7.4.16 Flashcards
gluconeogenesis: unique enzymes
- pyruvate decarboxylase
- phosphoenolpyruvate carboxykinase (PEPCK)
- fructose 1,6 bisphosphatase
- glucose 6 phosphatase
choriocarcinoma: ssx
- abnormal vag bleed
- uterine enlrg
- sig increased B-hCG
- hematogenous spread –> lung –> dyspnea, hemoptysis
what can increase incidence of statin-induced myopathy?
concomitant admin of drug that inh CYP450 –> inh statin metab
heme oxygenase: rxn
degrade heme to biliverdin –> green color of bruise
Chiari type I vs II
I: relatively benign –> adult –> occipital HA, cerebellar dysfx
- II: more severe –> neonate –> assoc w lumbar myelomeningocele, hydrocephalus
what is: Lambert-Eaten myasthenic synd
NM disorder presenting w:
- proximal muscle weak
- CN involvement
- autonomic ssx
abd/pelvic trauma: comp
retroperitoneal hematoma
what releases IL-5?
TH2
ulnar N: sensory fx
mid ring –> pinky
tRNA –> 3’ CCA tail: fx
- recog seq by proteins
- its terminal -OH grp serves as aa binding site
how does chronic kidney dz lead to renal osteodystrophy?
hyperphosphate –> hypocalc –> 2ndary PTH
migraine: acute tx
triptan –> abortive tx
how is S3 best heard?
L lat decubitus at end expiration
ectopic preg: RF
scarring:
- PID
- endometriosis
membranous nephropathy: nephritic or nephrotic?
nephrotic
subdural hematoma: CT scan
crescent-shaped mass
ulnar N injury: location
- medial epicondyle of humerus (funny bone)
- Guyon’s canal: near hook of hamate, pisiform
essential tremor: mode of inheritance
AD
when does neurosyphilis occur?
any stage of infect
what is: myopia
nearsighted: can’t focus on far object –> image focus in front of retina
measles: neuro comp
- w/in days: encephalitis
- wks: acute disseminated encephalomyelitis
- yrs: subacute sclerosing panencephalitis
what drug prolongs QT but has low risk of torsades?
amiodarone
intercostal V/A/N: location
subcostal groove on lower border of rib
SLE w Cushing synd –> died of LCA thrombus –> what increased risk of CAD?
cushing synd & lupus both increase risk of CAD
SLE: most common renal dz
diffuse prolif GN
amatoxin: MOA
poison from mushroom (Amanita phalloides, death cap) –> inh RNA pol II –> halt mRNA syn
what is: Chiari malformation
congenital disorder: post fossa underdev –> cerebellum, medulla –> herniate thru foramen magnum
piriformis: passes thru what?
greater sciatic foramen
what can cause a subdural hematoma in the young? elder? how does it present?
- young: fall, motor vehicle accident –> gradual onset HA, confuse
- elder: minor trauma –> variety of neuro ssx
what are the parts of tRNA?
- acceptor stem
- 3’ CCA tail
- D loop
- anticodon loop
- T loop
ulnar N: motor fx
- finger adduct
- finger abduct (except thumb)
- digit 4 & 5: flex
- wrist: flex, adduct
ectopic preg: classic presentation
lower abd pain few weeks after missed period
bipolar disorder –> tx –> why not use antidep?
risk of precipitating mania
hepatic encephalopathy: precipitating factors
- drugs
- hypovol
- excessive N load
- infect
hypoxic ischemic encephalopathy: pathophys
profound systemic hypotension (cardiac arrest, shock) –> disminish blood supply to entire brain –> global cerebral ischemia:
- in 5-10 sec –> syncope
- 4-5min –> permanent brain damage
choriocarcinoma is commonly preceded by?
normal preg but can occur following any preg (molar, ectopic, aborted)
Lambert-Eaten myasthenic synd: pathophys
Ab against presynaptic Ca channel of NMJ –> can’t release ACh
what is: Crigler-Najjar synd
AR –> no UGT –> no bile glucuronidation –> unconjugated hyperbilirubin –> kernicterus –> death
what is: RPGN
nephritic synd that progress to renal fail in wks-mos
what is: skin rhytides
skin wrinkle
RPGN: what disorders?
- Goodpasture synd
- PSGN
- diffuse prolif GN
- Wegener granulomatosis
- microscopic polyangiitis
- Churg-Strauss synd
enterobius vermicularis: tx
1st line: albendazole
preg: pyrantel pamoate
where should you perform thoracentesis?
bw parietal & visceral pleura:
- midclavicular line: bw rib 6-8
- midaxillary: 8-10
- paravertebral: 10-12
idiopathic membranous nephropathy: possible pathophys
IgG4 Ab to phospholipase A2 receptor found in high conc in glomerular podocytes –> immune deposition in glomerulus
what is: attrition bias
form of selection bias: disproportionate loss to FU bs exposed & unexposed grps
membranous nephropathy: assoc dz
- HBV
- HCV
- solid tumor
- SLE
- drugs –> NSAID, penicillamine
piriformis: fx
hip: ext rot
mucormycosis: classic clinical picture
paranasal sinus involvement in diabetic or immunosupp pt
A-fib: EKG
- irreg irreg rhythm
- no organized P waves
- varying R-R intervals
- f (fibrillatory) waves bw QRS complexes –> irreg, low amp –> rep chaotic atrial activation
Lambert-Eaten myasthenic synd: assoc dz
malig –> classically small cell lung CA
S3: indicates
- healthy YA: normal
- >40yo: V enlargement
when should you suspect inherited causes of hypercoag?
androgenetic alopecia: pathophys
polygenic –> but dihydrotestosterone is 1ary pathogenic factor
membranous nephropathy: prognosis
poor response to steroids –> progress to chronic renal fail
muscles: 2 fiber types? fx?
