Deck 15 Flashcards
What is polyarteritis nodosa?
Segmental, transmural, necrotizing inflammation of medium to small size arteries in any organ EXCEPT lungs; most commonly kidneys, heart, GI; bead-like aneurysm formation
What does carbon tetrachloride do?
Free radical injury in liver: centrilobular necrosis, fatty change
How do you know if someone has thrombocytopenic thrombotic purpura- hemolytic anemia?
Pentad of fever, neuro symptoms, renal failure, anemia, thrombocytopenia in setting of GI illness; Normal PT & aPTT
Symptoms of neonatal abstinence syndrome? Tx?
Neurologic (irritability, jitteriness, hypertonia), GI (diarrhea, vomiting), autonomic (sweating,s ; Tx = methadone, morphine
What med increases activity of azathioprine?
Allopurinol: xanthine oxidase catalyzes AZ inactivating pathways
What lesion can cause pure motor hemiparesis?
Lacunar infarct - small penetrating arterioles of INTERNAL CAPSULE
What can cause a pure sensory stroke?
Lacunar infarct - small penetrating arterioles of VP or VPN thalamus
Describe development of prion disease?
Prion protein (PrP) is normally a-helical > if converted to b-pleated sheet, protein becomes resistant to proteases > accumulation in grey matter leads to prion disease
What area of lungs are most often damaged in chronic and acute rejection of allograft?
Chronic = small bronchioles, Acute = pulmonary/ bronchiole vessels (perivascular infiltration with lymphocytes, macrophages, plasma cells)
What is the mechanism of uric acid stones in person with dehydration?
Diarrhea = reduced bicarb excretion > metabolic acidosis > increase H excretion > makes soluble urate solutes insoluble uric acid
What causes RBCs to sediment at faster rate? How?
Fibrinogen: causes RBCs to form stacks; Part of acute phase reactants stimulated by TNF-a, IL-1, IL-6
Firm coarse itchy rash (peau de orange) and breast swelling?
Inflammatory breast cancer: Cancer cells blocking lymph drainageafter spread to dermal lymphatic spaces
What do you give for NE extravasation?
Phentolamine: reverses NE a1 vasoconstriction/ ischemia of local tissue
Epigastric pain an hour after eating, weight loss, eating aversion…?
Chronic mesenteric ischemia
What is the best indicator of severity of mitral stenosis?
Presence of S3: indicates increased rate of LV filling due to large volume of regugitant flow entering ventricle during mid diastole
What is cause of disproportionate loss of pain & temp in hands/ arms?
Syringomelia: cavity enlarges pushing against ventral white commissure
How does pyruvate kinase deficiency manifest?
Hemolytic anemia in newborns (insufficient ATP > disrupted gradient > disrupted membrane)
What is the immunologic test that uses cardiolipin, lecithin, cholesterol?
Rapid plasma reagent test (RPR) => syphilis
What is the central regulator of iron homeostasis? How?
Hepcidin: synthesized by liver; inversely related to iron levels: binds and degrades ferroportin, decreasing iron absorption
What is vanillymandelic acid?
Biproduct of NE, EPI detected in neuroblastoma/ other neural crest tumors
What can cause urine to turn black overnight and blue black (ochronosis) of ears, cheeks, nose)? What pathway is inhibited?
Alkaptanuria: blocks homgentisic acid dehydrogenase; Blocks conversion of tyrosine > fumarate (tyrosine metabolism)
What are dextrans and what do they adhere to?
Extracellular polysaccharides (Strep viridians): adhere to fibrin and platelets which are deposited during endothelial trauma
What are most common organisms in secondary bacterial pneumonia (after getting flu)?
Strep pneumo, Staph, H. flu
Dx of women with recent pregnancy with respiratory symptoms, elevated b-HCG?
Gestational choriocarcinoma: arises from trophoblast; vaginal bleeding, bulky white intrauterine mass, necrosis, hemorrhage; lungs are common metastasis
What is the only abnormal test you will see on minimal change disease?
Electron microscopy: diffuse podocyte foot process effacement and fusion
Which ligament contains ovarian artery, vein, nerve, lymphatics?
Suspensory ligment (infundibulopelvic)
What is most likely cause of widened pulse pressure, large LV SV?
Aortic regurg
What causes paraneoplastic cerebellar degeneration?
Autoimmune response against tumor cells (small cell lung, breast, ovarian, uterine) that cross reacts with Purkinje neurons; Abs = anti-Yo, anti-P/Q, anti-Hu
When is KRAS active? What does it trigger?
When bound to GTP»_space; RAF»_space; MAP kinase and then transcription factors
What genetic defect causes increased iron?
Hereditary hemochromatosis: missense mutation in HFE gene (interacts with tranferrin receptor on cell) > reduced cell iron uptake leads to»_space; increased intestinal absorption, decreased hepcidin
Abdominal trauma (splenic rupture, peritonitis, hemoperitoneum) causes referred pain to where?
Shoulder (C3 - C5)
What condition is associated with migratory thrombophlebitis?
Pancreatic cancer (and some other GI): Trosseau syndrome
What is a selective antimuscarinic agent that only targets cholinesterase at muscarinic receptors (not nicotinic muscles)?
Scopolamine
What is the function of c-myc? On what chromosone is it found?
Transcription activator; Chromosone 8 (Burkitt lymphoma = [8;14] translocation)
What nerves provide general sensation of tongue?
Ant 2/3: mandibular CN V, Post 1/3: CN IX, Posterior tongue root: CN X
What nerves provde gustatory sensation of tongue?
Ant 2/3: chorda tympani (CN VII), Posterior 1/3: CN IX, Post tongue root and upper esophagus: CN X
What does the CFTR protein do in the respiratory/ intestinal epithelia vs the sweat glands?
(Opposite effect in CF): Respiratory = secretes Cl, decreases Na/H20 reabsorption (through ENaC); Sweat = absorbs luminal Cl, increases reabsorption of Na/ H20
What nuclei produces serotonin?
Raphe nuclei
Histo of hep B?
finely granular, homogenous pale pink cytoplasm in hepatocytes
Tx for hypertensive crisis?
Nitroprussid (incr cGMP), fenoldopam (D1 agonist)
What nerve is damaged in uncal/transtentorial herniation?
CN III: Ipsilateral fixed dilated pupil, ipsi paralysis of oculomotor muscles, contralateral homonymous hemaniopsia
What chromosone is RB tumor suppressor gene on?
13
