4/6&7 overall review Flashcards
What is underlying pathophys of ARDS?
-what will CXR look like?
Damage to endothelial cells lining the pulm caps.
- results in leakage of fluids into alveoli.
- CXR will show “white out” of the lungs.
Alveolar wall destruction
-which disease?
emphysema
aneurysmal dilations
-usually have absent what?
internal elastic lamina.
Cardiac tissue conduction velocity
- order?
- mnemonic:
Park At Ventura Ave.
- purkinje system = fastest
- atrial muscle
- ventricular muscle
- AV node = slowest
Which chamber are SA and AV node located?
RA
Conduction speed of atrial muscle vs ventricular muscle.
-which one faster?
atrial muscle faster than ventricular muscle.
Paget disease of bone
-most often associated w/which bone tumor?
osteosarcoma.
Age distribution in osteosarcoma?
bimodal.
radiological findings in osteosarcoma:
- areas of mixed lysis & sclerosis = radioopaque & radiolucent areas.
- periosteal elevation.
- reactive new bone formation.
- lifting of cortex.
Osteophytes
-RA or osteoarthritis?
osteoarthritis
Trabecular bone
- aka?
- damaged preferentially in which disease?
- spongy, cancellous.
- osteoporosis.
globus hystericus
-what is it?
“lump in your throat”.
karyorrhexis
-what is it?
nuclear fragmentation - part of apoptosis.
-get 180 bp fragments.
Blurred vision: think what mechanism?
-think a ciliary muscle/lens issue, NOT a pupillary size issue!
Pleiotropy
Impact a single gene has on multiple phenotypes.
tumor cell w/round nuclei and prominent lipid vacuoles.
Burkitt lymphoma
t(12;21): which disease?
ALL
-better prognosis.
IL-1 primarily released by which cell?
macros
TNF-alpha primarily released by which cell?
macros
GM-CSF
-stim prod of which cells?
granulocytes + monocytes
What can cause dissociation of cadherins?
Removing Ca from extracellular fluid. Leads to loss of cell-to-cell adhesion.
-Cadherin intercellular interactions are Ca dependent.
In post & ant dislocations of knee (so ACL/PCL injuries), which nerve or vessel is most likely to be injured?
Popliteal artery
- tibial n. in similar location but not as susceptible to this type of injury like pop. artery is.
- popliteal vein same location but superficial to artery. Also not as likely to be injured in this kind of injury.
Psych: reflection is most similar to what other technique?
summarization
Psych: facilitation
-what is it?
Encouraging the pt to talk more: “tell me how your drinking increased”.
What changes does cocaine cause to your nose area?
- atrophic nasal mucosa.
- chronic nasal discharge.
- thinning of nasal septum.
- oropharyngeal ulcers.
Hay fever
-what is it?
Seasonal form of allergic rhinitis.
-provoked by pollen from plants.
Which cell = primary player in asthma?
mast cell.
Long thoracic nerve
-which nerve roots?
C5-C7
Is there bicarb in sweat?
not really.
PTSD
- by definition how long has it been going on?
- what do you call it if it hasn’t been going on that long?
PTSD > 1 month.
< 1 month (but > 3 days) = acute stress disorder.
Schizo Sxs < 1 mo: whats it called?
brief psychotic episode
Number needed to treat: equation?
1/ARR
- ARR = absolute risk reduction.
- so if 40% survived w/Tx, and 20% survived w/o Tx. Then ARR = 40-20 = 20%.
- 1/ARR = 1/.2 = 5.
Viral cause of kluber bucy?
-explain:
HSV-1 encephalitis causes damage to temporal lobe.
- amygdala is in temporal lobe.
- damage to amydala => kluver bucy.
Acute intermittent porphyria
- what builds up?
- inheritance pattern?
- porphobilinogen.
- auto-dom.
Porphyria cutanea tarda
-what builds up?
uroporphyrinogen 3.
trinucleotide repeat diseases
-all cause Sxs in which system?
