Adam Shared "Boards" - 47 Picmonics
With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing. Whether you're studying for your classes or getting ready for a big exam, we're here to help.
Boards
Streptomycin
- Aminoglycoside drug class
- Interferes with 30S component of ribosome
- Mycobacterium tuberculosis (2nd line)
- IV only
- Resistance in mycobacterium is via ribosomal alterations (as well as other aminoglycoside mechanisms of resistance)
- Side Effects
- Tinnitus
- Vertigo
- Ataxia
- Nephrotoxicity especially with aminoglycosides
Dapsone
- MOA: Similar to sulfonamides, but structurally distinct agent (Inhibit dihydropteroate synthase)
- Indications
- Leprosy (lepromatous and tuberculoid)
- Pneumocystis jirovecii prophylaxis
- Dermatitis herpetiformis (celiac disease)
- Side effects
- Hemolysis if G6PD deficient
- Fever, rash and methemogloinemia
- Pigment changes
Daptomycin
- MOA: Lipopeptide that disrupts cell membrane of gram â cocci; Bactericidal
- Indications
- S aureus skin infections (especially MRSA), bacteremia, endocarditis, VRE
- Not used for pneumonia (avidly binds to and is inactivated by surfactant)
- Depolarizes cellular membrane by creating transmembrane channels
- Side effects
- Myopathy
- Rhabdomyolysis
- CPK elevation
Simeprevir
- HCV protease inhibitor, preventing viral replication
- Chronic HCV in combination with ledipasvir (NS5A inhibitor)
- Do not use as monotherapy
- Side Effects
- Photosensitivity reactions
- Rash
Menkes disease
- X-linked recessive
- Connective tissue disease
- Impaired copper absorption and transport due to defective Menkes protein (ATP7A)
- Decreased activity of lysyl oxidase (copper is a necessary cofactor); leads to defective collagen cross linking
- Presentation
- Brittle, "Kinky" hair
- Growth retardation
- Hypotonia
- May have silver hair
- Sideroblastic anemia
- Skin depigmentation
- Neurologic dysfunction (eg, ataxia, peripheral neuropathy)
- Osteoporosis
Scombroid
- Source
- Spoiled dark-meat fish such as tuna, mahimahi, mackerel, and bonito
- Mechanism
- Bacterial histidine decarboxylase converts histidine to histamine
- Frequently misdiagnosed as fish allergy
- Symptoms
- Mimics anaphylaxis
- Acute burning sensation of mouth
- Facial flushing
- Erythema
- Urticaria
- Pruritis
- May progress to bronchospasm, angioedema, hypotension
- Peppery taste
- Treatment
- Antihistamines. Albuterol and epinephrine if needed
- Symptoms: throbbing headache, palpitations, abdominal cramps , diarrhea
- These typically begin 10-30 minutes after ingesting the fish, and are self-limited
- Patients sometimes describe a bitter taste, but this is not always present
- Physical findings may include skin erythema, wheezing, tachycardia and hypotension
Hypophosphatemic Rickets
- Vitamin Dâresistant rickets
- Phosphate wasting at proximal tubule
- Rickets-like presentation
- Can be secondary to Proximal renal tubular acidosis (type 2) which can be caused by Fanconi syndrome
- Can be primary (X linked dominant)
Systemic 1° Carnitine Deficiency
- Inherited defect in transport of LCFAs into the mitochondria leads to toxic accumulation
- Weakness
- Hypotonia
- Hypoketotic
- Hypoglycemia
Medium chain acyl-CoA dehydrogenase deficiency
- Autosomal recessive disorder of fatty acid oxidation
- Decreased ability to break down fatty acids into acetyl-CoA
- Leads to accumulation of 8- to 10-carbon fatty acyl carnitines in the blood and hypoketotic hypoglycemia
- May present in infancy or early childhood
- Vomiting
- Lethargy
- Seizures
- Coma
- Liver dysfunction
- Minor illness can lead to sudden death
- Treat by avoiding fasting
- Patient is asymptomatic until fasting occurs
IIaâFamilial hypercholesterolemia
- Autosomal dominant
- Absent or defective LDL receptors
- Increased LDL, cholesterol
- Heterozygotes (1:500) have cholesterol â 300mg/dL; homozygotes (very rare) have cholesterol â 700+ mg/dL
- Accelerated atherosclerosis (may have MI before age 20)
- Tendon (Achilles) xanthomas
- Corneal arcus
- Defective ApoB-100
- Xanthelasmas
- Although other body parts have LDL recptors, 70% of LDL is cleared by the liver
- IIb - Familial hypercholesterolemia
- In addition to cholesterol and LDL increase, there is a VLDL increase
IVâHypertriglyceridemia
- Autosomal dominant
- Hepatic overproduction of VLDL
- Increased VLDL, TG
- Hypertriglyceridemia (> 1000 mg/dL) can cause acute pancreatitis because the binding capacity of albumin becomes overwhelmed
- Coronary disease
- ApoA-V
Ranolazine
- Inhibits the late phase of sodium current thereby reducing diastolic wall tension and oxygen consumption
- Indication: Angina refractory to other medical therapies
- SE: Constipation, dizziness, headache, nausea, QT prolongation.
