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7/20 Flashcards

1
Q

what can nitroprusside toxicity present as

A

cyanide poisoning

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2
Q

how can you treat cyanide poisoning

A

binding of cyanide ions:
tydroxycobalamin

induction of methemoglobinemia:
Sodium nitirite

Detoxifying sulfur donors:
sodium thiosulfate

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3
Q

what pts don’t have an upper vagina with variable uterine development? normal ovaries and 2ndary sex characteristics

A

Mayer-Roitansky-Kuster-Hauser syndrome

AKA Mullerian aplasia

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4
Q

where does vasopressin work

A

medullary segment of the collecting duct, which is the deeper part (vs cortical segment)

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5
Q

what is the primary stimulator of respiration in healthy pts

A

PaCO2

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6
Q

what is the primary stimulator of respiration in COPD pts

A

response to PaCO2 is blunted, so hypoxemia becomes the important contributor to respiratory drive

PERIPHERAL CHEMORECEPTORS (AKA CAROTID BODIES) are primarily responsible for sensing arterial PaO2 and can be suppressed if you administer O₂ to a COPD pt

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7
Q

how do central chemoreceptors function

A

they’re in the medulla, and
stimulated by decreased pH in the CSF

CO₂ readily diffuses through the BBB and forms H+ in the CSF, so
increased PaCO2 is the major stimulator of CENTRAL chemoreceptors

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8
Q

what heart abnormality is associated with Turner

A

Bicuspid aortic valve

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9
Q

what protein is released by eosinophils

A

Major Basic Protein

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10
Q

what is major basic protein’s function

A

released by eosinophils to kill helminths

also contributes to epithelial damage sustained by pts with allergic asthma

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11
Q

what types of adenomatous polyps are found in colon

A

tubular, villous, and tubulovillous

according to histologic appearance

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12
Q

how does a villous adenoma in the colon present

A

larger, sessile, and more dysplastic (vs the other tubular adenomas)

they can cause bleeding, secretory diarrhea, and partial intestinal obstruction

can secrete large quantities of watery mucus!!! which leads to secretory diarrhea and electrolyte abnormalities

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13
Q

which type of colon adenoma poses the highest malignant potential

A

VILLOUOS > tubulovillous > tubular

VILLAINS ARE THE WORST

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14
Q

what is the buzzword for cauliflower-like colon projections

A

villous adenoma

they’re large, sessile, and can have velvety or cauliflower-like projections

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15
Q

what does a colon tubular adenoma histology look like

A

dysplastic colonic mucosal cells that
form tube-shaped glands and
tend to be smaller and
pedunculated

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16
Q

what would you see in a hamartomatous polyp

A

disorganized mucosal glands, smooth muscle, and CT

may occur sporadically or with Peutz-Jeghers syndrome or Juvenile polyposis

these polyps can cause bleeding and intussusception, but
not secretory/mucos-y diarrhea

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17
Q

what would a hyperplastic polyp present like

A

well-differentiated mucosal cells that form glands and crypts

the crypts may be large or irregular but NOT dysplastic changes

almost always asymptomatic

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18
Q

what do signet ring cells look like

A

push nucleus to edge of cell with large central clearing

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19
Q

how do you use Hardy-Weinberg equation to calculate auto recessive questions

A

allele frequency = p + q = 1

phenotypic frequency = p^2 + 2pq + q^2 = 1

p^2 = frequency of NORMAL people (~1 in rare diseases)

2pq = CARRIER frequency (~2q in rare diseases)

q^2 = frequency of DISEASED people

when they give you disease prevalence (q^2), you can calculate the mutant allele frequency from the disease.  (q).
take sqrt(disease prevalence) = q

carrier frequency:
this is probability of being a heterozygote
carrier = 2pq
for rare auto recessive disorders, p = 1, so
probability of being a carrier = 2q

so....
P(auto recessive disorder) =
1/4 [P(mom carrier) x P(dad carrier)]
which will come out to be:
1/4[(2q)x(2q)]
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20
Q

what is most likely to bleed in epistaxis

A

nasal septum, containing the
Kiesselbach plexus

anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose this region

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21
Q

what is the MOA for bisphosphonates

A

similar to pyrophosphate- they attach to hydroxyappetite binding sites and inhibit bone respiration by MATURE osteoclasts

