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Caleb's Step 1 > March 21 > Flashcards

March 21 Flashcards

1
Q

Irreversible neuronal injury

A

neuronal shrinkage and intense cytoplasmic eosinophilia

–> Gliosis!

astrocyte proliferation and formation of a glial scar from astrocyte foot processes

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2
Q

Amyotrophic LateraL Sclerosis

A

ALS

atrophic precentral gyrus
thin anterior roots of spinal cord
loss of neurons at anterior horn - LMN lesion
loss of neurons in the hypoglossal and ambiguous cranial nerve nuclei
demyelination of lateral corticospinal tracts - UMN lesion

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3
Q

Relative Polycythemia aka Relative Erythrocytosis

A

normal RBC mass - Hct>52 in men or Hct>48 in women due to dehydration

as opposed to true erythrocytosis - increased RBC mass due to polycythemia vera or hypoxia

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4
Q

Cori Disease

A

defect in Debranching Enzyme

hepatomegaly
ketotic hypoglycemia
hypotonia and weakness
abnormal glycogen with short outer chains

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5
Q

McArdle Disease

A

defect in Muscle Glycogen Phosphorylase

weakness and fatigue with exercise
no rise in blood lactate after exercise
myoglobinuria

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6
Q

VonGierke Disease

A

defect in Glucose-6-phosphatase

Severe fasting hypoglycemia

increased: lactate, TGs, uric acid, liver glycogen (hepatomegaly)
hepatic steatosis

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7
Q

Typhoid Fever

A

Salmonella Typhi

Week 1: Fever, bradycardia, watery diarrhea

Week 2: abd pain +
salmon-colored rose spots on chest/abdomen = faint, erythematous maculopapular lesions

Week 3: HSM and GI bleeds

Salmonella is phagocytized by M-cells –> survive and proliferate in macrophages

complications: bowel perforation

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8
Q

Metabolism in the Mitochondria

A

beta-oxidation of fatty acids
TCA cycle
pyruvate carboxylation of gluconeogenesis

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9
Q

Metabolism in the Cytoplasm

A

glycolysis, fatty acid synthesis, pentose phosphate

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10
Q

elevated HbA2

A

Beta-thalassemia

can give falsely low HbA1c levels in diabetics with beta-thal

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11
Q

Paget’s Disease of the Bone

A

Bone deformity
Hearing loss - due to boney changes in skull

1st: increased osteoclast turnover of bone
2nd: disorganized bone reformation
- -> mixed bone sclerosis and lucency

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12
Q

Osteoclasts

A

multinucleated from mononuclear phagocytic cells that fuse (macrophage variant)

this requires:
M-CSF: macrophage colony-stimulating factor
RANK: NFkB

Osteoblasts have RANK-L aka NFkB-L and osteoclasts have the receptor RANK aka NFkB Receptor

normal osteoclasts have 2-5 nuclei
in pagets dz they have ~100 nuclei

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13
Q

Locations for Thoracentesis

A

Midclavicular @ 6-8th rib
–> lower can injure Right Hepatic Lobe
Midaxillary @ 8-10th rib

Paravertebral @ 10-12th rib

always go above rib!
below –> injury of subcostal neurovascular bundle

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14
Q

Anterior Humerus Dislocation

A

axillary nerve damage

deltoid and teres minor muscles and sensation over lateral shoulder

–> flattening of the deltoid

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15
Q

Pharyngeal Arch 1

A

Makes

Maxilla, Mandible, Muscles of mastication (masseter, temporalis, medial and lateral pterygoids)

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16
Q

Pharyngeal Arch 2

A

Some

Stapes
Styloid
Muscles of facial expression

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17
Q

Pharyngeal Arch 3

A

Interesting

Stylopharyngeus
Greater horn of hyoid

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18
Q

Pharyngeal Arch 4/6

A

Shit

pharyngeal and laryngeal muscles
cricoid and thyroid cartilage

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19
Q

Blinding in experiments prevents

A

Observer Bias

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20
Q

VSD

A

holosytolic murmur @ left sternal border

smaller = louder

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21
Q

Released on mast cell degranulation

A

histamine
MMPs - tryptase (measured)
heparin
eosinophilic chemotactic factors

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22
Q

Thymidine Kinase Independent antiviral

A

Cidofovir
Tenofovir
Foscarnet

for HSV, CMV, HIV

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23
Q

Source of NADPH

A

Pentose Phosphate Pathway

G-6-P –> –> Ribulose-5-phosphate
via G-6-P D (glucose-6-phosphate dehydrogenase)

