2015.04.04 Flashcards

Question

Choledocolithiasis

Answer 1

Obstruction of the cystic duct or common bile duct by a gallstone. Biliary colic, jaundice, cholangitis. Fever, RUQ pain, inspiratory pause during RUQ palpation (Murphy's sign)

Answer 2

Due to carpal tunnel syndrome or fractures of supracondylar humerus. Lose sensory innervation of palmar and dorsal 1st - 3rd digits. Motor deficits: extrinsic finger flexion, thumb movement, pronation. Flattening of thenar eminence.

Answer 3

Innerves extensor compartment of forearm. Injury causes wrist drop. Lose sensation of: posterior arm + forearm, small portion of distal thumb

Answer 4

Loss of sensation: lateral forearm Paralysis: forearm flexors at the elbow

Answer 5

Due to fracture of surgical neck of humerus or other shoulder trauma. Lose sensation: lateral upper arm.

Answer 6

1. Heart muscle is perfused during diastole and consumes ~5% of cardiac output. 2. Myocardial oxygen requirement is high - extracts more oxygen from blood than muscles. 3. Coronary flow is regulated by local metabolic factors, including hypoxia and adenosine accumulation.

Answer 7

Where the left and right coronary venous blood drains into in the right atrium.

Answer 8

Digested in DUODENUM Absorbed in JEJUNUM (requires bile acids)

Answer 9

Absence of gallbaldder causes an increase in rate of enterohepatic circulation as there is no storage place for bile, so it is constantly released into the duodenum. Patients are less likely to tolerate large fatty meals at one sitting.

Answer 10

Functional residual capacity. Increased lung volumes increase PVR due to longitudinal stretching of alveolar capillaries by the expanding alveoli. Decreased lung volumes also increase PVR due to decreased radial tract from adjacent tissues on the large extra-alveolar vessels.

Answer 11

Opportunistic pathogen that causes disseminated disease in HIV+ patients. Patients with CD4 counts \<50cells/uL should be administered prophylactic **azithromycin**. Different from M tuberculosis because: optimum growth at 41C, widespread involvement of the reticuloendothelial system.

Answer 12

Opportunistic infections in HIV CD4 count \< 200cells/uL Oropharyngela candidiasis Prophylaxis: Trimethoprim-sulfamethazole

Answer 13

Opportunistic infections in HIV CD4 count \<100cells/uL Positive Toxoplasma IgG antibody Prophylaxis: Trimethoprim-sulfamethoxazole

Answer 14

Opportunistic infection in HIV CD4 count \<150cells/uL Endemic area (Ohio and Mississippi river valleys) Prophylaxis: Itraconazole

Answer 15

Sydrome of inappropriate ADH (SIADH) Small cell carcinoma of the lung commonly presents symptoms related to ectopic hormone production (paraneoplastic effects)

Answer 16

Low plasma sodium and osmolality, inappropriately conecntrated urine, increased urinary sodium, and clinically normal body fluid volume. (ADH is increased, but other volume-regulating hormones - aldosterone and natriuretic peptides - are activated by renin-aldosterone axis, causing excretion of sodium.

Answer 17

Cyclic breathing in which apnea is followed by gradually increasing tidal volumes, and then gradually decreasing tidal volumes unti the next apneic period. Seen in advanced congestive heart failure and neurologic disease.

Answer 18

Deep, labored breathing pattern associated with severe metabolic acidosis (esp, diabetic ketoacidosis)

Answer 19

Ophthalmoplegia, ataxia, and confusion. Lethal in 10-20% of patients. Foci of hemorrhage and necrosis in the mamillary bodies and periaqueductal gray matter. Due to chronic thiamine deficiency, common in alcoholism.

Answer 20

Glucose metabolsim 1. Pyruvate dehydrogenase: converts pyruvate (end-product of glycolysis) into acetyl CoA (which enters the citric acid cycle) 2. a-ketoglutarate dehydrogenase: enzyme of citric acid cycle 3. Transketolase: enzyme of hexose monophosphate pathway. Converts pentoses to glyceraldehyde 3P (intermediary of glycolysis)

Answer 21

Pituitary Tumor should be suspected (compresses optic chiasm) Most common pituitary tumor is a prolactinoma; causes impotence in men and amenorrhea in women.

