3/20 - UW 16 Flashcards
What do koilocytes indicate?
HPV
What type of nuclear material does HPV have?
dsDNA, non enveloped
What type of cell classically shows a perinuclear clearing (“halo”) with a pyknotic nucleus?
Koilocyte
What is associated with angiomyolipomas?
Tuberous sclerosis
What disease is characterized by brain hamartomas, ash leaf skin patches, seizures, and mental retardation?
Tuberous sclerosis
What are some issues associated with fetal swallowing that can cause polyhydramnios?
GI obstruction (duodenal, esophageal, or intestinal atresia) Anencephaly
What are some issues associated with fetal urination that can cause polyhydramnios?
High cardiac output due to anemia
Twin-twin transfusion syndrome
What is the most common cause of nephrotic syndrome in kids (2-8 years old)?
Minimal change disease
Granulomatous inflammation of the media with fragmentation of the internal elastic lamina of branches of the carotid art. characterizes what type of arteritis?
Giant cell arteritis
What are some presenting sx of Giant Cell Arteritis?
Patients older than 50 with headache, facial pain, jaw claudication, and vision loss
Irreversible blindness due to opthalmic artery occlusion in Giant Cell Arteritis can be prevented by giving what?
Prednisone
Characterize the rash seen in measles
Starts in the face and spreads to the trunk and extremities. Postauricular and occipital LAD are common
What is a disease caused by Reoviruses?
Colorado tick fever!
What is the criteria for major depressive disorder?
At least 5 of 8 criteria for 2+wks:
SIGECAPS (must include depressed mood and/or anhedonia)
Sleep disorder Interest deficit (anhedonia) Guilt (worthless, hopeless, regret) Energy deficit Concentration deficit Appetite disorder Psychomotor retardation or agitation Suicidality
How does dysthymic disorder differ from major depressive disorder?
Dysthymic: 2 sx for 2+yrs
Depressive: 5 sx for 2+wks
How does TNF-a induce insulin resistance?
Activation of serine kinases, phosphorylating serine residues in IRS-1, preventing their activation by tyrosine kinase in response to insulin
What class of antiarrhythmics exhibits reverse use dependence?
Class 3; lower HR = longer QT
What of the class 1 antiarrhythmics are the slowest to dissociate from the Na channel?
Class 1C, resulting in use-dependence: higher HR = wider QRS
Anemia with neurologic sx indicates what?
B12 def
What is the best tx for HTN with CHF or prior MI? Why?
Lisinopril (or other ACE-I) due to its antiremodeling effects
Why is macular (central) vision spared in occlusion of the posterior cerebral artery (PCA)?
Because collaterals from the MCA supply the occipital pole
What should be watched for in hyperthyroid patient presenting with fever and sore throat?
Thionamide (e.g. methimazole, propylthiouracil)-induced agranulocytosis
When would you give methimazole over propylthiouracil for hyperthyroidism? Vice versa?
Methimazole: generally preferred - it’s less hepatotoxic
Propylthiouracil: in pregnancy - it’s not teratogenic. In thyroid storm - it inhibits peripheral T4-T3 conversion
What are the two Thionamides? Adverse effects?
Methimazole, teratogenic
Propylthiouracil, hepatotoxic
Thionamides MOA?
Inhibit thyroid peroxidase, impairing iodine organification
A patient with hyperthyroidism presents with fever and sore throat. What do you check for and why?
Check CBC for neutropenia (<500) in case they have thionamide-induced agranulocytosis
Pathogenesis of tumor lysis syndrome?
Chemotherapy for high grade lymphoma, leukemia, or other neoplasm results in lysis of tumor cells releasing ions and uric acid
Where does uric acid precipitate in the kidney?
In areas of low pH: distal tubules and collecting ducts
Why is tumor lysis syndrome an oncologic emergency?
Lysis of tumor cells could release uric acid, which precipitate into obstructive crystals in the distal tubules or collecting ducts (where there is low pH), causing obstructive uropathy, and then ARF
How do you treat tumor lysis syndrome?