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22
Q

what is the MOA for SERMs

A

they slow the rate of bone loss by inhibiting differentiation and maturation of pre-osteoclasts

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23
Q

what is the MOA for interferons alpha and beta

A

produced in response to viral infections

they help suppress viral replication by halting protein synthesis and promoting apoptosis in infected cells, to limit the virus’s ability to spread

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24
Q

what should you be suspicious of in a middle aged/older pt with iron-deficiency anemia but no “real” symptoms that jump out at you

A

occult blood loss from GI tract

this could even be if the pt denies bloody stools, menorrhagia, or any other sort of bleeding

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25
what do pressure values look like when a pt has an inferior wall MI with complete occlusion of the proximal RCA?
this pt has a RV presents with hypotension, elevated JVP, and clear lungs most often occurs in setting of LV inferior wall MI due to proximal RCA occlusion present with: high RA pressure (JVD, high CVP) high Central venous pressure (RV dysfunction--> backup blood) low PCWP (blood isn't making it to the LA) low cardiac output (LV
26
what characteristics does a Barr body have
it's an inactivated X chromosome in females' genetics it's compact heterochromatin heterochromatin is densely packed, heavily methylated DNA in tight association with DE-acetylated histones and a low level of transcriptional activity.
27
what is reactive arthritis associated with
it's associated with HLA-B27 seronegative (Rh negative) arhtropathies
28
what lab value is always low in the congenital adrenal hyperplasias?
cortisol/glucocorticoids that's why they don't make it in the "arrow" trick
29
what can sickle cell cause to femoral head most commonly
osteonecrosis (avascular necrosis) 2/2 impaired blood supply to that bone segment
30
what is contraindicated in hereditary angioedema
ACE inhibitors this disease causes activation of bradykinin, C3a, and C5a (2/2 lack of C1 esterase inhibition) so you have lots of vasodilation and vascular permeability
31
what is diagnostic of hereditary angioedema
low serum levels of C1 esterase inhibitor normally, the C1 esterase inhibitor suppresses activation of the C1 complement component and therefore the rest of the classic complement pathway
32
what does the Fas receptor do
Fas receptor initiates the extrinsic pathway of apoptosis mutations of Fas and Fas ligand can prevent apoptosis of auto-reactive lymphocytes, and increase risk of autoimmune disease (like SLE)
33
which 2 diseases have metaplasia
smoking will cause squamous metaplasia in lungs- normal columnar epithelium is replaced by squamous epithelium Barrett esophagus will cause esophageal squamous epithelium to be replaced by intestinal columnar epithelium
34
what holds osteocytes geother
they exchange nutrients and wastes with adjacent cell via gap junctions
35
what is NRTIs MOA
binds competitively to reverse transcriptase and is incorporated into viral genome as a thymidine analog it does not have a 3'-OH group, so 3'-5' phosphodiester bond formation is impossible
36
how would you describe the process of aortic aneurysms and dissections
myxomatous changes with pooling of proteoglycans in the media layer of arteries
37
what does follicular lymphoma histology look like
diffusely purple slide with tons of cells and thin white circles
38
what is follicular lymphoma's protein problem
over expression of anti-apoptotic BCL-2 protein
39
what protein problem goes with CML
BCR-ABL | able to eat Philadelphia cream cheese
40
what is the Burkitt lymphoma protein proglem
over expression of c-myc
41
what is over expressed in neuroblastoma and small cell carcinomas of the lung
N-myc
42
how do you treat congenital adrenal hyperplasia
low doses of exogenous corticosteroids to suppress excessive ACTH secretion to reduce stimulation to the adrenal cortex
43
how doe males with 17-alpha-hydroxylase deficiency present
