neutralizes H2O2 - Therefore, they are susceptible to infection by catalase-positive organisms* Note, sketchy says ALL fungal pathogens are catalase positive Watch Phagocytic Cell Disorders Watch Candida albicans Watch Aspergillus fumigatusReview Chronic Granulomatous Disease (CGD)Watch associated Bootcamp video - Oxidative Stress: Respiratory (Oxidative) Burst: Clinical Implications Watch associated Bootcamp video - Staphylococcus: Staphylococcus Aureus Principles Watch associated Bootcamp video - Opportunistic Mycosis: Candida Pathogenesis Watch associated Bootcamp video - Opportunistic Infections: Localized Kaposi Sarcoma, Oropharyngeal Candidiasis, Oral Hairy Leukoplakia7cba347c-2a2c-45f7-bf7d-72657e13144b
Which 4 classes of medications can predispose individuals to vaginal yeast infections? - {{c1::Antibiotics}} - {{c1::Oral contraceptives (OCPs)}} - {{c1::Corticosteroids (topical or systemic)}} - {{c1::SGLT-2 inhibitors}}- i.e., Candida albicans - Other risk factors include pregnancy (both pregnancy & OCPs ↑ estrogen) and diabetes mellitus Photo credit: Mikael Häggström, CC0, via Wikimedia CommonsWatch Candida albicansWatch Vulvovaginitis DDxReview SGLT2 Inhibitors (Gliflozins)Watch associated Bootcamp video - Opportunistic Mycosis: Candida Pathogenesis Watch associated Bootcamp video - Infectious Diseases of the Skin: Candidac14468a1-533c-4fae-95d8-acdb01e7ce04
Invasive aspergillosis is treated with {{c1::IV voriconazole}}- Amphotericin B is 2nd-line - This card previously said amphotericin B, however, this is 2nd-line and IV voriconazole is now preferredWatch Aspergillus fumigatusReview Aspergillus fumigatusWatch associated Bootcamp video - Opportunistic Mycosis: Aspergillus Diagnostics and Management Watch associated Bootcamp video - Antifungals: Azoles Watch associated Bootcamp video - Antifungals: Allylamines, Echinocandins, and Polyenes Watch associated Bootcamp video - Antifungals: Common Fungal Disease Management Watch associated Bootcamp video - Opportunistic Infections: Bacillary Angiomatosis, Infectious Esophagitis, Cryptosporidiosis, Aspergillosis38ab9383-fa19-4356-9d11-36ff16790e4e
Vaginitis that presents with itching, copious secretion, and “cottage cheese” appearing clumps are signs of {{c1::vaginal candidiasis}}"C. albicans overgrowth can result in: - Oral thrush: white exudate on mucous membranes - Vaginitis: itching, copious discharge, and clumps resembling ""cottage cheese"" - Cutaneous candidiasis: beefy red rash with satellite pustular lesions in moist interiginous areas where skin touches, such as under the breasts, armpits, or anogenital region. In infants, it manifests as diaper rash Photo credit: Mikael Häggström, CC0, via Wikimedia Commons"Watch Candida albicansWatch Vulvovaginitis DDxWatch associated Bootcamp video - Female pathology: Internal Vaginal Pathology Watch associated Bootcamp video - Opportunistic Mycosis: Candida Disease Variants Watch associated Bootcamp video - Infectious Diseases of the Skin: Infectious Diseases of the Skin: Candida8dc491a6-3af4-401e-b840-8403c74f8c77
The pili in {{c1::Neisseria gonorrhoeae::which bacteria}} allow for antigenic variation- The bacteria can change the proteins within the pili, thereby changing the antigens that the immune system has made antibodies towards - Therefore, individuals who have a gonorrhea infection are susceptible to more, as these pili may change the bug so that the immune system no longer recognizes itWatch Neisseria OverviewWatch associated Bootcamp video - Fundamentals of Bacteriology: Bacterial Adherence and Motility Watch associated Bootcamp video - Gram Negative Diplococci: Neisseria Gonorrhoeae2e993d94-05ef-4d19-a25b-a65e1fa99406
{{c2::Silver (methenamine)::2 names}} stain is used to stain: Fungi {{c1::Pneumocystis jirovecii}} {{c1::Cryptococcus neoformans}} {{c1::Coccidioides}} Bacteria {{c3::Legionella}} {{c3::H. pylori}}Photo credit: Yale Rosen, CC BY-SA 2.0, via Flickr, איתן פרמן, CC BY-SA 3.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 2.0Watch Legionella pneumophila Watch Cryptococcus neoformansWatch associated Bootcamp video - Dimorphic Mycosis: Coccidioides Watch associated Bootcamp video - Opportunistic Mycosis: Cryptococcus Watch associated Bootcamp video - Opportunistic Mycosis: Pneumocystis Watch associated Bootcamp video - Fundamentals of Bacteriology: Gram Stain Procedure Watch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Legionella Pneumophila90b86c09-c5a1-457f-b954-8d2c1daf793f
{{c1::Transformation}} is a way that bacteria uptake DNA from their surrounding environmentNaked DNA which is genetic material not associated with lipids or proteinsWatch associated Bootcamp video - Bacterial Genetics: Transformation0809e55c-990e-45b0-bccb-d2d8316eb640
Gram positive algorithm: Streptococcus, β-hemolysis, bacitracin {{c1::sensitive}} - {{c2::Streptococcus pyogenes}} (group {{c2::A}} Streptococcus)"""B-BRAS"""Watch Streptococcus pyogenes (Group A Strep)Watch associated Bootcamp video - Streptococcus: Streptococcus Pyogenesb4154202-aa40-4b04-923f-f6a0a287df95
Gram negative algorithm: Curved rod, produces urease - {{c1::Helicobacter pylori}}Watch associated Bootcamp video - Gram Negative Curved Rods: Helicobacter Pylori2d1ea7fc-ec9e-4976-86bf-96e9817d092d
Since Chlamydia spp. are obligate intracellular bacteria, they gram stain {{c1::poorly::well or poorly}}Watch Chlamydia trachomatis, Chlamydophila pneumoniae & Chlamydophila psittaciWatch associated Bootcamp video - Fundamentals of Bacteriology: Bacterial Morphology Watch associated Bootcamp video - Atypical Bacteria: Chlamydia Trachomatis Pathogenesis Watch associated Bootcamp video - Atypical Bacteria: Chlamydia Trachomatis Serotypes and Disease Variants Watch associated Bootcamp video - Cardiorespiratory Infections: Atypical Pneumonia Pathogens64fba71f-0621-4bb6-8540-a966a02b2079
Tertiary syphilis can present with aortitis, complete with {{c1::aneurysm}} of the ascending aorta due to endarteritis and resultant aortic valve {{c2::regurgitation}}Watch Treponema pallidum Watch Aortic Stenosis & RegurgitationWatch Aortic Regurgitation SOAP Watch Surgery Aortic Dissection Watch Internal Medicine Aortic DissectionWatch associated Bootcamp video - Spirochetes: Treponema Pallidum Watch associated Bootcamp video - Aortic Disease: Aortic Aneurysm Watch associated Bootcamp video - Valvular Disease: Aortic Regurgitation6977dfc6-a514-4092-b152-cf096df5d8a7
Administration of {{c3::penicillin}} for {{c1::syphilis}} may lead to the {{c2::Jarisch-Herxheimer}} reactionOccurs due to lysis of spirochetes (hence can occur with Borrelia and Leptospirosis as well)Watch Treponema pallidumWatch associated Bootcamp video - Spirochetes: Treponemal Diagnostics and Management39ab07ad-d53e-41db-8d3e-ca3e0edf5fba
The Jarisch-Herxheimer reaction is a response to the release of endotoxin-like factors from the lysis of {{c1::spirochete}} organisms that manifests as {{c2::fevers}}, {{c2::chills}}, and {{c2::myalgias}} within 12 to 48 hours of antibiotic initiation- Administration of penicillin for syphilis may lead to the Jarisch-Herxheimer reaction - Can happen with any spirochete infection (e.g., Borrelia, Treponema, Leptospira)Watch Treponema pallidumWatch associated Bootcamp video - Spirochetes: Treponemal Diagnostics and Managementdue to rapid lysis of spirochetes; self-limited and resolves spontaneously within 48 hours46a935b8-1ef1-49af-b9be-63c3f73e79b9
{{c1::Retroviruses (e.g., HIV)}} are diploid single-stranded RNA viruses- Atypical, usually RNA viruses are haploid (single RNA genome inside their virion) - Known as retroviruses because they use reverse transcriptase to synthesize DNA from RNA (go backwards) Photo credit: OpenStax, CC BY 4.0Watch HIV Overview (Retroviridae)Watch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis Watch associated Bootcamp video - Positive-sense RNA Viruses : HTLV-1462d88f3-14bf-4385-913f-d0e8c9e57517
HIV is a retrovirus, which is a(n) {{c1::di}}ploid {{c1::single}}-stranded {{c2::positive sense::positive/negative sense}} {{c2::RNA::RNA or DNA}} virusWatch HIV SOAPWatch HIV Overview (Retroviridae)Watch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis5a30cd77-47c8-4849-964c-87d8e4a1c302
The {{c1::env}} gene of HIV encodes {{c2::gp120}} and {{c3::gp41}}gp160 is a precursor that is cleaved to form gp120 and gp41 Photo credit: OpenStax, CC BY 4.0Watch HIV Overview (Retroviridae) Watch HIV Life Cycle (Retroviridae)Watch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesisc8e07ac4-a967-4a97-b5fc-81b1619a6f58
Once HIV is inside a cell, viral {{c1::reverse transcriptase}} converts viral RNA to double-stranded DNA (dsDNA) This double-stranded DNA is inserted into the host cell genome by {{c1::integrase}}, another viral enzymeRecall that the HIV gene pol encodes reverse transcriptase, aspartate protease and integraseWatch HIV Life Cycle (Retroviridae)Watch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis Watch associated Bootcamp video - Antivirals : HIV Antiretroviral Pharmacology0079ed96-b690-47fd-9233-08ecd11bc624
{{c1::Maraviroc}} is a(n) {{c2::CCR5}} inhibitor that inhibits HIV entrance into macrophages early in the disease courseCCR5 is still found on CD4+ T-cells and used as entry (however CXCR4 according to FC is major entry)Watch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis Watch associated Bootcamp video - Antivirals : Antiretroviral Attachment and Fusion Inhibitorsd0e179b4-479e-4090-aec4-e3abd287643f
{{c1::Herpetic whitlow}} is a painful hand vesicle that occurs when the skin comes in contact with HSV-1 or HSV-2 (common in {{c2::dentists}})e.g., dentists who spend a lot of time with their fingers in people's mouths (HSV-1), or genitals to hands (more common for HSV-2 - below the waist) Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Herpes Simplex Virus Types 1 & 2 (Herpesviridae)Watch associated Bootcamp video - Infectious Diseases of the Skin: Herpes Simplex and Varicella Infections Watch associated Bootcamp video - DNA Viruses: Herpes Simplex Virus: Diagnostics and Managementlow-grade fever and painful2eecca31-51ef-4c1b-9b59-bca01ce7f3aa
Disulfiram works by inhibiting {{c2::acetaldehyde}} dehydrogenase, resulting in a build up of {{c2::acetaldehyde}}"- Acetaldehyde is responsible for the hangover symptoms - Therefore, think of disulfiram and disulfiram-like reactions as a ""really bad hangover"""Watch Alcohol MetabolismReview Ethanol MetabolismWatch associated Bootcamp video - Substance Misuse: Alcohol Watch associated Bootcamp video - Oxidative Stress: Ethanol Metabolism: Pathway Watch associated Bootcamp video - Oxidative Stress: Ethanol Metabolism: Applications Across Biochemistry Watch associated Bootcamp video - Antifungals: Additional Antifungals Watch associated Bootcamp video - Antibiotics: Introduction to Cephalosporins6bdef288-a606-4f5b-9415-4474d0776a79
Flesh-colored, dome-shaped, umbilicated skin lesions are diagnostic of {{c1::molluscum contagiosum}}- A dermatofibroma is a skin lesion that when pinched produces a central dimple and may be described as umbilicated - Umbilicated = having a small depression resembling the belly button - Large lesions & diffuse infection often associated with HIV and/or immunosuppression Photo credit: Gzzz, CC BY-SA 4.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 4.0 Photo Credit: Evanherk, CC BY-SA 3.0, via Wikimedia CommonsWatch Smallpox Virus, Cowpox Virus, and Molluscum Contagiosum Virus (Poxviridae)Watch Common Childhood Exanthems: Pityriasis, Molluscum, Hand-Foot-Mouth Disease, and MumpsWatch associated Bootcamp video - Infectious Diseases of the Skin: Viral Infectious Conditions Watch associated Bootcamp video - Infectious Dermatologic Disease: Infectious Childhood Rashes (Impetigo, Molluscum, Scarlet Fever) Watch associated Bootcamp video - General Principles: Skin Lesions Watch associated Bootcamp video - DNA Viruses: Poxvirusbfe3779e-ed21-40b3-8b93-88f3bae2d58d
What is the likely diagnosis in a patient with weight loss/tachycardia and a diffusely tender thyroid with low TSH and high free T4? {{c1::Subacute granulomatous thyroiditis (de Quervain)}}- Typically follows an upper respiratory infection - Treatment is symptomatic (e.g., NSAIDs, β-blockers) - de QuerVAIN is associated with PAIN* follicular rupture → release of T4 → hyperthyroidism Watch Hypothyroidism Other CausesWatch Hyperthyroidism SOAPWatch associated Bootcamp video -Thyroid : Hyper/Hypothyroidism: De Quervain and Riedel Thyroiditisb2e96a04-12a2-41fc-bb70-e52f190726bf
Group A Strep (S. pyogenes) is {{c1::β}}-hemolyticWatch Streptococcus pyogenes (Group A Strep)Watch associated Bootcamp video - Streptococcus: Streptococcus Pyogenescedc85c8-17ee-4864-b5c8-812fd354dfca
Spe{{c2::A}} and {{c2::C}} of Streptococcus pyogenes cause {{c1::toxic shock-like}} syndrome- Superantigens - Spe = Streptococcal pyrogenic exotoxinWatch Streptococcus pyogenes (Group A Strep)Watch associated Bootcamp video - Bacterial Toxins: Exotoxin Watch associated Bootcamp video - Streptococcus: Streptococcus Pyogenes00715749-cca2-4282-a8d3-e7d3b766a3f8
{{c1::Rheumatic fever}} is caused by cross-reactivity between {{c2::Streptococcus pyogenes (GAS)::bug}} antigens (M protein) and self-antigens (via molecular mimicry)Self-antigens like the myosin found in cardiac muscle (esp. of the mitral valve) or neuronal antigens found in the basal ganglia (Sydenham chorea)Watch Streptococcus pyogenes (Group A Strep)Watch associated Bootcamp video - Streptococcus: Streptococcus Pyogenes Watch associated Bootcamp video - Cardiorespiratory Infections: Acute Rheumatic Fever Pathophysiology02ed0d48-2199-4452-8a30-7b51a5e4ad65
"The ""JONES"" criteria is used for {{c1::rheumatic fever}}: {{c1::Joints - migratory polyarthritis::J}} {{c1::♥ - carditis::O}} {{c1::Subcutaneous Nodules on extensor surfaces::N}} {{c1::Erythema marginatum::E}} {{c1::Sydenham chorea::S}}"Photo credit: Adsie, CC BY-SA 4.0, via Wikimedia Commons; Heard et al., CC BY 4.0, via Cureus; No information., Public domain, via Wikimedia Commons (modified by merging and cropping) Watch 'Sydenham's Chorea', NEJM Group, via Youtube (0:24)Watch Mitral Stenosis, Acute Rheumatic Fever & Rheumatic Heart Disease Watch Streptococcus pyogenes (Group A Strep)Watch Acute Rheumatic Fever Watch Strep PharyngitisWatch associated Bootcamp video - Streptococcus: Streptococcus Pyogenes Watch associated Bootcamp video - Cardiorespiratory Infections: Acute Rheumatic Fever Diagnostics and Management Watch associated Bootcamp video - Valvular Disease: Mitral Stenosisy1ea2942c-645b-4f7c-b382-353b522dfc85
Enterococci spp. are gram-{{c1::positive}}Group D Streptococci (all Streptococci are gram positive)Watch Enterococcus faecium & faecalisWatch associated Bootcamp video - Enterococcus and Bacillus: Enterococcus Watch associated Bootcamp video - Antibiotics: Bacterial Coverage Overview3194122f-a7f4-4fcf-8225-a49752e299ad
Mycobacterium tuberculosis grows {{c1::slow::fast or slow}}, requiring {{c1::2}}-{{c1::6}} weeks to growWatch Mycobacterium tuberculosis Watch Mycobacterium lepraeWatch associated Bootcamp video - Mycobacteria: Mycobacterium Tuberculosiseaba5eb0-8dbc-4e62-97c9-53bdf94ed573
The most serious adverse effect of {{c2::ethambutol::TB drug}} use is {{c1::optic neuropathy}}, characterized by loss of visual acuity and red-green colorblindness- Ethambutol (Eyethambutol) causes optic neuropathy - Can also cause central scotoma - Discontinuing the drug resolves symptoms in most patientsWatch Tuberculosis DrugsWatch associated Bootcamp video - Mycobacteria: Pulmonary Tuberculosis Diagnostics and Management Watch associated Bootcamp video - Antibiotics: Pyrazinamide, Ethambutol, Dapsone, and Clofazimine Watch associated Bootcamp video - Cranial Nerves 1-6: Cranial Nerve IIc5be70b7-cede-4090-b182-7c39f37ee62c
Resistance to penicillins comes from production of {{c1::β-lactamases}} that cleave the β-lactam ring, or from changes to {{c1::penicillin-binding proteins}} (confers methicillin resistance in MRSA)Hence methicillin resistant staph aureus (MRSA) with alteration of PBPsWatch PenicillinPenicillinase-Sensitive vs. Penicillinase-Resistant PenicillinsWatch associated Bootcamp video - Staphylococcus: Antibiotic Resistant Strains of Staph Aureus Watch associated Bootcamp video - Penicillinase Resistant Penicillins Watch associated Bootcamp video - 3rd, 4th, and 5th Generation Cephalosporins Watch associated Bootcamp video - Antibiotics: Classic Penicillinsb8c60dc6-1d47-45bf-a691-6532a65bfcfe
Amoxicillin/clavulanate therapy is one of the most common causes of drug-induced {{c1::liver}} injuryWatch Ampicillin, Amoxicillin, Piperacillin, TicarcillinWatch Acute Liver Disease DDxWatch associated Bootcamp video - Antibiotics: Aminopenicillinsb674adc4-9070-48ff-be5f-0b611365f511
{{c3::Epstein-Barr}} virus is associated with {{c2::Downey type II atypical CD8+ cytotoxic T::very specific}} cells on blood smearB-cell proliferation and heterophile antibody production results in lymphoid hyperplasia and Downey T-cell production Photo credit: Ed Uthman, CC BY 2.0, via Flickr, No machine-readable author provided. NicolasGrandjean assumed (based on copyright claims)., CC BY-SA 3.0, via Wikimedia Commons, איתן פרמן, CC BY-SA 3.0, via Wikimedia Commons; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously, licensed under CC BY-SA 3.0Watch Epstein-Barr Virus (Herpesviridae)Watch Infectious MononucleosisWatch Epstein-Barr Virus (Herpesviridae)Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Diagnostics and Management163af1d5-f4fd-4ecd-9377-47f6b9d42a87
Severe, permanent symptoms of congenital {{c1::CMV}} infection are remembered via the mnemonic {{c2::MR DICS}}- Microcephaly, in contrast to the macrocephaly secondary to hydrocephalus in congenital toxoplasmosis - Restricted intellectual ability (intellectual disability) - Deafness (sensorineural), which is also seen in congenital Rubella (most common sequela of congenital CMV) - Intracranial Calcifications (periventricular), in contrast to the intracranial calcifications distributed throughout the cortex and basal ganglia in congenital Toxoplasmosis - Chorioretinitis - Seizures, which may be due to the intracranial calcificationsWatch Cytomegalovirus (Herpesviridae)Watch Congenital (ToRCHeS) Infections DDxWatch associated Bootcamp video - DNA Viruses: Cytomegalovirus: Diagnostics and Management435df8f1-4131-4f1c-8181-b7ea35ca9a07
Severe, permanent symptoms of congenital {{c1::CMV}} infection are remembered via the mnemonic MR DICS: {{c1::Microcephaly::M}} {{c1::Restricted intellectual ability (intellectual disability)::R}} {{c1::Deafness (sensorineural)::D}} {{c1::Intracranial calcifications (periventricular)::I}} {{c1::Chorioretinitis::C}} {{c1::Seizures (may be due to intracranial calcifications)::S}}- Sensorineural deafness is the most common sequela of congenital CMV - Urine viral culture to confirm diagnosisWatch Cytomegalovirus (Herpesviridae)Watch Congenital (ToRCHeS) Infections DDxWatch associated Bootcamp video - DNA Viruses: Cytomegalovirus: Diagnostics and Managementy16a7596c-69b8-4fa7-90b2-17f94d0ab339
Organ transplant patients are at an increased risk of CMV {{c1::pneumonia}}Watch Cytomegalovirus (Herpesviridae)Watch associated Bootcamp video - Cardiorespiratory Infections: Atypical Pneumonia Pathogens Watch associated Bootcamp video - DNA Viruses: Cytomegalovirus: Pathogenesis and Clinical Manifestationsa6a25f9a-7f7f-4707-8b82-ab8c56f1fc89
What is the likely diagnosis in a patient with recent travel in rural areas of South America that presents after having a generalized tonic clonic seizure? Brain MRI reveals several cystic lesions with surrounding edema {{c1::Neurocysticercosis}}"Caused by ingestion of food / water contaminated with Taenia solium (pork tapeworm) eggs Photo Credit: Oscar H. Del Brutto, ""Neurocysticercosis: A Review"", The Scientific World Journal, vol. 2012, Article ID 159821, 8 pages, 2012. https://doi.org/10.1100/2012/159821, CC BY 3.0"Watch associated Bootcamp video - Cestodes : Taeniaa9b2831e-2272-4a47-b7e0-b3775f9efce0
Which drugs are used for hyperuricemia in tumor lysis syndrome (TLS)? - Prophylaxis: {{c1::Allopurinol}} - Management: {{c1::Rasburicase}}- Allopurinol is indicated as prophylaxis via inhibiting uric acid formation, it does NOT influence uric acid breakdown - Rasburicase is indicated for established hyperuricemia due to TLS via conversion of uric acid to allantoinWatch Gout Drugs Watch Purine Salvage PathwayReview Allopurinol/Febuxostat Review Purine ExcretionWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Tumor Lysis Syndrome Watch associated Bootcamp video - Non-Rheumatologic Diseases : Gout4806aaec-51a5-4383-9014-6173cd477534
Tumor lysis syndrome is most common during treatment of {{c1::lymphoma (NHL)}} and {{c2::leukemia (ALL, AML)}}- Hyperuricemia due to cytotoxic chemotherapy; treat with allopurinol - TLS is less common (~10%) in the treatment of solid tumors than hematologic malignanciesWatch Gout Drugs Watch Gout & PseudogoutWatch Acute Leukemias SOAP Watch Non-Hodgkin Lymphoma SOAPWatch Gout & PseudogoutWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Tumor Lysis Syndrome2a68c8b4-15a8-487f-9e39-a34b7d1df7f2
What is the likely diagnosis in a patient with recent travel to a (sub)tropical region that presents with fever, polyarthralgias, and a diffuse maculopapular skin rash? Laboratory exam reveals leukopenia and thrombocytopenia {{c1::Chikungunya fever}}- Due to the Aedes mosquito; presentation is very similar to Dengue fever, however Dengue fever has more pronounced bone pain (breakbone fever) and the second infection is more severe than the first - Commonly seen in Asia (e.g., India), Africa, South America, and the Pacific and Caribbean islands Photo credit: Nsaa, CC BY-SA 3.0, via Wikimedia CommonsWatch Polyarticular Joint Pain DDxWatch Equine Encephalitis Viruses & Chikungunya Virus (Togaviridae)Watch associated Bootcamp video - Positive-sense RNA Viruses : Chikungunya698323bc-adc5-40f2-8bd1-32ab2f4d66a7
What is the likely diagnosis in an elderly patient with multiple ecchymoses on the hands and forearms? The lesions are not itchy nor painful and laboratory studies are within normal limits. {{c1::Senile purpura}}Photo credit: José Reynaldo da Fonseca, CC BY-SA 3.0, via Wikimedia Commons - Due to age-related loss of elastic fibers in perivascular connective tissue → easy bruising - Usually spontaneously regress over weeks without intervention8b3d94cc-4904-4ef8-8b9b-a1c380942454
For a normal distribution, approximately {{c1::95}}% of all values are within 2 standard deviations from the mean68% for 1 standard deviation; 99.7% for 3 standard deviations Photo Credit: D Wells, CC BY-SA 4.0, via Wikimedia CommonsWatch Measures of Central TendencyWatch associated Bootcamp video - Statistical Distributions: Measures of Dispersion Watch associated Bootcamp video - Statistical Distributions: Normal and Non-Normal Distributions Watch associated Bootcamp video - Statistical Testing: Confidence Intervals49bb8584-5bcc-4b4f-b7b4-18af1df1ce9a
For the results of a study to be statistically significant, the 95% confidence interval must not contain {{c1::zero}} or the null value- In the case of relative risk, the confidence interval must not contain 1 - p-value ≤ 0.05 = statistical significanceWatch Hypothesis Testing & Statistical Significance (p Value, Confidence Intervals) Watch Meta-analyses & Systematic ReviewsWatch associated Bootcamp video - Statistical Testing: Hypothesis Testing Watch associated Bootcamp video - Confidence Intervals809bbb3d-d542-4505-9246-f7950576d345
What type of study design involves identifying similar patient cases and describing their disease course or treatment response? {{c1::Case series}}- No control group, does not correlate risk factor with disease - Example: identifying a group of patients with a rare form of cancer and describing their initial presentation, treatment regimen, and outcomeWatch Case Report & Case SeriesWatch associated Bootcamp video - Research Study Designs: Descriptive Studiesfc163443-6691-4ce6-a1d7-f8b85b8f9445
