6.26.16 Flashcards
obstructive sleep apnea: pathophys
sleep –> upper airway –> recurrent obstruct –> reduce ventilation –> transient hypercapnia, hypoxemia:
- reflexive systemic & pulm vasoconstrict
- sym cardiac stim
differentiate: class IA vs IB antiarr –> preferentially bind?
IC: open Na channel –> areas of normal automaticity
IB: inactivated Na channel –> areas of ischemia –> rapidly depolarize
class IA antiarrh: MOA
1) block Na channel –> depress phase 0 depolarization
2) moderate block K channel –> prolong repolarization
==> increase AP duration
injure cervical symp ganglia –> manifestation?
Horner synd
heroin withdrawal: key ssx
- dilated pupil
- yawn
- lacrimation
alcohol withdrawal w adv liver dz –> tx?
benzo without active metabolites –> lorazepam, oxazepam, temazepam
absence + tonic clonic sz –> tx?
valproate
what is: permissiveness
hormone allow another to exert its max effect
Dx: “bunches of grapes”
Caused by?
complete mole
trophoblast prolif
Dx: low LPL
familial chylomicronemia synd
how is copper eliminated?
secrete into bile –> excreted in stool
absence + tonic clonic sz –> tx –> ethosuximide?
no –> does not suppress tonic clonic sz
what is: celecoxib
selective COX2 inh
spasticity: clinical presentation
- muscle stiff
- painful muscle spasm
- scissoring gait
- lack of dexterity
T/F: familial hyperchol –> premature coronary artery dz?
T
dystrophin: fx
allow interaxn bw extracell CT & intracell contraction apparatus
what hormone exerts permissiveness?
cortisol
alcohol/benzo withdrawal: key ssx
sz
nitrate: MOA
vasc smooth muscle relax –> systemic vasodilate –> decrease LVEDV, wall stress –> decrease preload –> decrease myocardial O2 demand –> relieve angina ssx
what cytokines are produced in response to viral infect?
IFN a & B
suspensory lig of ovary: contains?
ovarian A, V, N, lymphatics
How do IFN a & B halt protein syn in virus infected cells?
signalling –> transcribe antiviral enzymes that can halt protein syn –> become active only in presence of dsRNA ==> inh protein syn only in virus infected cells
radial N injury: cause
repetitive pressure/trauma at axilla
huntingtin protein –> expand CAG trinucleotide repeats: effect?
gain of fx –> increase histone deacetylation –> repress transcription (silence) –> no neurotrophic factors –> neuron cell death
what is: lipid A
toxic component of LPS
difrerentiate: Duchenne vs Becker musc dystrophy –> type of mutation?
DMD: deletion –> frameshift
BMD: deletion –> no frameshift
2ndary bact pneumonia: 3 most common org
#1 strep pneumo #2 staph aureus #3 H flu
UV damaged DNA: repair mechanism?
nucleotide excision repair
renal A stenosis: who?
- elder (atherosclerosis)
- F of childbearing age (fibromusc dysplasia)
alcohol withdrawal –> tx?
benzo
“-cept” suffix: what kind of drug?
receptor mole
complete mole: karyotype?
46 XX or XY (paternal DNA only)
patella fracture: ssx
- acute swollen knee
- focal patella tender
- can’t extend knee against gravity
- palpable gap in extensor mechanism
complete mole: immunohist? why?
p57-
absence of maternal genome
ant cmpt of leg –> acute compartment synd –> will affect what struct?
- deep peroneal (fibular) N
- ant tibial A & V
infraorbital N injury: ssx
paresthesia:
- upper cheek
- upper lip
- upper gingiva
T/F: familial dysbetalipoproteinemia –> premature coronary artery dz?
T
septic shock: ssx
- fever
- hypotension
- diarrhea
- oliguria
- vasc compromise
- DIC
CT: location of esophagus
- bw trachea & vertebral bodies
- typically collapsed w no visible lumen
what type of dyslipidemia: tendon xanthoma
hyperchol
what can damage iliohypogastric N?
abd surg –> appendectomy
antipsychotics –> block CNS D2 receptor –> AE?
disrupt tuberoinfundibular pathway –> hyperprolactinemia –> galactorrhea, amenorrhea
what are the hydrophobic aa?
