11 Flashcards
Androgen deprivation therapy for prostate cancer
surgical orchiectomy or pharmacological suppression can slow disease and relieve bone pain
Trisomy 18 Edwards
meiotic nondisjunction (oocyte division error occurs prior to ovulation and fertilization and increases with maternal age >35)
Interalveolar septa destruction is seen in
AAT deficiency (Autosomal COdominant disorder) Walls contain large amounts of ELASTIN which is destroyed by uncheck neutrophil elastase (and other proteolytic enzymes)
Diagnosis of ATT def.
Serum ATT level followed by confirmatory genetic testing
Smoking plays a synergistic role in ATT def how?
inducing lung inflammation and permanently inactivating ATT through oxidation of crucial methionine residue
ATT liver biopsy
Intracellular globules of unsecreted ATT within periportal hepatocytes. PAS+ (reddish-pink) and resist digestion by diastase (an enzyme that breaks down glycogen)
Bronchial hyperactivity
Asthma
Intraalveolar substance accumulation
alveolar proteinosis
Produced by variety of immune cells, serves as leukotriene and lipoxin precursor. Causes neutrophil and macrophage chemotaxis and neutrophil degranulation
5-hydroxyicosatetraenoic acid (5-HETE)
L-selectin
an adhesion molecule that aids entry of lymphocytes from the blood into lymphoid tissue and margination of neutrophils during inflammation process
Immobilization (venous stasis) and recent surgery (inflammation induces hypercoaguable state)
PE risk factors (deep veins of pelvis and lower extremities)
PE risk as high as 50% w/ ortho surgeries
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
PE pathology
Diffusion impairment
pulmonary fibrosis, hyaline membrane disease
hypoxemia with a normal alveolar to arterial gradient (both are decreased)
hypoventilation
Systemic inflammatory response
IL-1, TNF-alpha and IL-6
produced by TH2 T-helper cells. Stimulates growth of B cells and increases the number of TH2 cells at sight of inflammation
IL-4
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)
IL-10
INF-gamma is produced by ______ and serves to recruit leukocytes and activate phagocytosis
activated T-cells
What is required before proteins are allowed to enter proteasome
attachment of 4 or more ubiquitin monomers
Mutations in what are associated with autosomal recessive forms of Parkinson’s disease and have early onset (before 50)
Parkin, PINK1, DJ-1
Together code for a protein complex that promotes degradation of misfolded proteins via ubiquitin-proteasome system
Histone acetylation promotes formation of Con
euchromatin
Conjugation of bilirubin with glucuronic acid occurs where in hepatocytes
ER
TB and HIV
HIPPA exception of disclosure of serious communicable disease (nationally reported)
Otherwise written>verbal by patient to release info to others (like husband)
Fever, flank pain, pyuria and possible white cells casts (indicating RENAL origin of pyuria)
acute pyelonephritis
Accumulation within RENAL CORTEX, causing ATN. Proximal tubular vacuolar degeneration is usually seen
Aminoglycoside antibiotics
Sterile pyruia. Ongoing exposure to offending drug. Peripheral eosinophilia and eosinophiluria help confirm dx
Hypersensitivity interstitial nephritis
Muddy brown granular and epithelial cell casts free of tubular epithelial cells in the urine
Ischemic tubular necrosis
Chronic tubulointerstitial nephritis (interstitial fibrosis and tubular atrophy seen on light microscopy) —> renal failure
Chronic lead intoxication
chronic vascular malformation appearing as soft, well-demarcated, red or blue nodules.
Angiomas
Capillary hemangiomas vs cavernous hemangioma
Capillary: small and superficial (infantile)
Cavernous: Lg. and more likely to involve deep structures
Small tan or brown macules most often see on sun-exposed skin of middle aged or elderly
Lentigines
Indicator of leukocytoclastic vasculitis
palpable purpura
Decreased by: decreases in GFR or increases in RPF
Filtration fraction
Cricothyrotomy requires an incision to be made through the following layers:
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
Thyroid cartilage is at the level of
C6
Deep cervical fascia is composed of three layers:
investing, pretracheal and prevertebral
prevertebral is not penetrated in cricothyrotomy
Retropharyngeal space infection
Buccopharyngeal fascia (extends from carotid sheath to invest the pharyngeal constrictor muscles) lies anterior to prevertebral fascia. This forms retropharyngeal space
can extend directly into the superior mediastinum and cause acute necrotizing mediastinitis
Metabolic imaging scan (PET scan) that shows decreased metabolic activity in the striatum (caudate and putamen)
Huntingtons (AD) disease
Imaging studies with show atrophy of the caudate
Caudate and putamen
striatum
Lentiform nucleus
putamen and globus palladius (separated from thalamus by POSTERIOR internal capsule)
Carries corticospinal motor and somatic sensory; also auditory and visual fibers
Posterior Limb of internal capsule
MOST IMPORTANT FOR TEST
Carries corticobulbar fibers
Genu (knee) of internal capsule
Separates the caudate from the GP and putamen (striatum)
carries a portion of thalaocortical fibers (anterior limb of internal capsule)
role in the limbic system (emotion) as well as in the coordination of autonomic functions, particularly of the cardiac system
insular cortex (insula)
Amatoxins (source)
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)
Amatoxins (MOA)
Bind DNA-dependent RNA polymerase type II and halt mRNA synthesis–> apoptosis. GI and PCT also affected
Amatoxins can cause acute hepatic and renal failure. How do you test for this?
Alpha-amanitin urine test
potent toxin that inhibits protein synthesis by cleaving the rRNA component of the eukaryotic 60s ribosome subunit
RICIN (castor oil plain Ricinus communis)
lol shaw lecture*
Only function of RNA pol I
transcribe the majority of eukaryotic ribosomal RNA (rRNA) components.
