April 11 Flashcards
What structure distinguishes an indirect from direct hernia?
Inferior epigastric artery
Indirect is lateral and direct is medial
Genetic shift in Influenza A involves what?
Reassortment of genomic segments of the human strain with genomic segments of the animal strain
What cells are seen on blood smear of pt with EBV?
Atypical lymphocytes–CD8+ T-cells
–Activated T-lymphocytes act to destroy virally infected B-lymphocytes
What drives the conversion of NE to Epi in the adrenal medulla and what enzyme is responsible for the conversion?
Cortisol increase driven by ACTH activates phenylethanolamine-N-methytrasferase which is the enzyme responsible for the conversion of NE to EPI
Therefore–decreased ACTH–Decreased cortisol–decreased EPI
The use of what has been suggested to decrease the risk of adenomatous polyp formation?
Aspirin–COX-2 inhibition
COX-2 plays are role in the development of adenomatous colon polyps
What is the cause of increased elastic recoil seen with pulmonary fibrosis?
Thickening and stiffening of the pulmonary interstitium
- -Away widening due to increased outward pulling (radial traction) by the surrounding fibrotic tissue
- -> leads to supernormal expiratory outflow rates
What does strep viridans group sanguinis produce that attaches to the fibrin-platelet aggregates on damage heart valves?
Dextrans–which use sucrose as a substrate
What is seen on histology of amniotic fluid emboli?
Fetal squamous cells and mucin in maternal pulmonary arteries
Uniformly enlarged uterus with extension of endometrial tissue (glandular) into uterine myometrium?
Adenomyosis
What type of lung cancer is associated with subacute cerebellar degeneration–an autoimmune paraneoplastic syndrome characterized by anti-yo, anti-P/Q and anti-Hu antibodies?
Small cell carcinoma
What type of adult brain tumor is associated with spindle cells concentrically arranged in a whorled patter–psammoma bodies?
Meningioma
Pts with Porcelain gallbladder–calcified gallbladder due to chronic cholecystitis are at an increased risk of developing what?
Gallbladder adenocarcinoma
What disorder during pregnancy results in ambiguous external genitalia in female infants and maternal virilization (hirsutism and deepening voice)?
Placental Aromatase deficiency
No conversion of testosterone to estradiol
What is the MOA of baclofen and what is it used for?
Activates GABAb receptors at spinal cord level–inducing skeletal muscle relaxation
Used for muscle spasms
What disease is associated with medullary carcinoma of the thyroid, pheochromocytoma, marfanoid habitus, oral and intestinal mucosal neuromas?
MEN2B
Loss of sensory or motor function (paralysis, blindness, mutism) often following an acute stressor?
Conversion disorder
What ligament encloses the ovarian artery and what must be identified prior to oophorectomy to avoid damage?
Suspensory ligament of the ovary–infundibulopelvic ligament–must be ligated to prevent ovarian bleeding prior to oophorectomy
ureter is in close proximity of the suspensory ligament of the ovary so must be identified prior to ligation
What nerves pass through the superior orbital fissure and what symptoms are seen if this area is damaged?
CN III, IV, VI
Diplopia
Unable to adduct affected eye
What heart murmur has a widen pulse pressure?
Aortic regurgitation–head bobbing
Diphenhydramine and other 1st gen antihistamines can cause dilated pupils and flushed cheeks by blocking what receptors?
Muscarinic receptors –anticholingeric effects
What complement protein promotes phagocytosis by binding and coating foreign cells in the body?
C3b–opsonization
What anti-epileptic drug is associated with Stevens-Johnson syndrome?
Lamotrigine –works through blockage of Na channels
Any type of abdominal process–ruptured spleen, peritonitis, hemoperitonium irritating the phrenic nerve can cause referred pain where?
Phrenic nerve originates from C3-C5–can cause referred pain to the shoulder
Deficiency that presents with hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar tract demyelination without megaloblastic anemia?
Vitamin E deficiency
Cerebellar hemangioblastoma in association with congenital cysts of the kidney, liver, and/or pancreas suggests what disease and what are these pts at increased risk of developing?
von-Hippel-Lindau disease
Increased risk of RCC
What neurotransmitters are effected in Huntington disease?
Increased DA
Decreased GABA and ACh –lost in the caudate
CAG–Caudate loses ACh and GABA
Hematogenous osteomyelitis is most common in children and most often effects the _______ of long bones due to the slower blood flow and capillary fenestrae in this region.
Metaphysis
What disorder is associated with infertility due to absent vas deferens bilaterally?
CF
What benzo is used for ETOH withdrawal?
Chlordiazepoxide
Mean corpuscular hemoglobin concentration is increased in what disorder?
Hereditary spherocytosis –less surface area and no central pallor
Acute intermittent porphyria is caused by deficient in what enzyme and what is the treatment?
Affected enzyme–porphobilinogen deaminase
Tx: glucose and heme–which inhibits ALA synthase
Supplementation of what can increase dTMP levels and reduce erythroid precursor cell apoptosis in the contexts of Vitamin B9 (folate) deficiency?
Thymidine
The thymus and inferior parathyroids are derivatives of what branchial pouch?
3rd pouch
Ear, tonsils, bottom-to-top
1-Ear 2-Tonsils 3- dorsal (bottom for inferior parathyroids 3- ventral (to= thymus 4- top= superior parathyroids
What is antiphospholipid syndrome?
primary or secondary autoimmune disorder–most commonly SLE
Diagnosed based on clinical criteria including history of thrombosis or spontaneous abortion along with laboratory findings of lupus anticoagulant, anticardiolipin, anti-B2 glycoprotein antibodies
Anticardiolipin antibodies and lupus anticoagulant can cause false-positive VDRL/RPR and prolonged PTT
What are the risk factors for the development of cervical cancer?
Related to the risk of acquiring the HPV infection–primarily by sexual contact
- -multiple sexual partners
- -lack of barrier contraceptive
What nerve runs through foramen rotundum?
CN V2–maxillary
What nerve runs through foramen ovale?
CN V3–mandibular
What disease does a patient have when they experience anaphylaxis after receiving a blood transfusion (O-)?
Selective IgA deficiency
What are the risk factors for bladder cancer?
Tobacco smoke
Occupational exposure–rubber, aromatic amine containing dyes, textiles, leather
Where does the phrenic nerve arise from and if affected by lung cancer what are the symptoms seen?
C3-C5
Hiccups and diaphragmatic paralysis with dyspnea
Where is the amino acid binding site on tRNA?
3’ OH end–opposite anticodon loop
Aminoacyl tRNA synthetase is responsible for “loading” of the amino acid at the 3’ end of the CAA tail
What is the MOA of anastrozole, letrozole, exemestane and what are they used for?
Aromatase inhibitors–inhibit periperal conversion of androgens to estrogen
Used for ER + breast cancer in postmenopausal women
What is p53?
Tumor suppressor gene that controls cell division and apoptosis
Is inactivated in many tumors
