6.29.16 Flashcards
hypoCa: ssx
- muscle cramp
- perioral paresthesia
- hypotension
- NM hyperexcitable
cavernous sinus thrombosis: ssx
- HA
- fever
- proptosis
- ipsilat deficits in CN III, IV, VI, V (ophthalmic & maxillary br)
what is: washout period
crossover study: period of no tx bw trtmt intervals to limit confounding effects of prior tx
adenine at end of tRNA: fx
aa binding site
xanthelasma: assoc dz
1ary, 2ndary hyper/dys-lipidemia
clomiphene: MOA
estrogen receptor modulator –> decrease neg feedback inh on hypothalamus by circulating estrogen –> increase gonadotropin (FSH & LH) production –> ovulation
LA enlarge –> leads to?
compress esophagus –> dysphagia
Dandy Walker malformation: clinical presentation
infant:
- dev delay
- progressive skull enlrg
- cerebellar dysfx
- non-communicating hydrocephalus
pulm HTN: comp
cor pulmonale (RV fail)
opportunistic infections in HIV –> toxoplasma gondii –> prophylactic? when?
TMP/SMX
MVP: #1 cause
mitral valve CT protein defect –> predispose to myxomatous degen of mitral leaflets & chordae tendinae
PCOS pt –> desire fertility –> tx?
clomiphene
ubiquitin proteasome pathway: fx in immune response
degrade foreign intracell proteins –> viral particles –> antigen presentation on MHC class I
pyruvate kinase def: pathophys
insuff ATP production –> cannot maintain RBC struct –> hemolytic anemia
splenic parenchyma –> increase work to remv deformed RBCs –> splenic hyperplasia
what is the most common indicator of obesity-related dz? what else might you find?
reduced ERV –> reduce FRC
decreased: FEV1, FVC, TLC
release of sarcoplasmic Ca stores following NM Ach stim allows?
synchronization of skeletal muscle contraction & glycogen brkdown –> provide energy necess for anaerobic muscle contract
toxic megacolon: what dx studies are CI?
- barium contrast
- colonoscopy
- -> risk for perforation
VSD: onset
neonatal period after pulm vasc resistance has declined –> enable L-to-R shunting
where is the descending aorta?
post to esophagus & LA
what is: case-ctrl study
1) select pts w dz (case)
2) no dz (ctrl)
- -> determine previous exposure status
what aa play an important role in transporting N throughout body?
- alanine
- glutamine
toxic megacolon: ssx
- abd pain/ distention
- bloody diarrhea
- fever
- signs of shock
renal cell CA: cell of origin
epithelial cells of proximal renal tubules
retinal artery occlusion –> leads to?
acute, painless, monocular vision loss
opportunistic infections in HIV –> mycobact avium complex –> prophylactic? when?
azithromycin
what is: expiratory reserve vol
max vol of air that can be expired after normal tidal expiration
viral bronchiolitis: ssx
- low grade fever
- cough
- tachypnea
- increased work of breathing –> retractions
- diffuse wheezes, crackles
ophthalmic V injury: ssx
impaired venous drainage:
- proptosis (eye protrusion)
- chemosis (conjunctival swelling)
what should you do if you suspect a VSD?
echocardiography –> confirm size & location
how are proteins marked to go to lysosome?
phosphotransferase enzyme –> phosphorylate specific mannose residues –> ensure proper transit thru Golgi apparatus
viral bronchiolitis: most common cause
RSV
how is acid primarily excreted in urine?
in the form of NH4+ & titratable acids (H2PO4-)
what can lead to a C diff infection?
absence of normal intestinal microbial flora
lobar pneumonia –> resolution: key features
microscopic: enzymatic digestion of exudate
gross: restoration of normal architecture
hairy cell leukemia: how dx?
- BM bx
- flow cytometry (has replaced tartrate-resistant acid phosphatase (TRAP) activity testing)
what are the 2 categories of ssx of hypoglycemia?
- neurogenic (autonomic)
- neuroglycopenic
what is: xanthelasma
type of xanthoma –> yellowish macule/papule on medial eyelid –> dermal accumulation of macrophages containing chol & TG
renal cell CA: gross appearance
golden yellow mass d/t high lipid content in cells –> “clear cell”
esophagus is in closest proximity to what part of the heart?
LA
free ammonia: fx
excreted into urine by kidney for acid-base reg
1ary biliary cirrhosis –> can lead to?
hyperchol
lobar pneumonia –> red hepatization: key features
day 2-3
microscopic: alveolar exudate –> RBC, neutrophil, fibrin
gross: red, firm –> liver-like consistency
Lyme dx: tx? use?
