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STEP 1 RECALL > General Knowledge 3 > Flashcards

General Knowledge 3 Flashcards

1
Q

Staph. epidermidis

A
  • 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)
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2
Q

Staph. Saprophyticus

A
  • Novobiocin resistant - Coagulase negative - 2nd leading cause of UTI in sexually active women * leukocyte esterase test positive = bacterial cause of UTI
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3
Q

Staph. aureus

A
  • 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
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4
Q

Strep. pyogenes

A
  • 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
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5
Q

Pathogens most often responsible for secondary bacterial pneumonia (after viral illness , like influenza)?

A

Strep. pneumonia Staph. aureus Haemophilus influenza

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6
Q

This bacterial structure mediates adherence to surfaces, especially foreign surfaces (catheters)

A

GLYCOCALYX

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7
Q

Unique to gram positive bacteria

A

Lipoteichoic acid , thick peptidoglycan cell wall

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8
Q

Unique to gram negative bacteria

A

Endotoxin (LPS)

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9
Q

The gram negative coccus bacteria

A

Neisseria

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10
Q

Gram positive bacteria with no cell wall

A

Mycoplasma

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11
Q

These bugs do not stain well with gram stain… “These Rascals May Microscopically Lack Color”

A

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)

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12
Q

Stain Used to diagnose Whipple’s dz

A

PAS

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13
Q

Stain used to diagnose Cryptococcus neoformans

A

India Ink

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14
Q

——- Is a TLR (toll like receptor) that recognizes LPS ( a PAMP) on gram neg bacteria

A

CD14

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15
Q

Arachidonic acid is released from the lipid membrane by —–?

A

Phospholipase A2

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16
Q

TLR activation results in upregulation of _____, a nuclear transcription factor that leads to production of more immune mediators

A

NF- kappa B

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17
Q

This prostaglandin mediates pain and fever

A

PGE2

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18
Q

Things that attract and activate neutrophils: (4)

A

LTB4, C5a, IL-8, and bacterial products

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19
Q

What 3 things activate mast cells?

A

Tissue trauma, C3a and C5a, and cross linking of surface IgE by antigen

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20
Q

gingivostomatitis, fever, lymphadenopathy in a young child

A

primary type 1 herpesvirus infection (HSV 1)

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21
Q

Herpesvirus –> enveloped?, DNA or RNA? double or single stranded?

A

enveloped, double- stranded DNA virus

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22
Q

serologic test for detecting EBV infection (mono)

A

monospot test –> tests for heterophile antibodies (IgM)

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23
Q

male with hemarthrosis, prolonged bleeding after tooth extraction or surgery

A

suspect Hemophilia (prolonged PTT)

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24
Q

deficiency of factors II, V, VII , X & fibrinogen cause the _____ time to be prolonged

A

PT (warfarin will also prolong this)

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25
Q

bilateral renal angiomyolipomas is associated with ______

A

Tuberous sclerosis (also look for >2 ash leaf macules!)

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26
Q

Why doesn’t chlamydia respond to Ceftriaxone?

A

NO cell wall peptidoglycan

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27
Q

What makes up “Hesselbach’s triangle” , the location of a direct inguinal hernia…

A

the inferior epigastric vessels, the lateral border of the rectus abdominus m. and the inguinal ligament

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28
Q

gingivostomatitis, fever, lymphadenopathy in a young child

A

primary type 1 herpesvirus infection (HSV 1)

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29
Q

Herpesvirus –> enveloped?, DNA or RNA? double or single stranded?

A

enveloped, double- stranded DNA virus

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30
Q

serologic test for detecting EBV infection (mono)

A

monospot test –> tests for heterophile antibodies (IgM)

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31
Q

male with hemarthrosis, prolonged bleeding after tooth extraction or surgery

A

suspect Hemophilia (prolonged PTT)

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32
Q

deficiency of factors II, V, VII , X & fibrinogen cause the _____ time to be prolonged

A

PT (warfarin will also prolong this)

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33
Q

bilateral renal angiomyolipomas is associated with ______

A

Tuberous sclerosis (also look for >2 ash leaf macules!)

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34
Q

Why doesn’t chlamydia respond to Ceftriaxone?

A

NO cell wall peptidoglycan

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35
Q

What makes up “Hesselbach’s triangle” , the location of a direct inguinal hernia…

A

the inferior epigastric vessels, the lateral border of the rectus abdominus m. and the inguinal ligament

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36
Q

Name all the Retroperitoneal structures

A

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)

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37
Q

What connects the liver to the anterior abd wall? And what structure does it contain?

A

Falciform ligament - contains the ligamentum teres (remnant of umbilical vein)

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38
Q

Which ligament contains the portal triad and what does that ligament connect?