The {{c1::external}} validity of a study pertains to the applicability of the study results to other populationsAKA generalizabilityWatch Randomized Controlled Trials0529e359-4e85-4bb9-90cd-682fb33d5d52
What is the approximate sensitivity and specificity of point X on the receiver operating characteristic (ROC) curve below? Sensitivity: {{c1::high::high or low}} Specificity: {{c1::low::high or low}}- True positive rate is sensitivity (y-axis), while false positive rate is 1 - specificity (x-axis) - Low specificity makes the false positive rate closer to 1 Photo Credit: cmglee, MartinThoma, CC BY-SA 4.0, via Wikimedia CommonsWatch associated Bootcamp video - Diagnostic Test Thresholds Watch associated Bootcamp video - Diagnostic Tests: Sensitivity and Specificty0e9ceaa5-5ddb-4d38-a5e1-e5a79ff5fe1c
The confidence interval of a study narrows as the sample size {{c1::increases}}Watch associated Bootcamp video - Statistical Testing: Confidence Intervals86081d9a-c37d-49d1-a81c-0b1560a9cbb7
What study design is best for determining the prevalence of disease? {{c1::Cross-sectional study}}Therefore, the null hypothesis can only discuss association between the variables of interest and cannot talk about risk (which implies a temporal relationship - this is for cohort study)Watch Cross-Sectional StudiesWatch associated Bootcamp video - Risk Quantification: Morbidity Frequency Measures Watch associated Bootcamp video - Research Study Designs: Descriptive Studies1d560a11-0f43-4795-9e3d-c5676900f9a6
"What type of study design measures exposure and outcome simultaneously at a particular point in time (""snapshot study"")? {{c1::Cross-sectional study}}"e.g., researchers are studying the relationship between a blood genotype and atherosclerosis. They randomly select patients and obtain blood samples for genotyping and perform ultrasound to assess for atherosclerosisWatch Cross-Sectional StudiesWatch associated Bootcamp video Watch associated Bootcamp video - Research Study Designs: Descriptive Studies33ada2eb-e17a-4f05-83d9-9416b9993d56
Which antibiotics bind divalent ions (Fe2+, Ca2+, and Mg2+) resulting in chelation? {{c1::Tetracyclines, fluoroquinolones::2}}- Thus, decreasing their absorption - Avoid taking them with antacids, milk, foodWatch Tetracyclines Watch FluoroquinolonesWatch associated Bootcamp video - Pharmacology: Antacids Watch associated Bootcamp video - Fluoroquinolones Watch associated Bootcamp video - Antiparasitics: Chloroquine-Resistant and Exo-Erythrocytic Antimalarials Watch associated Bootcamp video - Antibiotics: Tetracyclines and Derivativesbcbb0e08-fe58-40e9-b99b-04a3b6e45310
Which antibiotics should not be taken with antacids, milk, or ferrous sulfate? {{c1::Tetracyclines, fluoroquinolones::2}}- Ca2+ or Mg2+ or Fe2+ will chelate the drug, decreasing absorption - Just remember that they're all divalent cations and it should make sense as to what products you can and can't useWatch Tetracyclines Watch FluoroquinolonesWatch associated Bootcamp video - Pharmacology: Antacids Watch associated Bootcamp video - Fluoroquinolones Watch associated Bootcamp video - Antiparasitics: Chloroquine-Resistant and Exo-Erythrocytic Antimalarials Watch associated Bootcamp video - Antibiotics: Tetracyclines and Derivativesdbb8cfb7-b790-4adc-8a05-c9ba1c929a12
Tetracyclines are associated with {{c1::photosensitivity::cutaneous complication}}Photosensitivity includes solar urticaria, chemical photosensitization and polymorphous light eruptions Photo Credit: see above, CC BY-SA 2.0, via Wikimedia CommonsWatch TetracyclinesWatch associated Bootcamp video - Antiparasitics: Chloroquine-Resistant and Exo-Erythrocytic Antimalarials Watch associated Bootcamp video - Antibiotics: Tetracyclines and Derivativesmanifests as exaggerated sunburn reactions with erythema, edema, and vesicles in sun-exposed areasad33c45f-e0df-4ee3-9bc2-7a42965ace3b
Aminoglycosides are known to be both {{c1::oto}}toxic and {{c1::nephro}}toxic- Administration with another ototoxic/nephrotoxic agent (vancomycin, loop diuretics) increases risk - Recall that vancomycin can be used to help aminoglycosides penetrate cells, predisposing to adverse effectsWatch AminoglycosidesWatch associated Bootcamp video - Aminoglycosides Watch associated Bootcamp video - Antibiotics: Glycopeptides (including Vancomycin)4e86e158-045b-40b3-8964-aef52f21b928
Aminoglycosides are commonly paired with {{c1::β-lactams}} or {{c2::vancomycin}} to enhance their penetration of cellsβ-lactams such as aminopenicillins or aztreonamWatch AminoglycosidesWatch associated Bootcamp video - Antibiotics: Aminoglycosides602fc527-67a3-4ac6-b723-42bf12a6e6ac
The aminoglycosides {{c1::gentamicin}}, {{c2::tobramycin}}, and {{c3::amikacin}} have activity against {{c4::Pseudomonas}}Watch AminoglycosidesWatch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Pseudomonas Aeruginosa Watch associated Bootcamp video - Aminoglycosides40065f53-3eff-4442-88d2-23d14ebc8a3a
Which antibiotics can result in acute tubular necrosis? {{c1::Aminoglycosides}}Brown muddy casts seen on urinalysis Photo credit: Mohsenin V., CC BY 4.0, via Wikimedia CommonsWatch Aminoglycosides Watch Acute Tubular Necrosis (ATN)Watch associated Bootcamp video - Antibiotics: Aminoglycosides Watch associated Bootcamp video - Acute Tubular Necrosis2efd2101-8f2d-4247-a35f-b2b15a31866c
What type of paralysis is seen with Clostridium tetani? {{c1::Spastic paralysis::Spastic or Flaccid}}Tetanospasmin cleaves SNARE proteins, inhibiting GABA and glycine incorporation into vesicles → lack of inhibitory neurotransmitter releaseWatch Clostridium tetaniWatch associated Bootcamp video - Invasive Spinal Cord Disease: Tetanus Watch associated Bootcamp video - Clostridium: Clostridium Tetani Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junctiond7931951-1f63-4ff8-b164-c510ecdc8c24
Tetanospasmin is an exotoxin from Clostridium tetani that cleaves {{c2::SNARE}} proteins required for {{c2::neurotransmitter (GABA & glycine)}} releaseWatch Clostridium tetaniWatch associated Bootcamp video - Invasive Spinal Cord Disease: Tetanus Watch associated Bootcamp video - Bacterial Toxins: Exotoxin Watch associated Bootcamp video - Clostridium: Clostridium Tetani Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junctiond76b9c20-e555-467b-a6f3-728a3bf021e2
What bacteria releases a toxin that cleaves SNARE proteins in Renshaw cells? {{c1::Clostridium tetani}}Tetanospasmin, AKA tetanus toxinWatch Clostridium tetaniWatch associated Bootcamp video - Invasive Spinal Cord Disease: Tetanus Watch associated Bootcamp video - Clostridium: Clostridium Tetani Watch associated Bootcamp video - Infectious Neuropathology: Infectious Spinal Cord and Neuromuscular Junction3a919ef7-52d4-4403-a187-81c6a00e8e45
Clostridium perfringens can result in {{c1::crepitus}} upon palpation of the infected area of skinCrepitus is defined as crackling of the skin due to gas productionWatch Clostridium perfringensWatch associated Bootcamp video - Clostridium: Clostridium Perfringens Watch associated Bootcamp video - Infectious Diseases of the Skin: Bacterial Infectious Diseasesc60395b0-44b0-4bd6-84ba-a06475606b6a
"The alpha toxin of {{c2::Clostridium perfringens}} breaks down phospholipids, resulting in myonecrosis (""{{c1::gas gangrene}}"")"- Alpha toxin damages cell membranes lipoproteins - Gas gangrene is a type of necrotizing fasciitis caused by Clostridium perfringens (> 80% of cases) - Treatment: emergency debridement and penicillin plus clindamycinnotice the smoke/gas above the crashed motorcycle = gas gangrene Watch Clostridium perfringensWatch Postoperative Surgical FeversWatch associated Bootcamp video - Clostridium: Clostridium Perfringens Watch associated Bootcamp video - Infectious Dermatologic Disease: Systemic Infectious Dermatologic Pathology (Toxic Shock Syndrome, SSSS, Necrotizing Fasciitis) Watch associated Bootcamp video - Infectious Diseases of the Skin: Bacterial Infectious Diseasese8048398-8acf-4d91-9d01-81f5ca7d9973
Which bacteria releases a toxin which inhibits chemokine receptors on lymphocytes, ultimately resulting in lymphocytosis? {{c1::Bordetella pertussis}}Due to pertussis toxin ADP-ribosylating the Gi receptor, inhibiting chemokine receptors on lymphocytes - inhibits lymphocyte entry into lymphoid tissueWatch Bordetella pertussisWatch associated Bootcamp video - Gram Negative Coccobacilli: Bordetella Pertussis0b56188c-2300-4116-9a71-cb47b406ebef
Which stage of Bordetella pertussis infection is characterized by whooping cough and post-tussive vomiting (infants) or post-tussive syncope (older patients)? {{c1::Paroxysmal}}2 weeks - 2 monthsWatch Bordetella pertussisWatch associated Bootcamp video - Gram Negative Coccobacilli: Bordetella Pertussisad53286d-5f2c-4ebb-9f69-d7d192470828
Bordetella pertussis should be treated early with {{c1::macrolides (e.g., azithromycin)}}- Catarrhal stage - Azithromycin is preferred, however, it is used off-label - Alternatives include erythromycin and clarithromycinWatch Bordetella pertussisWatch MacrolidesWatch associated Bootcamp video - Gram Negative Coccobacilli: Bordetella Pertussis Watch associated Bootcamp video - Macrolides7cfd6fed-1bf9-499e-b8f8-d78cf2f87c94
Pseudomonas is known to thrive in {{c1::aquatic}} environments- Can cause hot-tub folliculitis - Look for people who go on vacation or own a hot tub and develop a red rash all over the body Photo Credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons & Da pacem Domine, CC0, via Wikimedia CommonsWatch Pseudomonas aeruginosaWatch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Pseudomonas Aeruginosa Watch associated Bootcamp video - Infectious Dermatologic Disease: Infectious Follicular Pathology Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Pustular Diseased286beef-3c78-476c-b53f-4fe9d8656b83
Which gram-negative bacteria is associated with hot tub folliculitis? {{c1::Pseudomonas aeruginosa}}- Pruritic, papular, pustular folliculitis - Commonly associated with under-chlorinated hot-tubs Photo Credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons & Da pacem Domine, CC0, via Wikimedia CommonsWatch Pseudomonas aeruginosaWatch associated Bootcamp video - Inflammatory Diseases of the Skin: Pustular Disease Watch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Pseudomonas Aeruginosa Watch associated Bootcamp video - Infectious Dermatologic Disease: Infectious Follicular Pathologyd21dbc58-b30b-46a5-adab-618444749f72
{{c1::Ehrlichiosis}} is a Rickettsial disease that presents with {{c2::monocytes}} with morulae in their cytoplasm- Mulberry-shaped intraleukocytic inclusions 'MEGA': - Monocytes for Ehrlichiosis - Granulocytes for Anaplasmosis Photo credit: Lamiot, from US CDC, Public domain, via Wikimedia CommonsWatch Anaplasma phagocytophilum & Ehrlichia chaffeensisWatch associated Bootcamp video - Atypical Bacteria: Ehrlichia and Anaplasma Watch associated Bootcamp video - Normocytic Anemia : Additional Normocytic Anemia1cd31609-37e0-4a22-9ce9-d8a04e2327a8
"{{c1::Erythema chronicum migrans}} is an initial cutaneous feature of Lyme disease that is described as an expanding ""{{c2::bull's eye}}"", red, target rash""Photo Credit: CDC/James Gathany, Public domain, via Wikimedia Commons; #14482, via CDC PHIL"Watch Borrelia burgdorferiWatch Lyme Disease SOAP Watch Bradycardia DDx Watch Staph & Strep Skin InfectionsWatch associated Bootcamp video - Spirochetes: Borrelia Burgdorferi Watch associated Bootcamp video - Infectious Dermatologic Disease: Localized Dermatologic Infectious Pathology7b8e3e63-c44a-45b6-bd10-aa5dc0c1dbe1
Which stage of Lyme disease is early and disseminated? {{c1::Stage 2}}Watch Borrelia burgdorferiWatch Lyme Disease SOAPWatch associated Bootcamp video - Spirochetes: Borrelia Burgdorferi45aceb8a-665b-431a-b0db-80a72f53c3f1
Yersinia {{c2::pestis (plague)}} first spreads to the {{c1::lymph nodes}}, forming characteristic {{c1::buboes}}Swollen, tender lymph nodes that often drain purulent fluid Photo Credit: CDC, Public domain, via Wikimedia CommonsWatch Yersinia enterocolitica & pestisWatch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Yersinia Pestis8942dcc5-cd90-4b98-8671-bf56ebd1d196
Which paramyxovirus can result in parotitis? {{c1::Mumps}}"Photo credit: #1861, via CDC PHIL"Watch Common Childhood Exanthems: Pityriasis, Molluscum, Hand-Foot-Mouth Disease, and MumpsWatch Measles, Mumps, Parainfluenza Viruses (Paramyxoviridae)Watch associated Bootcamp video - Negative-sense RNA Viruses : Mumps25bf4bb9-ea24-43bd-accb-c0436aa3840e
Which paramyxovirus can result in pancreatitis? {{c1::Mumps}}Watch Acute Pancreatitis Watch Common Childhood Exanthems: Pityriasis, Molluscum, Hand-Foot-Mouth Disease, and MumpsWatch Measles, Mumps, Parainfluenza Viruses (Paramyxoviridae)Watch associated Bootcamp video - Negative-sense RNA Viruses : Mumps518822b8-4f08-472d-87cc-1f65089fa796
RSV contains the virulence factor {{c1::F (fusion) protein}}, which allows the production of multinucleated giant cellsNot to be confounded with G protein: RSV uses the G protein in order to infect respiratory epithelial cellsWatch Respiratory Syncytial Virus & Human Metapneumovirus (Pneumoviridae)Watch associated Bootcamp video - Negative-sense RNA Viruses : Respiratory Syncytial Virus1d73ef26-e48d-4078-bbb2-be67273ea602
Which hepatitis virus is associated with cryoglobulins? {{c1::Hepatitis C virus}}- IgM immunoglobulins that precipitate out of the blood at cool temperatures - May also be IgG immunoglobulins involvedWatch Hepatitis C Virus (Flaviviridae) [Old Version]Watch Glomerulonephritis SOAPReview Hepatitis C Virus (HCV)Watch associated Bootcamp video - Hepatic Pathology : Viral Hepatitis Watch associated Bootcamp video - Positive-sense RNA Viruses : Hepatitis C Part 1 (Pathogenesis and Disease)35883f79-abf2-4546-8ca9-a0decf3dafb5
Hepatitis C virus is associated with {{c1::cryoglobulins}}, which are Ig{{c1::M}} immunoglobulins that precipitate out of the blood at cool temperaturesMay also be IgG immunoglobulins involvedWatch Hepatitis C Virus (Flaviviridae) [Old Version]Watch associated Bootcamp video - Hepatic Pathology : Viral Hepatitis Watch associated Bootcamp video - Positive-sense RNA Viruses : Hepatitis C Part 1 (Pathogenesis and Disease)3a66e53f-55c4-4662-8f2b-918474d245e9
Which NRTI is associated with dose-dependent pancreatitis? {{c1::Didanosine}}DIDAnosine causes pancreaDIDAsWatch Acute PancreatitisWatch NRTIsWatch associated Bootcamp video - Antivirals: Antiretroviral Nucleoside Reverse Transcriptase Inhibitors3650e2b5-ee9d-4572-9288-2caabfac42db
Maraviroc inhibits {{c1::gp120}} of HIV binding to the chemokine receptor {{c1::CCR5 (macrophages and T-cells)}}Recall that gp120 of HIV binds CD4 and a chemokine receptor (CXCR4 or CCR5) to attach to the host cellWatch Maraviroc, Fusion Inhibitors, Integrase InhibitorsWatch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis Watch associated Bootcamp video - Antivirals : Antiretroviral Attachment and Fusion Inhibitorsb38f395e-77f6-419b-b3c1-c587f977752a
Which HAART drug binds to gp41? {{c1::Enfuvirtide}}Watch Maraviroc, Fusion Inhibitors, Integrase InhibitorsWatch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis Watch associated Bootcamp video - Antivirals : Antiretroviral Attachment and Fusion Inhibitors3fdde901-d06d-46f1-9b54-532d93b0dda3
Enfuvirtide binds {{c2::gp41}} of HIV inhibiting viral cell {{c3::fusion}} with host cellsWatch Maraviroc, Fusion Inhibitors, Integrase InhibitorsWatch associated Bootcamp video - Positive-sense RNA Viruses : HIV Pathogenesis Watch associated Bootcamp video - Antivirals : Antiretroviral Attachment and Fusion Inhibitorsf4e36dde-8246-4c59-a416-9ed198d74b42
Which two enzymes are inhibited by fluoroquinolones? {{c1::DNA topoisomerase II (Prokaryotic DNA gyrase), DNA topoisomerase IV}}"- ""II, IV, hit the fluor"" (fluoroquinolone antibiotics) - Inhibit DNA replication, therefore are bactericidal - Topoisomerase II introduces negative supercoils and opens DNA to expose DNA to replication enzymes - Topoisomerase IV prevents sister chromatid from getting twisted and recombined"Watch Fluoroquinolones Watch DNA ReplicationWatch associated Bootcamp video - General Principles of Antibiotics Watch associated Bootcamp video - Antibiotics: Fluoroquinolones23df91e4-a1dd-4e71-a6f0-7b7574393dee
What drug withdrawal presents with nausea, muscle/joint aches, diarrhea, abdominal cramping, and pupillary dilation? {{c1::Opioid withdrawal (e.g., heroin)}}Other common findings include yawning, lacrimation, and piloerectionWatch Opioids, Naloxone, Naltrexonee7c08f23-3881-4bc8-a8a9-7509c5202dc6
Which chemotherapeutic drug can be used in the treatment of psoriasis and psoriatic arthritis? {{c1::Methotrexate}}Characterized by plaques with silver-scale and hyperproliferation of the epidermisWatch Methotrexate, Leucovorin, 5-fluorouracil, HydroxyureaWatch Seronegative Spondyloarthritis DDxWatch associated Bootcamp video - Clinical Applications of the Pyrimidine Pathway Watch associated Bootcamp video - Seronegative Spondyloarthritis: Psoriatic Arthritis Watch associated Bootcamp video - Inflammatory Disease of the Skin: Red Plaque Disease6bfd9946-140b-498f-ba37-e3cd2d9e087e
What enzyme is inhibited by 5-fluorouracil? {{c1::Thymidylate synthase}}Image licensed by Physeo and used with permission. Purchase full access here.Watch Methotrexate, Leucovorin, 5-fluorouracil, Hydroxyurea Watch Purine (De Novo) & Pyrimidine SynthesisReview De Novo Pyrimidine SynthesisWatch associated Bootcamp video - DNA Structure : Clinical Applications of the Pyrimidine Pathway Watch associated Bootcamp video - DNA Structure: Clinical Applications of the Purine Pathway Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targetscdf2781c-18b2-4316-bd75-e420a008c4dd
Methotrexate, 5-fluorouracil, and hydroxyurea inhibit {{c1::thymidine}} synthesisPhoto Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Methotrexate, Leucovorin, 5-fluorouracil, HydroxyureaReview De Novo Pyrimidine Synthesis Review HydroxyureaWatch associated Bootcamp video - DNA Structure : Clinical Applications of the Pyrimidine Pathway Watch associated Bootcamp video - DNA Structure: Clinical Applications of the Purine Pathway Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets78fe981c-bfd0-43e9-92df-9850fac69599
Busulfan can result in pulmonary fibrosis and ultimately {{c1::restrictive lung}} disease- Methotrexate, bleomycin, busulfan, amiodarone - Recall that late-stage fibrosis will present with honeycomb lung on CTWatch Alkylating AgentsWatch Hodgkin Lymphoma SOAPWatch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Independent Drug Targets Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Independent Drug Targets Watch associated Bootcamp video - Pulmonary Fibrosisa14ed5c8-3f74-4ba9-9663-81ba42136fd6
Bleomycin can result in pulmonary fibrosis and ultimately {{c1::restrictive lung}} diseaseAlso caused by methotrexate, busulfan, and amiodaroneWatch Cytotoxic AntibioticsWatch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Pulmonary Fibrosis Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Independent Drug Targets8fdc88f3-555e-40e2-9bb7-8e692af98123
Which of the vinca alkaloids is more commonly associated with neurotoxicity? {{c1::Vincristine}}Watch Mitotic InhibitorsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targetsd23077b7-d84c-422d-b8f6-2db4f586ab77
Which of the vinca alkaloids is more commonly associated with areflexia and peripheral neuritis? {{c1::Vincristine}}Watch Mitotic InhibitorsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets58e058f8-90a3-4e19-aee8-37fc85a161f0
Vincristine is associated with neurotoxicity, specifically {{c1::peripheral neuropathy (glove & stocking)}}Microtubule transport in neurons is knocked out (lack of nutrients to distal nerve)Watch Mitotic InhibitorsWatch Chronic Diabetes Complications SOAPWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets7828f3fe-28c9-4c00-93e3-9285097b725f
What class of drugs does paclitaxel belong to? {{c1::Taxanes}}Microtubule inhibitorWatch Mitotic InhibitorsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets76f1f4a2-767b-4a0a-a01c-4251ce147fe0
Which of the cytotoxic microtubule inhibitors bind microtubules and inhibit their depolymerization? {{c1::Taxanes (e.g., paclitaxel)}}Watch Mitotic InhibitorsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets4f57dd4b-dc66-44e9-a8bd-77203b7cbc96
Which of the cytotoxic microtubule inhibitors prevent mitotic spindle breakdown? {{c1::Taxanes (e.g., paclitaxel)}}Watch Mitotic InhibitorsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets
Paclitaxel (taxanes) inhibits mitotic spindle breakdown resulting in mitotic arrest in {{c1::metaphase}}- *cannot proceed to anaphase - This card used to say anaphase, but AMBOSS confirms that it happens in metaphase (Jul 2023) - ↑ stabilization of polymerized microtubules → ↓ mitotic spindle breakdownWatch Mitotic InhibitorsWatch associated Bootcamp video - Mitosis, Meiosis, and the Cell Cycle: Mitosis Watch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targets Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Dependent Drug Targets7971593c-59bb-48bc-8a4c-2e644880aeee
Paclitaxel and other taxanes can be used to treat {{c1::ovarian}} and {{c1::breast}} carcinomaWatch Mitotic InhibitorsWatch Epithelial Ovarian CancerWatch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Dependent Drug Targetsf937759c-e469-4da4-9fd8-c8f5d9aded82
{{c1::c-KIT}} is a(n) {{c2::tyrosine kinase}} gene that undergoes a point mutation to form a gastrointestinal stromal tumor (GIST)Inhibit with imatinib or dasatinibWatch Kinase InhibitorsWatch associated Bootcamp video - Esophageal and Gastric Pathology : Malignant Gastric Pathology73e5a3cb-6336-4934-9ce9-53270f811f73
Rituximab binds CD20 of B cells and tags it for natural killer cells via antibody-{{c1::dependent}} cytotoxicityWatch Monoclonal Antibody TherapyReview B Cells-OverviewWatch associated Bootcamp video - Principles of Oncology and Therapeutics: Cell Cycle Independent Drug Targets Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Lymphocytic Leukemia Watch associated Bootcamp video - Cellular Injury and Neoplasia: Cell Cycle Independent Drug Targetsf6751ce0-4a06-4741-afe1-b4db59255bcf
Which reaction to monoclonal antibodies includes skin rash, fever, and arthralgias? {{c1::Serum sickness}}- Due to immune-complex deposition in joints (type III HSR); proteinuria and lymphadenopathy can also be seen - Compare to an infusion reaction, which includes skin rash, fever, dyspnea, and hypotension (allergic (e.g., anaphylaxis) or non-allergic (e.g., vancomycin infusion reaction) response to infused substance, typically immediate)Watch Monoclonal Antibody TherapyWatch associated Bootcamp video - Hypersensitivity Reactions: Type III Hypersensitivity Reactions Watch associated Bootcamp video - Pharmacology : TNF-a Inhibitors and Monoclonal Antibodies Watch associated Bootcamp video - DNA Viruses: Hepatitis B Virus: Pathogenesis and Clinical Manifestationsca92ee37-c228-4669-90d0-a8ca8902266b
What is the first-line pharmacotherapy for attention-deficit hyperactivity disorder (ADHD) ≥ 6 years old? {{c1::Stimulants}}- e.g., methylphenidate, amphetamines - Non-stimulant treatment options include atomoxetine (no addiction risk!) and α2-agonists (e.g., guanfacine, clonidine) - < 6 years old: first-line is CBTWatch Amphetamine, Dexamphetamine, Lisdexamfetamine, MethylphenidateReview Clonidine & GuanfacineWatch associated Bootcamp video - Developmental Disorders : ADHD Watch associated Bootcamp video - Substance Misuse : Amphetamines6efb29ba-2822-4dcf-afc1-3968f6339ea2
