5/10 Flashcards
causes of target cells
HbC disease Asplenia Liver disease Thalassemia (HALT)
causes of echinocytes “burr cell”
End stage renal disease
liver disease
pyruvate kinase deficiency
Howell-Jolly bodies
basophilic nuclear remnants in RBCs
seen in asplenia or hyposplenia (because normally spleen macrophages remove them)
acute intermittent porphyria enzyme defect
porphobilinogen deaminase
acute intermittent porphyria symptoms
abdominal pain
wine colored urine
polyneuropathy
psych disturbances
precipitated by drugs, alcohol, starvation
porphyria cutanea tarda enzyme defected and symotoms
uroporphyrinogen decarboxylase
tea-colored urine
blistering photosensitivity
lead poisoning enzymes defect
ALA dehydratase
ferrochelatase
which protein helps retrograde transport of herpes virus (periphery–> CNS) and which protein helps anterograde transport of herpes (reactivation)?
retrograde- dyenin
anterograde- kinesin
what do you measure in amniotic fluid to test for neural tube defects?
elevated AFP
what do you measure in amniotic fluid to test for fetal lung maturity
phospholipids (pulmonary surfactant)
phenytoin Tx
gingival hyperplasia
CNS effects- ataxia, nystagmus
megaloblastic anemia
if pregnant–> fetal hydrantoin syndrome
what should you think when you hear calf swelling and then dyspnea?
pulmonary embolism
what are the blood gases with pulmonary embolism
respiratory alkalosis-
high pH, low CO2, low bicarb
hypoxemia from VQ mismatch
what is special about d-xylose?
monosaccharide that doesnt use pancreatic exocrine activity
can be used to differentiate between pancreatic insufficiency and mucosal malabsorption causes
what does the carpal tunnel contain?
flexor digitorum profundus tendons
flexor digitorum superficialis tendons
flexor policis longus tendon
median nerve
what should you incise in carpal tunnel syndrome
transverse carpal ligament (to relieve some pressure)
Antiphospholipid syndrome symptoms
DVT, PE, ischemic attacks
miscarriages!
risk factors for transitional cell carcinoma
smoking
occupational exposure- rubber, plastics, aromatic amine dyes, textiles, leather
damage to femoral nerve causes…
weak quads weak ilipsoas knee buckling- stairs difficulty diminished patella reflex sensory loss over anterior and medial thigh, and medial leg
which artery has an aneurym in CN III palsy
posterior communicating artery
on ipsilateral side
when and where is S3 best heard
during diastole, after S2, at end expiration
with bell at apex
in left lateral decubitus position
what are the sources of alkaline secretions in the duodenum
submucosal brunners glands
pancreatic secretions to the ampulla
staph scalded skin syndrome’s virulence factor
exotoxin
management of somatic symptom disorder
schedule regular visits with same provider
limit referrals and extra tests
legitimize symptoms
only mental health referral once relationship built
chancroid
painful penis ulcer with ragged borders and grey exudate
sex contact
by gram neg bacteria- Haemophilus ducreyi
chlorthalidone MOA and Tx
MOA- thiazide diuretic
Tx- reduce insulin–> high glucose, LDL cholesterol
newer generation antihistamines
loratadine, cetirizine
less side effects, safer in elderly
if male athlete suddenly gets acne, what should you think?
steroids- methyltestosterone for example
which type of cancer do people with down’s have increased risk?
ALL, and AML
what do small cell lung carcinomas stain for
neuroendorcine markers: neural cell adhesion molecule (NCAM) enolase chromogranin synaptophysin
dermatomyositis
autoimmune inflammatory disease
proximal muscle weakness, heliotrope rash
may occur alone or associated with malignancy (ovarian, lung, colorectal, non-Hodgkin lymphoma)
ionizing radiation MOA
cause double strand DNA breaks
in what way is vitamin K helpful for coag factors
cofactor for gamma-glutamyl carboxylase, which carboxylates coag factors 2,7,9,10
multidrug resistance genes encodes for…
P-glycoprotein, transmembrane ATP- dep efflux pump
cancers use this to pump out chemo drugs (hydrophobic)
CO poisoning affects…
increase in carboxyhemoglobin
decrease in oxygen carrying capacity and oxygen content in blood
but NO CHANGE in oxygen dissolved in plasma (partial pressure)
no effect on methemoglobin (drug toxicities…)
HFE mutation causes
hemochromatosis
affects HFE protein that interacts with transferritin to detect iron levels
leads to iron overload by increasing iron absorption from GI (decrease hepcidin and increase DMT1)
CD14
surface marker of monocyte/macrophages
present in granulomas of TB
what happens when Rb phosphorylated
releasese E2F txn factor
G1–>S
difference between pilocytic astrocytomas and medulloblastomas on imaging and prognosis?
pilo: solid and cystic parts, good prognosis
med: only solid; bad prognosis
Haldane effect
in lungs: binding of O2 causes release of protons and CO2 from Hb
Bohr effect
in peripheral tissues: high CO2 and H+ causes release of oxygen from Hb
pathway of neural crest cells in GI
move caudally along vagal fibers- finish at the rectum by 12 weeks
form the myenteric and meissner plexus
most common benign liver tumor
cavernous hemangioma (blood filled spaces)
antidote to rat poison
since most rat poisons contain brodifacoum (super-warfarin), antidote is fresh frozen plasma (immediate) and vitamin K (longer term)
phenotypic mixing
the acquisition of a new viral surface protein to infect a new host
but because no genetic exchange or change, the progeny will revert to not being able to bind that new host
CMV esophagitis morphology
shallow ulcers with intranuclear inclusion bodies
where does renal clear cell carcinoma originate from in the kidney?
proximal tubules
DNA pol I vs II vs III functions
all have 3’–>5’ exonuclease activity (remove mismatched nucleotides)
DNA pol I has added 5’–>3’ exonuclease activity (remove RNA primer)
which nerves are affected by injection between anterior and middle scalenes?
brachial plexus roots and trunks (eg. phrenic)
which nerves are affected temoromandibular disorder?
V3- mandible
lactate dehydrogenase deficiency
glycolysis is inhibited in strenuously exercising muscle because NAD+ cant be regenerated in the normal pyruvate –> lactate pathway
what is weak in direct hernia?
transversalis fascia
what type of hemolysis in enterococcus?
gamma hemolytic
pure red cell aplasia
rare form of marrow failure - severe hypoplasia of erythroid precursors but normal platelets and granulocytes
associated with thymomas, lymphocytic leukemias, and parvovirus b19
why is hep C genetically unstable
no proofreading 3’–>5’ exonuclease activity
how to best treat drug-induced parkisonism
centrally acting antimuscarinic agent (trihexyphidyl, benztropine)
most common cystic fibrosis mutation
F508- impaired posttranscriptional processing of CFTR
what does chronic rejection look like in lung vs kidney
lung- inflammation of small bronchioles
kidney- vascluar obliteration
conductive vs sensorineural hearing loss
c: impaired transmission of air vibration to inner ear
s: involves cochlea, or auditory nerve
rinne test
compares hearing vibration at external auditory meatus (air conduction) versus mastoid process (bone conduction)
air conduction is normally louder than bone conduction
so if someone hears mastoid better–> conductive hearing loss
weber test
put vibrating fork on top of head
sensorineural hearing loss: unaffected side will hear vibration better
conductive hearing loss: affected side will hear vibration better
how can lithium toxicities be precipitated?
volume depletion
drugs- thiazide diuretics, ACEI, NSAIDs