A

Hepatoduodenal ligament (connects liver to duodenum) **portal triad= common bile duct, hepatic artery & portal vein

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39
Q

Which ligament contains the splenic artery and vein?

A

Splenorenal ligament (connects spleen to post abd wall)

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40
Q

Which part of the small intestine has largest number of goblet cells?

A

Jejunum

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41
Q

structures of the foregut are supplied by the ______ artery and the _________ nerve

A

Celiac trunk and vagus nerve ((Foregut structures are —-> stomach , duodenum, liver, GB, pancreas and spleen ))

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42
Q

Midgut structures are supplied by the __________ artery and the _________ nerve

A

SMA and Vagus nerve ((Midgut structures —–> distal duodenum to proximal 2/3 of transverse colon (to splenic flexure))

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43
Q

Hindgut structures are supplied by ____ artery and _____ nerve

A

IMA and pelvic nerve ((Hindgut structures —> distal 1/3 transverse colon (splenic flexure) to upper rectum))

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44
Q

What is SMA syndrome?

A

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

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45
Q

Branches of the celiac trunk?

A

-Left gastric a. -splenic a. -common hepatic a.

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46
Q

Above the pectinate line —-> drains to portal vein and receives visceral innervation. Kind of hemmorhoids ? Kind of cancer?

A

Internal hemorrhoids (NOT painful) – sign of portal HTN Above line= Adenocarcinoma

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47
Q

Below pectinate line–> venous drainage is to inferior rectal vein—–> IVC and innervation is somatic (pudendal nerve) Type of hemmorhoids? Type of cancer?

A

External hemorrhoids (painful) and Squamous Cell Carcinoma

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48
Q

Which zone of a hepatocyte is the outermost and is affected first by viruses??`

A

Zone 1 – the periportal zone

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49
Q

Which zone of the hepatocyte is affected 1st by ischemia and is most sensitive to toxins and alcohol?

A

Zone 3 - pericentral zone

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50
Q

Acute pancreatitis causes:

A
  • 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
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51
Q

hormone secreted by cells in the antrum of the stomach, cause trophic growth of the gastric mucose, incrs acid secretion and incrs motility

A

GASTRIN (from G cells in the antrum)

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52
Q

hormone secreted from cells in the small intestine that incrs pancreatic secretions, GB motility & decrs gastric emptying

A

CCK (from I cells in the duodenum & jejunum)

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53
Q

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)

A

Secretin (from S cells in duodenum)

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54
Q

why is an oral glucose load used more rapidly by the body than an IV dose?

A

b/c the hormone GIP (from K cells in the small intestine) causes increased INSULIN RELEASE

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55
Q

hormone that increases water & electrolyte secretions and relaxes sphincters throughout the GI Tract

A

VIP –> a VIPoma causes copious diarrhea - VIP is inhibited by somatostatin

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56
Q

Loss of this hormone is implicated in the tight LES tone of Achalasia

A

loss of Nitric Oxide

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57
Q

B12 is taken up in the ____________ with the help of _____ secreted by parietal cells in the stomach

A

terminal Ileum w/ Intrinsic factor ((B12 and bile acids are absorbed in the ileum ))

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58
Q

3 things that act on parietal cells to increase gastric acid secretion

A

-Ach -Gastrin -Histamine –> (Histamine from ECL cells most potent activator of acid)

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59
Q

things that decrease acid secretion from parietal cells

A

-Prostaglandins / Misoprostol - Somatostatin

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60
Q

Iron (Fe++) is absorbed mainly in the ____

A

duodenum

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61
Q

Folate is absorbed mainly in the ____

A

jejunum

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62
Q

peyer’s patches in the Ileum have B cell germinal centers which make _______

A

IgA secreting plasma cells (secretory IgA)

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63
Q

function of bile?

A

cholesterol excretion, help absorb fats and fat soluble vitamins, antimicrobial properties

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64
Q

bilirubin gets conjugated with ______ in the liver to become “direct bilirubin” which is water soluble

A

conjugated with glucaronic acid

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65
Q

Types of Salivary gland tumors

A

-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

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66
Q

triad of dysphagia (esophageal webs), glossitis, iron deficiency anemia

A

Plummer - Vinson syndrome

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67
Q

Jaundice – 4 main causes:

A

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**

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68
Q

Treatment for physio neonatal jaundice

A

Phototherapy – makes the UCB water soluble (does not actually conjugate it)

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69
Q

Mild decrs in UDP-glucuronyl transferase –> generally asymptomatic until fasting or stress causes mild jaundice

A

Gilbert’s syndrome

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70
Q

completely absent UDP-glucuronyl transferase, jaundice, kernicterus, death

A

Crigler- Najjar syndrome

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71
Q

defective liver excretion of of bilirubin, BENIGN, just elevated conjugated bili, liver is dark color, lysosome are filled with Epinephrine