- alanine
- valine
- leucine
- isoleucine
- phenylalanine
- tryptophan
- methionine
- proline
- glycine
colchicine: MOA
bind tubulin –> inh microtubule formation –> impair neutrophil mitosis, chemotaxis
complete mole –> treated –> must monitor what? why?
B-hCG
high risk for malig transformation –> invasive mole, choriocarcinoma
“-nib” suffix: what kind of drug?
kinase inh
norovirus gastroenteritis: ssx
- vomit
- watery diarrhea
decreased V compliance –> leads to?
diastolic heart fail
Dx: unilat kidney atrophy
renal A stenosis
diastolic heart fail –> effect on: LVEF, LVEDV, LV filling pressure
- LVEF: normal
- LVEDV: normal
- LV filling pressure: increased
lactose intolerance: pathophys
lactase def
heroin is what type of subst?
opioid
Duchenne musc dystrophy: who?
2-5yo M
pernicious anemia: pathophys
autoimmune –> CD4+ T cells –> destroy parietal cell
IFN a & B: role in viral infect
suppress viral replication:
- halt protein syn
- promote apoptosis of infected cells
==> limit virus ability to spread
baclofen: MOA
GABA-A receptor agonist –> decrease excitability of spinal reflexes
radial N injury: motor findings
weak extensors:
- forearm
- hand
- finger
==> wrist drop, absent triceps reflex
direct frontal trauma to orbit –> fractures what?
orbital floor
name a microsomal monooxygenase
CYP450
cortisol –> permissiveness –> effect?
- increase glucose release by liver in response to glucagon
- increase vasc & bronchial SM reactivity to catecholamines
dystrophin gene: location
X chrom p21
what mutation causes mast cell prolif?
KIT
norovirus outbreaks: where?
school, cruise ship, nursing homes
CYP450 –> role in carcinogen?
convert pro-carcinogen to active carcinogen
lipid A: pathophys
activate macrophage –> widespread IL-1, TNFa release –> septic shock
complete mole: US
diffuse echogenic material –> “snowstorm”
tuberoinfundibular pathway: fx
inh prolactin secretion
major basic protein: where? fx?
eosinophil granules –> help defend against parasite
X chrom p21 mutation –> dx?
DMD or BMD
complete mole: high B-hCG –> leads to?
- hyperemesis gravidarum
- theca lutein cysts (d/t stim ovarian growth)
direct impact to ant aspect of knee –> leads to?
patella fracture
what induces CYP450?
- carbamazepine
- barbiturates
- phenytoin
- rifampin
- griseofulvin
- St John’s wort
- modafinil
- cyclophosphamide
etanercept: use
mod-severe RA –> adjunct to methotrexate if methotrexate alone not work
dx: wrist drop, absent triceps reflex
radial N injury
differentiate: alcohol vs benzo withdrawal
alcohol: delirium
benzo: no delirium
what type of dyslipidemia: acute pancreatitis
familial chylomicronemia synd
radial N injury: sensory findings
sensory loss:
- post arm, forearm
- dorsolat hand
- dorsal thumb
Duchenne musc dystrophy: pathophys
dystrophin deletion
skeletal muscle contraction: Ca2+ fx?
SR –> release Ca2+ –> bind troponin C –> allow actin to bind myosin
what is: power
probability of seeing a difference when there is one
what is: B-endorphin
endogenous opioid peptide
how does sun exposure cause DNA damage?
UV –> create pyrimidine dimers
Dx: dilated pupils, piloerection, hyperactive bowel sounds, lacrimation, yawning
opioid withdrawal
nigrostriatal pathway: fx
regulates coordination of vol mvmt
ipsilat shoulder pain, upper limb paresthesia, areflexic arm weak –> what struct is injured?
brachial plexus
etanercept: MOA
decoy receptor for TNFa –> inh TNFa
acute pancreatitis: 2 most common causes
#1 gallstone #2 alcohol abuse
where is: cerebellopontine angle
bw cerebellum & lateral pons
Dx: macrocytosis, AST:ALT >2
chronic alcohol use
what type of dyslipidemia: eruptive skin xanthoma
hyperTG
spasticity is a common problem in what dz?
mult sclerosis
what stimulates gastric acid secretion?
