Day 2 June 22 Flashcards
will patients with turner syndrome have normal internal and external genitalia?
YES except for STREAK ovaries
what causes a decreased maternal serum alpha fetal protein?
aneuploidies
what causes an increased maternal serum alpha fetal protein?
- open neural tube defects (spina bifida, anencephaly)
- ventral wall defects (omphalocele)
- multiple gestations
What is theophylline?
Methylxanthine derivative - stimulant used for asthma, COPD and bronchospasm (causes bronchodilation)
How does theophyline cause toxicity?
Overdose can lead to tacchyarrythmias or SEIZURES since it has stimulant activity on the heart
why doesnt menstruation and breast development occur in turner syndrome?
these process are estrogen dependent and the ovaries may be streak ovaries (replaced by fibrous tissue, atrophic)
what embryologically goes wrong in tetrallogy of fallot?
abnormal neural crest migration -> anterior deviation of the infundibular septum
pathogenesis of ankylosing spondylitis
- defects in mucosal barrier and abnormal intestinal microbiome induce IL-17 via t cells/lymph and IL-17 induces other inflammatory factors, specifically TNF alpha and prostaglandins
- > bony lesions and abnormal bone growth
RISK INCREASED IN HLA B27
presentation of ankylosing spondylitis?
<40 years old
- insidious onset of bone/buttock pain
- nocturnal pain, pain releived with movement
- dactylitis
- enthesitis (inflammation at tendon insertion point)
- anterior uveitis
leading cause of bacterial meningitis in adults?
S. pneumonia
what is focal nodular hyperplasia?
non-malignant lesion in liver most commonly in young women. Found incidentally
FNH pathophys
hepatic vascular abnormality causes local hyperperfusion followed by hyperplastic response, resulting in small solitary pale nodules with central stellate scar and fibrous bands
most lung abscesses are ____
polymicrobial
what is attrition bias?
A type of SELECTION bias where loss-to-follow up is disproportionate between exposure groups
how do you treat a patient with toxoplasmosis gondii?
sulfadiazine and pyrimethamine
ADD leucovorin
how do you treat a patient with toxoplasmosis gondii who has a sulfa allergy?
clindamycin and pyrimethamine
what is a common cause of ring enhancing brain lesions in an HIV patient, OTHER than toxo?
primary central nervous system lymphoma - B cell origin from EBV
EBV usually causes abnormal ___ cells, except for in the ____ where it causes abnormal B cells
T
brain
what is derealization/depersonalization disorder?
Disorder where patient has at least one of the following:
- depersonalization (detachment and unreality of self)
- derealization (detachment and unreality of environment)
what is dissociative identity disorder?
two or more distinct personalities
what is a common mechanism of chemo resistance in tumour cells?
The development of P-glycoprotein
How does p-glycoprotein work?
It uses ATP to pump out the chemo drugs
presentation of babesia infection?
flu-like symptoms - fatigue, myalgias, headache, respiratory symptoms
how is babesia spread?
bite of ixodes tick
what is seen on a blood smear of babesia?
maltese crosses - intracellular inclusions in RBCs
Presentation of cyanide poisoning
reddish skin discolouration, tachypnea, headache, tacyycardia, nausea/vomiting and can progress to seizures and cardiovascular collapse
how to treat cyandine poisoning?
nitrites
how do nitrites treat cyanide poisoning?
They convert hemoglobin to methemaglobin which has a high affinity for cyanide- it binds and sequesters cyanide away from cyt C
how does cyanide cause poisoning?
it binds Fe3+ thus inhibiting cyt C and blocking ETC -> lactic acidosis and death
flutamide MOA
competitively blocks androgen receptor binding
what will be found on urine electrophoresis of someone with multiple myeloma?
lambda light chains - kidney disease in multiple myeloma is often caused by light chain cast nephropathy
where is ribosomal RNA transcribed?
the nucleolus
all stages of syphillis are effectively treated with what?
penicillin - give slow release since treponoma divides slowly over time
what is the shape of treponema pallidum?
corkscrew shaped
high exposure to aflatoxins is related to which type of cancer?
hepatocellular carcinoma
ehrlichia chafeensis demonstrates what on microscopic investigation of monocytes?
mulberry shaped intracytoplasmic inclusions in monocytes
how is ehrlichia chafeensis spread?
by tick bites, but lives harboured by white-tailed deer and then spreads to mononuclear cells (such as those in bone marrow)
how does central retinal artery occlusion present?
acute, painless, monocular vision loss
fundoscopic findings of central retinal artery occlusion?
cherry red macula and retinal whitening
antisocial personality disorder clinical features?
- violates social norms, rights of others and laws
- impulsive, aggressive
- consistently irresponsible
- lack of remorse
- age >18
- evidence of conduct disroder before 15
what are the same clinical signs of antisocial personality disorder, in someone under 15, called?
conduct disorder
what is oppositional defiant disorder?
-these patients have irritability, vindictiveness and lack of personal accountability but dont necessarily break the law
what is disruptive mood dysregulation disorder?
- only diagnosed in those <18
- severe, persistant irritability in childhood with frequent verbal/aggressive outburts
pathophys of acute hemolytic transfusion reaction
type II hypersensitivity
-PREexisting anti ABO antibodies bind to donor cells resulting in lysis via complemement, vasodilation (C5a) and symptoms of shock
what is paroxysmal atrial fibrillation and what does it look like on an ECG?
atrial fibrillation that comes and goes on its own
ECG will show lack of p waves and irregularly spaced QRS complexes
where should ablation take place in someone with paroxysmal atrial fibrillation?
near the pulmonary veins (ectopic electrical foci are commonly found here in Afib)
where are bile acids usually reabsorbed?
terminal ileum via transporters
patients with crohns disease are at increased risk for what gallbladder pathology?
gallstones, due to increased cholesterol to bile ratio (lost bile in terminal ileum)
what is the most common complication of chagas disease?
chronic chagas heart disease - chronic low grade myocarditis leads to destructions of fibers and fibrosis -> heart failure, arythmias, etc.
what is seen on a blood smear of someone infected with T. cruzi?
tryptomastigotes