A

Dubin- Johnson Syndrome (Rotor’s syndrome is even milder and liver is not black)

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72
Q

Treatment for Wilson’s disease

A

Penicillamine (copper chelating agent )

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73
Q

air in the biliary tree

A

think –> fistula has formed btw GB and duodenum due to gallstones

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74
Q

tumor marker CA 19-9

A

Pancreatic cancer

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75
Q

Cimetidine, Ranitidine, Famotidine & Nizatidine

A

histamine (H2) receptor blockers —> (take H2 blockers before you –“dine”) - for ulcers, reflux, gastritis

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76
Q

Omeprazole, Lansoprazole

A

Proton pump inhibitors (irreversible inhibitors of Na/K/ATPase in parietal cells ) — no acid gets secreted

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77
Q

these bind directly to the base of the ulcer , providing physical protection

A

Bismuth, Sucralfate

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78
Q

a PGE1 analog, incrs mucous, decrs acid in stomach (can also be used to maintain a PDA or as an abortifacent)

A

Misoprostol

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79
Q

long acting Somatostatin analog -used for Acromegaly, VIPoma, Carcinoid tumors…

A

Octreotide

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80
Q

Infliximab

A

-MAB to TNF -used for Chron’s dz , RA - side effect is infection risk

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81
Q

Sulfasalazine

A

antibacterial + anti-inflammatory - used for U.C. & Chron’s

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82
Q

powerful, central acting antiemetic, 5-HT antagonist -used in chemo patients

A

Ondansetron (Zofran)

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83
Q

a prokinetic, D2 antagonist -incrs tone of sphincters, contractility, motility -used post surgery or in diabetics to get the bowel moving again!

A

Metoclopramide -has extra pyramidal side effects b/c it block’s dopamine!

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84
Q

painful ulcer in oral mucosa, gray base of granulomatous tissue surrounded by erythema

A

Aphthous Ulcer -related to stress - cause unknown (prob immune complexes) -“Behcet Syndrome” –> recurring ap. ulcers

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85
Q

most common location for SCC of the oral cavity

A

Floor of mouth -alcohol & smoking risk factors

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86
Q

Erythroplakia & Leukoplakia are precursor lesions to _____

A

Oral SCC -represent squamous cell dysplasia

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87
Q

rough, white patch on the lateral tongue of a man with AIDS or EBV

A

Hairy Leukoplakia - NOT PRECANCEROUS - represents squamous cell hyperplasia

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88
Q

elevated serum Amylase = rule out:

A

-Mumps / Salivary gland problem -Pancreatitis

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89
Q

Halitosis, dysphagia, obstruction

A

Zenker diverticulum

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90
Q

cause of subcutaneous emphysema (air bubbles trapped under skin, around neck)

A

Boerhaave syndrome (esophageal rupture-> air makes it’s way through mediastinum into subcutaneous tissues)

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91
Q

Most common cause of death from Cirrhosis

A

bleeding Esophageal varices

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92
Q

adult onset Asthma, chest pain after eating…

A

GERD -acid can irritate lungs -can also get up to mouth and damage enamel

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93
Q

olive like mass, projectile vomiting, 2 weeks after birth of baby boy

A

Pyloric Stenosis - hypertrophy of pyloric muscle

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94
Q

Risk factors for acute gastritis

A

-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)

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95
Q

Erosion = loss of ________ Ulcer = loss of _______

A

epithelium , mucosal layer

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96
Q

Chronic gastritis two types / causes

A

1- H. pylori (90%) – treat with ‘triple therapy’ 2- Autoimmune (10%)– T cell mediated (type IV hypersensitivity)

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97
Q

duodenal ulcer is almost always due to

A

H. pylori –improves with meals b/c the duodenum is starting to secrete neutralizing liquid

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98
Q

epigastric pain, worse with food

A

gastric ulcer

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99
Q

Risk factors for Intestinal type gastric carcinoma (most common gastric cancer)

A
  • Japanese - Smoked food - Blood type A - H. pylori *Note: Intestinal type can have ‘Sister Mary Joseph nodes”
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100
Q

signet ring cells, linitis plastica (from desmoplasia of stomach)

A

Diffuse type gastric carcinoma -NOT assoc with H. pylori

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101
Q

bilateral mucinous ovarian tumors are mets from _______ cancer

A

Diffuse type gastric cancer “Krukenberg Tumor”

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102
Q

failure of the vitelline duct to involute

A

Meckel’s Diverticulum ( a true diverticulum – outpouching of all 3 layers)

103
Q

twisting of the bowel along it’s mesentery

A

Volvulus (most common at sigmoid, cecum)

104
Q

Lactose intolerance is usually congenital or acquired???

