March 13

Question 1

Why is edema NOT seen in mild/moderate Right Heart Failure?

Answer 1

RHF causes:

Increased central venous pressure

Increased interstitial pressure

Increased lymphatic drainage!

ultimately lymphatic drainage is overwhelmed and edema is apparent

Question 2

Acute Promyelocytic Leukemia

Answer 2

APML t(15:17)

15=PML gene
17=RARa gene (retinoic acid receptor alpha)

tx: all-trans retinoic acid, forces promyelocyte differentiation
symp: anemia, bruising, mucosal bleeding, recurrent infections
smear: promyelocytes with auer rods

Question 3

Conus Medullaris Syndrome

Answer 3

Lesion at L2 (effects L2-S5)

impotence
flaccid paralysis of rectum and bladder
saddle anesthesia (S3,4,5)

causes: disc herniation, tumor, spinal fracture

Question 4

Wheal and Flare lesion (bee sting)

Answer 4

Type I hypersensitivity

1) IgM –> IgE class switching
2) Fc of IgE binds mast cell and basophils
3) cross linking of bound IgE
4) degranulation - Histamine Release! (leukotrienes, prostaglandins)

vasodilation and increased vascular permeability

Question 5

Gerstmann Syndrome

Answer 5

Lesion at Dominant Parietal Cortex

symp: agraphia, acalculia, finger agnosia

Question 6

Preeclampsia

Answer 6

Gestational Hypertension > 140/90 after 20 weeks
-and-
Proteinuria

due to abnormal placentation, lack of invasion of maternal arteries by trophoblasts

Question 7

HELLP Syndrome (pregnancy)

Answer 7

Hemolysis
Elevated Liver enzymes
Low Platelets

smear shows schistocytes

Question 8

Fibrillin-1

Answer 8

Mutated in Marfan Syndrome

large extracellular glycoprotein that forms a sheath around elastin

abundant at:
large vessels (aortic dissection)
zonular fibers of lens (subluxation)
periosteum

FBN1 gene at Chr15

Question 9

Marfan Syndrome

Answer 9

AD mutation of FBN1 gene at Chr15 - fibrillin deficit

Tall, thin, long fingers (arachnodactyly), hypermobile joints, pectus excavatum

dissecting aortic aneurysm
floppy mitral valve
subluxation of lens (up and out)

Question 10

small nuclear ribonuclearproteins (snRNPs)

Answer 10

Form Spliceosome

removes introns

Question 11

Spinal Muscular Atrophy

Answer 11

mutation in SMN1 gene - defective snRNPs –> defective spliceosome

symp: flaccid paralysis due to degeneration of anterior horn, motor delays, decreased DTRs

Question 12

What amino acid is essential in PKU patients?

Answer 12

Tyrosine
(lack phenylalanine hydroxylase which converts phenylalanine –> tyrosine)

symp: musty odor, light pigmentation, developmental delay, seizures

restrict phenylalanine from diet!

Question 13

Tyrosine derivatives

Answer 13

Catecholamines 
  norepinephrine
  epinephrine 
  dopamine 
  melanin

Question 14

Failure of spiraling at cardiac development

Answer 14

Transposition of Great Vessels

incompatible with life unless PDA or patent foramen ovale occurs too

Question 15

What serum substances increase with SIBO (small intestine bacterial overgrowth)

Answer 15

Folate
Vit K

(deficiency in B12, D, A, E, and iron)

Question 16

Ecological Study

Answer 16

study of POPULATIONS

ex. study of VitD intake and MS in multiple cities at same latitude

Question 17

Broca Aphasia

Answer 17

Comprehension - Intact
Speech - Non-fluent
Repetition - Impaired

Broca Broken Boca - frustrating

Question 18

Wernicke Aphasia

Answer 18

Speech - Fluent
Comprehension - Impaired
Repetition - Impaired

Wernicke is Wordy but makes no sense - gobledegook

Question 19

Hepcidin

Answer 19

Acute Phase Reactant

synthesized and released by hepatic parenchymal cells

increased with high iron load and inflammation

decreased with hypoxia and increased EPO

binds ferroportin –> degredation = decreased Fe absorption from gut

increases iron release from macrophages

responsible for anemia of chronic disease

Question 20

Communicating Hydrocele

Answer 20

Patent processus vaginalis allows peritoneal fluid to accumulate in Tunica Vaginalis

transluminating scrotum in newborn

Question 21

Medical (non-surgical) Management of Gallstones?

Answer 21

Hydrophilic Bile Acid supplementation
ex. ursodeoxycholic acid

improve cholesterol solubility and help dissolve the stones

Question 22

Rabies Virus

Answer 22

ssRNA with bullet shaped capsule

binds Nicotinic ACh receptors and travels retrograde

flu-like prodrome
agitation, fever, photophobia, hydrophobia, dysphagia, hypersalivation

Question 23

Where is rRNA transcribed?

Answer 23

Nucleolus - primary function!

Question 24

Toxic Shock Syndrome

Answer 24

caused by Toxic Shock Syndrome Toxin from Staph aureus

macrophages present toxin to T-cells –> widespread T-cell activation

T-cells release: IL-2
Macrophages release: TNF-alpha, IL-1

causes capillary leakage, sepsis, fever,

symp: altered mental status, sunburn-like rash, decreased BP, sepsis

Question 25

HBV Hepatocellular Carcinoma

Answer 25

likely caused by viral genome integration into host genome –> neoplastic changes

Question 26

How are extended spectrum beta-lactamases acquired?

Answer 26

plasmids!

treatment with carbapenems (imipenem)

Question 27

Where is the Sinoatrial (SA) node?

Answer 27

Right Atrium near the opening of the SVC

Question 28

Phenoxybenzamine

Answer 28

noncompetitive alpha-adrenergic antagonist

tx for pheochromocytoma

Question 29

Treatment for Restless Leg Syndrome?

Answer 29

Dopamine agonists

pramipexole, ropinirole

Question 30

Amlodipine

Answer 30

Dihydropyridine Calcium Channel Blocker (-dipines)

causes vasodilation

tx: HTN
side fx: peripheral edema, flushing, HA, dizziness

dilation of precapillary arterioles causes edema

ACEi and ARD cause dilation of postcapillar venuoles and prevent peripheral edema

Question 31

Incretin Effect

Answer 31

GLP1 and GIP

increased insulin release with some loading dose of glucose when taken orally instead of IV