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
What cells are lost in Hpylori infection? What type of ulcers are formed?
Chronic gastritis causes loss of delta cells (somatostatin) in antrum. Duodenal ulcers form.
Treatment for serotonin syndrome?
Cyproheptadine
Treats what?
Treatment for restless leg syndrome?
Dopamine Agonist like Ropinerole or pramipexole
Findings in reactive arthritis?
Conjunctivitis, Urethritis, arthritis
Also rash on palms/soles and sacroilitis uncommonly
p57 expression in different types of molar pregnancies? Villi?
Complete is p57 negative; Partial is p57 positive
Both have villi
McCune-Albright syndrome symptoms
unilateral cafe au lait spots; endocrine issues (hyperthyroid, precocious puberty), and fibrous dysplasia of bones
Surgical treatment for carpal tunnel syndrome?
Cut the transverse carpal ligament (flexor retinaculum)
What 2 vitamins do enteric bacteria make?
Vitamin K, Folate
Radical prostatectomy can cause what nerve damage and effect?
Can damage prostatic plexus, lead to erectile dysfunction
What is the first step in forming a valve vegetation in infectious endocarditis?
Valve damage, fibrin deposition creates a nidus for bacteria to adhere to.
What blood results change in chronic alcoholism?
Macrocytosis can exist outside of folate deficiency
Causes of hyaline arteriolosclerosis in the kidney
Diabetes and hypertension
Glossopharyngeal Nerve CNIX; Functions
Stylopharyngeous; Salivary response, taste posterior third; sensory eustacian tube/TM/tonsils/upper pharynx
What auscultation finding suggests the severity of mitral regurgitation?
Presence of an S3; overfilling of LV
In skin, CFTR is involved in Cl secretion. In lungs and GI, what is the problem?
Less Cl is pumped into lumens so more Sodium is reabsorbed!
What does PAS stain?
Glycoprotein
95% confidence interval
mean +/- 1.96 SD / rootn
Itchy rash with thickened skin overlying breast. Diagnosis?
Peau d’orange rash; inflammatory breast carcinoma
Integrins: What do they do?
Transmembrane proteins that bind the ECM including collagen, fibronectin, and laminin
Major risk factor with PCOS?
Endometrial CA: anovulatory cycles do not allow estrogen breaks
Major side effects of succinylcholine
Malignant Hyperthermia (give dantrolene) Hyperkalemia (arrhythmias)
Path of CSF flow
Lateral ventricles –> foramen of Monroe –> 3rd ventricle –> aqueduct –> 4th ventricle –> Lushka/Majendie –> Subarachnoid space –> arachnoid granulations –> LV
Sensation to the ear canal, what nerves?
Most of it is V3 but external portion is Vagus
Lifetime risks w/ bicuspid aortic valve
Speeds up aging process; early onset aortic stenosis and atherosclerosis
Symptoms with a T cell ALL vs B cell ALL
T cell might have mediastinal mass that would cause dysphagia, SVC syndrome, expiratory stridor, etc.
Differentiating Pneumoconioses
Coal: upper lesions, coal-laden macrophages
Silica: Birefringent, upper lesions, egg-shell calcifications
Asbestos: low lesions, pleural plaques
How long is depression normal post partum?
Post partum blues is normal up to 14 days. Then it is depression and treatment is needed.
Treatment for Whipple disease?
Antibiotics
Arginase deficiency symptoms and labs etc.
Elevated arginine from urea cycle dysfunction. Spastic diplegia, abnormal movement, growth delay. Treat w/ low protein diet.
Reducing cellular infiltration in asthma long term. What med?
Fluticasone. Long term corticosteroid best at dilating and reducing cell infiltration
Best way to hear an S3? What makes it louder?
Best heard will bell in left lateral decubitus, accentuated with end expiration (deflating lungs and bringing heart closer to chest wall)
How are elastin fibers connected extracellularly?
Interchain cross-links involving lysine
Bortezomib
Boron-containing proteasome inhibitor that treats multiple myeloma
What innervates Muscles of mastication? What else does it innervate?
V3; also innervates tensor tympani in the ear
What is the first step in age-related dystrophic calcification of an aortic valve?
Necrosis, the precursor to all dystrophic calcification
Comatose patients with rigid extended extremities, what is damaged? What about flexor positioning?
Extensor position is due to sub red nucleus damage, typically the pons.
Flexor position is damage about the red nuclues, the hemispheres or the internal capsule.
Arterial blood gas readings in PE
Respiratory alkalosis 2’ hyperventilation w/o getting oxygen in.
Low O2, Low CO2, High pH, Normal bicarb (for 48 hours or so)
Would Charcot-Bouchard aneurysms or lacunar infarcts cause CT abnormalities?
Charcot-Bouchard would produce small hemorrhage on CT Lacunar infarct (hypertensive arteriolar sclerosis) would not
What are Dohle bodies? Where are they seen?
Basophilic granules in neutrophils, seen in normal leukemoid reaction
Ovarian tumor w/ “cells in microfollicular pattern around pink eosinophilic center”. What are they?
These are Call Exner bodies. Seen in granulosa cell tumors
Abetalipoproteinemia
Inability to form chilomicrons, VLDL and ApoB due to MTP dysfunction. Fat accumulates in enterocytes because it cannot leave into circulation.
