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Boards Review by Day > 16 May wk8-A > Flashcards

16 May wk8-A Flashcards

1
Q

ARDS is characterized by…?

What are some potential causes?

A

Characterized by: hypoxemia with bilateral symmetric pulmonary infiltrates in the absence of fluid overload or heart failure

Causes: trauma, pulmonary contusions, infection/sepsis, fat embolism
Pathophysiology: injury and inflammation to the alveoli leads to neutrophil recruitment and they release proteases and other mediators that damage the pneumocytes and perpetuate the cycle of damage leading to endothelial damage and fluid accumulation in the lungs

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2
Q

Where would edema be expected in a patient with R heart infarct?

A

Failing R heart would cause peripheral edema more than it would lung edema

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3
Q

Diabetic nephropathy is characterized by…?

A

Mesangial expansion, glomerular basement membrane thickening, glomerular sclerosis
If the sclerosis is nodular, it is called Kimmelstiel-Wilson lesion
Onset is usually 10-15 years after start of DM I or II

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4
Q

What makes the proximal portions of the pulmonary veins unique?

A

They contain myocardial tissue that functions like a sphincter during atrial contraction
Has different electrical properties than other parts of the heart and is prone to initiating premature atrial contractions and atrial fibrillation

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5
Q

Order the conduction velocity through the different parts of the cardiac conduction system

A

1-Purkinje fibers (fastest)
2-Atrial muscle
3-Ventricular muscle
4-AV node (slowest)

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6
Q

In general, what is Paget disease of bone?

A

Imbalance between osteoclast and osteoblast activity
3 stages: 1-osteoclast, 2-mixed, 3-osteoblast
Unknown cause
Over 60 y/o

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7
Q

What is the end result of Paget disease of bone?

A

Thick, sclerotic bone that fractures easily

Biopsy shows mosaic pattern of lamellar bone

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8
Q

Patient has increasing hat size, bone pain, hearing loss, lion-like face, and elevated AP levels. Dx? What would be seen on biopsy of the bone?

A

Paget disease of bone

Biopsy shows mosaic pattern

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9
Q

What is the treatment strategy and potential complications of Paget disease of bone?

A

Tx: calcitonin to inhibit osteoclasts, Bisphosphonates to cause apoptosis of osteoclasts

Complications: high output heart failure from AV shunts in bone, Osteosarcoma

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10
Q

Risedronate

Risedronic acid

A

Bisphosphonate used to treat osteoporosis and Paget disease of the bone

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11
Q 
Features of osteosarcoma including:
Proliferating cells
Peak incidence
Risk factors
Location
Presentation
Imaging
A

Proliferation of osteoblasts
Peak in teenagers, but possible in elderly
Risk: familial retinoblastoma, Paget disease, radiation
Location: metaphysis of long bones, usually distal femur or proximal tibia
Presents: pathologic fracture, bone pain, swelling
Imaging: destructive bone mass with sunburst appearance (ossification of surrounding soft tissue) and lifting of the periosteum creating Codman triangle

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12
Q

What is the most common bone tumor associated with Paget disease of the bone? Where?

A

Osteosarcoma

Generally femur, tibia, humerus, and others

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13
Q

What is the pathognomonic radiographic sign for avascular necrosis of bone?

A

Crescent sign showing subchondral collapse

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14
Q

What radiograph findings are expected for osteoarthritis?

A

Osteophytes and joint space narrowing

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15
Q

Globus sensation

A

Abnormal sensation of something in throat
Worse when swallow saliva and may be better with food or liquid
Not associated with structural abnormality or motility disorder
Often associated with anxiety, underlying psychological distress, ongoing emotional Sx

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16
Q

Dysphonia vs Dysarthria

A

Dysphonia: more a problem with making sound
Dysarthria: more a problem with articulating speech to be comprehensible

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17
Q

What is a substernal goiter?

A

Hyperplasia of the thyroid goes down into the thoracic cavity compressing airway causing wheezing, dyspnea, or cough. Swallowing Sx less common.

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18
Q

What is a zenker diverticulum?

A

Mucosal outpouching from motor abnormalities of the esophagus. Cause dysphagia, regurgitation, aspiration, hallitosis. Dx with barium swallow

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19
Q

Describe what would be seen in a joint aspirate of a patient with gouty arthritis.

A

Monosodium Urate Crystals that are needle shaped and negative birefringent
Onset of Sx will often be acute and exposure of the crystals to IgG leads to an immune response producing neutrophils in the aspirate as well as macrophages.

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20
Q

What joints are preferentially affected by RA?

A

Peripheral Joints

21
Q

What is adenomyosis?

A

Endometrial tissue in the myometrium of the uterus

22
Q

What tumor of the female reproductive tract has a whorled pattern?

A

Leiomyoma: benign tumor of smooth muscle

23
Q

What is endometriosis?

A

Presence of endometrial glands and stromal tissue outside the uterus. Ovaries is most common site. Dysmenorrhea is most common presenting Sx. Adnexal masses appearing as chocolate cysts in the ovary is common.

24
Q

Why does consuming Vit A from plant sources not lead to toxicity?

