Kaplan Flashcards
Low fasting blood glucose with ___ C-peptide means what?
a) increased
b) decreased
a) increased C-peptide due to insulinoma or sulfonylurea abuse
b) decreased C-peptide due to exogenous insulin
A female has increased serum LH, increased testosterone, decreased FSH, cystic follicles.
What?
Treatment
PCOS, resulting in hirsutism, amenorrhea, and obesity.
Treatment - spironolactone to block MC-R (diuretic) and anti-androgen (tx hirsutism).
A 42 year old female with hyperthyroid symptoms, increased T4 and decreased radioactive iodine uptake.
Suspect?
factitious thyrotoxicosis
Clumped Leydig cells producing insufficient testosterone, leading to decreased plasma T, increased plasma LH, and increased plasma estrogen. decreased inhibin –> increased FSH.
Klinefelter
What antimicrobial drug potentiates effects of warfarin? Why?
Ketoconazole, clarithromycin, ciprofloxacin, protease inhibitors are potent inhibitors of P450 enzymes.
carbamazepine, phenytoin, phenobarbital, rifampin - all have what in common?
They are potent hepatic enzyme inducers
Three main defenses against hypoglycemia.
Decreased insulin (this is lost in DM1). Increased glucagon (this is lost in DM1). Increased epinephrine secretion (remains in DM1).
Downey type 2 cells are indicative of?
They are CD8 cytotoxic T cells, atypical lymphcotosis in the peripheral blood: indicative of Infectious mono caused by EBV.
Stellate granuloma, caused by gram negative bacillus, think?
Bartonella Henslae - Cat-scratch disease
Fungus, Camping in AZ v. Camping in Ohio-MS River Valleys.
Coccidiomycosis (AZ) Histoplasma capsulatum (OH-MS)
Rose garden fungus
Sporothrix schenckii
MCV values for…
Macrocytic anemia
Microcytic
Normocytic
Macrocytic 100
Normocytic: 80-100
Microcytic is less than 80
MCV >100. Neuro sx = what etiology?
No neuro sx = what etiology?
Macrocytic anemia caused by:
Neuro=B12 deficiency (methylmalonic acid)
No neuro=folate deficityy
Parvo B19, EBV, HIV, Hepatitis - all can cause what?
aplastic anemia
The acute phase reactant that plays a key role in iron regulation, and is the key mediator of Anemia of Chronic Disease.
Hepcidin, which internalizes iron and decreases iron release from macrophages and enterocytes.
IL-6 does what to hepcidin? How?
Increases hepcidin expression, leading to decreased absorption of iron from intestines and blockage of iron release from macrophages.
Decreased MCV, low TIBC, high Ferritin, low serum iron.
Anemia of Chronic Disease
Decreased MCV, low TIBC, high Ferritin, high serum iron.
Sideroblastic Anemias in which iron is available to developing erythrocytes, but not ised effectvely (X-linked ALAS-2 mutation)
High MCV with normal iron and normal MCV
nutritional megaliblastic anemias, secondary to folate for Vitamin B12 deficiency
Binucleate cells
Reed sterberg - ACD due to Hodgkin
Auer Rods - cancer and causes what if released by chemo?
Acute myelogenous Leukemia
causes DIC
transvaginal pudendal nerve block uses ___ as bony landmark?
ischial spine and sacrospinou sligament
21-hydroxylase deficiency
CAH (b/u of progesterone –> 17-hydroxyprogesterone
MPO stain
evaluates neuts, deficiency in MPO similar to chornic granulomatous disease. And used for AML.
Nitroblue tetrazolium
evaluate chornic granulomatous disease.
PAS stain
polysaccharides or glycoproteins or fungus
B cell, old men, SM, pancytopenia. stain?
hairy cell leukemia. TRAP with dry tap due to fibrosis.
primitive cell marker
CD34, TdT, CD10
mature cell marker
CD40, IgG, B7, cytoplasmic mu chains
Primary defense against chlamydia/obligate intracellular pathogens
cell mediated cytotoxicity (Th1 dominant response)
Primary defense against strep/staph/extracellular bacteria
complement mediated lysis
Prevention of autoimmune diseases/returning an immune response to homeostasis
T-reg cells.
associate a thyroidectomy with consequential hypocalcemia with…
hypoparathyroidism: reduced intestinal cell calcium transporter activity - PT-glands accidentally removed
PTH action
kidney: it activates 1-hydroxylase, converting 25-hydroxyvitamin D3 to its active metabolite (1,25-dhydroxyvitamin D3) –> decreasing serum Ca
five main tumors with paraneoplastic syndromes that are associated with overproduction of EPO
hepatocellular carcinoma, RCCa, hemangioblastoma, pheochromocytoma, uterine myomata
increased carboxyhemoglobin indicates what?
CO toxicity (occupational)
erythropoiesis, increased viscosity, low levels of EPO
polycythemia vera
Alpha thalassemia trait v. HBH v. HbBarts
trait=2/4 allele deletion
HBH=3/4 allele deletion
Hb Barts=4/4 allele deletion
male with alpha thalassemia trait has child with normal partner - probability he will have a child with trait
1/2 (probabliity he will transmit the 2 mutaitons together)
At clinically relevant doses of warfarin, what factor is significantly affected? Result on labs?
Overdose?
Factor 7, prolonged PT/INR (extrinsic). NORMAL PTT.
Overdose - both PT and PTT elevated.
What deficiency results in feminized external genitalia in a 46XY.