- doxycycline –> erythema chronicum migrans
- PCN-type abx –> ceftriaxone –> prevent progress to late Lyme dz
what part of the spleen undergoes hyperplasia in pyruvate kinase def?
red pulp –> reticuloendothelial cells in red pulp involved in remval of damaged RBCs
hairy cell leukemia –> BM fail –> pathophys?
infiltrate BM –> cytokine –> fibrosis –> BM fail –> pancytopenia
C diff infect: #1 RF?
abx tx
thyroid surg –> can injure what N? why?
recurrent laryngeal N
close proximity to inf thyroid A
opportunistic infections in HIV –> histoplasma capsulatum –> prophylactic? when?
itraconazole
hypoglycemia: neurogenic (autonomic) ssx
sympathoadrenal activation:
- NE/Epi: tremulous, palpitation, anxiety/arousal
- ACh: sweat, hunger, paresthesia
VSD: clinical presentation
depend on size of defect:
- small –> asympt holosystolic murmur
- lrg –> HF
viral bronchiolitis: onset
what is: crossover study
subject randomly allocated to seq of 2 or more tx given consecutively
increased cGMP –> leads to?
decrease intracell Ca –> decrease myosin light chain kinase activity –> myosin light chain dephosphorylate –> vasc SM relax
adult –> painless hematuria –> suspect?
GU malig
CN III palsy: ssx
- ptosis
- mydriasis
what is: Kartagener synd
triad:
- situs inversus
- chronic sinusitis
- bronchiectasis
PCOS: clinical features
- obesity
- menstrual irreg
- hirsutism
- enlarged ovary
- increase risk of DM, endometrial hyperplasia
CN III, iV, VI injury: ssx
ocular muscle paralysis
ubiquitin ligase: fx
recog specific protein substrate –> attach ubiquitin tag –> ubiquitin proteasome pathway
colchicine: AE? why?
disrupt microtubule –> impair GI mucosal fx –> diarrhea, N/V, abd pain
transesophageal echocardiography best visualizes what struct?
- LA
- descending aorta
what forms the majority of the post surface of the heart?
LA
what is: functional residual capacity
RV + ERV
what part of the body extracts the most O2?
myocardium
what is the most common indolent non-Hodgkin lymphoma in adults?
follicular lymphoma
Lyme dz –> late: ssx
- chronic asymm lrg jt arthritis
- encephalopathy
MVP: murmur
midsystolic click & mid-late systolic murmur of mitral regurg
hairy cell leukemia: charact
- BM fail
- infiltration into reticuloendothelial system –> massive splenomegaly
- dry tap
- lymphocytes w cytoplasmic projections
Lyme dz –> early: ssx
- flu-like ssx
- erythema chronicum migrans
how is phosphorylase kinase (PK) activated in liver?
liver –> Epi, glucagon –> bind Gs –> increase cAMP –> PKA –> phosphorylate PK
glucose-alanine cycle: fx
help remv excess N
protein catabolism: major steps
1) protein –> alanine
2) amino grp –> transfer to a-ketoglutarate –> form glutamate
3) liver –> process glutamate –> urea
what codon initiates protein syn?
AUG
acute gouty arthritis: 2nd line tx? MOA?
colchicine
leukocyte: inh tubulin polymerization –> inh microtubule formation –> reduce neutrophil chemotaxis & migration to sites inflamed by monosodium urate xl deposition
recurrent laryngeal N injury: ssx
vocal cord paralysis
follicular lymphoma: ssx
painless waxing & waning LAD
Dx: muscle cramp, perioral paresthesia, hypotension, NM hyperexcitable
hypoCa
ant wall MI: comp? when?
5-14 day after –> LV free wall rupture –> hemopericardium, cardiac tamponade –> profound hypotension, shock –> rapid progress to pulseless electrical activity –> death
what is: hibernating myocardium
- reduced coronary blood flow at rest –> chronic myocardial ischemia –> LV systolic dysfx –> decrease contractility
- partially, completely reversible by coronary revascularization
PCOS: charact
- elevated LH
- excess androgen production
- insulin resistance
what is used to degrade proteins for antigen presentation?
ubiquitin proteasome pathway
vitK def –> can lead to?
life-threatening bleeding diathesis:
- intracranial hemorrhage
- profuse bleeding from GI, umbilicus, surg sites
what are signs of NM hyperexcitability?
- Chvostek sign
- Trousseau sign
pyruvate kinase: rxn
glycolysis: PEP –> pyruvate + ATP
ulcerative colitis: comp
- toxic megacolon
- carcinoma
PCOS: tx? effect?
- wt loss –> reverse insulin resistance, restore normal ovulatory fx
- OCP (not want to become preg) –> minimize endometrial prolif, reduce androgenic ssx, prevent unwanted preg
xanthelasma: #1 cause
LDL receptor abnormality
C diff overgrowth –> leads to?
- transient diarrhea
- pseudomembranous colitis
what are the 4 stages of lobar pneumonia?
1) congestion
2) red hepatization
3) gray hepatization
4) resolution
retinal artery occlusion: cause
atherosclerosis –> thromboembolism –> travel from internal carotid A –> ophthalmic A –> retinal A
phosphorylase kinase (PK): fx
phosphorylate glycogen phosphorylase –> activate
opportunistic infections in HIV –> pneumocystis jirovecii –> prophylactic? when?