CNS
Is penetrance an all or nothing thing?
ya
genetic heterogeneity
-define:
mutations at diff genes cause same phenotype.
In adults, S3 usually heard in setting of what heart problem?
Heart failure - either systolic or diastolic.
Transudate vs Exudate:
-pleural fluid LDH/serum LDH: > .6
Exudate.
*transudates dont have LDH in them.
Osmotic fragility test: (+)
-which disease?
Hereditary spherocytosis
*pathognomonic.
Target cells:
- seen in which diseases?
- mnemonic:
HALT said the hunger to his target:
- HbC disease
- Asplenia
- Liver disease
- Thalassemia
Diabetic neuropathy of DM:
-symmetrical/bilateral?
yes, symmetrical.
There will be a question where you have to differentiate LEMS vs MG:
- Associated w/which organ?
- Which one is more common?
- Which one more commonly presents w/eye weakness?
- Which one gets better w/more activity?
- MG = thymoma. LEMS = small cell lung cancer.
- MG = much more common.
- MG = more likely to get diplopia.
- LEMS = better w/increased use.
RB gene
- which chrom?
- can lead to which tumors?
- 13
- retinoblastomas, osteosarcomas.
Neisseria
-gram +/-?
gram (-)
DiGeorge: pouch or arch?
-mnemonic?
Pouch.
-George Foreman “punches”.
serum sodium levels in DKA?
hyponatremia
-Dilutional hyponatremia. Water shifted from intra to extracellular compartments due to the hyperosmolarity.
spina bifida cystica
-aka?
myelomeningocele.
androgen insensitivity
-why do they develop breasts?
free testosterone aromatized to estrogen.
- develop breasts.
- there is inc. LH & testosterone (& therefore Estrogen) bc LH has no neg. feedback bc test. receptors in hypoT insensitive as well.
Intraventricular hemorrhage:
-happens in which pt population?
- Low birth weight babies (< 32 weeks).
* most often occurs in the germinal matrix.
How are transmembrane proteins anchored inside the cytoplasm?
palmitoylation.
Nitroglycerin:
-effect on HR?
reflex tachy.
-so give it w/a beta blocker.
pseudohypoparathyroidism
- inheritance pattern?
- Sxs:
- auto-dom.
- short stature, hypocalcemia, short 4th & 5th digit, PTH resistance.
Allelic heterogeneity
- define:
- example:
Different mutations in the same genetic locus cause similar phenotypes.
-ie. Duchenne MD vs Becker. Same gene, different mutation, similar phenotype.
- dont confuse w/genetic heterogeneity where mutations in different genes can cause similar phenotypes.
- dont confuse w/phenotypic heterogeneity where mutations in the same gene can result in different phenotypes.
lysyl oxidase
- whats it do?
- cofactor?
- which disease results in dec. absorption/transport of this cofactor?
- cross links collagen in extracellular space.
- copper
- Menke’s disease
polydactyly
-think what disease?
Patau
-P & P.
In what situation would a legit female have serum karyotyping w/XY?
She gone bone marrow transplant from a male donor!
*her peripheral blood cells will have XY, but rest of her tissues will obviously still have her own XX.
Signal sequences for SRP to take halt translation & take ribo+polypep to protein pore in RER:
-what type of AAs in that signal sequence?
hydrophobic.
Do sebaceous glands have sym inn?
No.
Safranin O
-stains what red?
Cartilage, mast cell granules, & mucin.
H.pylori quadruple therapy:
PPI, bismuth subsalicylate, tetracycline, metronidazole.
Red man syndrome of vanc.
- mechanism?
- IgE mediated?
- prevention?
- Rapid infusion of vanc causes histamine release.
- Not IgE mediated!
- Slow infusion rate + pre-treatment w/anti-histamine.
leiomyoma
- Sxs:
- whos the pt?