A

Acquired – after a GI illness/ infection

105
Q

Cecliac dz is associated with HLA _____

A

HLA-DQ2 & DQ8 -gliadin is presented via MHC class II -helper T cells mediate damage -mostly affects duodenum

106
Q

autosomal recessive deficiency of APO B-48 & APO B-100

A

Abetalipoproteinemia no B-48 –> no chylomicrons no B-100 –> no plasma VLDL & LDL

107
Q

tumor cells + for chromogranin

A

Carcinoid tumor

108
Q

what is secreted into the urine when someone has a Carcinoid tumor

A

5-hydroxy indoacetic acid (5-HIAA)

109
Q

Hirschsprungs and duodenal atresia are associated with what chromosomal defect?

A

Down’s syndrome

110
Q

____________ impairs the progression of the adenoma-carcinoma sequence

A

ASPIRIN -b/c COX is needed for the progression to carcinoma

111
Q

autosomal dominant, hamartomatous polyps all along GI tract , freckle like spots on lips, increases risk for colon, breast cancer

A

Peutz - Jeghers syndrome

112
Q

autosomal dominant inherited mutation in APC gene – if rectum & colon not removed, 100% chance of cancer

A

FAP

113
Q

decreased stool caliber, tumor wraps around lumen

A

Left sided colon cancer

114
Q

iron-deficiency anemia, occult bleeding, vague pain

A

Right sided colon cancer *an older adult with Fe deficiency anemia has colon cancer until disproven

115
Q

tumor marker for Colorectal cancer – only good for assessing response & recurrance

A

CEA (( Carcinoembryogenic antigen))

116
Q

complication of pancreatitis, fibrous tissue surrounding liquefactive necrosis

A

Pancreatic Psuedocyst

117
Q

risk factors for pancreatic cancer

A

SMOKING, & chronic pancreatitis

118
Q

What is the Whipple procedure?

A

removal of head & neck of pancreas, proximal duodenum and GB **need to supplement IRON after this procedure

119
Q

these gallstones are radiolucent (can’t see them)

A

Cholesterol stones

120
Q

pain radiating to right scapula, fever, WBC incrs, incrs alk phos

A

Acute cholecystitis

121
Q

cholecystitis in a thin, elderly women

A

think of GALBLADDER CARCINOMA

122
Q

fecal oral hepatitis viruses, NO chronic states

A

Hep A & E (“fEcAl -oral”)

123
Q

Hepatitis ______ is assoc with high mortality in pregnant women (from fulminant hapatitis)

A

Hep E

124
Q

most people infected with Hep ____ go into chronic carrier states

A

Hep C

125
Q

______ indicates a resolved Hep B infection (or vaccination)

A

IgG to HBaAB

126
Q

______ indicates that the Hep B virus is infective / transmissible

A

HBeAG (envelope)

127
Q

cirrhosis damage is mediated by

A

TGF-beta from stellate cells

128
Q

decreased synthesis of clotting factors in cirrhosis leads to prolongation of the ____ time

A

PT time

129
Q

obstructive jaundice & antimitochondrial antibodies in a 40 y.o woman

A

Primary Biliary Cirrhosis

130
Q

hydatid cysts from Echinococcus tapeworm infections look like “eggshell calcifications” in the liver and if disrupted during surgery can cause

A

Anaphylaxis

131
Q

Most common benign liver tumor

A

Cavernous Hemangioma – blood vascular spaces with single layer of epithelium

132
Q

this type of tumor can regress upon stopping oral contraceptives

A

Hepatic Adenoma

133
Q

serum marker for Hepatocellular Carcinoma risk

A

Alpha fetoprotein (AFP)

134
Q

Most common outcome of Hepatitis B infection

A

complete resolution (no chronic infection)

135
Q

air in biliary tree (“pneumobilia”)

A

Gallstone ileus

–large gallstone passes into intestine via a fistula

– eventually obstructs (usuallyat ileocecal valve)

136
Q

a patient with visible Kayser-Fleischer rings probbaly also has what other manifestations of Wilson’s dz?

A

neuropsych symptoms, especially basal ganglia atrophy

137
Q

characteristic histo finding of a child with hepatoc failure due to Reye’s syndrome

A

microvesicular steatosis of hepatocytes

138
Q

liver biopsy showing ballooning hepatocytes, lymphocytic infiltrates, necrosis, apoptosis (and subsequent pink/acidophilic “Councilman bodies” on H&E)

A

Viral Hepatitis

139
Q

pt w/ fever, fatigue, joint pain, skin rash…. then later his LFT’s are elevated

A

HEPATITIS B

  • has a “serum sickness like” prodrome period
140
Q

D-xylose absorption testing tests the function of what??

