Kaplan1 Flashcards
Primary infection with Mycobacterium tuberculosis presents as what?
Primary infection with Mycobacterium tuberculosis is most frequently located in the lung parenchyma and hilar lymph nodes, often generating a granulomatous reaction called the Ghon complex.
Chronic severe hypertension can produce the following changes in the vasculature: (4)
- Decreased number of arterioles
- Thick-walled arterioles with increased arteriolar wall-to-lumen ratio
- Increased vascular resistance of end organs
- Ischemic and/or hemorrhagic end organ damage
Cytotoxic T cells require _________ molecules on the surface of tumor cells to eliminate them.
MHC class I
What are the causes of early feeding difficulties in a neonate that presents in the first few days of life?
- Annular Pancreas
- Trancheoesophageal Fistula
- Duodenal atresia
Neonate presents with early feeding difficulties and CT shows a mass lesions surrounding the duodenum.. What is the most likely issue?
Annular Pancreas
What is an Annular Pancreas and what causes it.
The pancreas is formed from fusion of the dorsal and ventral buds, which develop from the embryologic foregut in the region that will form the duodenum.
At approximately the eighth intrauterine week of life, the ventral pancreas rotates around the duodenum to reach the dorsal bud and then fuse with it.
Normally, the ventral pancreas rotates around the right side of the duodenum. In annular pancreas, the ventral pancreas divides into two parts and one part rotates around the right side of the duodenum and the other part rotates around the left side of the duodenum.
This results in a encircling of the duodenum and may cause an obstruction. If the annular pancreas encircles the duodenum but does not constrict it, it is asymptomatic.
The figure below shows normal development of the pancreas and duodenum.
Acute intermittent porphyria (AIP) can manifest clinically as ?
acute attacks with abdominal symptoms such as pain and constipation, peripheral neuropathy, and psychiatric manifestations.
Attacks can be precipitated by drugs such as sulfonamides and phenobarbital.
What is the inheritance pattern of Acute intermittent porphyria (AIP)?
Acute intermittent porphyria (AIP) is an autosomal dominant genetic disorder.
Corneal reflex:
Afferent limb = ???
Efferent limb = ???
Corneal reflex:
Afferent limb of the corneal blink reflex is by ipsilateral CN V.
Efferent limb of the corneal blink reflex is by bilateral CN VII.
What syndrome presents as esophageal webs, dysphagia, and iron deficiency anemia.
Plummer-Vinson syndrome
Plummer-Vinson syndrome -ptients are at risk for developing what?
squamous cell cancer in the upper two-thirds of the esophagus.
What are the most common sequela associated with reflux esophagitis?
- Adenocarcinoma
- Barrett esophagus
Loss of elastic recoil in the lung ~w/ ?
COPD.
decrease lung elasticity –> decrease FEV1, increase residual & Total lung volume.
Lowing a cutoff point for a screening test towards normal would increase the SENSITIVY, what does this do to the Negative Predictive Value of the test?
Increases NPV, b/c of the DECREASE in FALSE NEGATIVES.
The __________ sinus is located in the sphenoid bone under the pituitary gland.
sphenoid sinus
The ________ can be approached transnasally via the sphenoid sinus for hypophysectomy.
pituitary
How does administering Triiodothyronine (T3) affect TSH, serum T3, and Serum T4?
Decreases TSH
Increases T3 (duh…)
Decreases T4, d/t negative feedback.
That’s why the standard Tx for Hypothyroidism is T4, which has a longer halg-life than T3, and can get converted to active T3 by the body, so that both T4 and T3 levels increase.
What is McCune-Alright Syndrome?
Herefitary disorder also known as POLYOSTOTIC FIBROUS DYSPLASIA.
auto stimulation of aromastase enzyme production of estrogen by the overies.
~ cyctic bone lesions
~ café-au-lait skin spots
cyctic bone lesions, café-au-lait skin spots, with or without precocious puberty == ?
McCune-Alright Syndrome
During the period of time between discontinuing the PTU and RAI therapy, the patient needs to have her hyperthyroid condition appropriately managed wiith what drug?
Propranolol is a nonselective beta-adrenergic receptor antagonist that may also mildly block the conversion of thyroxine (T4) to triiodothyronine (T3).
Beta-blockers can be used before, during, and after RAI therapy without interfering with radioiodine uptake into the thyroid gland.
Beta-blockers, such as propranolol and atenolol, are the drugs of choice for symptomatic therapy to improve adrenergic symptoms (tachycardia, tremor, and anxiety).
These agents do not affect the underlying hypermetabolic state. If the use of a beta-blocker is contraindicated, diltiazem or verapamil can be used for acute symptomatic treatment.