- histamine
- ACh
- gastrin
acoustic neuroma: common location
cerebellopontine angle
auer rod found in what cell?
myeloblast
radical mastectomy w axillary lymph node dissection: comp
chronic lymphedema –> angiosarcoma
what is: systemic mastocytosis
abnormal prolif of mast cells –> increase hist release
acoustic neuroma: ssx
- sensorineural hearing loss
- tinnitis
chlordiazepoxide: drug class?
benzo
Duchenne musc dystrophy: how does it manifest?
- proximal muscle weak
- distal muscle enlarge
acute compartment synd: most common location
ant cmpt of leg
acute compartment synd: ssx
- severe pain
- myonecrosis
- N injury
protein –> mult a-helical regions –> composed of valine, alanine, isoleucine –> what is the fx of this region?
anchor to cell membrane
complete mole: trophoblast secretes?
B-hCG
contact dermatitis: what happens with chronic exposure?
lesions become less edematous –> stratum spinosum & corneum thicken
status epilepticus: initial tx
IV lorazepam + phenytoin
differentiate: opioid vs alcohol/benzo withdrawal: how serious?
- opioid: non-life threatening
- alcohol/benzo: sz
iliohypogastric N: fx
sensory:
- suprapubic
- gluteal
motor:
- ant-lat abd wall muscles
orbital floor fracture –> why is vertical gaze impaired?
inf rectus M become entrapped
compound nevus: lesion
slight raised papule –> uniform pigment, symm sharp border
can HTN lead to hypertrophic cardiomyopathy?
no
familial chylomicronemia synd: onset?
childhood
Dx: Gower sign & calf enlargement
DMD
what is the major blood supply to the ovary?
ovarian A
carbamazepine: MOA
reduce Na channel ability to recover from inactivation –> inh neuronal high-freq firing
phenytoin: MOA
Na channel –> decrease ability to recover from inactivation –> inh neuron high freq firing
MI –> ventricular arrhythmia –> tx?
amiodarone
high levels of what decrease risk for gallstone?
bile salt & phosphatidylcholine –> increase chol solubility
carbamazepine: need to monitor what? why?
BM suppress –> monitor CBC
what inflamm dz can cause 2ndary (acquired) lactose intolerance?
celiac dz
what infection can cause 2ndary (acquired) lactose intolerance?
giardia
obstructive hydrocephalus: ssx
- papilledema
- HA
- vomit
what type of dyslipidemia: xanthelasma
hyperchol
what does proopiomelanocortin (POMC) produce?
- B-endorphins
- ACTH
- MSH
tachycardia, HTN, hyperthermia, diaphoresis, mydriasis –> intoxicated w what subst?
stimulant
familial chylomicronemia synd: clinical manifestation
- recurrent acute pancreatitis
- hyperTG
- lipemia retinalis
what is: infliximab
monoclonal Ab –> irrev bind & inh TNF-a
what is: Gower sign
use hands to get up –> compensate for proximal muscle weak
defect in nucleotide excision repair –> leads to?
xeroderma pigmentosum
nucleotide excision repair: MOA
1) endonuclease complex –> recog deformed helix –> single strand cleavage on both sides
2) damaged segment discarded
3) DNApol –> synthesize new segment
4) DNA ligase –> ligate gap
dorsal midbrain (Parinaud) synd: charact
- limited upward gaze
- bilat eyelid retraction
- light-near dissoc (pupil react to accommodation but not to light)
what is: Stewart-Treves synd
chronic lymphedema –> predispose to angiosarcoma
nicotine withdrawal: key ssx
increased appetite
when is LPS released?
bacterial cell:
- divide
- lyse
LPS is NOT actively secreted!
contact dermatitis: histology
spongiosis –> accumulation of edema fluid in intercell spaces of epidermis
systemic mastocytosis: ssx
- hypotension
- flushing
- pruritis
- gastric hypersecrete
germinoma: clinical presentation
- obstructive hydrocephalus
- dorsal midbrain (Parinaud) synd
- endocrinopathy (if in suprasellar region –> pit/hypo dysfx)
stimulant (cocaine, amphetamine) withdrawal: key ssx
- intense psychomotor retardation
- severe depression (“crash”)
what is the precursor to nitric oxide?
arginine
contact dermatitis: gross findings
erythematous, papulovesicular, weeping lesions
complete mole: composed of?
