Deck 6 Flashcards
Where are androgens and progesterones synthesized in female?
Theca interna cells
Where is estradiol syntehsized?
Granulosa cells (contain aromatase)
What neuronal structure is used to transport HSV to and from epithelial cells
Toward epithelium = kinesin
Retrograde axonal = dynein
WHere does PCL attach?
From posterior tibia to medial condyle femer
Where does ACL attach?
From anterior tibia to lateral condyle of femur
Equation for number needed to harm?
NNH = 1/ absolute risk increase
Equation for absolute risk increase?
(# dead/ total receiving Tx A) - (# dead/ total receiving Tx B)
What is the Kozak censensus sequence? What happens if there is a mutation in it?
gccgccRccAUGG (r = A or G)
Initiation of translation
If mutation occurs, initiation of translation stops, like in B thalessemia
What is MHC I made of?
MHC I class Heavy chain + B-2 microglobulin
Why can’t you use NSAIDs with loops?
Loops increase prostaglandins and increase GFR, NSAIDs will inhibit prostaglandins and block effects of loops
What are the main electrolytes influencing the electrochemical gradient in a cell?
K+ and Na+ (K+ most)
What does azathioprine get converted to?
6MP – will cause purine synthesis inhibition
What are hypocretin-1 levels in narcolepsy? What is wrong with sleep cycle?
Low hypocretin-1 in CSF
Less than 15 mins REM latency
WHat does IL-5 stimulate? Which cells secrete IL-5?
Secreted by Th2 for Eosinophilic activation. Also activates IL-4 which stim IgE
What is Lynnch syndrome? What gene mutation causes it?
Hereditary nonpolyposis colorectal cancer (adenocarcinoma) (HNPCC)
MSH1 gene - DNA mismatch repair
Who gets Lynnch syndrome/
Young people <50
What does HAART therapy do to body habitus?
Lipoatrophy (NRTI) loss of fat in face and extremities
Central fat deposition
Metabolic syndrome - insulin resistance, hypertriglycerides, reduced HDL levels
What is neuroblastoma? Symptoms?
opsoclonus-myoclonus, raised catecholamines, abdo mass (renal medulla), periorbital ecchymosis, may have spinal cord compression
How do NSAIDS cause gastric erosion?
COX 1 inhibition –> Decreased prostaglandin synthesis causes gastric hyperacidity and impaired defense
What causes flat contour of R cardiac silouhette?
Compresion of RA by R middle lobe
MOA macrolides in diabetic gastropareisis
Increases gastric motility (erythromycin). Agonist on motilin receptors** in muscularis externa
Use when metclopramide doesn’t work
Equation for NNT?
NNT= 1/ARR
How do you calculate ARR?
Control event rate - treatment event rate (same as absolute risk increase?)
What structures are at risk if you do a horizontal transection of the rectus abdominus muscles?
Inferior epigastric arteries
Must ligate them during C section to prevent bleeding
SE of digoxin?
color blindness, n/v, arrhythmias, anorexia
How does biliary atresia present?
Obstruction of extrahepatic bile ducts, increased direct bili, dark urine, pale stools
Woman with watery diarrhea, hypokalemia, achlorydia. WHat is it?
VIPoma. VIP stimulating pancreatic bicarbonate and chloride secretion
Tx VIPoma?
Somatostatin (octreotide) inhibits VIP and many other gastric secretions
Focal neurological deficit after SAH. What caused it?
Cerebral vasospasm
What conditions within gallbladder cause stone formation?
High cholesterol, low bile salts and PPDC
Bile salts and PPDC increase cholesterol solubility
What are RF and symptoms of lead poisoning?
Behavior changes, constipation, abdo pain, decreased vit D, encephalopathy, anemia, interstitial nephritis
RF include living in homes built before 1978
How to diagnose lead poisoning?
Blood lead level. Interrupts heme synthesis
How does glucagon work in hypoglycemia Tx?
Increases hepatic glycogenolysis (glycogen breakdown) and gluconeogenesis
Stimulates insulin secretion from pancreas
Little/no effect on other organs/tissues
Where does portal HTN due to cirrhosis affect other organs?
Connected to portosystemic collateral veins (L gastric, esophagus, rectum, abdomen. Caput medusae, anorectal varices, esophageal varices
What layer of vessel is affected in Marfan Syndrome?
Tunica media shows myxomatous changes (weakening) due to decreased extracellular glycoprotein fibrillin-1.
What type of collagen is used in scar tissue after MI?
Type I collagen
Where else is Type I collagen found?
Dermis, bone tendons, ligaments, dentin, cornea BV, scar tissue
Where is type II collagen found?
Cartilage, vitreous umor, nucleus pulposus
Where is type III collagen found?
Skin, lungs, intestines, BV, bone marrow, lymphatics, granulation tissue
Where is type IV collagen found?
Basement membranes
What type of collagen is defective in Alport syndrome?
Type IV collagen (BM)
What collagen type is defective in Ehlers Danlos type 3 and 4?
Type III collagen (skin)
What type of collagen is defective in osteogenesis imperfecta?