Transcribes tRNA, 5 S ribosomal RNA and other small RNA molecues
RNA pol III (eukaryotic)
Continuous murmur heard best in the left infraclavicular region with maximal intensity at S2
PDA
(can be asymptomatic and detected incidentally during routine auscultation). Occurs most commonly in patients born prematurely and those with cyanotic congenital heart disease.
Mid systolic click and a mid-to-late systolic murmur.
Mitral valve prolapse
Lutembacher syndrome (RARE) prob will never be an answer
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
Histology of MS neurological complications (sclerotic plaques throughout white matter)
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
Loss of axons, neurons, and oligodendrocytes (the myelin-producing cells of the central nervous system) occurs over time in chronic multiple sclerosis plaques
MS
Of note: Internuclear opthaloplegia would not show this…rather just loss of myelination (ACUTE)
PTSD first line Tx
CBT, SSRI, SNRI
Two most important congenital syndromes for QT prolongation
1) Romano-Ward Syndrome
2) Jervell and Lange-Nielsen syndrome
Cause of congenital QT syndrome (be smart even tho you don’t know disease you know heart phys)
Mutations in a K+ channel protein that contributes to delayed rectifier current (Ik) of the cardiac action potential
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.
1) low
2 high
Exposure to ionizing radiation (X-Ray/gamma rays) causes DOUBLE STRAND BREAK. How are they fixed?
The fractured ends can be joined by nonhomologous end joining
Incorrect base substitution occurs during normal DNA replication. Can result in mutations if they are not correct. How does the body handle this?
DNA mismatch repair (PROKARYOTES hypermethylation of parent strand, which helps to identify non-mutated strand)
Deamination of DNA bases (cytosine to uracil or adenine to hypoxanthine) can occur spontaneously or secondary to chemical exposure. How does your body deal?
Base excision repair. Recognized by specific glycosylases without disruption of phosphodiester backbone. Removed by specific endonucleases and replaced by correct base by DNA pol.
Lecithinase (phospholipase C)
alpha toxin of clostridium perfringens. Degrades lecithin, a component of cellular phospholipid membranes–>membrane destruction and cell death with necrosis and hemolysis
why does C. perfringens cause gas green?
uses carbs for energy. its rapid metabolism of muscle tissue carbohydrates produces lots of gas
How does excess copper (wilsons disease) cause injury?
binding to sulfhydryl groups of cellular proteins
Edetate calcium disodium
CaNa2EDTA = lead poisoning antidote via increased urinary excretion
Iron overdose tx
Deferoxamine
how does deferoxamine work?
chelating agent that binds ferric iron to convert it to ferrioxamine (water soluble form that can be secreted in urine)
Inheritance of achondroplasia
Sporadic mutation (85%) AD in (15%)
GAIN OF FUNCTION MUTATION (constitutive activation of FGFR3)- inhibits chondrocyte proliferation
Knee joint positively birefringment
involved in > 50% of CPPD/pseudogout
Deposition of calcium hydroxyapatite crystals in periarticular soft tissues (esp. tendons) like rotator cuff MC
Calcific tendonitis
Amniotic fluid embolism
HYPOTENSION and cardiogenic shock with DIC
Most common cause of DIC in pregnancy
Placental abruption (hypertension)
Rabies vaccine
various rhabdovirus strains grown in tissue culture inactivated by beta-propiolactone
Methemoglobinemia (gray or blue colored skin, SOB, chocolate colored blood) Tx
Methylene blue- acts as an artificial electron transporter for reduction of methemoglobin through NADH pathway
Most common sources of arsenic poisoning?
Insectacides and contaminated (well) water
How do you treat acute arsenic poisoning?
Dimercaprol (chelating agent)
Cyanide poisoning (cherry red skin, ab pain, vomiting) tx
Hydroxycobalamin (vit. B12 precursor) binds to intracellular cyanide forming cyanocobalamin, which can be easily excreted in the urine
Sudden deceleration and direction change that involves VALGUS stress on the knee
ACL injury
ACL is crucial for knee stabilization. Where does it attach?
Anterior intercondylar area (fossa)
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)
Osgood-Schlatter disease
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
Enterococcus
Risk factor for enterococcal endocarditis (30% of nosocomial endocarditis)
Recent manipulation in elderly men MC but anyone:
Recent GU (eg. cystoscopy) MC
Gastrointestinal (colonoscopy)
Obstetric procedures
Acts as antagonist in the presence of full opioid agonist and precipitate withdraw in opioid-tolerant patients with chronic pain
Buprenorphine is a PARTIAL opioid agonist that binds with high affinity but has low intrinsic activity
Cryptogenic stroke (ischemic stoke from an obscure or unknown reason) at an early age. REQUIRES echocardiogram to identify right to left shunts. 2 MC?
ASD and PFO (patent foramen ovale-25% of healthy people)…watch out for that valsava (increased R. atrium pressure–>paradoxical emboli)
incomplete development of the interventricular foramen leads to
VSD
Preferred agents for rate control in A-fib with rapid ventricular response (rate-control in general)
CCBs and beta-blockers > digoxin
Why is rapid ventricular rate a serious condition
inadequate diastolic filling time –> poor cardiac output and backup of blood in lungs (HF)
Atrial myoxoma (mid-diastolic rumbling murmur heard best at apex, dyspnea, syncope) histology
scattered cells within a mucopolysaccharide stroma, abnormal blood vessels, and hemorrhaging
Myoxomas produce large amounts of what interleukin leading to constitutional symptoms (weight loss, fever)
IL-6
