Missed Questions 2 Flashcards
What are the main side effects of Olanzapine?
Metabolic syndrome; hyperlipidemia, hyperglycemia, and obesity.
These symptoms are most common in which atypical anti-psychotics?
What do TSH, T4, and T3 levels look like in Hashimoto’s Thyroiditis?
Elevated TSH, Low T4, and Normal T3 (until very late in course). T3 has short half life and is mostly created intracellularly so it’s levels don’t change right away.
What disease?
Rinne and Webber Test results for conductive hearing loss
Rinne (mastoid and air): Bone heard better in affected ear
Webber (fork on head): lateralizes to effected ear
What type of hearing loss?
Rinne and Webber tests results in sensorineural hearing loss
Rinne: Air better than bone bilaterally (normal)
Webber: Lateralizes to UNaffected ear
What type of hearing loss?
What type of hemorrhages do berry aneurysms cause? Sub-arachnoid, intracerebral, subdural, etc.
Rupture causes a subarachnoid hemorrhage.
What kind of aneurysm causes this?
What effect does carcinoid syndrome have on the heart?
Fibrosis of right side valves and endocardial thickening
What is this seen in?
Persistent Lymphedema increases the risk for what?
Lymphangiosarcoma; neoplastic proliferation of lymph vessel endothelial cells.
Complication of what?
Variation in intrapleural pressure with breathing…. Resting and maximum
At FRC, intrapleural pressure is -5 and reaches -7.5 w/ inspiration.
Myxomatous changes with proteoglycan pooling in arteries is characteristic of…….
NO
Aortic Aneurysm
Is this process also seen in Berry Aneurysm?
Which anti-Arrhythmics have the greatest use-dependence? What does this mean?
IC has greatest use-dependence. This means that QRS interval will be increased at high heart rates
What is pulsus paradoxus? What is it caused by?
Significant reduction in systolic pressure during inspiration. Typically expect a small drop as venous return and pulmonary capacity increase (w/ slight drop in LA return). Tamponade (ex viral pericarditis) causes the enlarged RV to push into the LV (rather than into pericardium) and greatly reduce systolic BP w/ inspiration.
KIT receptor tyrosine kinase mutation can cause proliferation of what cell type?
Mast Cells
What mutation causes increased proliferation?
What symptoms do you see in systemic mastocytosis?
Huge Histamine: syncope, flushing, hypotension, pruritis, urticaria.
GI effects include acid secretion and diarrhea from pancreatic enzyme inhibition
2 main causes of nonbacterial thrombotic endocarditis (vegetations on valves made of platelets and fibrin)
Malignancy and Lupus
What effects can these have on the heart?
3 types of gallstones and their cause
Cholesterol = high cholesterol…..
Black pigment = high unconjugated bilirubin + calcium
Brown = also pigment stones but from beta-glucuronidase from hepatocytes in response to bacterial/fluke infection
What is a Cholesteatoma?
What can it cause?
A pearly-gray accumulation of squamous debris behind the tympanic membrane
Can cause painless otorrhea or produce enzymes that cause conductive hearing loss
Isolated inability to adduct on eye on lateral gaze. What is the problem?
Vs Down and Out gaze
Damage to the ipsilateral MLF at the pons
Damage to CNIII (typically compression)
What are the physical findings?
What does the superior colliculus do?
The lateral geniculate nucleus?
Vertical Gaze
Thalamic processing of visual information
What structures?
Where do uric acid crystals form in the nephron? Why? What causes them?
Form in the collecting duct due to low pH
Look out for these in tumor lysis syndrome, give allopurinol
What is happening?
Over-stimulation of the adrenal gland by ACTH; hypertrophy of hyperplasia?
Hyperplasia apparently……
How to treat side effects from anti-psychotic overdose
Drug-induced parkinsonism (D2 blockade) give benztropine or trihexyphenidyl
Neuroleptic malignant syndrome, give dantrolene
Overdose/side effect of what medication?
What is the liver’s response to nephrotic syndrome?
Lots of protein production! Makes everything from albumin to lipoproteins to try and increase oncotic pressure.
Will also see RAAS activation which retains sodium and water and exacerbates edema
Most common cause of death in Fredreich Ataxia?
Cardiomyopathy
Most common cause of death in what trinucleotide repeat disorder? Symptoms?
Where does chemotherapy cause nausea? Where is it located?
Area postrema in the medulla
What does this do?
How does gynecomastia occur in cirrhosis?
Increased estradiol from adrenals produces more sex-hormone-binding globulin from the liver. This binds up free testosterone and increases relative estrogen levels.
What are spider angiomata?
Small vessel dilations around a single larger dilated vessel. Seen with increased estrogens (pregnancy and cirrhosis)
What is the most common cause of aplastic anemia in kids? What are some other causes
Most common cause is idiopathic (toxin or viral)
Other causes are Fanconi (inherited, short w/ no thumbs), Parvovirus (erythrocyte loss in pts with overlying issues ex ss)
Obese woman with bilateral transient visual disturbances exacerbated by valsalva and daily headache. Diagnosis? Pathologic cause?
