Deck 4 Flashcards
1, 2, and 3 standard deviations from the mean = ______, _______, _______ % of the data
- 68
- 95
- 99.7
aromatase converts ________ to estrone and ________ to estradiol. Placental aromatase deficiency causes __________ in the mother and ______ in the neonate.
- Androstenedione
- Testosterone
- virilization in mom
- ambiguous external genitalia in female infants (normal internal genitalia)
What are cholinergic agonists’ effect on vasculature?
-bind to muscarinic receptors on endothelial cells –> promote release of NO —> activation of Guanalyl cyclase –> decr endoth calcium conc, —> Vasodilation
________ co-occurs in more than half of patients with temporal arteritis……What are the Sx of this?
- Polymyalgia rheumatica
- neck, torso, shoulder, pelvic girdle pain and morning stiffness….possibly also fever, fatigue, and weight loss
What is the initial treatment for staph epidermidis infection?
- Vancomycin
- possibly add rifampin or gentamicin
*frequently methicillin resistant
Through which foramen do cranial nerve 9, 10, and 11 leave?
- Jugular foramen
* part of 11 also leaves through foramen magnum
Where is somatostatin released from? WHat does it do?
- Pancreatic delta cells
- suppresses release of secretin, CCK, glucagon, insulin, and gastrin
CO poisoning causes a _______ shift in the O2-Hgb dissociation curve
-Left shift
Accumulation of lipids WITHIN muscle fibers is seen in what diseases? Example?
- Lipid myopathies
- Carnitine palmitoyltransferase deficiency
Pregnant lady with HIV who hasnt taken antiretrovirals…..whatdo you do?
- Start Zidovudine at 14 weeks!
- continue throughout pregnancy, IV administration during labor
- **Oral ZDV to the infant for 6 weeks post-partum
What areas of the brain are selectively more vulnerable to ischemic irreversible damage?
- HIPPOCAMPUS is first area damaged during global cerebral ischemia, damage to pyramidal cells
- Neocortex
- Purkinje cells of the cerebellum
CN3 exits the midbrain and courses between the _________ and ________ arteries.
- Posterior cerebral
- superior cerebellar
Aneurysm of the AICA can compress ________
- CN7
- CN8
What is Bethanechol used for? mech of action?
- Muscarinic agonist
- used to improve bladder emptying in patients with post-surgery urinary retention
- normal post-void resid. volume is < 50 cc
What is the most common benign lung tumor? What is it made out of? How is it found?
- Hamartoma
- disorganized cartilage, fat, fibrous tissue
- Usually found incidentally on CXR in 50-60 yr olds. Coin lesion with “popcorn” calcification
WHat are the 4 types of non-neoplastic colonic polyps?
- Hyperplastic = well diff, form glands and crypts
- Hamartomatous = mucosal glands, SM, conn. tissue (peutz jeghers, Juvenille polyposis)
- Inflammatory = UC and crohns (regenerating intestinal mucosa)
- Lymphoid = kids …mucosa infiltrated with lymphocytes
Which type of polyp is pre-malignant? what 3 things determine potential for malignant transformation?
- Adenomatous
1. Degree of dysplasia
2. Histologic pattern –> villous more likelly to transform than tbular
3. Size —> >4cm have 40% chance of transformation
What condition causes you to see hemosiderin-containing macrophages in the alveoli?
- aka “siderophages” , aka “heart failure cells”
- Chronic left heart failure!
- repeated episodes of pulm edema –> RBC extravasate into alveoli due to incr pulm vascular pressures –> hemosiderin dep in macrophages who eat it
What are some 1st-generation anti-histamines and what are their side effects?
- Chlorpheniramine, diphenhydramine, promethazine, hydroxyzine
- Anti-muscarinic, serotonergic (appetite stim) , alpha adrenergic (dizziness, orthostatic HoTN)
In scleroderma, deposition of collagen in tissues happens bc monoclonal ________ cells secrete _________ , increasing the production of collagen and ECM proteins by fibroblasts
- Monoclonal T-cells
- various cytokines, especially TGF-BETA
What are the 3 phases and characteristics of ATN from ischemia to kidney?