Which two classes of antifungals inhibit synthesis of ergosterol from squalene? {{c1::Azoles, allylamines (i.e. terbinafine)}}Photo Credit: Image licensed by Physeo and used with permission. Purchase full access here.Watch Azoles Watch Griseofulvin, Terbinafine, EchinocandinsWatch associated Bootcamp video - Antifungals: Azoles Watch associated Bootcamp video - Antifungals: Allylamines, Echinocandins, and Polyenes Watch associated Bootcamp video - Antifungals: General Principles of Azoles126ae163-548e-4cde-a6d2-7946d2485f71
{{c1::Azoles}} are a class of antifungals that inhibit the enzyme {{c2::14α-demethylase}}Required for making ergosterol Image licensed by Physeo and used with permission. Purchase full access here.Watch AzolesWatch associated Bootcamp video -Opportunistic Mycosis: Aspergillus Diagnostics and Management Watch associated Bootcamp video - Antifungals: Azoles22b44139-79d3-4827-b51a-baae5de7b1d6
{{c1::Polyenes (e.g. nystatin, amphotericin B)}} are a class of antifungals that bind {{c2::ergosterol}}, creating {{c2::pores}} in the fungal cell membranesvs. azoles, which are a class of antifungals that decrease production of ergosterol by inhibiting 14-alpha-demethylaseWatch Amphotericin, flucytosineWatch associated Bootcamp video -Opportunistic Mycosis: Aspergillus Diagnostics and Management Watch associated Bootcamp video - Antifungals: Allylamines, Echinocandins, and Polyenes76417a68-4eab-414c-9fca-19f856193b73
Which oral azole is used in the treatment of vaginal candidiasis? {{c1::Fluconazole}}Watch AzolesWatch Vulvovaginitis DDxWatch associated Bootcamp video - Opportunistic Mycosis: Candida Diagnostics and Management Watch associated Bootcamp video - Antifungals: Azoles Watch associated Bootcamp video - Antifungals: Common Fungal Disease Management Watch associated Bootcamp video - Infectious Diseases of the Skin: Candidafcb9b4d5-8fad-4e15-95b9-6c75f9c21e85
{{c2::Naegleria fowleri}} causes amoebic brain disease and is associated with {{c1::freshwater}} sourcesN. fowleri enters through the nasal passage via water sources infecting the olfactory mucosa then ascending the olfactory nerve through the cribriform plate Photo credit: CDC, Public domain, via Wikimedia CommonsWatch Naegleria fowleriWatch associated Bootcamp video - Systemic Protozoa: Naegleria Watch associated Bootcamp video - Infectious Neuropathology: Atypical Meningoencephalitis3de5a00e-cf81-49b3-8c60-02883f7b8dc3
The trophozoite form of Naegleria fowleri infects the CNS by passing through the {{c1::cribriform plate}}N. fowleri enters through the nasal passage via water sources infecting the olfactory mucosa then ascending the olfactory nerve through the cribriform plate Olfactory nerves (blue overlay) shown below: Photo credit: John A Beal, PhD Dep't. of Cellular Biology & Anatomy, Louisiana State University Health Sciences Center Shreveport, CC BY 2.5, via Wikimedia Commons. Image was modified by adding overlays ( © AnkiHub, LLC)Watch Naegleria fowleriWatch associated Bootcamp video - Systemic Protozoa: Naegleria Watch associated Bootcamp video - Infectious Neuropathology: Atypical Meningoencephalitisc34a49d7-2b3a-4bfa-800c-e68add3d4807
Naegleria fowleri can result in primary amoebic {{c1::meningoencephalitis}}Nuchal rigidity and fever (meningitis); altered mental status (encephalitis)Watch Naegleria fowleriWatch associated Bootcamp video - Systemic Protozoa: Naegleria Watch associated Bootcamp video - Infectious Neuropathology: Atypical Meningoencephalitis6d41a0b3-6fc8-490e-bfb1-82f68d4f5106
Which protozoa is often associated with water sports? {{c1::Naegleria fowleri}}- Due to its association with warm freshwater - N. fowleri causes amoebic meningoencephalitis, a rapidly progressive, high mortality disease Photo credit: CDC, Public domain, via Wikimedia CommonsWatch Naegleria fowleriWatch associated Bootcamp video - Systemic Protozoa: Naegleria Watch associated Bootcamp video - Infectious Neuropathology: Atypical Meningoencephalitis58815e19-a42f-4f95-b6b2-862af45aa1b0
What is the cause of primary amoebic meningoencephalitis? {{c1::Naegleria fowleri}}Watch Naegleria fowleriWatch associated Bootcamp video - Systemic Protozoa: Naegleria Watch associated Bootcamp video - Infectious Neuropathology: Atypical Meningoencephalitis3f73629d-9858-4ab6-8db3-690473402c64
How is Naegleria fowleri diagnosed? {{c1::Lumbar puncture w/ amoebas present in CSF}}Motile trophozoites seen on wet mount microscopy of CSF sample Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia Commons Photo credit: CDC, Public domain, via Wikimedia CommonsWatch Naegleria fowleriWatch associated Bootcamp video - Systemic Protozoa: Naegleria Watch associated Bootcamp video - Infectious Neuropathology: Atypical Meningoencephalitis62da468f-833f-442c-90a8-6fb8b18cdb87
Trypanosoma cruzi burrows into the {{c1::endocardium}} to cause dilated cardiomyopathy of Chagas diseaseUnlike the diffuse ventricular wall thinning that occurs in most dilated cardiomyopathies, chronic Chagas cardiomyopathy is characterized by localized apical wall thinning with large apical aneurysm development Photo credit: Ed Uthman, CC BY 2.0, via FlickrWatch Trypanosoma cruzi [Old Version]Watch Trypanosoma cruziWatch associated Bootcamp video - Cardiomyopathy: Chagas Disease Watch associated Bootcamp video - Systemic Protozoa: Trypanosoma Cruzi15890921-f718-41c8-9842-455f62f5c23d
Babesia is a group of protozoa that reside in {{c1::RBCs (intraerythrocytic)::cell/tissue}}Babesiosis presents with fever, hemolytic anemia, and hemoglobinuriaWatch Babesia spp.Watch associated Bootcamp video - Normocytic Anemia: Additional Normocytic Anemias Watch associated Bootcamp video - Systemic Protozoa: Babesiad90300e5-7dc0-4662-90cf-91e0e329567b
The trophozoites of Plasmodium {{c1::vivax / ovale}} are large, irregular ringsTwo P. Vivax Trophozoites: Photo credit: CDC, Steven Glenn, Laboratory & Consultation Division, via PHILWatch Plasmodium: Infection & LifecycleWatch associated Bootcamp video - Systemic Protozoa: Plasmodium36688b88-0c25-451b-a2ed-5942ba9ced2f
Sporozoites of Plasmodium mature into {{c1::schizonts}}, which rupture the hepatocytes and release {{c2::merozoites}}"Image licensed by Physeo and used with permission. Purchase full access here. Photo credit: Gonzales et al., CC BY 4.0, via Frontiers in Immunology Schizont (1st image); Schizont with 14 merozoites (2nd image) Photo credit: Dr. Mae Melvin, PHIL #12104; Ed Uthman, CC BY 2.0, via Flickr"Watch Plasmodium: Infection & LifecycleWatch associated Bootcamp video - Systemic Protozoa: PlasmodiumTertian malaria: mature schizont in Plasmodium vivax infection A conglomerate of approx. 16–25 merozoites within an erythrocyte form the so-called mature schizont. Red cell schizont (P. vivax) Giemsa-stained blood smear showing erythrocytes of a patient infected with Plasmodium vivax. In the middle, there is a red cell schizont, which is an erythrocyte containing many merozoites. Within the red cell schizont, merozoites replicate asexually every of 48–72 hours, depending on the type of Plasmodium. The increased parasite burden causes the infected erythrocytes to burst. A subsequent release of proinflammatory factors results in a fever spike. Merozoites, which have been set free from the erythrocyte, enter other erythrocytes in order to replicate again.0623a6d9-16e8-40ec-b902-6431bf918aac
Which anti-malarial has activity against Plasmodium hypnozoites? {{c1::Primaquine}}Hypnozoites due to infection with P. ovale or P. vivax can remain dormant in the liver for months to yearsPrimal queen throwing the spear at the hyptonizing ballsWatch Plasmodium: Treatment & PPXWatch associated Bootcamp video - Systemic Protozoa: Plasmodium Watch associated Bootcamp video - Antiparasitics: Chloroquine-Resistant and Exo-Erythrocytic Antimalarials80c829e1-ea88-4fce-8172-c6fa115b5434
Hookworm larvae penetrate the skin on {{c1::soles of feet}}Walking barefoot in the southern United States (Ancylostoma duodenale, Necator americanus)Watch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video -Nematodes: Hookworm47475556-3dd8-4d71-9c75-7266305bc819
Hookworms, a helminth, enter the {{c1::blood}} through the {{c1::feet}}, making their way to the {{c2::lungs}} where the {{c2::mucociliary escalator}} eventually causes them to be swallowed into the {{c3::GI tract}}Hence they are still intestinal nematodesWatch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video -Nematodes: Hookworm06df10a9-8c1d-4a2e-a7ea-fd3f81657b15
How is the presence of hookworms (Ancylostoma duodenale, Necator americanus) diagnosed? - {{c1::Eggs in stool O&P}} - {{c2::Eosinophilia}}Watch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video -Nematodes: Hookworm6c82bce8-9759-4c58-ba8f-dadd44b3e335
What is the route of transmission of Ascaris lumbricoides (giant roundworm)? {{c1::Fecal-oral}}- Ova are ingested and hatch in the small intestine, where they release larvae, penetrate the intestinal wall, and migrate hematogenously or lymphatically into the lungs - Larvae mature in the alveoli, where they ascend the bronchial tree and are swallowed Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video - Intestinal Pathology : Infectious Malabsorption Watch associated Bootcamp video - Nematodes : Ascaris35760c6d-71bb-4b40-870c-28f6d29ba132
{{c2::Ascaris lumbricoides}}, a helminth, enters the {{c1::blood}} through the {{c1::intestinal wall}}, making its way to the lungs; the mucociliary escalator eventually causes it to be swallowed into the GI tractFecal-oral transmission Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video - Nematodes : Ascaris52be3e19-f109-4830-bede-ac622b97f026
Trichinella spiralis is a helminth commonly found in {{c1::undercooked meat (e.g., pork)::food}}Watch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video - Nematodes: Trichinellae95d8b6d-6716-4c3b-8920-4a34c2614096
Which helminth can result in fever, vomiting, periorbital edema, and subungual splinter hemorrhages? {{c1::Trichinella spiralis}}- Can deposit in the striated muscles of the eye - Suspect trichinellosis in patients with eosinophilia, myositis, and periorbital edemaWatch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video - Nematodes: Trichinella- usually due to ingestion of undercooked pork in endemic areas - GI + periorbital edema, myositis, eosiniophilia.7b554f7e-e985-49a0-af93-34f812f4663e
The larvae of {{c2::Trichinella spiralis}} travel through the blood and form cysts in {{c1::striated muscle}}Cysts ingested in meat → larvae invade small intestine & develop into adult worms → adult worms release larvae into blood → larvae migrate to muscles and encyst Photo credit: TheMrGrove, CC BY-SA 4.0, via Wikimedia CommonsWatch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video - Nematodes: Trichinella30373b56-0898-4d65-82e0-9c148d6c4587
Which helminth can result in muscle inflammation and myalgia? {{c1::Trichinella spiralis}}- Recall that T. spiralis lays cysts in striated muscle, causing inflammation- Suspect trichinellosis in patients with eosinophilia, myositis, and periorbital edema Photo credit: TheMrGrove, CC BY-SA 4.0, via Wikimedia CommonsWatch Intestinal Nematodes: Enterobius, Ancylostoma, Necator, Ascaris, Strongyloides, and TrichinellaWatch associated Bootcamp video - Nematodes: Trichinella- usually due to ingestion of undercooked pork in endemic areas - GI + periorbital edema, myositis, eosiniophilia.c07fb03e-cb9b-4ba2-ac68-5576a49cb8f0
Ingestion of Taenia solium {{c1::eggs}} in contaminated water/food can result in {{c2::neurocysticercosis}}- Eating the eggs results in the oncospheres entering the brain, causing cystic brain lesions- Neurocysticercosis presents with neurological defects and impaired vision Photo credit: Brutto et al., CC BY 4.0, via PLOS Neglected Tropical DiseasesWatch CestodesWatch associated Bootcamp video - Cestodes: Taenia Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral Lesions81eb4055-e501-42f8-b196-2c7c70f93de5
Neurocysticercosis due to Taenia solium eggs can present with {{c1::seizures}} and {{c2::hydrocephalus}}Photo credit: Brutto et al., CC BY 4.0, via PLOS Neglected Tropical Diseases On histology, the presence of suckers (S) and refractile hooklets (arrows) is consistent with neurocysticercosis Photo credit: Zhang et al., CC BY 4.0, via MDPI Pathogens, modified by croppingWatch CestodesWatch associated Bootcamp video - Cestodes: Taenia Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral Lesions5829def7-5b7d-4284-8738-5a2cdc6f81b5
{{c2::Neurocysticercosis}} due to the helminth {{c3::Taenia solium}} has a(n) '{{c1::swiss cheese}}' appearance of the brain on CT/MRISuspect if patient is immigrant / farmer, has seizures or hydrocephalus Photo credit: Evans C, Garcia HH, Gilman RH and Friedland via CDC CC BY-SA; Brutto et al., CC BY 4.0, via PLOS Neglected Tropical Diseases- motion lines from girl flying into table → seizures - swiss cheese hat → swiss cheese appearance of brain Watch CestodesWatch associated Bootcamp video - Cestodes: Taenia Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral Lesions368c0d51-1c0d-42d7-a7c0-9ee29d95fcac
Schistosoma {{c1::mansoni}} eggs have a(n) {{c2::large lateral}} spineSchistosoma spp. Egg characteristic S. japonicum Very reduced terminal spine S. mansoni Lateral spine S. hematobium Terminal spineWatch TrematodesWatch associated Bootcamp video - Trematodes: Schistosoma99c64dae-b85e-42a1-8fa5-b94313f95551
Schistosoma haematobium tends to inhabit the {{c1::bladder}}Diagnose with urine sediment microscopyWatch TrematodesWatch associated Bootcamp video - Trematodes: Schistosoma61757b14-4279-464c-91da-1b6ae16869c0
Schistosoma {{c1::haematobium}} can result in hematuriaRemember, S. haematobium tends to inhabit the bladderWatch TrematodesWatch Approach to HematuriaWatch associated Bootcamp video - Trematodes: Schistosoma37cb5b79-4978-4128-895e-c295f8b6bcd3
What is the treatment for Schistosoma spp.? {{c1::Praziquantel}}Watch TrematodesWatch associated Bootcamp video - Trematodes: Schistosoma Watch associated Bootcamp video - Antiparasitics: Anthelminticsdecd2919-eac1-4eaa-a712-0b27e52414c9
{{c2::Metronidazole}} is an antimicrobial that can cause a(n) {{c1::disulfiram-like*}} reaction with concurrent alcohol use- *Metronidazole is no longer believed to cause a disulfiram-like reaction, however, a possible explanation for this reaction is due to metronidazole-induced gut flora changes and histamine reactions (Jun 2023) - Disulfiram-like reaction: flushing, tachycardia, palpitations, nausea, vomiting - Other metronidazole toxicities also include metallic taste and headacheWatch MetronidazoleWatch associated Bootcamp video - Oxidative Stress: Ethanol Metabolism: Applications Across Biochemistry Watch associated Bootcamp video - Antibiotics: Nitroimidazolese0df65a0-ddbf-4988-9d08-237a457d5278
Shigella causes {{c1::bloody::watery or bloody}} diarrheaInflammatory diarrhea (presence of leukocytes as well)Watch Shigella spp.Watch associated Bootcamp video - Platelets: Thrombotic Microangiopathies Watch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Shigellaa7e25d89-71a4-490d-8a44-b666233ccf56
Shigella causes a(n) {{c1::inflammatory}} diarrhea, with the presence of {{c2::blood}} and {{c2::leukocytes}}Watch Shigella spp.Watch Approach to DiarrheaWatch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Shigellacbd3bc97-d621-4f9f-9b22-05b8d8ccb557
On {{c1::eosin-methylene blue (EMB)}} agar, {{c3::E. coli}} will stain {{c2::metallic green}} while other lactose fermenters stain {{c2::purple}} or {{c2::black}}Photo Credit: Witmadrid, Public domain, via Wikimedia CommonsWatch Escherichia coli (ETEC, EHEC)Watch associated Bootcamp video - Fundamentals of Bacteriology: MacConkey Agar and Eosin Methylene Blue Agar Watch associated Bootcamp video - Lactose Fermenting Gram Negative Bacilli: Escherichia Coli Watch associated Bootcamp video - Lactose Fermenting Gram Negative Bacilli: Variant Strains of Escherichia Coli6a01ff15-644d-4eb6-a0fb-66e35d447eba
What is the 2nd most common cause of neonatal bacterial meningitis? {{c1::E. coli}}GBS (S. agalactiae) > E. coli > Listeria monocytogenes Bacterial Meningitis - Most Common CausesAgeBacteriaNeonatesGroup B streptococci > Escherichia coli > Listeria monocytogenesChildrenStreptococcus pneumoniaeAdolescentsNeisseria meningitidisAdultsStreptococcus pneumoniaeElderlyStreptococcus pneumoniae > Listeria monocytogenesWatch Escherichia coli (ETEC, EHEC)Watch associated Bootcamp video - Lactose Fermenting Gram Negative Bacilli: Escherichia Coli Watch associated Bootcamp video - Lactose Fermenting Gram Negative Bacilli: Variant Strains of Escherichia Coli Watch associated Bootcamp video - Neonatal Meningoencephalitis19124518-fa8d-4d6e-a2cb-002b355871d7
Vibrio cholerae produces {{c4::cholera}} toxin, which {{c3::ADP-ribosylates}} and {{c2::activates}} {{c1::Gs}} resulting in a(n) {{c2::increase}} in {{c1::cAMP}} in epithelial cellsOpening CFTR → ↑ Cl- secretion in crypt cells → ↓ Na+ absorption → osmotic loss of water Photo credit: Mclaneb1, CC BY-SA 4.0, via Wikimedia Commons"Watch Vibrio spp. Old ""new"":"Watch associated Bootcamp video - Physiology : Electrolytes Watch associated Bootcamp video - Gram Negative Curved Bacilli : Vibrio10352345-b7bc-464d-b142-1d59e4cd4d65
{{c2::Helicobacter pylori}} is a bacteria associated with peptic ulcers of the {{c1::duodenum}} and stomach- ~90% of all duodenal ulcers are caused by H. pylori - 70% of stomachWatch Helicobacter pyloriWatch Peptic Ulcer Disease Watch Upper Abdominal Pain DDx Watch Vomiting in Older Children & Adolescents DDxWatch associated Bootcamp video - Esophageal and Gastric Pathology : Gastritis and Peptic Ulcers Watch associated Bootcamp video - Gram Negative Curved Bacilli : Helicobacter Pylori9681df1c-31b4-4779-b915-e3793fa193bd
Helicobacter pylori is urease-positive, allowing production of ammonia which creates a(n) {{c1::alkaline}} environment- Protects H. pylori from the gastric acid - Urea → NH3 and CO2 (NH3 combines with H+ which increases pH) - Inflammatory response from host leads to damage of the mucosa, loss of mucus-secreting cells leading to gastritis - Resulting hypersecretion of acid increase risk for duodenal ulcersWatch Helicobacter pyloriWatch Peptic Ulcer Disease Watch Upper Abdominal Pain DDxWatch associated Bootcamp video - Esophageal and Gastric Pathology : Gastritis and Peptic Ulcers Watch associated Bootcamp video - Gram Negative Curved Bacilli : Helicobacter Pylorifef74f7b-ed33-414a-9ba8-2b691d5af75f
Which form of Plasmodium spp. is seen here? {{c1::Schizont (with merozoites)}}"Photo credit: CDC Dr. Mae Melvin via PHIL Recall that the schizont bursts, releasing merozoites which go on to infect more cells Schizont (1st image); Schizont with 14 merozoites (2nd image) Photo credit: Dr. Mae Melvin, PHIL #12104; Ed Uthman, CC BY 2.0, via Flickr"Watch Plasmodium: Infection & LifecycleWatch associated Bootcamp video - Systemic Protozoa: Plasmodium1ad4e03d-8c09-4bcd-8ab8-95afd96ec52f
The pathophysiology of trigeminal neuralgia is related to demyelination along the trigeminal nerve root, often due to localized {{c1::compression}} from nearby vascular structuresPatients with multiple sclerosis (MS) may present with bilateral trigeminal neuralgia due to the presence of demyelinating plaques in the pons that affect the trigeminal nerve rootsWatch Cranial Nerve V (Trigeminal Nerve): Clinical CorrelatesWatch associated Bootcamp video - Cranial Nerves 1-6: Cranial Nerve V313f1aa3-2cc8-4aea-ad6a-0529aebaf78e
Bendazoles are antihelminthic agents that work by inhibiting {{c1::microtubules}}- Mebendazole is used for pinworm, giant roundworm, threadworm, hookworms, trichinosis, whipworm, Toxocara canis; Albendazole is used for Echinococcus, neurocysticercosis - Can cause a peripheral neuropathy (due to microtubule destabilization)Watch Tissue Nematodes: Dracunculus medinensis, Wuchereria bancrofti, Onchocerca volvulus, Toxocara canis, and Loa loaWatch associated Bootcamp video - Cell Biology: Cytoskeleton Watch associated Bootcamp video - Antiparasitics: Anthelmintics4d87f05c-8c48-4665-b4ab-f7b0a08a62f9
Praziquantel is used as an anti-helminthic agent that works by increasing cell permeability to {{c1::calcium}}, which leads to paralysis and {{c1::vacuolization}} of integument- Calcium paralyzes helminths, aiding the host phagocyte response to parasites - Particularly useful for Trematodes (also interferes with adenosine uptake - trematodes can't synthesize purine de novo); also used to treat Taenia solium and Diphyllobothrium latumWatch Trematodes Watch CestodesWatch associated Bootcamp video - Antiparasitics: Anthelmintics Watch associated Bootcamp video - Antiparasitics: Ectoparasiticidesa4d45f48-3a1c-4e27-a085-0862ecd05d64
Permethrin is an anti-scabies/louse therapy that works by causing {{c1::spastic::spastic or flaccid}} paralysis of scabies/liceInhibits Na+ channel deactivationWatch Scabies, Lice, CrabsWatch associated Bootcamp video - Antiparasitics: Ectoparasiticides217a9d62-1077-40e6-b2d9-ad8acaef1a05
Enfuvirtide and maraviroc are used in patients with {{c1::treatment-resistant}} HIVThese patients will have persistent viral replicationWatch Maraviroc, Fusion Inhibitors, Integrase InhibitorsWatch associated Bootcamp video - Positive-sense RNA Viruses : HIV Diagnosis and Managementf12bf714-e730-4e3f-84fa-996c1299fb7f
What are the three constrictions of the ureter from proximal to distal? 1 - {{c1::Ureteropelvic}} junction 2 - At the {{c1::pelvic}} inlet 3 - {{c1::Ureterovesical}} junction1. Ureteropelvic junction of the renal pelvis and the ureter - pain refers to T10-L1; this starts at the level of the pelvic brim 2. As the ureter enters the pelvis and crosses over the common iliac artery bifurcation - hypogastric; courses medially and anteriorly to the bifurcation of common iliac arteries 3. The ureterovesical junction (UVJ) as the ureter obliquely pierces the bladder wall (at the intramural part) - S2-S4y312a7c5b-08f8-4b3c-a541-c964546e63ab
What two cholesterol-modulating drug classes should not be combined due to a high risk of causing rhabdomyolysis? {{c1::Statins + fibrates}}- Do not give with a CYP450 inhibitor - Other drugs include daptomycin, integrase inhibitors, and drugs that can cause seizuresWatch Fibrates & NiacinWatch Statins Watch FibratesWatch associated Bootcamp video - Lipid Metabolism: Hyperlipidemia Pharmacology22170d95-593d-4795-a032-113d9c273ef2
Greater trochanteric pain syndrome (GTPS) results from inflammation of the {{c1::gluteus medius}} or {{c1::minimus}} tendon located lateral to the greater trochanter of the femur- Typically due to gluteus medius overuse / tendinitis - Previously known as trochanteric bursitis, renamed as bursa involvement is uncommon - Initial treatment includes local heat, activity modification and NSAIDs; PT often helpful; treat persistent symptoms with corticosteroid injection Photo credit: James Dunlop via New York Public Library CC0 1.0a87399ba-c3a8-41b9-a5b4-6c5883634e52
Patients with greater trochanteric pain syndrome (GTPS) present with {{c1::lateral}} hip pain that may radiate down the {{c2::thigh}}- Notably, no groin pain (a true hip disease has referred pain to the groin) - Previously known as trochanteric bursitis, renamed as bursa involvement is uncommonWatch Approach to Hip Pain9ed242d3-b986-4a48-bbf1-c33f0e642877
De Quervain tenosynovitis presents with pain over the {{c1::radial::radial/ulnar}} side of the wristSpecifically over the radial styloid; pain radiates proximally to the forearm, and distally to thumbWatch associated Bootcamp video - Wrist and Hand: De Quervain Tenosynovitisf0916858-1758-475c-bf5f-69e7f2e8d5f5
