miscellaneous Flashcards
liquefactive necrosis
Enzymatic digestion of cells. Necrosis associated with bacterial and fungal infection and abscesses. Common in CNS.
splenic rupture presentation
scenario: blunt abdominal trauma + abdominal pain radiating to left scapula + marked hypotension + peritoneal hemorrhaging.
structure passing beneath uterine arteries
ureter
Weber Test, analyzing results
Lateralizes to affected ear in cases of conductive deafness and to the normal ear in cases of sensorineural hearing loss.
proteoglycans and clinical significance
1) Heavily glycosylated proteins that form a component of the ECM.
2) Inability to break down proteoglycans is characteristic of mucopolysaccharidoses (lysosomal enzymes usually break them down).
Enzyme kinetics - kcat
Turnover number – the number of substrate molecules each enzyme site converts to product per unit time.
Treatment for bilateral hydronephrosis
Acute treated by insertion of a nephrostomy tube. Chronic treated by insertion of a stent.
Foley catheter use?
Foleys are just a flexible tube inserted through urethra and into the bladder for people who can’t urine (eg BPH, sedated, genital injury)
Locations of fat necrosis
pancreas, breast, salivary glands, neonates after a traumatic delivery.
hyaluronic acid
Glycosaminoglycan that is a chief component of ECM.
exercise electrolytes…
hyponatremia
phospholamban
Protein that regulates the calcium pump in cardiac muscle and skeletal muscle cells.
melena indicates…
upper GI bleed
Proteoglycans and relevance
Heavily glycosylated proteins that basically serve to absorb water and maintain lubrication. This is why pleura and peritoneum are rich in proteoglycans.
C-jun
Transcription factor involved in cardiac remodeling. Increased with cardiac disease
endothelin and cardiac relevance
Implicated in cardiac remodeling. Thus, will go up with heart disease.
How do you distinguish between choriocarcinoma and GTN?
No villi in choriocarcinoma
Choriocarcinoma vs. gestational trophobolastic disease
Choriocarcinoma is a malignancy of the trophoblastic tissue on the malignant end of the spectrum in gestational trophoblastic disease.
trophoblast
Cells forming the outer layer of a blastocyst.
anti-Jo 1 targets
tRNA
Normal reflexes
2+
osteoclast markers
1) hydroxyproline
2) deoxypyridinoline
fibronectin
Part of ECM that binds integrins, providing structural support.
Aldosterone escape – why does chronic aldosterone not lead to edema in hyperaldosteronism?
Increased Na and water reabsorption causes back flow of Na and water into the tubules.
How does aldosterone increase Na reabsorption?
Stimulation of ENac channels in principal cells of the renal collecting tubules.
Receptor that endotoxin binds to to activate macrophages?
TLR4 (CD14)
Problem with occult blood testing for CRC?
Low sensitivity (specificity is high)
Buerger’s…
Berger = IgA nephropathy Burger = thromboangiitis obliterans
Accelerated atherosclerosis
Chronic transplant rejection in the heart.
Normal A-a gradient
10-15 mm Hg
paraesophageal hernia vs. sliding hiatal hernia
sliding hiatal hernia –> esophagus slides up. GEJ moves up.
paraesophageal hernia –> fundus protrudes into the stomach.
What do you give someone for severe anemia?
Packed RBCs
What do you give someone for acute blood loss?
Packed RBCs
Wilms tumor characteristic
Highly vascularized
Neuropathy pain description
Burning pain
Pralidoxime MOA
Binds to AChe and regenerates AChE.
Organophosphate poisoning mechanism
AChE inhibitors
Inhibitory neurotransmitters
Glycine + GABA
Stimulatory neurotransmitter
Glutamate
antimuscarinic used to inhibit oral secretions
glycopyrrolate
Aspirin affect on PT, PTT, bleeding time.
- Increases bleeding time.
- No affect on PT or PTT.
Conversion disorder + presentation + epidemiology
- Loss of sensory or motor function (eg paralysis, blindness, mutism) often following an ACUTE stressor.
- Patient is aware of but sometimes indifferent toward symptoms.
- More common in females + adolescents + young adults.
