General Knowledge 3 Flashcards
Staph. epidermidis
- Novobiocin sensitive - coagulase negative - part of normal skin flora - infects prosthetic devices, IV catheters by producing adherent biofilms ((think–> bacterial endocarditis on a prosthetic valve)) “At the Staph retreat there was NO StRES” (Saprophyticus novobiocin resistant, epidermidis sensitive)
Staph. Saprophyticus
- Novobiocin resistant - Coagulase negative - 2nd leading cause of UTI in sexually active women * leukocyte esterase test positive = bacterial cause of UTI
Staph. aureus
- gram + cocci in clusters Manifestations: - recurrent URIs in cystic fibrosis - toxic shock syndrome - scalded skin syndrome - food poisoning (preformed enterotoxin– rapid onset & resolve) - abscesses ( think pus, empyema, surgical wounds) - bronchopneumonia or lung abscess - bacterial endocarditis - osteomyelitis (w/ elevated CRP and ESR) - infectious arthritis - impetigo - breast abscess (during breastfeeding) - catalase positive - coagulase positive - has protein A (prevents phagocytosis) - treat w/ penicillinase resistant penicillins (methicillin, naficillin or VANC for MRSA
Strep. pyogenes
- gram positive cocci in chains - group A strep - beta hemolytic (complete clearance) - pharyngitis - Rheumatic fever (cross reactive antibodies to the M protein) - glomerulonephritis - cellulitis, impetigo - scarlet fever - bronchopneumonia - toxic shock syndrome (exotoxin A) - has streptolysin O (lyses RBC membranes) - sensitive to bacitracin Treat: penicillin
Pathogens most often responsible for secondary bacterial pneumonia (after viral illness , like influenza)?
Strep. pneumonia Staph. aureus Haemophilus influenza
This bacterial structure mediates adherence to surfaces, especially foreign surfaces (catheters)
GLYCOCALYX
Unique to gram positive bacteria
Lipoteichoic acid , thick peptidoglycan cell wall
Unique to gram negative bacteria
Endotoxin (LPS)
The gram negative coccus bacteria
Neisseria
Gram positive bacteria with no cell wall
Mycoplasma
These bugs do not stain well with gram stain… “These Rascals May Microscopically Lack Color”
Treponema (too thin) Rickettsia (intracellular) Mycobacteria ( high lipid content, needs acid fast stain) Mycoplasma (no cell wall) Legionella (intracellular- needs silver stain) Chlamydia (intracellular, lacks muramic acid)
Stain Used to diagnose Whipple’s dz
PAS
Stain used to diagnose Cryptococcus neoformans
India Ink
——- Is a TLR (toll like receptor) that recognizes LPS ( a PAMP) on gram neg bacteria
CD14
Arachidonic acid is released from the lipid membrane by —–?
Phospholipase A2
TLR activation results in upregulation of _____, a nuclear transcription factor that leads to production of more immune mediators
NF- kappa B
This prostaglandin mediates pain and fever
PGE2
Things that attract and activate neutrophils: (4)
LTB4, C5a, IL-8, and bacterial products
What 3 things activate mast cells?
Tissue trauma, C3a and C5a, and cross linking of surface IgE by antigen
gingivostomatitis, fever, lymphadenopathy in a young child
primary type 1 herpesvirus infection (HSV 1)
Herpesvirus –> enveloped?, DNA or RNA? double or single stranded?
enveloped, double- stranded DNA virus
serologic test for detecting EBV infection (mono)
monospot test –> tests for heterophile antibodies (IgM)
male with hemarthrosis, prolonged bleeding after tooth extraction or surgery
suspect Hemophilia (prolonged PTT)
deficiency of factors II, V, VII , X & fibrinogen cause the _____ time to be prolonged
PT (warfarin will also prolong this)
bilateral renal angiomyolipomas is associated with ______
Tuberous sclerosis (also look for >2 ash leaf macules!)
Why doesn’t chlamydia respond to Ceftriaxone?
NO cell wall peptidoglycan
What makes up “Hesselbach’s triangle” , the location of a direct inguinal hernia…
the inferior epigastric vessels, the lateral border of the rectus abdominus m. and the inguinal ligament
gingivostomatitis, fever, lymphadenopathy in a young child
primary type 1 herpesvirus infection (HSV 1)
Herpesvirus –> enveloped?, DNA or RNA? double or single stranded?
enveloped, double- stranded DNA virus
serologic test for detecting EBV infection (mono)
monospot test –> tests for heterophile antibodies (IgM)
male with hemarthrosis, prolonged bleeding after tooth extraction or surgery
suspect Hemophilia (prolonged PTT)
deficiency of factors II, V, VII , X & fibrinogen cause the _____ time to be prolonged
PT (warfarin will also prolong this)
bilateral renal angiomyolipomas is associated with ______
Tuberous sclerosis (also look for >2 ash leaf macules!)
