Practice Test 6 Flashcards
What disease is distinguished on light microscopy by “lumpy-bumpy” deposits in the renal basement membrane?
Post-infectious glomerulonephritis-deposits of IgG and C3b
What are the immune complex deposits in Berger disease and what do they cause?
IgA immune complex deposits -> activate alternative complement pathway
What is FSGS?
Glomerular hypertrophy without compensatory growth of podocytes leads to a loss of the filtration barrier and leakage of proteins
- MCC of nephrotic syndrome in adults
- Associated with drug use, HIV, HTN, hyperlipidemia, and hematuria
What are the classic symptoms of polycystic kidney disease?
- Flank pain, symptoms exacerbated by cyst rupture, gross hematuria, HTN and chronic UTIs
- Anemia and inc BUN/Cr
What is acute cholecystitis?
- Inflammation of the gallbladder
- Commonly caused by a gallstone in the cystic duct
- Sx-fever, vomiting, palpable GB, and RUQ pain that radiates to the back
- Labs-inc bili
What is granulomatosis with polyangitis?
Nephritic disorder
- Triad of respiratory symptoms, kidney symptoms, and hematuria
- C-ANCA and immune complex deposition in renal vessels
Describe the pain sensation associated with appendicitis
- Rebound tenderness, as well as, RLQ pain with pressure on the LLQ
- Psoas pain with hip extension
- Pain 1/3 the distance from the ASIS to the umbilicus
What is renal cell carcinoma?
Cancer of the renal parenchyma
- Sx-flank pain, fever, HTN, unexplained weight loss, hematuria, and an abdominal mass
- Increase in RBC production due to EPO release from the kidney
What is the difference in presentation between the autosomal dominant form of PKD and the autosomal recessive form of PKD?
Age of presentation
- ADPKD presents in adulthood
- ARPKD presents childhood (usually fatal)
What are the characteristics of epidural hemorrhages?
- Result from rupture of the middle meningeal artery
- Pts present with a lucid interval, severe headache, and pupil abnormalities
What is the change in preload/afterload due to Mueller maneuver?
Increases preload
What is the change in preload/afterload due to squatting?
Increases preload
What is the change in preload/afterload due to handgrip?
Increases afterload
What is the change in preload/afterload due to valsalva maneuver?
Decreases preload
What is the change in preload/afterload due to standing?
Decreases preload
Important to understand the difference between aortic stenosis and hypertrophic cardiomyopathy and what happens when there is increased blood in each
Aortic stenosis-A fixed lesion, when more blood is passing through the stenotic area, there will be a greater intensity in the murmur
Hypertrophic cardiomyopathy-A dynamic lesion, when more blood is passing through the valve pushes open the obstructed portion making a larger space for it to pass through, lowering the intensity of the murmur
What is the murmur associated with aortic regurgitation?
High pitched diastolic murmur heard best heard at the left sternal border
-Will increase in intensity with a maneuver that increases afterload (handgrip)
What is the murmur associated with aortic stenosis?
Systolic crescendo-decrescendo murmur that radiates into the carotids
-A fixed lesion, when more blood is passing through the stenotic area, there will be a greater intensity in the murmur
What is the murmur associated with mitral regurgitation?
Systolic murmur with a high pitched blowing quality heard best at the apex
- The murmur can radiate to the left axilla
- Decreases in intensity with standing
- Increases in intensity with squatting
What is the murmur associated with mitral stenosis?
- Low pitched diastolic rumble
- Best heard at the apex with patient in the left lateral decubitus patient
- Decreases in intensity with maneuvers that decrease preload
Intrauterine devices are associated with?
- Reduced risk of pregnancy
- BUT if the patient does become pregnant, there is an increased risk that it will be ectopic
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
What is the presentation of nephrotic syndrome?
- Hypoalbuminemia
- Proteinuria
- Hyperlipidemia
- Generalized edema
What is the treatment for minimal change disease?
Corticosteroids
What type of hypersensitivity reaction is post strep glomerulonephritis?
Type 3 hypersensitivity
What is centrilobular congestion and necrosis of the liver indicative of?
Budd-Chiari syndrome-thrombosis of two or more hepatic veins
- Associated with hypercoagulable states
- Classic triad-RUQ pain, hepatomegaly, and ascites
What is seen on abdominal US in patients with Budd-Chiari syndrome?
Collateral vessels in a spider web pattern and decreased hepatic venous blood flow
What are the treatments for Budd-Chiari syndrome?
Initial medical treatment is thrombolysis followed by anticoagulation
-Treatments that are more definitive include the TIPS (transjugular intrahepatic portosystemic shunt) procedure or liver transplant
Diffuse fibrosis of the liver and nodular regeneration is associated with?
Cirrhosis
-Signs and sx include hematemesis and melena (d/t esophageal varices and/or peptic ulcers), splenomegaly, caput medusae, ascites, and hemorrhoids
What are caput medusae?
Tortuous paraumbilical collateral veins
Granuloma formation within the portal triad is seen in what dz?
