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STEP1 Flashcards > 3/28 MSK, Pulm, immuno > Flashcards

3/28 MSK, Pulm, immuno Flashcards

1
Q

Mutation in hereditary spherocytosis

A

Ankyrin, band 3, protein 4.2, spectrin

small round RBCs
splenomegaly

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2
Q

Bacterial transformation

A

taking up naked DNA (from cell lysis) from environment

SHiN
S. pneumoniae
H. influenza type B
Neisseria

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3
Q

What doe deoxyribonuclease do to bacteria?

A

degrade naked DNA so see no transformation

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4
Q

viral/bacterial Transduction

A

Use of phage
Generalized–> lytic phage packages bacterial DNA into viral capsid that can then infect another bacterium
Specialized–> lysogenic phage infects bacterium–viral DNA incorporates into bacterial chr. Excised phage DNA takes flanking genes with it

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5
Q

What drug activates antithrombin?

A

Heparin–> decreases action of IIa (thrombin) and factor Xa

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6
Q

where are the metastasis coming from if show osteoblastic lesions in the bone?

A

Prostate

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7
Q

Z line is what

A

the place where actin attaches to structural proteins (titin and alpha actinin)

sarcomere is defined as the distance between two Z lines

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8
Q

What calculation for a case control study

A

Odds ratio

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9
Q

Salicyate effect on ABG

A

Early–> Respiratory alkalosis

Late–> Anion gap metabolic acidosis

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10
Q

what nerve controls protrusion of the tongue

A

Hypoglossal XII

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11
Q

functions of the glossopharyngeal

A

somatic: stylopharyngeous muscle (elevates larynx)
Parasympathetic: parotid gland secretions
General sensory: tympanic membrane, tonsillar region, posterior third of tongue, upper pharynx (afferent gag reflex)
carotid body and sinus
Taste: posterior 1/3 of tongue

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12
Q

MOA morphine

A

mu agonist–> G protein–> increased potassium efflux

Close Ca channels

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13
Q

Host defense against candida

A

T lymphocytes–> prevent superficial infection (HIV)

Neutrophils–> prevent hematogenous spread (immunocompromised)

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14
Q

Bipolar I vs. Bipolar II

A

Bipolar I–> just mania +/- depression and hypomania

Bipolar II–>Hypomania + depression

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15
Q

Hypomania vs. mania

A

Hypomania: less severe, no psychotic features, >4 days

Mania: SEVERE, marked impairment in social or occupational function may require hospitalization. Psychotic features

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16
Q

SIADH body fluid and plasma osm

A

normal body fluid (increased body fluid–> RAAS–> excretion of sodium)

Low plasma osm

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17
Q

Tx for DKA

A

Regular insulin
30min start
peak 2-4hr
lasts 5-8

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18
Q

Role of glutathione peroxidase

A

detoxify free radicals (H2O2)

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19
Q

Role of glutathione reductase

A

Regenerates reduced glutathione to continue detoxifying free radicals

uses NADPH

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20
Q

Where does CN V3 come out?

A

Foramen ovale

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21
Q

Where does CN V2 come out?

A

Foramen rotundum

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22
Q

what goes through the foramen spinosum?

A

Middle meningeal artery

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23
Q

Cyclosporine

A

inhibits NFAT–> modulates transcription activity–> decrease release of IL-2

tx for psoriasis

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24
Q

pearly mass behind the tympanic membrane in the middle ear

A

cholestetomas
collection of squamous cell debris

cause hearing loss from erosion of auditory ossicles

cause: congenital, infection, trauma, surgery

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25
Q

MOA colchicine

A

inhibit micro tubular polymerization
disrupts chemotaxis, phagocytosis and degranulation

also reduces the formation of LTB4

SE: nausea, ab pain, diarrhea

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26
Q

Zileuton

A

inhibits 5-lipoxygenase and inhibits leukotriene formation

tx for asthma and allergic rhinitis

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27
Q

Cause of prepatellar bursitis

A

repeat anterior knee trauma from kneeling

Gardeners, mechanics, plummers, carpet layers

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28
Q

Causes of suprapatellar bursitis

A

direct blow to the distal thigh or prolonged quadriceps activity (running)

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29
Q

Churg-Strauss vs. PAN

A

Similar histologically but churg-Strauss effects smaller vessels and has granulomas with eosinophilic necrosis

PAN–fibrinoid necrosis with transmural inflammation

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30
Q

when do you get graft vs. host dz?

