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U-World > 11 > Flashcards

11 Flashcards

1
Q

Androgen deprivation therapy for prostate cancer

A

surgical orchiectomy or pharmacological suppression can slow disease and relieve bone pain

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2
Q

Trisomy 18 Edwards

A

meiotic nondisjunction (oocyte division error occurs prior to ovulation and fertilization and increases with maternal age >35)

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3
Q

Interalveolar septa destruction is seen in

A 
AAT deficiency (Autosomal COdominant disorder)
Walls contain large amounts of ELASTIN which is destroyed by uncheck neutrophil elastase (and other proteolytic enzymes)
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4
Q

Diagnosis of ATT def.

A

Serum ATT level followed by confirmatory genetic testing

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5
Q

Smoking plays a synergistic role in ATT def how?

A

inducing lung inflammation and permanently inactivating ATT through oxidation of crucial methionine residue

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6
Q

ATT liver biopsy

A

Intracellular globules of unsecreted ATT within periportal hepatocytes. PAS+ (reddish-pink) and resist digestion by diastase (an enzyme that breaks down glycogen)

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7
Q

Bronchial hyperactivity

A

Asthma

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8
Q

Intraalveolar substance accumulation

A

alveolar proteinosis

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9
Q

Produced by variety of immune cells, serves as leukotriene and lipoxin precursor. Causes neutrophil and macrophage chemotaxis and neutrophil degranulation

A

5-hydroxyicosatetraenoic acid (5-HETE)

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10
Q

L-selectin

A

an adhesion molecule that aids entry of lymphocytes from the blood into lymphoid tissue and margination of neutrophils during inflammation process

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11
Q

Immobilization (venous stasis) and recent surgery (inflammation induces hypercoaguable state)

A

PE risk factors (deep veins of pelvis and lower extremities)

PE risk as high as 50% w/ ortho surgeries

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12
Q

PE–>V/Q mismatch–>ischemic injury/ inflammation–> surfactant deficiency and atelectasis in surrounding lung regions–> high volume of deoxygenated blood transversing poorly ventilated lung regions–> R-L intrapulmonary shunting–>hypoxemia

A

PE pathology

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13
Q

Diffusion impairment

A

pulmonary fibrosis, hyaline membrane disease

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14
Q

hypoxemia with a normal alveolar to arterial gradient (both are decreased)

A

hypoventilation

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15
Q

Systemic inflammatory response

A

IL-1, TNF-alpha and IL-6

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16
Q

produced by TH2 T-helper cells. Stimulates growth of B cells and increases the number of TH2 cells at sight of inflammation

A

IL-4

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17
Q

Anti-inflammatory cytokine produced by macrophages and TH2 helper cells. Limits the production of pro-inflammatory cytokines (INF-gamma, IL-2, IL-3, TNF-alpha)

A

IL-10

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18
Q

INF-gamma is produced by ______ and serves to recruit leukocytes and activate phagocytosis

A

activated T-cells

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19
Q

What is required before proteins are allowed to enter proteasome

A

attachment of 4 or more ubiquitin monomers

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20
Q

Mutations in what are associated with autosomal recessive forms of Parkinson’s disease and have early onset (before 50)

A

Parkin, PINK1, DJ-1

Together code for a protein complex that promotes degradation of misfolded proteins via ubiquitin-proteasome system

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21
Q

Histone acetylation promotes formation of Con

A

euchromatin

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22
Q

Conjugation of bilirubin with glucuronic acid occurs where in hepatocytes

A

ER

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23
Q

TB and HIV

A

HIPPA exception of disclosure of serious communicable disease (nationally reported)
Otherwise written>verbal by patient to release info to others (like husband)

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24
Q

Fever, flank pain, pyuria and possible white cells casts (indicating RENAL origin of pyuria)

A

acute pyelonephritis

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25
Q

Accumulation within RENAL CORTEX, causing ATN. Proximal tubular vacuolar degeneration is usually seen

A

Aminoglycoside antibiotics

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26
Q

Sterile pyruia. Ongoing exposure to offending drug. Peripheral eosinophilia and eosinophiluria help confirm dx

A

Hypersensitivity interstitial nephritis

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27
Q

Muddy brown granular and epithelial cell casts free of tubular epithelial cells in the urine

A

Ischemic tubular necrosis

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28
Q

Chronic tubulointerstitial nephritis (interstitial fibrosis and tubular atrophy seen on light microscopy) —> renal failure

A

Chronic lead intoxication

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29
Q

chronic vascular malformation appearing as soft, well-demarcated, red or blue nodules.

