7.3.16 Flashcards
what is: nondisjunction in meiosis II
sister chromatids fail to sep
what is: pulm cap wedge pressure
indirect measure of the left atrial pressure
hyaline arteriolosclerosis: cause
long-standing:
- benign HTN
- DM
Kaposi sarcoma: cell of origin
primitive mesenchymal cells
inhibin: fx? secreted by?
Sertoli cell –> inhibin –> inh FSH
basal ganglia –> direct pathway: what is?
excitatory pathway –> facilitate mvmt:
1) cortex –> (dopamine –> D1 receptor) –> stim striatum
2) striatum -> release GABA
3) disinh thalamus (via globus pallidus internus)
hyperplastic arteriolosclerosis: cause? appearance?
malig HTN –> SM hyperplasia –> “onion-skin”
ganciclovir: what will increase risk of neutropenia?
co-admin:
- zidovudine
- TMP/SMX
what worsens hypertrophic cardiomyopathy?
decrease preload/afterload –> decrease LV vol –> worsen dynamic LV outflow tract obstruction:
- vasodilator: DHP CCB, nitrate
- diuretic
when do you suspect hypertrophic cardiomyopathy?
- FHx of premature sudden death
- systolic murmur that accentuates w standing from supine position
hepatocell CA: #1 cause
HBV
diastolic heart fail: cause? gross appearance?
HTN heart dz
- concentric V hypertrophy
- decreased LV chamber size
DKA: tx? results in what lab changes?
IV normal saline + insulin
insulin:
- utilize glucose –> decrease glucose
- decrease ketone syn –> increase HCO3
- drive K into cell –> decrease K
hydration:
- normalize Na –> increase Na
- decrease serum osmolality
what is: secretin
hormone from duodenum –> released in response to acid/fat in small intest:
- pancreas: secrete HCO3
- gastric G cell: inh gastrin release
6-mercaptopurine: how activated? inactivated?
- activate: hypoxanthine-guanine phosphoribosyl transferase (HGPRT)
- inactivate: xanthine oxidase, thiopurine methyltransferase (TMPT)
what indicates a mononucleosis-like synd?
- fever
- fatigue
- splenomegaly
- atypical lymphocytosis
pharyngitis, LAD less common w CMV
JAK2 mutation: pathophys
cytoplasmic tyrosine kinase –> constitutively actie –> activate signal transducers and activators of transcription (STAT) proteins –> JAK-STAT signaling pathway
pure motor hemiparesis –> indicates damage to?
- post limb of internal capsule
- basal pons
nocardia –> affects?
immunocomp:
- lung –> cavitary infiltrates –> cavitary pneumonia (look like TB)
- brain –> brain abscess
- skin
disinfectant –> iodine –> MOA?
halogenate proteins & nucleic acids
hereditary fructose intolerance: enzyme def
aldolase B
disinfectant –> chlorhexidine –> MOA?
- disrupt cell membrane
- coag of cytoplasm
Charcot-Bouchard aneurysm: pathophys
chronic HTN –> lenticulostriate A –> hyaline arteriolosclerosis –> weak wall –> Charcot-Bouchard microaneurysm
glucagonoma: ssx
- DM
- necrolytic migratory erythema
- anemia
how do you test for Strep pyogenes infection?
pyrrolidonyl-arylamidase (PYR) + –> has replaced the bacitracin test (not very specific for S pyogenes)
putamen: location
pizza crust
ovarian torsion: pathophys
lrg adnexal mass –> heavy –> ovary twist around infundibulopelvic lig –> occlude blood & N supply to ovary –> severe acute pelvic pain, ovarian ischemia
thrombotic thrombocytopenic purpura: tx
plasma exchange (plasmapheresis) –> remv autoAb from blood
classic galactosemia: enzyme def
galactose 1 phosphate uridyl transferase
number needed to trt (NNT): calc
1/absolute risk reduction (ARR)
lead poisoning –> blood findings
- microcytic anemia w normal iron studies
- PBS: basophilic stippling
what is: necrolytic migratory erythema
elevated painful & pruritic rash –> usu face, groin, extremities –> gradually coalesce –> lrg lesion w central clearing of bronze induration
loop diuretic: stim what?
PG release –> increase renal blood flow –> increase GFR –> enhance drug delivery
GVHD: ssx
- skin: diffuse maculopapular rash –> predilection for palms, soles –> may desquamate in severe cases
- liver: increase LFT
- GI: diarrhea
dysarthria-clumsy hand synd –> indicates damage to?