A

Allogenic bone marrow txt
organs rich in lymphocytes (liver)
transfusion of non-irradiated blood

pts severely immunocompromised

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31
Q

MOA in GVHD

A

immunodeficient host

immunocompetent donor T cells from graft attack host MHC antigens

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32
Q

Features of GVHD

A

maculopapular rash (palms and soles)
jaundice
diarrhea
hepatosplenomegaly

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33
Q

Precursor vitamin for synthesis of NAD+ coenzyme

A

Niacin

If deficient can make up for it with tryptophan

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34
Q

What is arginine the precursor to?

A

NO, urea, ornithine, agmatine and creatine

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35
Q

skin slipping off with gentle pressure (Nikoldky’s sign), epidermal necrolysis, fever, and pain associated with skin rash

A

Staph scalded skin syndrome

caused by exfoliatin exotoxin

blistering only the superficial epidermis

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36
Q

Pityriasis versicolor

A

Malassezia species of yeast

Hypo, hyper pigmented or erythematous macule or patches on upper body

hot humid climates and move visible after tanning

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37
Q

Diagnosis of Malassezia

A

KOH prep of skin

Spaghetti and meatballs

hyphae have short cigar-butt appearance

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38
Q

How is androgenic alopecia inherited?

A

Polygenic inheritance with variable expressivity

similar to epilepsy, glaucoma, HTN, ischemic heart dz, schizophrenia, DMII

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39
Q

Junctional nevis vs. compound nevis

A

Junctional–> dermoepidermal junction
flat black to brown pigmented macule with darker coloration in the center

Compound–> extend into dermis
raised papule with uniform brown to tan pigment

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40
Q

Out patient tx for non purulent cellulitis

A

Cephalexin to cover both beta hemolytic strep and MSSA

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41
Q

empiric Tx for UTI in child

A

Third generation cephalosporins and AGs

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42
Q

Most common organism in spontaneous bacterial peritonitis

A

E. Coli

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43
Q

How and how long to treat community acquired pneumonia?

A

third generation cephalosporin plus a macrolide or Doxycycline

5-7 days

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44
Q

Pneumocystis jiroveci labs

A

Elevated LDH

also occurs CD4 count

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45
Q

Watery non-bloody diarrhea with WBCs

A

invasive diarrhea

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46
Q

How to diagnose subcutaneous emphysema?

A

Fiberoptic bronch

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47
Q

presents with the abrupt onset of colicky abdominal pain, knee flexing, emesis, and bright red blood per rectum.

A

intussusception

Exam: sausage shaped mass in upper right quadrant

Diagnosis: ultrasound see “Target sign”

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48
Q

Treatment for HSV

A

Acyclovir

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49
Q

Fever, hemolytic anemia, thrombocytopenia, renal dz and change in mental status

A

Thrombotic thrombocytopenic purpura (TTP)

inhibition or deficiency of ADAMTS 13 (vWF metalloprotease)–> decreased degradation of vWF multimers

increased large vWF multimers–> increased plt adhesion –> increase plt aggregation and thrombosis

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50
Q

TTP labs

A

Schistocytes
increased LDH

microangiopathic hemolytic anemia

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51
Q

MOA TTP and symptoms

A

ADAMTS 13 deficiency or inhibition–> increase vWF–> more plt aggregation

FAT TN
Fever
Anemia 
Thrombocytopenia 
Renal dz
Neuro dysfunction (change in mental status)
52
Q