A

Angiomas

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30
Q

Capillary hemangiomas vs cavernous hemangioma

A

Capillary: small and superficial (infantile)
Cavernous: Lg. and more likely to involve deep structures

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31
Q

Small tan or brown macules most often see on sun-exposed skin of middle aged or elderly

A

Lentigines

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32
Q

Indicator of leukocytoclastic vasculitis

A

palpable purpura

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33
Q

Decreased by: decreases in GFR or increases in RPF

A

Filtration fraction

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34
Q

Cricothyrotomy requires an incision to be made through the following layers:

A

1) Skin
2) Superficial cervical fascia (including subQ fat and platysma muscle)
3) Investing and pretracheal layers layers of the deep cervical fascia
4) Cricothyroid membrane

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35
Q

Thyroid cartilage is at the level of

A

C6

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36
Q

Deep cervical fascia is composed of three layers:

A

investing, pretracheal and prevertebral

prevertebral is not penetrated in cricothyrotomy

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37
Q

Retropharyngeal space infection

Buccopharyngeal fascia (extends from carotid sheath to invest the pharyngeal constrictor muscles) lies anterior to prevertebral fascia. This forms retropharyngeal space

A

can extend directly into the superior mediastinum and cause acute necrotizing mediastinitis

38
Q

Metabolic imaging scan (PET scan) that shows decreased metabolic activity in the striatum (caudate and putamen)

A

Huntingtons (AD) disease

Imaging studies with show atrophy of the caudate

39
Q

Caudate and putamen

A

striatum

40
Q

Lentiform nucleus

A

putamen and globus palladius (separated from thalamus by POSTERIOR internal capsule)

41
Q

Carries corticospinal motor and somatic sensory; also auditory and visual fibers

A

Posterior Limb of internal capsule

MOST IMPORTANT FOR TEST

42
Q

Carries corticobulbar fibers

A

Genu (knee) of internal capsule

43
Q

Separates the caudate from the GP and putamen (striatum)

A

carries a portion of thalaocortical fibers (anterior limb of internal capsule)

44
Q

role in the limbic system (emotion) as well as in the coordination of autonomic functions, particularly of the cardiac system

A

insular cortex (insula)

45
Q

Amatoxins (source)

A 
Amanita phalloides (death cap mushroom)
-symptoms start within 6-24 hours of ingestion: abdominal pain, vomiting and severe chorea like diarrhea (may contain blood and mucus)
46
Q

Amatoxins (MOA)

A

Bind DNA-dependent RNA polymerase type II and halt mRNA synthesis–> apoptosis. GI and PCT also affected

47
Q

Amatoxins can cause acute hepatic and renal failure. How do you test for this?

A

Alpha-amanitin urine test

48
Q

potent toxin that inhibits protein synthesis by cleaving the rRNA component of the eukaryotic 60s ribosome subunit

A

RICIN (castor oil plain Ricinus communis)

lol shaw lecture*

49
Q

Only function of RNA pol I

A

transcribe the majority of eukaryotic ribosomal RNA (rRNA) components.

50
Q

Transcribes tRNA, 5 S ribosomal RNA and other small RNA molecues

A

RNA pol III (eukaryotic)

51
Q

Continuous murmur heard best in the left infraclavicular region with maximal intensity at S2

A

PDA
(can be asymptomatic and detected incidentally during routine auscultation). Occurs most commonly in patients born prematurely and those with cyanotic congenital heart disease.

52
Q

Mid systolic click and a mid-to-late systolic murmur.

A

Mitral valve prolapse

53
Q

Lutembacher syndrome (RARE) prob will never be an answer

A

A small atrial septal defect can cause a continuous murmur (rare), and typically does so only when associated with mitral valve obstruction due to elevated pressure gradient across the atria

54
Q

Histology of MS neurological complications (sclerotic plaques throughout white matter)

A

1) Demyelination with relative preservation of axons
2) Accumulation of lipid-laden macrophages (containing products of myelin breakdown)
3) ASTROCYTOSIS (proliferation in response to injury)
4) Infiltration by lymphocytes and mononuclear cells

55
Q

Loss of axons, neurons, and oligodendrocytes (the myelin-producing cells of the central nervous system) occurs over time in chronic multiple sclerosis plaques

A

MS

Of note: Internuclear opthaloplegia would not show this…rather just loss of myelination (ACUTE)

56
Q

PTSD first line Tx

A

CBT, SSRI, SNRI

57
Q

Two most important congenital syndromes for QT prolongation

A

1) Romano-Ward Syndrome

2) Jervell and Lange-Nielsen syndrome

58
Q

Cause of congenital QT syndrome (be smart even tho you don’t know disease you know heart phys)

A

Mutations in a K+ channel protein that contributes to delayed rectifier current (Ik) of the cardiac action potential

59
Q

A patient with a high probability of having a disease will have a _______ NPV if a test is negative. Vs a person with a low probability of a disease will have a ____ NPV if test is negative.

A

1) low

2 high

60
Q

Exposure to ionizing radiation (X-Ray/gamma rays) causes DOUBLE STRAND BREAK. How are they fixed?

A

The fractured ends can be joined by nonhomologous end joining

61
Q

Incorrect base substitution occurs during normal DNA replication. Can result in mutations if they are not correct. How does the body handle this?