edematous hydropic villi –> “bunches of grapes”
radial N: fx
motor: extensors –> forearm, hand, finger
sensory:
- post arm, forearm
- dorsolat hand
- dorsal thumb
Dx: benign prolif of melanocytes –> dermis & epidermis
compound nevus
giardia –> can lead to?
lactose intolerance
acid a-glucosidase: fx
brkdown glycogen in lysosome
lots of auer rods can be found in what dz?
acute promyelocytic leukemia
IV lorazepam + phenytoin for initial tx of status epilepticus –> role of each?
lorazepam: stop sz
phenytoin: prevent sz recurrence
signs of radial N injury but triceps brachii is spared –> dx?
distal radial N injury
what nerve is found at the orbital floor?
infraorbital N
what is: status epilepticus
- 1 sz –> >5min
- mult sz –> incomplete recovery of consciousness bw episodes
Pompe dz: ssx
early infancy:
- cardiomegaly
- macroglossia
- profound musc hypotonia
alcohol abuse: liver lab finding?
> 2 AST: ALT
what is: spasticity
- increase resistance to passive muscle mvmt
- velocity-dep increase in tonic stretch reflex
2ndary (acquired) lactose intolerance: pathophys
inflamm, infect –> damage microvilli –> damage cells slough off –> immature cells replace –> low lactase
brain, spinal cord dz –> spasticity –> tx?
- baclofen
- tizanidine
gamma-glutamyl transpeptidase (GGTP): use
GGTP predominantly present in hepatocytes & biliary epithelia –> determine whether elevated alk phos is of hepatic of bony origin
acid a-glucosidase def –> leads to?
Pompe dz
power: calc
1-B
B = type II error rate
what is: auer rod
deformed azurophilic granules in myeloblast cyto –> stain positively for myeloperoxidase
improperly fitted crutches –> lead to?
“crutch palsy” (proximal radial N injury)
what is: eczematous dermatitis
grp of conditions charact by erythematous, papulovesicular, weeping lesions
hypertrophic cardiomyopathy: pathophys
AD –> cardiac sarcomere –> severe myocardial hypertrophy
Duchenne musc dystrophy: mode of inheritance
XR
trigeminal neuralgia –> tx?
carbamazepine
nitric oxide synthase: rxn
arginine –> nitric oxide
what inh CYP450?
- amiodarone
- cimetidine
- fluoroquinolone
- clarithromycin
- azole antifungal
- grapefruit juice
- isoniazid
- ritonavir (protease inh)
cryptococcus neoformans: most common manifestation
meningoencephalitis
what is another name for the suspensory lig of ovary?
infundibulopelvic lig
elder –> insomnia –> tx?
ramelteon
acoustic neuroma: derived from?
vestibulocochlear N –> vestibular portion –> Schwann cell
what is: suspensory lig of ovary
fold of peritoneum that attach ovary to pelvic sidewall
what part of brain is responsible for inh prolactin secretion?
tuberoinfundibular pathway
what is the major form of copper in the human body?
ceruloplasmin
alcohol withdrawal: ssx
- insomnia
- tremulous
- anxiety
- autonomic hyperactivity
dx: suprapubic region –> decrease sensation, burning pain
iliohypogastric N injury
obstructive sleep apnea: comp
- systemic HTN
- pulm HTN –> RH fail
Pompe dz: muscle bx
lysosomes –> abnormal glycogen accumulation
to avoid excessive bleed during oophorectomy, the surgeon should ligate what struct?
suspensory lig of ovary
what is the most common pineal gland tumor?
germinoma
T/F: familial chylomicronemia synd –> premature coronary artery dz?
F
familial chylomicronemia synd: enzyme
lipoprotein lipase
mesolimbic & mesocortical pathway: fx
regulate cognition, beh
what are the major dopaminergic pathways in the brain?
- mesolimbic & mesocortical
- nigrostriatal
- tuberoinfundibular
angiosarcoma: RF
chronic lymphedema
complete mole: classic clinical findings
- 1st trimester –> vaginal bleed
- enlarged uterus inconsistent w dates
- extremely high B-hCG
viral gastroenteritis: #1 cause?
norovirus
acute compartment synd: cause
increased pressure in fascial compartment of limb –> impair perfusion
E.coli –> septic shock –> what bacterial factor caused it?
lipid A
Pancoast tumor: can involve what struct?
- brachial plexus
- cervical sym ganglia
Pompe dz: enzyme?
acid a-glucosidase