Initial treatment for persistent a fib

A

start warfarin

after 3 weeks of warfarin cardiovert

53
Q

Lead time bias

A

early detection is confused with increased survival

correction: measure “back-end” survival (adjust for severity of dz at time of diagnosis)

54
Q

Tanner stages for boys

A

2–pubic hair just appears, testicles 4cc and penis just starts to enlarge

3–more, darker pubic hair, elongation of penis, 10 cc scrotum

55
Q

Severe bacterial and viral infections in infancy, chronic diarrhea, thrush

A

Severe combined immunodeficiency

absent thymic shadow, germinal centers, and T cells

56
Q

craniofacial abnormalities, conotruncal cardiac anomalies, hypoplastic thymus, hypocalcemia

A

DiGeorge syndrome

57
Q

where do you aspirate when lying down?

A

Posterior segment of the upper lobes and superior segment of the lower lobes

58
Q

Effects of PE on ABG

A

Respiratory Alkalosis

Hypoprofusion->V/Q mismatch –> R to L shunting

Hypoxemia–> increased respiratory drive–> hyperventilation

59
Q

which cells are involved in creating granulomas in the lungs?

A

CD4 T cells activate Macrophages that can form Langhans giant cells (horseshoe shaped)

60
Q

where is the highest resistance in the bronchial tree?

A

Medium sized bronchi

drops further on because there is a large net cross sectional area

61
Q

How to treat asthma that is resistant to inhaled steroids and long acting beta 2 agonists?

A

Omalizumab (anti-IgE Ab)

62
Q

what are the carotid bodies? what do they respond to?

A

Peripheral chemoreceptors

sensitive to PaO2 and stimulated by hypoxemia

63
Q

what kind of channel is CFTR?

A

ATP-binding transmembrane ion transporter pumps Cl ions out of epithelial cells (pump in in sweat glands)

64
Q

What is Dihydrorhodramine (DHR) flow cytometry?

A

Test for CGD
assess the production of superoxide radicals–> measure conversion of DHR to rhodamine (a green compound)

if cell is deficient NADPH oxidase then will not have as much green

Can also use nitroblue tetrazolium testing

65
Q

Which bugs have vaccines with capsular polysaccharide conjugated with a toxoid?

A

S. pneumonia
N. meningitides
H. flu

all are encapsulated bacteria with conjugate vaccines

66
Q

defense mechanism of inhaled particles in the terminal bronchioles

A

Mucociliary clearance (from the trachea to proximal resp bronchioles)

67
Q

Where are goblet cells in the lungs?

A

from trachea to the larger bronchioles

NOT in terminal bronchioles

68
Q

Defense in the distal terminal bronchioles?

A

Macrophages

69
Q

what is the main indication of total alveolar ventilation?

A

The inverse of the PaCO2

ex: Hypocapnia implies alveolar hyperventilation

70
Q

decreased breath sounds, hemithorax opacification on one side and tracheal deviation to that same side

A

collapsed lung dure to bronchial obstruction

appears opaque because can not get air into lung because it is collapsed.

usually after mainstream bronchus obstruction (central lung tumor)

71
Q

BMPR2 gene

A

Pulmonary HTN

plexiform lesions
intimal fibrosis
medial hypertrophy

72
Q

red hepatization

A

2-3 days

alveolar exudate continuing erythrocytes, neutrophils, and fibrin

73
Q

Gray hepatization

A

4-6 days

RBCs disintegrate
alveolar exudate contains neutrophils and fibrin

74
Q

what allows elastin to stretch?

A

interchain cross-links involving lysine

uses lysol oxidase

75
Q

Where does the right ovarian vein drain to?

