5/5-5/6 Mixed, Behavioral Science Flashcards
Nucleolus function
Primary site of ribosome synthesis and assembly
All ribosomal RNA except 5S rRNA is transcribed in the nucleolus
Low pitched holosystolic murmur heard best at left sternal border with accentuation during hand grip exercise
Ventricular septal defect
Major immune mechanisms against Giardia
CD4+ T helper cells
Secretory IgA production
IgA deficiency, X-linked agammaglobulinemia, common variable immune deficiency have a predisposition to developing chronic giardiasis
Clinical manifestations of left vs. right sided frontal lesions
Left sided: apathy, depression
Right sided: disinhibited behavior
Root causes analysis
Quality improvement measure that identifies what, how, and why a preventable adverse outcome occurred.
The first step involves collecting data mainly through interviewing multiple individuals involved in the steps leading to the outcome.
Heart failure compensatory actions
Activation of renin-angiotensin-aldosterone
Activation of sympathetic nervous system
ADH secretion
Result in increased afterload (from excessive vasoconstriction), excess fluid retention, and deleterious cardiac remodeling.
Risperidone SE
Hyperprolactinemia
Risperidone inhibits D1 and D2 receptors, as well as serotonergic and alpha-adrenergic pathways (loss of normal tonic inhibition of prolactin release)
Galactorrhea and beast soreness, amenorrhea
Mitral stenosis heart sounds
Loud first heart sound
Early diastolic opening snap after second heart sound
Low pitched diastolic rumble
Best heard at cardiac apex
Dizygotic twins
Dichorionic/Diamnionic
Left ventricular leads in biventricular pacemakers
Course through coronary sinus
Resides in the atrioventricular groove on the posterior aspect of the heart
First line agent Rx for narcolepsy
Modafinil (psychostimulant) to improve daytime sleepiness
Bisphosphonates (Alendronate, Risedronate)
Preferred initial treatment for osteoporosis
Similar chemical structure to pyrophosphate
Disrupt osteoclast function by attaching to hydroxyapatite binding sites on bony surfaces
Vertebral subluxation
Long-standing rheumatoid arthritis can affect the cervical spine, causing vertebral malalignment (subluxation) that can affect the atlantoaxial join
Extension of the neck during endotracheal intubation can worsen the subluxation, leading to acute compression of the spinal cord and/or vertebral arteries
Patient can develop paralysis with decreased or absent reflexes below the level of compression (spinal shock), hypotension due to loss of sympathetic tone, and/or sudden death
Statistical test employed to determine if the means of 2 populations are equal
Two sample t test
Need: 2 mean values, sample variances (standard deviations), sample sizes
If p
Most common SE of Aspirin
GI mucosal injury and bleeding
Due to COX-1 inhibition, results in impaired prostaglandin-dependent GI mucosal defense and decreased platelet aggregation
Acute promyelocytic leukemia (APML)
Translocation involving retinoic acid receptor alpha (RARA) gene from chromosome 17 and the promyelocytic leukemia (PML) gene on chromosome 15 leads to PML/RARA, a fusion gene whose produce inhibits differentiation of myeloblasts and triggers development of APML
Auer rods
Anemia, thrombocytopenia, neutropenia, DIC,
Rx: All-trans retinoic acid
Small cell carcinoma of the lung
most aggressive type of lung cancer
neuroendocrine origin
tumor cells express neuroendocrine markers and contain neurosecretory granules in the cytoplasm
Ultraviolet light exposure
Pyrimidine dimers are formed > covalent bonds between adjacent thymine or cytosine residues
They are recognized by a specific endonuclease complex that initiates the process of repair by nicking the damaged strand on both side of the pyrimidine dimer. The damaged segment is excised and replacement DNA is synthesized by DNA polymerase.
