Deck 12 Flashcards
What makes you think of fibromuscular dysplasia?
Women 20-30, renal artery stenosis, string of beads appearance of renal arteries
What is defect in paroxysmal nocturnal hemoglobinuria?
Mutation in PIGA gene that synthesizes Gpi anchor protein: lack CD 55, CD 59; hemolytic anemia (low haptoglobin, incr bilirubin, LD), thrombosis, iron deposition in kidney (hemosiderosis)
What muscle can get an abscess from appendix, hip joint, vertebral bodies?
Psoas: fever, flank or back pain, difficulty walking, +psoas sign
How long does a patient need symptoms to diagnose with major depressive disease?
2 weeks
What are three cranial nerve abnormalities that present first with botulism?
Diplopia, dysphagia, dysphonia with descending paralysis
What medications prevent dihydrofolate reductase and prevent reduction of folic acid to THF?
Trimethoprim (bacteria), methotrexate (humans), pyrimethamine (some protozoa)
What fracture is suspected with pain in anatomical snuffbox?
scaphoid
What is a paradoxical embolism? What would you find?
Embolism that originates from venous side but passes through cardiac defect (PFO, ASD, VSD, AV malformation) to arterial side to cause stroke; ASD would cause wide splitting of S2- Qid 189
What two components make up an MHC class I?
heavy chain, B2-microglobulin
Which cranial nerves do preganglionic parasympathetic nerves come from?
III, VII, IX, X
Where do most interventricular hemorrhages from premature delivery arise from?
Germinal matrix: subventricular zone with thin vessels and lacks glial support, becomes less prominent by 32 weeks
Where is most common location of medulloblastoma?
Cerebellar vermis
How can isoniazid cause microcytic anemia?
Decreased activity of d-ALA synthetase (prevents conversion of Vit B6 cofactor)»_space; blocks rate limiting step of heme synthesis»_space; sideroblastic anemia
What does the Her2 oncogene do?
Codes for human epidermal growth factor receptor w TYROSINE KINASE activity > increased proliferation
What causes the clear cytoplasm in the rounded polygonal cells in renal cell carcinoma?
lipid and glycogen accumulation
What does liver biopsy show in hepatitis?
anlobular lymphocytic infiltrate, ballooning hepatocytes, necrosis and apoptosis
What are councilman bodies?
Apoptotic hepatocytes that form round acidophilic bodies
Phosphoribosyl pyrophosphate synthetase (PPRP) mutation leads to what?
Gout: PRPP is necessary for purine synthesis»_space; increased purines = increased gout
What cell types are responsible for inflammatory response in gout?
Neutrophils
Why do myocytes swell in myocardial ischemia?
Switch to anaerobic»_space; can’t maintain ATP levels»_space; membrane ATPases fail leading to incr Ca and Na in cell»_space; attract free water
Oxalate crystals in tubular lumen is suggestive of what?
Ethylene glycol poisoning
Proximal tubule cell ballooning and vacuolar degeneration is suggestive of what?
Acute tubular necrosis
What is the cause of bruise colors? Explain process.
- Hemoglobin-containing erythrocytes escape into tissue = blue/purple; 2. Heme oxygenase breaks down heme to biliverdin = green; 3. Biliverdin reductase reduces to bilirubin = yellow»_space; travels to liver with albumin to get conjugated
What detects tension in muscle and prevents injury? How?
Golgi tendon organs: connected in series at junction of tendon; with resistance sensory 1b fibers > inhibitory interneuron»_space; stop contraction
Patient with HIV, seizures, multiple ring enhancing lesions…? Tx?
Toxoplasmosis; Pyrimethamine & sulfadiazine
What does ventral posterior medial nucleus of thalamus do?
Receive input from trigeminal (stroke = loss of sensation of ispi face)
What are the most common cause of lacunar infarcts?
Lipohyalinosis & microatheromas- Qid 2077
What nerve passes through supinator canal?
Radial - weakness of fingers and thumb from excessive pronation/supination movement
What is not improved by atropine with organophosphate poisoning? What can help?
Muscle weakness: atropine doesn’t have effect in nicotinic receptors; Pralidoxime works at both
What cytokine is particularly important for severity of temporal arteritis? What Tx?
IL-6; can give IL-6 monoclonal antibody tocilizumab
What’s similar/ different between curling/ cushing ulcer?
Stress-related mucosal disease; Curling: from burns/ trauma»_space; ischemia; Cushing: cranial trauma»_space; vagal stimulation»_space; hypersecretion of acid
What stimulates B cells?
IL-4 from Th2
What will the vessels of the lung do when hypoxic?
Vasoconstrict to dilate blood to better ventilated areas: unique hypoxic vasoconstriction!
What lab findings have poor prognosis for cirrhosis?
PT time, hypoalbuminemia, elevated bilirubin
What kind of hypertrophy occurs with mitral insufficiency?
Eccentric (incr cavity size- not wall): regurgitant flow increases the amount of blood returned to LV during diastole
Describe the process of interferon-gamma signaling in tuberculosis…
Infected Mx secrete IL-12»_space; Tcells & NKs: secrete IFN-g»_space; IFN-g leads to activation of JAK1/2»_space; nuclear signaling via STAT1 & transcription of protecting/killing genes
What is X-linked agammaglobulinemia and what infections do they get?
Reduced mature B cell production: deficient in all immunoglobulins»_space; lower respiratory tract infections and Giardia
What nucleotides are on 3’ end of tRNA?
CCA: 3’ end with OH- that binds to AA
What nerves are involved in vagal maneuvers?
Afferent = CN IX (carotid baroreceptors > vagal nucleus & medullary centers); Efferent = vagus nerve (to SA and AV node)
What squamous keratin debris in middle ear can cause conductive hearing loss?
Cholesteatomas