De Quervain tenosynovitis can be diagnosed with the Finkelstein test, in which pain is elicited over the radial styloid with {{c1::ulnar}} deviation of the hand while the {{c2::thumb}} is flexed in the palm- Clinical diagnosis - no additional testing / imaging required! - AKA De Quervain tendinopathy Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Wrist and Hand: De Quervain Tenosynovitisc24d59a8-cacd-4996-8d58-4958a2b6b58b
Rh- mothers must be treated during pregnancy with {{c1::anti-D}} immunoglobulin (RhoGAM) to prevent {{c1::anti-D}} IgG formation- This opsonizes any D+ RBCs the mom may have been exposed to and results in rapid macrophage clearance before the mom can generate an immune response - For Rh- mothers, this is done during the third trimester (week 28 to week 32) and again within 72 hours of delivery if baby is Rh+ - If not done, subsequent pregnancies will result in Rh hemolytic disease of the newbornWatch Rh Incompatibility & Alloimmunization Watch OB Early Pregnancy & Prenatal Care Watch FM Early Pregnancy & Prenatal Care Watch Vaginal Bleeding in Early Pregnancy DDx Watch Ectopic Pregnancy Watch Early Pregnancy Loss Watch Third Trimester Bleeding DDx Watch Routine Postpartum CareWatch associated Bootcamp video - Embryology: Hemolytic Disease of the Newborn9313d310-4df2-4309-974e-d33b4e35a18a
Assuming RhoGAM is not given, the first time an Rh- mother delivers an Rh+ fetus, the mother will form what substance? {{c1::}}- Exposure to fetal blood (often during delivery) results in the formation of maternal anti-D IgG - Subsquent pregnancies with Rh+ babies will be affected as anti-D IgG can cross the placentaWatch Rh Incompatibility & Alloimmunization Watch OB Early Pregnancy & Prenatal Care Watch FM Early Pregnancy & Prenatal Care Watch Vaginal Bleeding in Early Pregnancy DDx Watch Ectopic Pregnancy Watch Early Pregnancy Loss Watch Third Trimester Bleeding DDx Watch Routine Postpartum CareWatch associated Bootcamp video - Embryology: Hemolytic Disease of the Newborn9b7d511e-7846-46c6-9884-192d75cb83a7
If an Rh- mother with anti-D IgG antibodies has a subsequent pregnancy with an Rh+ fetus and the baby survives to delivery, the newborn can develop {{c1::jaundice}}, which in serious cases can also manifest with {{c2::kernicterus}}- AKA bilirubin-induced neurologic dysfunction - This is due to the autoimmune destruction of RBCs leading to lots of unconjugated bilirubin being formed - Unconjugated bilirubin can deposit in the basal ganglia, causing kernicterusWatch Neonatal Jaundice OverviewWatch associated Bootcamp video - Embryology: Hemolytic Disease of the Newborn Watch associated Bootcamp video - Hypersensitivities: Type II Hypersensitivity Reactions Watch associated Bootcamp video - Hypersensitivities: Type II Hypersensitivity Reactions56e7f142-dab7-4e5b-80cb-d1c4921e8fdc
Alterations in natural {{c1::vaginal bacterial}} flora can lead to overgrowth of {{c2::Candida spp.}} and {{c2::Gardnerella vaginalis}}- Normal flora includes gram-positive Lactobacillus spp. - Gardnerella is classically seen with sexual activity (vaginal pH > 4.5) - Candida classically occurs with antibiotic and OCP usage (vaginal pH < 4.5)Watch Gardnerella vaginalis Watch Candida albicansWatch Vulvovaginitis DDxReview Gardnerella vaginalis Review Candida albicansWatch associated Bootcamp video - Atypical Bacteria: Gardnerella Vaginalis Watch associated Bootcamp video - Opportunistic Mycosis: Candida Disease Variants27dfe59f-86aa-4685-a799-49ff282a758e
Which form of poliovirus vaccine forms IgG and IgA antibodies? {{c1::Oral polio vaccine (Sabin)}}- Live attenuated vaccine - Recall that poliovirus replicates in GI tract, thus IgA antibody production is bestWatch Poliovirus (PicoRNAviridae)Watch Vaccination Schedule 1Watch associated Bootcamp video - Vaccinations : Live Attenuated Vaccines Watch associated Bootcamp video - Positive-sense RNA Viruses : Poliovirusd5a02ce4-ecbb-4b7f-8e0f-c6cee376213d
Is coronavirus enveloped? {{c1::Yes}}Watch Coronavirus (Coronaviridae) [Old Version]Watch Coronavirus (Coronaviridae)Watch associated Bootcamp video - Positive-sense RNA Viruses : Coronavirus Part 1 (Pathogenesis and Disease)0053461a-2d4e-4d39-8988-018475fa7267
Which envelope protein of Influenza facilitates viral spread from cells? {{c1::Neuraminidase (NA)}}Cleave HA-sialic acid interaction → Release virionWatch Influenzavirus (Orthomyxoviridae)Watch associated Bootcamp video - Negative-sense RNA Viruses : Influenza (Pathogenesis) Watch associated Bootcamp video - Antivirals : Respiratory Antiviral Therapy78a89e1b-7dfa-4f63-b031-6922350d5e71
{{c1::Neuraminidase}} is a viral envelope protein that allows for mature virion releaseby cleaving the HA-sialic acid interactionWatch Influenzavirus (Orthomyxoviridae)Watch associated Bootcamp video - Negative-sense RNA Viruses : Parainfluenza Watch associated Bootcamp video - Negative-sense RNA Viruses : Influenza (Pathogenesis) Watch associated Bootcamp video - Antivirals : Respiratory Antiviral Therapybe292406-2913-4aaa-961d-f2911a8060fd
Which animal is the most common carrier of rabies virus (rhabdovirus) in the United States? {{c1::Bats}}- Can often go unrecognized - Recall that Histoplasma capsulatum (fungus) is also transmitted by bats (as well as birds)Watch Rabies Virus (Rhabdoviridae) [Old Version]Watch Rabies Virus (Rhabdoviridae)Watch associated Bootcamp video - Invasive Spinal Cord Disease: Rabies Watch associated Bootcamp video - Infectious Neuropathology : Infectious Spinal Cord and Neuromuscular Junction Watch associated Bootcamp video - Negative-sense RNA Viruses : Rabiessmall, painless bites → unnoticede03206e7-6fc7-4789-892b-a06a71c73a61
Rabies virus travels {{c1::retro}}grade along peripheral nerves- Towards the CNS - 1-3 mm/dayWatch Rabies Virus (Rhabdoviridae) [Old Version]Watch Rabies Virus (Rhabdoviridae)Watch associated Bootcamp video - Invasive Spinal Cord Disease: Rabies Watch associated Bootcamp video - Infectious Neuropathology : Infectious Spinal Cord and Neuromuscular Junction Watch associated Bootcamp video - Negative-sense RNA Viruses : Rabies3d61985b-d0d0-4fd7-abaf-9be513a4ba82
{{c2::Osgood-Schlatter}} disease is an overuse injury caused by inflammation of the apophysis located on the {{c1::tibial tuberosity}}- These patients present with progressive anterior knee pain - Repeated stress on this point results in microtrauma and microavulsion (proximal patellar tendon insertion separating from the tibial tubercle) Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Knee JointWatch Pediatric Knee Disorders Watch Common Pediatric Fractures Watch Approach to Knee PainWatch associated Bootcamp video - Childhood Musculoskeletal Pathology: Osgood-Schlatter Diseasef359bd94-f6e4-45bd-a894-f3eb2ea7025a
In Osgood-Schlatter disease, healed microavulsions can be noted on physical exam by the presence of a pronounced/enlarged {{c1::tibial tubercle}}During healing process, callus formation causes tubercle to become elevated and prominent Photo credit: D3aj86, CC BY 3.0, via Wikimedia CommonsWatch Knee JointWatch Pediatric Knee Disorders Watch Common Pediatric FracturesWatch associated Bootcamp video - Childhood Musculoskeletal Pathology: Osgood-Schlatter Disease8a4f436f-da83-4b4a-84eb-8a92630e02ce
Osgood-Schlatter disease is commonly seen in which demographic? {{c1::Childhood athletes}}Overuse of the quadriceps pulls on the patellar tendon, repeatedly transmitting force onto the tibial tuberosity apophysisWatch Knee JointWatch Pediatric Knee Disorders Watch Common Pediatric FracturesWatch associated Bootcamp video - Childhood Musculoskeletal Pathology: Osgood-Schlatter Disease9eca767f-6db0-4b52-bf39-6c06e8b85be4
How do the following laboratory values change in anemia of chronic disease? Serum iron: {{c1::decreased}} TIBC: {{c1::decreased}} % Saturation (of transferrin): {{c1::decreased}} Ferritin: {{c1::increased}}High ferritin and low TIBC help distinguish ACD from iron deficiency anemiaWatch Anemia Intro: Microcytic Anemia DDxWatch associated Bootcamp video - Microcytic Anemia: Anemia of Chronic Diseasey05508172-905a-4b0c-8558-cecfd0d7e49c
Which of the following usually occurs in children between 10-16 years old? {{c1::Slipped capital femoral epiphysis (SCFE)::Legg-Calvé-Perthes disease vs Slipped capital femoral epiphysis (SCFE)}}- While Legg-Calvé-Perthes disease occurs in children aged 5-7 years old - During the growth spurt (which occurs during this age range), there is rapid cellular proliferation in the growth plate - The resultant change in vasculature manifests with a suboptimal blood supply to the growth plate → unstable growth plate which can be sheared by axial force Photo Credit: Baig M, Glynn O A, Egan C (October 01, 2018) Slipped Upper Femoral Epiphysis: Are We Missing the Point?. Cureus 10(10): e3394. doi:10.7759/cureus.3394. CC BY 3.0Watch Pediatric Hip DisordersWatch associated Bootcamp video - Childhood Musculoskeletal Pathology : Slipped Capital Femoral Epiphysise7cbd675-ad50-499b-a12f-e4febc1945d9
Which of the following is more associated with obesity? {{c1::Slipped capital femoral epiphysis (SCFE)::Legg-Calvé-Perthes disease vs Slipped capital femoral epiphysis (SCFE)}}Increased body weight → increased axial force transmitted through hip joints → increased axial force on femoral head Photo Credit: Baig M, Glynn O A, Egan C (October 01, 2018) Slipped Upper Femoral Epiphysis: Are We Missing the Point?. Cureus 10(10): e3394. doi:10.7759/cureus.3394. CC BY 3.0Watch Pediatric Hip DisordersWatch associated Bootcamp video - Childhood Musculoskeletal Pathology : Slipped Capital Femoral Epiphysis25023d40-a8fc-4bb4-a1ff-ca1f4db333f1
In slipped capital femoral epiphysis (SCFE), increased {{c1::axial}} force on the femoral head results in the femoral {{c2::epiphysis}} displacing relative to femoral neck- Thus obese children have an increased axial force (due to their weight) applied to an unstable growth plate; slippage impacts MCFA - On imaging, this looks like a scoop of ice cream slipping off of a cone Photo Credit: Baig et al., CC BY 3.0, via CureusWatch Pediatric Hip DisordersWatch associated Bootcamp video - Childhood Musculoskeletal Pathology : Slipped Capital Femoral Epiphysis03e9837f-a76f-4f68-b28d-3ba8c3c6f08e
HHV-8 infection is common in {{c1::immunocompromised}} patientsKaposi sarcoma (manifestation of HHV-8) is most common cause of cancer in AIDS patientsWatch HHV-8 & Kaposi's Sarcoma (Herpesviridae)Watch associated Bootcamp video - Additional Dermatologic Disorders: Vascular Tumors Watch associated Bootcamp video - Opportunistic Infections: Localized Kaposi Sarcoma, Oropharyngeal Candidiasis, Oral Hairy Leukoplakia Watch associated Bootcamp video - Opportunistic Infections: Pneumocystis Pneumonia, PML, Disseminated Kaposi Sarcoma Watch associated Bootcamp video - Positive-sense RNA Viruses: Secondary HIV-Associated Diseases Watch associated Bootcamp video - DNA Viruses: Herpesvirus Family Overview Watch associated Bootcamp video - DNA Viruses: Human Herpes Virus 8 (Kaposi Sarcoma)8fa5a922-e004-4c67-b01e-004e9641c21d
Precocious puberty is defined as the onset of secondary sexual characteristics in girls < {{c1::8}} and boys < {{c1::9}} years of age7ef28dab-08c9-4a05-a1e7-e6844598a967
What is the next step in management for a healthy adolescent male that presents with tender, subareolar masses on both breasts? {{c1::Reassurance and follow-up}}- Pubertal gynecomastia (seen in up to 67% of pubertal boys) is due to transient testicular production of estrogen > testosterone and typically resolves without treatment in a few months to years - Can be unilateral or bilateral - Also important to rule out substance use (anabolic steroids, alcohol, marijuana)Watch associated Bootcamp video - Female Pathology: Benign Breast Conditionsbca8f7c8-be19-4c3c-9377-c5d1f78a4894
{{c3::BK virus}} is a virus associated with {{c1::hemorrhagic cystitis}} in {{c2::kidney and bone marrow transplant::specific}} patientsBK = Bone marrow & KidneyWatch JC Polyomavirus & BK Polyomavirus (Polyomaviridae)Watch Approach to Dysuria Watch Approach to HematuriaWatch associated Bootcamp video - DNA Viruses: Polyomavirus590c62dc-01d0-4f9d-a905-251a2e2a35eb
{{c1::Parvovirus B19}} commonly causes {{c2::aplastic crisis}} in patients with sickle cell, thalassemias, and hereditary spherocytosis- The effect is transient and remits with resolution of the illness - Characterized by severe reticulocytopenia with normal myeloid lineage in patients requiring erythropoiesisWatch Parvovirus B19 (Parvoviridae) Watch Sickle Cell DiseaseWatch Extravascular Hemolytic Anemia: Intrinsic DDxWatch associated Bootcamp video - Normocytic Anemia: Aplastic Anemia Watch associated Bootcamp video - DNA Viruses: Parvovirus B19 Watch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia Watch associated Bootcamp video - Microcytic Anemia: β-Thalassemia Watch associated Bootcamp video - Normocytic Anemia: Sickle Cell Anemia Watch associated Bootcamp video - Normocytic Anemia: Hereditary Spherocytosis53002a3b-a756-4cac-a70b-2ef6ac05d1d7
Demographics affected by adenovirus include {{c1::children}}, {{c2::military recruits}}, and {{c3::swimmers in public pools}}Can spread via fecal-oral transmission, respiratory droplets, or direct contactWatch Adenovirus (Adenoviridae)Watch associated Bootcamp video - DNA Viruses: Adenoviruscd6af356-a410-4cc0-b5e0-707401f4e47b
Which circular DNA virus causes hemorrhagic cystitis? {{c1::BK virus}}- Especially in kidney and bone marrow transplant recipients - Adenovirus also causes hemorrhagic cystitis, but is a linear DNA virusWatch JC Polyomavirus & BK Polyomavirus (Polyomaviridae) Watch Adenovirus (Adenoviridae)Watch Approach to Dysuria Watch Approach to HematuriaWatch associated Bootcamp video - DNA Viruses: Polyomavirus66f07d6f-5646-4907-a069-258254698977
Adenovirus commonly causes the common cold, which will present with {{c1::pharyngitis}}, rhinitis, and coughWatch Adenovirus (Adenoviridae)Watch Strep PharyngitisWatch associated Bootcamp video - DNA Viruses: Adenovirus024a0c87-4cac-45f2-9304-dc33625f8189
Acute otitis media often follows a(n) {{c1::upper respiratory}} infection- Nasal congestion → Eustachian tube inflammation → fluid accumulation → bacterial growth in the middle ear space Other predisposing factors include: - Cigarette smoke exposure - Day care attendance - Formula feedsWatch Otitis Media Watch Strep PharyngitisWatch associated Bootcamp video - Gram Negative Diplococci: Moraxella Catarrhalisc31726b3-a64e-4180-9aa2-12f5055b04dd
A leukemoid reaction is a severe elevation in WBC, typically >{{c1::50,000}} cells/mm3Typically occurs in response to severe infection / hemorrhage, solid tumors, or acute hemolysisWatch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Watch associated Bootcamp video - Leukemias and Lymphomas: Chronic Myeloid Leukemia933d4197-a19e-490d-8cb9-60376b5e42b4
The intermediate filament vimentin is found in {{c1::mesenchymal}} tissue- e.g., fibroblasts, endothelial cells, macrophages - Thus, IHC stains can be developed for tumors of mesenchymal origin - Endogenously, vimentin's role is to maintain cell structure in mesenchymal cellsWatch associated Bootcamp video - Cell Biology: Cytoskeleton59945874-2442-4512-9945-c7d5c9ab75b6
The intermediate filament desmin is found in {{c1::muscle}} cells- Thus IHC stains can be developed for tumors of muscle cells - Endogenously, desmin's role is to maintain cell structure in muscle cells (smooth, cardiac, skeletal)Watch associated Bootcamp video - Cell Biology: Cytoskeleton93afeb7a-bbc3-494b-85f5-efc6b660bc81
"De Quervain tenosynovitis is most commonly associated with patients who are {{c1::new mothers (""mother's wrist"")}} and patients who type on {{c2::small handheld devices (""texting thumb"")}}"- Seen in new mothers / daycare workers due to repetitive lifting of the baby - Also seen in factory workers / racquet sport players Photo credit: Σχέδιο: Δρ.Χαράλαμπος Γκούβας, CC BY-SA 3.0, via Wikimedia CommonsWatch associated Bootcamp video - Wrist and Hand: De Quervain Tenosynovitis273e0e2a-d2cc-4ef8-a9cd-5549dfcc5ef7
"Li-Fraumeni syndrome is also known as ""SBLA"" syndrome, which stands for: {{c1::Sarcoma::S}} {{c1::Breast Cancer::B}} {{c1::Leukemia::L}} {{c1::Adrenal Gland tumor::A}}"- Also associated with brain tumors, lymphoma, and lung cancer - Loss of the P53 tumor suppressor results in a constellation of tumors due to absence of G1-S checkpoint (restriction point) regulationWatch Breast CancerReview Li-Fraumeni Syndrome (LFS)Watch associated Bootcamp video - Adrenal Glands : Adrenal Neoplasms Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genesy3bb5e1f9-5162-426e-8907-bb55e144ec58
A hamartoma is a disorganized overgrowth of tissues in a(n) {{c1::native}} locatione.g., Peutz-Jeghers syndrome polyps Spleen hamartoma: Photo credit: Ed Uthman, Public domain, via Wikimedia Commons Hamartomatous colonic polyp: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Carcinoid Tumor & Small Bowel Neoplasms Watch Colorectal Polyps & CancerReview Peutz-Jeghers Syndromed9cc1057-556d-495f-9d75-d976f909d7e5
Exposure to carcinogenic asbestos is most commonly seen in: - {{c2::Shipyard}} workers - {{c1::Construction}} workers - {{c3::Plumbers}}"- ""Shipyard Construction requires Plumbers"" - Asbestos is an insulator that was infused into cement, woven into mats / fabrics, and used as insulation for home construction - Asbestos is a set of six naturally occurring silicate minerals, which all have in common their eponymous asbestiform habit: i.e., long, thin fibrous crystals, with each visible fiber composed of millions of microscopic ""fibrils"" that can be released by abrasion - Ultimately causes interstitial lung disease (fibrosis) → restrictive pattern of PFTs"Watch PneumoconiosesWatch Lung CancerWatch associated Bootcamp video - Pneumoconiosis1b208d5c-eafa-4bbf-bbbe-48064d81e7e3
Mutations in which tumor suppressor gene can lead to FAP-associated colorectal cancer? {{c1::APC}}"- Endogenously involved in regulation of the β-catenin/WNT pathway - Mutations in this begin the ""chromosomal instability"" pathway of colorectal cancer; ""You need A PC to FAP"""Watch Colorectal Polyps & CancerWatch Colorectal Cancer: CarcinogenesisWatch associated Bootcamp video - Colorectal Pathology : Colorectal Cancer Watch associated Bootcamp video - Cellular Injury and Neoplasia : Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genesc28c0154-d298-438a-bcad-969200c0f81d
Dermatomyositis can present as a paraneoplastic syndrome associated with {{c1::adenocarcinomas}}Especially ovarian adenocarcinoma; others include lung, colorectal, and non-Hodgkin lymphomaWatch Polymyositis & DermatomyositisWatch associated Bootcamp video - Rheumatologic Diseases: Polymyositis and Dermatomyositis9c9f779b-b177-437d-8fed-002bc0a11921
Which paraneoplastic syndrome presents with progressive proximal muscle weakness, papules on the knuckles, and a rash around the eyes? {{c1::Dermatomyositis}}Photo Credit: Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Polymyositis & DermatomyositisWatch associated Bootcamp video - Signal Recognition Watch associated Bootcamp video - Rheumatologic Diseases: Polymyositis and Dermatomyositis2700e4fa-748e-4070-adbd-79022d8ac422
Lambert-Eaton myasthenic syndrome (LEMS) is a paraneoplastic syndrome associated with {{c1::small cell lung cancer (SCLC)}}- Proximal muscle weakness + ocular / bulbar symptoms syndrome that gets better throughout the day - LEMS resolves with treatment of the cancer - Myasthenia gravis is a paraneoplastic syndrome associated with thymomaWatch Myasthenia Gravis & Lambert Eaton Myasthenic Syndrome Watch Lung CarcinomaWatch Lung CancerWatch associated Bootcamp video - Pulmonary Small Cell Carcinoma Watch associated Bootcamp video - Neuromuscular Junction (NMJ): Lambert-Eaton Syndromeaa31bf7d-64cb-4b0d-922a-24749e6c1705
Tumor cells that downregulate MHC class I can be detected and destroyed by {{c1::natural killer}} cells- Normally, NK cells separately bind an activating ligand as well as MHC I resulting in NK inactivation - However if MHC I is downregulated, NK cells only receive activating signals and release cytotoxic mediators to kill tumor cells Photo credit: OpenStax, CC BY 4.0Watch The Innate Immune System's Response to VirusesReview Natural Killer (NK) CellsWatch associated Bootcamp video - T-cells: Major Histocompatibility Complexf79cd29b-8586-48f9-b50a-b76e5d82b2c3
In invasive carcinoma, cell-cell contacts are lost by inactivation of {{c1::E-cadherin}}- Normally, this is how epithelial cells maintain attachment (and prevent cellular overgrowth) - Once cells detach via cadherin connections, cells will continue to grow outwards and over each other (aided by the resultant inactivation of the Merlin tumor suppressor protein) Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Cellular Injury and Neoplasia: Dysplasia and Neoplasia Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Dysplasia and Neoplasiaddae6659-7f35-469c-bfc7-de39b1ba0dee
After the regional lymph nodes, what are the two most common sites of metastasis? {{c1::Liver and lung}}Both HIGHLY vascularized areasWatch Surgery Hepatocellular Carcinoma Watch Internal Medcine Hepatocellular CarcinomaWatch associated Bootcamp video - Hepatic Pathology : Malignant Hepatic Pathology6f7178f3-b144-4cdd-a3cd-1d56bc107794
The primary tumors for liver metastases can be ranked in the following order (patients with liver mets Can't Get Pints): {{c1::Colon::C}} >> {{c1::Gastric::G}} > {{c1::Pancreas::P}}Watch Colorectal Cancer: Presentation & Management Watch Surgery Hepatocellular Carcinoma Watch Internal Medcine Hepatocellular CarcinomaWatch associated Bootcamp video - Hepatic Pathology : Malignant Hepatic Pathologyy93932630-896a-4e21-a452-30744ee9965a
"The primary tumors for liver metastases can be ranked in order using the mnemonic ""{{c1::patients with liver mets Can't Get Pints}}"""Colon >> Gastric > PancreasWatch Colorectal Cancer: Presentation & Management Watch Surgery Hepatocellular Carcinoma Watch Internal Medcine Hepatocellular CarcinomaWatch associated Bootcamp video - Hepatic Pathology : Malignant Hepatic Pathology4a2fd5a2-e281-4a1e-87e5-23ca2686473e
Tumor {{c1::grade}} is the degree of cellular differentiation and mitotic activity on histologyGrading a cancer involves a microscopic assessment of differentiation that takes into account architectural and nuclear featuresWatch associated Bootcamp video - Cellular Injury and Neoplasia: Dysplasia and Neoplasia Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Dysplasia and Neoplasia72e50e24-eea9-4e64-8dce-d8825347fa17
"The palpable ""bag of worms"" of a patient who has a varicocele may be exacerbated by the {{c1::Valsalva}} maneuver"Accentuated by standing as wellWatch Testicular Disorders & CancerWatch associated Bootcamp video - Varicocele Watch associated Bootcamp video - Testicular Fluid Collections2ce68011-e73b-46be-a288-41f26912eb97
In a posterior urethral injury, the {{c1::membranous}} part of the urethra is damaged- Whereas in an anterior urethral injury, the spongy part of the urethra is damaged - This part of the urethra is relatively unsupported by the adjacent tissues and is the weakest point of the posterior urethra Image licensed by Physeo and used with permission. Purchase full access here.Watch associated Bootcamp video - Rupture of the Male Urethra Watch associated Bootcamp video - Fetal Development : Male Anatomyafd42b23-b701-41db-b3a4-448f682b3f76
Arterial insufficiency (peripheral artery disease) is due to occlusion of arteries, most commonly due to {{c2::atherosclerosis}} or other artery specific inflammatory processesTreat with lifestyle modifications, cilostazol, or BP control with ACE inhibitorsWatch Peripheral Artery DiseaseWatch Lower Extremity Peripheral Arterial Disease: Presentation & Workup Watch Lower Extremity Peripheral Arterial Disease: ManagementWatch associated Bootcamp video - Peripheral Venous and Arterial Disease: Peripheral Artery Disease9c0d4b8b-b203-443d-b67a-495108a38d86
