Day 3 Flashcards
What enzyme catalyzes the rate-limiting step in cholesterol synthesis? What class of drugs inhibits this enzyme? (FA15 p96) (FA16 p84) (SU p123)
HMG-CoA reductase
Statins
Simvastatin
Atorvastatin
KNOW RATE-DETERMINING ENZYMES OF METABOLIC PROCESSES
What arteries supply the adrenal glands? From what arteries do these arteries arise? (COA p296)
BILAT
superior suprarenal / middle suprarenal / inferior suprarenal a.
inferior phrenic a / Aorta / renal a.
Many factors are involved in the proper morphogenesis of organs in utero. In the case of oligohydramnios, lack of fluid flowing in and out of the fetal lungs leads to pulmonary hypoplasia. This is an example of which type of error in organ morphogenesis? (FA15 p559) (FA16 p563) (SU p144)
Agenesis - absent organ due to absent primordial tissue
Aplasia - absent organ despite presence of primordial tissue
Hypoplasia - incomplete organ development; primordial tissue present
Disruption - secondary breakdown of previously normal tissue or structure (amniotic band syndrome)
Deformation - Extrinsic disruption; occurs after embryonic development
Malformation - intrinsic disruption; occurs during embryonic period (3-8 weeks)
Sequence - abnormalities result from a single primary embryonic event (oligohydramnios –> Potter sequence)
Given the following scenarios describe the corresponding complement deficiency? (FA15 p206)
(FA16 p199) (SU p371)
Clinical scenario
Complement deficiency
Frequent Neisseria infections
Frequent pyogenic respiratory tract infections
Paroxysmal nocturnal hemoglobinuria
Increased frequency of type III hypersensitivity reaction
C5-C9 deficiencies
C3 deficiencies
Strep pneumo / H influ
DAF (GPI-anchored enzyme) deficiency
- CD55 / CD59
C3 deficiency
Which neoplasm is most commonly responsible for the following paraneoplastic effects? (FA15 p238) (FA16 p229) (SU p115, 163)
Syndrome or Effect
Neoplasm
ACTH Cushing’s syndrome
PTH-related peptide hypercalcemia
Erythropoietin polycythemia
ADH SIADH
Small cell lung cancer
Squamous cell carcinoma of: - lung - head - neck Renal cancer Bladder cancer Breast cancer Ovarian cancer
Renal cell cancer Hepatocellular carcinoma Hemangioblastoma Pheochromocytoma Leiomyoma
Small cell lung cancer
Intracranial neoplasms
What nerve is damaged when a patient presents with the following symptom (upper extremity)? (FA15 p418-420) (FA16 p419-421) (SU p238-239) (Answers given for self study) Symptom Claw hand Ape hand Wrist drop Scapular winging Unable to wipe bottom/anus Loss of forearm pronation Cannot abduct or adduct fingers Loss of arm abduction Weak lateral rotation of arm Loss of arm and forearm flexion Loss of forearm extension Trouble initiating arm abduction Unable to abduct arm beyond 10 degrees Unable to raise arm above horizontal
Nerve
Ulnar
Median
Radial
Long thoracic
Thoracodorsal
Median
Ulnar
Axillary
Suprascapular and/or axillary
Musculocutaneous
Radial
Suprascapular
Axillary
Long thoracic
What renal pathology is characteristic of RBC casts and proteinuria? (FA15 p539-541) (FA16 p544-547) (SU p104, 154) (R p910, Table 20-5)
Glomerulonephritis
Acute malignant HTN w/ EOD of kidneys
In which pulmonary disease would you see an increased Reid index? (FA15 p610) (FA16 p618)
(SU p104)
Chronic Bronchitis (RI >50%)
Reid Index – thickness of mucosal gland layer to thickness of wall between epithelial and cartilage