- genu of internal capsule
- basal pons
fibrate –> gallstone: pathophys
inh bile acid syn –> decrease chol solubility –> gallstone
acute intermittent porphyria: enzyme? ssx?
porphobilinogen deaminase
5 P’s:
- painful abd
- portwine urine
- polyneuropathy
- psych disturbance
- precipitated by drugs, alcohol, starve
Parkinson dz –> intractable ssx –> tx?
high freq deep brain stim –> globus pallidus, subthalamic nucleus –> inh firing –> increase activity of downstream nuclei –> thalamo-cortical disinh –> improve mobility
infundibulopelvic lig: aka
suspensory lig of the ovary
lacunar infarct: what is? cause?
HTN –> small penetrating arterioles –> arteriolosclerosis –> deep brain (basal ganglia), subcortical white matter (internal capsule, corona radiata) –> small ischemic infarct
Charcot-Bouchard aneurysm: comp
intracerebral hemorrhage –> usu basal ganglia
branched chain aa –> metab to?
propionyl CoA –> methylmalonic acid
PKU: pathophys
deficient phenylalanine hydroxylase –> cannot convert Phe to tyrosine –> Phe accum in body fluids, CNS
PKU: clinical presentation
normal at birth –> gradually dev:
- severe intell disability
- sz
- musty body odor
- hypopigment: skin, hair, eyes, catechoaminergic brain nuclei
ataxia-hemiplegia synd –> indicates damage to?
- post limb of internal capsule
- basal pons
RVMI: clinical presentation
- hypotension
- distended jugular veins
- clear lungs
persistent gallbladder outflow obstruction –> leads to?
1) lysolecithin –> disrupt mucosa
2) bile salt –> irritate luminal epithelium
3) transmural inflamm, PG
4) gallbladder hypomotility
5) increase intraluminal pressure –> ischemia
6) bact invasion
porphyria cutanea tarda: enzyme? ssx?
uroporphyrinogen decarboxylase
- blistering cutaneous photosens
- tea color urine
RVMI –> what happens to:
- RA pressure
- central venous pressure
- PCWP
- cardiac output
- RA pressure: increase
- central venous pressure: increase
- PCWP: decrease
- cardiac output: decrease
caudate nucleus: location
inferolat to ant horn of lat ventricle
LRT: what contributes most to airway resistance?
1st 10 gen of bronchi
when suspect lead poisoning?
microcytic anemia + constipation + mental status change in setting of construction work
what is: 3rd deg AV block
complete block of conduction from atria to ventricles:
- SA node –> atrial contract
- AV node –> ventricle contract –> narrow QRS
==> complete desynchronization bw P waves & QRS complexes
familial retinoblastoma: increased risk of?
2ndary tumors –> esp osteosarcoma
how damage ACL?
sport –> extended knee:
- sudden decelerate
- pivot
lead poisoning: features
LEAD Sucks:
- Lead Lines in gums
- Encephalopathy, Erythrocyte basophilic stippling
- Abd colic, sideroblastic Anemia
- Drops: wrist & foot drop
- Dimercaprol, EDTA –> 1st line tx
- Succimer –> chelation for kids
basal ganglia –> indirect pathway: what is?
inhibitory pathway –> inh mvmt:
1) cortex –> (dopamine –> D2 receptor) –> stim striatum
2) striatum –> disinh subthalamic nucleus (via globus pallidus externa)
3) STN –> stim GPi
4) inh thalamus
theca cell, granulosa cell: fx
LH –> theca interna –> androgen
FSH –> granulosa cell –> androgen to estradiol
theca externa cell: CT support struct for follicle
Zollinger-Ellison synd: ssx
- peptic ulcer –> esp distal duodenum
- heartburn
- diarrhea
what is: lentiform
putamen + globus pallidus
pure sensory stroke –> indicates damage to?
thalamus:
- ventropostlat
- ventropostmed
what is: acute calculous cholecystitis
acute inflamm of gallbladder initiated by gallstone obstruction of cystic duct
hereditary fructose intolerance: ssx
- after ingest fructose: hypoglycemia, vomit
- failure to thrive
- liver, renal fail
methadone: what is? use?
mu-opioid receptor agonist –> maintenance tx for opiod abuse –> suppress cravings & withdrawal ssx for >24hr
resistant schizophrenia: tx
clozapine
essential fructosuria: enzyme def
fructokinase
prolactin –> inh?