Complement binding site on IgG and IgM
At the Fc portion closer to the hinge region
Classical complement cascade begins with binding of C1 complement component to either 2 molecules of IgG or 2 molecules of IgM
Chronic granulomatous disease
Inactivation mutation of NADPH oxidase (X linked)
Impaired respiratory burst inhibits phagocytic intracellular killing
Recurrent infections with catalase-positive bacteria and fungi
Lungs, skin lymph nodes and liver most commonly involved
Diffuse granuloma formation
Dx: measurement of neutrophil superoxide production of DHR flow cytometry
-absence of fluorescent green pigment
B thalassemia
Hypochromic, microcytic anemia due to decreased B globin chain synthesis
Unpaired a chains precipiate within red cells and cause membrane damage leading to ineffective erythropoisesis and extravascular hemolysis.
Conversion disorder
Functional neurologic symptom disorder
Neurologic symptom incompatible with any known neurologic disease, often acute onset associated with stress
Southwestern blotting
Used to detect DNA-binding proteins such as transcription factors, nucleases, histones.
Ex. c-Jun and c-Fos
Calculating blood flow
Directly proportional to the vessel radius raised to the fourth power.
Resistance to blood flow is inversely proportional to the vessel radius raised to the fourth power.
MOA of morphine
Morphine binds mu receptors (G protein-coupled receptors) whose actions are mediated through several 2nd messenger pathways.
One pathway involves increased K efflux. Binding of morphine to mu results in G protein-couple activation of K conductance. K efflux increases and causes hyperpolarization of postsynaptic neurons effectively blocking pain transmission.
Most common site for acute compartment syndrome and associated structures
Anterior compartment of the leg
Foot extensor muscles, anterior tibial artery, deep peroneal (fibular) nerve
Injury to the nerve causes decreased sensation between the first and second toes, decreased dorsiflexion of the food, foot drop, claw foot
Thoracentesis placement
ABOVE the 8th rib in the midclavicular line, 10th rib along the midaxillary line, the 12th rib along the posterior scapular/paravertebral line
Insertion of needle lower than these points increases the risk of penetrating abdominal structures
Insertion of the needle on the inferior margin of the rib risks striking the subcostal neurovascular bundle
Risk factors for angiosarcoma (Stewart-Treves syndrome)
Chronic lymphedema predisposes to the development of angiosarcoma.
Axillary lymph node dissection is a risk factor for the development of chronic lymphedema involving the ipsilateral arm.
SE of first generation antihistamines (chlorpheniramine, diphenhydramine)
Antimuscarinic, antialpha adrenergic and antiserotonergic properties.
Anticholinergic effects on the ocular ciliary muscles impair accommodation and cause blurring of vision for close objects.
Histoplasma capsulatum
Small ovoid bodies within a macrophage
Can survive intracellularly and cause systemic disease disseminated histoplasmosis causes hepatosplenomegaly and ulcerated lesions on the tongue.
SE of phenytoin
Phenytoin is a anticonvulsant effective in the Rx of tonic-clonic seizures, partial seizures, and status epilepticus.
Gingival hyperplasia is a common side effect and is sometimes reversible when phenytoin is withdrawn.
Phenytoin causes increased expression of platelet derived growth factor (PDGF). When gingival macs are exposed to increase PDGF, they stimulate proliferation of gingival cells and alveolar bone.
Phenytoin toxicity mainly affects the cerebellum and vestibular system, causing ataxia and nystagmus.
MOA of Flutamide
A nonsteroid agent that acts as a competitive testosterone receptor inhibitor.
Used in the treatment of prostate cancer.
Rx for restless leg syndrome
Dopamine agonists
Cholestyramine MOA
Bile acid-binding resin
Binds bile acids in GI tract, causing increased bile acid excretion. Results in hepatic synthesis of new bile acids, activated HMG CoA reductase and increases hepatic cholesterol synthesis. (Block with statin drug)
Increases hepatic cholesterol and bile acid synthesis.
Best auscultatory indicator of mitral stenosis severity
Length of time between S2 (specifically the A2 component, caused by aortic valve closure) and the opening snap (OS), i.e. A2-OS interval.