Why doesn’t chlamydia respond to Ceftriaxone?
NO cell wall peptidoglycan
What makes up “Hesselbach’s triangle” , the location of a direct inguinal hernia…
the inferior epigastric vessels, the lateral border of the rectus abdominus m. and the inguinal ligament
Name all the Retroperitoneal structures
Suprarenal (adrenal) glands Aorta and IVC Duodenum (parts 2,3,4) Pancreas (head and body) Ureters Colon (descending & ascending) Kidneys Esophagus (lower 2/3) Rectum (upper 2/3)
What connects the liver to the anterior abd wall? And what structure does it contain?
Falciform ligament - contains the ligamentum teres (remnant of umbilical vein)
Which ligament contains the portal triad and what does that ligament connect?
Hepatoduodenal ligament (connects liver to duodenum) **portal triad= common bile duct, hepatic artery & portal vein
Which ligament contains the splenic artery and vein?
Splenorenal ligament (connects spleen to post abd wall)
Which part of the small intestine has largest number of goblet cells?
Jejunum
structures of the foregut are supplied by the ______ artery and the _________ nerve
Celiac trunk and vagus nerve ((Foregut structures are —-> stomach , duodenum, liver, GB, pancreas and spleen ))
Midgut structures are supplied by the __________ artery and the _________ nerve
SMA and Vagus nerve ((Midgut structures —–> distal duodenum to proximal 2/3 of transverse colon (to splenic flexure))
Hindgut structures are supplied by ____ artery and _____ nerve
IMA and pelvic nerve ((Hindgut structures —> distal 1/3 transverse colon (splenic flexure) to upper rectum))
What is SMA syndrome?
The transverse part of the duodenum can become trapped btw the aorta and the SMA if the angle of the SMA decreases—> leading to a partial small bowel obstruction
Branches of the celiac trunk?
-Left gastric a. -splenic a. -common hepatic a.
Above the pectinate line —-> drains to portal vein and receives visceral innervation. Kind of hemmorhoids ? Kind of cancer?
Internal hemorrhoids (NOT painful) – sign of portal HTN Above line= Adenocarcinoma
Below pectinate line–> venous drainage is to inferior rectal vein—–> IVC and innervation is somatic (pudendal nerve) Type of hemmorhoids? Type of cancer?
External hemorrhoids (painful) and Squamous Cell Carcinoma
Which zone of a hepatocyte is the outermost and is affected first by viruses??`
Zone 1 – the periportal zone
Which zone of the hepatocyte is affected 1st by ischemia and is most sensitive to toxins and alcohol?
Zone 3 - pericentral zone
Acute pancreatitis causes:
- Something obstructing the duct (tumor at head of pancreas, gallstones) - Alcohol - (causes sphincter of Oddi to contract) - Scorpion sting - Trauma (MVA) - Hypercalcemia , hyperlipidemia - Mumps - Rupture of a posterior duodenal ulcer
hormone secreted by cells in the antrum of the stomach, cause trophic growth of the gastric mucose, incrs acid secretion and incrs motility
GASTRIN (from G cells in the antrum)
hormone secreted from cells in the small intestine that incrs pancreatic secretions, GB motility & decrs gastric emptying
CCK (from I cells in the duodenum & jejunum)
hormone secreted by cells in the duodenum that incrs pancreatic HCO3- secretion, incrs bile secretion and decreases gastric acid (wants to neutralize acid in the duodenum)
Secretin (from S cells in duodenum)
why is an oral glucose load used more rapidly by the body than an IV dose?
b/c the hormone GIP (from K cells in the small intestine) causes increased INSULIN RELEASE
hormone that increases water & electrolyte secretions and relaxes sphincters throughout the GI Tract
VIP –> a VIPoma causes copious diarrhea - VIP is inhibited by somatostatin
Loss of this hormone is implicated in the tight LES tone of Achalasia
loss of Nitric Oxide
B12 is taken up in the ____________ with the help of _____ secreted by parietal cells in the stomach
terminal Ileum w/ Intrinsic factor ((B12 and bile acids are absorbed in the ileum ))
3 things that act on parietal cells to increase gastric acid secretion
-Ach -Gastrin -Histamine –> (Histamine from ECL cells most potent activator of acid)
things that decrease acid secretion from parietal cells
-Prostaglandins / Misoprostol - Somatostatin
Iron (Fe++) is absorbed mainly in the ____
duodenum
Folate is absorbed mainly in the ____
jejunum
peyer’s patches in the Ileum have B cell germinal centers which make _______
IgA secreting plasma cells (secretory IgA)
function of bile?