Urine alkalinization and hydration. Allopurinol can be used to reduce uric acid production during tumor cell lysis
Allopurinol MOA?
Xanthine oxidase inhibitor
Chronic myeloproliferative disorders have a mutation in what protein? Except which disorder?
JAK2 (tyrosine kinase) mutation: V617F
Except CML: Philadelphia chromosome t(9:22) BCR ABL
What is the mutation in CML?
Philadelphia chromosome
t(9:22)
BCR-ABL
What is the Haldane effect?
Binding of O2 to Hgb causes it to release H and CO2
What is the Bohr effect?
High tissue concentrations of CO2 and H facilitate O2 release from Hgb
What is the most common cause of vision impairment in HIV patients?
CMV induced retinitis
What are the tx options for CMV retinitis?
Ganciclovir, Foscarnet, Cidofovir
Foscarnet MOA?
Pyrophosphate analog that can chelate Ca
Also induces renal Mg-wasting, reducing PTH release
Causes hypoCa and hypoMg, which can cause sz
Sz in HIV patient with vision impairment is likely due to what?
Foscarnet tx from CMV induced retinitis
What are the major acyclovir toxicities?
Crystal nephropathy and neurtoxicity
What toxicity is gancyclovir associated with?
Severe neutropenia
Which drug for CMV induced retinitis is contraindicated in an HIV patient receiving Zidovudine? Why?
Gancyclovir, due to BM suppression from Zidovudine and potential for increased neutropenia
Why might you recommend adequate hydration with Indinavir administration?
Kidney stones
What organism grows well at low temps? GNR, beta hemolytic, facultative intracellular…
Listeria monocytogenes
What type of immunity gets rid of Listeria?
Cell mediated (due to their facultative intracellular characteristic)
What are the most common cardiac abnormalities seen in Turner patients?
- Bicuspid aortic valve
- Coarctation of the aorta
- Aortic root dilation
What is diagnosed with a low serum C1 esterase inhibitor level?
Hereditary angioedema: AD condition of episodic, painless, non-pitting, well circumscribed edema
How does decreased C1 esterase inhibitor lead to angioedema?
Allows the C1 (classical) complement pathway and kallikrein-catalyzed bradykinin to increase vasodilation and permeability
Why are ACE-I contraindicated in Hereditary Angioedema (HA)?
Bradykinin production is increased in HA, and its breakdown is inhibited by ACE-I
Dopamine agonists? MOA?
Ergot compounds: bromocriptine, pergolide
Nonergot compounds: pramipexole, ropinirole
MOA: directly stimulates D2 receptors
Why do non-selective alpha blockers (phenoxybenzamine, phentolamine) cause tachycardia?
In addition to blocking a1, which causes vasodilation, it blocks a2.
Presynaptic a2 inhibit NE release, causing bradycardia
What 2 receptors does vasopressin (ADH) act on? What do they do?
V1: vasoconstriction, prostaglandin release
V2: antidiuretic response
Chronic rejection of lung transplant involves what part of the lung?
Small bronchioles (Bronchiolitis obliterans)
Chronic rejection of kidney transplant involves what part of the kidney?
Vascular obliteration
Myxomatous changes in the media of large arteries are associated with what disease?
Cystic medial degeneration, as in Marfan syndrome
Why do you see cystic medial degeneration in Marfan syndrome?
AD fibrillin-1 defect leads to dysfunction of the extracellular matrix microfibrils, which prevents proper elastic fiber formation and leads to myxomatous changes
What food mimics Marfan syndrome?
Sweet peas, due to their beta-aminopropionitrile inhibiting lysyl oxidase which cross links elastin and collagen fibers
What is NF-kB?
Transcription factor for cytokine production
What causes increased NF-kB expression in Crohn’s disease?
NOD2 gene mutation increases NF-kB
What are the HLA gene associations with Crohn’s disease?
HLA-DR1/DQw5
What are the HLA gene associations with UC?
HLA-DR2
Most common side effect of Ethambutol?
Optic neuritis