A

IVC

76
Q

What is a preventable medical error

A

harm to patient by act of commission or omission due to failure to follow evidence based best practice guidelines

77
Q

columnar mucin-secreting cells that line alveolar spaces and do not invade stroma or vessels

A

Adenocarcinoma in situ of the lungs (Bronchioloalveolar carcinoma)

Most common cancer in nonsmokers

KRAS, EGFR, ALK

78
Q

pathophys of a Meckel diverticulum

A

failed obliteration of the vitelline (omphalomesenteric) duct

current jelly stools, painless GI bleed

99mTc-pertechnetate –> tests for parietal cells of gastric mucosa

79
Q

99mTc pertechnetate scan

A

Looking for Meckel diverticulum

affinity for parietal cells of stomach

80
Q

what would you see on a EBV blood smear?

A

Cytotoxic CD8 T cells

they multiply to try to kill virally infected B cells

81
Q

prenatal tx for Group B strep

A

intrapartum Penicillin or ampicillin

Screening at 35-37 weeks

82
Q

MOA Caspofungin

A

block 1,3-beta-D- Glucan synthesis

Echinocandins suppress fungal cell wall synthesis

83
Q

increased peripheral metabolic rate and hypercapnia has what effect on CO2 transport

A

Chloride shift

More CO2 converted to H2CO3 by CA then H and HCO3

HCO3 transported out of RBC in exchange for Cl-

84
Q

Restrictive lung disease on pulmonary function test (TLC, FEV1, FVC, RV, DLCO)

A

All decreased

85
Q

Neuromuscular weakness on pulmonary function test (TLC, FEV1, FVC, RV, DLCO)

A

decreased TLC, FEV1, FVC

increased RV

normal DLCO

86
Q

hypercapnia leads to the build up of what enzyme in the lungs?

A

Carbonic anhydrase

87
Q

First line treatment for strep pneumo

A

amoxicillin or penicillin

if resistant then vanco

88
Q

HLA DR2

A

MS, hay fever, SLE, Goodpastures

89
Q

HLA DR3

A

DM I, SLE, Graves, Hashimoto

90
Q

HLA DR5

A

Pernicious anemia

Hashimotos

91
Q

TNF alpha function

A

Mediate septic shock
Causes vascular leakage
induces leukocyte recruitment
helps form and maintain granulomas

92
Q

Neutropenia, hypergammaglobulinemia, anemia with recurrent UTIs and skin abscesses

A

CGD

x-linked recessive

93
Q

Pathophys of ARDS

A

Initial insult to alveoli from neutrophils, coagulation cascade and free radicals–> increase alveolar cap perm.–> exudate into alveoli and noncardiogenic pulm edema

intra-alveolar hyaline membranes
fluffy lung infiltrate
Widespread destruction of both type I and II pneumocytes

94
Q

Back pain that is improved by leaning forward and with rest, diffuse weakness in legs bilaterally, numbness that travels down legs.

A

Lumbar spinal stenosis

signs of neurogenic claudication

Vertebral body compression fractures mainly pain not as many neuro signs

95
Q

Lennox-gastaut

A

childhood epilepsy syndrome characterized by frequent and difficult to control seizures of different types and developmental delay

multifocal slow spike and wave on EEG

96
Q

Lennox-gastaut on EEG

A

Multifocal slow spike and wave

97
Q

Benign childhood epilepsy on EEG

A

may just be normal

98
Q

how to prevent worsening of non proliferative retinopathy in a DM?