What drug decreases the uptake of 131-Iodine by the thyroid follicular cell sodium-iodine symporter?
Potassium Iodine;
drug of choice for treatment of hyperthyroidism in preoperative thyroidectomy patients, because this agent decreases the vascularity of the thyroid gland, thereby increasing the chance for a more successful surgery.
Post MI:
ventricular wall rupture leads to ?
Papillary muscle rupture leads to ?
Post MI:
ventricular wall rupture leads to cardiac tamponade.
Papillary muscle rupture leads to acute mitral valve prolapse.
When do you see a True Ventricular Aneurysms?
seen several weeks post-MI.
Aneurysm is produced prom an outpouching of damage tissue that in lined by fibrotic tissue.
ST elevation in leads: II, II, aVF, V5 and V6 ===> ?
Inferior myocardial infarction; d/t occulusion in RIGHT CORONARY a.
What are the potential complications of an Inferior myocardial infarction; d/t occulusion in RIGHT CORONARY a.?
- rupture of posterior left ventricular wall, leading to hemopericardium and cardiac tampnade (pulses paradoxus).
- rupture of interventricular septum
- rupture of the posterior papillary muscle –> acute mitral valve prolapse.
___________ is a feared complication of a ruptured ectopic pregnancy.
Exsanguination
_______________ is a very serious complication of mucinous tumors of the ovary or appendix.
Pseudomyxoma peritonei
What should be suspected in a patient with lower abdominal pain, vaginal discharge, adnexal tenderness, and tenderness with cervical motion.
pelvic inflammatory disease
Pelvic inflammatory disease may be due to infection with what?
N. gonorrhoeae, C. trachomatis, vaginal anaerobes, and/or facultative gram-negative rods.
What are complications of Pelvic inflammatory disease?
Complications include sterility, ectopic tubal pregnancy, bacteremia, peritonitis, and intestinal obstruction.
What can lithium therapy inhibit and what labs are needed for monitoring?
Lithium can inhibit thyroid function, which should be monitored by measuring thyroid-stimulating hormone (TSH) every 6-12 months of therapy.
In a patient with amenorrhea, a very shallow vagina and no obvious uterus and cervix, what should be suspected?
testicular feminization and look for palpable masses in the labia that might be abnormal testes.
Patients with testicular feminization have 46,XY genetics and a disorder of the androgen receptor that prevents normal male external genitalia from developing.
Secretion of Müllerian inhibiting factor and testosterone still occurs in these patients.
What cell releases MIF, and what does MIF do?
Sertoli Cells release MIF.
MIF prevents that development of the Paramesonephric duct.
What is a sign of stage 2 sleep?
K-complexes (choice B) are a sign of stage 2 sleep, the most common stage of sleep.
Although more sleep time for the elderly person is spent in Stage 2 sleep, the decline in total sleep time also means that Stage 2 sleep and K-complexes would also decline.
REM or Rapid Eye Movement sleep is characterized by what?
an aroused EEG pattern, sexual arousal, saccadic eye movements, and elaborate visual imagery (dreaming). The figure below summarizes the different types of sleep.
- Low-grade tumor in children and young adults
- Usually in the posterior fossa in children
- Cyst with a mural nodule
- Pathology: Rosenthal fibers, immunostaining with GFAP
Pilocytic astrocytoma
Pathology: Rosenthal fibers, immunostaining with GFAP
is what ???
Pilocytic astrocytoma
The presence of corkscrew-shaped, intensely eosinophilic structures deriving from accumulation of αβ-crystallin within astrocytic processes is an important histopathologic clue for pilocytic astrocytoma.
This are aka ???
Rosenthal fibers
cells organized around small vessels (perivascular pseudorosettes) or around small lumina (true ependymal rosettes), mimicking the primordial ependymal canal == ???
Ependymoma
What presents as a tumor that is solid (not cystic) and consists ofundifferentiated small cellsarranged around neuropil (Homer-Wrightrosettes).
Note: these structures are actually considered “pseudorosettes” since they do not surround a lumen (definition of a true rosette).
Medulloblastoma
____________ is a defense mechanism in which the unacceptable is transformed into its opposite, i.e., the patient manifests the opposite of what she feels.
Reaction formation
What are the S/Sx of Multiple Myeloma?
mnemonic CRAB: Calcium Renal failure Anemia Bone lytic lesions
Patients also have increased infections due to secondary deficiency/defective immunoglobulin secretion.
______________ is a monoclonal neoplastic proliferation of plasma cells, which involves the vertebral column, skull, ribs, pelvis, and other bones. The bone marrow is expanded and replaced by proliferating neoplastic plasma cells.
Multiple myeloma
What is common in pt. with Multiple Myeloma?
