first assessment Flashcards
paget’s dz of bone increases risk of
osteosarcoma; destruction of normal bone pattern, mixed radiodense/radiolucent areas, periosteal new bone formation, lifting of the cortex, “sunburst” pattern of adjacentsoft tissue
radiographic sign of avascular necrosis
crescent sign (subchondral collapse)
globus hystericus
sensation of a “lump in the throat” with no exam findings
vitamin A toxicity
micrcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, spontaneous abortion
DNA laddering
used to distinguish apoptotic cells from necrotic cells; during karyorrhexis, endonucleases degrade DNA into 180 base pair fragments, equally spaced on gel electrophoresis
physostigmine
cholinesterase inhibitor
atropine
competitive inhibitor of acetylcholine
pralidoxime
antidote to organophosphorus anticholinesterase that inhibit cholinesterase through phosphorylation
anticholinergic toxicity
confusion, blurred vision, dry MM, intense thirst
acute promyelocytic leukemia
t(15,17)
burkitt lymphoma
round nuclei with basophilic cytoplasm containing prominent lipid vacuoles; t(8,14)
chronic myelogenous leukemia
immature myeloid cells t(9,22)
acute lymphocytic leukemia
t(12,21)
follicular lymphoma
malignant cells with notches or clefts; t(14,18)
IL-2 produced by, moa
antigen-stimulated T cells; stimulate growht and differentiation of T cells (binds IL-2R), B cells, NK cells, and macrophages
IL-1 produced by, moa
macrophages, activates lymphocytes and stimulates systemic illness (fever, lethargy, anorexia)
TNF-alpha produced by, fxn
activated macrophages, induces systemic inflammatory response (and in high levels, causes shock)
interferon-alpha produced by, fxn
monocytes, macrophages, B cells, NK cells; antiviral functions (replication inhibition w/i cells, protection of uninfected cells, and stimulation of cytotix lymphocyte and NK cell antiviral activity)
GM-CSF produced by, fxn
macrophages, t cells, Nk cells, mast cells, endothelial cells, and fibroblasts; stimulates rpoduction of granulocytes and monocytes
cadherins
Ca-dependent transmembrane proteins that participate in desmosome formation with cadherins of adjoining cells; do not parcitipate in hemidesmosome function
hemidesmosomes structure, fxn
integrin-mediated binding to basement membrane (type 4 collagen), facilitated by fibronectin
acid chyme in duodenum triggers what response?
- gallbladder bile release, and 2. stimulates S-cells in the crypts of lieberkuhn to release secretin into systemic circulation which stimulate pancreas to release bicarb-rich fluid (via CL/bicarb exchange protein on the apical surface of the pancreatic cells)
endometritis
uterus infection; fever, leukocytosis, uterine tenderness and foul discharge; most commonly caused by bacteroides
nunmular eczema
occurs in xerosis (dry skin); pw pruritic, coin-shaped, erythematous patches
sublimation vs displacement
former is a mature defense mechanism where one channels socially unacceptable thoughts/impulses into acceptable actions
tyrosine kinase receptor structure, and signals that use tyrosine kinase receptor
transmembrane proteins with ligand-binding extracellular region, hydrophobic transmembrane regino, and intracellular domain that dimerizes and has inducible tyrosine kinase activity; insulin, epidermal growth factor, PDGF and VEGF
receptor mediated endocytosis moa, example
receptors are pooled in clathrin-coated regions (“pits”) that are internalized upon binding; LDL receptor
interview: reflection vs summarizing
repeating what pt said; summarizing has multiple ideas
vasomotor rhinitis
chronic nasal congestion that worsens with abrupt changes in temperature/humidity or exposure to odors/alcohol
heminephrectomy effect on GFR
immedatiely, 50 percent; compensatory hyperfiltration and hypertrophy of remaining neurons leads to 80 percent in several weeks
erection intracellular moa
local release of NO increases activity of GC, stimulating cGMP which relaxes smooth muscle around the cavernous venous sinus of the corpora cavernosa
HSV encephalitis
m/c, affects both immunocompetent and immunosuppressed; affects temporal lobe, so pts can present with seizures, personality changes, psychosis on top of fever, HA, and malaise
bunyavirus encephalitis
transmitted by mosquitoes, rarely fatal and cause transient infection with HA and fever
AIP
excess porphobilinogen and aminolevlinic acid in urine; many asymptomatic; begins after puberty, folllows consumption of drugs that increase heme synthesis; pw severe vague abdominal pain, N/V, motor/sensory neuropathy; no cutaneous findings/photosensitivity, completely symptom free between attacks
1st heart sound
closure of AV valve as systole begins
2nd heart sound
closure of the semilunar valves
light criteria
pleural protein/serum protein > 0.5; pleural LDH/serum LDH > 0.6; pleural fluid LDH > 2/3 upper limit of normal LDH
spherocytes
dense, spherical erythrocytes with no central pallor, increased MCHC
sickle cell/thalassemia on osmotic fragility test
decreased osmotic fragility
echinocytes / burr cells (RBC with multiple surface proejctsion) means?
