Kaplan Flashcards
complications of thyroidectomy
Hypocalcemia (due to PTH gland damage) resulting in cramps, paresthesias, tetany (trousseau’s sign and chvostek’s sign)
Hoarseness (recurrent laryngeal nerve damage)
Primary cell type responsible for wound contracture
myofibroblasts bc they express actin and myosin
fibroblasts only extracellular matrix, collagen, proteoglycan, and elastin
Signs and sx’s of scarlet fever. Associated bug and toxin
pharyngitis followed by blanching “sandpaper” rash (palms and soles spared), circumoral pallor, “strawberry tongue” and N/V
Strep pyogenes
fever and rash due to pyogenic exotoxins A-C which are phage-encoded
Which bugs have alpha toxins and how do they differ?
Staph aureus alpha toxin is pore forming - toxic shock syndrome with desquamating (skin peeling) rash
C. perfringens is lecithinase. bug causes gas gangrene
What is bacterial endotoxin?
LPS found in the outer leaflet of the outer membrane of G- bugs. Activates macs to overproduce IL-1, IL-6, and TNFa producing G- shock.
Hyaluronic acid capsule and M protein are both produced by which bug? function of each?
Strep pyogenes
Hyaluronic acid capsule non-immunogenic, makes it difficult for immune system to recognize pathogen
M protein is anti-phagocytic surface protein
Ulnar nerve damage at the level of the elbow results in what symptoms
weakened wrist flexion, loss of abduction and adduction of the digits, loss of the hypothenar muscles, and weakened flexion of the interphalangeal joints of the 4th and 5th digits. Clawing of medial 2 digits (may be worse with injury at the wrist). There may also be sensory loss on digit 5 and the medial half of digit 4.
Median nerve injury results in what symptoms
loss of function of lateral two lumbricals, flattening of the thenar eminence, and sensory loss on the palmar surface of digits 1, 2, 3, and the lateral half of 4.
Musculocutaneous nerve injury would result in what symptoms?
rarely happens but will result in loss of sensation to lateral forearm and decreased flexion at the elbow.
loss of wrist extension is due to what nerve injury? what are the common locations associated with this nerve injury?
Radial nerve injury, commonly mid-humoral fractures. additional sx’s include decreased extension of digits, weakened supination, and sensory loss to posterior forearm and hand.
The following describes what disease?
Autosomal dominant
Facial lesions (adenoma sebaceum)
Hypopigmented “ash-leaf” spots on the skin
Multiple hamartomas, including cortical tubers
Renal angiomyolipomas
Cardiac rhabdomyomas
Astrocytomas
Subependymal giant cell astrocytoma
Tuberous sclerosis
mutations in TSC1 or TSC2
Lisch nodules-what are they and what are they associated with
small, pigmented, nodular lesions (hamartomatous) associated with NF1
(also associated with NF1 are cafe-au-lait spots, axillary freckling, neurofibromas, scoliosis, pheochromocytoma, and optic gliomas)
Bilateral schwannomas of the 8th cranial nerve are associated with what disease?
NF2
What are the serologic markers for SLE.
anti-nuclear antibody (sensitive, not specific)
anti-dsDNA (specific, not sensitive)
anti-Smith (specific, not sensitive)
anti-histone (for drug induced lupus)
Why is lactulose given to patients with hepatic encephalopathy?
reduces ammonia absorption in the gut by acidifying colonic contents to convert NH3 to NH4 which will be trapped and excreted in feces.
Immunocomprimised patient from Eastern Great Lakes, Ohio, Mississippi, or Missouri, presenting with flu like symptoms and a rash should cause concern for what organism? what are characteristics of this organism?
Histoplasma capsulatum
intracellular yeast therefore non-communicable from person to person
acquired though inhalation of conidia or spores in soil or dust
What dangerous side effects are possible with Succinylcholine?
Hyperkalemia (tall T waves on EKG)
malignant hyprethermia
prolonged paralysis
respiratory depression
cardiac arrhythmias
rhabdomyolysis
myoglobinemia
Sickle cell nephropathy most commonly causes occlusion of what vessel producing what kind of symptoms?