A

the intestinal brush border absorption independent of pancreatic enzymes

  • used to distinguish malabsorption caused by panc or intestine
141
Q
  • rectum always involved
  • inflammation of mucosa & submucoas only
  • continuous mucosal damage
  • bloody diarrhea is hallmark of this dz
A

Ulcerative Colitis

142
Q

confirmatory test for Celiac disease

A

small intestine biopsy

  • atrophy & villi blunting
  • chronic inflammatory infiltrate in lamina propria
143
Q

porcelain gallbladder puts the pt at high risk for ______

A

gallbladder cancer

  • develops in pts with chronic cholecystitis
  • cholecystecomy is reccommended
144
Q

Where are most Zollinger Ellison (gastrinomas) tumors found?

A
  • Pancreas
  • some in duodenum, stomach..
145
Q

Shigella exhibits specificty for what kind of cell in the intestine??

A

M- cells in the Peyer’s patches of the Ileum

146
Q

Pruritis in a woman w/ a history of Sjogren’s syndrome

A

suspect Primary Biliary Cirrhosis

  • pruritis is 1st symptom, worse at night
  • fatigue
  • hepatosplenomegaly
  • xanthelasmas
147
Q

most common location of an anal fissure

A

posterior midline of anus distal to the dentate line

  • associated w/ low fiber diet, constipation
148
Q

conditions that cause hyperosmotic volume contraction

A
  • Diabetes insipidus
  • Excessive sweating w/out electrolyte & fluid replenishing
149
Q

Functions of **Thyroid Peroxidase **

A
  • Iodide oxidation
  • Formation of MIT & DIT
  • Coupling of MITs & DITs that forms T3 & T4
150
Q

function of **Glyburide **

A

an oral hypoglycemic (sulfonylurea) that stimulates the release of Insulin from any remaining functioning beta cells in Type 2 diabetics

151
Q

function of **Metformin **

A

-a biguanide

– **increases the SENSITIVITY of target tissues to Insulin **

–decrs gluconeogenesis

**– incrs glycolysis **

(have little effect on actual Insulin secretion)

152
Q

mechanisn of Acarbose

A

inhibits alpha-glucosidase in the intestinal brush border

  • inhibits the absoroption of ingested sugar
153
Q

an injection of hCG in a woman on fertility treatment will mimic what hormone??

A

hCG mimics LH

  • ovulation can be induced in a woman by a shot of hCG which mimics the LH surge
154
Q

hypocalcemia and a overactive ‘jaw-jerk’ reflex when you tap on the angle of the jaw

A

**Hypoparathyroidism **

  • possibly removed in thyroid surgery
  • causes low calcium
  • “Chvostek’s Sign” – twitching or reflex when tap of facial nerve
155
Q

Neurophysins are secreted into systemic circulation from ____________

A
  • from nerve terminals of the posterior pituitary
  • they are secreted along with ADH and Oxytocin
156
Q

term meaning decreased response to a drug with repeated administration

A

Tachyphylaxis

157
Q

two tissue types that use INSULIN DEPENDENT Glucose uptake (Glut 4)

A
  • Adipose
  • Skeletal muscle
158
Q

Glut transporter in the placenta, brain & kidneys

A

GLUT 3

159
Q

Glut transporter in the spermatocytes & GI tract

*hint : uptake of Fructose

A

GLUT-5

160
Q

LH stimulates the release of _________ from the Leydig cells and FSH stimulates the release of _________ from the Sertoli cells

A

LH —> testosterone

FSH –> Inhibin B

161
Q

which hormone level can be used to confirm that a woman is in menopause

A

FSH

  • will be high due to loss of inhibition by estrogen feedback
162
Q

NF-kappa B stimulates ____________ production

A

more cytokines

163
Q

an elevated alk phos should be followed up with what other test to pinpoint the problem to the liver??

A

gamma-glutamyl transpeptidase (ggt)

164
Q

first test used in screening for Malabsorption

A

Fecal fat test

-“Sudan III stool stain”

165
Q

What causes appendicitis?

A

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 **

166
Q

to diagnosie Hirschsprung’s disease you want to do a ____________ from the narrow or distended part of the intestine?

A
  • 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)
167
Q

most common liver neoplasm

A

metastases!

  • multiple , well demarcated nodules
168
Q

TH___ cells involved in Chron’s

TH___ cells involved in Ulcerative Colitis

A

TH1 – Chron’s

TH2 – Ulcerative Colitis

169
Q
  • thyrotoxicosis (fetures of hyperthyroid), elevated ESR, reduced radioactive Iodine uptake and tenderness over thyroid
  • histologically: mixed infiltrate with occasional multinucleated giant cells
A

Subacute (granulomatous) thyroiditis

170
Q

extensive fibrosis of the thyroid gland that can extend into other nearby structures

A

Riedel thyroiditis

171
Q

Must check a patient’s ____ levels before starting Amiodarone therapy because it is 40% Iodine!

