Missed Questions Retake Flashcards
Adolescent with neuropathic pain (burning sensations) and hypohidrosis (decreased sweating) exacerbated by stress, exercise, and fatigue. Later he develops angiokeratomas (dark red, non-blanching macules and papules in clusters over the butt, groin, and umbilicus) and telangiectasias.
What is the diagnosis?
Fabry Disease
X-linked recessive
alpha-galactosidase A deficiency
Buildup of globotriaosylceramide
Leads to: cerebrovascular and cardiac issues, renal failure due to Gb3 buildup
How does sepsis cause ARDS?
As cytokines circulate in response to the infection, they activate the pulmonary epithelium and provoke an inflammatory response mediated by neutrophils. This leads to capillary damage and the leakage of protein and fluid into the alveolar space.
Newborn girl with normal internal genitalia but ambiguous or male-type external genitalia (clitoromegaly). Baby caused mother to be virilized (hirsutism, deep voice). What is deficient in the baby?
Aromatase Deficiency
AR
High androgen and low estrogen in a female fetus.
What enzyme functions exclusively in the nucleolus?
RNA Polymerase 1
Transcribes 45S pre-rRNA into a template that is processed into mature 18S, 5.8S, and 28S rRNAs.
FORMATION OF RIBOSOMES
Functions of IL-2
- Proliferation and differentiation of Helper T cells
- Monocyte activation
- NK Cell activation
- Growth of T cells and INF gamma secretion
- Stimulation of division of B cells
*Anti-cancer effect on metastatic melanoma and renal cell carcinoma*
First line treatment for Narcolepsy (daytime) for stimulation
Modafinil
Non-amphetamine stimulant
Well-tolerated
Rarely causes drug abuse
What is a developmental field defect?
Multiple malformations that occur secondary to an embryonic disturbance in an adjoining group of cells.
Ex = holoprosencephaly
Penicillins, cephalosporins, and vancomycin target what part of an organism?
Peptidoglycan cell wall
Most common pathogens causing nosocomial bloodstream infections
Coag neg staph
Staph aureus
Enterococci
Candida
An IL-1 or TNF-alpha inducible enzyme that is highly expressed by inflammatory cells and undetectable in surrounding normal tissue….
COX-2
Target it specifically with Celecoxib
An increased total RBC mass in the presence of an increased hematocrit level
Absolute Erythrocytosis
Increased hematocrit with normal RBC mass
Relative Polycythemia
Likely due to dehydration or excessive diuresis
Absolute polycythemia with decreased Erythropoietin levels
Primary erythrocytosis
Caused by a myeloproliferative disorder like PV
Absolute polycythemia with increased erythropoietin levels
Secondary erythrocytosis
Chronic hypoxia from high altitudes, smoking, COPD OR abnormal secretion by neoplastic or otherwise diseased tissues
Pt. with hemolytic anemia, hypercoagulability (hepatic vein thrombosis), pancytopenia
Paroxysmal nocturnal hemoglobinuria (PNH)
Absence of GPI anchor and CD55 and CD59 deficiency leads to complement-mediated hemolysis (more often at night due to lower blood pH)
What is the only prokaryotic polymerase with 5’-3’ exonuclease activity?
DNA Polymerase 1
Removes the RNA primer created by RNA primase and repairs damaged DNA sequences.
In a patient with acute mesenteric ischemia, what causes the resulting acid-base disorder?
Inadequate delivery of oxygen to intestinal tissues –> hypoxic conditions –> intracellular accumulation of NADH –> inhibition of pyruvate dehydrogenase –> pyruvate is converted to lactate –> lactic acidosis
This type of cell found on a pap smear… sign of what?
Koilocyte
HPV infection - double stranded, non-enveloped DNA virus with a predilection for squamous epithelium of skin/vagina/cervix
Leuprolide has what initial effect on hormones?
GnRH agonist that causes a transient increase in pituitary LH secretion, which leads to a rise in testosterone levels. If used continuously, it will suppress LH release and lead to a decrease in testosterone production.
Kyphoscoliosis
High arches (pes cavus)
Hypertrophic cardiomyopathy and CHF
Gait ataxia
Spastic muscle weakness
Loss of position and vibration sensation
Diabetes mellitus
Friedreich ataxia
AR
Mutated frataxin gene –> GAA repeats
Decreased mitochondrial energy production and increased oxidant stress –>
- Spinocerebellar and Lateral corticospinal tract degeneration
- Dorsal column and DRG degeneration
Enteropeptidase is responsible for activation of what? Where is it located?
Trypsin
Jejunal brush border enzyme
Deficiency = protein and fat malabsorption –> diarrhea, failure to thrive, edema
Lesion of the lateral optic chiasm can cause ipsilateral nasal hemianopia. An issue with what artery can cause this issue?
Aneurysm of the internal carotid (cavernous or opthalmic segments)
*uncrossed optic nerve fibers from the temporal portion of the retina*
Spontaneous deep intracerebral hemorrhage
Hypertensive vasculopathy from penetrating branches of major cerebral arteries.
Basal ganglia (putamen), cerebellar nuclei, thalamus, pons
Lenticulostriate arteries off MCA –> basal ganglia
Postpartum hemorrhage is usually due to what artery?
Internal iliac –> uterine arteries
Clue cells
Epithelial cells covered with gram-variable rods
Gardnerella vaginalis (bacterial vaginosis)
Off-white discharge
Fishy odor
Metronidazole or Clindamycin
Thick cottage cheese discharge from cervix
Normal pH
Candida vaginitis
Pseudohyphae
Give Fluconazole
Most characteristic skeletal abnormality of Primary Hyperparathyroidism
Osteitis Fibrosa Cystica:
Cortical (compact) bone: pelvic girdle, pectoral girdle, limbs)
Bone pain
Subperiosteal erosions affecting fingers
Salt-and-pepper skull
Brown tumor bone cysts in long bones
Pt presents with constipation, new-onset 2nd degree AV block, and syncope in the setting of a new medication for atrial fibrillation
Calcium channel block
Diltiazem, Verapamil
Kid with poor exercise tolerance, muscle cramps, and rhabdomyolysis
McArdle disease
Deficient myophosphorylase
Major virulence factor for Strep Pyogenes that inhibits phagocytosis and the activation of complement
Protein M
Functions of Insulin
Increases peripheral glucose uptake
Inhibits lipolysis
Inhibits ketoacid formation
Decreases glucagon release
What class of antiarrythmetics prolongs QRS duration without affecting the QT interval?
Class 1C
Flecainide
Propafenone
*only affect fast sodium channels*
Direct thrombin inhibitors are the DOC for treating what? Why?
Heparin-induced thrombocytopenia (HIT)
They do not require antithrombin-3 for their action because they bind directly to the thrombin active site.
Argatroban, Hirudin, Lepirudin
Which TB drug causes optic neuropathy?
Ethambutol
Ascertaining a patient’s volume status and checking urine chloride are important steps in working up what?
Metabolic Alkalosis
Crescent formation in RPGN is caused by the deposition of what?
Deposition of fibrin within Bowman’s space + proliferatied glomerular parietal cells, monocytes, macrophages that have migrated into Bowman’s space