A 56-year-old man develops right lower extremity edema after returning from Europe from a business trip. An exam of the right lower extremity demonstrates a red, warm, lower leg with a positive Homan’s sign. What is the patient’s diagnosis? What is a positive Homan’s sign? What is Virchow’s triad? What is the most common inherited hypercoagulability syndrome? (FA15 p608) (FA16 p616) (SU p103)
Pulmonary Embolism / *** DVT
Virchow’s Triad – hypercoagulability / Epithelial injury / stasis of blood flow
MC inherited hypercoagulability syndrome – Factor V Leiden mutation
clotting factor V cannot be degraded by protein C, resulting in inability for protein C to control the clotting cascade
Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in patients with benign prostatic hyperplasia (BPH)? What is the difference between the prostate exam findings in BPH versus adenocarcinoma of the prostate? (FA15 p594) (FA16 p599) (SU p76)
Alpha1-antagonists (Terazosin / Prazosin / Doxazosin)
A type 2 diabetic with a HgbA1c of 10% presents to your clinic with many complaints. You are concerned about the effect of the patient’s long-term hyperglycemia. What diabetic complications can be attributed to sorbitol-induced osmotic damage? Which enzyme converts glucose to sorbitol? (FA15 p104) (FA16 p92)
Cataracts / Retinopathy / Peripheral neuropathy
Glucose – Aldose Reductase –> Soritol – Sorbitol dehydrogenase (lacking in schwann cells) –> Fructose
Which efferent fibers carry input from the brain that influences the outer hair cells (OHCs) of the cochlea in much the same way that gamma motor neurons influence muscle spindles? What is the result of this input? (SU p34) (Phys p639) (H p248) What is the result of damaging the OHCs (as with antibiotics such as gentamicin and streptomycin)? (H p250)
Olivocochlear bundles
Contraction of the outer hair cells –> stiffening of basilar membrane in cochlea –> sensitizes inner hair cells to a particular frequency
Damaging OHC w/ gentamicin or streptomycin
Wide deflection of basilar membrane –> hearing loss
What is type II (β) error? (FA15 p54) (FA16 p38) (SU p19)
saying that there is no difference when there is a difference
A child in India is brought to the doctor with symptoms of muscle weakness, malaise, headache, fever,
and hyporeflexia. For the past few weeks, he had been swimming in a waterway known to contain
sewage. You think this boy has contracted a pathogen via the fecal-oral route. Which area of the body
is this pathogen attacking to give the neurologic symptoms seen? (FA15 p471) (FA16 p474) (SU p45)
Poliomyelitis
Werdnig-Hoffmann disease
Amyotrophic Lateral Sclerosis
Complete occlusion of anterior spinal artery
Tabes dorsalis
Syringomyelia
Vitamin B12 deficiency
Polio virus –> fecal-oral
destruction of cells in anterior horn of the spinal cord –> ultimately causes lower motor neuron destruction
What are the risk factors for osteosarcoma? (FA15 p428) (FA16 p429) (SU p231)
Paget disease of bone
bone infarcts
radiation
familial retinoblastoma (mutation in Rb gene)
Li Fraumeni syndrome (germline p53 mutation)
Male Sex
Age 10-20
What disorders can cause cotton-wool spots on the retina? (H p231)
Diabetes
HTN
AIDS Lupus Temporal arteritis Wegener granulomatosis Polyarteritis nodosum
Which cardiac valve is most commonly involved in infective endocarditis and acute rheumatic fever?
