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UWorld > pathophysiology > Flashcards

pathophysiology Flashcards

1
Q

diet supplement to improve homocysteinuria

A

B6 (homocysteinuria is often a deficiency of cystathionine synthetase, which requires pyridoxine as a cofactor)

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2
Q

viral phenotypic mixing

A

co-infection of a host cell by two viral strains resulting in progeny virions that contain nucleocapsid proteins from one strain and the genome of the other. No change in genome so progeny will revert to original, unmixed phenotypes

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3
Q

urethritis, conjunctivitis, arthritis

A

triad of reactive arthritis (type of spondyloarthropathy)

-symptoms manifest following a primary infection

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4
Q

2 sequelae of subarachnoid hemorrhage

A 
rebleeding
secondary vasospasm (prevent with nimodipine)
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5
Q

why do kids squat when they have tetralogy of fallot

A

squatting cuts off some of the circulation to legs which increases resistance in left heart. The increasing pressure then limits the right to left flow through the VSD.

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6
Q

Eisenmenger syndrome

A

reversal of shunt to right-left (occurs with increasing pulmonary hypertension that increases right-sided heart pressures that overcome left)

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7
Q

how to tell the difference between myasthenic and cholinergic crisis in pts with myasthenia gravis

A

administer edrophonium (Tensilon test)

  • clinical improvement indicates the pt is undertreated (myasthenic crisis) and meds should be increased
  • no improvement indicates cholinergic crisis (too much meds)
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8
Q

coronary steal

A

phenomenon in which blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas

  • can lead to hypo perfusion and worsening of ischemia
  • drugs like adenosine and dipyramidole
  • used in myocardial perfusion imaging to simulate coronary vasodilation induced by exercise
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9
Q

erythema infectosum

A

fifth disease (parvoviridae)

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10
Q

only non-enveloped, single stranded DNA virus

A

parvoviridae (fifth disease)

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11
Q

complication of ulcerative colitis presenting with signs of shock

A

toxic megacolon

  • diagnose with X-ray
  • risk of perforation
  • usually along transverse colon
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12
Q

pulsus paradoxus

A

decrease in systolic BP greater than 10 with inspiration

  • acute cardiac tamponade, restrictive cardiomyopathy
  • constrictive pericarditis, severe obstructive lung disease
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13
Q

pro-carcinogens are metabolized into carcinogens by…

A

cytochrome p450 system (microsomal monooxygenase)

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14
Q

pathogenesis of centriacinar emphysema

A

chronic, heavy smoking causes release of proteinases, especially elastase, from infiltrating neutrophils and alveolar macrophage

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15
Q

true vs. false diverticuli

A

true contain all parts of intestinal wall but false don’t have muscle component

  • true: meckel’s, appendix
  • false: colon diverticuli, Zenker’s
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16
Q

hypoglycemia following prolonged fasting (>24 hrs) with low ketones

A

think beta-oxidation enzyme deficiency (vs. glycogen storage disorder)

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17
Q

which non-essential amino acid becomes essential in phenylketonuria?

A

tyrosine (need to supplement)

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18
Q

atypical/malignant phenylketonuria

A

deficiency of dihydriopterin reductase

  • responsible for reduction of BH2 to BH4
  • BH4 is a cofactor for many enzymes in tyrosine pathway
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19
Q

silicosis impairs what cell type?

A

macrophage due to internalized silicon particles

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20
Q

cause of low calcium following blood transfusion

A

calcium chelation by citrate coagulation in whole blood/packed RBC blood transfusions

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21
Q

cysteinuria defect and only clinical manifestation

A
  • defect of transporter of cysteine, ornithine, lysine and arginine
  • chronic nephrolithiasis
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22
Q

3 causes of HIV-associated esophagitis

A

candida, HSV-1, CMV

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23
Q

pelvic fracture and inability to void in male suggests….

A

urethral injury, usually at membranous urethra (weakest point)
Foley catheter contraindicated

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24
Q

glomangioma

A
  • benign bluish lesion under the nail bed

- originates from smooth mm. cells that control the thermoregulatory function of dermal glomus bodies

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25
Q

reperfusion injury

A

paradoxical death of cells via apoptosis or necrosis after blood flow restored
- can cause oxidative damage, cell membrane damage, mitochondrial damage, complement and inflammation

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26
Q

chronic diseases associated with amyloidosis

A

AL - multiple myeloma. nephrotic syndrome

AA - RA, IBD, spondyloarthropathy

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27
Q

ligating the inferior thyroid artery can damage which nerve?