5alpha-reductase
Infancy (Salt wasting) or childhood (percocious puberty) - what deficiency?
17alpha-hydroxylase
Competitive inhibitor of 5alpha-reductase.
Finasteride, used to treat androgenic alopecia and BPH. CI in pregnancy
What is the primary receptor for growth factors (of the 5 major types).
intrinsic tyrosine kinases.
Ras–> MAPK activation—> cell growth
Most common cause of secondary hyperparathyroidism.
Chronic renal failure.
decreased phosphate excretion, = increased plasma phosphate, inhibiting Vit D production, decreasing intestinal Ca absorption, further lowering plasma Ca and stimulating PTH
Dermatitis, tenosynovitis, polyarthritis triad. Sexually active, pili with antigenic phase variation that occur in pili (increased recurrent infectiton susceptibilty).
Gonococcal dermatitis-arthritis syndrome
Polyarteritis in sexually active patients, think?
Neisseria gonorrhea.
Triad of low grade fever, pain, impaired ROM.
Septic arthritis.
Equation for active tension.
Active tension = total tension = passive tension
Genetics:
Duchenne v. Becker MD
X-linked
Duchenne - frameshift
Becker - missense/point mutation
Winged scapula - nerve, muscle, action deficit
long thoracic (serratus anterior muscle, shoulder abduction/flexion)
Pathogen that causes: Rash, bell’s palsy, chronic arthritis, heart palpitations.
borrelia burgdorferi (lyme disease)
Axillary and radial nerves:
from what cord?
What muscle does axillary nerve supply?
Posterior cord.
Axillary nerve supplied deltoid and teres minor
Tongue:
- Sensory: posterior 1/3 vs. anterior 2/3
- Taste: posterior 1/3 vs. anterior 2/3
- Motor and actions of genioglossus, hyoglossus, palatoglossus muscle
Anterior 2/3 sensory trigeminal (CN5) and taste facial (CN7)
Posterior 1/2 - both sensory/taste are CN9 (glossopharyngeal)
-Motor and actions of genioglossus (protrusion to opposite; CN12), hyoglossus (retraction (CN12), palatoglossus muscle (up towards palate (CN10)
What nerve carries general sensation from anterior 2/3 of tongue. What else is this nerve responsible for
V3 (trigeminal 3). Also responsible for motor innervation of muscles of mastication - temporalis, masseter, medial and lateral pterygoids.
Chorea, athetosis (slow writhing movements), demenita, personality change. 20-40 year old.
What is this, what is the anatomical finding upon autopsy, what genetics?
Huntington Disease. AD CAG repeat expansion on chromosome 4). Find caudate nucleus atrophy.
What structure is responsible for fine tuning movement?
Lesion of what part of this structure manifests as wide-based “drunken” gait?
Lesions of ___ hemispheres of ___ will affect movement of what body parts?
Cerebellum
vermis
lesions of LATERAL hemispheres of CEREBELLUM will affect movement of EXTREMITIES.
What innervates the posterior half of the External Auditory Canal?
Auricular branch of Vagus Nerve (nerve that causes vasovagal syncope, cough, gag)
Hip action nerve: actions
- superior gluteal
- obturator
abduction
adduction
All four limbs affected paralyzed, bilateral Babinski, only vertical eye movements.
Basilar Artery - locked in syndrome.
Supplies ventral/medial pons.
Internal capsule blood supply from ___ artery. Ischemia commonly due to uncontrolled HTN causes ___ deficit.
Middle Cerebral Artery.
Contralateral hemiplegia (CST).
A lacunar stroke (lenticulostriate arteries) can result in a pure motor deficit due to involvement of the ____ internal capsule. Symptoms of this include ___.
Posterior IC.
Symptoms - UMN deficit signs on contralateral side of body. Contralateral lower face, sparing forehead.
Medial longitudinal fasciculus connects the ___ nerve to the contralateral oculomotor nucleus, allowing conjugate gaze.
Disease and state when MLF is demyelinated producing inability to adduct affected eye in lateral conjugate gaze.
abducens
Multiple sclerosis, often has intranuclear opthalmoplegia.
Salivary glands innervated by glossopharyngeal v. facial nerves.
Glossopharyngeal nerve innervates Parotid Gland (via Otic Ganglion)
Facial nerve innervates Submandibular and Sublingual Glands
Cortex that processes visual information
occipital cortex
Lesion of ___ nerve leads to loss of sensation of laryngeal mucosa above the vocal folds and loss of cough refelx?
Internal Branch of superior laryngeal nerve
Right lower quadrantanopia caused by lesion of left ___ lobe.
Right upper quadrantanopia caused by lesion of left ___ lobe.
parietal lobe
temporal lobe
Left sided sensory neglect is caused by damage to what two areas?
Right frontal or parietal lobe.
Rare genetic disease characterized by accumulation of abnormal chemical material in lysosomes as a result of abnormal phosphotransferase in _____ (cell organelle).
Golgi apparatus
I-Cell Disease
Golgi cannot phosphorylate mannose residues on N-glycosylated enzymes destined to enter lysosomes.
Antagonists of ___ receptor effective in tx BPH.
Alpha 1 antagonists.
Terazosin and doxazosin.
Alpha-1R found on bladder neck and stroma of prostate and in vasculature (inc. BP).
hypersensitivity reaction to parasites.
type 1 - eosinophilic response
Infant with hepatomegaly, cardiomegaly (often the CoD), and muscle weakness.
Disease and enzyme deficiency responsible.
Pompe
lysosomal alpha-1,2-glucosidase