A

control blood sugar better (give insulin)

99
Q

Two toxins of B. anthracis

A

Edema factor–> increases AC thus cAMP–> edema and disruption of innate immunity

Lethal factor–> inactivates MAP kinase pathway leading to rapid cell death

100
Q

Treatment for status epilepticus

A

Benzos
phenytoin
phenobarbital (third line)

if continue then use general anesthesia such as propofol

101
Q

Treatment for DKA

A
  1. normal saline

2. IV regular insulin

102
Q

tests for muscle inflammation

A

creatine phosphokinase
aldolase
AST ALT
lactic acid dehydrogenase

103
Q

Tuberous sclerosis

A 
HAMARTOMAS
Hamartomas in CNS and skin
Angiofibromas
Mitral regurg 
Ash-leaf spots
cardiac Rhabdomyoma
Tuberous sclerosis 
autosomal dOminant
Mental retardation 
renal Angiomyolipoma
Seizures
Shagreen patches
104
Q

Perianal pain that is constant and progressive

A

Ischiorectal abscess

105
Q

persistant anal pain that is worse with defecation

A

Anorectal fistula

106
Q

Treatment for hip dysplasia in an infant

A

place in a harness

diagnosis via ortolani or barlow maneuver

107
Q

Function of cysteine

A

forming disulfide bonds

ex: forming insulin

108
Q

What do mast cells release during anaphylaxis?

A

Histamine, bradykinin, tryptase

Tryptase is specific to mast cells and can be used for diagnosis of anaphylaxis

109
Q

Calcitonin is a marker of…

A

produced by C cells of thyroid gland

marker of medullary thyroid carcinoma

110
Q

Pathophys of Anaphylaxis

A

Type I hypersensitivity rxn

antigen binds to high affinity IgE receptor on mast cells and basophils–> cross linking receptors–> aggregation–> activates non-receptor TK– degranulation

111
Q

Macrophage surface markers

A

CD14, CD40, B7, MHC-II, Fc and C3b receptors

112
Q

Anti-U1-RNP

A

Mixed connective tissue disease

113
Q

Anti-Scl-70

A

Diffuse type scleroderma

Anti-DNA topoisomerase I

114
Q

Anti-centromere

A

Limited type scleroderma (CREST)

115
Q

Anti cardiolipin

A

Syphilis and SLE
antiphospholipid

also Anti-Beta2 glycoprotein I
Lupus anticoag

116
Q

What kind of hypersensitivity rxn is eczema?

A

Type I

117
Q

what type of graft is best for pts with Hodgkin lymphoma?

A

Autograft

from self–>no immunosuppression needed

118
Q

role of Sargramostim (GM-CSF) and Filgrastim (G-CSF)

A

Stimulate myeloid stem cells to produce more granulocytes

use: treat neutropenia and thrombocytopenia from chemo

119
Q

Presentation of Acute leukemia

A

anemia (fatigue), Thrombocytopenia (bleeding), neutropenia (infection)

symptoms due to “crowd out” in bone marrow

120
Q

repeated staph infections, papulovesicular dermatitis, coarse facial features

A

AD hyper IgE syndrome (job syndrome)

High IgE
red hair
staph abscess
retained primary teeth

due to low IFN gamma
deficiency of Th17 cells (STAT3 mut)

121
Q

hemolytic anemia, fever, thrombocytopenia purpura, renal failure and neurologic abnormalities

A

TTP

122
Q

how does intrinsic factor work?

A

B12 bound by R-proteins in the stomach and transported to duodenum. B12 then binds to intrinsic factor in duodenum and transported to terminal ilium

123
Q

Shillings test

A

Test for pernicious anemia

see if B12 is being absorbed

1: radiolabled oral B12
- -high amt in urine–>dietary deficiency
2. B12* + oral intrinsic factor
- -high B12–> pernicious anemia
3. B12 + oral antibiotics
- -High B12–>bacterial overgrowth
4. B12 + pancreatic enzymes
- ->high B12*–>pancreatic insufficiency

124
Q

Widespread rash and intractable diarrhea after transplant

A

GVHD

125
Q

Clinical use for IFN-alpha

A

Chronic hep B and C, Kaposi sarcoma, malignant melanoma

126
Q

Clinical use for IFN-beta

A

MS

127
Q

Clinical use for IFN-gamma

A

CGD

STEP1 Flashcards (9 decks)

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