A

recurrent laryngeal nerve

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28
Q

most common cardiac defect in Down’s

A

endocardial cushion defects

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29
Q

special types of necrosis

A 
liquefactive = CNS
fat = acute pancreatitis
caseous = TB
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30
Q

most common tumor of pineal gland

A

germinoma

  • kids/adolescents, males more
  • precocious puberty, impaired upward gaze, possible obstructive hydrocephalus all due to mass effect
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31
Q

test for hereditary spherocytosis

A

osmotic fragility test (do RBCs lyse in hypotonic soln?)

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32
Q

fundoscopy for diabetic retinopathy

A

“cotton wool” exudates, retinal hemorrhages, new vessel formation

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33
Q

2 tumors of cerebellum

A

medulloblastoma and pilocytic astrocytoma

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34
Q

superior vena cava syndrome

A

MOA: obstruction of SVC that impairs blood drainage from head
S/S: swelling of face/neck, dilated collateral vv., elevated ICP possible
- medical emergency

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35
Q

heteroplasmy

A

coexistence of both mutated and wild type versions of mitochondrial genomes in an individual cell

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36
Q

holosystolic murmur that increases with inspiration

A

tricuspid regurgitation (more venous return causes increase with inspiration)

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37
Q

CREST syndrdome

A

type of scleroderma

Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia

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38
Q

toe gangrene, renal failure following invasive procedure

A

artheroembolic renal disease (cholesterol crystals in arteriole lumen)

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39
Q

myxomatous degeneration

A

pathological weakening of connective tissue

- associated with Marfan’s, aortic aneurysms, mitral prolapse

40
Q

alpha-1 antitrypsin deficiency associated with

A

panacinar emphysema DON’T SMOKE

41
Q

MOA alpha-1 antitrypsin deficiency

A

A1AT main role is to protect lungs from neutrophil elastase (breaks down elastase, also found in alveolar macrophage)

42
Q

pathophysiology of tertiary syphilis aneurysm

A

obliterative endarteritis of the vasa vasorum

43
Q 
CD55/59 deficiency on RBC
venous thrombosis (ie: hepatic vein)
pancytopenia
A

paroxysmal nocturnal hemoglubinuria
MOA: complement-mediated RBC lysis due to impaired GPI anchor for decay-accelerating factor that protects RBC membrane from compliment)
tx: eculizumab

44
Q

porcelain gallbladder

A

diffuse gallbladder calcification

  • usually an incidental finding
  • 11-33% will develop gallbladder carcinoma
  • recommend cholecystectomy
45
Q

thalamic syndrome

A

total sensory loss (not motor) on contralateral side of body

46
Q

hydrocele MOA

A

MOA: incomplete obliteration of processus vaginalis forming a connection between scrotum and abdominal cavity that allows for fluid leakage

47
Q

mechanism of panic attacks

A

hyperventilation causes decreased PCO2, hypercapnia causes vasoconstriction and decreased cerebral blood flow (dizziness, weakness, blurred vision)

48
Q

how to tell in an elevated alk phos is of bony or liver origin

A

follow up with gamma-glutamyl transpeptidase (GGTP)

- will be elevated if biliary/liver origin

49
Q

hemiballism occurs due to a lesion where?

A

contralateral subthalamic nucleus (often due to lacunar strokes)

50
Q

origin of small cell lung tumors

A

neuroendocrine (will stain for neuroendocrine markers)

51
Q

murmur heard with intracardiac shunt

A

splitting of S2 (no change with respiration)

52
Q

solvent that can inactivate enveloped viruses

A

ether

53
Q

pathophys of Janeway lesions

A

emboli of fragments of infected intracardiac vegetations

54
Q

enzyme to screen for carcinoid tumors

A

5-hydroxyindoleacetic acid (breakdown product of serotonin)

55
Q

scotoma

A

area in visual field that is diminished
central or arcuate (arc shape)
due to lesions on macula

56
Q

ectopy definition

A

microscopically and functionally normal tissue found in an abnormal location due to embryonic maldevelopment (i.e.: Meckel’s)

57
Q

recurrent pulm/sinus infections
ataxia
telangectasias

A

ataxia-telangiectasia (defect in ATM gene responsible for repairing double strand DNA breaks)

58
Q

MOA stable vs unstable angina vs prinzmental

A

stable: fixed plaque occluding >75% of coronary a. lumen
prinzmetal: vasospasm
unstable: ulcerated plaque with partially obstructive thrombus

59
Q

increased activity of what enzyme may contribute to colon adenocarcinoma

A

COX-2 (over expression)

60
Q

hemoglobin S aggregates in which conformation

A

deoxygenated/taut form (curve shifted to right)

61
Q

pathophysiology of nondestructive fibrinous vegetations on cardiac valve cusps

A

nonbacterial thrombotic endocarditis (NBTE)

