3/29 - UW 31 Flashcards by Allen Ruan

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

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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

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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

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What is the difference in duration between acute stress disorder and PTSD?

Acute stress disorder: 3d - 1mo

PTSD: > 1mo

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What are the most common organisms that cause necrotizing fasciitis?

Strep pyo
Staph aureus
C. perfringens

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What organisms are positive for the PYR (like bacitracin) test?

Group A and D streptococcus

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What enzyme and reaction does Methimazole inhibit?

Thyroid peroxidase, organification and coupling of iodotyrosines, to treat hypERthyroidism

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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

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What disease presents as a Male with a long history of UC, with fatigue and a high alk phos?

Primary sclerosing cholangitis

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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

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What disease presents as an Older Female with weight loss, abd discomfort, jaundice, and epigastric mass?

Pancreatic cancer

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What nerve can be damaged in a thyroidectomy?

Superior laryngeal, which innervates ONLY the cricothyroid muscle

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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)

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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

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What IL are secreted by Th2 cells?

IL 4, 5, 10, 13

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Which IL stimulates Th0 to differentiate into Th1? Th2?

Th1: IL-12 from macrophages
Th2: IL-4 from other APCs

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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

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Clinical features of melanoma? (ABCDE)

Asymmetry
Border irregularity
Color variation
Diameter > 6mm
Evolution in appearance

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What is the embryological origin of melanocytes?

Neural crest

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What are the derivatives of surface ectoderm?

Epidermis (and its appendages), mammary glands, lens of the eye, and the adenohypophysis

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What are the derivatives of the neuroectoderm?

CNS, preganglionic autonomic neurons, retina, and posterior pituitary

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What wrist bone is under the thumb?

Trapezium

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What is the most common enzyme deficiency that causes CAH?

21 hydroxylase def

What inheritance is CAH?

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