Primary biliary cirrhosis
- An AI rxn associated with serum mitochondrial Abs
- Results in damage to the mitochondrial proteins in the bile duct epithelium with lymphocytic infiltration and granuloma formation
What are the presenting symptoms of primary biliary cirrhosis?
Pruritis, jaundice, dark urine, pale stools, and hepatomegaly
What diseases can cause microvascular changes within the liver?
- Acute fatty liver of pregnancy
- Medications including tetracyclines and salicylates
- Reye’s syndrome
- Ethanol use
What are the symptoms of acute fatty liver of pregnancy?
- RUQ pain, nausea, vomiting, and jaundice
- Microvascular changes within the liver
- No ascites or signs of portal HTN
If ascites and portal HTN are present they are indicative of?
Thrombosis of the portal system
What is Reye’s syndrome?
- Caused by aspirin use in young children
- Presents with hypoglycemia, encephalopathy, and microvesicular fatty liver
What are swollen hepatocytes with neutrophilic inflammation indicative of?
Hepatitis (inflammation of the liver)
- Acute hepatitis-MC causes are viruses (HAV, HBV, HCV, HDV, HEV) and drugs
- Chronic hepatitis-chronic viral infx, alcohol, AI hepatitis, and metabolic syndromes (Wilson’s, hemochromatosis, and A1AT deficiency)
What drugs are capable of causing acute hepatitis?
Acetaminophen, INH, and methyldopa
What is the presentation of acute hepatitis?
- Malaise, nausea vomiting, followed by jaundice and RUQ pain
- Dramatic increase in liver enzymes
What is complex regional pain syndrome?
- Chronic progressive disease
- Type 1 CRPS-No evidence of nerve damage, characterized by severe burning pain at the site of injury. Muscle spasm, joint spasm, restricted mobility, rapid hair/nail growth, vasospasm, edema, and skin changes can also occur
- Type 2 CRPS-Same symptoms as type 1, the difference is the presence of a defined nerve injury
Occlusion of the inferior division of the middle cerebral artery is associated with what defect?
- Wernicke’s aphasia (difficulty understanding spoken language, speech is preserved but language content is not correct)
- Can also include contralateral homonymous hemianopia and apraxia
Occlusion of the superior division of the middle cerebral artery is associated with what defect?
Broca’s aphasia (Non-fluent speech, language comprehension is intact)
Describe the protocol for the initial diagnosis and treatment of a stroke
- Initial test-non-contrast CT imaging
- If imaging shows a normal or hypodense area consistent with acute ischemic stroke, consider aspirin to decrease the incidence of a second event and IV thrombolytics
What are charcot-bouchard aneurysms?
Microinfarction of the branches of the lenticulostriate vessels that develop into aneurysms
- Have the propensity to rupture -> hematomas w/in brain tissue
- Most common sites of hemorrhage are the basal ganglia, thalamus, pons, and cerebellar hemispheres
Explain the effects of teratogens during the different stages of fetal development
Exposure to teratogens during:
- Early embryogenesis (first 2 weeks after conception)-usually causes spontaneous abortion or no adverse effect (known as the all or none period)
- Embryonic period-weeks 3-8-organogenesis begins, extremely sensitive to teratogens
- After week 8-teratogens can cause minor morphological abnormalities
When is the heart most susceptible to teratogens (i.e when does it undergo major development)?
During the 3rd/4th weeks of gestation
When is the external genitalia most susceptible to teratogens (i.e when does it undergo major development)?
During the 8th/9th weeks of gestation
What is gastrulation and when does it occur?
Development of the 3 layers (ectoderm, mesoderm, and endoderm) occurs in week 3
-The primitive streak, notochord, and neural plate also begin to form
What does an elevated DHEA-S level indicate?
Androgen secreting tumor
What is normal pressure hydrocephalus?
A condition where the ventricles are enlarged but normal opening pressures on lumbar puncture
What is the triad of symptoms consistent with normal pressure hydrocephalus?
Gait disturbance, dementia, and urinary incontinence (“Wet, wacky, and wobbly”)
What is the MCC of acute infective endocarditis in IV drug users?
Staph aureus followed by pseudomonas aeruginosa
Which heart valve is most often involved in acute infective endocarditis in IV drug users?
Tricuspid valve
What are viridans streptococci (specifically strep mutans) a common cause of?
Subacute endocarditis
Patients with pre-existing heart conditions, such as valvular defects are at higher risk for infections caused by?
Viridans strep, staph epidermidis, and HACEK organisms
Describe the murmur associated with hypertrophic cardiomyopathy
- Systolic murmur typically in a crescendo-decresendo fashion
- Best heard between the apex and left sternal border
- Radiates to the suprasternal notch (not to carotid arteries or neck)
- Murmur and gradient are inverse to preload and afterload (intraventricular septum is enlarged and gets in the way of blood flow)
What is the treatment for hypertrophic cardiomyopathy?
Increase the preload/afterload (try to push the septum out of the way)
-Can do this with beta blocker or verapamil
