Day 5 Flashcards
What ratio indicates fetal lung maturity? What is the proper name for the main component of pulmonary surfactant? (FA15 p600) (FA16 p607) (SU p96) (Phys p468)
L/S >2 is health (<1.5 is predictive of RDS)
Dipalmitoylphosphatidylcholine
Which nutrient deficiency is associated with spooning of the nails (koilonychia)? (H p846)
Sign of hypochromic anemia –> iron deficiency & Plummer-Vinson syndrome
You start a patient on a drug that has been on the market for five years. It has excellent efficacy. However, your patient begins to have an annoying side effect one month after initiation of this drug. She contacts the manufacturer about it, and they, in turn, contact you to gather data on her course while on the drug. In which phase of the clinical trial would this example fall? (FA15 p48) (FA16 p32)
Clinical Trials
Phase I – Small # of healthy volunteers
Trial on normal patients
Phase II – Small # of patients with disease of interest
See if works on diseased patients
Phase III – Large # of patients randomly assigned either to the treatment under investigation or to the best available treatment (or placebo)
Head-to-Head trial with another drug
Phase IV – Postmarketing surveillance of patients after treatment approval
Which bacteria are known for being obligate intracellular bacteria? (FA15 p122) (FA16 p112) (SU
p335-336)
“stay inside cells when it is Really CHilly and COld”
Rickettsia
CHlamydia
COxiella burnetii
What is the equation for determining a drug’s clearance? (FA15 p243) (FA16 p237) (SU p395)
CL = rate of elimination of drug / plasma drug concentration
= Vd x Ke (elimination constant)
= 0.7 x Vd / half-life
The protein derived from what gene serves as a transcription factor for the development and function
of regulatory T cells? (R p784)
FOXP3 Found on the X chromosome Codes for Forkhead Box Protein P3 Important for self-tolerance Absence has been implicated in autoimmune diseases
Where would you expect to find B cells in a lymph node? Where would you find T cells, plasma cells,
and macrophages? (FA15 p198) (FA16 p190) (SU p367, 369) (Phys p427)
B cells – Follicles (cortex)
T cells – Paracortex (region between follicle and medulla)
Plasma cells – Medullary cords
Macrophages – Medullary sinus
What important intracellular proteins are common to both the extrinsic and intrinsic apoptotic
pathways? (FA15 p222) (FA16 p216)
Intrinsic Pathway
- Bcl-2 (anti-apoptotic) - BAX (pro-apoptotic) - BAK (pro-apoptotic)
Extrinsic Pathway
- Fas - FasL
Common proteins to both In & Ex are CASPASES
What is the female homolog to each of the following male structures? (FA15 p568) (FA16 p572) (SU
p197-198)
Corpus spongiosum
Cowper’s glands
(bulbourethral glands)
Prostate
Glans penis
Ventral penile shaft
Scrotum
vestibular bulbs ------------------------------------ Bartholin glands ------------------------------------ urethral and paraurethral glands Skene glands ------------------------------------ Glans clitoris ------------------------------------ Labia minora ------------------------------------ Labia majora ------------------------------------
Which amino acids are necessary for purine synthesis? (FA15 p63) (FA16 p49) (SU p279)
GAG - amino acids necessary for purine synthesis
Glycine
Aspartate
Glutamine
Your 46-year-old male patient is asking your advice on whether to take a daily aspirin. How does taking an aspirin a day prevent platelet aggregation and myocardial infarction? Which two arachidonic acid products affect platelet aggregation? (FA15 p444) (FA16 p446) (SU p243-244)
Irreversibly inhibits COX-1 and COX-2 –> less production of Thromboxane A2 –> less platelet aggregation –> less thrombosis
Thromboxane A2 stimulates platelet aggregation
Prostacyclin (PGI2) inhibits platelet aggregation
What is compartment syndrome, and how is it treated? (SU p242) (COA p540)
