7.5.16 Flashcards
what inh prolactin release?
dopamine secretion from hypo
AL amyloidosis: histology
- eosinophilic extracell deposit
- apple green birefringence w Congo red stain under polarized light
what is: lesser omentum
double layer of peritoneum that extend from liver to lesser curv of stomach & beginning of duodenum –> 2 parts:
- hepatogastric lig
- hepatoduodenal lig
acute rheumatic fever: comp
chronic valvular dz –> mitral regurg, stenosis
fidaxomicin: gen charact
- macrocyclic abx
- bacteriocidal
- oral admin
- minimal systemic absorption
when should you suspect SIADH?
hypoNa + lung mass
what is: alpha-1 antitrypsin
major serum inh of neutrophil elastase
plasma cell: charact appearance
- abundant basophilic cyto
- eccentrically placed nucelus
- “clock face” distribution of nuclear chromatin
- perinuclear pale zone
what is: acute acalculous cholecystitis
acute inflamm of gallbladder in absence of gallstones
Goodpasture synd: pathophys
autoAb against BM collagen –> inflamm destruction:
- renal glomeruli
- lung alveoli
what can cause hyperprolactinemia?
decreased dopamine:
- antipsych, antidep –> block dopamine D2 receptors
- suprasellar, infundibular lesion –> disrupt dopaminergic pathway
exclusively ketogenic aa
- lysine
- leucine
when should you suspect ASA intoxication?
triad:
- fever
- tinnitis
- tachypnea
when should you suspect mucormycosis?
DKA –> face pain, HA, black necrotic eschar in nasal cavity
NOD2 mutation –> leads to?
decrease activity of NF-kB –> reduce cytokine production –> impair innate barrier fx of intestinal mucosa –> intestinal microbe –> exagg response by adaptive immune system –> chronic GI inflamm
what hormone is necess for maintenance of preg?
progesterone
what stimulates renal ammoniagenesis?
acidosis
how induce hemostasis in a pt w hemophilia?
admin thrombin
abdominal aortic aneurysm: pathophys
transmural inflamm –> chronic –> proteases degrade elastin & collagen:
- lose elastin
- lose smooth muscle
- collagen –> abnormal remodeling & crosslinking –>
==> weaken wall
external auditory canal: sensory innervation
- post wall: vagus N –> small auricular br
- rest: trigeminal N –> mandibular division
what is: ventromedial nucleus
center of satiety
idiopathic pulm fibrosis: CT
patchy involvement –> usu subpleural, paraseptal spaces:
- dense fibrosis
- “honeycomb” changes (formation of cystic spaces)
- fibroblastic foci
duodenal peptic ulcer: cause
H pylori
what is: chronic myelogenous leukemia
unctrled mature granulocyte production –> mostly neutrophils, but also basophil, eosinophil
what is: vasovagal syncope
stim vagus N –> parasym outflow –> decrease HR, BP –> syncope
what is: Osler-Weber-Rendu synd
AD –> telangiectasias –> skin & mucus membrane:
- lips
- oronasopharynx
- resp tract
- GI
- urinary
chronic hemolysis can lead to?
iron deposition in kidney (hemosiderosis)
paroxsymal nocturnal Hburia: pathophys
mutated phosphatidylinositol glycan class A (PIGA) gene –> cannot syn glycosylphosphatidylinositol (GPI) anchor protein –> can’t attach CD55 decay acclerating factor blood cells –> can’t inh C3 convertase –> can’t inactivate complement –> unctrled complement-med hemolysis
mult myeloma –> infect –> pathophys
increased monoclonal Ab –> lack antigenic diversity –> infection
diphtheria vaccine: MOA
induce production of circulating IgG against exotoxin B subunit
lesion to ventromedial nucleus –> leads to?
hyperphagia –> obesity
orbital blowout fracture –> inferior orbital wall –> can lead to herniation into?
maxillary sinus
mesothelioma: #1 RF
asbestos exposure
what is: ristocetin test
cause vWF bind GP1b –> induce platelet aggregation
cryptoorchidism: what happens to leydig cell?
nothing –> normal fx –> normal 2ndary sex charact, sex performance
differentiate: CML vs leukemoid rxn
- leukemoid rxn: normal/elevated leukocyte (neutrophil) alk phos
- CML: decreased
mult myeloma –> hyperCa –> pathophys
activate osteoclast
hypoNa: ssx
altered mental status
mifespristone: what is? use? MOA?