1) slow twitch (Type 1): axns requiring low level sustained force –> postural maintenance
2) fast twitch (Type II): rapid forceful pulses of mvmt
T cell maturation –> neg selection: what is? where?
thymus –> medulla –> eliminate T cells that bind to self MHC or self Ag with overly high affinity
essential tremor: ssx
- slowly progressive symm postural/kinetic tremor –> usu UE
- improve w alcohol
nephritic synd: charact
immune complex –> inflamm –> bleed:
- oliguria/azotemia
- salt retention –> periorbital edema, HTN
- RBC casts
what is: choriocarcinoma
malig gestational trophoblastic dz –> anaplastic cytotrophoblasts & syncytiotrophoblasts –> no villi
what is the best test to dx 1ary hypothyroid?
serum TSH –> most sensitive screening test
retroperitoneal organs
SAD PUCKER:
- suprarenal glands
- aorta, IVC
- duodenum (1st part)
- pancreas (head & body)
- ureter, bladder
- colon (ascending & descending)
- kidney
- esophagus
- rectum (mid-distal)
what is the most common inherited cause of intell disability?
fragile X synd
Type I & II muscle fibers –> where do they get their ATP?
I: aerobic –> high myoglobin (O2 storage), mito
IIa (fast twitch): aerobic metab
IIb: anaerobic glycogenolysis –> glycolysis
what is: piriformis synd
piriformis muscle –> injury, hypertrophy –> compress sciatic N in greater sciatic foramen –> sciatica like ssx –> pain, tingle, numb –> buttocks, N distribution
what is the most common mvmt disorder?
essential tremor
age related change can lead to what eye condition? pathophys?
presbyopia
lens –> struct proteins denature –> lose elasticity
what is a pulm lab finding specific for PE?
vent-perfusion scan: sig mismatched defect
membranous nephropathy: who?
white adult
what is: bupropion
1st line antidep w amphetamine-like properties
membranous nephropathy: histology
- thick BM
- granular IF
- subepi deposit –> spike & dome
how can GI bleed lead to hepatic encephalopathy?
1) bleed –> more N (Hb) in gut
2) enterocyte –> convert to ammonia
3) into blood –> liver
4) liver cannot degrade to urea –> ammonia buildup
rhabdomyolysis: comp
acute renal fail
what is the most common cause of inherited hypercoag state?
factor V leiden
migraine: prophylactic tx
- BB
- antidep: amitriptyline, venlafaxine
- anticonv: valproate, topiramate
gluconeogenesis: initial 2 steps
1) pyruvate decarboxylase: pyruvate –> oxaloacetate
2) phosphoenolpyruvate carboxykinase (PEPCK): oxaloacetate –> PEP
PE –> leads to? how?
- hypoxemia
- resp alk
vent (air) but no perfusion (blood flow) –> hypoxemia –> stim resp drive –> hypervent –> hypocapnia –> resp alk
MI –> 12 days after –> sudden cardiac death –> most likely cause?
V arrhythmia
membranous nephropathy: cause
usu idiopathic
hepatic encephalopathy: clinical presentation
- confuse, disorientation
- lethargy
- asterixis
- stigmata of chronic liver dz: jaundice, edema/ascites, palmar erythema, telangiectasia, caput medusae
what muscle passes thru the greater sciatic foramen
piriformis
factor V leiden: pathophys
mutated factor V –> can’t be deactivated by protein C/S –> excess factor V activity
cerebral watershed infarct: gross appearance
bilat wedge of necrosis over cerebral convexity, parallel & adj to longitudinal cerebral fissure
S3: cause
sudden limitation of V mvmt during rapid passive V filling
what is: presbyopia
can’t focus on near objects –> image focuses behind retina
fragile X synd: cytogenetic abnormality
X chrom –> long arm –> fragile X mental retardation 1 (FMR1) gene –> oocyte meiosis –> CGG trinucleotide repeats expand –> >200 repeats –> hypermethylation –> FMR1 inactivation
subdural hematoma: results from?
rupture of cortical bridging vein
what is: gumma
3ary syphilis: necrotizing granuloma –> skin, mucosa, subQ tissue, bone, other organs
S3, S4: diastolic or systolic?
S3: diastolic
S4: systolic
nephrotic synd: charact
proteinuria (>3.5g/day):
- hypoalbumin –> pitting edema
- hypoIg –> infect
- hypercoag
- hyperlipid/chol –> fatty cast
hepatic encephalopathy: pathophys
chronic liver fail –> impaired detoxification ability –> ammonia, other neurotoxins accum –> cross BBB:
- increase inh neurotransmission
- impair excitatory NT release
how can hyperTB lead to acute pancreatitis?
pancreas –> lipase –> metab TG to ffa –> toxic & inflamm effects on pancreas
who could develop a unilat cerebral watershed infarct?
severe carotid A stenosis
essential tremor: tx
propranolol (nonspec B-adrenergic ant)
MLF: location
pons –> dorsal –> paramedian
hydrops fetalis: ssx
- severe anemia
- HF
- pleural effusion
- pericardial effusion
- ascites
how do macrophage reduce plaque stability?
secrete metalloproteinase –> degrade extracell matrix proteins (collagen)