A

DNA mismatch repair (PROKARYOTES hypermethylation of parent strand, which helps to identify non-mutated strand)

62
Q

Deamination of DNA bases (cytosine to uracil or adenine to hypoxanthine) can occur spontaneously or secondary to chemical exposure. How does your body deal?

A

Base excision repair. Recognized by specific glycosylases without disruption of phosphodiester backbone. Removed by specific endonucleases and replaced by correct base by DNA pol.

63
Q

Lecithinase (phospholipase C)

A

alpha toxin of clostridium perfringens. Degrades lecithin, a component of cellular phospholipid membranes–>membrane destruction and cell death with necrosis and hemolysis

64
Q

why does C. perfringens cause gas green?

A

uses carbs for energy. its rapid metabolism of muscle tissue carbohydrates produces lots of gas

65
Q

How does excess copper (wilsons disease) cause injury?

A

binding to sulfhydryl groups of cellular proteins

66
Q

Edetate calcium disodium

A

CaNa2EDTA = lead poisoning antidote via increased urinary excretion

67
Q

Iron overdose tx

A

Deferoxamine

68
Q

how does deferoxamine work?

A

chelating agent that binds ferric iron to convert it to ferrioxamine (water soluble form that can be secreted in urine)

69
Q

Inheritance of achondroplasia

A 
Sporadic mutation (85%)
AD in (15%)

GAIN OF FUNCTION MUTATION (constitutive activation of FGFR3)- inhibits chondrocyte proliferation

70
Q

Knee joint positively birefringment

A

involved in > 50% of CPPD/pseudogout

71
Q

Deposition of calcium hydroxyapatite crystals in periarticular soft tissues (esp. tendons) like rotator cuff MC

A

Calcific tendonitis

72
Q

Amniotic fluid embolism

A

HYPOTENSION and cardiogenic shock with DIC

73
Q

Most common cause of DIC in pregnancy

A

Placental abruption (hypertension)

74
Q

Rabies vaccine

A

various rhabdovirus strains grown in tissue culture inactivated by beta-propiolactone

75
Q

Methemoglobinemia (gray or blue colored skin, SOB, chocolate colored blood) Tx

A

Methylene blue- acts as an artificial electron transporter for reduction of methemoglobin through NADH pathway

76
Q

Most common sources of arsenic poisoning?

A

Insectacides and contaminated (well) water

77
Q

How do you treat acute arsenic poisoning?

A

Dimercaprol (chelating agent)

78
Q

Cyanide poisoning (cherry red skin, ab pain, vomiting) tx

A

Hydroxycobalamin (vit. B12 precursor) binds to intracellular cyanide forming cyanocobalamin, which can be easily excreted in the urine

79
Q

Sudden deceleration and direction change that involves VALGUS stress on the knee

A

ACL injury

80
Q

ACL is crucial for knee stabilization. Where does it attach?

A

Anterior intercondylar area (fossa)

81
Q

Overuse injury of the secondary ossification center (apophysis) of the tibial tubercle. Adolescent athletes. Pain and swelling at the tibial tubercle (insertion point of patellar ligament)

A

Osgood-Schlatter disease

82
Q 
Gram positive cocci
Component of normal colonic flora
Bile resistant and can grow in hypertonic saline
Gamma-hemolytic (no hemolysis on agar)
Catalase negative
Pyrrolidonly arylamidase-positive
A

Enterococcus

83
Q

Risk factor for enterococcal endocarditis (30% of nosocomial endocarditis)

A

Recent manipulation in elderly men MC but anyone:
Recent GU (eg. cystoscopy) MC
Gastrointestinal (colonoscopy)
Obstetric procedures

84
Q

Acts as antagonist in the presence of full opioid agonist and precipitate withdraw in opioid-tolerant patients with chronic pain

A

Buprenorphine is a PARTIAL opioid agonist that binds with high affinity but has low intrinsic activity

85
Q

Cryptogenic stroke (ischemic stoke from an obscure or unknown reason) at an early age. REQUIRES echocardiogram to identify right to left shunts. 2 MC?

A

ASD and PFO (patent foramen ovale-25% of healthy people)…watch out for that valsava (increased R. atrium pressure–>paradoxical emboli)

86
Q

incomplete development of the interventricular foramen leads to

A

VSD

87
Q

Preferred agents for rate control in A-fib with rapid ventricular response (rate-control in general)

A

CCBs and beta-blockers > digoxin

88
Q

Why is rapid ventricular rate a serious condition

A

inadequate diastolic filling time –> poor cardiac output and backup of blood in lungs (HF)

89
Q

Atrial myoxoma (mid-diastolic rumbling murmur heard best at apex, dyspnea, syncope) histology

A

scattered cells within a mucopolysaccharide stroma, abnormal blood vessels, and hemorrhaging

90
Q

Myoxomas produce large amounts of what interleukin leading to constitutional symptoms (weight loss, fever)

A

IL-6

U-World (16 decks)

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