Primary hypothyroidism vs. central (secondary) hypothyroidism
Primary = inadequate function of the thyroid gland. TSH will be elevated. Secondary = Not enough stimulation by TSH. TSH will be low.
location of sella turcica
https://www.google.com/search?q=sella+turcica&biw=1149&bih=556&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwi-95Kz2vHLAhVpvoMKHVRPBxkQ_AUIBigB#imgrc=Lsaj4pZ8HUEHGM%3A
Most common type of pituitary adenoma
prolactinoma
Where are very long chain fatty acids metabolized?
peroxisomes
Antisocial personality disorder presentation
History of criminality and impulsivity. More common in males. Must be over 18. Disregard for and violation of rights of others.
ABO hemolytic disease of the newborn presentation
Mild jaundice in the neonate within 24 hours of birth.
How does histamine cause edema? AKA MOA for edema in anaphylaxis…
Causes gap formation between endothelial cells.
Origin of connective tissue (fibroblasts, etc.)…
mesoderm
paraxial vs. intermediate mesoderm
Pretty much all impt mesoderm-derived structures are from paraxial mesoderm (muscle, connective tissue and dermis)
cervix drainage
internal iliac
lupus hematologic abnormality
thrombocytopenia (antibodies against platelets)
IkB function in NF-kB pathway
Releases NF-kB after undergoing phosphorylation
Insulin-dependent Type 2 DM
They lose ability to synthesize insulin thus blood levels will be very low.
Diphtheria vaccine mechanism
Killed toxin (toxoids)
Fat necrosis in pancreatitis mechanism
pancreatic enzymes autodigesting cells
Origin of adrenal medulla
neural crest cells
why is prolactin increased with craniopharyngiomas or pituitary adenomas?
compression of the pituitary stalk and reduced inhibition by dopamine.
respiratory zone histology
Mostly cuboidal cells in respiratory bronchioles, then simple squamous cells up to alveoli.
When do cilia terminate?
respiratory bronchioles (since cilia everywhere except alveolar ducts and alveoli)
good syndrome
paraneoplastic hypogammaglobulinemia associated with thymoma
explain epinephrine reversal
epinephrine is an agonist at A1,A2, B1,B2. give phentolamine after epic, thus epic can only stimulate beta receptors, which produces a decrease in BP.
Large difference in blood pressure between upper and lower limbs in an older person think…
severe atherosclerosis
Flow through what artery is responsible for perfusion of lower extremities in pt with aortic coarctation?
Internal thoracic (mammary) arteries
First line drug for T2DM
sulfonylureas
2nd gen sulfonylureas
**glimepiride
glipizide
glyburide
difference between adenomatous polyps and hyperplastic polyps
Adenoma means nuclear atypia by definition (dysplasia).
Hyperplastic is a proliferation of glands without atypia.
Differentiating serrated and hyperplastic polyps
Both have a saw-tooth pattern, but serrated are premalignant so should have neoplastic features.
Polyp genetics
BRAF —> serrated
Adenomatous (villous and tubular) –> APC + KRAS
berger presentation + impt lab feature
- **RBC casts
- glomerulonephritis post gastroenteritis
- serum complement remains normal
explain lead-time bias.
False estimate of survival rates. Patients seem to live longer with a disease if a screening test picks it up but there’s no effect on outcome, there just diagnosed earlier.
GI secretory cells in the antrum
G cells
D cells
Miosis pathway
1) 1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III
2) 2nd neuron: short ciliary nerves to pupillary sphincter muscles.
Mydriasis pathway
1st neuron: hypothalamus to ciliospinal center of Budge (C8-T2)
2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels)
3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles. Sympathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face.
CN III carries what type of fibers?
Parasympathetics.
Adduction of the thumb is a function of what nerve?
Adductor pollicis, which is innervated by ulnar
Surface location of spleen
Lies between 9th and 11th ribs
“popping” of LP indicates…
Penetration of the dura
thoracentesis
/invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. /always ABOVE the rib so as not to poke vessels or nerves of the rib. Blocks of hash + ivy running up and down midclavicular/midclavicular line = between 6th and 8th ribs. ivy + ties running up and down midaxillary line/midaxillary line = between 8th and 10th ribs. tin cans lining midscapular line + red ties wrapped around them/paravertebral line = between 10th and 12th ribs.
Thoracostomy
Think of picture below with tube covered in hair and hailing onto the chest/chest tubes (thoracostomy) are placed into the 4th or 5th intercostal space in the midaxillary line through the serratus anterior line.
