PBL Cases

Which bilirubin give you yellowish skin?

Unconjugated bilirubin causes jaundice, leading to yellowish skin.

Direct and Indirect bilirubin

Direct: conjugated (in urine)

Indirect: unconjugated (jaundice)

Bile salts digest fat but accumulation causes ________

itching (cholestatic pruritus)

Pemphigus vs Pemphigoid

Pemphigus: Intraepithelial (within epidermis) (nikolsky sign) (mortality)

Pemphigoid: Subepithelial (beneath epithelium)

Which viral hepatitis is never chronic?

Hepatitis A

Time for acute and chronic hepatitis

Acute is less than 6 month

Chronic more than 6 month

3 stages of Hep B

Prodromal: 3 to 10 days, 

Icteric: Dark urine, light color stool, jaundice, pale color stool

Convalescent: 

Acholic Stool

Light color pale stool in hepatitis

HBsAg vs HBsAb vs HBcAb

Active Hep B

Vaccinated and immune to Hep B (appear last)

Antibody to Hep B

Urobilinogen is excreted by 

feces (gut)

Murphy’s Sign

Deep palpation in right upper abdomen causes pt to stop breathing due to sharp pain

Indicates cholecystitis (gall bladder)

SSYC culture

Salmonella, Shigella, Yersinia, Campylobacter

If you have Anti-HAV IgG but not IgM, what does that mean?

Previous infection of HAV

Anti-HBs negative

Anti-HBc IgM positive

HBV DNA positive

HBsAg positive

No immunity yet

Early infection

Virus actively replicating

Active infection

Window period

Antigen is not present

Antibody not yet made

Hepatitis B vaccine is made form _______

HBsAg

Antibiotics safe in hepatitis

Antibiotics high risk in hepatitis

Beta-lactams, cephalosporins, Aminoglycosides, Macrolides (azithromycin)

Tetracycline, Erythromycin, Fluoroquinolones

Serum concentration of ______ mg /L of tylenol will require treatment of antidote

150

Trigeminal neuralgia suppresses what artery?

superior cerebellar artery

Glasgow Coma Scale

EVM

Eye opening

Verbal

Motor

Etomidate and Succinylcholine

Rapid sedative-hypnotic agent and Short acting muscle relaxant

Dopamine on blood pressure

Low to intermediate dose: Cause vasodilation and decrease BP

High dose: Vasoconstriction and increase BP

N-acetylcystine

Treat acetaminophen overdose

Piperacillin/Tazobactam

Levofloxacin

Extended spectrum penicillin and beta-lactamse inhibitor

Levofloxacin: Fluroquinolone on DNA gyrase

Vancomycin

Glycopeptide

Inhibit synthesis of cell wall

Clindamycin MOA

Bacterial protein synthesis of 50S

Alpha 1 Antitrypsin

Inhibit elastase (elastase breakdown lung tissue)

What is FFP

Fresh frozen plasma

Increase INR

What is the toxic dose of acetaminophen in adult?

4000 mg/day

Lactulose

Removes ammonia from blood

Why did the pt get cerebral edema from acetaminophen toxicity?

High ammonia caused astrocyte swelling

Fluid shifts and increased intracranial pressure

What is torticollis?

Neck muscles are tight causing head to tilt to one side and chin point other

Auer Rods are in what disease?

Acute Myeloid Leukemia

Which bone marrow cancer causes DIC

Acute Myeloid Leukemia

Myeloperoxidase stain for what disease?

Acute myeloid leukemia

Cytarabine

Idarubicin

Inhibit DNA polymerase kills rapidly dividing myeloblasts

Induces DNA breaks apoptosis of leukemic cells

Philidelphia chromosome is associated with what blood cancer

Chronic Myeloid Leukemia

9 and 11

Prostate cancer usually spread to ______ 

bone

Check calcium level to see bone metastasis

What is adenocarcinoma?

cancer made of cells from glands

Goserelin is a GnRH _______

Flutamide is a anti-________ drug

agonist, androgen

Used to treat prostate cancer

Raise testosterone at first but then shut down pituitary becuase the GnRH receptor desensitizes and stops releasing of LH.

Without LH, testes don’t make testosterone

Condyloma acuminatum is caused by which HPV virus

6 and 11

16 and 18 cause most cervical cancer

______ differentiated cells are more aggressive

Poorly

What is brachytherapy

Internal radiation. Places radioactive source right next to tumor inside so higher dose can be given

How does chemotherapy help with radiation?

It enhances the effectiveness of radiation by sensitizing cancer cells to the effects of radiation.

Koilocyte is a squamous epithelial cell showing changes caused by _______ infection

HPV

Tamoxifen

Estrogen receptor modulator

Blocks estrogen from binding to breast cancer cells

Stop growing or dividing

Anastrozole is a _______ inhibitor

aromatase

Stops body from making estrogen from other hormones

Stops breast cancer cells from growing

HER2 is a protein on breast cancer cells

HER2 positive tumors are grow ______ and more _____

They are treated with ________

Grow faster and more aggressive

Trastuzumab (Herceptin) block HER2 signaling

4 types of lung cancer

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

Small cell lung cancer

Adenocarcinoma: most common and in EGFR

Squamous cell carcinoma: most common in smoker

Large cell carcinoma: rare, fast growing

Small cell lung cancer: Most dangerous, Very aggressive and fast growing (strongly associated with smoking)

Which clotting factor have the shortest half life?

Factor VII

napqi

Active toxic metabolite of acetaminophen

Sentinel lymph nodes

Node right beside cancer

Separation between pemphigus vs pemphigoid

Pemphigus: Suprabasilar separation

Pemphigoid: Sub basilar separation

What is the primary infection of varicella-zoster virus

What is the secondary

Vericella (chickenpox)

Herpes zoster (shingles)