Compartment syndrome
Increased pressure within the fascial compartment
Treatment
Fasciotomy
Thiazolidinediones (TZDs) increase expression of one type of GLUT receptors—those in adipose tissue—as one of their antidiabetic actions. Which GLUT receptors would you expect to find on skeletal muscle and fat? (FA15 p314) (FA16 p308) (SU p298)
Insulin-DEPENDENT
GLUT4 - adipose tissue, striated muscle (exercise can also increase GLUT4 expression
Insulin-independent
GLUT1 - RBCs / brain / cornea / placenta
GLUT2 (bidirectional) - beta islet cells / liver / kidney / small intestine
GLUT3 - brain / placenta
GLUT5 (fructose) - spermatocytes / GI tract
Brain uses glucose normally and ketones during starvation
RBCs always use glucose bc they lack mitochondria for aerobic metabolism
"BRICKL" B: brain R: RBCs I: Intestine C: cornea K: kidney L: liver
Which GI ligaments match the following descriptions? (FA15 p344) (FA16 p340)
Separates the greater and lesser sacs
May be cut during surgery to access the lesser sac
2 ligaments that connect the spleen to other structures
Contains the portal triad
Connects liver to the anterior abdominal wall
gastrohepatic ligament (right) gastrosplenic ligament (left) -------------------------------------- Gastrohepatic ligament -------------------------------------- Gastrosplenic ligament Splenorenal ligament -------------------------------------- Hepatoduodenal ligament Portal Triad proper hepatic a. portal v. CBD -------------------------------------- Falciform ligament
An 18-year-old woman has seasonal allergies. She complains that her eyes water and her nose runs constantly during the spring. Which cell type is responsible for her symptoms, and what drug inhibits these cells’ actions? What WBCs descend from the myeloblast (granulocyte) lineage? (FA15 p382-383) (FA16 p378-379) (SU p376)
Mast cells – mediate allergic reaction in local tissues
Cromolyn sodium prevents mast cell degranulation (used for asthma ppx)
Membrane binds with Fc portion of IgE –> crosslinks –> degranulates –> release histamine, heparin, tryptase, eosinophil chemotactic factors
Antihistamines block the downstream effects of histamine
Granulocytes Neutrophils Eosinophils Basophils Mast cells come from a different cell line
In the lower extremity, what are some of the clinical differences between peripheral vascular disease (PVD, also known as peripheral artery disease (PAD)) and deep venous thrombosis (DVT)?
(H p2066, 2170)
PVD/PAD Atherosclerosis of the peripheral arteries Claudication Decreased/absent peripheral pulses Foot may be cool to the touch Skin can become pale/shiny/hairless
DVT
Blood clot in a peripheral vein
Leg is warm (not cool)
Increased calf circumference
Moses sign (calf tenderness with compression)
Homan sign (calf pain with dorsiflexion of the ankle)
You have a patient who is experiencing progressive difficulty with swallowing liquids and solid food. Subsequently, the patient undergoes a barium swallow that reveals stenosis of the lower esophageal sphincter. What is the diagnosis associated with this barium swallow finding? What are some common causes of this diagnosis? (FA15 p357) (FA16 p354)
Achalasia Loss of Auerbach plexus Secondary to Chagas disease (T cruzi) Amyloidosis Sarcoidosis Extraesophageal malignancy CREST
A 66-year-old man currently taking warfarin for atrial fibrillation is instructed to avoid food products that contain vitamin K in order to optimize anticoagulation. For what coagulation factors is vitamin K necessary? (FA15 p94) (FA16 p82) (SU p270)
Factor II, VII, IX, X
Proteins C & S
A 22-year-old man suffers a stabbing injury to the chest. He has lost a lot of blood, and you are concerned that his cardiac output is low. What are the two equations for cardiac output?
