practice test 2 Flashcards
what are 2 inherited causes of premature coronary artery disease
familial hypercholesterolemia (LDL receptor or ApoB100 deficiency) or familial dysbetalipoproteinemia (defective ApoE)
What does a low-pitched, rumbling, mid-diastolic murmur heard best over the apex when the patient is lying in the left lateral decubitus position indicate
mitral stenosis
Peutz-Jeghers syndrome is an autosomal dominant disease characterized by _____ and _______
mucocutaneous pigmented macules
gastrointestinal hamartomatous polyps (prone to bleeding and increased risk for malignant transformation)
what is a hamartoma
overgrowth of tissue in its native location
What mass will histologically show nuclear indentations and round clear cytoplasmic vacuoles scalloping of the nuclear membrane
liposarcoma
Differentiate pemphigus vulgaris and Bullous pemphigoid
pemphigus vulgaris:
IgG agaisnt demoglein-1 or desmoglein-3 (part of desmosomes between karatinocytes)
oral involvement
extension of lesion with direct pressure
flaccid blisters
IgG and C3 deposits on fluorescence = net-like
bullous pemphigoid: IgG against hemidesmosomes (epidermal basement membrane) tense blisters eosinophils linear pattern on fluorescence
Patients with alcohol related _____ degeneration experience ataxia that may present as broad based gait, truncal instability, tremor, dysarthria, and diplopia
cerebellar
cerebellar vermis; due to loss of Purkinje cells
How does lithium cause diabetes insipidus
nephrogenic: impairs aquaporin 2 water channels and reduces responsiveness to endogenous and exogenous vasopressin
Brisk rectal bleeding in a 2 yr old previously healthy child with no other symptoms including no abdominal tenderness or distention with normoactive bowel sounds is most likely due to what
mekel divertriculum with gastric mucosa
Prokaryotic _____ is responsible for the removal of RNA primers and the synthesis of new DNA in their place
DNA polymerase I
what is 1-specificity
false positive rate
Lynch syndrome has increased risk of what neoplasms and is associated with what gene mutation
colorectal
endometrial
ovarian
mismatch repair genes (MSH2, MLH1, MSH6, PMS2)
CA-125 is a common tumor marker for what
ovarian cancer
Ticrolimus MOA
calcineurin inhibitor (immunosuppressive)
cyclosporine MOA
calcineurin inhibitor (immunosuppressive)
How are calcineurin inhibitors (tacrolimus, cyclosporine) nephrotoxic
arteriolar vasoconstriction (afferent and efferent) --> increased blood urea nitrogen and creatinine long term use --> obliterative vasculopathy, tubular vacuolization , and glomerular scarring
A 2 yr old with black stains on her cloth diapers when a wet diaper is not immediately changed is what diagnosis? due to what deficiency?
alkaptonuria
defect in homogentisic acid dioxygenase –> impaired tyrosine metabolism
elevated homogentisic acid levels in urine
tx: restrick phenylalanine and tyrosine
other symptoms: ochronotic osteoarthropathy
What are the relative extracellular levels of the following electrolytes during ischemia: Na K Ca HCO3
reduced Na/K ATPase –> extracellular K increased and Na decreased
Extracellular Ca and bicarb: decreased
(intracellular Ca accumulation is hallmark of ischemic injury)
homocystinuria lens subluxation vs Marfan syndrome
homocystinuria: down and in
Marfan: up and out
why is heparin permitted during pregnancy but warfarin is not
warfarin has a low molecular weight, allowing it to cross the placenta to produce teratogenic effects
what is the main bacterial factor responsible for N. gonnorrhea to initiate infection
pili
_____ describes the mixing of genomic segments in segmented viruses that infect the same host cell. This process results in major antigenic ____ that are responsible for pandemics and epidemics of influenza A
reassortment
shifts
what is the cause of McArdle disease and how might it present
deficiency of muscle glycogen phosphorylase (no glycogenolysis)
adolescence or early adulthood with muscle pain, weakness, and decreased exercise tolerance (may have second wind effect due to increased blood flow during exercise)
What are the effects of Pineal tumor (pinealoma)
parinaud syndrome due to mass effect on the dorsal midbrain in the superior colliculus region:
upward gaze palsy
absent pupillary light reflex
impaired convergence