cholesterol excretion, help absorb fats and fat soluble vitamins, antimicrobial properties
bilirubin gets conjugated with ______ in the liver to become “direct bilirubin” which is water soluble
conjugated with glucaronic acid
Types of Salivary gland tumors
-Pleomorphic adenoma – benign, most common tumor of the parotid, high rate of recurrance -Warthin’s tumor – benign, glands + lymph tissue, in parotid - Mucoepidermoid carcinoma – malignant , usually in parotid , involves Facial nerve
triad of dysphagia (esophageal webs), glossitis, iron deficiency anemia
Plummer - Vinson syndrome
Jaundice – 4 main causes:
1- Direct injury to hepatocyte (incr total bili) 2- Obstruction of bile flow (incr direct bilirubin) 3- Hemolysis (incr indirect bilirubin) 4- **Physiologic neonatal jaundice — due to immature UDP-glucuronyl transferase -> high indirect bilirubin –> risk of kernicterus**
Treatment for physio neonatal jaundice
Phototherapy – makes the UCB water soluble (does not actually conjugate it)
Mild decrs in UDP-glucuronyl transferase –> generally asymptomatic until fasting or stress causes mild jaundice
Gilbert’s syndrome
completely absent UDP-glucuronyl transferase, jaundice, kernicterus, death
Crigler- Najjar syndrome
defective liver excretion of of bilirubin, BENIGN, just elevated conjugated bili, liver is dark color, lysosome are filled with Epinephrine
Dubin- Johnson Syndrome (Rotor’s syndrome is even milder and liver is not black)
Treatment for Wilson’s disease
Penicillamine (copper chelating agent )
air in the biliary tree
think –> fistula has formed btw GB and duodenum due to gallstones
tumor marker CA 19-9
Pancreatic cancer
Cimetidine, Ranitidine, Famotidine & Nizatidine
histamine (H2) receptor blockers —> (take H2 blockers before you –“dine”) - for ulcers, reflux, gastritis
Omeprazole, Lansoprazole
Proton pump inhibitors (irreversible inhibitors of Na/K/ATPase in parietal cells ) — no acid gets secreted
these bind directly to the base of the ulcer , providing physical protection
Bismuth, Sucralfate
a PGE1 analog, incrs mucous, decrs acid in stomach (can also be used to maintain a PDA or as an abortifacent)
Misoprostol
long acting Somatostatin analog -used for Acromegaly, VIPoma, Carcinoid tumors…
Octreotide
Infliximab
-MAB to TNF -used for Chron’s dz , RA - side effect is infection risk
Sulfasalazine
antibacterial + anti-inflammatory - used for U.C. & Chron’s
powerful, central acting antiemetic, 5-HT antagonist -used in chemo patients
Ondansetron (Zofran)
a prokinetic, D2 antagonist -incrs tone of sphincters, contractility, motility -used post surgery or in diabetics to get the bowel moving again!
Metoclopramide -has extra pyramidal side effects b/c it block’s dopamine!
painful ulcer in oral mucosa, gray base of granulomatous tissue surrounded by erythema
Aphthous Ulcer -related to stress - cause unknown (prob immune complexes) -“Behcet Syndrome” –> recurring ap. ulcers
most common location for SCC of the oral cavity
Floor of mouth -alcohol & smoking risk factors
Erythroplakia & Leukoplakia are precursor lesions to _____
Oral SCC -represent squamous cell dysplasia
rough, white patch on the lateral tongue of a man with AIDS or EBV
Hairy Leukoplakia - NOT PRECANCEROUS - represents squamous cell hyperplasia
elevated serum Amylase = rule out:
-Mumps / Salivary gland problem -Pancreatitis
Halitosis, dysphagia, obstruction
Zenker diverticulum
cause of subcutaneous emphysema (air bubbles trapped under skin, around neck)
Boerhaave syndrome (esophageal rupture-> air makes it’s way through mediastinum into subcutaneous tissues)
Most common cause of death from Cirrhosis
bleeding Esophageal varices
adult onset Asthma, chest pain after eating…
GERD -acid can irritate lungs -can also get up to mouth and damage enamel
olive like mass, projectile vomiting, 2 weeks after birth of baby boy
Pyloric Stenosis - hypertrophy of pyloric muscle
Risk factors for acute gastritis
-Severe burns (“Curling Ulcer”) - hypovolemia, less perfusion to stomach -NSAIDS - Alcoholism - Chemotherapy -Incrs ICP (“Cushing Ulcer”) –> vagus (Ach) stimulation, more acid is made - Shock (hypoperfusion)
Erosion = loss of ________ Ulcer = loss of _______
epithelium , mucosal layer
Chronic gastritis two types / causes
1- H. pylori (90%) – treat with ‘triple therapy’ 2- Autoimmune (10%)– T cell mediated (type IV hypersensitivity)
duodenal ulcer is almost always due to
H. pylori –improves with meals b/c the duodenum is starting to secrete neutralizing liquid
epigastric pain, worse with food
gastric ulcer
Risk factors for Intestinal type gastric carcinoma (most common gastric cancer)
- Japanese - Smoked food - Blood type A - H. pylori *Note: Intestinal type can have ‘Sister Mary Joseph nodes”
signet ring cells, linitis plastica (from desmoplasia of stomach)
Diffuse type gastric carcinoma -NOT assoc with H. pylori
bilateral mucinous ovarian tumors are mets from _______ cancer
Diffuse type gastric cancer “Krukenberg Tumor”
failure of the vitelline duct to involute
Meckel’s Diverticulum ( a true diverticulum – outpouching of all 3 layers)
twisting of the bowel along it’s mesentery
Volvulus (most common at sigmoid, cecum)
Lactose intolerance is usually congenital or acquired???