GnRH release
what is: glucose oxidase dipstick test
detect glucose in urine
globus pallidus: location
pizza –> inner part
JAK2 kinase: location
cytosol NOT nucleus
what is: striatum
putamen + caudate
thrombotic thrombocytopenic purpura: hallmarks
- microangiopathic hemolytic anemia
- thrombocytopenia
lactose intolerance: confirmatory test?
stool pH –> low
bact –> ferment lactose –> short chain ffa –> lower pH
middle cerebral A occlusion –> leads to
- contralat hemiplegia of face & UE –> LE relatively preserved
- aphasia (if dominant hemis affected (usu L))
what is: human multidrug resistance (MDR1) gene
codes for P-glycoprotein –> transmembrane ATP-dep efflux pump –> broad specificity for hydrophobic cmpds –> reduce drug influx & increase efflux from cytosol –> prevent axn of ctx agents
Klinefelter synd: clinical features
- 1ary hypogonad
- long LE
- small firm testes
- azoospermia
sporicidal disinfectant
- hydrogen peroxide
- iodine
acute mitral regurg –> what happens to:
- preload
- afterload
- contractile fx
- ejection fraction
- stroke vol
- preload: increase increase
- afterload: decrease (decreased cardiac output –> severe hypotesion)
- contractile fx: normal
- ejection fraction: increase increase (increased preload, decreased afterload)
- stroke vol : decrease
how do you get lead poisoning?
occupational exposure:
- lead paint
- battery
- ammunition
- construction
1ary myelofibrosis: pathophys
atypical megakaryocyte hyperplasia –> stim fibroblast prolif –> progressive replace marrow space by extensive collagen deposition
what is: INF-gamma assay
test for latent TB: expose to Mycobact tuberculosis antigens –> measure amt of IFN-gamma released by Tcells
Kallmann synd: pathophys
impaired GnRH syn by hypo:
- 1ary amenorrhea
- no 2ndary sex charact
- olfactory sensory defect
Klinefelter synd: hormone changes
1ary hypogonad:
- low testosterone
- elevated FSH, LH
- low inhibin
what is: nondisjunction in meiosis I
homologous chrom fail to sep
JAK2 mutation –> seen in
chronic myeloprolif disorders:
- polycythemia vera
- essential thrombocytosis
- 1ary myelofibrosis
lightning injury: most common COD
- fatal arrhythmia
- resp fail
odd chain ffa –> metab to?
propionyl CoA –> methylmalonic acid
hematogenous osteomyelitis: what org? who?
children --> long bones (2ndary to bacteremic event): #1) staph aureus #2) S pyogenes
how do you dx essential fructosuria?
copper reduction test: detect reducing sugar
how do you dx gastrinoma vs other causes of hypergastrinemia?
admin exogenous secretin –> stim gastrin release from gastrinoma –> increase gastrin instead of decrease
polycythemia vera: ssx
- nonspecific ssx: HA, weak, diaphoresis
- aquagenic pruritis
- facial plethora
- splenomegaly
disinfectant –> alcohol –> MOA?
- disorg lipid struct in membranes –> leaky
- denature cellular proteins
==> bactericidal, tuberculocidal, fungicidal, virucidal –> but not destroy bact spores
aminolevulinic acid synthase requires what cofactor?
vitB6
basophilic stippling: seen in
Basically, ACiD alcohol in LeThal:
- Anemia of Chronic Disease
- alcohol abuse
- Lead poisoning
- Thalassemia
how do you acquire sideroblastic anemia?
- alcoholism: mito poison
- lead poisoning: inh ALAD, ferrochelatase
- vitB6 def: required cofactor for ALAS
ethanol –> hypoglycemia: pathophys
ethanol metabolism –> reduce NAD to NADH –> increase NADH/NAD ratio –> no NAD for gluconeogenesis
how does pancreatitis lead to ARDS?
release large amt of inflamm cytokine, pancreatic enzyme –> activate neutrophils in alveolar tissues –> interstial & intraalveolar edema, inflamm, fibrin deposition –> alveoli –> waxy hyaline membranes
systolic heart fail: cause? gross appearance?
- ischemic heart dz
- dilated cardiomyopathy
dilated ventricle
what is normal tracheal pO2? alveolar pO2?
tracheal pO2 = 150mmHg
alveolar pO2 = 104
saccular aneurysm: what is? comp?
aka berry aneurysm –> thin walled saccular outpouching that lack media layer –> usu at ant comm A branch point
subarachnoid hemorrhage
sideroblastic anemia is d/t?
defective protoporphyrin syn
1ary myelofibrosis: ssx
- pancytopenia
- HSM
- teardrop RBC
imperforate hymen: ssx
- 1ary amenorrhea
- normal 2ndary sex charact
- cyclic abd/pelvic pain d/t accum of menstrual blood in vagina/uterus (hematocolpos)