TMP/SMX
pyruvate kinase def: ssx
- hemolytic anemia
- splenic hyperplasia
tRNA –> what serves as the aa binding site?
adenine residue at 1 end of the mole
phosphoprotein phosphatase: fx
dephosphorylate glycogen phosphorylase –> inactivate
Epi: fx in glucose metab
- limit glucose use by insulin-sens tissues
- stim hepatic glycogenolysis, gluconeogenesis
what is: hairy cell leukemia
middle age M –> indolent B cell neoplasm
location: degraded protein coupled to MHC class I
ER
neonatal vitK def: RF
- parental refusal of vitK prophylaxis at birth
- exclusive breastfeeding
acidotic state: what happens to bicarb?
completely resorbed from tubular fluid
what are the opportunistic infections in HIV?
- pneumocystis jirovecii
- toxoplasma gondii
- mycobact avium complex
- histoplasma capsulatum
1ary ciliary dyskinesia: pathophys
AR –> proteins resp for normal flagellar & ciliary struct/fx (dynein, assembly proteins)
1ary ciliary dyskinesia: clinical manifestation
- situs inversus
- chronic sinusitis
- bronchiectasis
- infertility
what toxins does C diff produce?
- enterotoxin (toxin A)
- cytotoxin (toxin B)
H2PO4-: fx in acid-base balance
titratable acid: metab acidosis –> excreted in urine
glycogen phosphorylase: fx? how is it regulated?
brkdown glycogen
phosphorylated –> active state
dephos –> inactive state
toxic megacolon: what imaging?
plain abd XR –> reveal colonic dilation
what is: inclusion cell (I-cell) dz
AR lysosomal storage disorder –> defect in protein targeting
what happens to urine pH in metab acid? why?
decrease
increase excrete free H+, NH4+, H2PO4-
CD4 tx? for what?
prophylactic azithromycin for mycobact avium complex (MAC)
what drugs should be used with caution in DM? why? what should be used instead?
nonselective BB:
- exacerbate hypoglycemia
- mask its adrenergic ssx mediated by NE, Epi
if BB is necess –> selective B1 ant
how is N disposed from the body?
- urea
- free ammonia
lobar pneumonia –> congestion: key features
24hr
microscopic:
- vasc dilation
- alveolar exudate –> mostly bact
gross: red, heavy, boggy
what distinguishes heart circ from systemic circ?
- heart muscle is perfused during diastole
- myocardial O2 extraction is very high
- myocardial O2 demand & coronary blood flow are tightly coupled
what is: Dandy Walker malformation
dev analomy –> cerebellar vermis –> hypoplasia/absence –> cystic dilation of 4th ventricle w post fossa enlrgmt
what can lead to a cavernous sinus thrombosis?
medial face, sinus (ethmoidal, sphenoidal), teeth –> infect –> spread to valveless facial venous system –> cavernous sinus –> thrombosis
follicular lymphoma: what is the cell of origin?
B cell
Lyme dz –> 2nd stage: ssx
- AV block
- facial palsy
renal cell CA: ssx
asympt til relatively advanced:
- hematuria
- abd mass
- flank pain
- wt loss
- polycythemia
lobar pneumonia –> gray hepatization: key features
day 4-6
microscopic:
- RBC disintegrate
- alveolar exudate –> neutrophil, fibrin
gross: gray-brown firm lobe
increased pulm A pressure –> on auscultation?
accentuation of pulm compt of S2 (P2)
what are the stop codons?
- UAG
- UAA
- UGA
CN V –> ophthalmic & maxillary br –> injury –> ssx?
lose:
- upper facial sensation
- aff limb of corneal reflex
how is phosphorylase kinase (PK) activated in muscle?
- Epi
- intracell Ca
no glucagon receptors on skeletal muscle
follicular lymphoma: cytogenetic change
t(14; 18) –> bcl-2 overexpression
Dx: central obesity, resp ssx
obesity-related restrictive lung dz
mutated BMPR2 –> leads to?
1ary pulm art HTN
hereditary pulm art HTN: pathophys
2-hit hypothesis:
1) inactivating mutation in BMPR2 –> predispose to excessive endothelial & SM cell prolif
2) 2nd insult –> activate dz process –> vasc remodeling, elevated pulm vasc resistance, progressive pulm HTN
what is: coronary sinus
large vessel that collects blood from the heart muscle –> drain most coronary venous blood –> RA
hypoglycemia: neuroglycopenic ssx
- beh change
- confuse
- visual disturb
- stupor
- sz
follicular lymphoma: histology
mixture of cleaved & noncleaved follicle center cells in a nodular pattern
what is responsible for synchronization of glycogen degradation w skeletal muscle contraction?
release of sarcoplasmic Ca following NM stim