Type I collagen–> bone
What are symptoms of Mullerian duct agenesis? Karyotype?
46 XX
Variable uterine growth —>primary amenorrhea
Short/absent upper vagina
Normal ovaries –> 2ndary sexual characteristics present
How does androgen insensitivity syndrome present? Karyotype?
46 XY
Phenotypically female
Cryptorchid testes, no uterus or ovaries
Due to complete androgen receptor insensitivity
What is Kallman syndrome? Presentation?
Decreased GnRH secretion from hypothalamus
- Primary amenorrhea
- Lack secondary sexual characteristics
- Olfactory sensory defect
What is Klinefelter syndrome? Presentation?
47, XXY Males with tall stature Poor secondary sexual characteristics Atrophic testes Infertility
New test for disease A that is 95% specific. If 8 people with disease A are tested, what is the probability that ALL tests will come back negative?
0.95^8 = 35%
Which antiviral causes nephrotoxicity?
Acyclovir - use aggressive IV hydration
WHat is the effect of estrogen on thyroid hormone levels?
Increases TBG levels, which bind T4 and cause more stimulation of TRH from anterior pituitary –> greater overall T4 levels
What antigen is needed for formation of integrins?
CD18
Absence causes leukocyte adhesion deficiency
What are symptoms of leukocyte adhesion deficiency?
Recurrent skin and mucosal infections with *No pus** (no neutrophils at site)
Poor wound healing
Delayed umbilical cord separation (>21 days)
Marked peripheral leukocytosis and neutrophilia
What disease causes progressive neurological degeneration of the putamen
Wilson’s disease
Where is the caudate nucleus?
C shape in the lateral ventricles
What heart murmur is seen with pulmonary artery HTN?
Tricuspid regurg from enlarged R ventricle
What agents are used to treat primary pulmonary artery HTN?
Endothelin receptor antagonists. They inhibit vasoconstriction and SM proliferation in pulmonary arteries. (Bosentan, ambrisentan)
What substances cause vasodilation?
Substance P, Ach, serotonin, bradykinin, sheer force
What is pathway for activating vasodilation?
Substance (Ach etc) –> synthesis of endothelial nitric oxide synthase –> NO —> Vasodilation
What is nitric oxide synthesized from?
Argenine, O2, NADPH
What type of reaction is occurring when transplant patient has decreased UO, fever, and renal failure within first few weeks?
Acute graft rejection
What is acute graft rejection usually caused by?
Host T-cell sensitization against graft MHC antigens, lymphocytic infiltrate(cellular)
Or humoral reaction (C4 deposition, nec vasculitis, neutrophilic infiltrate)
What are symptoms of temporal arteritis (giant cell arteritis)
jaw claudication
headaches
visual disturbance (ischemic optic neuropathy)
May be associated with polymyalgia rheumatica
What does oculomotor CN III palsy look like?
No reaction to light or accomodation
Ptosis
“down and out” appearance of eye due to unopposed action of Lateral rectus and Superior oblique (CN VI and CN IV)
Where is aneurysm if it causes CN III palsy?
Posterior communicating artery
What are clinical symptoms of splenic laceration?
Shoulder pain and hiccups (C3-C5) phrenic nerve irritation
Where do you do femoral catherization?
Medial to femoral artery and below inguinal ligament
What do pheochromocytoma cells contain?
Synaptophysin, chromogranin, neuron-specific enolase, catecholamines
What type of CAH does infant have if they have ambiguous genatalia, hypokalemia, and HTN?
11-B-OH deficiency
11-Deoxycorticosterone is weak mineralcorticoid so they’ll have hypokalemia and HTN
**HTN distinguishes it from 21-OH deficiency
What happens to venous return and CO after MI?
Decreased CO, normal venous return
What is function of RNA polymerase i?
Transcribes 45S pre-rRNA gene that codes for ribosomal subunits
Found only in nucleus
What is p53? Which stage of cell cycle does it act?
Tumor suppressor gene
G1, prevents it from moving on to mitosis
What is a cholesteatoma made of? Effect?
Squamous cell debris, appears like a pearly white mass behind tympanic membrane
Causes conductive hearing loss, may cause vertigo or affect facial nerve if large enough
What high potency antipsychotics cause tardive diskenesia?
Haloperidol
Fluphenazine
What do blotchy red muscle fibers of Gomori stain indicate?
Midochondreal myopathies
“red ragged fiber”
Can only be passed down maternally
Which receptors do atenolol work on?
Selective B1 adrenergic receptors found in cardiac tissue and JG cells
Decreased Gs pathway, decreases cAMP
When do you use chi square test?
2x2 table
2 categorial variables compared
when is t-test used?
to compare the means in 2 groups
when does vasospastic angina occur?
at night
What medication precipitates vasospastic angina
Dihydroergotamine (for headaches), provokes vasoconstriction. Triptans, smoking, and cocaine can also provoke variant angina
MOA enfurvitide?
Binds gp41 and inhibits it from making conformational changes that allow viral fusion and entry
Ash leaf-spots, brain hamartomas, and renal angiolipomas. What is it?