(FA15 p298-299) (FA16 p293-294) (SU p87)
Mitral Valve most commonly involved
Tricuspid Valve involved with IV drug abusers (“dont TRI drugs”)
Name the syndromes below that are common causes of anovulation. (FA15 p323, 585) (FA16 p317,
591) (SU p207-208)
Elevated cortisol, central obesity
Amenorrhea + hirsutism + obesity
Cushing Syndrome
PCOS
Which neurotransmitters in the brain are affected in each of the following disorders? Are the levels increased or decreased? (FA15 p507) (FA16 p511) Schizophrenia Parkinson disease Alzheimer disease Huntington disease Anxiety Depression
increased dopamine ------------------------------ decreased dopamine increased ACh Increased 5-HT ------------------------------- decreased ACh Increased glutamate ------------------------------- decreased GABA decreased ACh increased dopamine ------------------------------ increased NE decreased GABA decreased 5-HT ------------------------------ decreased NE decreased 5-HT decreased dopamine
5-HT decreased in both anxiety and depression –> why we use SSRIs to treat both disorders
What is the underlying cause of DiGeorge syndrome? What are the manifestations of DiGeorge
syndrome? (FA15 p88, 214, 566) (FA16 p76, 208, 570) (SU p167, 382)
Microdeletion at chromosome 22q11
** Underlying cause –> 3rd and 4th branchial pouches fail to develop –> no thymus or parathyroid glands
C: cleft palate
A: abnormal facies
T: thymic asplasia (absent thymic shadow on CXR) –> failure to develop 3rd and 4th pharyngeal pouches –> T cell deficiencies
C: cardiac defects –> tetralogy of Fallot, truncus arteriosus
H: hypocalcemia 2/2 parathyroid aplasia –> tetany
22: 22q11 deletion –> FISH
T cell deficiencies:
recurrent viral & fungal infections
Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhea infections. Which generation of cephalosporin is ceftriaxone? Which generation of cephalosporin is effective against Pseudomonas? Are cephalosporins bacteriostatic or bactericidal? (FA15 p182) (FA16 p172) (SU p337-338)
Ceftriaxone = Third Generation cephalosporin
Pseudomonas
Ceftazidime / Cefoperazone (3rd generation)
Cefepime (4th generation)
Bactericidal "Very Finely Proficient At Cell Murder" V: vancomycin F: fluoroquinolones P: penicillin A: aminoglycosides C: cephalosporins M: metronidazole
Bacteriostatic: ECSTaTiC E: erythromycin C: clindamycin S: sulfamethoxazole T: trimethoprim T: tetracycline C: chloramphenicol
A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis? (H p269)
Maybe Giant Cell Arteritis (Temporal Arteritis) but… 35yo is too young
TMJ syndrome = young woman / 2nd MC cause of facial pain Exacerbated by stressful life events Nocturnal bruxism (grinding teeth at night)
A patient is undergoing treatment with recombinant interferon for his hepatitis C. In what ways do
interferons interfere with viral protein synthesis? (FA15 p207-208) (FA16 p200-201) (SU p431)
Interferons are glycoproteins synthesized by virus-infected cells that act locally on uninfected cells, priming them for viral defense by helping to selectively degrade viral nucleic acid and protein
- RNA protein kinase (inhibits viral protein synthesis by degrading viral mRNA)
- Trigger pro-apoptotic pathways
- Influence activities of macrophages / dendritic cells
Your patient develops a cough with the new antihypertensive drug you prescribed her. What are some
other side effects associated with this medication? (FA15 p555) (FA16 p559) (SU p76-77, 84)
ACE inhibitors C: cough A: angioedema P: hyperKalemia (Potassium) T: taste changes O: hypOtension P: pregnancy changes R: rash I: increased renin L: low angiotensin II
In regard to seizures, what do the terms partial, generalized, simple and complex mean? (FA15 p489)
(FA16 p494) (SU p44)
Seizures
Partial – affect single area
Generalized – diffuse area
Simple – consciousness intact
Complex – impaired consciousness
How is thyroid hormone made and stored? (SU p190) (Phys p907) (H p2913)
epithelial cells of thyroid bring in iodide from blood using Na/I cotransporter
- Iodide oxidized by peroxidase –> bind to thyroglobulin (organification)
- MIT / DIT links together to make T3 and T4
- T3 is the active
- T4 is most that gets released
A 35-year-old man is seen in the office for his chronic, recurrent peptic ulcer disease. It has been
refractory to conventional treatment with PPIs. Your attending mentions that this might be caused by
a tumor. Which type of tumor may be responsible for this condition? If this patient also presented with
kidney stones and signs of hypogonadism, what syndrome might you suspect? (FA15 p336-337) (FA16
p332-333) (R p769, 1136)
Zollinger-Ellison syndrome (gastrinoma)
duodenum and pancreas
MEN I (???)
** Kidney stones (calcium --> hyperparathyroidism) & hypogonadism (pituitary disease, prolactinoma)
What is the role of clomiphene in the treatment of PCOS? What is the mechanism of action of
clomiphene? (FA15 p596) (FA16 p601) (SU p224)
Clomiphene – used to treat infertility in PCOS
Antagonist at estrogen receptors in hypothalamus Prevents normal feedback inhibition and increase release of LH and FSH from pituitary, which stimulates ovulation