phenotypically female at birth (but LACK internal female genitalia- like a blind ending vagina) because absent virilizing androgens in utero females develop normal internal and external gentility at birth during puberty, neither sex can undergo synthesis of sex hormones, so no secondary sex characteristics develop you'll also have hypertension, hypokalemia, and low renin levels 2/2 excessive mineralocorticoid production but the over-stimulated adrenals
44
what's the embryology of tetralogy of fallot
"deviation of the infundibular septum" results form anterior and cephalic devotion of the infundibular septum during development, causing a: PROVe Pulmonary infundibular stenosis (most important prognosis determinant; this is AKA "RVOT obstruction") maligned VSD overriding aorta RV outflow tract obstruction (systolic murmur) RV hypertrophy
45
which pts squat to help with cyanosis and why
Tetralogy of Fallot pts squat it increases peripheral systemic vascular resistance (after load) and decrease R to L shunting across the VSD
46
what does flattening of deltoid muscle mean
anterior humerus dislocation, causing axillary nerve injury
47
what are the phases of a pacemaker cell action potential
phase 4: slow Na inward (funny current) phase 0: rapid-ish upstroke with Ca influx phase 3: repo with K efflux
48
what are the phases of a non-pacemaker cardiac action potential
phase 0: rapid depo with Na influx phase 1: K begins to open to start to bring it down phase 2: K and Ca offset each other to make a plateau phase 3: un-opposed K to repo the cell phase 4: hyperpo by K
49
which tumor cells express CD31, and what is it
hepatic angiocarcinoma | CD31 is an endothelial cell marker
50
which cancer is associated with exposure to carcinogens like arsenic, PVC, and thorotrast
liver angiosarcoma "lung cancer" squamous cell carcinoma on skin
51
What do you call it when a pair of alleles are inherited together in the same gamete (haplotype) more or less often than would be expected given random pairing?
linkage disequlibrium
52
which anti fungal decreases ergosterol incorporation into the cell membrane
Nystatin and Amphotericin | both bind ergosterol
53
which anti fungal inhibits ergosterol synthesis
azoles
54
which anti fungal inhibits cell wall syntehsis
caspofungin
55
which anti fungal inhibits DNA and RNA synthesis
flucytosine
56
which anti fungal inhibits mitosis
Griseofulvin
57
what does alternative splicing do
allows a single gene to code for various unique proteins by selectively including or excluding different DNA coding regions (eons) into mature mRNA
58
how does Toxic Shock super antigen work
it interacts with MHC molecules on antigen-presenting cells and the variable region of the T lymphocyte receptor, to cause nonspecific, widespread activation of T cells causes release of IL-2 from T cells and IL-1 and TNF from macrophages
59
what 2 lab values indicate biliary injury
Alk phos and | gamma-glutamyl transpeptidase
60
what are the prognostic factor labs you should look at for cirrhosis
serum albumin levels bilirubin levels prothrombin time
61
what is the major determinant of the degree of R-->L intracardiac shunting and cyanosis in TOF patients?
the degree of RVOT obstruction
62
which drugs can cause coronary steal
adenosine dipyridamole they're both selective coronary vasodilators, which will cause coronary steal
63
what are the classic histo findings for Alzheimer
amyloid plaques and neurofibrillary angels Neuritic (senile) plaques composed of amyloid beta core overproduction of amyloid precursor protein neurofibrillary tangles- aggregates of hyperphosphorylated tau protein
64
what is the pathology of Klinefelter syndrome
destruction and hyalinization of seminiferous tubules causes damaged sertoli cells, so low Inhibin high FSH damaged Leydig cells, so low testosterone high LH pts can develop gynecomastia 2/2 increased aromatase activity (stimulated by gonadotropin excess) most Klinefelter pts are azoospermic and infertile this is PRIMARY HYPOGONADISM- high FSH and LH; low Testosterone
65
what is first line for Rheumatoid arthritis