Occlusion of vasa recta due to very high osmolarity and hypoxic environment (sickle cells predisposed to sickling in this environment)
ischemia results in patchy papillary necrosis, hematuria, proteinuria and sometimes cortical scarring.
A pt with history of emphysema and chronic bronchitis should be treated with what kind of antihypertensive?
Beta-1 receptor antagonist (selective)
A BEAM acebutolol betaxolol esmolol atenolol metoprolol
at low doses this will not exacerbate bronchoconstriction
Which antimicrobials should be avoided during pregnancy?
Sulfonamides-kernicterus
Aminoglycosides-ototoxicity
Flouroquinolones-cartilage damage
Clarithromycin-Embrotoxic
Tetracyclines-discolored teeth inhibition of bone growth
Ribavirin-teratogenic
Groseofulvin-teratogenic
Chloramphenicol-Gray Baby syndrome
“SAFe Children Take Really Good Care”
Name the layers of the anterior abdominal wall from outside to inside
Skin-Campers fascia-Scarpa fascia-external oblique-internal oblique-transversus abdominis muscle-transversalis fascia-parietal peritoneum
describe schizophreniform disorder
symptoms similar to schizophrenia lasting more than 1 month but less than 6 months
Describe schizoaffective disorder
symptoms of schizophrenia with mood changes like depression or mania
describe schizoid personality disorder
withdrawl from social relationships and flat affect
describe schizotypal personality disorder
eccentric behavior, odd beliefs like magic, difficulties with relationships
describe the clinical symptoms of myasthenia gravis
ptosis, diplopia, weakness, WORSENS with muscle use, improvement after edrophonium test
Describe Wiskott-Aldrich syndrome and characteristic lab findings
TRIAD: thrombocytopenia, eczema, and immunodeficiency (recurrent sinopulmonary infections)
IgM and IgG levels are depressed; IgE and IgA levels are normal to elevated
Name disease:
PAS positive inclusion bodies in neurons
UMN/LMN deficits but no sensory or bowel/bladder deficits
treatment for this disease?
Lou Gehrig aka Amyotrophic lateral sclerosis
treat with Riluzole (unclear mechanism that decreases gluatamate excitoxicity)
African/endemic burkitt lymphoma can present as masses in what areas of the body?
jaw, ovarian, breast, and GI tract
“get a JOB G”
What is the underlying cause of epithelial foot effacement in Minimal change disease? What are other conditions associated with MCD?
abnormal secretion of lymphokines by T cells, reduces the production of anions in the GBM, thereby increasing the glomerular permeability to albumin and other proteins
Hodgkin disease and T-cell lymphoma, are sometimes associated with minimal change disease.
Describe Delusional disorder
one or more non-bizarre delusions in the absence of other significant psychopathology (delusions are believable)
The patient is usually quite functional, without odd or bizarre behavior
Describe how to calculate APGAR? When are scores taken and what do they indicate?
Appearance, Pulse, Grimace, Activity, and Respiration.
The 1-minute score determines how well the newborn tolerated the birthing process and the 5-minute score determines how well the newborn is doing outside the mother’s womb
0-2 in each category max score 10: HR >100bpm, Respirations crying, color pink, tone active motion, and reflex irritability cry or active withdrawal.
What is familial gestational hyperthyroidism?
caused by increased responsiveness of thyroid-stimulating hormone (TSH) receptors to human chorionic gonadotropin (hCG) and/or luteinizing hormone (LH).
hCG rises early in pregnancy and then declines (which would cause elevated thyroid hormones in the serum the first 10 weeks).
Progesterone, estrogen, and human chorionic somatomammotropin increase throughout pregnancy and do not have the same effect on TSH receptors.
Causes of metabolic acidosis?
MUD PILES
M-Methanol
U-Uremia (chronic kidney failure)
D-Diabetic ketoacidosis
P-Propylene glycol ("P" used to stand for Paraldehyde but this substance is not commonly used today)
I-Infection, Iron, Isoniazid, Inborn errors of metabolism
L-Lactic acidosis
E-Ethylene glycol (Note: Ethanol is sometimes included in this mnemonic as well, although the acidosis caused by ethanol is actually primarily due to the increased production of lactic acid found in such intoxication.)