A

TSH

-excessive iodine can cause hypothyroidism

172
Q

Pituitary tumors

Parathyroid tumors

Pancreatic endocrine tumors (ZE syndrome/VIPomas…)

Presents as: **kidney stones, stomach ulcers, prolactin or GH incrs…))

A

**MEN 1 **

-autosomal dominant

173
Q

Parathyroid tumors

Pheochromocytomas

Medullary Thyroid carcinoma (calcitonin secreting)

A

MEN 2A

  • autosomal dominant
  • associated with RET gene
174
Q

Oral/intestinal neuromas & Marfan habitus

Pheochromocytomas

Medullary Thyroid Carcinoma (celcitonin secreting)

A

MEN 2B

  • autosomal dominant
  • assoc w/ ret gene
175
Q

A man in DKA needs Insulin, after an initial Insulin bolus & fluids, continuous IV _________ Insulin is the preferred tx for DKA

A

Regular insulin –given IV

-tales effect very rapidly

176
Q

pancreatic islet amyloid deposition is characteristic of Type ____ DM

A

TYPE 2

177
Q

diarrhea, abdominal pain, duodenal & jejunal ulcers

A

Gastrinoma

178
Q

increased AFP leves in a pregnant woman…..

A
  • Dating error
  • multiples
  • Neural tube defects
  • ompahlocele/gastroschisis
179
Q

child with fever, vomiting, altered mental status, hypotension, tachycardia, nuchal rigidity, petichial rash

A

meningicoccal meningitis

  • Neisseria septicemia
  • beware of adrenal hemorrhage in these kids (Waterhouse Friderichsen syndrome)
180
Q

How do Methimazole & Propylthiouricil work to treat hyperthyroidism?

A

they block the Peroxidase enzyme –blocking organification & coupling of iodotyrosines

((Propylthiouricil also decreases the Peripheral conversion of T4 to T3 ))

181
Q

a patient in DKA will have what kind of potassium values in the cell and outside the cell??

A

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)

182
Q

What structures are neural crest cell derived?

A
  • 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
183
Q

How does increased Estrogen affect thyroid hormone levels?

A
  • 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’
184
Q

what is the mechanism of injury in diabetics who develop neuropathy and cataracts?

A
  • 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 ))

185
Q

most common type of pituitary tumor

A

**Prolactinoma **

  • bitemporal henianopsia
  • galactorrhea in females
  • hypogonadism
186
Q

Treatment of Congenital Adrenal Hyperplasia involves directly suppressing what hormone??

A

ACTH

-give low (physiologic) doses of exogenous corticosteroids to suppress the overproduction of ACTH

187
Q

Dexamethasone suppression test will suppress ACTH levels if the tumor is from ___________

A

a pituitary adenoma

– it will NOT suppress exogenous ACTH from a small cell lung cancer for example

188
Q

a person with diabetes is most likley to die from _________

A

a Myocardial Infarction

189
Q

Glucocorticoids will cause an increase in protein production in which organ/tissue?

A
  • the LIVER
  • steroids cause an increase in gluconeogenesis and glycogenolysis
  • they contribute to hyperglycemia
190
Q

mechanism of action of Sulonylureas (ie: Glyburide, Glipizide…)

A

trigger more Insulin release via Ca++ influx

191
Q

what hormones are decreased in a woman with anorexia nervosa causing amenorrhea?

A
  • low LH, FSH, Estradiol and Estrone
  • “hypogonadotropic amenorrhea”
192
Q

excessive Growth Hormone increases linear bone growth by stimulating ____________

A

IGF-1 from the LIVER

(Gigantism – if before growth plates fuse, Acromegay – if after)

193
Q

Which symptom of thyrotoxicosis (ie: Graves dz) will not be helped with a beta blocker?

A
  • Exophthalmos
  • b/c this is due to incrs soft tissue mass within the orbit behind the eye
194
Q

pt with a “cold” thyroid nodule, Calcitonin producing tumor with splindle shaped cells

A

Medullary Thyroid Cancer

  • assoc with MEN 2 syndromes
  • RET proto oncogene
195
Q

drugs used to treat the proptosis and prevent exophthalmos of Grave’s dz

A
  • Prednisone
  • you have to prevent the inflammation and edema behind the eye
196
Q

why do antipsychotics cause Hyperprolactinemia?

A

they inhibit Dopamine (which normally inhibits Prolactin)

197
Q

how can ADH (desmopressin) be used to treat the bleeding of von Willebrand’s disease?

A

ADH increases vWF release from endothelial cells

198
Q

a man with a testicular tumor starts to develop hyperthyroidism … which hormone could be causing the thyroid symptoms?