uremia or pyruvate kinase deficiency
hereditary retinblastoma moa
germline mutation in tumor suppressor RB1 gene (c13); example of knudson’s 2 hit hypothesis
parental imprinting
preferential transcription of genes from a set of a homologous pair of chromosomes depending on the parental origin of the chromosomes (e.g. prader-willi, angelmans)
DKA: moa for hyperkalemia and hyponatremia
- hyperkalemia: decreased insuline (cant drive K into cells) and H+/K+ exchanger; 2. hyponatremia: osmotic activity of glucose and hyperglycemia-induced osmotic diuresis
arnold-chiari malformation
downward displacement of elongated cerebellar tonsils through foramen magnum and into upper cervical canal; CSF is blocked
dandy walker malformation
enlarged posterior fossa, absent/shrunken cerebellar vermis is replaced by large, midline cyst
syringobulbia
fluied-filled cavities within medulla oblongata
male genotype and female phenotype with normal external female genitali and blind-pouch vagina
complete androgen insensitivity syndrome
leydig cell agenesis
male pseudohermaphroditism that presents with complete external female genitalia; LH/FSH levels are increased while testosterone levels are decreased
phenoxybenzamine moa
irreversibly alkylates alpha-adrenergic receptors, with half life of 24 hours
intraventricular hemorrhage in premature/respiratory distress syndrome infant
germinal matrix (highly cellular and vascular regino that generates neurons and glia during fetal development; no network fibers are present, which makes it vulnerable to hemorrhage)
amiodarone lung SE
delayed-onset/chronic interstitial pneumonitis
procainamide lung SE
delayed onset pleuritis generally associated with drug-induced SLE
PG1 function; why does it get low; and how to fix
stimulate gastic epithelial cell mucous production and decrease parietal cell acid secretion; NSAID use; misoprostol is a PGE1 analog that binds to plasma membrane prostaglandin receptors
palmitoylation
method to increase hydrophobicity of a protein by attaching a FA that is covalently anchored to PM cysteine residues (GPCR, V2 vasopressin)
hereditary albright osteodystrophy moa, pw
pseudohypoparathyroid; end-organ resistance to PTH, TSH, and LH/FSH; pw skeletal/development defects (short stature, short metacarpal/metatarsal bones) and end-organ resistance to PTH
allelic heterogeneity
different mutations in same genetic locust cause similar presentatinos (duchenne vs becker)
phenotypic heterogeneity
mutatinos in the same gene result in different phenotypes
bronchial asthma pathogenesis, rx
leukotriene D4 is synthesized by eosinophil/mast cells; induces bronchospasm and increase bronchial mucous secretion; anti-leukotriene medicatino like montelukast antagonists leukotriene D4 activity at the cysteinyl leukotriene receptor
hemochromatosis moa, pw
AR excess GI absorption of iron, annual increase in stored Fe; hepatomegaly, hyperpigmentation, DM 2/2 pancreatic islat destruction, impotence, arthropathy and cardiac dysfunction (bronze diabetes); lab findings: elevated plasma iron with more than 50 percent saturation of transferrin, and elevated serum ferritin
cirrohosis results in enlargement of what other organ
spleen 2/2 portal venous hypertension causing splenic vein hypertension
indirect ELISA
anti-human IgG antibody coupled to a substrate-modifying enzyme (peroxidase) binds to serum antibodies bound to antigen; finally, substrate that is modified by the enzyme to elicit a detectable signal is added to see if the serum antibody is present
s. epidermis found in wound culture: what does it mean?