- Initiation:
- original insult
- start of damage, GFR starts to fall, UOP decreases - Maintenance (oliguric phase)
- renal tubule injury established
- GFR stabilizes at well below normal
- lasts for 1-2 weeks
- microscopy = granular casts in tubular lumina, tubular epith. necrosis - Recovery phase:
- re-epithelization of tubules
- polyuria and gradual normalization of GFR
IL-4 is responsible for ______, while IL-5 is responsible for ______
- B-cell growth and isotype switching, IgE secretion, diff. of naive T cells
- B-cell differentiation, IgA production, eosinophil activity
What protein is secreted by Eosinophils, causing Bronchial epithelial damage in pts with allergic asthma? What else does it do?
- Major basic protein
- kills helminths!
What is seen in the urine of patients with cystinuria? How is presence of cysteine tested?
- Hexagonal cystine crystals
- Sodium Cyanide nitroprusside test: detects cystine’s sulfydryl groups
*Cyanide converts cystine to cysteine, nitroprusside then binds to cysteine –> turns purple
Dofelitide is a class _____, ______- blocking agent used for arrhythmia. It affects phase ______ of the cardiac myocte AP
- class 3
- K+ blocking
- phase 3
Describe Osler-Weber-Rendu syndrome:
- Autosomal dominant
- telangiectasias of the skin and mucous membranes (lips, oronasopharynx, resp tract, Gi tract, urinary tract)
Function of BRCA genes?
DNA repair
Why do people get neuro sx during panic attacks?
- Decr CO2 –> Vasoconstriction of cerebral vessels
* CO2 is normally a very potent vasodilator in the brain …….PO2 has much less of an effect
How can you differentiate between sarcoidosis and hypersensitivity pneumonitis?
- CD4/CD8 ratio = high in sarcoid, low in others
* sarcoid also can have hypercalcemia and hilar adenopathy
What receptors does carvedilol antagonize? What is it particularly useful for?
- Beta 1 and 2
- Alpha 1
-CHF!
What enzyme induces class switching in B cells?
- DNA recombinase
* remember the order…. Ig M, D, G, E, A
Mechanism of pulsus paradoxus?
-Incr venous return with inspiration —> poor compliance of pericardium causes RV to bulge into LV space —> decr LV filling and subsequent SV —> decr BP with inspiration
How is digoxin cleared?
Renally
- half life 1.5 days
- older patients get lower dose bc of declining renal function
What arteries supply the ureters?
- Upper 1/3 = branches of renal artery
- Lower 2/3 = branches from aorta, iliac, gonadal, vesical
______ is a polypeptide precursor of beta-endorphins, ACTH, and MSH?
-POMC (propiomelanocortin)
What is the most common clinical manifestation of botulism in adults?
- 3 D’s
1. Diplopia
2. Dysphagia
3. Dysphonia
What drugs can cause hepatic granulomatosus? (hint: MHQ)
- Methyldopa
- Hydralazine
- Quinidine
Which cancers of the thyroid are associated with the RET proto-oncogene?
- Medullary thyroid cancer
* associated with MEN 2A and 2B
What does medullary thyroid cancer look like on histology?
-Spindle-shaped cells in an amorphous background
In males, incomplete fusion of the ________ causes hypospadias
-Urogenital folds
What do you need to periodically monitor in patients taking Lithium?
- blood lithium levels
- TSH
- renal function
What is the most common renal malignancy and what does it look like on histology?
- Clear cell carcinoma
- Rounded or polygonal cells with abundant clear cytoplasm (packed with glycogen and and lipids)
What is the formula for half-life?
half life = 0.7 x Vd / CL
After blunt trauma to the eye…..If the inferior orbit is broken, blood would leak into the _______, and if the Medial orbital wall is damaged, blood would leak into the _________.