A

hCG from the testicular mass

  • hCG is structurally similar to TSH (and also LH in women) and could cause the hyperthyroidism
199
Q

name the diabetes drugs that inhibit intestinal brush border enzyme (alpha glucosidase) to decrs glucose absorption

A
  • Acarbose
  • Miglitol
200
Q

treatment for SIADH

  • has toxicities of Nephrogenic DI, photosensitiivy, bone & teeth abnormalities
A

Demeclocycline

  • an ADH antagonist
  • from the tetrocycline family (hence the SE’s)
201
Q

hormone responsible for fetal lung maturity and surfactant production , only secreted late in gestation

A

Cortisol

  • only secreted late in gestation
  • premature –> low surfactant –> IRDS
202
Q

2 places in the body with their own portal circulation

A
  • Pituitary
  • Liver
203
Q

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
A

INSULIN

204
Q

Insulin is secreted in exchange for ______________ into the cell

A

Ca++

205
Q

GLUT receptor for the brain and RBC’s

A

GLUT 1

206
Q

Why do women who are breastfeeding stop ovulating?

A

Prolactin inhibits GnRH

207
Q

which is the more active form of Thyroid hormone?

A

T3

-but T4 is made more and just converted as needed by 5-deiodinase

208
Q

hormones that use the cAMP second messenger system

A

“FLAT CHAMP”

  • FSH
  • LH
  • ACTH
  • TSH
  • CRH
  • hCG
  • ADH
  • MSH
  • PTH
  • also Caclitonin, GnRH and Glucagon
209
Q

how do you tell a Follicular thyroid Adenoma (benign) from a Follicular Carcinoma (malig)?

A

the Follicular Carcinoma INVADES THE CAPSULE

210
Q
  • 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.
A

DIC

211
Q

cytokine that stimulates NK cells to destroy target cells and makes T helper cells secrete IFN-gamma

A

IL-12

212
Q

impairement of the ____________ process can lead to neurodegenerative disorders like Parkinson’s & Alzheimer’s

A

Ubiquitin- proteosome system

-failure of this system to degrade abnormal proteins leads to accumulation of misfolded proteins

213
Q

test you use to determine if the means of 2 populations are equal

A

2 Sample T Test

214
Q

MOST COMMON primary brain tumor in adults

A

Glioblastoma Multiforme

  • in frontal or temporal lobe or basal ganglia
  • can cross hemispheres (but not always)
  • foci of necrosis and hemorrhage
215
Q

RNA Pol 1 — functions?

RNA Pol 2—

RNA Pol 3—

A

RNA Pol 1 – makes rRNA in the nucleolus

RNA Pol 2– make mRNA

RNA Pol 3– DNA to tRNA some rRNA and snRNPS

216
Q

When doing a Cricothyrotomy, what structures do you pass through to get to the airway?

A

1- Skin

2- Superficial cervical fascia (including fat & Platysma m)

3- Investing & Pretracheal layers of the deep cervical fascia

4- Cricothyroid membrane

217
Q

Molecule with the amino acid sequence of (Gly -x-y)333 ((Glycine every 3rd amino acid)

A

COLLAGEN

  • folds into a triple helix
  • glycine is the smallest aa, so needed to fold into a triple helix!
218
Q

Medical treatment for aldosterone secreting adenoma (Conns syndrome)

A

Spironolactone, Eplerenone

219
Q

a segmenting vasculitis that can extend into the veins and nerves (eventually encasing all 3 infibrous tissue)

A

Buerger’s disease (aka “thromboangiitis obliterans”)

  • male heavy smokers < age 35
  • pt w/ “hypersensitivity to injection of tobacco extract”
220
Q

child with BP of 160/98, hypokalemia, lack of secondary sexual characteristics

A

17-a-hydroxylase deficiency

221
Q

some non-polar, hydrophobic amino acids that span lipid membranes in transmembrane proteins:

A

Valine, Alanine, Isoleucine, Metionine, Phenyalanine

222
Q

Which ligement contains the ovarian artery and vein and must be carefully ligated when removing an overy to prevent hemorrhage?

A

the Suspensory Ligament

223
Q

Which ligament contains the uterine artery and must be carefully ligated before a radical hysterectomy?

A

Cardinal ligament (aka ‘transverse cervial lig”)

224
Q

Most common cause of Meconium Ileus in a child?

(child most likely also has what dz?)

A

CYSTIC FIBROSIS

  • meconium Ileus is a distal, small bowel obstruction in a neonate due to abnormally dehydrated meconium
  • it is quite specific for CF
225
Q

Some children who have gotten the Hib vaccine can still get infections with H.flu….. how?

A
  • 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
226
Q
  • connects the lateral femoral condyle to the anterio-medial tibial head
  • prevents anterior motion of the tibia w/ respect to the femur
A

ACL

227
Q

Which type of Heparin binds to antithrombin and thrombin to allow antithrombin to inactivate thrombin

A

Unfractionated Heparin

228
Q

girl with heavy periods and history of frequent nosebleeds as a child– what is the most likley bleeding disorder?