- menorrhagia, miscarriage, palpable mass in lower abdomen, passing clots occasionally.
- black woman in her 30s or 40s (pre-menopausal).
Why are chlamydia resistant to penicillins?
1) They’re intracellular.
2) They dont have cell wall. They have disulfide bonds in their outer membrane that give them stability instead.
Glitazones
- mech:
- tox:
- PPAR receptor agonist, inc. insulin receptor sensitivity.
- weight gain, edema, hepatotox, HEART FAILURE.
*PPAR receptor agonist = for instance, one action of that gene is to inc. GLUT4 receptors on adipocytes.
Biguanides: metformin
- mech:
- tox:
- dec gluconeo, inc. glycolysis, inc. peripheral insulin sensitivity.
- lactic acidosis, mild inc. in LFTs, GI upset.
Glyburide
- what is it?
- whats it do?
- Sulfonylurea.
- Closes K channel, causes influx of Ca, and release of insulin from pancreas.
*mimics normal action of ATP.
Pt shows up to ER w/asthma attack - if she’s treat w/b-2 agonist, how long will it take on that nebulizer to experience significant relief?
Could be as long as 15-20 min.
-this shit is not instantaneous!
MAP kinase
-what does MAP stand for?
Mitogen Activated Protein kinase.
woven bone vs lamellar bone
-which one is immature/pathologic?
woven is either immature or pathologic bone.
Only enveloped virus who gets its envelope from nuclear envelope?
herpesvirus
Only DNA virus that does NOT replicate in the nucleus:
poxvirus
Papovirus
-what is it?
Includes papillomaviridae & polyomaviridae.
Lichen Planus
-associated w/which virus?
hepC.
Duchenne
-what type of mutation?
frameshift
Ego defense: intellectualization
- mature or immature?
- what is it?
- immature.
- man intellectualizing his cancer Dx by researching it extensively & talking about it in a detached fashion.
G6PD def.
-why do you get back pain?
Hb in urine = nephrotoxic.
-back pain is from kidney pain.
Names some unmyelniated nerves:
- afferent for olfaction, heat, slow pain.
- post-ganglionic autonomic neurons.
What can cause a marfanoid body habitus?
- Marfans.
- Homocystinuria.
- Men 2B.
genetic heterogeneity vs allelic heterogeneity.
-which one deals w/1 gene and which one deals w/2 genes?
genetic heterogeneity = deals w/2 or more genes.
-allelic deals w/1 gene.
Aerobic respiration: how many max ATP?
Anaerobic: how many max ATP?
- 38
- 2
leukoplakia
-occurs on what type of tissue?
Only occurs on mucosal surfaces!
Reactive arthritis
-what does this include?
- conjunctivitis/uveitis.
- urethritis.
- arthritis.
Callus
- inc. thickness of which layer of skin?
- whats the medical term for this?
- what other disease shows this?
- stratum corneum.
- hyperkaratosis.
- psoriasis.
Whats the regulatory protein that dictates the differentiation of a progenitor cell into a more specializes cell?
-growth factor? txn factor?
- transcription factor.
* growth factors usually regulate synthesis of txn factors, but the answer here is txn factors.
Peutz-Jegher syndrome
-inheritance:
auto-dom.
Can you refer to warfarin as a vitamin-k antagonist?
yes
Someone given a mechanical valve, which med do you give them to prevent clot formation. Life-long med.
warfarin.
-NSAIDs wont cut it alone. You can add a daily low-dose aspirin though which will be useful.
Which Ig types are made w/o any class switching?
IgM & IgD.
CD40 receptor
-is receptor on B cell or T cell?
B cell.
H__ is the only histone not in the nucleosome core.
H1
Most prevalent lysosomal storage disease:
Gaucher disease.
What % occlusion of coronary for stable angina?
-how does it progress to unstable?
- 75%
- Thrombus formation w/incomplete coronary occlusion = unstable angina. Someone w/unstable angina needs to be admitted.