NADPH restores glutathione for antioxidant activity
NADPH is required for cholesterol, steroids and fatty acid synthesis

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24
Q

Narcolepsy

A

caused by decreased hypocretin (=orexin) from lateral hypothalamus

tx: modafinil > amphetamines

hypnaGOgic -hallucinations while GOing to sleep
hypnopompic - hallucinations upon waking
cataplexy - loss of muscle tone following strong emotions (laughing and crying)

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25
Q

Paroxysmal Nocturnal Hemoglobinuria

A

mutation in PIGA gene –> GPI (glycosylphosphatidylinositol) deficiency –> CD55 and CD59 deficiency

GPI anchors CD55 and CD59 on RBC membranes - these CDs prevent complement-mediated hemolysis

Triad: hemolytic anemia, hypercoag, pancytopenia –> PNH

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26
Q

Biceps Reflex

A

C5-C6

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27
Q

Triceps Reflex

A

C7-C8

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28
Q

Pick’s Disease

A

Frontotemporal dementia

disinhibition, apathy, social inappropriateness, compulsive behavior, irritability/aggression, decreased speech

atrophy of frontal and temporal lobes

Pick Bodies = cytoplasmic inclusions of tau

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29
Q

Alzheimer Disease

A

neuronal loss in temporal and parietal lobes

intracellular neurofibullary tau tangles - hyperphosphorylated tau protein
beta-amyloid plaques - extracellular at gray matter

decreased ACh (synth at Basal nucleus of Meynert)

tx: AChE agonists: donepezil, rivastigmine

30
Q

Neurofibrillary tangles

A

intracellular hyper-phosphorylated tau protein

Alzheimer disease
Pick bodies

31
Q

Senile Plaques

A

extracellular amyloid deposition in gray matter

32
Q

Cytokine associated with Cachexia

A

TNF-alpha

suppress appetite and increase basal metabolic rate

33
Q

Leukocyte Adhesion Deficiency

A

Autosomal Recessive absence of CD18

CD18 necessary for integrins which are necessary for leukocyte adhesion

recurrent skin and mucosal infections with poor wound healing and no pus (no neutrophils at infection site)

delayed umbilical cord separation >3weeks

persistent leukocytosis - neutrophils trapped in vessels

34
Q

Always give Thiamine with Glucose

A

glucose without thiamine can precipitate encephalopathy

thiamine is required for glucose metabolism, if you only give glucose you will make thiamine deficiency WORSE

35
Q

Phenotypic mixing

A

host cell is infected with 2 viruses

genomes are unchanged

progeny are packaged in the others capsid/envelop

can infect target animal of other virus

but progeny revert back to OG because thats the genome they have

36
Q

Pancreatic islet amyloid deposition

A

Type II DM

37
Q

Diabetic Opthamoplegia

A

down and out with reactive pupil and ptosis

due to nerve ischemia @ CN III

38
Q

Graft-vs-Host

A

Weeks after transplant

Triad: Hepatitis, Dermatitis, Gastroenteritits

39
Q

Acute Transplant Rejection

A

Weeks to Months

CD8+ against donor MHC I

vasculitis of graft vessels with lymphocytic infiltrate

Type IV

40
Q

Chronic Transplant Rejection

A

CD4+

Type II (antibody mediated) and Type IV (delayed)

arteriosclerosis

41
Q

Sensory below dentate=pectinate

A

Pudendal Nerve and its branches (external hemorrhoids @ inferior rectal nerve)

42
Q

Achondroplasia

A

Autosomal Dominant
2 copies = fatal

mutation at FGFR3 (fibroblast growth factor receptor)

inhibition of chondrocyte proliferation

43
Q

Statistical Power

A

1-beta

ability to detect a difference when one exists

probability of rightfully rejecting a null hypothesis when it is truly false

increase sample size : increase power

44
Q

Null Hypothesis = H0

A

hypothesis that there is no difference/no relationship

45
Q

Alternative Hypothesis = H1

A

there is a difference

46
Q

Type I error = alpha

A

false positive, accepting H1 when you should accept H0

saying there is a difference when there is not

alpha = probability of making a type I error = p-value

if p/alpha is very low we can be confident that we made a true positive.