MOA: progesterone ant –> block progesterone receptor –> apoptosis & necrosis of uterine decidua
use: + misoprostol (PGE1 agonist) –> terminate 1st trimester preg
mult myeloma –> anemia –> pathophys
BM infiltration –> suppress normal hematopoiesis –> normocytic, normochromic anemia
musculocutaneous N: nerve roots
C5-7
growth factors that promote angiogenesis
- vascular endothelial GF (VEGF)
- fibroblast GF (FGF)
enteropeptidase def: ssx
protein & fat malabsorption:
- diarrhea
- fail to thrive
- hypoproteinemia –> edema
what area of the brain has greatest atrophy in Alzheimer’s dz?
hippocampus
carcinoid tumor: histology
islands or sheets of uniforms cells:
- eosinophilic cyto
- oval to round stippled nuclei
pericardial knock: seen in?
constrictive pericarditis
vWF: fx
1) bind glycoprotein (GP) 1b recetpors on platelet –> mediate platelet aggregation & adhesion to subendo collagen
2) carrier for factor VIII –> prolong its halflife
what causes centriacinal emphysema?
heavy smoking
how can Crohn’s dz lead to gallstones?
terminal ileum involved –> can’t resorb bile acid –> supersat bile w chol –> gallstone
pilocystic astrocytoma: histology
well-differentiated neoplasm:
- spindle cells w hair-like glial processes –> assoc w microcysts
- Rosenthal fibers (thick eosinophilic processes of astrocytes) + granular eosinophilic bodies
idiopathic pulm fibrosis: features
- progressive exertional dyspnea, dry cough
- restrictive profile on pulm fx test
- interstitial fibrosis w cystic air space enlrgment
GERD: histology
- basal zone hyperplasia
- elongation of lamina propria papillae
- scattered eosinophils
brain MRI –> what highly suggests Alz dz?
hippocampus atrophy
when is a result considered statistically sig?
95% CI does not cross null value
myoglobin: O2-dissociation curve
hyperbolic
trauma or strenuos UE exercise –> can injure what?
brachial plexus –> upper trunk (C5-7) –> affecting the musculocut N (derived from C5-7)
seminiferous tubule: fx
spermatogenesis
L colon CA: clinical manifestation
infiltrate intestinal wall –> encircle lumen:
- constipation
- ssx of intestinal obstruction
Sertoli cell: location
they form the epithelium of the seminiferous tubule
misoprostol: what is? MOA?
PGE1 agonist –> cervical softening, uterine contract –> expulsion of preg
hyperCa: ssx
- mental status change
- muscle weak
- constipation
- polyuria/polydipsia
- dehydrate
what is structurally analogous to myoglobin?
indiv subunits of Hb mole
renal blood flow: calc
RPF/(1-Hct)
when should you suspect a pilocystic astrocytoma?
cystic tumor in cerebellum of child
pyruvate decarboxylase: rxn
pyruvate –> acetyl CoA
chronic nonhealing ulcer: most likely what type of org?
necrosis, diminished blood supply –> anaerobe
thionamide: drug
- methimazole
- propylthiouracil
mult myeloma –> AL amyloid –> pathophys
increased monoclonal Ig light chains
acute acalculous cholecystitis: who?
critically ill pt (sepsis, severe burn, trauma, immunosupp) –> gallbladder stasis, ischemia
paroxsymal nocturnal Hburia: classic triad
- hemolytic anemia (Hburia)
- pancytopenia
- thrombosis at atypical sites –> hepatic, portal, cerebral V
what can decrease effects of radioactive iodine tx? how?
perchlorate, pertechnetate –> iodide isotypes –> sodium-iodide symporter –> uptake to thyroid –> reduce uptake of other iodine (radioactive iodine) thru competitive inh
persistent lymphedema: comp
lymphangiosarcoma
Osler-Weber-Rendu synd: ssx
telangiectasia –> rupture –> epistaxis, GI bleed, hematuria
cryptoorchidism: what happens to the seminiferous tubules?
high temp –> damage seminiferous tubule –> atrophy, hyalinization:
- decrease sperm count
- decrease inhibin
renal plasma flow: calc
= PAH clearance
= (urine PAH)(urine flow)/(plasma PAH)
acute acalculous cholecystitis: ssx
- fever
- RUQ pain
- leukocytosis
Kussmaul sign –> seen in? why?
constrictive pericarditis
what hormone is necess for implantation?
progesterone
what is: bacteroides fragilis
G- anaerobic rod that can produce B-lactamase
what drugs are used for preg termination?
- misoprostol
- mifepristone
- methotrexate
mult myeloma –> bone resorption –> pathophys
activate osteoclast –> lytic, punched out bone lesions –> esp vertebrae, skull
CML: findings
- elevated WBC
- increase in precursor forms (bands, metamyelocyte, myelocyte)
- decrease leukocyte alk phos
- myelocytic bulge (more myelocytes than the more mature metamyelocyte)
- basophilia
- eosinophilia
pyruvate decarboxylase complex def: tx? MOA?
ketogenic diet:
- fat, ketogenic aa –> acetyl CoA –> ketones –> energy
- no glucose –> decrease pyruvate syn –> decrease lactate
orbital blowout fracture –> medial orbital wall –> can lead to herniation into?
ethmoid sinus
what is: NF-kB
pro-inflamm TF –> increase cytokine production
Syndenham chorea: when?
months after GAS infect
portal V: location on CT
- medial to R liver lobe
- ant to IVC
what is responsible for the vast majority of renal acid excretion in chronic acidotic states?
