8 Flashcards
An adult trauma patient begins to experience shortness of breath on day 3 of his hospital stay. The patient had an open reduction internal fixation of a right femur fracture. You are concerned the patient’s shortness of breath might be attributed to an embolus. What type of embolus is this patient at risk of getting? What are the different types of emboli? (FA15 p609) (FA16 p617)
at risk for thromboemboli due to stasis
also risk for fat emboli due to long bone (also pelvic) fracture
“An embolus moves like a FAT BAT.”
Types: Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor
How can a skull fracture at the base of the brain lead to pulsating exophthalmos (protrusion of the eye)?
skull fracture–>torn ICA in cavernous sinus–>^BP in sinus–>blood fills ophthalmic vein and orbital tissue–>exophthalmos (which pulses)
What is the site of action of each of the following diuretics? (FA15 p552) (FA16 p556) (SU p148, 164) Thiazide diuretics- Loop diuretics- Carbonic anhydrase inhibitors- Osmotic diuretics- Potassium-sparing diuretics-
Thiazide diuretics- DCT
Loop diuretics- thick ascending loop of Henle
Carbonic anhydrase inhibitors- PCT
Osmotic diuretics- PCT (also thin descending loop of Henle and collecting duct (mannitol))
Potassium-sparing diuretics- Collecting duct
In patients with a prolactinoma, what pharmacologic agent can be used to inhibit the release of prolactin? In normal physiology, how is prolactin secretion regulated? (FA15 p316) (FA16 p310)
*bromocriptine (D2 agonist), cabergoline
PRL secretion from ant pit is tonically inhibited by dopamine from hypothalamus.
PRL in turn inhibits its own secretion by ^dopamine synthesis and secretion from hypothalamus.
TRH ^ PRL secretion (e.g., in 1° or 2° hypothyroidism).
Dopamine ANTagonists (e.g., most antipsychotics) and estrogens (e.g., OCPs, pregnancy) stimulate PRL secretion.
The different hereditary hyperbilirubinemias can all present with jaundice and scleral icterus. What is the underlying cause in the following hyperbilirubinemias, and what form of bilirubin is elevated in the serum in each disease? (FA15 p372) (FA16 p370)
Gilbert syndrome
Crigler-Najjar syndrome, type I
Dubin-Johnson syndrome
Gilbert syndrome: Mildly decreased UDP-glucuronosyltransferase (UGT) conjugation and impaired bilirubin uptake, ^UC bilirubin
Crigler-Najjar syndrome, type I: absent UDP-glucuronosyltransferase (UGT)–>inhibited conjugation, ^UC bili
Dubin-Johnson syndrome: inhibited transport out (defective liver excretion), ^C bili (Rotor syndrome is similar)
What is the cause of hypertrophic cardiomyopathy (HCM)? (FA15 p296) (FA16 p291)
60–70% of cases are familial, autosomal dominant, variable penetrance (commonly a β-myosin heavy-chain mutation (sarcomuric proteins)) Can be associated with Friedreich ataxia.
myocyte hypertrophy–>massively hypertrophied LV–>decreased compliance–>impaired diastolic filling and decrease SV
What are the Jones criteria for the diagnosis of acute rheumatic fever? (FA15 p129) (FA16 p120)
Evidence of strep infection + 2 major criteria OR 1 major + 2 minor JONES: major criteria J: joints- polyarthritis O: pancarditis N: nodules (subQ) E: erythema marginatum S: sydenham chorea
minor: fever, arthralgias, ^ESR, ^PR interval
During fetal development what structure traps the inferior poles of the kidney resulting in a horseshoe kidney? Do patients with horseshoe kidneys have abnormal renal function? (FA15 p527) (FA16 p531)
Inferior mesenteric artery (IMA)
have normal renal function
What is the mechanism of action of the following cholinergic agents? (FA15 p250-251) (FA16 p244-245) pralidoxime neostigmine bethanechol hexamethonium atropine carbachol
pralidoxime: regenerates AChE (antimuscarinic)
neostigmine: AChE inhibitor (muscarinic)
bethanechol: muscarinic agonist
hexamethonium: Nicotinic ACh receptor antagonist
atropine: antimuscarinic (competitive inhibitor of ACh)
carbachol: muscarinic agonist (muscarinic and nicotinic)
A 25-year-old man is evaluated in the clinic for red, swollen, and painful right wrist and left knee joint. During the exam, the patient brags about his sexual conquests. What sexually-transmitted organism can cause osteomyelitis as well as this patient’s septic arthritis? (FA15 p173) (FA16 p163)
N. gonorrhoeae
From where does the amygdala receive inputs? To where does it send output?
RECEIVES inputs from Limbic cortex and Neocortex (Parietal, Temporal, and Occipital lobes; esp. visual and auditory association areas)
SENDs signals back to cotical areas from where it received inputs:
Hippocampus, Septum, Thalamus, Hypothalamus
What are some of the reasons a woman might have primary amenorrhea? (has never started menstruating)
Turner syndrome, imperforate hymen, androgen insensitivity syndrome, Mullerian duct agenesis (due to lack of uterine development), delayed puberty
The body uses both the cell-mediated and the humoral immune system to fight infection. Which T cell type regulates the humoral response? (FA15 p202) (FA16 p194)
Th2 helper T cells
- Secretes IL-4, IL-5, IL-10, IL-13
- Recruits eosinophils for parasite defense and promotes IgE production by B cells
- Activated by IL-4
- Inhibited by IFN-γ (from Th1 cell)
IN CONTRAST Th1 cells augment CMI by generating IL-2 and IFN-y
Coal miners are at an increased risk for skin cancer because of their exposure to arsenic. Which type of skin cancer is associated with this exposure? (FA15 p443) (FA16 p445)
Squamous cell carcinoma
What is syringomyelia? What symptoms are commonly seen in patients with syringomyelia?
(FA15 p450) (FA16 p452)
Cystic cavity (syrinx- "tube") within central canal spinal cord (C8-T1 typ.) Crossing anterior spinal commissural fibers (AWC) are typically damaged first. Results in a “cape- like,” bilateral loss of pain/ temp in UE (fine touch sensation is preserved, could see motor deficits). Associated with Chiari malformations, trauma, and tumors.
In performing a lumbar puncture to obtain a sample of CSF, what structures are pierced, starting with the most exterior?
skin/superficial fascia supraspinous ligament interspinous ligament ligamentum flavum epidural space dura mater subdural space arachnoid mater subarachnoid space NOT pia