COX-1 or COX-2
-aspirin blockage of this inhibits platelet aggregation:
COX-1
TXA2 production: dep on COX-1 or COX-2?
COX-1
focal segmental glomerulosclerosis
- nephrotic or nephritic?
- mnemonic?
- nephrotic.
- focal focal sounds like fuck. HIV pts are fucked and fucking got them their HIV.
Berger disease (IgA nephropathy) -nephrotic or nephritic?
nephritic
Asthma exacerbation:
-What will CXR show?
CXR is typically normal.
Spont. pneumothorax
-trachea deviates toward or away from lesion?
toward.
Tension pneumothorax
-trachea deviates toward or away from lesion?
away.
nephrogenic DI
-Tx:
hydrochlorothiazide, indomethacin, amiloride.
Ethylene glycol
-how does it result in kidney stones?
Its converted to oxalate.
Serum anion gap:
- equation?
- whats normal?
- anion gap = (Na) - (Cl + HCO3)
- normal = 10-14
Ethylene glycol poisoning
-presentation:
- anion gap metabolic acidosis
- gross hematuria, flank pain, oliguria.
- its toxic metabolite causes ATN.
How does Iron OD cause inc. anion gap metabolic acidosis?
Iron OD => ox. phos. uncoupler (like salicylates) => lactic acidosis => inc. anion gap metabolic acidosis.
PCR:
-what happens during cooling (2nd step, after heating)?
Primers bind.
*important to know that the primers are added in excess.
Coronal image
-which side is the patients right side?
left side of image.
-just like if a pt was lying down.
URI: which sinuses are most commonly affected?
-why?
maxillary sinuses
-bc their path of drainage is located superior to the floor of the sinus. Thus, gravity does not favor drainage of these sinuses.
MCA territory infarct
- what sort of visual defect?
- why?
- homonymous hemianopsia.
- can damage optic radiations.
Central scotoma
-can it be caused by a vessel occlusion?
Not usually bc macula has more than 1 blood supply.
-usually due to macular degeneration or optic neuritis.
Virchow node
-which node?
left supraclavicular.
*you know its left bc thoracic duct drains into it.
Sarcomere: what are its borders:
- extends from ______ to _______.
- whats attached to these borders?
Z line to Z line.
-actin.
Sarcomere electron micrograph
-whats the darkest portion called? perpendicular to actin/myosin.
Z line.
-where actin attaches.
Z-lines
-what overlies the Z-lines?
T tubules & terminal cisternae of SR overlie the Z lines and I bands.
Which band doesn’t change length during muscle contraction?
A-band.
white patches on gingival and oral mucosa
-what is it?
oral thrush most probably.
Acute leukemia
-how can the thrombocytopenia present?
Bleeding complications like
- petechiae
- gingival bleeding
- retinal hemorrhages
Acute leukemia
-how can the leukopenia present?
Opportunistic infections
- candida (oral thrush).
- aspergillosis
- bacterial pneumonia
- perirectal infection.
What is a prominent virulence factor of aspergillus that allows it to disseminate?
Vascular invasion.
expansion of red pulp in the spleen
-one common cause?
cirrhotic liver leading to hepatosplenomegaly.
-that excess blood backup in the spleen causes expansion of the red pulp sinusoids.
Red pulp of spleen
-structure:
Blood filled sinuses and cords lined by macrophages.
esophageal varice hemorrhage
- Tx:
- mechanism?
octreotide
-indirectly constricts splanchnic vasculature by inhibiting splanchnic vasodilators (VIP, glucagon).
ADP receptor inhibitors
-which is the only one that is a reversible blocker?
ticagrelor
cutaneous anthrax
-is the black eschar painful or painless?
painless
A positive ferric chloride test is strongly suggestive of:
An aspirin overdose (b/c phenols are used in production of aspirin and this test looks for phenols).
Which thyroid carcnioma spreads hematogenously?
follicular carcinoma