Methotrexate
66
what are methotrexate side effects
stomatitis (mouth ulcers) bone marrow suppression elevated LFTs
67
which "normal" drug is associated with osteoporosis risk when used chronically
omeprazole
68
what is neprilysin
a metalloproteinase that cleaves and inactivates peptides like BNP/ANP, if you inhibit Neprilysin, you get increased levels of these natriuretic peptides, which promotes diuresis, natriuresis, and vasodilation. all of these are helpful/beneficial in combatting heart failure
69
what do hypersegmented neutrophils indicate
megaloblastic anemia
70
which part of the spine does rheumatoid arthritis attack
cervical spine
71
how can you test for H pylori
urease test- gastric mucosa is added to a urea solution urease will convert urea to CO₂ and NH3 to cause a pH increase and color change, indicating alkalinization of the solution could also use a breath test
72
what presents with nosebleeds, telangectasias on oral and nasal mucosa, face, and arms?
Osler-Weber-Rendu syndrome AKA hereditary hemorrhagic telangiectasia rupture of the telangectasias may cause epistaxis, GI bleeds, and hematuria
73
what does a pt have with neurofibromas, optic nerve gliomas, Lisch nodules, and cafe au late spots
Von Recklinghausen's | or NF1
74
what does a pt have with multiple meningiomas and bilateral CN8 schwannomas
NF2
75
what does a pt have with congenital cutaneous facial angiomas, leptomeningeal angiomas, mental retardation, seizures, hemiplegia, and skull radiopacities
Sturge Weber syndrome | AKA encephalotrigeminal angiomatosis
76
what disease has characteristic "tram track" on skull XR
Sturge Weber Syndrome
77
which embryologic derive do melanocytes (and therefore melanoma) come from
neural crest cells
78
what is the serious drug effect you have to look out for when treating hypothyroidism
agranulocytosis! present with sudden onset fever and erythematous pharynx with drugs like methimazole or propylthiouracil
79
what is pulsus paradoxes and when is it seen
drop in systolic pressure during inspiration commonly seen in pts with cardiac tamponade
80
what should you check before starting a TNF-alpha inhibitor
for latent TB
81
what is ataxia telangiectasia
ineffective DNA damage repair- DNA has hypersensitivity to ionizing radiation, so you get CELLEBAR ATROPHY leads to ataxia severe immunodeficiency, with recurrent sinopulmonary infections
82
what is dystrophic calcification
a hallmark of cell death and injury, occurring in all types of cellular necrosis
83
what is the primary course of morbidity in a strep pyo infection
you get acute rheumatic fever, then | heart failure from severe pancarditis!
84
what is Henoch Schonlein purpura's pathogenesis
IgA immune complex mediated vasculitis!! with PALPABLE PURPURA ON BUTTOCKS generally following a URI
85
what is the most common congenital heart defect in Down Syndrome pts
a complete AV canal defect: ASD VSD common AV valve
86
how do you increase preload and/or afterload on a pt's heart
squatting sustained hand grip passive leg raise
87
how do you decrease preload on a pt's heart
sudden standing valsalva (Straining) nitroglycerin
88
how do you make a pt with HCM have a louder murmur
they will have asymmetric ventricular septal hypertrophy 25% of these pts will have a dynamic LVOT obstruction, which causes harsh systolic ejection-type murmur the degree of LVOT obstruction (and murmur intensity) depend on LVEDV, or the preload. decreasing preload/venous return or after load decrease the LV chamber size, which decreases the separation between the mitral valve and inter ventricular septum, increasing obstruction to make this murmur louder, you should DECREASE PRELOAD to cause a smaller LV space, and a bigger obstruction
89
What presents with onion-like concentric thickening of arteriolar walls in the renal vasculature and elsewhere
hyperplastic arteriolosclerosis in renal arterioles, which can perpetuate malignant HTN
90
what are the IF deposits in PSGN
IgG, IgM, and C3
91
what disease do you see Fibrin deposits in the glomeruli
RPGN

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