Deck 8

Question 1

Describe infantil beri beri

Answer 1

2-3 months- fulminant cardiac syndrome w cardiomegaly, tachycardia, cyanosis, dyspnea, vomiting

Question 2

Describe adult beri beri?

Answer 2

Dry = peripheral neuropathy of distal extrem w/ sensory + motor; Wet = additional cardiac involvement

Question 3

What deficiency causes beri beri?

Answer 3

Thiamine

Question 4

Which vitamin is important for complex I & II (ECT) and TCA? How?

Answer 4

Riboflavin (B2); Qid 1807; Can get modified into FMN (complex I) and FAD (complex II & TCA)

Question 5

Which enzyme in TCA needs riboflavin?

Answer 5

Succinate dehydrogenase (succinate > fumarate)

Question 6

What’s the effect of IgA protease?

Answer 6

Prevents adherence to mucosa&raquo_space; increased mucosal colonization

Question 7

Characteristics of disseminated gonorrheal infection?

Answer 7

Triad of arthritis, dermatitis, tenosynovitis in sexually active women

Question 8

What is the most common cardiac defect in turners? How would it sound?

Answer 8

Bicuspid aortic valve: early systolic, high frequency click heard over right second interspace

Question 9

In what conditions is mitral valve prolapse common?

Answer 9

CT disorders: Marfan, Ehler-Danlos

Question 10

Cause of elderly man w dysphagia, foul breath, food regurgitation?

Answer 10

Zenkers diverticulum: mucosal outpouching through area of muscle weakness in wall of hypopharynx

Question 11

Treatment with statins increases what?

Answer 11

LDL receptor density: hepatocytes increase surface expression of LDL receptors to increase uptake of circulating LDL

Question 12

What causes red man syndrome? Mechanism?

Answer 12

Vanco: Histamine release due to non-IgE mediated mast cell degranulation

Question 13

Triglyceride med with cutaneous flushing and warmth? How can you prevent?

Answer 13

Niacin: mediated by release of prostaglandins; aspirin can reduce if given 30-60 minutes prior

Question 14

What vitamin deficiency can occur in sickle cell or other hemolytic diseases?

Answer 14

Folic acid: increased erythrocyte turnover

Question 15

What does the EBV glycoprotein bind to?

Answer 15

CD21 = cellular receptor for C3d complement component, present on B cells & nasopharyngeal epthelial cells

Question 16

What medical therapy can be given to help with cholesterol gallstones?

Answer 16

Bile acid supplements: solubilize cholesterol

Question 17

What are treatments for PCOS?

Answer 17

Weight loss, oral contraceptives (minimize endomet prolif, prevent pregnancy, reduce androgenic symptoms), estrogen receptor modulation (if they want to get pregnant)

Question 18

What is first line in essential tremor?

Answer 18

Propanolol: non-selective B blocker

Question 19

Kid with myopathy with activity, cardiomyopathy, hypoketotic hypoglycemia…?

Answer 19

Primary carnitine deficiency

Question 20

Most common symptom of meckel diverticulum? What else?

Answer 20

Spontaneous, painless lower GI bleeding; ; also intussusception = colicky abd pain and “currant jelly” stools

Question 21

What is 99m-Tc-pertechnetate scan used for?

Answer 21

Affinity for parietal cells- finds ectopic gastric mucosa (Meckels)

Question 22

Distal duodenal ulcer…? How can secretin be used to confirm?

Answer 22

ZE gastronoma; Secretin = released from duodenum to incr pancreatic bicarb and decr gastrin -> in gastrinomas it stimulates gastrin release b/c abnormal adenylate cyclase

Question 23

Where is iron absorbed?

Answer 23

Duodenum and proximal jejunum

Question 24

What tests are abnormal for extrinsic pathway? What clotting factors?

Answer 24

PeT: extrinsic - II, V, VII, X

Question 25

What tests are abnormal for instrinsic? What clotting factors?

Answer 25

PiTT: Intrisic - II, V, VIII, IX, X, XI, XII

Question 26

What tests are abnormal in hemophilia?

Answer 26

PTT; normal PT, BT, platelet

Question 27

Infant with malabsorption low triglyceride, cholesterol, VLDLs?

Answer 27

Abetaliproteinemia- can’t make apoB forming proteins

Question 28

What RBC abnormality in abetalipoproteinemia?

Answer 28

Acanthocytes: Deficient fat-soluble vitamins (can’t absorb) and abnormal membranes w thorny projections Qid: 327

Question 29

Most common causes of SAH?

Answer 29

Saccular (berry) aneurism: usually at circle of willis- anterior communicating…. Associated with Ehlers-Danlos & autosomal dominant PKD

Question 30

What drugs improve survival in decompensated HF?

Answer 30

BBs, ACEI, ARBS, Aldo antagonist

Question 31

What processes maintain blood sugar in fasting?

Answer 31

Glycogenolysis (predominates first 12-18 hours) & gluconeogenesis (>18 hours)

Question 32

What is Romberg test used for?

Answer 32

Proprioception: positive test = sensory (dorsal column/ peripheral nerves) ataxia vs. cerebellar

Question 33

In what conditions is Romberg test positive?

Answer 33

B12 & syphilis (tabes dorsalis)

Question 34

Most common vasculitide in kids? What causes it?

Answer 34

Henoch-Schonlein purpura: caused by circulating IgA complexes (type III sensitivity) - complexes in small vessels and kidneys; suspect in kids 3-10 with palpable purpura, hematuria, GI; self-limiting so Tx is supportive

Question 35

What autoantibodies are most specific for RA?

Answer 35

Anti-CCP (cyclic citrullinated peptides); Tissue arginine is converted to citrulline in inflammation; diagnosed through ELISA. RF is present in 10% healthy & 30% SLE

Question 36

Where does most cutaneous lymph from umbilicus - feet, external genitalia (scrotum), anus go to?

Answer 36

Superficial inguinal lymph nodes

Question 37

Lymph from testes goes to where?

Answer 37

Para-aortic (retroperitoneal)

Question 38

Lymph from glans penis & cutaneous posterior calf goes to where?

Answer 38

Deep inguinal

Question 39

What causes dilation of coronary sinus?

Answer 39

(drains into R atrium) so R sided pressure -> pulmonary hypertension

Question 40

What cells make AMH?

Answer 40

Sertoli cells