Answer 22

Most common small vessel vasculitis in children. Antigen from infection stimulates production of IgA antibodies and forms immune complexes that deposit on vessel walls. 1. GI tract - abdominal pain, bleeding 2. Kidneys - like IgA nephropathy - mesangial proliferation and crescent formation. 3. Skin - palpable purpura on buttocks and lower extremities 4. Joints - migratory arthralgias and arthritis

Answer 23

Unwinds DNA at replication fork. Initial separation of dsDNA at the origin of replication is facilitated by DnaA protein and Strand binding proteins (SSB)

Answer 24

Erythrocytes and other cells lacking mitochondria cannot utilize ketone bodies for energy. Hepatocytes contain mitochindria, but cannot utilize ketone bodies because they lack **succinyl CoA-acetoacetate CoA transferase (thiophorase)** for conversion: acetoacetate to acetoacetyl CoA.

Answer 25

Autosomal dominant Abnormal nucleotide mismatch repair. MSH2 and MLH1 which code for components of the human **MutS and Mut L homologs** (mismatch detection)

Answer 26

Diffferentiates between dietary deficiency of vitamin B12, pernicious anemia and malabsorption syndromes. Phase I - radiolabeled B12 and B12 - detects dietary deficiency Phase II - radiolabeled B12 and IF - detects pernicious anemia If absorption of cobalmin is not correctable by IF, it indicates malabsorption syndrome - ileal disease, pancreatic insufficiency or bacterial overgrowth

Answer 27

Neisseria gonorrhoeae or Chlamydia Trachomatis Both cause dysuria and mucopurulent urethral discharge. Ceftriaxone - N. gonorrhea Doxycycline or Azithromycin (Macrolides) - C. trachomatis (since they have no cell wall, beta-lactam based antibiotics like cephalosporins are not effective)

Answer 28

HIgh estrogen levels during pregnancy stimulate growth of the pituitary, causing it to enlarge and become more vascular. If significant hypotension occurs while pituitary is still enalrged, ischemic necrosis of the pituitary occurs. Panhypopituitarism follows this ischemia. (Hypoprolactin, hypothyroidism, hypocortisolism)

Answer 29

Calcified cystic tumors that arise from remnants of Rathke's pouch (evagination of the ectoderm that lines the fetal oral cavity). Headaches, growth failure, and bitemporal hemianopia.

Answer 30

1. Increasing bone resoprtion 2. Increasing GI absorption of calcium by creating the active form of calcium-absorbing vitamin D 3. Increasing renal absorption of calcium

Answer 31

1. Colicky abdominal pain, constipation, headaches, impaired concentration and deficits in short-term memory. 2. Bluish pigmentation at the gum-tooth line. 3. Wrist drop or foot drop due to peripheral neuropathy. 4. Microcytic hypochroic anemia and basophilic stippling on peripheral smear.

Answer 32

4 separate stages. 1. ND, abdominal pain, hemorrhage, hypovolemia, and shock. 2. GI symptoms resolve and patient appears better. 3. Metabolic acidosis, hepatic dysfunction and hypoglycemia. 4. Scarring of recovering GI tract

Answer 33

Attach to and colonize the pharynx via pilus-mediated adherence to mucosal epithelial cells. Invade the epithelium and gain access to vasculature where they can spread hematogenously. Vaccines directed against Neisseria pili are hard to develop due to extensive antigeneic variation. It also produces IgA protease that destroys antibodies that can inihibit bacterial attachment and penetration. Current vaccines target the polysaccharide capsule.

Answer 34

Increase insulin secretion: Beta-2 adrenergic, Glucagon-like peptide-1 Decrease insulin secretion: alpha-2 adrenergic, somatostatin 2 (alpha-2 adrenergic inhibition is dominant)

Answer 35

HSV-1 infection. (Enveloped, dsDNA virus) Measles also have intranuclear inclusions, but tends to produce Koplik spots.

Answer 36

Deep to the muscular mucosae is the submucosa, which is occupied by compound tubular Brunner's glands. These glands secrete alkaline mucous into ducts that track upward through the muscularis mucosae and into the crypts of Lieberkühn for release into the lumen.