- Does not affect heart rate or contractility
Laron syndrome (dwarfism)
- Defective growth hormone receptors
- Decreased linear growth
- Increased GH, decreased IGF-1
- Clinical Features
- Short height
- Small head circumference
- Characteristic facies with saddle nose and prominent forehead
- Delayed skeletal maturation
- Small genitalia
Glucagonoma
- Tumor of pancreatic Îą cells
- Overproduction of glucagon
- Dermatitis (necrolytic migratory erythema), typically affects the groin mostly (but also face/extremities)
- Elevated, painful, pruritic, coalesces to form large lesion with central clearing and bronze colored induration
- Blistering and scaling
- Diabetes (hyperglycemia)
- Easily controlled with oral agents & diet, Usually does not require insulin
- DVT
- Declining weight
- Depression
- Anemia
- Glossitis, cheilitis, blepharitis
- MEN 1 Association
- Gastrointestinal symptoms: Diarrhea, anorexia, abdominal pain, or occasional constipation
- Neuropsychiatric (eg, ataxia, dementia, proximal muscle weakness)
- Treatment
- Octreotide
- Surgery
- Diagnosis
- Hyperglycemia with elevated glucagon >500 pg/ml
- Abdominal imaging (computed tomography or magnetic resonance imaging) to localize tumor &/or metastases
- Normocytic, normochromic anemia due to likely anemia of chronic disease or glucagon directly affecting erythropoiesis
- GLUCAGON LEVELS reach >500pg/mL NOT GLUCOSE the diabetes is mild usually
- Most glucagonomas are malignant and have metasta sis, mainly in the liver, at the time of diagnosis
- Some of its clinical manifestations are due to the secretion of other peptides, such as VIP, calcitonin, and GLP1
Somatostatinoma
- Tumor of pancreatic δ cells
- Overproduction of somatostatin
- Decreased secretion of secretin, cholecystokinin, glucagon, insulin, gastrin
- Symptoms
- Diabetes/glucose intolerance
- Steatorrhea
- Gallstones because somatostatin decreases CCK secretion (decreased gallbladder contraction)
- Can be hyperglycemia or hypoglycemic
- Achlorhydria (due to inhibition of gastrin)
- Inhibiting GI motility
- Treatment
- Surgical resection
- Somatostatin analogs (eg, octreotide) for symptom control
Salivary gland tumors
- All Three
- Most commonly in the parotid gland
- Facial pain or paralysis suggests malignant involvement of CN VII
- The facial nerve runs through the parotid gland
- Pleomorphic adenoma
- Benign mixed tumor which rarely transforms to a carcinoma (facial nerve invasion/pain)
- Composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively
- Mobile, painless, circumscribed
- Most common salivary gland tumor
- Mucoepidermoid carcinoma
- Most common malignant tumor
- Mucinous and squamous components
- Often involves the facial nerve
- Warthin tumor
- Alternative name: papillary cystadenoma lymphomatosum
- Benign cystic tumor with germinal centers
- Lymph node like stroma
- Typically found in smokers. Bilateral in 10%; malignant in 10%.
- Second most common
- Almost always arises inthe parotid
Esophageal Carcinoma
- Both
- Presents with progressive dysphagia (first solids, then liquids)
- Weight loss
- Pain; hematemesis
- Poor prognosis; presents late
- Lymph node spread: Upper 1/3 (cervical), Middle 1/3 (mediastinal and tracheobronchial), Lower 1/3 (celiac and gastric)
- Can cause pseudoachalasia
- Endoscopic evaluation can differentia te between achalasia and pseudoachalasia
- Tumor metastasis (eg, mediastinal nodes) or local involvement may give a radiologic appearance similar to that seen with widened mediastinum
- Definitive diagnosis of esophageal cancer requires esophageal endoscopy with biopsy
- Young, low-risk patients with undetermined esophageal symptoms may start with barium esophagram
- Surgery for definitive cure is advised for patients with limited-stage disease
- Adenocarcinoma
- Lower 1/3
- Risk factors: Chronic GERD, Barrett esophagus, obesity, smoking, achalasia
- More common in America
- Arises from glandular tissue
- Ulcerative/exophytic
- Distal esophagus (from barretts)
- Squamous Cell Carcinoma
- Upper 2/3
- Risk factors: Alcohol, hot liquids, caustic strictures, smoking, achalasia, esophageal web (Plummer-vinson), Injury (lye ingestion)
- N-nitroso containing foods, betel nuts
- More common worldwide
- May have hoarse voice (Recurrent laryngeal) and cough (tracheal involvement)
- Can cause GI bleed and iron deficiency anemia
- Histology: Eosinophilic cytoplasm, keratin pearls, intercellular bridging
- Plaque like thickening, may become ulcerated
- Usually occurs in men over 50
- Retrosternal discomfort/burning
- U. In the USA its mostly due to alcohol and smoking
- Caustic injestion is another cause
- Arises anywhere in the esophagus
Fludrocortisone
- Synthetic analog of aldosterone with little glucocorticoid effects
- Mineralocorticoid replacement in 1° adrenal insufficiency
- Side Effects
- Similar to glucocorticoids
- Edema
- Exacerbation of heart failure
- Hyperpigmentation
Cinacalcet
- Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ ÂÂcausing a decrease in PTH
- Indication: 1° or 2° (secondary in dialysis patients) hyperparathyroidism
- Side Effects
- Hypocalcemia
Secondary and tertiary hyperparathyroidism
- Secondary
- 2° hyperplasia due to decreased Ca2+ absorption and/or increased PO4 3â
- Chronic renal disease (causes hypovitaminosis D Âdecreased Ca2+ absorption)
- Hypocalcemia, hyperphosphatemia
- Increased ALP and PTH
- Renal osteodystrophy
- Tertiary
- Refractory (autonomous) hyperparathyroidism
- Result of chronic renal disease
- Highly increased PTH, increased calcium
- Requires surgery
- Bone pain and an elevated bone-specific alkaline phosphatase (due to high bone turnover)