- Maxillary sinus
- Ethmoid air cells
What drugs are used to treat Cholinergic toxicity (organophosphates)?
- Atropine (does not prevent muscle paralysis however, bc it doesn’t work on Nicotinic receptors)
- Pralidoxime reverses both nicotinic and muscarinic by “restoring” cholinesterase
Describe the pathophys of a serum sickness type of reaction:
- Type 3 hypersensitivity (immune complex deposition)
- Fever, pruritic rash, arthralgias 7-14 days after exposure to antigen
- small vessel vasculitis with fibrinoid necrosis and neutrophil infiltration
- Low complement!!!*** bc consumed locally in affected tissues
- neutropenia
*reaction to non-human proteins…..including the “mab” monoclonal Ab drugs
Dobutamine is mainly _________ - selective, and used for ________
- Beta-1
- Heart failure for chronotropy and inotropy….also for stress tests (chemical)
SIADH can be caused by paraneoplastic syndrome of what lung cancer?
- Small cell carcinoma
* Clinically normal body fluid volume!!
What virulence factor allows E. Coli to survive in the bloodstream and establish meningeal infection?
- K1 capsule
- prevents recognition, complement deposition, and subsequent phagocytosis
When do myoclonic seizures normally occur in a patient with myoclonic syndrome?
Treatment?
- in the morning, typically induced by lack of sleep or stress
- Valproic acid
What is the function of the 16S rRNA in prokaryotic ribosomes?
- Found in the 30S subunit
- Contains a sequence complementary to the shine-dalgarno sequence on mRNA
- necessary to bind mRNA for initiation of protein translation
What are some aggravating factors, including meds, of restless-leg syndrome?
- alcohol
- nicotine
- caffeine
- glucocorticoids
- SSRIs
- Lithium
What is the most crrucial gene regulated by PPAR-gamma?
-Adiponectin (cytokine secreted by fat tissue….low in diabetics)
Male infants with 21-hydroxylase have _______ genitalia.
Normal !
-females have ambiguous (virilization)
How do you calculate renal plasma flow from renal blood flow?
(1 - hematocrit) x renal blood flow
What do xanthelasmas look like on histology?
-benign-appearing macrophages with abundant, finely vacuolated (foamy) cytoplasm containing cholesterol (free and esterified), phospholipids, and TGs
Blood type A or B moms have ____ immunoglobulins, whereas O moms have _______.
- IgM (cant cross the placenta)
- IgG
What lab value is abnormal in both hemophilia A and B?
-PTT
The 3rd pharyngeal arch is associated with the _______ aortic arch and the _______ nerve, and gives rise to _________
- 3rd aortic arch
- glossopharyngeal nerve
- parts of hyoid bone, stylopharyngeus muscle, common and proximal internal carotid arteries
Pt with a lung mass (or breast, ovarian, uterine) has progressively worsening dizziness, limb and truncal ataxia, dysarthria, visual disturbances……….brain tissue shows extensive cerebellar purkinje cell degeneration.
-What is the diagnosis and what is the underlying patholog. process?
- Paraneoplastic cerebellar degeneration
- immune response against tumor cells that cross-reacts with with purkinje neuron antigens —-> acute onset rapid degeneration of the cerebellum
- Anti-Yo, anti-P/Q, and anti-Hu
PsychoPharm: _________ is associated with retinitis pigmentosa, while _______ is associated with corneal deposits
- Thioridazine
- chlorpromazine
Which beta-blocker also has class 3 anti-arrhythmic properties? How does it work and what are some side effects?
- Sotalol
- blocks K+ channels, slows repolarization
- Side eff = QT prolongation, PR interval prolongation
Decreased heme concentration leads to increase in ___________ activity, which can cause porphyria
What things can precipitate acute attacks of intermittent hepatic porphyria?