Answer 37

Thrombolytic agent that converts plasminogen into plasmin, which subsequently degrades fibrin, fibrinogen and factors V and VII. Most common side effect: hemorrhage. Derived from beta-hemolytic Streptococci and can induce hypersensitivity reactions.

Answer 38

Supplies the medial portions of the frontal and parietal lobes. Occlusion causes contralateral motor and sensory deficits of the lower extremities, behavioral changes, and urinary incontinence.

Answer 39

Motor control of hand, face/mouth, and throat. Broca aphasia (dominant hemisphere), anosognosia (non-dominant hemisphere), conjugate gaze deviation toward the side of the stroke, contralateral homonymous hemianopsia, and spatial neglect of the contralateral side.

Answer 40

autosomal recessive protein "frataxin" essential for normal mitochondria function. Causes degeneration of neural tracts and peripheral nerves: 1. Gait ataxia - degeneration of ascending and descending spinocerebellar tracts 2. Loss of position and vibration sensation. 3. Kyphoscoliosis and foot abnormalities. 4. Hypertrophic cardiomyopathy and CHF 5. Diabetes mellitus.

Answer 41

Poliomyelitis - flaccid paralysis, atrophy, areflexia, and muscle fasciculation. Amyotrophic lateral sclerosis.

Answer 42

Type 1 hyperlipoproteinemia Lipoprotein lipase (LPL) deficiency. Hypertriglyceridemia, recurrent acute pancreatitis, lipemia retinalis (milky-appearing retinal vasculature), eruptive xanthomas (small yellowish papules surrounded by erythema found on extensor surfaces)

Answer 43

Type IIA Defects in LDL receptor it is ligand, ApoB-100. High LDL concentrations. Increased risk of accelerated coronary artery disease, ischemic chest pain, tendon xanthomas (nodular lipid deposits in tendons), xanthelasmas.

Answer 44

Type III Deficiency of ApoE Elevated chylomicron and VLDL remnants. Premature coronary artery disease & PVR; tuboeruptive & palmar xanthomas

Answer 45

Type IV Deficeincy of Apo A-V Elevated VLDL Increased pancreatitis risk; associated with obesity & insulin resistance

Answer 46

Antidepressant medication that does not cause sexual dysfunction. Side effects: agitation, insomnia, seizures. Acts on norepinephrine transmission. Also effective for treatment of nicotine dependence.

Answer 47

Highly sedating anti-depressant useful for patients with insomnia. Causes priapism and other sexual side effects.

Answer 48

Chlorpromazine, Thioridazine Non-neurolgoic side effects: Sedation (histamine block) Anticholinergic side effects Orthostatic hypotension (alpha-1 block)

Answer 49

Haloperidol, Fluphenazine Side effects: extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism) due to D2 antagonism

Answer 50

Hyperplastic polyps: well-differentiated mucosal cells that form glands and crypts. Hamartomatous polyps: mucosal glands, SM, CT; Peutz-Jeghers syndrome or juvenile polyposis Inflammatory polyps: UC and Crohn disease. Regenerating intestinal mucosa. Lymphoid polyps: children, intestinal mucosa infiltrated with lympocytes.

Answer 51

autoimmune disease triggered by unknown antigen. Cartilage components serve as autoantigens that activate CD4+ T-cells, which stimulate B-cells to secrete rheumatoid factor (IgM antibody against Fc component of self IgG)

Answer 52

Maxillary or mandibular mass with intermediate-sized lymphocytes with round nuclei. Benign macrophages phagocytize the resulting cellular debris causing a "starry sky" appearance. t(8;14) resulting in c-myc oncogene and production of transcription activator controlling cell proliferation, differentiation, and apoptosis.

Answer 53

Follicular Lymphoma Chromosome 18 has bcl-2 gene (apoptosis inhibitor)

Answer 54

Philadelphia chromosome in Chronic myelogenous leukemia (CML) Bcr-abl encodes a protein that inhibits apoptosis while promoting mitogenesis and increased tyrosine kinase activity.

Answer 55

Mantle cell lymphoma Cyclin D1 on chromosome 11 with IgH chain on 14. Increased production of cyclin D1, promotes G1 to S-phase transition.