(FA15 p272) (FA16 p266) (SU p68)
CO = SV x HR
CO = rate of O2 consumption / (arterial O2 content - venous O2 content)
A 5-year-old boy is treated with mebendazole for a pinworm infection. Mebendazole acts on microtubules to inhibit the pinworms. What other medications act on microtubules? What syndrome demonstrates a defect in microtubule polymerization? (FA15 p74, 215) (FA16 p60, 209)
"Microtubles Get Constructed Very Poorly" M: mebendazole (antihelminthic) G: Griseofulvin (antifungal) C: colchicine (antigout) V: vincristine/vinblastine (anticancer) P: placlitaxel (anticancer)
Chediak-Higashi syndrome Macrophage microtubules do not polymerize properly Recurrent pyogenic infections Peripheral neuropathy Partial albinism
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) (SU p103)
Fat embolism
FAT BAT
Fat emboli (hypoxemia, neurologic abnormalities, petechial rash) Air emboli Thrombus Bacterial Amniotic (can lead to DIC) Tumor
How can a skull fracture at the base of the brain lead to pulsating exophthalmos (protrusion of the eye)? (H p237)
Skull fx –> Torn ICA in cavernous sinus –> increase 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-
early Distal Convoluted Tubules -------------------------------------- Ascending loop of Henle -------------------------------------- Acetazolamide Proximal tubules -------------------------------------- Mannitol Proximal tubules Descending loop of Henle Collecting duct -------------------------------------- coritcal collecting tubules
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)
(SU p170, 184)
Bromocriptine (dopamine agonist)
regulated by dopamine
Prolactin – secreted by Anterior Pituitary
– inhibited by dopamine from hypothalamus
– INCREASED by TRH / pregnancy / OCPs / estrogen
– STIMULATED by anti-psychotics
– Prolactin inhibits its own secretion by increasing dopamine production and release from the hypothalamus
What is the cause of hypertrophic cardiomyopathy (HCM)? (FA15 p296) (FA16 p291) (SU p89)
(R p569)
beta-myosin heavy-chain mutation
cardiac troponin T
alpha tropomyosin
60-70% familial, AD
Myocyte hypertrophy –> Massively hypertrophied LV –> decreased compliance –> impaired diastolic filling and decreased SV
What are the Jones criteria for the diagnosis of acute rheumatic fever? (FA15 p129) (FA16 p120)
(SU p87-88)
MAJOR J: joints -- polyarthritis O: carditis N: nodules (subcutaneous) E: erythema marginatum S: sydenham chorea
MINOR Fever Arthralgias elevated ESR / CRP prolonged PR interval
GAS - strep pyogenes
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)
(SU p144)
Inferior Mesenteric a.
Kidneys function normally
What is the mechanism of action of the following cholinergic agents? (FA15 p250-251)
(FA16 p244-245) (SU p76, 407-408, 411, 441, 446)
pralidoxime
neostigmine
hexamethonium
atropine
carbachol
Cholinesterase inhibitor
Increase ACh
Direct cholinergic agonist
activates bowel and bladder smooth muscle resistant to AChE ------------------------------------- Nicotinic ACh receptor antagonist ------------------------------------- Muscarinic antagonist Hot as a hare / Dry as a bone / Red as a beet / Blind as a bat / Mad as a hatter ------------------------------------- Muscarinic agonist
Direct agonist – carbon copy of ACh
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) (SU p235)
S. Aureus is most common overall
Strep penumo is also common in children
If sexually active –> N. gonorrhea , but this causes Septic Arthritis more often than Osteomyelitis
From where does the amygdala receive inputs? To where does it send output? (Phys p719)
Input Limbic cortex Neocortex - Parietal lobe - Temporal lobe - Occipital lobe
Output Coritacal areas from which it received inputs Hippocampus Septum Thalamus Hypothalamus
What are some of the reasons a woman might have primary amenorrhea? (SU p204, 207) (H p385)
Turner syndrome Imperforate hymen Androgen insensitivity syndrome Mullerian duct agenesis 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 cells
- augment humoral immune response by generating IL-4 & IL-5
Th1 cells
- augment cell-mediated response by generating IL-2 & IFN-gamma
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
Sunlight
Immunosuppression
Arsenic exposure
What is syringomyelia? What symptoms are commonly seen in patients with syringomyelia?
(FA15 p450) (FA16 p452) (SU p39)
Syringomyelia – cystic cavity within central canal of spinal cord
"cape-like" bilateral loss of pain & temperature sensation in UE Touch sensation unaffected Associated with Chiari malformations, trauma, tumors
In performing a lumbar puncture to obtain a sample of CSF, what structures are pierced, starting with
the most exterior? (COA p505)
Skin / Subcutaneous tissue Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space Dura mater Subdural space Arachnoid mater Subarachnoid space
In which phase of meiosis is a primary oocyte arrested until just prior to ovulation? In which phase of
meiosis is an oocyte arrested until fertilization? (FA15 p575) (FA16 p578) (SU p199, 205)
Arrested in prophase I until ovulation
Arrested in metaphase II until fertilization
Does the notochord become the neural tube? (FA15 p448) (FA16 p450)
No
Notochord becomes nucleus pulposus of intervertebral disc in adults
Neural plate becomes the neural tube
A 65-year-old woman with primary pulmonary hypertension is in severe respiratory distress, and she
has cyanosis and signs of right-sided heart failure. What medications are used in the treatment of
pulmonary hypertension? What are their mechanisms of action? (FA15 p620) (FA16 p627)
Bosentan / Ambrisentan – competitively antagonizes endothelin-1 receptors –> decrease pulmonary vascular resistance
Hepatotoxic (monitor LFTs)
Sildenafil / Tadalafil – (phosphodiesterase inhibitors) Inhibits cGMP PDE-5 and prolongs vasodilatory effect of NO
Epoprostenol / Iloprost – PGI2 (prostacyclin) with direct vasodilatory effects on pulmonary and systemic arterial vascular beds. Inhibits platelet aggregation.