S-Salicylates
**Recognize acute respiratory acidosis by a decrease in pH, an elevation in the PCO2, and a NEAR-NORMAL bicarbonate on arterial blood gas.
Which lysosomal storage disease presents with hepatosplenomegaly and cherry-red spot(s) on the macula
Neimman-Pick (sphingomyelinase deficiency)
sphingomyelin in histiocytes (macrophages) referred to as “sea blue” histiocytes
EM-> “zebra bodies”
higher in ashkenazi jews
Which condition should be suspected in infants with growth failure, cataracts, liver disease, aminoaciduria, and mental retardation?
what other condition causes cataracts in early life?
Classical galactosemia, autosomal recessive disease caused by a deficiency of galactose-1-phosphate uridyltransferase, which is necessary for the formation of glucose from dietary galactose, derived from milk lactose.
Treatment involves strict dietary lactose restriction,
Galactokinase deficiency can also cause catarcts in early life
What are the major microscopic findings in Alzheimer’s disease?
Neurofibrillary tangles:
Intraneuronal aggregates of insoluble cytoskeletal elements
Composed mainly of abnormally phosphorylated tau protein, forming paired helical filaments
During the first few minutes of exercise what happens to tissue levels of creatine phosphate, myoglobin oxygen, and ATP?
ALL will decrease to feed muscles as oxygen demands increase about 10 fold during exercise. Depletion of stores results in plataued increased level of oxygen consumption
What is the name and characteristics of the “rare protein losing gastropathy”?
Ménétrier disease, commonly seen in elderly patients, is a hyperplastic gastropathy characterized by enlarged rugal folds
marked hyperplasia of mucus-secreting cells (foveolar cells), leading to hypersecretion of mucus in such large quantities as to cause decreased protein absorption and losses through the gastrointestinal tract.
What are the four exceptions to informed consent rule:
Emergency
Waiver by the patient
Patient is incompetent
Therapeutic privilege (used if the patient is unconscious, confused, or the physician deprives patient of autonomy in interest of health).
ectopic pregnancy is a life threatening condition
Toxoplasmosis from toxoplasma gondii results in symptoms in what kinds of patients?
immunocompromised patients, the infection arises as a REACTIVATION of a latent infection, generally in the form of central nervous system infection (ring-enhancing lesions).
Primary infection during pregnancy may cause severe congenital infections (early infection) or long-term complications such as blindness (later infection).
Acid fast oocytes 4-6 microns in diameter in stool is what bug?
Cryptosporidium
Hypothalamic somatostatin acts on the anterior pituitary to inhibit the release of which hormones?
growth hormone (GH) and thyroid-stimulating hormone (TSH)
The most common cause of neonatal meningitis is? what are it’s distinguishing factors?
Group B streptococci or Streptococcus agalactiae (second is E.coli, third Listeria)
S. agalactiae are beta-hemolytic on blood agar positive with the CAMP test
Describe areas of drainage associated with thoracic and right lymphatic ducts.
thoracic duct drains lymph from left side of the head, neck and chest, the left upper limb and the entire body below the diaphragm.
The right lymphatic duct drains the right upper limb, the right side of the chest, and the right side of the head and neck
What are symptoms of Ataxia telangiectasia? What gene is it associated with? Gene function/consequence of mutation?
characterized by telangiectasias of the skin and eyes, variable immunodeficiency, and progressive ataxia
ATM codes for a DNA-dependent protein kinase responsible for recognizing and correcting DNA double strand breaks.
Mutation of ATM causes increased sensitivity to ionizing radiation and defective DNA repair
lymphoreticular malignancies (Hodgkin and non-Hodgkin lymphomas and leukemias) is increased
Which antidepressant is associated with ischemic priapism?
Trazodone
lesion of the oculomotor nerve can result in ?
Inability to adduct the eye (leading to horizontal diplopia)
Mydriasis (dilation)
Ptosis
Inability to constrict the eye
Loss of accommodation
What is Reiter syndrome?
a reactive arthritis, is triggered following urogenital or enteric infections
conjunctivitis, urethritis, and arthritis.
“can’t see, can’t pee, can’t climb a tree”
HLA-B27 is associated with this disease.