Because continuous leuprolide downregulates GnRH receptors, patients can present with {{c1::decreased}} libido, {{c1::erectile::male}} dysfunction, and {{c1::hypo}}gonadismGoserelin is in the same classWatch Benign Prostatic Hyperplasia (BPH) & Prostate Cancer Watch ReproductiveWatch LHRH Agonists/GnRH AnalogsWatch associated Bootcamp video - Pharmacology: GnRH Modulators494e972d-4344-4eca-8392-91526cf1ebe7
{{c1::Euthyroid sick}} syndrome is an apparent alteration of thyroid hormone level with normal thyroid gland function seen in {{c2::critically ill}} patients- AKA nonthyroidal illness syndrome or low T3 syndrome - Seen in cancer, pneumonia, cardiac disease, sepsisWatch Hypothyroidism SOAPWatch associated Bootcamp video - Thyroid : Hypothyroidism: Other Causesb2051a9d-6e28-431e-aade-31808f964fb7
Most commonly, patients with euthyroid sick syndrome will have: - Serum TSH {{c1::normal}} - Total serum T4 {{c1::normal}} - Total serum T3 {{c1::↓}} - Reverse T3 {{c1::↑}}- Patients with severe euthyroid sick syndrome may have low free and total T4 levels AND TSH levels - This is because in critical illness there is decreased activity of D1/D2 5-monodeiodinase activity (normally T4 → T3, and rT3 → T2), and increased activity of D3 5' monodeiodinase (normally T4 → rT3)Watch Hypothyroidism SOAPWatch associated Bootcamp video - Thyroid : Hypothyroidism: Other Causesybe113e11-d3c8-4fae-a8b8-f3b0095dabae
What trinucleotide repeat disorder is associated with autism? {{c1::Fragile X syndrome}}Patients have a normal life expectancyWatch Fragile X SyndromeWatch Autism Spectrum DisordersReview Fragile X SyndromeWatch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseasesa9eb02da-1430-46c5-adbd-3c2a886e53b4
Which immunodeficiency is associated with an infiltrative lymphohistiocytosis? {{c1::Chédiak-Higashi syndrome}}"This is an ""accelerated phase"" that some patients with Chédiak-Higashi syndrome can experience; this is a fulminant multiorgan infiltration by lymphoid cells, results in bone marrow failure / hepatosplenomegaly"Watch Phagocytic Cell DisordersReview Chediak-Higashi SyndromeWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)9fc45121-8e58-4dc6-aae1-c1b9ab35667a
Acute inflammation typically results in resolution and healing, which is mediated by {{c1::IL-10}} and {{c2::TGF-β}}Review TGF-beta Review IL-10Watch associated Bootcamp video - Inflammatory Response: Acute Inflammatory Response (Pathology) Watch associated Bootcamp video - Cytokines: Additional Cytokines4954f507-0b68-4780-8dba-744baa89bd64
Fluid accumulates in the right paracolic gutter from pathology involving {{c1::intra}}peritoneal GI organs (particularly right-sided ones)e.g., appendix, gallbladdere4d97187-a593-40db-8fa7-29bedc6c59e5
Characteristic histological findings of GERD include {{c3::basal zone}} hyperplasia, elongation of the {{c2::lamina propria papillae}}, and scattered {{c1::eosinophils}} and neutrophilsIn contrast, eosinophilic esophagitis has numerous superficially located intraepithelial eosinophils Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Structural Esophageal Disorders & GERDWatch associated Bootcamp video - Esophageal and Gastric Pathology : Benign Gastric Pathologyb3b3053e-2109-4d1b-8a28-ff52f8f2f8dd
Endothelial dysfunction of the pulmonary vasculature results in increased {{c1::vasoconstrictors}} and decreased {{c1::vasodilators}}- Vasoconstrictors = endothelin - Vasodilators = NO, prostacyclins - e.g., in left heart disease, pulmonary venous congestion leads to increase in pulmonary capillary / arterial pressure → endothelial dysfunction → increased vascular toneWatch Congestive Heart Failure Clinical ManifestationsWatch associated Bootcamp video - Blood Physiology : Pulmonary Vascular Resistancea0993069-0e7f-409c-877b-f4361efeac2d
Procarbazine is a chemotherapeutic {{c1::alkylating}} agent used to treat Hodgkin lymphoma and brain tumorsWatch Alkylating Agents5c35cfe6-2c0e-45a7-be86-1a6849f5212f
Twin-twin transfusion syndrome (TTTS) most commonly occurs in {{c1::mono::mono/di}}chorionic {{c1::di::mono/di}}amniotic twins- When two amnions share the SAME blood supply (chorion = placenta), unbalanced AV anastomoses are present between shared placental vessels shunting blood from one baby to another - Monozygotic monochorionic diamniotic and monozygotic monochorionic monoamniotic Photo Credit: Kevin Dufendach, CC BY 3.0, via Wikimedia CommonsWatch Multifetal Gestations8a20f422-51bb-4b42-98da-30a0eb328032
If compression of the hepatoduodenal ligament via the Pringle maneuver does not cease bleeding, the source of the RUQ bleed is most likely the {{c1::inferior vena cava}} or the {{c2::hepatic vein}}Watch Portal Circulation: Clinical Correlatesf00ef9b8-4d64-4665-97ee-58432c4ce37a
{{c2::Gastric (fundal) varices}} result from portosystemic shunting between the {{c1::short gastric veins}} (portal) and {{c1::inferior phrenic}} vein (systemic)- AKA the gastrocaval shunt; short gastric veins → splenic vein, inferior phrenic → IVC - Appear in portal hypertension and splenic vein thrombosis (isolated variceal formation) - When ruptured can cause gastric bleeding and melena Image licensed by Physeo and used with permission. Purchase full access here.Watch Portal Circulation: Clinical CorrelatesWatch Acute Upper GI Bleed: Esophageal VaricesWatch associated Bootcamp video - Visceral Anatomy : Veins, Anastomoses, and Hemorrhoids055500da-14df-4392-a2f7-6518e9590871
The left renal vein can become compressed between the {{c1::aorta}} and {{c1::superior mesenteric artery (SMA)}} as it crosses the midline- AKA nutcracker syndrome - Presents with hematuria, left flank pain, nausea, vomiting - Can present with varicocele and varicose veinsWatch Testicular Disorders & Cancer Watch Superior Mesenteric ArteryWatch Vomiting in Older Children & Adolescents DDxWatch associated Bootcamp video - Male Pathology : Testicular Fluid Collections Watch associated Bootcamp video - Fetal Development : Male Anatomy Watch associated Bootcamp video - Adrenals : Adrenal Gland Physiologye458a036-8380-47ce-8f26-8162a28d591d
"Branches of the {{c1::subclavian artery}} may be remembered with the mnemonic ""VIT CD"" {{c1::Vertebral artery::V}} {{c1::Internal thoracic (internal mammary) artery::I}} {{c1::Thyrocervical trunk::T}} {{c1::Costocervical artery::C}} {{c1::Dorsal scapular artery::D}}"- Traumatic vascular dissection / occlusion of the vertebral artery is the most common cause of Wallenberg syndrome - Internal thoracic artery can be used for CABG instead of saphenous, more resistant to failure / stenosis; superior epigastric artery comes off the ITA and anastomoses with inferior epigastric, allowing collateral circulation between subclavian and external iliac (e.g., in coarctation of the aorta) - Inferior thyroid artery (off the thyrocervical trunk) ligation can damage the recurrent laryngeal nerve - Dorsal scapular artery anastomoses with the subscapular artery to provide blood flow to scapula in case of subclavian obstruction; can be damaged by knife woundsWatch Simple Mastectomy OverviewWatch associated Bootcamp video - Aneurysms and Intracranial Hemorrhage: Circle of Willisy9803ceef-2787-4de5-a553-d59c82170092
Branches of the subclavian artery may be remembered with the mnemonic {{c1::VIT CD}}- Vertebral artery - Internal thoracic (internal mammary) artery - Thyrocervical trunk - Costocervical artery - Dorsal scapular artery - Traumatic vascular dissection / occlusion of the vertebral artery is the most common cause of Wallenberg syndrome - Internal thoracic artery can be used for CABG instead of saphenous, more resistant to failure / stenosis; superior epigastric artery comes off the ITA and anastomoses with inferior epigastric, allowing collateral circulation between subclavian and external iliac (e.g., in coarctation of the aorta) - Inferior thyroid artery (off the thyrocervical trunk) ligation can damage the recurrent laryngeal nerve - Dorsal scapular artery anastomoses with the subscapular artery to provide blood flow to scapula in case of subclavian obstruction; can be damaged by knife woundsWatch associated Bootcamp video - Aneurysms and Intracranial Hemorrhage: Circle of Willisf3c9a0dd-ff10-4a8e-88db-c55a784d8cad
What is the most likely diagnosis in a patient with sharp, well-localized chest pain, worse with movement, and reproducible on palpation? {{c1::Costochondritis}}AKA costosternal syndrome / anterior chest wall syndrome952a9a9b-89b9-4701-83e8-a072d5e4520d
Costosternal syndrome (costochondritis) typically presents after repetitive activity and involves the upper costal cartilage at the {{c1::costochondral}} or {{c1::costosternal}} junctionsPhoto credit: BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons33dcadb3-82e5-4882-b19d-234cd792cd70
What cells synthesize the myelin for cranial nerve II? {{c1::Oligodendrocytes}}"- This is because these nerves are essentially ""extensions"" of cranial tissue - Importantly, oligodendrocytes do not synthesize myelin for cranial nerve I (CN I has no myelin)"Watch Cranial Nerves I & II (Olfactory & Optic)Watch associated Bootcamp video - Cell Types Watch associated Bootcamp video - Adult Primary Brain Tumors: Vestibular Schwannoma Watch associated Bootcamp video - Cranial Nerves 1-6: Cranial Nerve II303a2140-5166-4ce0-9f12-a02f5071f448
A putamen hemorrhage (e.g., rupture of Charcot-Bouchard microaneurysm on vessels supplying putamen) manifests with: {{c1::Contralateral::ipsilateral / contralateral}} hemiparesis - damage to internal capsule / genu {{c1::Contralateral::ipsilateral / contralateral}} hemisensory loss - damage to thalamus Gaze deviation {{c1::towards::towards / opposite}} the side of bleed - damage to frontal eye fieldse.g., patient manifests with left paralysis / sensory loss but eyes deviated to right Charcot-Bouchard microaneurysm: Photo credit: Jamali et al., CC BY 4.0, via Journal of the Belgian Society of RadiologyWatch associated Bootcamp video - Aneurysms and Intracranial Hemorrhage: Intraparenchymal Hemorrhagey4f3e3b3a-1716-41b8-b4f7-6249a9c64369
The great saphenous vein courses superiorly from the {{c1::medial foot}}, anterior to the medial malleolus, and up the {{c1::medial}} aspect of the leg/thighTypically, surgeons access the great saphenous vein in the medial leg Photo credit: OpenStax, CC BY 4.0Watch associated Bootcamp video - Vascular System: Coronary Bypass Grafting6885cdd5-5c3b-4c14-8422-112119d85a1c
What is the likely diagnosis in a patient with unilateral arm pain and dizziness while exercising? Physical exam reveals blood pressure discrepancy between the left and right arm {{c1::Subclavian steal syndrome}}Due to stenosis of the proximal subclavian artery, which causes reversal of blood flow in the ipsilateral vertebral artery, stealing blood away from the posterior circulation (dizziness, ataxia, dysequilibrium) Photo credit: Hellerhoff, CC BY-SA 3.0, via Wikimedia CommonsWatch Approach to Dizziness814e48e9-1d96-41fc-838d-f5c494de7437
Pulsus alternans refers to the beat-to-beat variation in pulse amplitude due to a change in {{c1::systolic}} blood pressure- Prevalent in patients with significant LV systolic dysfunction - Not the same as electrical alternans; which is the beat-to-beat variation in the amplitude of the QRS complexWatch Pericardial Effusion, Cardiac Tamponade, and Constrictive Pericarditis SOAP Part 22ef182b9-3c43-4b9e-ab2c-62825c0ffd83
Pulsus alternans is most commonly seen in patients with severe {{c1::left ventricular dysfunction}}da9c94f7-0d6c-4d90-8adf-6be418dbeb76
The piriformis normally acts to: - {{c1::Externally rotate}} the thigh when extended - {{c1::Abduct}} the thigh when flexedInserts onto the greater trochanter of the femur, and originates on the anterior aspect of the sacrum Photo credit: Patrick J. Lynch & KDS4444, CC BY-SA 2.5, via Wikimedia CommonsWatch Sciatic NerveWatch Approach to Hip Painb3d03cb8-a022-4f70-b02f-9cbc1cde9376
Poor maternal glucose control leads to excessive transplacental {{c1::glucose}} transfer to the fetus- Maternal insulin is not transferred to the fetus but is instead catabolized by the placenta - Fetal hyperglycemia → stimulation of fetal pancreas → fetal hyperinsulinemia950519e9-500e-46d6-8a7b-c62d3941c69a
In the setting of gestational diabetes with poor control, fetal hyperglycemia leads to fetal hyperinsulinism and {{c1::β cell}} hyperplasiaβ cell hyperplasia will resolve over timeWatch Gestational Diabetes Watch Macrosomiaf06dc366-2471-4acb-8cfa-9ea815be9ace
Cryoglobulinemic vasculitis is a(n) {{c1::small}} vessel vasculitis that can be seen in patients with {{c2::HCV}}Caused by deposition of mixed cryoglobulinsWatch Small Vessel VasculitidesWatch associated Bootcamp video - Vasculitides: Mixed Cryoglobulinemia Watch associated Bootcamp video - Positive-sense RNA Viruses : Hepatitis C Part 1 (Pathogenesis and Disease)440a8f34-0afc-4c6b-9b3b-16283a8fceaf
Adults receiving parenteral nutrition are at high risk for fungal infection with {{c1::Candida (candidemia)}}Whereas neonates on TPN can have M. furfurWatch associated Bootcamp video - Opportunistic Mycosis: Candida Disease Variantse844aaf8-f863-4605-8959-7177e1e9a1b3
Upon delivery from a mother with untreated gestational diabetes, neonates can develop transient {{c1::hypoglycemia}}- β cell hyperplasia in the fetus → fetal hyperinsulinism → postpartum hypoglycemia (once placental transfer of maternal glucose ends) - This typically resolves within 3-7 days of birth as hyperinsulinemia remitsWatch Gestational Diabetes77eefdf8-1b0f-432b-af2b-5f989d6a81ab
Genotypic females with uterovaginal agenesis AND genotypic males with androgen insensitivity syndrome both have: - Breasts? {{c1::yes::yes/no}} - Uterus? {{c1::no::yes/no}}Watch OBGYN Primary Amenorrhea DDx Watch Pediatric Primary Amenorrhea DDxWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders Watch associated Bootcamp video - Fetal Development: Disorders of Sexual Development Part 1e0463bcc-9552-49cb-bc6f-bec4e10fbf3e
{{c2::Myoclonic epilepsy with ragged red fibers (MERRF)}} is a mitochondrial disorder that presents with myoclonic seizures and myopathy associated with {{c1::exercise::trigger}}- Episodes are short-lived, also may be triggered by startle - Ragged red fibers are seen on skeletal muscle biopsy stained with gomori trichromeWatch Mitochondrial Inheritance DisordersReview Mitochondrial Myopathies8f2f8929-41f5-49a7-b428-7ea4b0090bc9
The inactivated influenza vaccine results in {{c2::humoral (antibody)::cell-mediated or humoral}} response to the {{c1::hemagglutinin}} antigenAntibodies produced thus inhibit HA interaction with sialic acid → inhibits entry into cellsWatch Vaccination Schedule 1Watch associated Bootcamp video - Vaccinations: Whole Inactivated Vaccines3e2366a1-6d8c-4e94-b30e-157f29b1c8c2
The inactivated influenza vaccine results in antibody production that inhibits viral {{c1::entry (into host cells)}} via binding to hemagglutinin- Vaccine to HA antigens → Abs produced to HA → HA cannot bind sialic acid - HemagglutinIN...IN allows entryWatch associated Bootcamp video - Vaccinations: Whole Inactivated Vaccines854904a5-98ec-47ba-b9a8-1f7c93e17ad0
If the confidence interval does not include the null value, the result is statistically {{c1::significant}}Watch Hypothesis Testing & Statistical Significance (p Value, Confidence Intervals)Watch associated Bootcamp video - Statistical Testing: Hypothesis Testing Watch associated Bootcamp video - Confidence Intervals5b01b989-22c1-48d1-be05-91ed0f6f0fe1
Which parasitic infection can present with cysts in the brain? {{c1::Neurocysticercosis (Taenia solium)}}Said to have a swiss-cheese appearance Photo credit: Brutto et al., CC BY 4.0, via PLOS Neglected Tropical DiseasesWatch associated Bootcamp video - Cestodes: Taenia Watch associated Bootcamp video - Infectious Neuropathology: Infectious Cerebral Lesionsf9b00c34-dbe8-4604-8b4d-c1dc367677b6
During pregnancy, a woman may experience intermittent sharp pain due to sudden movements of the stretching {{c1::round}} ligament- AKA round ligament pain - Pain may be caused by tightening or spasm of the ligament / irritation of nearby nerves; typically presents on the right sideWatch associated Bootcamp video - Female Anatomy918b42a7-0c8c-4ded-8027-21e4e838a7bc
The {{c1::deep}} branches of the posterior cerebral artery supply the thalamus, splenium, parahippocampal gyrus, and fusiform gyrus- Thus infarcts to PCA can result in contralateral paresthesia and numbness affecting face / trunk / limbs (due to damage to lateral thalamus) - Fusiform gyrus is implicated in face blindnessWatch Localizing a Stroke: PCA2a19d31c-b1c1-4fa7-9762-746e149a34c7
What is the next step in management for a patient found to have positive HCV antibodies? {{c1::HCV RNA testing}}Hepatitis C antibodies remain positive in acute, chronic, and previous hep C infection, so we need to confirm with PCR testing of RNA; many patients also spontaneously clear the virusWatch Acute Liver Disease DDx Watch Chronic Liver Disease DDxWatch associated Bootcamp video - Positive-sense RNA Viruses : Hepatitis C Part 2 (Diagnostics and Management)40570df9-40e8-4864-8193-3f921a424ba1
The saphenous nerve is the largest pure sensory branch of the {{c2::femoral}} nerve and supplies the {{c1::medial}} aspect of the leg- This can be damaged during saphenous vein stripping during CABG - Whereas the sural nerve supplies the posterior lateral aspect of the leg Photo credit: Henry Gray, Public Domain, via BartlebyWatch Femoral Nerved4d308e8-480d-4798-968b-a1deb6010c68
The neurogenic symptoms of hypoglycemia are caused by stimulation of the {{c2::adrenal glands}} and the {{c1::sympathetic}} nervous system- Large amounts of norepinephrine / epinephrine are released, causing tremulousness, palpitations, anxiety, and arousal - Large amounts of acetylcholine are released, causing sweating, hunger, and paresthesiasWatch Diabetes Managementb4d201f4-f11f-4c32-b27f-de27ba056aee
Infections in the sphenoid or ethmoid sinus may extend to the {{c1::cavernous}} sinus and cause complicationse.g., rhinosinusitis in these regions leading to cavernous sinus syndrome Photo credit: Okkes Kuybu, MD and Diana, CC BY 4.0, via Wikimedia CommonsWatch Nasal Cavity & Paranasal SinusesWatch associated Bootcamp video - Cranial Nerves 1-6: Cavernous Sinus Thrombosiscbaebe74-17d2-41e2-bd61-a4c009aa6ca3
One complication associated with lung cancer is {{c1::pericardial effusion}}, which can lead to obstructive shockPhoto credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons* wet pericardial case = pericardial effusions also seen in lung cancer Watch Lung CarcinomaWatch Shock: Undifferentiated Shock SOAP Watch Lung CancerWatch associated Bootcamp video - Lung Cancer Basics Watch associated Bootcamp video - Shock: Obstructive Shock Watch associated Bootcamp video - Pericardial Disease: Pericardial Effusion56472a36-5abb-40fa-bbb2-c5373d6dedcb
{{c1::Silver}} staining or gram-staining of the gastric mucosa can reveal H. pyloriWatch associated Bootcamp video - Fundamentals of Bacterioloy: Poor Staining Organisms and Variant Staining Procedures Watch associated Bootcamp video - Gram Negative Curved Rods: Helicobacter Pylori Watch associated Bootcamp video - Fundamentals of Bacteriology: Gram Stain Procedure9693303b-1362-4e7f-888b-d9183535409b
Anal squamous cell carcinoma often presents with rectal bleeding and a visible {{c1::ulcerative}} mass- Anal cancers are ulcerative in >50% of cases - Anal cancers are mostly caused by HPV infection - An immunocompromised (AIDS, post-transplant) state increases the risk for malignant transformationWatch Anorectal DisordersWatch Anorectal Cancer825fc648-19cd-41cc-9ec5-81bc65d485cb
Sarcoptes scabiei causes {{c1::scabies}}Photo credit: Gzzz, CC BY-SA 4.0, via Wikimedia Commons Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Scabies, Lice, CrabsWatch Scabies & Lice Watch Approach to RashesWatch associated Bootcamp video - Ectoparasites: Sarcoptesb98b1fae-0f18-41b3-aca7-03623eeff7c3
Which parasite commonly affects the webspace of the fingers and feet? {{c2::Sarcoptes scabiei (Scabies)}}Other commonly affected areas include periumbilical region, genitalia, and axillae Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Gzzz, CC BY-SA 4.0, via Wikimedia CommonsWatch Scabies, Lice, CrabsWatch Scabies & Lice Watch Approach to RashesWatch associated Bootcamp video - Ectoparasites: Sarcoptes Watch associated Bootcamp video - Antiparasitics: Ectoparasiticidesf1ee3bdc-bff0-4e58-8370-8e50ca14cd8d
Scabies is common in {{c1::children::demographic}} and crowded populationsCan be passed from children to adults via direct skin-to-skin contact (e.g., day care workers, teachers, etc) Photo credit: Gzzz, CC BY-SA 4.0, via Wikimedia Commons Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch Scabies, Lice, CrabsWatch Scabies & LiceWatch associated Bootcamp video - Ectoparasites: Sarcoptes6a837190-6563-4f9e-839d-4713e73e5504
Scabies is highly contagious and is most commonly transmitted via {{c1::skin-to-skin contact}} or via fomitesFamily members with the same symptoms support a diagnosis of scabies Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Gzzz, CC BY-SA 4.0, via Wikimedia CommonsWatch Scabies, Lice, CrabsWatch Scabies & Lice Watch Approach to RashesWatch associated Bootcamp video - Ectoparasites: Sarcoptesac411c3c-f62e-40cb-9057-175c0331fe20
Which anti-scabies/louse therapy inhibits Na+ channel deactivation? {{c1::Permethrin}}Watch associated Bootcamp video - Antiparasitics: Ectoparasiticidesb19bbbea-40a3-4a55-867e-624dcbcea6ae
What is the most common pediatric elbow fracture? {{c1::Supracondylar fracture of the humerus}}Supracondylar ridges are immediately proximal to the lateral / medial epicondyles Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia Commons Photo credit: OpenStax, CC BY 4.0Watch Common Pediatric FracturesWatch associated Bootcamp video - Shoulder and Elbow: Humerus Fractures Watch associated Bootcamp video - Childhood Musculoskeletal Pathology: Pediatric Fractures8e5ebb60-ba84-4699-bfe6-65cabca8a24c
Because the {{c1::brachial}} artery is paired with the median nerve at the elbow, supracondylar fractures of the humerus that displace anteromedially may result in a pulseless handPhoto credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Common Pediatric FracturesWatch associated Bootcamp video - Shoulder and Elbow: Humerus Fractures Watch associated Bootcamp video - Childhood Musculoskeletal Pathology: Pediatric Fractures Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Median Nerve551b373b-f5c1-459b-8d23-142223ab972a
Biceps tendon injury and rupture typically occur following sudden extension of a(n) {{c1::flexed}} elbow while contracting the biceps- e.g., lifting a heavy object - Surgical repair for distal biceps tendon rupture, especially in patients who are younger, active and/or who require rapid restoration of elbow functionality (e.g., athletes, manual laborers) - Reassurance and follow-up for proximal biceps tendon rupture or in those with a distal biceps tendon injury who do not require a rapid return of functionality or are poor surgical candidates2466608d-8d84-495c-a0be-79195d200667
When performing thoracentesis, it should ideally be performed: - Midclavicular line above the {{c1::8th}} rib - Midaxillary line above the {{c1::10th}} rib - Paravertebral line / posterior scapular line above the {{c1::12th}} ribThus MCL in the 7th ICS, MAL in the 9th ICS, PVL / PSL in the 11th ICS Photo credit: Mikael Häggström, Public domain, via Wikimedia CommonsWatch Pleurayd184284e-9125-440b-b305-c66149d54a38
Hyperkalemic and hypokalemic periodic paralysis are examples of {{c1::ion channel}} myopathies- These present with myotonia and episodes of hypotonic paralysis often associated with exercise - No muscle atrophy is seen on LM, however PAS-positive intracytoplasmic vacuoles are seenWatch Hyperkalemia: Clinical Presentation & DDx Watch Hypokalemia: Clinical Presentation & DDxba1c0cae-cba3-4795-be30-7ff6478ed5f6