How does cortisol increase conversion of NE to epinephrine in the adrenal medulla?
Increasing the expression of phenylethanolamine-N-methyltransferase.
Larynx muscle innervation
Recurrent laryngeal innervates all the intrinsic muscles of the larynx except for the cricothyroid muscles, which is innervated by the superior laryngeal nerve.
Overall stage grouping for cancer:
Stage 0: Carcinoma in situ
Stage I: Cancer localized to one part of the body.
Stage II: Locally advanced cancer.
Stage III: Locally advanced. specific staging of II or III depends on cancer type.
Stage IV: Metastasis.
Ang II mechanism in adrenal cortex
Stimulates aldosterone synthase
Glycyrrhetic acid (active ingredient in licorice) mechanism in adrenal cortex
Inhibits cortisol –> cortisone
17,20 lyase mechanism
17-hydroxypregnenolone –> DHEA
17-hydroxyprogesterone –> androstenediione
origin of adrenal gland
medulla from neural crest, cortex from mesoderm.
Omphalomesenteric cyst is just a…
viteline duct cyst
Normal saline concentration
0.9
saline to use for sepsis
0.9 (normal saline)
hypertonic saline concentration
3%ase
How do you give bad news….
be honest and tell them it’s bad.
Enzyme that converts dopamine to NE
dopamine beta-hydroxyl
cofactor for carboxylation reactions
biotin
Don’t confuse ADRENAL with RENAL medulla
ok
paralysis caveat
Can still by hyper reflexive.
What happens with cold and blood flow physiologically?
Shunts blood toward central organs and vasoconstricts peripheries. Body doesn’t want to lose heat.
Central blood volume
Combined volume of blood in heart, lungs, and arterial tree.
Cytokines mediating sepsis
**IL-1
Pas
TNF-alfa
Interferon
Primary sites of gluceoneogenesis other than the liver
Kidney
Intestinal epithelium
Eremites – what does increase or decrease indicate?
Increase = denser or inflamed lung tissue. Decrease = air or fluid in pleural spaces.
Temperature sensitive cells in the gonad and metabolic effects of cryptorchidism
*sertoli cells are temp sensitive.
*
Examples of psychomotor agitation
- wringing one’s hands
- uncontrolled tongue movements
- ripping, tearing, chewing at skin
- biting nails
what nerve transmits the cremasteric reflex?
Genitofemoral nerve
SIGECAPS caveat
9th symptom is depressed mood.
agraphesthesia due to
parietal lobe damage
agraphesthesia
Disorder of directional cutaneous kinesthesia (can tell orientation of skin sensation across space)
babesiosis on smear
1) ring forms
2) maltese cross
gamma hemolysis means..
no hemolysis
gamma-hemolytic bugs
1) S bovis
2) enterococcus
All hindgut innervation is..
pelvic splanchnic
External anal sphincter innervation…
pudendal
Location of SA node
Junction where SVC enters the right atrium.
Corticosteroids immunosuppressive effects
1) Inhibit NF-kappaB
2) Suppress both B- and T-cell function by decrease transcription of many cytokines.
3) Induce apoptosis of T lymphocytes.
Classic immune cell elevated in Hodgkin’s
eosinophils due to increased IL-5
Listeria catalase negative or positive?
Positive
Catalase positive organisms
Cat-s Need PLACESS to Belch their Hairballs Nocardia Pseudomonas Listeria Aspergillus Candida E Coli Staphylococci Serrate B cepacia H pylori
Thyroid type with high output cardiac failure
Hyperthyroidism (due to increased beta receptors)
omeprazole interactions
Inhibits absorption of drugs that depend on an acidic environment, such as ketoconazole or atazanavir.
21-hydroxylase deficiency pathophys
Defective conversion of 17-hydroxyprogesterone to 11-deoxycortisol. This leads to a buildup of 17-hydroxyprogesterone.
Mineralocorticoids in 11beta-hydroxylase
1) decreased aldosterone
2) Increased 11-deoxycorticosterone (results in higher BP)
when do you get decreased androstenedione?
17alpha-hydroxylase deficiency
osteoprotegerin
Decoy receptor for RANKL, thus inhibits osteoclast action.
Gastrosplenic contains what vasculature?
Short gastric + left gastroepiploic