Pseudotumor Cerebri, bilateral equal papiledema. Caused by reduced axoplasmic flow down optic nerves
Kid gets little scattered puritic pustules after eating certain foods. Underlying cause?
Asthma, this is atopic dermatitis
Skin findings?
What mutation can cause MODY? Or also gestational hyperglycemia?
Mutation in glucokinase. Beta cells are less responsive to glucose so less insulin is produced.
This can cause?
Accumulation of fluid in the lung parenchyma in heart failure causes what change in lung physiology?
Reduced compliance
What causes this in the lung?
What effect will uncal herniation have on the eyes?
Ipsilateral occulomotor palsy. Down and out gaze with a dilated pupil.
What kind of herniation produces this finding?
Why does skin get lighter in vitiligo?
Autoimmune destruction of melanocytes
What is the pathogenesis of HIV dementia?
At <200 CD4, inflammatory activation of microglia
Most common mutation in hemochromatosis?
HFE, it associates with transferrin and is the sensor of iron levels.
What disease is this?
Waxing and waning lymph node size is suggestive of what lymphoma
Follicular lymphoma
What cytokine is responsible for cachexia in cancer (also fever)? What cell make it?
TNF-alpha secreted by macrophages.
What does it do?
How can you distinguish polycythemia vera from dehydration?
Both have increased levels of all cells but polycythemia has additional findings like splenomegaly and pruritis
What is the cause of wrinkles?
Reduced collagen fibril production; typically due to UVA damage
Elderly patient with recurrent small lobar hemorrhages. What is it?
Elderly patient with recurrent deep structure hemorrhages?
Recurrent small lobar hemorrhages are associated with cerebral amyloid angiopathy; similar to AD amyloid, non-systemic.
Recurrent small deep structure hemorrhages are likely Charcot Bouchard, HTN associated.
CD55, what is it? What does it cause? Common findings? Renal findings?
Decay accelerating factor, deficient in paroxsysmal nocturnal hemolysis. Will see hemolysis labs (bilirubin, low haptoglobin). High iron can cause hemosiderosis in the kidney
Disease?
Thoracic Outlet Anatomy
Brachial plexus passing through scalenes above first rib. Compression of lower trunk can cause upper extremity numbness, compression of subclavian vein causes swelling, compression of subclavian artery causes claudication.
What is this syndrome?
Drug to treat osteoporosis while reducing breast cancer risk?
Raloxifene: SERM that inhibits estrogen signaling at breast and uterus while acting on bone
Why not Tamoxifen? It has uterus agonism which is not desired.
What causes a hematoma to turn green as it heals?
Heme in the tissue is degraded to biliverdin by heme oxygenase (green). Biliverdin will be converted to biliverdin reductase into bilirubin and go to the liver.
Typical carcinogenesis cascade in colon adenocarcinoma
APC –> KRAS –> P53
What are pseudogout crystals made out of? What do they look like?
Crystals of calcium pyrophosphate, rhomboid shape and appear blue on bi-refringence.
Symptoms of uncal (temporal lobe pressing in), subfalcine (upper at falx cerebri), and tonsilar herniations
Uncal: down and out gaze w/ blown pupil, CNIII compression
Sufalcine: compression of anterior cerebral artery
Tonsilar: coma and death from brainstem compression
Torticollis
intrauterine malpositioning that leads to sternocleidomastoid fibrosis. Head tilted toward lesion and chin pointed away
What can cause IgE-independent mast cell degranulation? Symptoms?
Radiocontrast, Opiods, and Vancomycin can cause pruritis on administration
Another name for Osler-Weber-Rendu Syndrome. Symptoms?
Hereditary Hemorrhagic Telangiectasia. Nose bleeds, telangectasias on lips and skin
Patient has antrial and vetricular septal defects, genetic cause?
Down syndrome. Heart defects?
Ambiguous genitalia plus virilized mother during pregnancy. Diagnosis?
Aromatase deficiency
What secondary tumor is associated w/ familial retinoblastoma?
Osteosarcoma. Sarcomas in general are common
Where does the radial nerve enter the forearm?
Over the lateral epicodyle of the humerus and through the supinator canal (through the supinator muscle)
What makes RBCs look blue on Wright Giemsa stain?
Ribosomal RNA
Turns RBCs what color w/ what stain?
Visual information is processed through what structure?
Lateral Geniculate Nucleus
Why does ESR change with inflammation?
Chronic systemic inflammation, macrophages release IL-1, IL-6 and TNF-alpha. Fibrinogen release is increased by the liver which makes RBCs stick together.
What enzyme increases carcinogen formation?
Cytochrome P450 Microsomal Monooxygenase
