3/29 - UW 31 Flashcards
How does long term use of systemic steroids lead to osteoporosis?
Decreased synthesis of bone matrix
Inhibition of intestinal action of vit D
Increased PTH
What causes nipple inversion and skin retraction/dimpling in invasive breast carcinoma?
Invasion of the central region of the breast, and infiltration of the suspensory Cooper ligaments
What is “peau d’orange” in breast cancer?
Orange peel appearance, due to tumor blockage of the lymphatic drainage, causing lymphedema, pitting, and thickening of the skin
What is the difference in duration between acute stress disorder and PTSD?
Acute stress disorder: 3d - 1mo
PTSD: > 1mo
What are the most common organisms that cause necrotizing fasciitis?
Strep pyo
Staph aureus
C. perfringens
What organisms are positive for the PYR (like bacitracin) test?
Group A and D streptococcus
What enzyme and reaction does Methimazole inhibit?
Thyroid peroxidase, organification and coupling of iodotyrosines, to treat hypERthyroidism
What is the clinical presentation of primary biliary cirrhosis?
Early: Pruritus, esp severe at night
Fatigue is common. HSM and evidence of cholestasis (xanthelasma, pale stool)
Late: jaundice, steatorrhea, portal HTN, osteopenia
What disease presents as a Male with a long history of UC, with fatigue and a high alk phos?
Primary sclerosing cholangitis
What are the histologic findings of primary biliary cirrhosis?
Destruction of interlobular bile ducts by granulomatous inflammation (florid duct lesion) and heavy portal tract infiltrate of WBCs
What disease presents as an Older Female with weight loss, abd discomfort, jaundice, and epigastric mass?
Pancreatic cancer
What nerve can be damaged in a thyroidectomy?
Superior laryngeal, which innervates ONLY the cricothyroid muscle
Aside from the cricothyroid muscle, what nerve are the laryngeal muscles innervated by?
Recurrent laryngeal (also sensory innervation to the larynx below the vocal folds)
What nerves provide sensory innervation to the larynx above and below the vocal folds?
Above: Internal branch of the Superior laryngeal nerve
Below: Recurrent laryngeal
What IL are secreted by Th2 cells?
IL 4, 5, 10, 13
Which IL stimulates Th0 to differentiate into Th1? Th2?
Th1: IL-12 from macrophages
Th2: IL-4 from other APCs
In the absence of IL-12, what cytokine should be administered to make up for the lack of Th1 differentiation?
IFN-y, to activate macrophages
Clinical features of melanoma? (ABCDE)
Asymmetry Border irregularity Color variation Diameter > 6mm Evolution in appearance
What is the embryological origin of melanocytes?
Neural crest
What are the derivatives of surface ectoderm?
Epidermis (and its appendages), mammary glands, lens of the eye, and the adenohypophysis
What are the derivatives of the neuroectoderm?
CNS, preganglionic autonomic neurons, retina, and posterior pituitary
What wrist bone is under the thumb?
Trapezium
What is the most common enzyme deficiency that causes CAH?
21 hydroxylase def
What inheritance is CAH?
AR
What are the sx of vit A def?
Night blindness, xeropthalmia, vulnerability to infx (esp measles)
What are the sx of vit B1 (thiamine) def?
Infantile beriberi: cardiomegaly, tachycardia, cyanosis, dyspnea, vomiting
Adult dry beriberi: symmetrical peripheral neuropathy, esp in distal extremities
Adult wet beriberi: dry sx + cardiac involvement
Wernicke-Korsakoff in alcoholics
What are the sx of vit B2 (riboflavin) def?
Cheilosis, stomatitis, glossitis, dermatitis, corneal vascularization, ariboflavinosis
What are the sx of vit B6 (pyridoxine) def?
Cheilosis, glossitis, dermatitis, peripheral neuropathy
Def of what vit causes pellagra?
Niacin
What are the sx of infant hydrocephalus?
Macrocephaly, irritability, poor feeding, muscle hypertonicity and hyperreflexia (UMN damage)
Tinnitus, vertigo, and hearing loss are sx of acoustic neuroma, from what neoplasm? Where is it located?
Schwannomas in the cerebellopontine angle (attached to CN VIII)
In what genetic abnormality do you see bilateral acoustic neuromas? Inheritance?
Neufofibromatosis (NF) type 2 (fewer cutaneous manifestations than NF-1), AD
Which neurofibromatosis type is more CNS involvement?
NF-2 (tumor suppressor gene for Merlin protein), on Chr 22 (Bilateral acoustic…22 looks like ears…)
What gene mutation causes renal cysts, renal cell carcinoma, and hemangioblastoma of the cerebellum and retina?
VHL on chr3
What virus is Burkitt’s lymphoma strongly associated with?
EBV
What does c-myc encode for? What chromosome is it on, and what neoplasm can its translocation cause?
Protein for transcription activation, on chromosome 8
t(8;14) causes Burkitt’s lymphoma
What does cyclin D1 do? Chromosome? Translocation causes what neoplasm?
Promotor of G1 to S phase, on chromosome 11
t(11;14) causes mantle cell lymphoma
What is the function of the BRCA genes?
Code for DNA repair enzymes
What to give for trigeminal neuralgia?
Carbamazepine
Why should carbamazepine be used with care (i.e. what does it cause)?
Aplastic anemia
Which “part” of triglyceride breakdown goes to the liver? First enzyme?
TG into glycerol and FA in adipose (by Lipase)
GLYCEROL goes to liver, converted to Glycerol 3-phosphate by glycerol kinase
Where is COX2 expressed?
Sites of inflammation
Where is COX1 expressed?
Constitutively expressed in platelets and GI tract
Which abortifactant is an anti-progestin?
Mifepristone
What drugs inhibit formation of progesterone from pregnenolone?
“-ostane” drugs
Epostane
Trilostane
What enzyme converts pregnenolone to progesterone?
3-beta-hydroxysteroid dehydrogenase
Which abortifactant is a prostaglandin agonist? Why does it work?
Misoprostol, because prostaglandins induce uterine contraction and cervical dilation. Used with Mifepristone.
What is the only type of renal calculi that is radioLUCENT?
Uric acid
What organism causes Magnesium ammonium phosphate calculi?
Proteus (form struvite, staghorn calculi)
Why is digoxin used for AF with RVR?
Increases parasympathetic tone from vagus, decreasing AV conduction
In addition to increasing parasympathetic tone on the AV node, what is the other main effect of digoxin?
Increased ventricular contractility by blocking Na-K-ATPase on myocytes, increasing intracellular Ca
What type of mitochondrial damage is associated with irreversibly myocardial injury?
Vacuoles or phospholipid containing amorphous densities (permanent inability to generate ATP). Simple mitochondrial swelling can be reversible.
What are 2 selective COX2 inhibitors and when would you want to use them?
Celecoxib and Rofecoxib, when you wnat to reduce risk of bleeding and GI ulceration
What is the difference between dystonia and myoclonus?
Dystonia: sustained muscle contraction
Myoclonus: sudden, brief, sometimes severe muscle contraction
A lesion in what part of the CNS will cause hemiballism?
Contralateral subthalamic nucleus