-ALA synthase
- Phenobarb, griseofulvin, phenytoin
- alcohol and low calorie diet too
How does morphine exert its effects via Mu receptors?
- G-protein coupled –>activation of K+ channels –> increased efflux of potassium –> hyperpolarization of post-synaptic neurons –> decr pain
- Can also inhibit adenalyl cyclase –> decr calcium conductance –> decr transmitter release
What does alpha-1-antitrypsin look like in the liver?
-reddish-pink, PAS + granules of un-secreted polymerized A1AT in the periportal hepatocytes
Triad of cerebellar ataxia, incr risk of pulmonary infxns, and telangiectasia…..diagnosis?
-underlying pathophys and inheritance?
- Ataxia telengiectasia
- Autosomal recessive
- mutates ATM gene –> responsible for DNA break repair. Pts hypersensitive to X-rays and UV rays
- IgA deficiency –> airway infections
- incr risk of hematologic malignancies
In liver disease, when synthetic function declines, the first factor depleted is factor ________, which causes prolongation of the _______ first.
- Factor 7
- PT
WHat type of cancer is never treated with surgery, even if localized?
-Small cell carcinoma
C3a of the complement system recruits and activates _______ and _____.
- Eosinophils
- Basophils
Tumors in ovaries that are poorly differentiated and heavily loaded with mucous…..most likely came from where?
-Stomach (adenocarcinoma)
Where is the thrombus in budd chiari? and what is seen on Liver pathology?
- Hepatic vein
- Centrilobular congestion and fibrosis
What are the 3 signs of pre-eclampsia?
- HTN
- Proteinuria
- Edema
*sometimes TCP
WHat is HELLP syndrome?
- Hemolytic anemia
- Elevated liver enzymes
- Low platelets
Pre-eclampsia may progress to this!
What is a glomangioma and what cells does it arise from?
-Bluish neoplasm found underneath the nail bed
Glomus bodies:
-Neurovascular organs found in the dermis of nail bed, pads of fingers and toes, and ears
-function = shunt blood away from skin in cold temps and vice versa
Celecoxib is a _________ inhibitor, and causes fewer side effects, such as ________
- Selective COX-2
- GI ulcers/bleeding
When does ventricular free wall rupture normally occur, and why?
- 3-7 days after onset of total ischemia
- Coagulative necrosis, neutrophil infiltration, enzymatic lysis of connective tissue —> weakens the infarcted myocardium
T or F……amyloid is not seen in the brains of patients with Vascular dementia
-True
Renal embryology:
- The ureteric bud ultimately gives rise to the ________
- The metanephric blastema gives rise to the _________
- collecting tubules and ducts, major and minor calices, renal pelvis, ureters
- Glomeruli, bowman’s space, proximal tubules, loop of henle, DCT
What kind of drug is Raltegravir?
- Integrase inhibitor
- prevents viral ds-DNA integration into host genome, therefor decreasing mRNA transcription
What are contraindications to metformin?
- Renal failure (Cr > 1.5 males or 1.4 females)
- hepatic dysfunction
- hypersensitivity to metformin
- severe CHF and alcoholics –> due to incr risk of lactic acidosis
Pathophys of Pompe disease and clinical presentation?
- Glycogen storage disease type 2
- Deficiency of alpha-1,4-glucosidase in lysosomes —> accumulation of abnormal glycogen in lysosomes
- Clinically: NO Hypoglycemia, HEPATOMEGALY, incr risk of cirrhosis, HYPOTONIA, FEEDING difficulty, cardiomegaly
What organism, usually acquired after travel to 3rd world, manifests with Hepatosplenomegaly, low fever, rose-colored spots on abdomen, Diarrhea OR constipation
-Salmonella typhi or paratyphi
- can lead to sepsis, bloody diarrhea, peritonitis, carrier state
- fecal-oral route
What fungus can infect immunocompetent people, causing flu-like illness, cough with sputum production, possible hemoptysis, dyspnea, pleuritic cp?