Acquired – after a GI illness/ infection
Cecliac dz is associated with HLA _____
HLA-DQ2 & DQ8 -gliadin is presented via MHC class II -helper T cells mediate damage -mostly affects duodenum
autosomal recessive deficiency of APO B-48 & APO B-100
Abetalipoproteinemia no B-48 –> no chylomicrons no B-100 –> no plasma VLDL & LDL
tumor cells + for chromogranin
Carcinoid tumor
what is secreted into the urine when someone has a Carcinoid tumor
5-hydroxy indoacetic acid (5-HIAA)
Hirschsprungs and duodenal atresia are associated with what chromosomal defect?
Down’s syndrome
____________ impairs the progression of the adenoma-carcinoma sequence
ASPIRIN -b/c COX is needed for the progression to carcinoma
autosomal dominant, hamartomatous polyps all along GI tract , freckle like spots on lips, increases risk for colon, breast cancer
Peutz - Jeghers syndrome
autosomal dominant inherited mutation in APC gene – if rectum & colon not removed, 100% chance of cancer
FAP
decreased stool caliber, tumor wraps around lumen
Left sided colon cancer
iron-deficiency anemia, occult bleeding, vague pain
Right sided colon cancer *an older adult with Fe deficiency anemia has colon cancer until disproven
tumor marker for Colorectal cancer – only good for assessing response & recurrance
CEA (( Carcinoembryogenic antigen))
complication of pancreatitis, fibrous tissue surrounding liquefactive necrosis
Pancreatic Psuedocyst
risk factors for pancreatic cancer
SMOKING, & chronic pancreatitis
What is the Whipple procedure?
removal of head & neck of pancreas, proximal duodenum and GB **need to supplement IRON after this procedure
these gallstones are radiolucent (can’t see them)
Cholesterol stones
pain radiating to right scapula, fever, WBC incrs, incrs alk phos
Acute cholecystitis
cholecystitis in a thin, elderly women
think of GALBLADDER CARCINOMA
fecal oral hepatitis viruses, NO chronic states
Hep A & E (“fEcAl -oral”)
Hepatitis ______ is assoc with high mortality in pregnant women (from fulminant hapatitis)
Hep E
most people infected with Hep ____ go into chronic carrier states
Hep C
______ indicates a resolved Hep B infection (or vaccination)
IgG to HBaAB
______ indicates that the Hep B virus is infective / transmissible
HBeAG (envelope)
cirrhosis damage is mediated by
TGF-beta from stellate cells
decreased synthesis of clotting factors in cirrhosis leads to prolongation of the ____ time
PT time
obstructive jaundice & antimitochondrial antibodies in a 40 y.o woman
Primary Biliary Cirrhosis
hydatid cysts from Echinococcus tapeworm infections look like “eggshell calcifications” in the liver and if disrupted during surgery can cause
Anaphylaxis
Most common benign liver tumor
Cavernous Hemangioma – blood vascular spaces with single layer of epithelium
this type of tumor can regress upon stopping oral contraceptives
Hepatic Adenoma
serum marker for Hepatocellular Carcinoma risk
Alpha fetoprotein (AFP)
Most common outcome of Hepatitis B infection
complete resolution (no chronic infection)
air in biliary tree (“pneumobilia”)
Gallstone ileus
–large gallstone passes into intestine via a fistula
– eventually obstructs (usuallyat ileocecal valve)
a patient with visible Kayser-Fleischer rings probbaly also has what other manifestations of Wilson’s dz?
neuropsych symptoms, especially basal ganglia atrophy
characteristic histo finding of a child with hepatoc failure due to Reye’s syndrome
microvesicular steatosis of hepatocytes
liver biopsy showing ballooning hepatocytes, lymphocytic infiltrates, necrosis, apoptosis (and subsequent pink/acidophilic “Councilman bodies” on H&E)
Viral Hepatitis
pt w/ fever, fatigue, joint pain, skin rash…. then later his LFT’s are elevated
HEPATITIS B
- has a “serum sickness like” prodrome period
D-xylose absorption testing tests the function of what??
the intestinal brush border absorption independent of pancreatic enzymes
- used to distinguish malabsorption caused by panc or intestine
- rectum always involved
- inflammation of mucosa & submucoas only
- continuous mucosal damage
- bloody diarrhea is hallmark of this dz
Ulcerative Colitis
confirmatory test for Celiac disease
small intestine biopsy
- atrophy & villi blunting
- chronic inflammatory infiltrate in lamina propria
porcelain gallbladder puts the pt at high risk for ______
gallbladder cancer
- develops in pts with chronic cholecystitis
- cholecystecomy is reccommended
Where are most Zollinger Ellison (gastrinomas) tumors found?