renal ammoniagenesis
how can mitral stenosis lead to hoarseness?
mitral stenosis –> LA dilation –> impinge L recurrent laryngeal N –> L vocal cord paresis –> hoarse
Graves dz: tx
ablating doses of radioactive iodine
what poses a physical barrier to neovascularization?
laminin in BM
what is: Syndenham chorea
face, arms, legs –> invol rapid irreg jerking mvmts
ASA intoxication –> 4-5hrs later –> what kind of acid/base disturbance? what will ABG show?
mixed resp alk + metab acid:
- normal pH
- low PaCO2
- low HCO3
mesothelioma: histology
tumor cells:
- long slender microvilli
- abundant tonofilaments
leydig cell: location
adj to seminiferous tubule
what changes does a neuron undergo w irrev injury?
12-24hr after injury –> red neuron:
- cell body shrink
- eosinophilic cyto
- nucleus pyknosis
- lose Nissl subst
Ras exists in what 2 states?
- inactive GDP-bound
- active GTP-bound
How is Ras activated? what happens when Ras is activated?
growth factor –> bind receptor tyrosine kinase –> –> Ras remv GDP –> bind GTP –> active Ras
Ras-MAPK signal transduction pathway: active Ras –> phosphorylation cascade –> activate mitogen-activated protein kinase (MAPK) –> enter nucleus –> gene transcription
methacholine: MOA
muscarinic cholinergic agonist:
- contract bronchial SM
- increase bronchial mucus production
C. diff infection: tx
- 1st line mild-mod: metronidazole
- 1st line severe: vancomycin
- recurrent C diff: fidaxomicin
what estimated renal plasma flow?
PAH clearance
what is: constrictive pericarditis
chronic condition –> normal pericardial space –> replaced by thick fibrous shell –> restrict V vol –> eventually HF
what is: lymphangiosarcoma
rare malig neoplasm of endothelial lining of lymphatic channels
vascular dementia: typical presentation
sudden/stepwise cog decline in pts w CV risk factors, ischemic stroke
how do you dx a malabsorptive disorder?
Sudan III stain –> detect fat in stool
acute rheumatic fever: #1 COD
severe pancarditis
what is: renal ammoniagenesis
renal tubular epithelial cell –> metab glutamine to glutmate –> generate ammonium + bicarb:
- excrete ammonium in urine
- absorb bicarb –> buffer acids in blood
pyruvate decarboxylase complex def: pathophys
pyruvate accum –> shunt to lactate –> lactic acidosis
musculocutaneous N: fx
motor:
- major forearm flexors: biceps brachii, brachialis
- coracobrachialis
sensory: lat forearm
how can pro-inflamm cytokines promote angiogenesis?
increase VEGF expression
what type of amyloid deposition will be seen in Alzheimer’s dz?
- neuritic plaque: extracell core of AB amyloid + entangled neuritic processes
- cerebral amyloid angiopathy
- neurofibrillary tangle: intracell aggregates of fibers composed of hyperphos tau
why is matching used in case-ctrl studies?
to ctrl confounding
enteropeptidase: what is? fx?
jejunum –> brush border enzyme –> responsible for activating trypsinogen to trypsin
Osler-Weber-Rendu synd: aka
hereditary hemorrhagic telangiectasia
SIADH: lab findings
- euvolemic hypoNa: normal body fluid vol, low plasma Na & osmolality
- inapprop concentrated urine
coracobrachialis muscle: fx
flex & adduct arm
how do you dx mucormycosis?
tissue bx –> histologic exam
pyruvate decarboxylase complex def: ssx
- lactic acidosis
- neuro defects
AAT def –> leads to?
panacinar emphysema –> affects lower lobes more severely
how do you dx mult myeloma?
BM bx –> >30% plasma cells
lactate deH: rxn
pyruvate –> lactate –> pyruvate
cryptoorchidism: comp
- damage to seminiferous tubules
- testicular CA
R colon CA: clinical manifestation
exophytic mass –> occult bleed –> iron def anemia
Kussmaul sign: what is? cause?
normally: JVP drop during inspiration
Kussmaul sign: JVP increase during inspiration
RV –> vol restricted –> cannot accomodate inspiratory increase in venous return
95% CI corresponds to what pvalue?
less than 0.05
what is the most common congenital cardiac anomaly in Down synd?
complete AV canal defect
how do you dx paroxysmal nocturnal Hburia?
flow cytometry –> lack of CD55 (DAF) on blood cells
mesothelioma: clinical features
- hemorrhagic pleural effusion
- pleural thickening
what mutation is assoc w Crohn dz?
NOD2
what is: complete AV canal defect
1) atrial septal defect
2) V septal defect
3) common AV valve
mult myeloma: ssx
- anemia
- bone resorption
- hyperCa
- infection
- AL amyloid
- renal fail
thionamide: MOA
inh thyroid peroxidase –> inh iodine organification, coupling of iodotyrosines –> decrease TH syn
PTU: also decrease peripheral conversion of T4 to T3