Side effects: flushing / jaw pain
Nifedipine – dihydropyridine CCB
A 35-year-old man develops hallucinations just before sleep, episodes of excessive sleepiness, and
cataplexy during times of laughter and sadness. Narcoleptic sleep episodes begin with what stage of
sleep? What are the different stages of normal sleep? How do they differ from one another?
(FA15 p455) (FA16 p457) (SU p43)
Narcoleptic sleep – REM sleep
What is the mechanism of action for methylphenidate? (FA15 p520) (FA16 p524) (SU p58) (GG p298) What are the signs of intoxication of amphetamine? (FA15 p518) (FA16 p522) (SU p52)
CNS stimulants (Methylphenidate / Dextroamphetamine / Methamphetamine)
Indirect sympathomimetic
Releases stored catecholamines into the synaptic cleft, especially norepinephrine and dopamine
Used in: ADHD, narcolepsy, appetite control
Amphetamine intoxication: Euphoria Insomnia Pupillary dilation (mydriasis) Fever / Diaphoresis HTN Tachycardia Paranoia Anxiety Anorexia Seizures
What are the effects of stimulating the amygdala? (Phys p719)
Fluctuating BP, HR Defecation or micturition Pupilllary dilation or constriction Piloerection Secretion of various anterior pituitary hormones Movements related to eating Negative emotions Sexual responses
What anatomical structure is implicated in hematoma formation as a sequela of vulvar trauma? (COA p432-433)
Saddle trauma
Bulb of vestibule
Given each of the following deficits, list the corresponding affected artery. (FA15 p464) (FA16 p467) (SU p31)
Loss of motor and sensation of leg and foot
Contralateral homonymous hemianopia with macular sparing
Aphasia with generalized sensory and motor dysfunction
Loss of motor and sensation of the face
Loss of motor and sensation of the arms
Anterior Cerebral a. ------------------------------------ Posterior Cerebral a. ------------------------------------ Middle Cerebral artery Anterior communicating a. Anterior Cerebral a. ------------------------------------ Middle Cerebral a. ------------------------------------ Middle Cerebral a. ------------------------------------
A 50-year-old roofing worker develops a cough for the past month that is now associated with hemoptysis. The patient denies a smoking history or prolonged exposure to second-hand smoke. An x-ray reveals a left-sided lower lung coin-shaped lesion. What type of lung cancer is suspected in this individual? What is the appearance of asbestos fibers in the lung? What cancers are associated with asbestosis? (FA15 p612, 617) (FA16 p620, 624) (SU p108)
Bronchogenic adenocarcinoma (coin lesion) > risk of mesothelioma
Ferruginous bodies are golden-brown fusiform rods resembling dumbbells / visualized with Prussian blue stain
When performing a femoral arterial line placement or femoral venous catheter placement, it is important to palpate the femoral artery to determine where the inguinal structures are located. What structures are found under and just inferior to the inguinal ligament? List them in order from lateral to medial. (FA15 p350) (FA16 p347) (SU p250)
NAVL == femoral nerve / femoral a. / femoral vein / lymphatics
What are the causes of iatrogenic Creutzfeldt-Jakob disease (CJD)? What measures can be taken to avoid iatrogenic CJD? (FA15 p171) (FA16 p161)
Transmissible via CNS related tissue
- Transplant (cornea or liver) - Dural grafts - Cadaveric pituitary hormones - Surgical procedures
- ** preventive measures
- Automated surgical instrument washers
- Autoclave and sodium hydroxide
- Keeping surgical instruments in a moist environment after use
Sertoli cells release a substance that acts on the paramesonephric ducts in order to prevent the formation of what structures in a normal male fetus? What other name is given to the paramesonephric ducts? (FA15 p567) (FA16 p571) (SU p198)
Mullerian Inhibitory Factor (MIF) from Sertoli cells suppresses development of paramesonephric ducts