Aspirated joint fluid resembles that of rheumatoid arthritis (inflammatory arthritis with predominance of neutrophils)
CREST syndrome is associated with what autoantibodies?
Anticentromere
Chagas disease is associated with what symptoms? how do you contract the disease?
myocarditis or esophageal involvement, producing achalasia mega colon
spread by the reduviid bugs (“kissing bugs”)
What is the formula for volume of distribution when clearance and half life are known?
t1/2 = (0.7 x Vd)/CL
Will PE show up on a chest Xray?
No. but useful to rule out other disease
What is the most common site of intestinal involvement with Crohn’s disease?
Gross characteristics?
terminal ileum
harp demarcation of affected segments of bowel, which may show edema, stricture and fibrosis–risk obstuction
JVD indicates increased pressure in which part of the circulatory system?
central venous pressure is increased
ELEK test can be used for diagnosing what infection?
Diptheria vs non toxin producing normal flora diptheroid.
Can also use ELISA testing
Characteristics of Antisocial Personality Disorder?
Inability to conform to social norms (delinquency, theft, etc.)
Cannot hold a stable job
Prone to violence and crime
ecthyma gangrenosum, the hallmark lesion of?
Pseudomonas aeruginosa infection. Common nosocomial infection in cystic fibrosis, neutropenia, chronic granulomatous disease, or severe burns
Gram-negative, oxidase-positive bacillus
Endotoxin results in gram-negative shock in septicemia.
Exotoxin A inactivates elongation factor-2, inhibiting protein synthesis (like diphtheria toxin).
Describe location of cervical nerves in relation to vertebral bodies?
C1-C7 exit above C8 exits below C7
bilateral parotitis, orchitis, and pancreatitis is characteristic of what?
Mumps
Paramyxovirus: negative-sense, single-stranded RNA, helical, enveloped virus
which hypersensitivity is implicated in parasitic infections?
type I
eosinophilia and IgE mediated
Which drug should be used as first line in a type 2 Diabetic? When should this drug not be used? Which is the next drug in line to add to the first line drug when the diabetes is still out of control?
Usually 1st-Metformin should not be used in patients with renal insufficiency, heart failure, conditions predisposing to hypoxemia, or lactic acidosis.
Glimepiride is a second-generation sulfonylurea that undergoes hepatic clearance and is safer to use in patients with renal dysfunction than metformin.
Sulfonylureas are indicated in patients with type 2 diabetes when their diabetes cannot be controlled with metformin, diet and exercise alone.
What is a paradoxical embolism?
Emboli from venous circulation that bypasses the lungs and goes into systemic circulation. May cause ischemic stroke in the brain.
This can happen with persistent foramen ovale
What is a distinguishing CSF finding in viral meningitis?
normal glucose (45-80)
How can you distinguish bacterial CSF findings from mycobaterial/fungal?
In bacterial meningitis the distinguishing factor is the markedly elevated leukocytes (up to 90,000 neutrophils.
In mycobacterial/yeast meningitis you will see 100-1000 lymphocytes.
normal is <5
What is elevated in all forms of meningitis?
proteins (>50) and pressure (viral less than bacterial/mycobaterial/yeast)
eosinophilic granulomatosis with polyangiitis is also known as what? what are characteristics of this disease?
Churg-Strauss syndrome
necrotizing vasculitis affecting multiple organ systems.
history of asthma or allergic rhinitis, labs show eosinophilia and elevated p-ANCA
What is the inheritance pattern of familial hypercholesterolemia?
AD–> xanthomas
What is the drug of choice for pre-operative thyroidectomy?
Potassium iodide -hyperthyroidism in preoperative thyroidectomy patients. decreases vascularity for better surgery outcomes
X-linked recessive disorder that results from near-complete deficiency of the purine salvage enzyme hypoxanthine-guanine phosphoribosyl transferase (HPRT)
what would be increased in the serum of this pt?
Lesch Nyhan
intellectual disability, spastic cerebral palsy with compulsive biting of hands and lips, hyperuricemia (leading to gouty arthritis, urate crystal formation, tophi, and urate nephropathy), and death, often in the first decade
monosodium urate