Diagnosis?
Treatment?
- Blastomyces dermatitidis
- Sputum stain with KOH –> round yeast with doubly refractive walls, each yeast with a single, broad-based bud.
- Tx = Itraconazole
What is the clinical presentation of reactive arthritis?
- non-gonococcal urethritis, conjunctivitis, arthritis —-> weeks after a primary infection
- Can have skin findings as well, including vesicular rash on the palms and soles
- HLA-B27
What is seen histologically is aortic aneurysms?
- myxomatous changes in the media of large arteries
- aka “cystic medial degeneration”
How do you calculate the net renal excretion rate of a substance?
total filtration rate - total tubular reabsorption rate
total filtration rate = GFR x conc. of substance in plasma
Overactivity of what enzyme has been implicated in the development of colon cancer?
COX-2
What is an “axonal reaction” in neurons and when can it be seen?
- Reaction in cell body seen when axon is severed
- swelling of acute reversible damage is seen….first visible 24-48 hours after injury
- reflect incr synthesis of protein to restore axon
What does vitamin D deficiency look like in the bone, histologically?
- Osteoid matrix (unmineralized) around trabeculae
- widening between osteoid seams
Only _________ heparin can bind to both anti-thrombin and thrombin, making it the most effective at unactivating thrombin
-Unfractionated heparin
What 2 vascular disorders can show granulomas in the media?
- Giant cell (temporal) arteritis
- Takayasu arteritis
- takayasu - aortic arch, females < 40, lower BP in upper extremities, cold or numb fingers
WHich skull foramen does the middle meningeal artery go thru?
-Foramen spinosum
What aspect of the myocyte Action potential does myasthenia gravis change?
- Reduces the motor end-plate potential
* partly bc of damae to motor endplate from complement fixation
What are P bodies and where are they located?
- Distinct foci in eukaryotic cells that are involved in mRNA regulation and turnover
- control mRNA expression repression, degradation, silencing, store them for later, etc
- happens in the CYTOPLASM
What is the clinical presentation and histo features of Lymphogranuloma venereum?
- caused by Chlamydia trachomatis
- initial painless small ulcer on genital mucosa —> weeks later swollen, painful inguinal nodes that coalesce, ulcerate, and rupture. —> stellate abcesses may develop and coalesce into large, necrotic, draining foci
-Histo: mixed granulomatous and neutrophilic inflammation, chlamydial inclusion bodies in the epith. and inflamm. cells
Colchicine for gout should not be used in who??
- elderly
- renal dysfunction
Name the target and use of each of the following drugs:
- Infliximab
- Rituximab
- Interleuken-2
- Imatinib
- Abciximab
- Infliximab = vs TNF-alpha –> RA, ankylosing spond, fistulizing crohns
- Rituximab = vs CD20 —> ??
- IL2 = activates and helps differentiate T cells —> RCC, melanoma
- Imatinib = inhibits BCR/Abl tyrosine kinase —-> CML
- Abciximab = vs GP2b/3a —> PCI
Why would someone with a testicular/ovarian mass also have hyperthyroidism?
- Certain tumors like teratomas (usually found in gonads) produce B-HcG
- B-HcG is structurally similar to TSH, LH and FSH —-> binds to thyroid receptors and causes hyperthyroidism
What is the histological feature of hodgkins?
- Reed-Sternberg cells
- Bi-lobed or double nuclei, ample cytoplasm, inclusion-like eosinophilic nucleoli, background of lymphocytes, histiocytes, eosinophils
What are the differences in immunophenotyping in immature B-cell vs T-cell ALL?
B-cell:
- TdT positive
- CD10
- CD19
T-cell:
- TdT positive
- CD1a maybe
- CD2, 3, 4, 5, 7, 8