Marfanoid habitus, visual issues. What are the risks? What do you supplement with?
Homocysteinuria, at risk for thromboembolic disease, give pyridoxime
Mitral Valve Prolapse is a defect in what tissue?
Connective Tissue
Grading extent of chronic bronchitis
Wall thickness. Ratio of mucus glands to rest of wall (excluding cartilage). Typically 0.4
Where do yo utake the saphenous for a graft?
Inferolateral to the pubic tubercle
Timolol Uses (optic)
Treatment of open angle glaucoma by targeting the ciliary epithelium and reducing aqueous humor
Markers for small cell lung cancer
Neuroendocrine markers: chromogranin, neural cell adhesion molecules, enolase
Weird drugs that inhibit cytochrome oxidases apparently
macrolides, ciprofloxacin, verapamil
Earliest sign of diabetic nephropathy
micoalbuminuria
4 major muscles that attach to the clavicle
Sternocleido, Pec Major, deltoid, trapezius
Endoneural Inflammatory Infiltration vs Endoneural Arteriole Hyalinization
Inflammatory infiltration = Guianne Barre
Arteriole Hyalinization = Diabetic Neuropathy
Distinguishing Febrile Seizure from Fever of Meningitis
Febrile seizure temperature will improve with acetaminophen
Changes in K levels over course of acute tubular necrosis?
Maintenance stage is hyperkalemia, recovery phase is hypokalemia due to high volume diuresis
Rifaximin: purpose and MOA
Non-absorbed ABX, reduces ammonia production by enteric bacteria. Used in hyper ammonemia
Chronic lung transplant rejection attacks what? What about hyperacute and acute?
Chronic attacks small bronchi
Acute and Subacute attack blood vessels
DIC in pregnancy?
Likely due to tissue factor released from placental damage.
Two cytokines involved in angiogenesis?
VEGF and FGF
Which kidney stones prefer what pH?
Calcium Phosphate = >7
Magnesium = >7
Citrate = <7
Uric Acid = <7
Insidious liver and brain vs insidious liver and heart/endocrine
Wilsons (+eyes) and Hemochromatosis
What nerves make up the pupillary light reflex? What do palsys look like?
Afferent is CNII Efferent is CNIII
CNIII palsy is down and out, blown pupil, and ptosis (levator palpibrae)
Kid with isolated toe cyanosis and clubbing with normal arms
PDA
Aspergillus causes cancer by altering what protein?
P53
CNIII ischemia vs compression
Ischemia (diabetes) causes down and out, pupil, ptosis, etc.
Compression (uncal herniation) only causes pupil issues
Massive spleen, bone marrow fibrosis, pancytopenia
Hairy Cell Leukemia (B cells). Diagnose with TRAP stain
Ejection fraction, end diastolic volume, and end diastolic pressure in diastolic heart failure
Normal EF, Normal EDV, Increased EDP
What is polyarteritis nodosa associated with?
HepB
Androgenic alopecia has what type of inheritance?
Polygenic
What metabolic abnormality can lead to bilateral cateracts in children?
Galactosemia from galactokinase defect. Increased Galactitol (benign metabolically) can cause cataracts
What artery supplies the AV node?
The Posterior Descending (typically off of right coronary)
Three main cell types that cause COPD progression
Neutrophils, Macrophages, CD8s
What heritable disease is a contraindication for ACE inhibitor use? Why?
C1 esterase inhibitor deficiency/ hereditary angioedema. Produces high levels of Bradykinin through Kalikrein. Exacerbated by ACEIs
How to distinguish chronic HepB from HepC on histology
HepB has surface antigen in cytoplasm giving it a “ground glass appearance”. Plus typical hepatitis findgins of ballooning, portal inflammation, mononuclear inclusions and counsilman bodies
HepC only has typical hepatitis findings plus lymphoid aggregates in portal tracts
Pulmonary findings in scleroderma
Cor pulmonale: intimal thickening of pulmonary arterioles.
How is Lipofuscin created?
Lipid peroxidation
Symptoms of Multiple Myeloma
Easily fatigued, constipation, back pain, high serum protein
Multiple myeloma nephropathy
Intense eosinophilic casts (Bence Jones protein)
Effect of alcohol consumption on heart
Can cause Afib, absent P waves. “holiday heart syndrome”
Which TCA Cycle enzyme requires B2?
Succinate Dehydrogenase, involves w/ complex II
What other rheumatologic condition is giant cell associated with?
Polymyalgia Rheumatica
Angiomyolipoma, what disease?
Tuberous Sclerosis, typically bilateral in kidneys
Most common ligament in an ankle sprain?
Anterior talofibular
High urine concentrations of what reduce the risk of calcium oxylate stone formation?
High Citrate
Vasopressin increases tubular permeability to what two things?
water and urea
What parts of the TCA cycle require niacin?
All dehydrogenases
3 things made from POMC
ACTH, MSH, Enkephalins
What part of the spleen houses the reticuloendothelial system?
the red pulp
Where is most water reabsorbed by the kidney regardless of hydration/hormone status?
Proximal Tubule
What amino acid is necessary for renal acid excretion?
Glutamate
Cryptococcus is a budding yeast, not a spherule. That is coccidiodes.
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