normal skin flora, not commonly associated with skin disease; regard as contaminant
achondroplasia moa
AD point mutation (arg for gly in position 375) of FGFR-3 on c4, which causes increased function of FGFR-3 which inhibits cartilage proliferation; pw shortened proximal extremities (with normal trunk length) and enlarged head with frontal bossing
bruton’s agammaglobulinemia
X-linked defect in the signal transduction molecule known as bruton’s tyrosine kinase which is important in B cell maturation
signal recognition particles
recognize translatin of N-terminal sequences in the cytosol, after which they halt translation and carry ribosome to RER so that the polypeptide is fed into RER; composed of 15-20 AA, mostly hydrophobic
maple syrup urine dz moa
defect in branched-chain alpha-keto acid dehydrogenase complex, responsible for catabolism of leucine, isoleucine and valine; requires B1 as a coenzyme
hydrops fetalis
severe form of alpha-thalassemia with four nonfunctional alpha globulin loci, pw pallor, edema, and massively enlarged liver (extramedullary hematopoesis)
how does the seminiferous tubules and epididymis concentrate testosterone?
sertoli cells produce androgen-binding protein which binds to testosterone/dhydrotestosterone and makes these hrmones less lipophilic, allow them to be concentrated in the luminal fluid
RAS-GTP cascade
Ras-GTP triggers mitogen-activated protein kinase cascade that controls entry of cell into cell cycle; intrinsic GTP-ase converts oncoprotein back to GDP-Ras; many tumors have reduced GTPase activity that allows continued GTPase activity
glucagon moa
promotes glycogenolysis and gluconeogeneis in hepatocytes; enhances activity of AC, increases cAMP, activates glycogen phosphorylase;
epinephrine affects glycogenolysis and gluconeogensis how?
bind to beta-2 receptor on hepatocytes, which activates Gs and adenylate cyclase
sweating moa
SNS activation of eccrine (cholinergic) and apocrine glands
hyperhidrosis rx
systemic antiCh, local ACh injectables like botulin toxin, and surgical sympathectomy of the thoracic sympathetic trunk (for axillary)
red safranin O stains for
cartilage, mast cells, and mucin
cartilage in articular cartilage
hyaline cartilage, chondrocytes embedded in a matrix of proteoglycans and collagens
keratin is
cytplasmic intermediate filament produced by squamous cell cells of skin
sphingomyelin is
found in myelin sheath
round ligament
vestige of the gubernaculum, projects from uterus through the inguinal canal into labia majora
NE to epi; epi to metanephrine requires what biochemical steps?
methylation
platelet activating factor (PAF)
phospholipid inflammatory mediator (works via Gq pathway) that causes platelet aggregation (with microthrombus formation), bronchoconstriction, vasoconstriction
platelet activation has what kind of intracellular pathway?
IP3-mediated release of Ca from the ER
prostaglandin fxn and synthesis pathway
strongly inhibits platelet functions and increase platelet cAMP synthesis by stimulating adenylate cyclase; COX convert AA to PGH2, the precursor to prostaglandin
vanc-induced red man syndrome is not what
though it releases histamine from mast cells, it is not an IgE mediated reaction
cyclin D1
promotor of G1 to S phase transition
Km
inversely related to affinity of the enzyme for substrate; affected by competitive agonists (lower affinity, higher Km); unrelated by amount of enzyme
bile salt function in GI system
microbicidal emulsifying agents that disrupt the outer membrane of GN enteric bacili; chronic cholestatsis permits bacterial overgrowth and translocation across the gut wall in the distal small intestine
prokaryote
haploid genome consistenting of single chromosome, no nuclear membrane
eukaryote rRNA synthesis
28, 18, 5.8S rRNA formed from single 45S pre-rRNA, transcribed by RNA polymerase I; 5S rRNA formed separately by RNA polymerase III
rosiglitazone/thiazolidenones
PPAR agonist that increases GLUT-4 expression at SK and adipose tissue, which increases insulin sensitive glucose uptak
change in warfarin metabolisms manifests clinically in how many days?
gradually
lactulose moa in HE rx
acidifies GI content, converting NH3 to NH4
ostemalacia (2/2 vita D deficiency): bone type
excessive, unmineralized osteoid matrix in bone
MEN1 vs MEN2: difference in gene mutation
MEN1 loss of tumor-suppressor gene; MEN2 gain of function mutation on protooncogene
HNPCC increase risk of
colorectal and endometrial cancer
papomavirus
papillomavirus and polyomavirus, replicate within host cell nucleus
poxvirus unique characteristics
among DNA viruses, only one that replicates in cytoplasm