- Pancreas
- some in duodenum, stomach..
Shigella exhibits specificty for what kind of cell in the intestine??
M- cells in the Peyer’s patches of the Ileum
Pruritis in a woman w/ a history of Sjogren’s syndrome
suspect Primary Biliary Cirrhosis
- pruritis is 1st symptom, worse at night
- fatigue
- hepatosplenomegaly
- xanthelasmas
most common location of an anal fissure
posterior midline of anus distal to the dentate line
- associated w/ low fiber diet, constipation
conditions that cause hyperosmotic volume contraction
- Diabetes insipidus
- Excessive sweating w/out electrolyte & fluid replenishing
Functions of **Thyroid Peroxidase **
- Iodide oxidation
- Formation of MIT & DIT
- Coupling of MITs & DITs that forms T3 & T4
function of **Glyburide **
an oral hypoglycemic (sulfonylurea) that stimulates the release of Insulin from any remaining functioning beta cells in Type 2 diabetics
function of **Metformin **
-a biguanide
– **increases the SENSITIVITY of target tissues to Insulin **
–decrs gluconeogenesis
**– incrs glycolysis **
(have little effect on actual Insulin secretion)
mechanisn of Acarbose
inhibits alpha-glucosidase in the intestinal brush border
- inhibits the absoroption of ingested sugar
an injection of hCG in a woman on fertility treatment will mimic what hormone??
hCG mimics LH
- ovulation can be induced in a woman by a shot of hCG which mimics the LH surge
hypocalcemia and a overactive ‘jaw-jerk’ reflex when you tap on the angle of the jaw
**Hypoparathyroidism **
- possibly removed in thyroid surgery
- causes low calcium
- “Chvostek’s Sign” – twitching or reflex when tap of facial nerve
Neurophysins are secreted into systemic circulation from ____________
- from nerve terminals of the posterior pituitary
- they are secreted along with ADH and Oxytocin
term meaning decreased response to a drug with repeated administration
Tachyphylaxis
two tissue types that use INSULIN DEPENDENT Glucose uptake (Glut 4)
- Adipose
- Skeletal muscle
Glut transporter in the placenta, brain & kidneys
GLUT 3
Glut transporter in the spermatocytes & GI tract
*hint : uptake of Fructose
GLUT-5
LH stimulates the release of _________ from the Leydig cells and FSH stimulates the release of _________ from the Sertoli cells
LH —> testosterone
FSH –> Inhibin B
which hormone level can be used to confirm that a woman is in menopause
FSH
- will be high due to loss of inhibition by estrogen feedback
NF-kappa B stimulates ____________ production
more cytokines
an elevated alk phos should be followed up with what other test to pinpoint the problem to the liver??
gamma-glutamyl transpeptidase (ggt)
first test used in screening for Malabsorption
Fecal fat test
-“Sudan III stool stain”
What causes appendicitis?
Obstruction of the appendix –> usually by a Fecalith (adults) or hyperplastic lymphoid tissue (in kids after an illness)
*general principle = inflammation & infection will set in behind an obstructed lumen **
to diagnosie Hirschsprung’s disease you want to do a ____________ from the narrow or distended part of the intestine?
- Suction Biopsy (must get down to submucosa at least to sample Meissners plexus)
- take it of the narrow part (the affcted section cannot relax and the normal part above wil be distended)
most common liver neoplasm
metastases!
- multiple , well demarcated nodules
TH___ cells involved in Chron’s
TH___ cells involved in Ulcerative Colitis
TH1 – Chron’s
TH2 – Ulcerative Colitis
- thyrotoxicosis (fetures of hyperthyroid), elevated ESR, reduced radioactive Iodine uptake and tenderness over thyroid
- histologically: mixed infiltrate with occasional multinucleated giant cells
Subacute (granulomatous) thyroiditis
extensive fibrosis of the thyroid gland that can extend into other nearby structures
Riedel thyroiditis
Must check a patient’s ____ levels before starting Amiodarone therapy because it is 40% Iodine!