Shorter =more severe stenosis.
Meglitinides (repaglinide, nateglinide) MOA
Short-acting glucose lowering medications
Functionally similar to sulfonylureas, act by binding to and closing the ATP-dependent K channel in beta cells, inducing depolarization and L type Ca channel opening, Ca influx stimulates beta cell insulin relase
Changes of respiratory tract lining
Bronchi have a pseudostratified columnar ciliated epithelium with goblet cells and submucosal mucoserous glands and cartilage.
Bronchioles, terminal bronchioles, and respiratory bronchioles generally lack goblet cells, glands, and cartilage.
By the level of the terminal bronchioles, the airway epithelium is ciliated simple cuboidal. Epithelial cilia persist up to the end of the respiratory bronchioles.
Patients with chronic hemolytic anemia (i.e. sickle cell disease) are predisposed to____
Folic acid deficiency and macrocytic changes due to increased erythrocyte turnover.
First line medications for bipolar maintenance
Lithium, Valproate, Quetiapine
Oppositional Defiant Disorder
Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness for >6 months
Behavioral disorder of childhood
Learning disorders
Difficulties with key academic skills (reading, writing, mathematics), resulting in performance well below expectations for age level.
Children commonly display symptoms of anxiety, inattention, or hyperactivity when under stress.
Generalized Anxiety Disorder
Experience excessive and uncontrollable worry about multiple issues
Symptom duration >6 months
Muscle tension, sleep disturbance, sweating/nausea
Rx: cognitive behavioral therapy and antidepressants (SSRI and SNRI)
Major Depressive Disorder
Last > 2 weeks
>5 of the following 9 symptoms (at least 1 symptom is either depressed mood or loss of interest or pleasure)
Depressed mood Loss of interest or pleasure Change in appetite or weight Insomnia or hypersomnia Psychomotor retardation or agitation Low energy Poor concentration or indecisiveness Thoughts of worthlessness or inappropriate guilt Recurrent thoughts of death or suicide
Buspirone
Nonbenzodiazepine anxiolytic
Rx: GAD
No useful in the treatment of acute anxiety due to its slow onset of action (clinical response typically delayed 2 weeks). Not effective in treating panic disorder.
ADHD Rx MOA
Stimulant drugs (methylphenidate, amphetamines)
Increase release of NE and dopamine
Block NE and dopamine reuptake at synapses in prefrontal cortex
Delirium
Reversible, acute confusional state involving a reduced or fluctuating level of consciousness with difficulties sustaining attention and impaired memory and executive function.
Commonly seen in elderly patients with medical illness
Often associated with anxiety, agitation, delusions, hallucinations
Schizotypal personality disorder
Eccentric behavior, odd thoughts, perceptual distortions, social anxiety, magical thinking
Rx for Generalized Anxiety Disorder
SSRIs (citalopram), SNRI
Rapidly progressive glomerulonephritis (RPGN)
Deposition of fibrin within Bowman’s space
Crescent formation on light microscopy
Crescents consist of glomerular parietal cells, monocytes, macrophages, abundant fibrin
Crescents eventually become sclerotic, disrupting glomerular function and causing irreversible renal injury
Homeobox
Highly conserved DNA sequence (180 nucleotides in length)
A gene containing a homeobox sequence is called a homeobox or hox gene
These genes typically code for transcription factors that bind to regulatory region on DNA, altering the expression of genes involved in segmental organization of the embryo.
Homeobox gene mutations interrupt the developmental process, often resulting in severe abnormalities such as skeletal malformation and improperly positioned limbs and appendages.