Compression fractures of vertebral bodies, such as the one depicted in the middle of this gross photograph, are frequently encountered in patients with multiple myeloma and manifest with pain. Note: Blue arrows indicate lytic areas of vertebral bone softening and hemorrhage.
_______________ is a suppurative infection of the bone and medullary cavity, usually affecting long bones or vertebrae.
Pyogenic osteomyelitis.
Bone destruction surrounded by a rim of bone condensation is a characteristic pathologic and radiologic finding.
Ninety percent of cases are due to Staphylococcus aureus
_____________ is characterized by repetitive cycles of osteolysis and disorganized osteoblastic activity, leading to thickened bone with a haphazard lamellar orientation.
Paget disease
A histologic jigsaw puzzleor mosaic pattern appearance of bone lamellae is pathognomonic of what disease?
Paget disease.
Clinical manifestations include bone pain, bone deformities, and chalk stick-type fractures. There is increased risk for development of osteosarcoma and fibrosarcoma.
90% of Pyogenic osteomyelitis is caused by ????
Staphylococcus aureus
Bone destruction surrounded by a rim of bone condensation is a characteristic pathologic and radiologic finding of what disease pathology?
Pyogenic osteomyelitis.
How do the kidneys handle the filtered load of phosphate?
The PCT reabsorbs most of the filtered load of phosphate, mainly via 3 or more Na+/Pi cotransporter located in the apical membrane.
What increases and decreases Phosphate reabsorption at the PCT?
PTH decreases Pi reabsorption by down-regulation of Na+/Pi cotransporter expression.
Calcitriol increases transporter expression and INCREASES Pi reabsorption.
** Calcitonin is NOT a major regulator of Pi reabsorption.
What is the site of action of Furosemide? what is its effects?
Furosemide, a loop diuretic, is used in congestive heart failure to decrease edema. It inhibits the Na+-K+-2Cl- cotransporter, weakens the corticopapillary osmotic gradient, and thereby causes diuresis.
When does the max velocity of muscles shortening occur?
when there is no afterload on the muscle. (force = 0)
Maximum velocity of shortening of a muscle is greater with what?
maximum velocity of shortening will be greater if ATPase activity is high.
In muscle, what has a profound effects on the rate of relaxation?
Sarco/endoplasmic reticulum calcium ATPase (SERCA) activity is responsible for renormalization of intracellular calcium concentrations following contraction.
Altered SERCA activity would have a profound effect on rate of relaxation, but less effect on maximum velocity of contraction.
Force–velocity relationships are created by measuring muscle contraction velocity against varying _________.
afterloads.
Contraction is fastest (Vmax) when there is no afterload, because all available ATP is applied toward moving the thick filaments (myosin) and thin filaments (actin) against each other.
As afterload increases, energy is expended in lifting the load, so a fewer number of cross-bridge cycles are available for muscle shortening. When the afterload becomes so great that all cross-bridge cycles are engaged in attempting to lift the load, shortening is no longer possible and Vmax = 0.
The pressure at the point of aortic valve opening is equal to what?
Diastolic BP.
Pressure here is equal to aortic end-diastolic pressure.
A person with cholera without fluid replacement undergoes what changes body fluid compartments?
A person with cholera without fluid replacement undergoes isosmotic volume contraction caused by loss of isotonic fluid.
A decrease in extracellular volume without significant change in intracellular volume occurs.
What ion exchanger is located in cardiac muscle, moves a net positive charge into the sarcoplasm ==> causes sarcolemmal depol.
A plasma Na+-Ca2+ exchanger,
change in volume/change in pressure = ?
Compliance.
A decrease in compliance, such as that caused by age-related arteriosclerosis, will cause what?
an increase in systolic pressure and a decrease in diastolic pressure, leading to a widened pulse pressure. (SP - DP = PP)
What causes widened pulse pressure?
decrease in arterial compliance
What is the effects of acetazolamide on H+ at the PCT?
Carbonic anhydrase inhibitors decreases H+ secretion, which decreases NH4+ secretion.
If the blood sample for an ABG is mistakenly exposed to atmospheric air, what would be the sample’s Po2, PCO2, and pH?
Higher PO2 (b/c PO2 in air is 160mg)
Lower PCO2 (b/c CO2 is near 0mmHg in air)
Higher pH (Basic); lower CO2 = low carbonic acid = basic
At high altitude, the reduced atmospheric pressure does what to the alveoli and arterials?
alveolar and arterial hypoxia.
Alveolar hypoxia is a stimulus for pulmonary ___________ ;
vasoconstriction.
therefore, the diameter of the pulmonary vessels of a person who lives at sea level would be greater than that of a person who lives at high altitude.