Tuberous sclerosis, autosomal dominant disease
What is cystinuria?
Condition where amino acid transporter is defective, resulting in impaired renal and intestinal absorption/reabsorption
**recurrent Cysteine kidney stones form - flat yellow hexagonal crystals
What is premature ejaculation?
Ejaculation in less than 1 min of penetration for at least 6 months
Clubbing and cyanosis in lower extremities but not upper, increased fatigability on exertion, recurrent respiratory infections. Which heart abnormality is it?
PDA
MOA fatty liver/ hepatic steatosis?
Triglyceride accumuliation, decreased free fatty acid oxidation due to excess NADH production via alcohol dehydrogenase and aldehyde dehydrogenase
Wha are sofosbuvir and ledipasvir for?
TTx of HCV
How do sofosbuvir and ledipasvir work?
RNA dependent RNA polymerase inhibitors, protease inhibitors, NS5A inihbitors
Inhibits viral repllication and assembly
What fails to fuse in patent foramen ovale?
Septum premum and septum secundum
What does patent foramen ovale put you at risk for?
Paradoxical brain embolism
What is heteroplasmy?
Different mitochondreal genomes within a single cell Some cells will have normal mitochondrea and others won’t
Inheritence pattern will still go through mother but only some of the offspring will be effected
Why do parkinson’s disease drugs sometimes cause good mobility and other times cause bradykinesia/rigidity?
“on-off” patterns, drug is upredictable in response, there is a small therapeutic window and as the nigrostriatum degenerates this window gets smaller
Tx for juvenile myoclonic epilepsy?
Valproic acid (broad spectrum)
Diastolic decrescendo murmur best year L sternal border?
AR - valvular type best heart at L 3rd intercostal space
Marfan’s AR due to root dilation best heard at R upper sternal border
What does osteoporosis from hyperparathyroidism look like?
Subperiosteal respotion with cortical thinning
Equation for RR?
RR = (a/(a+b))/(c/(c+d))
What are symptoms of CMV colitis and who gets it?
Diarrhea, abdominal pain, fever, fatigue.
Renal transplant pts on immunosuppressive therapy
What is Tx for CMV colitis? What do you see on colonoscopy? On histology?
Gancyclovir
Colonic ulcerations
Intracytoplasmic basophilic inclusions
SE of gancyclovir?
Neutropenia
Anemia
Thrombocytopenia
DMS criteria for MDD?
> 5 symptoms for >2 weeks, one must be depressed mood or anhedonia
Main risk tamoxifen
Endometrial hyperplasia, and cancer
Also hot flashes and VTE
What is age cutoff for understanding death
under 7 won’t understand
What are hindgut derivatives?
Distal 1/3 of transverse colon, descending colon, sigmoid colon, and rectum
What supplies the hindgut derivatives?
Inferior mesenteric artery
How does silicosis increase risk of TB?
Impairs macrophage function
What does tetrodotoxin from pufferfish do?
Bind voltage-gated sodium channels in nerve and cardiac tissue
Papilledema, headache, vomiting from obstructive hydrocephalus. Limited upward gaze. What is it?
Pineal gland mass causing Parinaud syndrome
What is pineal gland mass usually caused by?
Germinomas. They may present in young boys in gonads or mediastinu. Can cause hypothalamic/pituitary dysfunction
Man dies from lung condition- what is condition if spindle cells positive for cytokeratin and calretininmean?
Mesothelioma
Asbestos exposure
What is hyperacute renal rejection caused by?
Antibody-mediated reaction- preformed IgG against donor antigens (ABO and anti-HLA)
Type II hypersensitivity
Will see rapid necrosis and oligria
What is graves ophthalmopathy caused by? What is treatment?
T-cell acivation and inflammatory infiltration, stimulation of orbital fibroblasts
Glucocorticoids
MOA phenytoin?
blocks Na+ channels, inhibits depolarization
Tx status epilepticus?
IV lorazepam and phenytoin concurrently
What is Tx for hypertrigliceridiemia causing acute pancreatitis?
Fibrates (fenofibrate, gemfibrozil)
Time length to diangose dysthymia?
> 2 years + presence of 2 depressive symptoms
What changes will kidney undergo if they have hydronephrosis?
pressure induced parenchymal atrophy, scarring
What does portal hypertension for alcoholic liver disease do to spleen?
Splenomegaly, **expansion of red pulp from venous congestion
How does septic shock cause lactic acidosis?
Tissue hypoxia impairs oxidattive phosphrylation. Pyruvate gets shunted to lactate after glycolysis (due to NADH buildup).
History o dementia/stroke will put someone at risk for aspiration pneumonia. Where will aspirate go?
Superior regions of lower lobes. Superior and posterior regions. Superior of lower lobes, posterior of upper lobes
Which vessel does RCC usually obstruct?
IVC AFTERinvading the renal vein
Why do RCC patients have erythrocytosis?
Excessive EPO production by RCC. May have hypercalcemia from overpoduction of PTHrP