A

Plant sources do not have preformed Vit A like that which comes from supplements and animal sources.
Conversion to the active form is a very regulated process and won’t produce enough to cause toxicity.

25
Q

What is the first-line medication for nausea and vomiting in pregnancy?

A

Vitamin B6

Pyridoxine

26
Q

What are some of the teratogenic effects of Vit A on a fetus during the first trimester?

A 
Microcephaly
Cardiac anomalies
Early epiphyseal closure
Growth retardation
Spontaneous abortion
27
Q

What is the Drug of choice for Influenza A and B virus and MOA?

A

Oseltamivir (Tamiflu)
Inhibits the neuraminidase that cleaves the terminal sialic acid residue on the newly formed virions that are attached to the host cell surface. Inhibiting this cleavage prevents their release and spread to other cells.

28
Q

What types of proteins tend to undergo posttranslational cleavage?

A

Proteins destined to be exported from the cell tend to have signaling and protective sequences cleaved off before or after cell export.

29
Q

What is DNA laddering?

A

The finding of DNA fragments in 180 base pair lengths on gel electrophoresis that is a sensitive indicator of apoptosis carried out by programmed cell death with specific endonucleases during karyorrhexis.

30
Q

Most follicular B cell lymphomas have what mutation that produces over expression of what protein with what function?

A

t(14;18)
BCL2
Anti-apoptotic protein

31
Q

Pralidoxime

A

Antidote to organophosphate poisoning
Organophosphates inhibit AchEsterase by phosphorylation and Pralidoxime removes this phosphorylation allowing AchE to break down Ach.

32
Q

How are benzodiazepines processed differently in a young vs elderly patient? What Sx might result?

A

Benzos have a much longer half life in the elderly and thereby the effects of the drugs are potentiated.
Possible side effects of Benzo toxicity include: confusion, impaired consciousness, anterograde amnesia, psychomotor retardation, ataxia, weakness, vertigo, syncope, paradoxical agitation or aggression

33
Q

What is cycloplegia?

A

Paralysis of the ciliary muscle in the eye resulting in loss of accommodation and inability to focus on close objects
If accompanied by mydriasis, often caused by and anti-muscarinic agent of some kind

34
Q

What is accommodation?

A

The process of adjusting the power of the lens in the eye in order to maintain focus on the retina

35
Q

Describe anticholinergic syndrome

A

Fever, dry skin and mucous membranes, flushing, mydriasis, cycloplegia, altered mental status
“Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, mad as a hatter”

36
Q

Name some diseases with trinucleotide repeats

A

Fragile X
Huntington
Friederich ataxia
Spinocerebellar ataxia

37
Q

When should germline mosaicism be considered?

A

Whenever offspring are found to have a genetic mutation that is not present in the parents

38
Q

When is fish oil recommended?

A

Refractory hypertriglyceridemia

Not for patients with DM as it may affect glucose regulation

39
Q

In what disease do you see promyelocytes with folded nuclei and Auer rods? What gene mutation is associated?

A

Acute Promyelocytic Leukemia
t(15;17) involving the retinoic acid receptor
This mutation is highly specific for APL and no other leukemias or solid tumors

40
Q

What disease has a t(15;17)?

A

Acute Promyelocytic Leukemia

41
Q

What disease has tumor cells with round nuclei with basophilic cytoplasm with lipid vacuoles and has a t(8:14)?

A

Burkitt Lymphoma

42
Q

What disease has a t(9;22) and has leukocytosis with many immature myelocytes on peripheral blood smear?

A

Chronic Myelogenous Leukemia

43
Q

What is the most common translocation mutation in child B-cell acute lymphocytic leukemia?

A

t(12;21)

44
Q

What translocation is common in follicular lymphoma?

A

t(14;18)

45
Q

What is the function of IL-2?

A

Released by activated T cells to promote the growth and differentiation of B cells, T cells, NK cells, and macrophages
It stimulates T cells in an autocrine manner to promote clonal proliferation of the cell that has been activated.

46
Q

Which cytokine causes fever, lethargy, and anorexia? What cells release it?

A

IL-1

Mostly produced by mononuclear phagocytes

47
Q

What cells produce TNF-alpha and what does it do?

A

Macrophages primary source

Produces inflammatory response, in high concentrations can cause Sx of septic shock and cachexia

48
Q

What cells produce IFN-alpha and what does it do?

A

Monocytes, macrophages, B cells, NK cells
Many antiviral actions: inhibiting viral replication in cells, preventing infection of new cells by the virus, inducing cytotoxic response by Lymphocytes and NK cells to destroy infected cells

49
Q

Compare personality disorders:
Schizoid
Schizotypal
Antisocial

A

Schizoid: lack interest in social, solitary, secret, emotional coldness, apathy, extensive fantasy worlds in mind

Schizotypal: severe social anxiety and paranoia, often have unconventional beliefs, see normal events as having special meaning, assume others harbor bad feelings towards them and therefore avoid relationships, may dress oddly or react oddly in conversation

Antisocial: disregard for, or violation of the rights of others, low moral conscience, impulsive, aggressive, history of crime

Boards Review by Day (19 decks)

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