Febrile neutropenia is a fever with an absolute neutrophil count (ANC) < {{c2::500}} cells/mm3 often seen during {{c1::chemotherapy}}- These patients are at risk for severe infection (most commonly due to endogenous bacterial flora), thus broad spectrum antibiotic therapy is indicated - Monotherapy with an antipseudomonal beta-lactam (e.g., cefepime, meropenem, piperacillin-tazobactam) provides both gram-negative and gram-positive coverage and is recommended initially - Give filgrastim/sargramostim to boost defensesWatch Neutropenic Fever SOAPa329ae06-ad5e-4c08-9544-93c32e2e3dee
In female infertility testing, a hysterosalpingogram (HSG) is primarily used to determine {{c1::fallopian tube patency}}- To determine whether there is a tubal occlusion or another anatomic abnormality; can be used for uterine cavity abnormalities but saline infusion sonohysterography / hysteroscopy are preferred - Contrast extravasation into the peritoneal cavity is a normal finding Normal HSG: Photo credit: Jmarchn, CC BY-SA 3.0, and https://zealthy.in/en, CC BY-SA 4.0, both via Wikimedia Commons2731a7d2-3982-4252-b10c-fd7c75a3d3f9
The {{c1::pouch of Douglas}} is the furthest point of the abdominopelvic cavity in women, and is typically where infections and fluids collect- AKA the rectouterine pouch or the posterior cul-de-sac - This peritoneal sac lies behind the posterior fornix of the vagina and separates the uterus and the rectum Photo credit: Briceag et al., CC BY 3.0, via Journal of Medicine and Life; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)Watch Blunt Abdominal Trauma: Presentation & WorkupWatch associated Bootcamp video - Female Anatomy13ebe5d2-ba32-483c-8b14-c526de9f6dd6
Patients with pelvic inflammatory disease or a ruptured ectopic pregnancy may have {{c1::culdocentesis}} performed to extract and ascertain the fluid contentsCuldocentesis is using a needle to extract fluid from the pouch of Douglas (posterior cul-de-sac) by inserting a needle through the posterior fornix of the vaginaWatch Gestational DisordersWatch Ectopic Pregnancy90ceed0a-6d13-4341-92a6-8ec2ea87f8d9
Is codeine by itself bioactive? {{c1::No}}Must be activated by liver CYP2D6 into morphineWatch associated Bootcamp video - Substance Misuse: Opioid Classification Watch associated Bootcamp video - Pharmacokinetics: Cytochrome P450 Interactions69d74f81-2287-4398-ae28-c826938ffca9
What lymph node cluster drains the apex of the tongue, floor of the mouth, and lower lip? {{c1::Submental lymph nodes}}- Thus, a tumor on the apex of the tongue would drain here - AKA cervical lymph node level 1A Photo credit: Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: None Mikael Häggström, M.D., CC0, via Wikimedia CommonsWatch associated Bootcamp video - Non-Visceral Anatomy : Oral Cavity, Mastication and Swallowing5264ae9a-f21f-446d-9031-68b75ea7f3aa
The patient's perception that a physician is {{c1::uncaring}} is the most likely precipitating factor in a patient’s decision to file a malpractice lawsuitWatch associated Bootcamp video - Communication: Interviewing Patients439bdd16-ef6a-4acc-9696-4ee7f3fee839
Patients with avascular necrosis of the femoral head will present with hip pain that is exacerbated by {{c1::weight bearing}}Disrupted articular cartilage with underneath irregular necrotic and collapsed yellow dead bone: Photo credit: © Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)Watch Approach to Hip Pain Watch Systemic Lupus Erythematosus SOAP Watch Pediatric Hip DisordersWatch associated Bootcamp video Watch associated Bootcamp video - Hip and Knee : Avascular Necrosis1feea035-35b0-4267-b5c8-5af5ba61f229
Is dating a patient ever okay? {{c1::NO*}}Some ethicists argue that it is okay once patient-provider relationship terminated, but this response may terminate the patient-provider relationship in hopes of dating the physician3d79d6d3-6842-4352-a14d-15a6911bdbcd
Patients with renal artery stenosis will present with {{c1::abdominal}} and {{c1::flank}} bruitsSpecific signsWatch HypertensionWatch Hypertension SOAWatch associated Bootcamp video - Hypertension: Secondary Hypertension71bdc2f6-8880-4378-a18e-c6d45a968dd5
Constrictive pericarditis typically causes {{c1::right::left/right}} heart failure due to restrictive diastolic filling- Due to thickened right ventricle during diastolic filling - May present with hepatomegaly, JVD, pericardial knock, pulsus paradoxus, and Kussmaul signWatch Pericarditis & Constrictive PericarditisWatch Pericardial Effusion, Cardiac Tamponade, and Constrictive Pericarditis SOAP Part 3Watch associated Bootcamp video - Pericardial Disease: Constrictive Pericarditis86ed4ef3-5d52-4755-9465-988069e417cf
What procedure is used to establish the diagnosis of spontaneous bacterial peritonitis (SBP)? {{c1::Paracentesis}}- Diagnostic criteria: ascitic fluid PMN ≥ 250/mm3, with or without positive ascitic fluid cultures, and absence of another intra-abdominal source of infection - Always order gram stain and fluid culture, but these are low sensitivity and NOT required for diagnosis - Paracentesis should be done before starting antibiotic therapy, which often results in negative ascites culturesWatch Cirrhosis Complications & Management Watch Ascites DDx52b2e6a1-84f9-415d-b067-6e4196bc29fd
What is the most common type of inguinal hernia? {{c1::Indirect}}Images licensed by Physeo and used with permission. Purchase full access here Photo credit: Mikael Häggström, M.D., CC0, via Wikimedia CommonsWatch Small Bowel Obstruction, Ileus & HerniasWatch Inguinal Hernia Repair OverviewWatch associated Bootcamp video - Non-visceral Anatomy : Indirect Inguinal Hernias1397b200-d8fc-4800-ba47-e3c3d4d77788
What is the most common cause of death in Marfan syndrome? {{c1::Aortic dissection}}- Presents with sudden-onset tearing chest pain - Secondary to aortic root dilation and cystic medial degeneration of the aortaWatch Aortic DissectionWatch Cardiac Chest Pain DDx Watch Surgery Aortic Dissection Watch Internal Medicine Aortic Dissection6386c8e1-0f83-4260-aa52-4a60789dc511
Angina, syncope, and CHF is suggestive of {{c1::aortic stenosis::condition}}; diagnosis is confirmed with {{c1::transthoracic echocardiogram (TTE)}}- Syncope in aortic stenosis patients at rest is usually caused by an arrhythmia - Restricted outflow → not enough to heart + brain - Diagnosis is done by cardiac physical examination to detect valvular or congenital heart disease - Auscultatory findings reveal a crescendo-decrescendo systolic murmur, and a delayed pulse is an indicator of this diagnosis - Aortic valve replacement is the most effective treatmentWatch Aortic Stenosis SOAP Watch Approach to Palpitations & Arrythmias Watch Syncope DDxWatch associated Bootcamp video - Valvular Disease: Aortic Stenosis8cbcd924-3f6b-4b3d-8718-fab2d72fb712
What is the likely diagnosis in a patient with low urine osmolality that improves by > 50% following administration of desmopressin? {{c1::Central diabetes insipidus}}Note: Central diabetes insipidus has been renamed arginine vasopressin deficiency (AVP-D)Watch Diabetes Insipidus & SIADHWatch Diabetes InsipidusWatch associated Bootcamp video - Hypothalamus : Diabetes Insipidus2768de80-9a2d-4f4f-bd1c-eccd3f715613
What is the preferred first-line treatment for central diabetes insipidus? {{c1::Desmopressin (intranasal preferred over oral)}}Replace ADH that isn't being made (vasopressin/desmopressin)Watch ADH, DDAVP, ADH receptor antagonists Watch Diabetes Insipidus & SIADHWatch Diabetes Insipidus Watch Moderate & Severe Traumatic Brain Injury: ManagementWatch associated Bootcamp video - Hypothalamus : Diabetes Insipidusabad46e8-0f25-405c-8acc-f8eaa148650c
What underlying cause of DVT must be ruled out in an older patient with their first episode of DVT and no history of immobilization, surgery, or provocative medications? {{c1::Malignancy (hypercoagulable state)}}- e.g., age-appropriate cancer screening (colonoscopy, mammogram) and CXR - More detailed testing may be indicated depending on the patient's symptomsWatch Deep Vein Thrombosis & Pulmonary EmbolismWatch DVT SOAP Watch Approach to Leg SwellingWatch associated Bootcamp video - Peripheral Venous and Arterial Disease: Peripheral Venous Diseaseec87f669-ef44-4532-b4e1-0cbd95a2b2fe
How is the diagnosis of knee issues (meniscus, ACL/PCL) done? {{c1::MRI::imaging}}MRI = soft tissue ACL (blue); PCL (red) Photo credit: Lykissas et al., , CC BY-SA 2.0, via Wikimedia Commons. The supplement image with overlays was taken from the previous source, licensed under CC BY-SA 2.09dca1ff8-d021-4574-890b-13efbfcf3874
What is the first-line imaging for pheochromocytoma? {{c1::CT abdomen and pelvis with contrast*}}*MRI is preferred for pregnant patients or known metastatic diseaseWatch associated Bootcamp video - Adrenal Glands : Adrenal Neoplasms1b0eaa32-b814-4803-afc6-44cf8aa115ac
What is the likely diagnosis in a patient living in a nursing facility that presents with a 2 x 1 cm skin ulcer overlying the sacral region? {{c1::Pressure ulcer / decubitus ulcer}}Stage 1-2 → change mattress, roll q2h Stage 3-4 → flap reconstruction surgery Photo credit: Babagolzadeh, CC BY-SA 3.0, via Wikimedia Commons Photo credit: Jmarchn, CC BY-SA 3.0, via Wikimedia CommonsWatch Cervical Spine Injuries: Workup & Management058cbd79-aa87-43b6-9f6c-385ec9e39bbd
Following X-ray, how do you diagnose malrotation? {{c1::Upper GI series (barium swallow)}}- X-ray first to rule out pneumoperitoneum (perforation) Upper GI series (barium swallow) may reveal: - Intestinal malrotation: displaced duodenojejunal junction and/or the small bowel is right-sided - Midgut volvulus: duodenal obstruction and/or corkscrew pattern of the small intestines - Congenital malrotation may lead to volvulus; if untreated can progress to bowel ischemia (hematochezia) and perforation The upper GI study clearly demonstrates that the small bowel projects to the right of the spine. Photo credit: Image(s) provided by www.radiologyassistant.nl. Used with permission. The upper GI-study shows a malrotation complicated by a volvulus. This results in the typical corkscrew or reversed 3 sign. Photo credit: Image(s) provided by www.radiologyassistant.nl. Used with permission.Watch Malrotation and Volvulus Watch Life-Threatening Causes of Abdominal Pain in the Neonate/Infant DDx Watch Vomiting in Neonates, Infants, and Toddlers DDx Watch Volvulus & Ogilvie's Syndromeeb57b762-19f2-4e49-82f0-1ed390def66d
Bulging fontanelle in an irritable baby is suggestive of {{c1::meningitis::diagnosis}}Bulging = full fontanelleWatch Neonatal Meningitis Watch Meningitis in Children >1 mo. Watch Aseptic Meningitis Watch Vomiting in Neonates, Infants, and Toddlers DDxWatch associated Bootcamp video - Neonatal Meningoencephalitis1eb9b117-1197-43aa-9fa6-c01d4f21933e
What childhood immunodeficiency presents with absent thymus and tonsils? {{c1::Severe combined immunodeficiency (SCID)}}- No thymus → no T cells - No tonsils → no B cellsWatch 22q11 Deletion Syndrome and Williams SyndromeWatch associated Bootcamp video - Immunodeficiency Syndromes: SCID5c777d4b-6e33-46a1-a8df-bdada02e8667
What is the next step in management for a healthy 12-year-old male who presents with delayed growth spurt, delayed puberty, and delayed bone age? {{c1::Reassurance and follow-up}}- This patient has constitutional growth delay and is expected to have a normal growth spurt and reach a normal adult height - Growth chart typically shows the child dropping percentiles on the growth curve between 6 months to 3 years of age before regaining normal growth velocity Photo Credit: CDC, Public Domaincfe3eef8-32b9-43e4-807a-38d403e52acc
↑ Preload = {{c1::↓::↑/↓}} intensity of HOCM murmurIncreased preload (blood return) means less obstruction = softer HOCM murmurWatch Hypertrophic Cardiomyopathy SOAPd7e317cb-2ed2-4320-bf95-8ce1dd32a314
Cystic fibrosis is due to a(n) {{c1::autosomal recessive::inheritance pattern}} CFTR defect; commonly seen in people of {{c2::Northern European}} descentCl- cannot be secreted via CFTR, causing compensatory reabsorption of Na+/H2O, decreasing mucosal H2O contentWatch Cystic Fibrosis SOA Watch Cystic Fibrosis ManagementWatch associated Bootcamp video - High Yield Genetic Disorders: Key Mutations: Cystic Fibrosis & Sickle Cell Anemia85f19d50-8020-42bc-bafb-681e64db7e72
{{c1::Parvovirus (B19)::Virus}} can cause an aplastic crisis in patients with hemoglobinopathiesWatch Parvovirus B19 (Parvoviridae)Watch associated Bootcamp video - DNA Viruses: Parvovirus B19 Watch associated Bootcamp video - Microcytic Anemia: β-Thalassemia Watch associated Bootcamp video - Normocytic Anemia: Aplastic Anemia81e7598c-18ff-4d64-a035-e39f1e6799fa
What is the likely diagnosis in a child that presents with scattered petechiae with isolated thrombocytopenia and enlarged platelets following a viral infection? {{c1::Immune thrombocytopenia (ITP)}}Most commonly occurs in children age 2–5 following a viral infectionWatch Quantitative Platelet DisordersWatch Bleeding Disorders: Platelet Disorders DDxReview Immune Thrombocytopenic Purpura (ITP)Watch associated Bootcamp video - Platelets: Platelet Disorders4871be56-908d-44e8-b1b1-d16b0b31fc96
- Obesity, hirsutism, acne and menstrual irregularity is suggestive of {{c1::PCOS::diagnosis}} - Above and moonlike facies, HTN, muscle wasting, abdominal striae is suggestive of {{c1::Cushing syndrome::diagnosis}}- PCOS due to ↑ androgen and insulin resistance - Cushing syndrome due to ↑ cortisol Above image licensed by Physeo and used with permission.Watch Hirsutism & Virilization DDx Watch Abnormal Uterine Bleeding DDx Watch Cushing Syndrome SOAPWatch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome)26518e03-6478-4493-aaab-614bfbb66551
Anorexia = {{c1::↓}} LH/FSH/estrogen→ amenorrhea Gonadal axis ↓LH pulsatility ↓Estrogens ↓AndrogensAdrenal axis ↑Cortisol no change in DHEAS Growth hormone GH resistance (↑ GH/ ↓IGF-1)Appetite-regulating hormones ↓Leptin ↑Ghrelin ↑PYYWatch associated Bootcamp video - Anxiety, Trauma, and Stress Disorders: Eating Disordersbf778d3f-48d7-4088-8925-25e3aef3daf9
{{c1::Huntington disease}} is a neurological disorder characterized by a classic triad of choreiform movement, dementia/depression, and behavioral changes- The movement disorder can progress to full-on rigidity in severe cases - Behavioral changes vary, but typically involve irritability, moodiness and antisocial behavior - Patients often have a strong family history (autosomal dominant inheritance)Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons DiseaseWatch associated Bootcamp video - Basal Ganglia: Disorders of the Basal Ganglia Watch associated Bootcamp video - Dementia: Additional Causes of Dementia Watch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseases7818e22a-c558-4f97-b982-30b39e1f2b0e
At what age do children realize death is permanent? {{c1::7}} years of ageDeath = 7th, 7 heaven1090edeb-7919-4399-ba62-0a19d48b8258
All patients with polymyositis/dermatomyositis should be screened for {{c1::occult malignancy}}Most commonly ovarian, lung, pancreatic, stomach, or colorectal cancers, or non-Hodgkin lymphomaWatch Polymyositis & DermatomyositisWatch associated Bootcamp video - Rheumatologic Diseases: Polymyositis and Dermatomyositis39fc6614-9f07-4189-ac4d-b695ef6aa013
What is the likely diagnosis? {{c1::Keratosis pilaris}}"Photo credit: Image licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ - Keratinized hair follicles (""rough bumps"") typically distributed over extensor arms and thighs - Described as painless papules, with a roughened skin texture - Treatment includes keratolytics (e.g., salicyclic acid, urea) - ddx. with lichen nitidus which is on flexor surfaces"0098d9e7-6055-47a2-a96d-ec7d3a702b07
What is the likely diagnosis in a hemodynamically unstable patient that presents with fever, vomiting, and a diffuse, confluent maculopapular rash? The patient recently had anterior packing for nosebleed or was using tampons {{c1::Staphylococcal toxic shock syndrome}}"Photo credit: Public Health Image Library (PHIL) ID#: 5116 Photo credit: Public Health Image Library (PHIL) ID#: 22889 - Rash covers trunk/extremities plus palms and soles (the latter will often desquamate) - The rash here is much different than that of meningococcemia (purpura, petechiae) and there's usually a history of tampon/nasal packing"Watch Postoperative Surgical Fevers3098c909-4970-4957-b4ca-3d23f99bbdb6
Resistant hypertension, hypokalemia, and abdominal bruit is suggestive of {{c1::renal artery stenosis::diagnosis}}Due to hyperaldosteronism: low renal perfusion → activation of the RAAS → induces aldosterone secretion → augments potassium excretion → hypokalemiaWatch HypertensionWatch Hypertension SOAWatch associated Bootcamp video - Hypertension: Secondary Hypertensionfb2a63dc-1b23-436c-9d6c-79ad5c102051
To prevent isoimmunization, Rhogam-D is given to Rh(D) {{c1::-::+/-}} moms {{c1::without::with / without}} Rh(D)-antibodies at {{c1::28–32}} weeks gestation and within {{c1::72}} hours following delivery or any feto-maternal blood mixing event- e.g., spontaneous or induced abortion, amniocentesis, delivery - The goal is to bind up all the antigen before mom can make antibodies to it - If she already has the antibodies, it’s too late; giving her more antibodies doesn’t helpWatch Rh Incompatibility & Alloimmunization Watch OB Early Pregnancy & Prenatal Care Watch FM Early Pregnancy & Prenatal Care Watch Vaginal Bleeding in Early Pregnancy DDx Watch Ectopic Pregnancy Watch Early Pregnancy Loss Watch Third Trimester Bleeding DDx Watch Routine Postpartum Careyf77c7e77-f467-4293-a4b4-fcdd32c7c661
In twin-twin transfusion syndrome (TTTS): {{c1::Recipient::Donor/Recipient}} twin = polycythemia, polyhydramnios, risk for heart failure {{c1::Donor::Donor/Recipient}} twin = anemia, growth retardation, oligohydramniosWatch Multifetal Gestations Watch Amniotic Fluid Disorders4f1aae83-db62-4ad3-b632-55f46931ee56
Anterior vaginal wall prolapse is suggestive of {{c1::cystocele::condition}}- Due to pelvic floor dysfunction - Can also cause urethrocele Photo credit: Mikael Häggström, CC0, via Wikimedia CommonsWatch Pelvic Organ Prolapse0f59b793-879f-4adf-b384-a85755fa1356
What is the likely diagnosis in a young woman that develops amenorrhea, weight gain, hypertension, hirsutism, muscle weakness, and easy bruising (striae)? {{c1::Cushing syndrome}}Cushing syndrome may be similar in presentation to PCOS (obesity, hirsutism, amenorrhea), but PCOS does not cause muscle weakness nor easy bruisability Photo credit: Masryyy, CC BY-SA 4.0 & Ozlem Celik, et al, CC BY 2.5, via Wikimedia CommonsWatch Cushings Syndrome Watch GlucocorticoidsWatch Cushing Syndrome SOAP Watch Hypertension Management Watch Hirsutism & Virilization DDxWatch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome) Watch associated Bootcamp video - Hypertension: Secondary Hypertension0be6ce5d-fba1-475a-8594-8c7e03a866a7
Post-pregnancy dyspareunia is due to elevated {{c1::prolactin::hormone}} levels associated with breastfeeding- Breastfeeding (↑ prolactin) → ↓ GnRH → ↓ LH and ↓ FSH → ↓ estrogen → vaginal dryness (atrophy) - Treat with lubricants / moisturizers / vaginal estrogen - Often resolve after cessation of breastfeeding since prolactin will return back to normalWatch Anterior Lobe of the Pituitary4e044be3-b89f-4ff6-a2fa-bee9d9fc154f
- Karyotype of Müllerian agenesis = {{c1::XX::XX/XY}} and {{c2::↔::↓/↑/↔}} testosterone levels - Karyotype of androgen insensitivity syndrome (AIS) = {{c1::XY::XX/XY}} and {{c2::↑::↓/↑/↔}} testosterone levels- The presentation is the same except for karyotype and testosterone levels - Testosterone comes from testes in AISWatch OBGYN Primary Amenorrhea DDx Watch Pediatric Primary Amenorrhea DDxWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disordersac358307-9d3e-4f7c-8702-8b971d0a85ad
Peripartum cardiomyopathy typically causes rapid-onset systolic heart failure at ≥ {{c1::36}} weeks gestation or in the early postpartum period (≤ 5 months post-delivery)e.g., fatigue, dyspnea, cough, pedal edema50a01246-9fd4-4cfb-80d6-340016134a71
Hereditary spherocytosis is most often inherited in a(n) {{c1::autosomal dominant}} patternPhoto credit: Ed Uthman, CC BY 2.0, via Flickr; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)dominoes, think of structural = AD Watch Extravascular Hemolysis Overview & RBC Membrane DefectsReview Hereditary SpherocytosisWatch associated Bootcamp video - Normocytic Anemia: Hereditary Spherocytosisdominoes, think of structural = AD2779e66f-a97c-4a83-97fc-566af8130b20
Once a diagnosis of myasthenia gravis is established, patients should receive a chest CT/MRI to evaluate for {{c1::thymoma}}- Thymectomy can result in long-term disease remission in patients with or WITHOUT thymoma or thymic hyperplasia - ~70% of patients with AChR antibodies have thymic hyperplasia, ~15% have thymoma - Compared with Lambert-Eaton myasthenic syndrome (LEMS) to evaluate for small cell lung cancer (SCLC) Photo credit: Kurukumbi et al., CC BY 2.0, via Wikimedia CommonsWatch associated Bootcamp video - Neuromuscular Junction (NMJ): Myasthenia Gravis Watch associated Bootcamp video - Lymphoid Tissue: Primary Lymphoid Tissue4059e12e-ebf7-4168-a601-8e23d98a6449
Congestive heart failure (CHF) is diagnosed with {{c1::echocardiography::echocardiography/ECG}}Useful for calculating ↓ ejection fraction for systolic dysfunction and ↓ filling for diastolic dysfunction Photo credit: Patrick J. Lynch, medical illustrator, CC BY 2.5, via Wikimedia CommonsWatch Chronic Heart Failure SOA Part 3 Watch Chronic Heart Failure: Workup & DDx Watch Chronic Dyspnea DDx Part 36e04f96d-f76b-41b6-a766-f986665cc91a
What type of AV block involves completely regular RR intervals with dissociated P and QRS complexes? {{c1::3rd degree AV block}}- 1st degree and 2nd degree type I = problem at the AV node - 2nd degree type II and 3rd degree = problem in the His-Purkinje systemWatch Bradycardia ECG Interpretation Watch Shock: Cardiogenic & Obstructive SOAPsWatch associated Bootcamp video - Conduction Blocks : Atrioventricular Blocksb11f2a8e-a199-4ede-9696-766191379688
What is the recommended treatment for organophosphate or acetylcholinesterase inhibitor poisoning? {{c1::Atropine, then pralidoxime}}- Equally important is the removal of any clothes, which may be contaminated with pesticides, and washing of skin to prevent further cutaneous absorption - Atropine reverses muscarinic symptoms only as a competitive inhibitor at the muscarinic ACh receptors so the excessive ACh can't bind (stops secretions) - Pralidoxime regenerates ACh-esterase = ↓ ACh = reverses muscarinic and nicotonic symptoms - Pralidoxime has poor blood-brain barrier penetration and can lead to a transient worsening of acetylcholinesterase inhibition following administration, which is why atropine is typically administered first to treat CNS symptoms and prevent further acetylcholinesterase inhibition - Pralidoxime induces a transient increase in acetylcholinesterase inactivation, so administering the drug without pretreatment with another drug could cause an exacerbation of the patient's symptomsWatch Acetylcholinesterase InhibitorsWatch Organophosphate Exposure Watch Bradycardia DDx Watch Bradycardia Workup & ManagementWatch associated Bootcamp video - Autonomic System : Anticholinesterase Poisoning Watch associated Bootcamp video - Side Effects and Toxins : Pharmacological Toxicity and Treatment Watch associated Bootcamp video - Neuromuscular Junction (NMJ): Medications Targeting the NMJc7c619ea-ae0e-4fd8-8036-7898a8863b70