Acute serum sickness
Caused by tissue deposition of circulating immune complexes = type III hypersensitivity
Fever, pruritic skin rash, arthralgia, lymphadenopathy, proteinuria, low serum C3 and C4
Small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration
Deposition of IgG and IgM complement fixing antibodies results in localized complement consumption and hypocomplementemia (decreased serum C3 level)
Can occur follow admin of antigenic heterologous proteins such as chimeric monoclonal Ab (rituximab, infliximan) or nonhuman immunoglobulins (venom antitoxins), also associated with use of certain nonprotein drugs (penicillin, cefaclor, TMX-SMP)
Internal laryngeal nerve
Mediates the afferent limb of the cough reflex above the vocal cords
Foreign bodies (eg chicken or fish bones) can become lodged in the piriform recess and may cause damage to the nerve, impairing the cough reflex
Nerves responsible for biceps reflex
C5-C6 spinal nerves
also control brachioradialis reflex
Reid Index
Ratio of the thickness of the mucous gland layer in the bronchial wall submucosa to the thickness of the bronchial wall between the respiratory epithelium and bronchial cartilage
Chronic bronchitis
Elevations of reid index above the normal value of 40% (0.4) correlate well with the duration and severity of chronic bronchitis
Non-lactose fermenting, oxidase negative, motile, gram negative organism with a capsule
Salmonella
Common cause of osteomyelitis in patients with sickle cell disease (asplenia)
Capsule protects from opsonization/phagocytosis
Female with ambiguous genitalia, hypertension, and hypokalemia….enzyme deficiency?
11-hydroxylase deficiency
results in excessive adrenal androgen and mineralocorticoid (11-deoxycorticosterone) production
Aortic regurgitation
Early “blowing” diastolic decrescendo murmur
Bounding femoral and carotid pulses
Head bobbing
Causes an increase in total stroke volume with abrupt distension and rapid falloff of peripheral arterial pulses > wide pulse pressure.
Maintenance dose
= cpss (steady-state plasma concentation) x CL (clearance) / [bioavailability fraction, =1 if IV
x 60 min x X hours (for intervals)
Rx for hypertriglyceridemia
Fibrates (fenofibrate, gemfibrozil)
Activate peroxisome proliferator activated receptor alpha (PPAR-a), which increases lipoprotein lipase activity; then can rapidly lower triglycerides by 25-50%
Severe hypertriglyceridemia can lead to acid pancreatitis
Spherocytosis
Red cell index
Elevated mean corpuscular hemoglobin concentration (MCHC)
Rx pulmonary infections/abscesses involving anaerobic flora (bacteroides, prevotella, fusbacterium, peptostreptococcus) and aerobic bacteria
Clindamycin!!
Alcoholics are more likely to develop these infections
Hepcidin
Acute phase reactant
Synthesized in liver
Acts as a central regulator of iron homeostasis
High iron levels and inflammatory conditions increase the synthesis of hepcidin; hypoxia and increased erythropoiseis act to lower hepcidin
Low hepcidin levels increase intestinal iron absorption and stimulate iron release by macrophages
Rx calcium oxalate kidney stones
Thiazide diuretics
Decrease urine Ca excretion, increase Ca reabsorption through inhibition of the Na/CL cotransporter (DCT) and hypovolemia
Contraindicated in hypercalcemia
Rx status epilepticus
IV benzodiazepine (lorazepam)
Cause increase influx of chloride ions in response to GABA binding, leads to hyperpolarization of postsynaptic neuron and suppression of action potential firing
Legionella infection
High fiber in smoker accompanied by diarrhea, confusion, and cough
Sputum sample often shows few or no bacteria (lipopolysaccharide chains on outer membrane inhibit gram staining)
Test for legionella antigen in urine, hyponatremia
Rx: respiratory fluoroquinolones
Myasthenia gravis
Ptosis and diplopia
muscle weakness worsens with activity
Majority of patients have thymoma or thymic hyperplasia
Thymus is derived from the third pharyngeal pouch, as are the inferior parathyroid glands
ACE inhibitors
Reduce angiotensin II levels
Cause efferent arteriole dilation
Decrease glomerular pressure/filtration rate
Can precipitate acute renal failure in patients with reduced intrarenal perfusion pressure (renal artery stenosis, CHF, hypovolemia, chronic renal disease)…increased creatinine