A

von Willebrand factor deficiency

  • easy bleeding from mucosal sites (gingiva, nasal mucosa, GI tract, and heavy periods)
  • autosomal dominant
229
Q

function of vWF in the blood

-what does it bind to?

A
  • carrier of factor VIII (protects it from degredation)
  • binds to exposed collagen and platelet glycoproteins and promotes more platelet binding
230
Q

child with eczema, recurrent infections (combined B & T cell deficiency) and thrombocytopenia

A

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)
231
Q
  • 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.
A

Glanzmann’s thrombasthenia

232
Q

drug that blocks gpIIbIIIa on platelets to prevent platelet plug formation

A

Abciximab

233
Q
  • child w/ abdominal pain, joint pain, proteinuria, blood in stool
  • the most common kind of systemic vasculitis in kids
A

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
234
Q

lacunar stroke affecting the subthalamic nucleus will cause

A

contra Hemiballismus

235
Q

severe hypoplasia of erythroid precursors in the marrow, but normal granulopoesis and thrombopoesis

A

Pure Red Cell Aplasia (PRCA)

  • form of marrow failure assoc. with Thymic tumors and leukemias
  • can also result from Parvovirus infection (pref attacks proerythroblasts)
236
Q

in a male, non-fusion of the urethral folds would cause:

A

Hypospadias

237
Q

type of renal cell cast most specific for pyelonephritis

A

WBC casts

-esp in conjunction with burning, urgency, fever

238
Q

Radiation therapy for cancer treatment – how does it kill/ affect the cancer cells?

A
  • Double stranded DNA breaks or
  • Formation of free radicals
239
Q

dry, nagging cough, low grade fever, malaise, _CXR that looks much worse than the pt feels _

A

“Walking Pneumonia”

  • caused by Mycoplasma pneumonia
  • requires cholesterol agar to grow in lab
240
Q

baby born with Hydrocephalus, intracranial calcifications and chorioretinitis (inflammation that leaves “cotton like” white/yellow lesions on the chorio/retinas)

A

–classic presentation of a baby with **Congenital Toxoplasmosis **

  • fetus gets the dz only if mom is infected in 1st 6 months of pregnancy
241
Q

cyclophosphamide (& other mustard chemo agents) get metabolized to Acrolein (toxic to urothelium) & cause hemorrhagic cystitis — what agent can prevent this?

A

MESNA (aka 2-mercaptoethanesulfonate)

242
Q

baby with fever, pharyngitis, diffuse rash that blanches w/ pressure, strawberry tongue

A

Scarlett fever (group A strep)

243
Q

transplant patient with onset of rash, jaundice, hepatosplenomegaly, diarrhea 1 week after surgery —what kind of rxn?

A

Graft vs Host disease

  • Graft T cells attack the “foreign” host cells (that’s why so many organ systems are affected)
244
Q

anaphylactic rxn to blood transfusion

A

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
245
Q

Pt with recurrent pyogenic infections, his neutrophils fail to turn blue upon nitroblue tetrazolium exposure—- he is deficient in what enzyme?

A
  • NADPH Oxidase
  • the pt has Chronic Granulomatous dz (manifest by recurring infections w/ catalase producing organisms like Staph aureus)
246
Q

lack of complement C5b -C9 results in recurring ___________ infections

A

NEISSERIA

247
Q

woman with Lupus and antiphospholipid antibodies is predisposed to ____________

A
  • Recurrent Miscarriages
  • they will have the ‘lupus anticoagulant’– which actually causes clotting
  • they will have _a false + VDRL test and a prolonged PTT _
248
Q

In type A & B mothers, Erythroblastosis fetalis does not occur b/c the antibodies are _____

A

IgM

-With type O mothers, the antibodies in the serum are usually IgG so they can cross the placenta and cause EF

249
Q

T cells undergo positive selection in the thymic ______ & negative selection in the thymic ______

A

positive selection –> cortex

negative selection –> medulla

250
Q

Isotype switching of B cells in the lymph node happens in the _________

A

germinal center

  • it is the heavy chain Fc region that determines the isotype
251
Q

Muscle biopsy in a pt w/ polymyostitis would show _________

A

CD8+ T cells, and overexpression of MHC I

252
Q

Erythroblastosis Fetalis (maternal IgG crossing the placenta and lysing baby’s A or B blood) is an example of a Type ______ hypersensitivity

A

TYPE 2 (antibody mediated)

253
Q

Drugs that increase IL-2 (Aldesleukin) can be used to reduce tumor burdens in renal cell cancer b/c _______

A

IL-2 activates more NK cells and monocytes to kill the tumor cells

254
Q
A

STEP 1 RECALL (12 decks)

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