Should addiction history affect acute pain management? {{c1::No*}}- It is ok to give patients with an addiction history opiates in the acute setting when indicated - Consider malingering but try to avoid letting unconscious bias direct care *Before treating with opiates, consider having a discussion with the patient in regard to their wishes. Inform them of the objective risks and benefits. Be mindful of potential bias when having these discussions. Shared decision making is importanta7fb7480-b80b-4064-98fc-3e74c703dad6
A loud P2 implies {{c1::pulmonary hypertension::pathology}}MTAPWatch Pulmonary Hypertensioncee0ec96-e764-471d-8e04-ede9717f7e1c
{{c1::Orthostatic}} hypotension can be due to volume depletion or autonomic nervous system dysfunctione.g., dehydration / diarrhea / diuresis / hemorrhage vs. diabetes / ageWatch Seizure vs. Syncope Watch Syncope DDx Watch Hemorrhage & Hypovolemic Shock Watch Approach to Dizziness Watch Nausea & Vomiting in PregnancyWatch associated Bootcamp video - Side Effects and Toxins: Age Considerations for Pharmacokinetics854f6f55-a318-4567-9463-62428e512ca1
Orthostatic hypotension is managed with {{c1::rehydration::treatment}}+ compression stockings, adjust medications (diuretics), fludrocortisone if non-responsiveWatch Syncope DDxf23b6ba9-879a-4068-b175-382665e40682
Cushing syndrome causes pain{{c1::less}} proximal muscle weakness due to direct {{c1::catabolic}} effects of cortisol on skeletal muscle, leading to atrophyDue to increased proteolysis leading to weakness without painWatch Cushings Syndrome Watch GlucocorticoidsWatch Cushing Syndrome SOAPWatch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome)31f91f1e-d7f8-4c9d-beaa-6469cb698c53
Brain cysts and seizures = ingestion of Taenia solium {{c1::eggs}}- These eggs are excreted through human feces - Taenia solium is a cestode - Treatment for intestinal infection = praziquantel - For brain cysts = albendazole + corticosteroids Photo credit: Brutto et al., CC BY 4.0, via PLOS Neglected Tropical DiseasesWatch associated Bootcamp video - Antiparasitics: Anthelmintics Watch associated Bootcamp video - Cestodes : Taeniaabf158a5-a702-4c1b-b93c-e9d5e3390668
Exercise-induced {{c1::hypo}}natremia occurs due to a combination of excessive hypotonic fluid intake and non-osmotic release of {{c2::ADH}}- SIADH due to exertion, pain, hypoglycemia, nausea - May present as seizures, profound confusion, and death in severe casesWatch SIADHWatch associated Bootcamp video - Endocrine SIADH23f4a90e-2df1-46ac-9923-61a4b2204c95
General treatment of seronegative spondyloarthropathies (PEAR) include: (1) {{c1::NSAIDs}} (2) Local {{c1::steroid}} injections (3) {{c1::DMARDs}} (except axial skeleton) (4) {{c1::TNF-α}} inhibitorsDisease-modifying antirheumatic drugs (DMARDs)Watch Seronegative Spondyloarthritis DDx Watch Polyarticular Joint Pain DDxWatch associated Bootcamp video - Seronegative Spondyloarthritis: Seronegative Spondyloarthritis Overviewy74e42647-19bc-4ac2-b2b5-07363aeac51e
Disseminated intravascular coagulation (DIC) presents with: {{c1::↓::↑/↓}} Platelet count {{c1::↑::↑/↓}} PT {{c1::↑::↑/↓}} PTT {{c1::↓::↑/↓}} Fibrinogen {{c1::↑::↑/↓}} D-dimer↓ Platelet count because of excessive clot formation (important distinguishing feature from fibrinolysis, which presents with a normal platelet count) ↑ PT/PTT because clotting factors are being consumed ↓ Fibrinogen because it is being turned into fibrin clots ↑ D-dimer because it is a fibrin split productWatch Acquired Coagulation DefectsWatch Intravascular Hemolytic Anemia: Intro & MAHA DDx Watch Bleeding Disorders: Coagulation Factor Disorders DDx Watch Third Trimester Bleeding DDxWatch associated Bootcamp video - Coagulation and Fibrinolysis: Disseminated Intravascular Coagulationye52e0d2b-7cba-4588-8462-f609ddad2f2b
Interosseous muscles of the hand (DAB, PAD) are innervated by the {{c1::ulnar}} nerve"""DAB the old man with a PAD"" The palmar interossei adduct the fingers (PAD) The dorsal interossei abduct the fingers (DAB)"Watch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Ulnar Nerve6da52c9c-2fd4-437c-841b-b2f149c2c4ba
What MSK pathology is characterized by impaired relaxation after a single muscle contraction? {{c1::Myotonic dystrophy}}Myotonia = difficulty relaxing muscles Watch 'Myotonic Dystrophy', NEJM Group, via Youtube, 0:53Watch Muscular DystrophiesReview Myotonic DystrophyWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular Dystrophies Watch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseases5e5e43e3-1c55-4b62-82b9-0a09c70ac1ae
{{c1::Platelet::Platelet / Factor}} bleeding is superficial/mucosal (e.g., petechiae, purpura, epistaxis, gingival bleeding, menorrhagia) {{c1::Factor::Platelet / Factor}} bleeding is deep (e.g., joints, muscles)7c65af58-9829-4af9-822c-8d399dd49d5d
- Starry-sky morphology (below) - EBV infection - C-myc translocation = {{c1::Burkitt lymphoma::lymphoma}}Photo credit: “Burkitt lymphoma, H&E” by Ed Uthman is licensed under CC BY 2.0 - Starry cloak: white spaces due to macrophages eating up rapidly dividing B-cells - EBV bar (also micro) - Myc mice (promotes growth)Watch Non Hodgkin LymphomaReview Burkitt LymphomaWatch associated Bootcamp video - Opportunistic Infections: HPV Carcinoma, Reactivation Tuberculosis, Burkitt Lymphoma Watch associated Bootcamp video - Leukemias and Lymphomas: Burkitt Lymphoma5c22f9bf-5db7-4364-927b-13b3c52f592d
Motor weakness of elbow flexion and supination Sensory loss of lateral forearm {{c1::Musculocutaneous}} nerve damageInnervates biceps/brachialis NerveMotorSensationInjury LocationPresentationMusculocutaneousElbow flexion, forearm supination (biceps brachii)Lateral forearmUpper trunkElbow extended, pronated Photo Credit: Public domainWatch associated Bootcamp video - Brachial Plexus Nerves and Lesions: Musculocutaneous Nerve69cd79da-646a-4a8a-a42b-9b11152d390c
Harsh, holosystolic murmur with palpable thrill: {{c1::Ventricular septal defect}}Same holosystolic sound as mitral regurgitation, distinguish with location (VSD = lower left sternal border, mitral at mitral area) and MR is soft, no thrill Photo credit: Centers for Disease Control and Prevention, Public domain, via Wikimedia CommonsWatch Left to Right ShuntsWatch Acyanotic Congenital Heart Disease DDxWatch associated Bootcamp video - Acyanotic Congenital Heart Defects: Ventricular Septal Defect82bbdcec-9987-4d07-a280-64090971cd22
What is the diagnosis in a patient with the following findings? ECG: regular and narrow complex tachycardia with rate > 150 Clinical: brief episodes of palpitations, dizziness, chest pain, dyspnea, syncope {{c1::Supraventricular tachycardia}}"Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia Commons, modified by adjusting color - Defined as any tachycardia originating above bundle of His (thus narrow QRS) - ""Paroxysmal"" SVT just means it happens abruptly (paroxysm) Image licensed by Physeo and used with permission. Purchase full access here."Watch Narrow-Complex Tachycardia 1: Intro & pSVT SOAP Watch Narrow-Complex Tachycardia: AFib & AFlutter SOA Watch Narrow-Complex Tachycardia: MAT SOAP Watch Narrow-Complex Tachycardia: AFib & AFlutter Management Watch Approach to Palpitations & Arrythmias Watch Syncope DDx Watch Approach to DizzinessWatch associated Bootcamp video - Ventricular Arrhythmias: Supraventricular Tachycardia9e320cd8-513d-4d71-b9cb-a32459d73c54
Systolic ejection murmur crescendo/decrescendo, louder with squatting, softer with Valsalva, and pulsus parvus et tardus {{c1::Aortic stenosis::Murmur}}"- ""Blowing"" sound - Squat = more preload - Valsalva = less preload - Hypokinetic pulse (pulsus parvus): soft/low amplitude pulse"Watch Aortic Stenosis SOAPWatch associated Bootcamp video - Valvular Disease: Aortic Stenosis844f2905-3230-455c-aa07-96ddaf38b156
Causes of exudative pleural effusion with glucose < 30 mg/dL may be remembered with the mnemonic Make Room for ExudaTes {{c1::Malignancy::Make}} {{c1::Rheumatoid arthritis::Room for}} {{c1::Empyema, Tuberculosis::ExudaTes (2)}}WBCs vs. bacteria eat up the glucose Parapneumonic EffusionsUncomplicatedComplicatedEtiologySterile fluid in pleural spaceBacteria in pleural spacepH≥ 7.2< 7.2Glucose> 60mg/dL< 60mg/dLWBC≤ 50,000/mm3> 50,000/mm3Gram stain & CultureNegativeTypically false negative (not enough bacteria - would be positive with empyema)TreatmentAntibioticsAntibiotics + DrainageM: R: (sketchy typo should say RA) E: T: Watch Exudative Pleural Effusions DDx M: R: E: T:y7ceba8dc-368f-4520-84a3-f3dfdb16b0f3
What is the empiric treatment for ehrlichiosis? {{c1::Doxycycline}}Dogs in the lone star stateWatch TetracyclinesWatch associated Bootcamp video - Antibiotics: Tetracyclines and Derivatives599386cf-721f-4c14-a8bc-7e96c6148039
{{c1::Mode::Mean/Mode}} = least affected by outliers {{c1::Mean::Mean/Mode}} = most affected by outliersAdding a single outlier is unlikely to affect the most frequent value (mode)Watch Measures of Central TendencyWatch associated Bootcamp video - Statistical Distributions: Measures of Central Tendency406a052e-34a2-4e85-9c39-10e881db8105
Four associated cardiac problems with Marfan syndrome: {{c1::MVP}} {{c1::Thoracic aortic aneurysm}} {{c1::Aortic dissection}} {{c1::Aortic regurgitation}}- Marfan's Mighty Aortic Trio (MVP + aortic aneurysm, aortic dissection, and aortic regurgitation) - Fibrillin gene → aortic dilation → regurgitationWatch Aortic Regurgitation SOAPWatch associated Bootcamp video - Valvular Disease: Aortic Regurgitation Watch associated Bootcamp video - Aortic Disease: Cardiac Considerations of Marfan Syndrome0bf55d98-4d3e-4e78-80db-58b3e63cac0d
First-line treatment of acute angle-closure glaucoma includes a topical {{c1::β}}-blocker, topical {{c1::α2}}-agonist, topical {{c1::pilocarpine::M3 agonist}}, and a systemic {{c1::carbonic anhydrase inhibitor (e.g., acetazolamide)}}- These all decrease aqueous humor production - The 3 topical drugs are typically given in succession with a minute in-between each application - Prostaglandins (latanoprost) are typically used for oPen angle glaucomaWatch GlaucomaWatch associated Bootcamp video - Renal Pharmacology: Carbonic Anhydrase Inhibitorsyef1c7f45-1fa5-49e0-9119-284ab8bd8cff
Tenderness at the tibial tubercle is suggestive of {{c1::Osgood-Schlatter disease::diagnosis}}- Due to repeated microfracture at the tendon insertion (i.e., traction apophysitis) - Inflammation where the patellar ligament attaches to the tibial tuberosity Photo credit: James Heilman, MD, CC BY-SA 3.0, via Wikimedia CommonsWatch Pediatric Knee Disorders Watch Common Pediatric FracturesWatch associated Bootcamp video - Childhood Musculoskeletal Pathology: Osgood-Schlatter Disease4a6a02f9-6dd6-4af8-a770-82605e4fed2a
Female puberty occurs through the following stages: 7 years: {{c1::Adrenals (Adrenarche)}} 8 years: {{c1::Breasts (Thelarche)}} 9 years: {{c1::Pubic hair (Pubarche)}} 10 years: {{c1::Maximal growth velocity}} 11 years: {{c1::Menses (Menarche)}}"Remembered with the mnemonic ""boobs, pubes, grow, flow"""ye7c87363-d639-4fa2-a6b7-10b863d25293
Maternal sensitization to a fetus' Rh+ blood may be reduced using {{c1::anti-D immunoglobulin (RhoGAM)::treatment}}- Prevents maternal antibody production - Give at 28 weeks and within 72 hours of delivery (each dose lasts 12 weeks) - Also give any time blood mixesWatch Rh Incompatibility & Alloimmunization Watch OB Early Pregnancy & Prenatal Care Watch FM Early Pregnancy & Prenatal Care Watch Vaginal Bleeding in Early Pregnancy DDx Watch Ectopic Pregnancy Watch Early Pregnancy Loss Watch Third Trimester Bleeding DDx Watch Routine Postpartum Carebea71747-3a97-4760-8f65-a1beb8476d78
What is the first-line treatment for syphilis? {{c1::Penicillin G}}You need to hit the G for the STDWatch PenicillinWatch associated Bootcamp video - Antibiotics: Classic Penicillins0ae9c58b-da9a-4505-a2a0-f20beb70565e
What is the likely diagnosis in a patient that develops acute posterior calf pain / swelling while walking? Physical examination shows tenderness / induration at the medial head of the gastrocnemius and a crescent-shaped patch of ecchymosis at the medial malleolus. {{c1::Ruptured popliteal cyst}}- Due to extrusion of synovial fluid from the knee joint into the gastrocnemius / semimembranosus bursa, often in those with underlying osteoarthritis - Ddx. with DVT (onset with exercise, location of tenderness, ecchymosis at medial malleolus)Watch Approach to Knee Pain772ee7da-adc6-4c05-998f-9d5e78f8cf5c
{{c1::Indirect inguinal hernias::Indirect inguinal hernias or varicoceles}} are reducible with manipulation and feel like a soft-tissue mass- If hernia is not visualized on exam, it can often be reproduced by Valsalva - Varicoceles can't be reduced and feel like a bag of worms Images licensed by Physeo and used with permission. Purchase full access hereWatch Inguinal Hernia Repair Overview18746ef6-e013-44a1-ab71-c830aba8b80e
What is the likely diagnosis in a teenage boy that presents after having an episode of unconsciousness followed by drowsiness and headache? The symptoms started and ended quickly. Physical exam is significant for a mild rash around the patient's mouth. Routine toxicology screen is negative {{c1::Inhalant abuse (e.g., glue, toluene)}}Perioral skin changes (glue sniffer's rash) is classic due to chemical exposure; abuse of nitrous oxide → B12 deficiency → polyneuropathyd2438151-15a3-4420-9882-a7023e997654
Pulmonary edema is seen in {{c1::dilated cardiomyopathy::dilated cardiomyopathy / cardiac tamponade}}Cardiac tamponade: - Problem of getting blood in to the right heart → Beck's Triad (JVD, hypotension, distant heart sounds, alternans, clear lungs) - Compare with cardiogenic shock, where we have JVD + crackles + S3 + hypotensionWatch Dilated Cardiomyopathy Watch Dilated & Restrictive Cardiomyopathy SOAPsWatch associated Bootcamp video - Lung Pathology Special Topics (Pulmonary Edema)c32bf5f7-8eff-43b6-b3f7-575fd762171a
Fragile X syndrome: {{c1::CGG}} repeats {{c1::FMR-1}} gene repression due to {{c1::hypermethylation}} {{c1::X-linked dominant}} inheritance {{c1::Mitral valve prolapse (MVP)::Cardiac abnormality}} {{c1::Autism::Behavioral disorder}}Watch Fragile X SyndromeWatch Autism Spectrum DisordersReview Fragile X SyndromeWatch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseasesy09e997bb-5b7a-4c46-b51f-8fdaaaced96f
Disease prevention: {{c1::Secondary}} = screen early to prevent disability (mammogram, Pap smear) {{c1::Primary}} = prevent disease before it occurs (vaccination) {{c1::Tertiary}} = treatment to maximize remaining function {{c1::Quaternary}} = prevent overtreatment {{c2::Community}} = population intervention {{c2::Clinical}} = employ preventions with therapeutic efficacy- Onset, Progression, Complication - Primary, Secondary, Tertiary = PST = Prevent, Screen, Treat - Community (e.g., sugar, candy, or carbonation tax) - Clinical (e.g., pharmaceuticals, physical therapy, etc.)Watch associated Bootcamp video - Delivering Care: Disease Preventiony2fda56c8-bc93-4a9d-ad76-c725823ed4d7
The {{c1::hippocampus (CA1 pyramidal neurons)::area of the brain and cells}} is affected first in hypoxic stroke due to high metabolic demande.g., shock Photo credit: OpenStax, CC BY 4.0Watch Ischemic & Hemorrhagic StrokeWatch associated Bootcamp video - Histologic Timeline of Stroke Watch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Types of Stroked2d5644d-f188-41fa-a864-52d157bae339
Propionic acidemia results in {{c1::increased}} levels of propionyl-CoA and {{c1::decreased}} levels of methylmalonic acidWatch Organic AcidemiasReview Propionyl Acid Pathway Review Propionic AcidemiaWatch associated Bootcamp video - Carbohydrates: Gluconeogenesis: Starting Substrates Watch associated Bootcamp video - Cystinuria and Organic Acidemias: Organic Acidemiasf87bfc72-c39a-421e-869c-b23cec535925
Propionic acidemia presents with poor feeding, {{c2::vomiting}}, hypotonia, {{c1::high anion gap metabolic acidosis::blood pH pathology}}, hepatomegaly and seizuresSubstances that metabolize into propionyl-CoA cause you to VOMIT: Valine, Odd-chain fatty acids, Methionine, Isoleucine, ThreonineWatch Organic AcidemiasReview Propionyl Acid Pathway Review Propionic AcidemiaWatch associated Bootcamp video - Carbohydrates: Gluconeogenesis: Starting Substrates Watch associated Bootcamp video - Cystinuria and Organic Acidemias: Organic Acidemiasc1d927ee-b3d5-4902-85b9-fc121f543e12
The {{c1::metabolic rate}} drastically increases after a large surface area burn due to the release of inflammatory mediators- Thus, start enteral nutrition immediately - Characterized by an initial hypometabolic phase followed by a hypermetabolic state due to an increase in catecholamines, cortisol, and inflammatory cytokinesabde4cd8-d0a3-44c5-b8bd-c50b15c672b2
AV fistula: Preload: {{c1::Increased::Increased/Decreased}} Afterload: {{c1::Decreased::Increased/Decreased}} CO: {{c1::Increased::Increased/Decreased}}Due to the fistula: - Blood can bypass the high resistance of the systemic arterioles → SVR is effectively decreased → decreased afterload - Blood returns to the right atrium more quickly and easily → increase in venous return → increased preload - Decreased SVR requires a compensatory increase in CO to maintain organ perfusion (MAP = CO × SVR), increased venous return contributes to the increase in COy98e1cfcc-8052-421f-8d33-4f045ec905b1
The radiologic and histologic pattern of idiopathic pulmonary fibrosis may be referred to as {{c1::usual interstitial pneumonia (UIP)}}Watch Idiopathic Pulmonary FibrosisWatch associated Bootcamp video - Pulmonary Fibrosisa1c37b79-dc3a-42ab-864c-5330f0d20415
Cirrhosis will cause a(n) {{c1::hypo}}-osmotic volume {{c1::expansion::contraction/expansion}}- Peeing out albumin / decreased production → decreased serum oncotic pressure → decreased intravascular volume → increased extravascular pressure, which then goes to interstitial space - Chronic decreased intravascular volume → increased ADH and aldosterone + fluid retention (hyposmotic expansion)Watch Osmolality & Sodium DisordersWatch Cirrhosis SOA Watch Chronic Liver Disease DDxWatch associated Bootcamp video - Hepatic Pathology : Cirrhosis799f000f-a2cf-48a0-8ea4-3d87037bfed1
Hepatopulmonary syndrome is characterized by {{c1::vasodilation}} of pulmonary capillaries because the liver is unable to metabolize {{c2::NO and endothelin-1::2}}- Hepatic endothelin-1 binds pulmonary endothelin B receptors (ETBR) resulting in increased nitric oxide via eNOS stimulation - This should not be confused with endothelin A receptors (ETAR), which primarily mediate vasoconstriction - If vasodilation is severe enough, the lungs can lose their ability to effectively transfer oxygen to the body - Currently, the only known cure for HPS is a liver transplant* NO and endothelin-1 (ET-1) cause pulmonary vasodilatation Watch Cirrhosis Pathogenesis & Clinical ManifestationsWatch associated Bootcamp video - Hepatic Pathology : Cirrhosisf33199bb-55c3-494e-8159-9277624cccf0
Effective brief interventions for alcohol use disorder require a(n) {{c1::understanding of the patient's level of awareness}} of the problem and readiness to change2eaac51a-0404-4d18-9481-7ee652c00370
In ATN, ischemia damages endothelial cells resulting in {{c1::decreased}} NO and {{c1::increased}} endothelinWhich causes afferent vasoconstrictionWatch Acute Tubular Necrosis (ATN)Watch associated Bootcamp video - Acute Tubular Necrosis1088ea47-eaa2-424f-a68b-e5c16cb7f4b7
Rhabdomyolysis releases heme pigments into the bloodstream, which may cause {{c1::acute tubular necrosis (nephrotoxic)::renal pathology}}In addition to ATN, there is a component of intravascular volume depletion that worsens AKIWatch Acute Tubular Necrosis (ATN)Watch Intra-Renal AKIWatch associated Bootcamp video - Acute Tubular Necrosisfa891b66-258e-4198-9da9-94f2980ede7e
Uremia, a consequence of renal failure, may cause severe {{c1::pruritus}} and purpura of the skinWatch Chronic Kidney Disease (CKD)Watch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Chronic Kidney Disease4bc40f6c-d166-4395-b8b8-a1bca3ff9803
Chronic kidney disease (CKD) may cause {{c1::secondary hyperparathyroidism::endocrine disorder}}Hypocalcemia stimulates the parathyroid gland to release parathyroid hormone (PTH) → may see hyperplasia of parathyroid glandsWatch Chronic Kidney Disease (CKD) Watch Parathyroid Gland DisordersWatch Chronic Kidney Disease (CKD): Complications & ManagementWatch associated Bootcamp video - Chronic Kidney Diseasee31ca3fc-cfdc-4e67-92b9-bc28b687f33e
What is seen on X-ray for neonatal respiratory distress syndrome (NRDS)? {{c1::- Diffuse ground-glass appearance - Air bronchograms - Atelectasis - Decreased lung volumes::4}}Ground Glass BAD (Ground Glass, Bronchograms, Atelectasis, Decreased lung volumes) CXR Findings in NRDS Photo credit: Image(s) provided by www.radiologyassistant.nl. Used with permission. Example of air bronchogram in NRDS: Image(s) provided by www.radiologyassistant.nl. Used with permission. DiagnosisTransient tachypnea of the newborn (TTN)Respiratory distress syndromePersistent pulmonary hypertensionPathophysiologyAlveolar fluid not cleared properly at birthAlveolar collapse and atelectasis due to lack of surfactantRight to left shunting due to high pulmonary vascular resistance resulting in hypoxiaClinical featuresTachypnea resolves by day 2Respiratory distress (premature birth)Tachypnea and cyanosisChest x-rayPerihilar linear streaking bilaterallyGround glass (reticulogranular), air bronchograms, decreased lung volumesClear lung fields, decreased pulmonary vascularityWatch Lung Diseases of Prematurity: Respiratory Distress Syndrome and Apnea of Prematurity5993186d-005f-4822-b4e6-347f5fe91846
Idiopathic acidic urine accounts for 50% of {{c1::uric acid}} kidney stonesPhoto credit: Iqbal Osman, CC BY 2.0, via Wikimedia CommonsWatch Magnesium Ammonium Phosphate (MAP) Stones, Uric Acid Stones, & Cystine StonesWatch Types of Kidney StonesWatch associated Bootcamp video - Uric Acid Stones07eac238-d9ef-480a-b790-c4251f79e98f
{{c1::Clear cell}} renal cell carcinomas are composed of cells with high lipids and glycogen contentLarge clear, vacuolated cytoplasm Photo credit: Nephron, CC BY-SA 3.0, via Wikimedia CommonsWatch Renal Cell Carcinoma & NephroblastomaWatch associated Bootcamp video - Inflammatory Conditions and Malignancy: Renal Cell Carcinomacf330b6e-dd20-497c-af89-98bf39878354
Where does keratosis pilaris most commonly manifest on the body? {{c1::Posterior surface of the upper arm}}Tx: Topical keratolytics (eg, salicylic acid, urea) Photo credit: QuarterNotes, CC BY-SA 4.0, via Wikimedia Commonse41a9915-8d34-4c5f-be70-b5794e7c54ed
What are the effects of severe acute pancreatitis on serum calcium levels? {{c1::Decreased (hypocalcemia)}}- Due to extensive fat necrosis and release of fatty acids, which bind to large amounts of calcium leading to dystrophic calcification and hypocalcemia - Hypocalcemia (<8mg/dL) at 48 hours is a strong predictor of mortality (Ranson's criteria)Watch Calcium Disorders Watch Acute & Chronic PancreatitisWatch Acute Pancreatitis Watch Hypocalcemia: Clinical Presentation & DDxWatch associated Bootcamp video - Pancreatic and Biliary Pathology: Acute Pancreatitis Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Calcification Watch associated Bootcamp video - Electrolytes: Calcium Watch associated Bootcamp video - Cellular Injury and Neoplasia: Calcification85b29308-35ba-4afd-9de3-9291facb9d3a
Androgen insensitivity syndrome (AIS): Minimal to no axillary or pubic hair development occurs due to {{c1::peripheral androgen resistance}}Watch OBGYN Primary Amenorrhea DDx Watch Pediatric Primary Amenorrhea DDxWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders5126a6f8-d7bd-472b-a33f-6ffad4321c55
Myocardial scar formation (weeks-months post-MI) may present with mural thrombi, {{c1::heart failure}} and/or {{c1::ventricular arrhythmias}}- Due to decreased contractile function - Ventricular arrhythmias may cause sudden cardiac deathWatch Acute Myocardial Infarction & Post MI TimelineWatch MI Complications SOAPWatch associated Bootcamp video - Myocardial Infarction: Post-Myocardial Infarction Timeline8368ba81-5120-47f2-a8e2-b4d29ac6df4b