47
Q

Type II error = beta

A

false negative = accepting H0 when you should accept H1

saying there is no difference when there is!

increase power by decreasing beta
increase sample size
increase precision of measurement

48
Q

Hyperammonemia and Astrocytes

A

astrocytes take up excess ammonia in the blood –> increase glutamine production –> increased intracellular osmolarity –> astrocyte swelling –> less glutamine released to neurons –> less glutamine to glutamate conversion in neurons –> disruption of excitatory transmission

49
Q

Measles

A

paramyxovirus

Koplik spots, cough, conjunctivitis, fever
rash on face –> trunk –> arms and legs

acute infection depletes vitamin A stores

giving Vitamin A can speed recovery and decrease morbidity

50
Q

Dermatomyositis

A

Anti-Jo, CD4+

heliotrope rash = rash @ eyelids
and/or SLE-like malar rash

plus worsening proximal muscle weakness

increased aldolase
increased creatinine kinase

51
Q

IFN-beta

A

MS

52
Q

Where does mRNA processing occur?

A 
in the nucleus
5'-cap
poly AAA tail
intron splicing (in the trash)
methylation of 5'Guanine cap
53
Q

Alternate to aspirin for stroke prevention?

A

Clopidogrel

blocks the P2Y12 component of ADP receptors at platelet and prevent aggregation

54
Q

increased 14-3-3 protein

A

Creutzfeldt-Jakob Dz

55
Q

Jet lag

A

suprachiasmatic nucleus

56
Q

elevated urinary 5-hydroxyindoleacetic acid

A

carcinoid syndrome

elevated 5-HIAA in the urine due to 5-HT breakdown

57
Q

Secondary bacterial pneumonia after influenza infection in pts >65

A

step pneumo > staph aureus > haemophilus influenzae

58
Q

Clostridium perfringens

A

anaerobic gram positive bacillus

gas gangrene
food poisoning –> transient watery diarrhea

59
Q

Cardiac tamponade

A

Becks Triad

  • JVD
  • hypotension
  • diminished heart sounds

+ pulsus paradoxus - inspiration causes drop is systolic BP >10mmHg

60
Q

Adrenal Crisis

A

Seen in pts with adrenal insufficiency

severe hypotension
abd pain
vomiting
weakness
fever

give fluids + glucocorticoids

61
Q

Cheyne-Stokes breathing

A

advanced congestive heart failure

dying patients

62
Q

Thoracic outlet syndrome

A

compression of the brachial plexus lower trunk @ the scalene triangle

scalene triangle: anterior and middle scalene and 1st rib

symp: upper extremity numbness, tingling weakness, pain

63
Q

Methotrexate causes an accumulation of

A

dihydrofolate polyglutamate

inhibits DHFR = dihydrofolate reductase

64
Q

Drug-Induced Lupus

A 
Hydralazine
Procainamide
Isoniazid
Minocycline
Quinidine

+ANA
+anti-histone
no anti-dsDNA

65
Q

Osteoporosis drug similar to pyrophosphate

A

bisphosphonates

alendronate
riseronate

bind to hydroxyapatite preferentially in areas of increase osteoclast activity –> taken up by osteoclasts –> osteoclast dysfunction :)

decrease osteoclast activity
(also increase osteoclast apoptosis)

66
Q

Decreased choline acetyltransferase activity at nucleus basalis

A

Alzheimers Dz

decreased ACh in basal nucleus of Meynert

67
Q

Vitamin E deficiency

A

Vitamin E is an antioxidant

hemolytic anemia - RBCs receive more oxidative damage
degeneration of spinocerebellar and dorsal column - ataxia, impaired proprioception

68
Q

Periodic Acid-Schiff (PAS) Stain

A

highlights glycogen and glycoproteins

polysacchrides of fungal cell walls
mucosubstances from epithelia
basement membranes

alpha-1-antitrypsin deficiency @ liver

69
Q

spindle cells with surrounding blood vessel proliferation

A

Kaposi carcoma

70
Q

Metabolism of 6-MP (6-mercaptopurine)

A

inactivation by xanthine oxidase

activated by HGPRT

71
Q

Silicosis

A

eggshell calcification of hilar lymph nodes

birefringent silica particles surrounded by dense collagen fibers

Caleb's Step 1 (16 decks)

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