-hypercoagulability caused by procoagulant effects of circulating products of cancers

62
Q

red neurons

A

first microscopic change following ischemic brain injury

  • 12-24 hours
  • will be phagocytized by macrophage
63
Q

pathophysiology of diabetic mononeuropathy

A

ischemic nerve damage
- in CNIII damage, peripheral nerve is spared, core damaged so motor function impaired but not pupillary size and reactivity

64
Q

heart problems associated with carcinoid syndrome

A

right-sided valvular heart disease (tricuspid, pulmonary)

65
Q

free air in the biliary tree

A

fistula forms between gallbladder and small intestine

- can lead to obstruction of ileoceccal valve

66
Q

serum autoantibodies highly specific for RA

A

anti-cyclic citrullinated peptides (rheumatoid factor is not specific)

67
Q

vitamin deficiency that mimics Friederich ataxia

A

vitamin E

68
Q

pulsus paradoxus

A

seen with cardiac tamponade

  • drop of > 10 mmHg on inspiration
  • radial pulse disappears with inspiration
69
Q

structure commonly injured in anterior or posterior dislocations of knee

A

popliteal artery (tibial nerve more likely injured with tibial fracture)

70
Q

skin condition associated with celiac disease

A

dermatitis herpatiformis

71
Q

heart problems in DiGeorge

A

great vessel defects: persistent truncus arteriosus, Fallot, interrupted aortic arch

72
Q

most common cause of death from MI before hospitalization

A

ventricular fibrillation precipitated from ischemia

73
Q

most common cause of death from MI in hospital

A

ventricular failure/contractile dysfunction

74
Q

most common cardiac manifestation of SLE

A

pericarditis (sharp pleuritic pain relieved by leaning forward)

75
Q

medulloblastoma vs pilocytic astrocytoma on imaging

A

medulloblastoma is solid but pilocytic astrocytoma is solid and also cystic

76
Q

S. bovis endocarditis is associated with….

A

colon cancer

77
Q

kidney stones that are radiolucent

A

uric acid stones (all others radioopaque), use ultrasound to visualize

78
Q

where do clear cell carcinomas originate?

A

epithelial cells of proximal renal tubule

79
Q

ezcema
thrombocytopenia
recurrent infections

A

Wiskott-Aldrich syndrome

  • X-linked
  • tx: bone marrow transplant
80
Q

order of cardiac AP velocity (fastest to slowest)

A

“Park AT VENTura Avenue”

Purkinji system, atrial mm., ventricular mm., AV node

81
Q

cell type that prevents hematologic spread of candida

A

neutrophils (T cells responsible for fighting local infection only)

82
Q

myotonia (abnormally slow relaxation)
frontal baldness
cataracts
testicular atrophy

A

myotonic dystrophy

  • CTG repeat expansion
  • abnormal expression of myotonin protein kinase
83
Q

AML vs ALL (stains)

A

AML: auer rods stain positive for myeloperoxidase
ALL: TdT

84
Q

psammoma bodies

A

papillary CA of thyroid
meningioma
mesothelioma
serous endometrial CA

85
Q

nerve commonly injured during thyroidectomy

A

superior laryngeal (innervates cricothyroid mm.)

86
Q

renal papillary necrosis diseases

A

“SAAD papa”

  • Sickle cell disease/trait, Analgesics, Acute pyelo, DM
  • from ischemia, causes hematuria
87
Q

S-100 positivity

A

tumors of neural crest origin (melanoma, schwanomma, etc.)

88
Q

proto-oncogene examples

A

ras, ERB, N-myc, abl (anti-oncogenes: Rb, WF-1, p53, APC, BRCA)

89
Q

3 ways to get Down’s

A
  1. meiotic nondisjunction
  2. unbalanced Robertsonian translocation
  3. mosaicism
90
Q

BRAF mutation

A

melanoma (signaling pathway for melanocytes)

91
Q

dysthymic disorder

A

less severe than major depressive disorder

  • only 4 or fewer symptoms present (> 5 for MDD)
  • must be present at least 2 years
92
Q

uptake of promodeoxyuridine indicates…

A

high grade in brain tumor (reflects number of cells in S phase - preparing to divide)

93
Q

first area damaged by global cerebral ischemia

A

hippocampus (pyramidal cells) followed by purkinje cells of cerebellum

94
Q

chronic diarrhea
bacterial and viral infections
mucocutaneous candidiasis

A

SCID

95
Q

parinaud syndrome

A

paralysis of conjugate vertical gaze due to lesion in superior colliculi (ie: pinealoma), upward gaze palsy

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