Paramesonephric ducts = Mullerian ducts
A 54-year-old man presents with a blood pressure of 200/160 mm Hg, and the examination reveals right-sided abdominal bruit suggestive of renal artery stenosis. What is the mechanism by which renal artery stenosis causes hypertension? What are some other common causes of secondary hyperaldosteronism? (FA16 p318) (SU p185)
increase aldosterone, increase renin
JG cell tumor Chronic renal failure CHF Cirrhosis Nephrotic syndrome
A 38-year-old man’s AIDS is being managed by his infectious disease physician, who has decided to start him on trimethoprim-sulfamethoxazole (TMP-SMX). Why would you place an AIDS patient on TMP-SMX when his CD4 count drops below 200? (FA15 p148) (FA16 p138) (SU p357)
PPx for PCP pneumonia
During what week of fetal development will the fetus reach the following landmarks? (FA15 p558) (FA16 p562)
Implantation
Organogenesis
Heart begins to beat
Can distinguish male or female genitalia
Gastrulation
Formation of primitive streak and neural plate
Within 1 week ----------------------------------- 3-8 weeks ----------------------------------- 4 weeks ----------------------------------- 10 weeks ----------------------------------- 3 weeks ----------------------------------- 3 weeks
What is the initial medical treatment for the arrhythmia known as torsades de pointes? (FA15 p283) (FA16 p277) (SU p68-69) (H p1892)
Magnesium sulfate
What are the adverse reactions of exogenous testosterone in males? (FA15 p577) (FA16 p582)
(SU p224)
Exogenous testosterone –> inhibition of hypothalamic-pituitary-gondal axis –> decrease INTRATESTICULAR testosterone –> hypogonadism –> azoospermia
Premature puberty Premature closure of epiphyseal plate Erythrocytosis Worsening of sleep apnea Suppression of spermatogenesis Increased LDL & decreased HDL
Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important
side effects? (FA15 p554) (FA16 p558) (SU p164-165)
Potassium-sparing diuretics
Hyperkalemia
Endocrine effects
What structures give rise to the blood brain barrier? (FA15 p453) (FA16 p455)
Inside to Outside
Tight junctions between nonfenestrated capillary endothelial cells
Basement membrane
Astrocyte foot processes
What is the first-line treatment for a patient with erectile dysfunction? (FA15 p598) (FA16 p603)
(SU p222, 225) (H p377)
Phosphodiesterase inhibitors - Sildenafil - Vardenafil - Tadalafil If hypogonadal - Testosterone replacement
A patient with Crohn disease fails traditional therapy (5-ASA, steroids, and, immunosuppressants).
What other drugs are used to treat Crohn disease that target TNF-α? (FA15 p220) (FA16 p214)
(SU p141)
Adalimumab
Infliximab
Certolizumab
With what physical exam finding must you presume a scaphoid fracture despite a normal initial x-ray?
What might result in a proximal fracture of the scaphoid if left untreated? (COA p686)
Tenderness at the anatomical snuff box
Avascular necrosis in the proximal fragment
What is a cholesteatoma, and how does it present? (H p249) (R p740)
Overgrowth of desquamated keratin debris
Located in the middle ear space
Can eventually erode the ossicles in the middle ear and the external auditory canal, and lead to hearing loss
A mother brings in her 2-year-old child who has had multiple viral and fungal
infections and is found to be hypocalcemic. Which of the three germ layers
(ectoderm, endoderm, or mesoderm) gives rise to the missing structure in this
child? (FA14 p212, 560) (FA15 p214, 566)
DiGeorge syndrome - caused by failure of 3rd and 4th branchial pouches to develop
Branchial pouches derived from endoderm
Describe sensory innervation of the tongue
Anterior 2/3 – CN VII (Facial n.) does Taste & CN V3 (Mandibular branch of Trigeminal n.) does sensation
Posterior 1/3 – (glossopharyngeal n.) CN IX and CN X does Taste
CN IX does sensation.