TSH
-excessive iodine can cause hypothyroidism
Pituitary tumors
Parathyroid tumors
Pancreatic endocrine tumors (ZE syndrome/VIPomas…)
Presents as: **kidney stones, stomach ulcers, prolactin or GH incrs…))
**MEN 1 **
-autosomal dominant
Parathyroid tumors
Pheochromocytomas
Medullary Thyroid carcinoma (calcitonin secreting)
MEN 2A
- autosomal dominant
- associated with RET gene
Oral/intestinal neuromas & Marfan habitus
Pheochromocytomas
Medullary Thyroid Carcinoma (celcitonin secreting)
MEN 2B
- autosomal dominant
- assoc w/ ret gene
A man in DKA needs Insulin, after an initial Insulin bolus & fluids, continuous IV _________ Insulin is the preferred tx for DKA
Regular insulin –given IV
-tales effect very rapidly
pancreatic islet amyloid deposition is characteristic of Type ____ DM
TYPE 2
diarrhea, abdominal pain, duodenal & jejunal ulcers
Gastrinoma
increased AFP leves in a pregnant woman…..
- Dating error
- multiples
- Neural tube defects
- ompahlocele/gastroschisis
child with fever, vomiting, altered mental status, hypotension, tachycardia, nuchal rigidity, petichial rash
meningicoccal meningitis
- Neisseria septicemia
- beware of adrenal hemorrhage in these kids (Waterhouse Friderichsen syndrome)
How do Methimazole & Propylthiouricil work to treat hyperthyroidism?
they block the Peroxidase enzyme –blocking organification & coupling of iodotyrosines
((Propylthiouricil also decreases the Peripheral conversion of T4 to T3 ))
a patient in DKA will have what kind of potassium values in the cell and outside the cell??
Intracellular K+ –decreased
Extracellular K+ – normal or increased
((and Total K+ is low))
*They lose K+ as part of the osmotic diuresis with glucose loss in the urine (also remember, Insulin normally puts K+ in the cells, if you have no Insulin, K+ comes out)
What structures are neural crest cell derived?
- All sensory ganglion and autonomic ganglion
- Melanocytes
- Chromaffin cells (adrenal medulla)
- Schwann cells & Satellite cells
- Meninges (Pia and arachnoid mater)
- Pharyngeal arch cartilage
- Odontoblasts
- Parafollicular (C) cells
- Aorticopulmonary septum
- Endocardial cushions
How does increased Estrogen affect thyroid hormone levels?
- Estrogen decreases the catabolism of Thyroid Binding Globulin (TBG) –> therfore increases the TBG
- incrs TBG = incrs total T4 and total T3
- increase is in the BOUND to TBG forms so the Free thyroid hormone remains normal and they are ‘euthyroid’
what is the mechanism of injury in diabetics who develop neuropathy and cataracts?
- Osmotic injury!
- the excess plasma glucose is converted to Sorbitol & Fructose by _aldose reductase _
- Sorbitol accumulates within some cells and draws water in, causing osmotic injury
(( this occurs in the lens, nerves, blood vessels & kidneys ))
most common type of pituitary tumor
**Prolactinoma **
- bitemporal henianopsia
- galactorrhea in females
- hypogonadism
Treatment of Congenital Adrenal Hyperplasia involves directly suppressing what hormone??
ACTH
-give low (physiologic) doses of exogenous corticosteroids to suppress the overproduction of ACTH
Dexamethasone suppression test will suppress ACTH levels if the tumor is from ___________
a pituitary adenoma
– it will NOT suppress exogenous ACTH from a small cell lung cancer for example
a person with diabetes is most likley to die from _________
a Myocardial Infarction
Glucocorticoids will cause an increase in protein production in which organ/tissue?
- the LIVER
- steroids cause an increase in gluconeogenesis and glycogenolysis
- they contribute to hyperglycemia
mechanism of action of Sulonylureas (ie: Glyburide, Glipizide…)
trigger more Insulin release via Ca++ influx
what hormones are decreased in a woman with anorexia nervosa causing amenorrhea?
- low LH, FSH, Estradiol and Estrone
- “hypogonadotropic amenorrhea”
excessive Growth Hormone increases linear bone growth by stimulating ____________
IGF-1 from the LIVER
(Gigantism – if before growth plates fuse, Acromegay – if after)
Which symptom of thyrotoxicosis (ie: Graves dz) will not be helped with a beta blocker?
- Exophthalmos
- b/c this is due to incrs soft tissue mass within the orbit behind the eye
pt with a “cold” thyroid nodule, Calcitonin producing tumor with splindle shaped cells
Medullary Thyroid Cancer
- assoc with MEN 2 syndromes
- RET proto oncogene
drugs used to treat the proptosis and prevent exophthalmos of Grave’s dz
- Prednisone
- you have to prevent the inflammation and edema behind the eye
why do antipsychotics cause Hyperprolactinemia?
they inhibit Dopamine (which normally inhibits Prolactin)
how can ADH (desmopressin) be used to treat the bleeding of von Willebrand’s disease?