How can breastfeeding lead to vaginal atrophy? {{c1::Breastfeeding (↑ prolactin) → ↓ GnRH → ↓ LH and ↓ FSH → ↓ estrogen → vaginal dryness (atrophy)}}This short-term dyspareunia can be managed with lubricants04c44a90-0442-4190-8e4e-7c8d08a984ca
Why do patients with androgen insensitivity syndrome (AIS) have breast development? {{c1::Increased testosterone is aromatized to estrogen}}Androgen insensitivity syndrome (AIS): - Caused by a dysfunctional androgen receptor - Inherited in an X-linked recessive manner - XY genotype with a female phenotype due to male brain and body being unresponsive to androgens and feminized by maternal estrogens - During puberty, testes do not descend and female secondary sexual characteristics appear, such as breast development - Vagina is a blind pouch, uterus is absent and amenorrhea occursWatch OBGYN Primary Amenorrhea DDx Watch Pediatric Primary Amenorrhea DDxWatch associated Bootcamp video - Pregnancy and Menstruation: Menstrual Cycle Disorders Watch associated Bootcamp video - Fetal Development: Disorders of Sexual Development Part 1f740ddf8-3cd8-4214-8e5f-752ed58c6d9c
Bullous pemphigoid: pruritic tense bullae Epidemiology: ages {{c1::>60}} Autoantibodies against: {{c1::Hemidesmosomes}} Mucosal involvement: {{c1::No::Yes/No}} Nikolsky sign: {{c1::Negative::Positive/Negative}} Diagnosis: {{c1::Skin biopsy (subepidermal cleavage) with immunoflurescence (linear deposits)}} Treatment: {{c1::High potency topical steroids (e.g., clobetasol)}}"Image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZ Photo credit: Tham et al., CC BY 4.0, via BMC Veterinary Research (1st image); Si et al., CC BY 2.0, via BMC Diagnostic Pathology, modified by brightening, cropping, and removing letter ""A""; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)"Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Autoimmune Blistering Conditionsy400161de-c135-4b79-a75a-243d5d12cf51
What is the mechanism for decreased bone mineral density in patients with Cushing syndrome? {{c1::High levels of cortisol inhibits calcitriol synthesis}}Photo credit: Mikael Häggström, CC0, via Wikimedia CommonsWatch associated Bootcamp video - Adrenal Glands : Hypercortisolism (Cushing Syndrome)28ffded6-8f8c-4256-b5be-a62ba2658fca
{{c1::Methemoglobinemia}} will present with pulse oximetry readings of ~85% regardless of the true oxygen saturation levelBecause methemoglobin absorbs light at a different wavelength than hemoglobinWatch O2 TransportWatch associated Bootcamp video - Blood Physiology : Abnormal Oxygen Levels Watch associated Bootcamp video - Side Effects and Toxins: Environmental Toxins and their Treatments8d2f43f4-6934-48aa-b5c6-339e7e20390b
Common peroneal neuropathy = {{c1::foot drop and weak eversion::physical exam findings?}}AKA common fibular neuropathyWatch associated Bootcamp video - Lower Extremity Nerves: Common, Deep and Superficial Peroneal (Fibular) Nervesbd358c5e-9a4f-42bc-b570-3132d43f6caa
An active hepatitis C diagnosis requires both a serologic test for the HCV antibody and a confirmatory {{c1::molecular test}} for the presence of {{c1::HCV RNA}}- Note: Antibodies take up to 6 weeks after exposure to develop and HCV RNA may take 2-3 weeks to become detectable - HCV antibody = ELISA - HCV RNA = PCRWatch Acute Liver Disease DDxWatch associated Bootcamp video - Positive-sense RNA Viruses : Hepatitis C Part 2 (Diagnostics and Management)73d5af83-406d-46d1-808d-a3e7d46b2cbe
{{c1::Constitutional delay of growth and puberty (CDGP)}} is the isolated, temporary halting of skeletal growth in the absence of other causal physical abnormalities- Secondary to delayed onset of pulsatile nighttime GnRH release - Eventually resume normal growth; MCC of short stature and delayed puberty - Normal hormone levelsbeaea67d-4660-440d-bd86-7931739eda24
What is the likely diagnosis in a patient with severe epigastric pain radiating to the back and CT scan showing non-enhancing pancreatic parenchyma ± peripancreatic edema / hemorrhage? {{c1::Acute necrotizing pancreatitis}}Watch Acute & Chronic PancreatitisWatch Acute PancreatitisWatch associated Bootcamp video - Pancreatic and Biliary Pathology : Acute Pancreatitis80975cff-5298-4564-8cc1-77800f95872f
"The causes of {{c1::microcytic anemia}} may be remembered by ""TAILS"": {{c1::Thalassemia::T}} {{c1::Anemia of chronic disease (late)::A}} {{c1::Iron deficiency (late)::I}} {{c1::Lead poisoning::L}} {{c1::Sideroblastic anemia::S}}"Early anemia of chronic disease and early iron deficiency are usually normocytic Photo credit: Ed Uthman, CC BY 2.0, via Flickr, modified by cropping; the supplementary image with overlays of the relevant areas was adapted from the image mentioned previously (© AnkiHub, LLC)Watch Microcytic Anemia: Overview & ThalassemiasWatch associated Bootcamp video - Microcytic Anemia: Overview of Anemiay9f465845-632f-458f-b2e6-d1851ae4621d
The causes of microcytic anemia may be remembered with the mnemonic {{c1::TAILS}}Thalassemia Anemia of chronic disease Iron deficiency Lead poisoning Sideroblastic anemiaWatch Microcytic Anemia: Overview & ThalassemiasWatch associated Bootcamp video - Microcytic Anemia: Overview of Anemiabe71255b-cd57-413b-8e5e-45b95f0c67ea
Early emphysema presents with respiratory {{c1::alkalosis}}, while late emphysema presents with respiratory {{c1::acidosis}}* Late respiratory acidosis due to airway trapping causing CO2 retention* Late respiratory acidosis due to airway trapping causing CO2 retention Watch COPD & EmphysemaWatch associated Bootcamp video - Respiratory Acidosis Watch associated Bootcamp video - COPD835d14e7-b545-43b8-98a7-7995a28ee612
Phagocytosis of IgG-coated platelets in the spleen and systemic thrombosis are the two causes of thrombocytopenia in {{c1::heparin-induced thrombocytopenia (HIT)}}Phagocytosis of IgG-coated platelets in the spleen is the major cause of platelet consumption, systemic thrombosis causes platelet consumption to a lesser extentWatch Quantitative Platelet DisordersWatch DVT SOAPWatch associated Bootcamp video - Coagulation and Fibrinolysis: Anticoagulationb57a6f73-98ab-450c-983c-8b197d1f2a19
The {{c1::posterior cerebral artery (PCA)::artery}} supplies the thalamus, which when infarcted can cause thalamic syndrome with contralateral sensory abnormalitiesWatch Localizing a Stroke: PCAWatch associated Bootcamp video - Ischemic Cerebrovascular Accidents: Stroke Presentation by Territory15da7b12-fcf2-44a7-8297-d21e0f05de95
Leukocyte adhesion deficiency presents with loss of adult {{c1::teeth}} by adolescence due to periodontitisWatch Phagocytic Cell DisordersWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)454f912c-9019-41f9-ac9d-e49150ee8631
Those with leukocyte adhesion deficiency are susceptible to bacterial invasion, particularly nonpurulent {{c1::skin::location}} and {{c1::mucosal::location}} infections*e.g., gingival erythema, ulceration, skin abscesses, cellulitis, otitis media (because the skin and oral mucosa are susceptible to bacterial invasion)Watch Phagocytic Cell DisordersWatch associated Bootcamp video - Disorders of the Leukocyte Migration Watch associated Bootcamp video - Inflammatory Response: Disorders of the Leukocyte Migration (Pathology)3f0ba456-8778-467a-aaf4-e3a4b1c60a1a
Myeloperoxidase deficiency (MPO) is a(n) {{c1::autosomal recessive::inheritance pattern}} primary immunodeficiencyWatch Phagocytic Cell Disorders6e3ee2f6-b5e7-433e-ac9d-f2ac60334a65
In {{c1::myeloperoxidase (MPO) deficiency::MPO deficiency/CGD}}, the respiratory burst is intact, and thus will produce superoxide (O2-) and hydrogen peroxide (H2O2)Watch Phagocytic Cell DisordersWatch associated Bootcamp video - Fundamentals of Bacteriology: Bacterial Morphologyd461e9aa-1f1c-40f4-bb76-50d654d7b49f
What treatment of ankylosing spondylitis is most likely to improve mobility? {{c1::TNF-α inhibitors}}- e.g., infliximab, adalimumab - Life expectancy is not affectedWatch TNF InhibitorsWatch Seronegative Spondyloarthritis DDx Watch Polyarticular Joint Pain DDxWatch associated Bootcamp video - Seronegative Spondyloarthritis: Ankylosing Spondyloarthritis Watch associated Bootcamp video - Pharmacology : TNF-a Inhibitors and Monoclonal Antibodies86da17f0-342f-44c2-9dac-6762a358d2c3
Renovascular disease due to {{c1::fibromuscular dysplasia}} typically occurs in the distal 2/3 of the renal artery and/or segmental branchesvs. due to atherosclerosis, which occurs in the proximal 1/3 of the renal artery Photo credit: See page for author, CC BY 2.0, via Wikimedia CommonsWatch Hypertension57cead7d-7d0f-4dee-8938-9cb6bd13691f
Vancomycin, opioids, and {{c1::radiocontrast dye}} can cause IgE-independent mast cell degranulation"- Termed a pseudoallergic response (non-IgE-dependent) - May present with hypotension, tachycardia, pruritus, urticarial rash, and wheezing - With vancomycin, this is termed vancomycin infusion reaction (previously ""red man syndrome"")"Watch associated Bootcamp video - Hypersensitivity Reactions: Type I Hypersensitivity Reactions Watch associated Bootcamp video - Inflammatory Diseases of the Skin: Atopic and Allergic Diseases Watch associated Bootcamp video - Blood Cells: Mast Cell24bb53f9-e6df-43b3-967a-23b9dbc35797
{{c1::Trichotillomania}} is compulsively pulling out one's hair which causes significant distress but persists despite attempts to stopAssociated with OCD Photo credit: Robodoc (original uploader), Public domain, via Wikimedia Commons and image(s) licensed by DermNet and used with permission, CC-BY-NC-ND 3.0 NZWatch associated Bootcamp video - Anxiety, Trauma, and Stress Disorders : Urge Disorders5f6a4b46-4246-4921-9ab2-f4e0dfa75398
Severe combined immunodeficiency (SCID) may be caused by mutations in {{c1::RAG}} which leads to VDJ recombination defectsWatch associated Bootcamp video - Immunodeficiency Syndromes: SCID4c76a862-fb31-4797-b951-717bdb0e0695
Essential thrombocythemia is a myeloproliferative neoplasm with an increased number of {{c1::megakaryocytes::what cells}} in the bone marrowNormocellular marrow with marked proliferation of large to giant megakaryocytes: Photo credit: ©️ Dr. Jian-Hua Qiao, all rights reserved, via Flickr (used with permission)* Platelets also seen on peripheral blood smear Watch Myeloproliferative Neoplasms & Myelodysplastic SyndromesWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Polycythemia Vera and Essential Thrombocythemia85cc1ecc-b50f-4d51-9bbc-33acf647445c
Exposure to benzene (plastics, rubber tire industries) is a risk factor for {{c1::acute myeloid leukemia::leukemia}}Also ionizing radiation and chemotherapy* Also ionizing radiation and chemotherapy Watch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Watch Acute Leukemias SOAPReview Acute Myelogenous Leukemia (AML)Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Myeloid Leukemia7de00e85-3e7a-4840-81c3-8f46c9f87e78
Acute {{c1::lymphoblastic}} leukemia presents with fever, bone pain, weakness and fatigueDue to infection, bone marrow expansion, and anemiaWatch Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), Hairy Cell Leukemia & Adult T cell LeukemiaWatch Acute Leukemias SOAPWatch Acute Lymphocytic Leukemia (ALL)Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Lymphoid Leukemiae8f28f61-8e77-48ba-bc6e-922b93ee4d55
Acute myeloid leukemia presents with {{c1::petechiae and ecchymoses::skin findings (2)}} due to thrombocytopeniaSecondary to functional pancytopenia, which is thrombocytopenia, anemia, and functional neutropenia despite leukocytosisWatch Acute Myeloid Leukemia (AML) & Chronic Myeloid Leukemia (CML)Watch Acute Leukemias SOAPReview Acute Myelogenous Leukemia (AML)Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Myeloid Leukemia37e35bc6-a089-484c-8999-0c1d03daa638
What co-infection can cause diffuse large B-cell lymphoma? {{c1::EBV & HIV::2}}Watch Non Hodgkin LymphomaWatch Non-Hodgkin Lymphoma SOAPReview Diffuse Large B Cell Lymphoma (DLBCL)Watch associated Bootcamp video - Adult Primary Brain Tumors : Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Positive-sense RNA Viruses : Secondary HIV-Associated Diseases Watch associated Bootcamp video - Leukemias and Lymphomas: Additional B-cell Non-Hodgkin Lymphomas231f6cf4-5f6e-40e9-a9b0-3acf64429f04
{{c1::Primary CNS}} lymphoma is a form of non-Hodgkin lymphoma that may present with headache, seizure, or behavioral changesUsually diffuse-large-B-cell typeWatch Non Hodgkin LymphomaWatch Primary Brain Tumors in Adults Watch Non-Hodgkin Lymphoma SOAP Watch Approach to HeadacheReview Diffuse Large B Cell Lymphoma (DLBCL) Review Primary CNS Lymphoma (PCNSL)Watch associated Bootcamp video - Adult Primary Brain Tumors: Primary Central Nervous System Lymphoma Watch associated Bootcamp video - Opportunistic Infections: Toxoplasmosis, Primary CNS Lymphoma, Cryptococcal Meningitis Watch associated Bootcamp video - DNA Viruses: Epstein-Barr Virus: Diagnostics and Management Watch associated Bootcamp video - Leukemias and Lymphomas: Additional B-cell Non-Hodgkin Lymphomas1ec863eb-f633-4406-8d3f-2be5a843bfd0
Waldenstrom macroglobulinemia may present with {{c1::cryoglobulinemia}}, which manifests as Raynaud phenomenon, urticaria, purpura, and tissue necrosisDue to precipitation of IgM pentamers at low temperaturesWatch Plasma Cell NeoplasmsWatch Plasma Cell Dyscrasias SOAPWatch associated Bootcamp video - Plasma Cell Dyscrasias and Myeloproliferative Disease: Additional Plasma Cell Dyscrasias2592bc58-4edc-413b-8730-e3bd64047c54
The skull, femur, and pelvic bones are most commonly affected in {{c1::Paget disease of bone::MSK disorder}}Photo credit: Jmarchn, CC BY-SA 4.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 4.0 (right)Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)d4da7d6b-e49f-4408-9fdc-ca7024c100b2
What MSK pathology presents as dark areas of radiolucency (early disease) and abnormally thick bone (late disease) on X-ray? {{c1::Paget disease of bone (osteitis deformans)}}Photo credit: Jmarchn, CC BY-SA 4.0, via Wikimedia Commons (left); AMBOSS, CC BY-SA 4.0 (right)Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteitis Deformans (Paget disease of the bone)04e63a0d-3d2c-4399-bb9f-84748a6e893e
Modifiable risk factors for osteoporosis and osteopenia include corticosteroids, {{c1::smoking}}, and heavy {{c1::alcohol}} useAlso low body weightWatch Osteoporosis & Paget Disease of BoneWatch Muscular DystrophiesWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteoporosis74379576-ea33-4c20-bca2-803aaaaec3f0
Chondrosarcomas, Ewing sarcomas, and osteosarcomas commonly metastasize to which location? {{c1::Lungs (hematogenously)}}Watch Malignant Bone TumorsWatch Pediatric Bone Tumors DDxWatch associated Bootcamp video - Primary Bone Tumors: Osteosarcoma Watch associated Bootcamp video - Chondrosarcoma Watch associated Bootcamp video - Ewing Sarcomac386c178-998a-4b35-9330-e62750ea8fd4
Mouth dropping, ptosis, thin distal forearms/hands, and a long narrow face are physical changes seen in {{c1::myotonic dystrophy::MSK disorder}}Long face due to temporal muscle wasting Photo credit: Sydney S. Gellis and Murray Feingold, Public domain, via Wikimedia Commons, modified by cropping and censoring Photo credit: Cacucci et al., CC BY 4.0, via Case Reports in Denistry, modified by cropping* long face due to temporal muscle wasting Watch Muscular DystrophiesWatch associated Bootcamp video - High Yield Genetic Disorders: Muscular Dystrophies Watch associated Bootcamp video - High Yield Genetic Disorders: Trinucleotide Repeat Expansion Diseasesb16271dc-1285-4d39-8ad2-c45a00f345ac
Which neuromuscular junction pathology is characterized by proximal upper extremity muscle weakness? {{c1::Both :) (MG > LEMS)::MG or LEMS}}- Proximal arm weakness at presentation is more common in MG, but shoulder weakness eventually develops in many LEMS patients per AMBOSS and UpToDate - LEMS frequently presents with proximal leg weakness - Important in distinguishing proximal muscle weakness involvement in Lambert-Eaton syndrome (difficulty walking / getting up from chair)Watch Myasthenia Gravis & Lambert Eaton Myasthenic SyndromeWatch associated Bootcamp video - Neuromuscular Junction (NMJ): Myasthenia Gravis533a4682-31bb-44fe-92e7-223595f19772
{{c1::Acute lymphoblastic leukemia}} is a childhood cancer that may present with bruising, petechiae, and mucosal bleeding due to {{c2::thrombocytopenia}}Photo credit: James Heilman, MD, CC BY-SA 4.0, via Wikimedia CommonsWatch Trisomy 21Watch associated Bootcamp video - Leukemias and Lymphomas: Acute Lymphoid Leukemia70200e30-efa4-4ee0-8110-18e982ab615c
Steroids cause {{c1::↑::↑↓}} production of RANK-L and {{c1::↓::↑↓}} production of osteoprotegerin- Leads to ↑ bone resorption - Due to decreased estrogen* dropped Osteoprotegerin case below steroid moon Watch Osteoporosis & Paget Disease of BoneWatch associated Bootcamp video - Non-Rheumatologic Diseases: Osteoporosisdae57f53-2091-4fe0-9348-ccdf85748fe8
Below is an ECG with {{c1::premature atrial complexes}}Photo credit: Michael Rosengarten BEng, MD.McGill, CC BY-SA 3.0, via Wikimedia Commons - This recording shows sinus rhythm with premature atrial complexes. The p wave can be seen deforming the T wave in the lead II rhythm strip. Note also that the atrial premature complexes reset the sinus node and hence there is no compensatory pause before the next sinus p wave. The QRS is deformed with a rsR' in V1 and a broad S in I with a duration of > 120 ms. diagnostic of aberrance with a right bundle branch morphology - The S1 Q3 and the right ward axis of the aberrant complexes suggest an additional left posterior fasicular block - Sinus rhythm with a heart rate of approx. 55–62/min (borderline bradycardia) - Normal heart axis (R > S in both I and aVF) - Both normal and deformed P waves can be seen. As the occurrence of P waves is variable, PR intervals are not consistent. Abnormal P waves are generally followed by narrow QRS complexes. Occasionally, there is aberrant conduction with broadening of QRS, as seen in the first beat in III - The fourth QRS complex in lead II represents an exemplary APB, preceded by a deformed P wave. Note that no full compensatory pause is present (the RR interval between the preceding and the following normal QRS complexes is less than twice the normal RR interval) - Diagnosis: atrial premature beatsWatch Narrow-Complex Tachycardia 1: Intro & pSVT SOAP Watch Approach to Palpitations & ArrythmiasWatch associated Bootcamp video - Bundle Branch Blocksea643240-9592-40c4-9296-88d198d6afc1
Is dermatomyositis associated with intramuscular inclusion bodies? {{c1::No}}- Intramuscular inclusion bodies are a hallmark finding in inclusion body myositis (IBM) - IBM is a distinct inflammatory myopathy characterized by progressive muscle weakness, and the presence of rimmed vacuoles seen on muscle biopsyWatch associated Bootcamp video - Rheumatologic Diseases: Polymyositis and Dermatomyositisb0aeb58b-cdd1-4a7d-a11d-a704ef29ff5d
What drug blocks production of T3 and T3 receptors (and is directly toxic to the thyroid gland)? {{c1::Amiodarone}}Also blocks conversion of T4 to T3Watch Hypothyroidism Other CausesWatch Hypothyroidism SOAPReview AmiodaroneWatch associated Bootcamp video - Thyroid : Hypothyroidism: Other Causes612ef8e4-2081-4424-af7e-e13a39ae9adb
N. meningitidis, sepsis, and septic shock all may cause bilateral {{c1::adrenal hemorrhage}}Watch Adrenal InsufficiencyWatch Adrenal Insufficiency SOAPWatch associated Bootcamp video - Gram Negative Diplococci: Neisseria Meningitidis Watch associated Bootcamp video - Infectious Neuropathology: Bacterial Meningoencephalitis92e3bc5f-ae5d-44d3-8521-2d4b2159aca1
Lubiprostone is a(n) {{c1::Cl-}} channel agonist that is used to treat constipationWatch Laxatives & Antidiarrheal Agents [Old Version]Watch LaxativesWatch associated Bootcamp video - Intestinal Pathology : Irritable Bowel Syndrome969349de-a59d-4471-820f-7aa14db81f1a
PCOS, early menarche, late menopause, nulliparity are ovulatory cycle-related risk factors for endometrial {{c1::hyperplasia/carcinoma}}Watch Abnormal Uterine Bleeding (AUB) & EndometriosisWatch Endometrial Hyperplasia & Cancer Watch Abnormal Uterine Bleeding DDxWatch associated Bootcamp video - Female Pathology: Adenomyosis, Endometrial Hyperplasia, and Asherman Syndrome2db6bd36-b2b8-4f05-a81a-6045cf8aac23
BRCA1/2 are {{c1::autosomal dominant::inheritance pattern}} tumor suppressor genes, thus family history is a risk factor for breast cancerWatch Breast CancerWatch associated Bootcamp video - Female Pathology: Breast Cancer Overview Watch associated Bootcamp video - Cellular Injury and Neoplasia: Oncogenes and Tumor Suppressor Genes Watch associated Bootcamp video - Principles of Oncology and Therapeutics: Oncogenes and Tumor Suppressor Genes82f8235c-963b-41eb-b0c5-5142ba646ebb
Peptostreptococcus, Fusobacterium, Prevotella, and Bacteroides fragilis are associated with {{c1::decubitus}} ulcersAKA pressure ulcers2ed1e8f3-d305-407a-88ab-e18b0e406646
What type of study analysis uses the data of all patients who initially enrolled in the study, including drop-outs? {{c1::Intention-to-treat analysis}}- A method of statistical analysis in which the initial randomized treatment groups are compared regardless of the treatment they eventually receive, i.e., regardless of medication nonadherence or refusal of allocated treatment. This method preserves the balance between the two groups created by randomization and reduces selection bias - Compare with per-protocol analysis, which includes only those patients who strictly adhered to a research protocol (i.e., excluding all nonadherent patients from analysis)Watch Randomized Controlled Trials98130541-2fa2-411b-9366-17df2a2c25db
What equation is used to calculate specificity using the table below? {{c1::Specificity = TN / (TN + FP)}}Alternatively, specificity = (1 - false positive rate)Watch Sensitivity & SpecificityWatch associated Bootcamp video - Diagnostic Tests: Sensitivity and Specificty0b56ca12-8d12-4d1c-be27-171dad6cadf1
What is the likely diagnosis in an infant with history of recurrent bacterial infections and labs showing persistent neutropenia & monocytosis? {{c1::Severe congenital neutropenia}}- Defined as ANC <200; bone marrow biopsy demonstrates cellular arrest at promyelocyte/myelocte stage, as well as signs of apoptosis - Treat with daily G-CSF, curative approach is hematopoietic stem cell transplant - Caused by mutation in neutrophil elastase gene57472657-1b7f-417e-8ed5-6762e3452304
What is the treatment of Salmonella gastroenteritis in low-risk patients? {{c1::Supportive care}}- High-risk: >10 episodes of diarrhea per day, immunocompromised, sickle cell disease, cardiovascular disease, age <1 or age >50 - Use of antibiotics is associated with prolonged carrier state & prolonged excretionWatch FluoroquinolonesWatch Salmonella: Intro to Salmonella & NTSWatch associated Bootcamp video - Non-Lactose Fermenting Gram Negative Bacilli: Salmonella Typhi7b549c9d-e951-4dc1-b95a-0b116f1a3b36
SURFACE ECTODERM: CLEAN surface W/ S_AP {{c1::Canal (anal)}} {{c2::Lens}} {{c3::Epidermis}} {{c4::Adenohypophyis}} {{c5::Nipple (mam. gland)}} {{c6::Sweat gland }} {{c7::Auditory organs}} {{c8::Parotid gland}}
NEURAL TUBE: a tube of NASPOREN {{c1::Neural Tube }} {{c2::Astrocytes}} {{c3::Spinal Cord}} {{c4::Pineal Gland}} {{c5::Oligodendrocytes }} {{c6::Retina}} {{c7::Ependymal cells}} {{c8::Neurohypophysis}}
NEURAL CREST: SPAMS MOTEL w/ Crest Toothpaste {{c1::Schwann cells }} {{c2::PNS}} {{c3::Adrenal medulla }} {{c4::Myenteric (Auerbach) plexus }} {{c5::Spiral membrane }} {{c6::Melanocytes}} {{c7::Odontoblasts}} {{c8::Thyroid C-cells }} {{c9::Endocardial cushion}} {{c10::Laryngeal Cartilage}}