ADH increases vWF release from endothelial cells
a man with a testicular tumor starts to develop hyperthyroidism … which hormone could be causing the thyroid symptoms?
hCG from the testicular mass
- hCG is structurally similar to TSH (and also LH in women) and could cause the hyperthyroidism
name the diabetes drugs that inhibit intestinal brush border enzyme (alpha glucosidase) to decrs glucose absorption
- Acarbose
- Miglitol
treatment for SIADH
- has toxicities of Nephrogenic DI, photosensitiivy, bone & teeth abnormalities
Demeclocycline
- an ADH antagonist
- from the tetrocycline family (hence the SE’s)
hormone responsible for fetal lung maturity and surfactant production , only secreted late in gestation
Cortisol
- only secreted late in gestation
- premature –> low surfactant –> IRDS
2 places in the body with their own portal circulation
- Pituitary
- Liver
this hormone:
- incrs glucose transport into skeletal m
- incrs glycogen synthesis
- incrs trig synthesis / storage
- incrs Na+ retention, protein synthesis
- incrs cellular uptake of K+ and amino acids
INSULIN
Insulin is secreted in exchange for ______________ into the cell
Ca++
GLUT receptor for the brain and RBC’s
GLUT 1
Why do women who are breastfeeding stop ovulating?
Prolactin inhibits GnRH
which is the more active form of Thyroid hormone?
T3
-but T4 is made more and just converted as needed by 5-deiodinase
hormones that use the cAMP second messenger system
“FLAT CHAMP”
- FSH
- LH
- ACTH
- TSH
- CRH
- hCG
- ADH
- MSH
- PTH
- also Caclitonin, GnRH and Glucagon
how do you tell a Follicular thyroid Adenoma (benign) from a Follicular Carcinoma (malig)?
the Follicular Carcinoma INVADES THE CAPSULE
- pathological activation of coagulation (blood clotting) mechanisms that happens in response to a variety of diseases
- leads to the formation of small blood clots inside the blood vessels throughout the body.
- As the small clots consume coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding occurs from the skin.
DIC
cytokine that stimulates NK cells to destroy target cells and makes T helper cells secrete IFN-gamma
IL-12
impairement of the ____________ process can lead to neurodegenerative disorders like Parkinson’s & Alzheimer’s
Ubiquitin- proteosome system
-failure of this system to degrade abnormal proteins leads to accumulation of misfolded proteins
test you use to determine if the means of 2 populations are equal
2 Sample T Test
MOST COMMON primary brain tumor in adults
Glioblastoma Multiforme
- in frontal or temporal lobe or basal ganglia
- can cross hemispheres (but not always)
- foci of necrosis and hemorrhage
RNA Pol 1 — functions?
RNA Pol 2—
RNA Pol 3—
RNA Pol 1 – makes rRNA in the nucleolus
RNA Pol 2– make mRNA
RNA Pol 3– DNA to tRNA some rRNA and snRNPS
When doing a Cricothyrotomy, what structures do you pass through to get to the airway?
1- Skin
2- Superficial cervical fascia (including fat & Platysma m)
3- Investing & Pretracheal layers of the deep cervical fascia
4- Cricothyroid membrane
Molecule with the amino acid sequence of (Gly -x-y)333 ((Glycine every 3rd amino acid)
COLLAGEN
- folds into a triple helix
- glycine is the smallest aa, so needed to fold into a triple helix!
Medical treatment for aldosterone secreting adenoma (Conns syndrome)
Spironolactone, Eplerenone
a segmenting vasculitis that can extend into the veins and nerves (eventually encasing all 3 infibrous tissue)
Buerger’s disease (aka “thromboangiitis obliterans”)
- male heavy smokers < age 35
- pt w/ “hypersensitivity to injection of tobacco extract”
child with BP of 160/98, hypokalemia, lack of secondary sexual characteristics
17-a-hydroxylase deficiency
some non-polar, hydrophobic amino acids that span lipid membranes in transmembrane proteins:
Valine, Alanine, Isoleucine, Metionine, Phenyalanine
Which ligement contains the ovarian artery and vein and must be carefully ligated when removing an overy to prevent hemorrhage?
the Suspensory Ligament
Which ligament contains the uterine artery and must be carefully ligated before a radical hysterectomy?
Cardinal ligament (aka ‘transverse cervial lig”)
Most common cause of Meconium Ileus in a child?
(child most likely also has what dz?)
CYSTIC FIBROSIS
- meconium Ileus is a distal, small bowel obstruction in a neonate due to abnormally dehydrated meconium
- it is quite specific for CF
Some children who have gotten the Hib vaccine can still get infections with H.flu….. how?
- there are several ‘non-typable’ strains of H. flu that do not have a capsule
- the vaccine only confers immunity to the type B strain
- connects the lateral femoral condyle to the anterio-medial tibial head
- prevents anterior motion of the tibia w/ respect to the femur
ACL
Which type of Heparin binds to antithrombin and thrombin to allow antithrombin to inactivate thrombin
Unfractionated Heparin
girl with heavy periods and history of frequent nosebleeds as a child– what is the most likley bleeding disorder?
von Willebrand factor deficiency
- easy bleeding from mucosal sites (gingiva, nasal mucosa, GI tract, and heavy periods)
- autosomal dominant
function of vWF in the blood
-what does it bind to?
- carrier of factor VIII (protects it from degredation)
- binds to exposed collagen and platelet glycoproteins and promotes more platelet binding
child with eczema, recurrent infections (combined B & T cell deficiency) and thrombocytopenia
Wiskott - Aldrich syndrome
- X linked (only in males)
- increased risk of pyogenic infections do to humoral (B cell) deficit -(Neisseria, H.flu, S. pneumo)
- risk of opportunistic pathogens due to T cell deficit (P. jiroveci , Herpes)
- dz in which platelets contain defective or low levels of GpIIb/IIIa, which is a receptor for fibrinogen
- As a result, no fibrinogen bridging of platelets to other platelets can occur, and the bleeding time is significantly prolonged.
Glanzmann’s thrombasthenia
drug that blocks gpIIbIIIa on platelets to prevent platelet plug formation
Abciximab
- child w/ abdominal pain, joint pain, proteinuria, blood in stool
- the most common kind of systemic vasculitis in kids
Henoch- Schonlein Purpura
- expect the child to develop palpable purpura esp on legs, buttocks
- occurs due to deposition of IgA immune complexes
- males 3-10 years old usually
lacunar stroke affecting the subthalamic nucleus will cause
contra Hemiballismus
severe hypoplasia of erythroid precursors in the marrow, but normal granulopoesis and thrombopoesis
Pure Red Cell Aplasia (PRCA)
- form of marrow failure assoc. with Thymic tumors and leukemias
- can also result from Parvovirus infection (pref attacks proerythroblasts)
in a male, non-fusion of the urethral folds would cause:
Hypospadias
type of renal cell cast most specific for pyelonephritis
WBC casts
-esp in conjunction with burning, urgency, fever
Radiation therapy for cancer treatment – how does it kill/ affect the cancer cells?
- Double stranded DNA breaks or
- Formation of free radicals
dry, nagging cough, low grade fever, malaise, _CXR that looks much worse than the pt feels _
“Walking Pneumonia”
- caused by Mycoplasma pneumonia
- requires cholesterol agar to grow in lab
baby born with Hydrocephalus, intracranial calcifications and chorioretinitis (inflammation that leaves “cotton like” white/yellow lesions on the chorio/retinas)
–classic presentation of a baby with **Congenital Toxoplasmosis **
- fetus gets the dz only if mom is infected in 1st 6 months of pregnancy
cyclophosphamide (& other mustard chemo agents) get metabolized to Acrolein (toxic to urothelium) & cause hemorrhagic cystitis — what agent can prevent this?
MESNA (aka 2-mercaptoethanesulfonate)
baby with fever, pharyngitis, diffuse rash that blanches w/ pressure, strawberry tongue
Scarlett fever (group A strep)
transplant patient with onset of rash, jaundice, hepatosplenomegaly, diarrhea 1 week after surgery —what kind of rxn?
Graft vs Host disease
- Graft T cells attack the “foreign” host cells (that’s why so many organ systems are affected)
anaphylactic rxn to blood transfusion
IgA deficiency
- these pts must recieve blood products with no IgA in it (they have no IgA so any in their blood is foreign)
- they form IgG against the IgA
Pt with recurrent pyogenic infections, his neutrophils fail to turn blue upon nitroblue tetrazolium exposure—- he is deficient in what enzyme?
- NADPH Oxidase
- the pt has Chronic Granulomatous dz (manifest by recurring infections w/ catalase producing organisms like Staph aureus)
lack of complement C5b -C9 results in recurring ___________ infections
NEISSERIA
woman with Lupus and antiphospholipid antibodies is predisposed to ____________
- Recurrent Miscarriages
- they will have the ‘lupus anticoagulant’– which actually causes clotting
- they will have _a false + VDRL test and a prolonged PTT _
In type A & B mothers, Erythroblastosis fetalis does not occur b/c the antibodies are _____
IgM
-With type O mothers, the antibodies in the serum are usually IgG so they can cross the placenta and cause EF
T cells undergo positive selection in the thymic ______ & negative selection in the thymic ______
positive selection –> cortex
negative selection –> medulla
Isotype switching of B cells in the lymph node happens in the _________
germinal center
- it is the heavy chain Fc region that determines the isotype
Muscle biopsy in a pt w/ polymyostitis would show _________
CD8+ T cells, and overexpression of MHC I
Erythroblastosis Fetalis (maternal IgG crossing the placenta and lysing baby’s A or B blood) is an example of a Type ______ hypersensitivity
TYPE 2 (antibody mediated)
Drugs that increase IL-2 (Aldesleukin) can be used to reduce tumor burdens in renal cell cancer b/c _______
IL-2 activates more NK cells and monocytes to kill the tumor cells
