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STEP Flash Cards > PT8 > Flashcards

PT8 Flashcards

1
Q

Lesser curvature of the stomach - ulcer perforates - artery at risk?

A

L. gastric

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2
Q

Gram negative bacteria protease that splits the IgA molecule @ hinge region - biological significance of this enzyme?

A

IgA protease - it facilitates mucosal penetration

Neisseria bacteria secrete these

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3
Q

What impairs opsonization and phagocytosis?

A

Encapsulated bacteria - S. pneumo, N. meningitidis, H. influ, Cryptococcus neoformans

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4
Q

Inhibition of phagosome-lysosome fusion or resistance to lysosomal enzymes to promote intracellular survival exhibited by:

A

M. tuberculosis, M. leprae, Legionella

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5
Q

Function of protein A

A

Staph bacteria - impairs complement-mediated cell lysis

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6
Q

Where is bile reabsorbed

A

Terminal ileum

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7
Q

Mayo-containing salad that causes vomiting and nausea - what organism?

A

Staph. aureus - produces heat-stable enterotoxin (prior to ingestion) - rapid onset of Sx

Hint: foods that sit @ room temperature at picnics, pot lucks, etc. Meat, eg, tuna, macaroni salads, milk, dairy products

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8
Q

B. cereus poisoning

A

Rapid onset, nausea, vomiting, cramping - pre-formed heat-stable exotoxin
Usually contaminates starchy foods (rice) - so, reheated fried rice

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9
Q

Where is H. pylori located in stomach

A

Antrum (pre-pyloric region)

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10
Q

Where do you biopsy in Hirschsprung to find the problem?

A

NOT the dilated portion - you biopsy the submucosa of the narrow region to look for aganglionosis

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11
Q

H. pylori-associated antral gastritis

A

Leads to decrease in somatostatin producing antral cells - increase in gastrin - increased risk for duodenal ulcer

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12
Q

Parietal cells located where in stomach?

A

They are pale pink, round, in the periphery of the upper-layer glands

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13
Q

Splenic flexure & blood supply

A

Watershed region for SMA and IMA - susceptible to ischemia and necrosis

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14
Q

How carcinoid tumor looks on histo

A

Composed of nests or sheets of uniform cells - eosinophilic cytoplasm and oval-to-round stippled nuclei; derived from enterochromaffin cells (endocrine) of intestinal mucosa

Commonly found in ileum, appendix, and rectum

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15
Q

GERD on histo

A

Mucosal erythema- basal zone hyperplasia, elongation of laminal propria, inflammatory cells (eosinophils, neutrophils, lymphocytes)

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16
Q

What would you expect to see in someone who has acute pancreatitis due to alcohol abuse

A
  1. AST:ALT ratio > 2

2. MCV > 100 indicating macrocytosis probably due to nutritional deficiencies (such as B12 or folate)

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17
Q

K+ sparing drugs

A

work on CD

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18
Q

Tetralogy of Fallot embryological event

A

Abnormal neural crest cell migration

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19
Q

What kind of drug would be associated with coronary steal phenomenon

A

One that dilates coronary arterioles (ex: adenosine and dipyridamole)

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20
Q

Child with difficulty breathing, fever, gray pharyngeal exudate, enlarged cervical lymph nodes & partial soft palate paralysis - bacteria and mechanism of infection

A

C. diphtheriae - has an AB exotoxin
A subunit ribosylates EF-2 (causing cell death)
B subunit allows A subunit to enter

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21
Q

Exotoxin released by C. perfringens

A

Lecithinase (aka phospholipase C) - degrades membrane phospholipids (including lecithin) leading to cell membrane destruction and cell death

C. perfringens causes gas gangrene

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22
Q

Pertussis toxin MOA

A

AB exotoxin that stim. cAMP production - increases insulin production, lymphocyte & neutrophil dysfunction, and increased sensitivity to histamine

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23
Q

Shiga toxin MOA

A

Causes inactivation of 60s ribosomal unit (as does EHEC shiga-like toxin)

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24
Q

Viridans strep

A

normal inhabitants of the oral cavity and cause transient bacteremia after dental procedures; produce dextrans which facilitate strep adherence TO FIBRIN AGGREGATES

Thus, strep viridans requires a pre-existing lesion containing fibrin/platelet aggregates to attach (unlike S. aureus which can just attach to intact endothelium)

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25
Q

Why don’t calcium channel blockers work on skeletal muscle?

A

Skeletal muscle does not require calcium to enter from the EC space to cause calcium release from the cell - opening of the L-type calcium channel in skeletal m. is triggered by depolarization of the cell membrane - this opens the Ryanodine channels in the SR which releases intracellular stores of calcium = MECHANICAL COUPLING - calcium then binds troponin C allowing actin & myosin to bind - ATP becomes hydrolyzed = contraction

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26
Q

How calcium is released from cardiac muscle

A

Depolarization causes L-type calcium channels on plasma membrane to open and allow influx of EC calcium - binds to ryanodine receptors which then allows SR release of calcium - then binds to troponin C etc.

27
Q

Smooth muscle calcium release

A

EC calcium enters cell during depolarization which then causes IC calcium release from RyR after binding - calcium then binds CALMODULIN (no troponin in smooth muscle) which then activates myosin light chain kinase which phosphorylates myosin - allows actin to bind = contraction

28
Q

Alcohol affect on arrhythmias - and what you’ll see on ECG

A

Can cause atrial fibrillation - will see absent p waves!

29
Q

What causes RVH

A

Cor pulmonale due to pulmonary HTN

30
Q

Formula for odds ratio (OR)

A

OR = ad/bc

31
Q

How does digoxin affect HR

A

Decreases it! via increased parasympathetic tone by stim. vagus nerve - leads to decreased rate of AV conduction

32
Q

digoxin affect on contractility

A

INC.

33
Q

CXR for acute LV failure

A

pulmonary edema, cardiomegaly, pleural effusions, Kerley B lines (represents edema), increased vascular shadowing bilaterally

34
Q

Cardiac consequence of lithium

A

Ebstein’s anomaly: in infants, in utero, apical displacement of tricuspid valve leaflets, decreased RV volume, atrialization of RV

Lithium used to treat bipolar disorder

35
Q

First line of treatment to manage VTach

A

Amiodarone

36
Q

NItrate agent with the highest bioavailability if given orally

A 
(Least amt of first-pass metabolism in liver)
Isosorbide mononitrate (nearly 100%!!)
37
Q

Local factors influencing coronary blood flow

A

Adenosine, NO, Prostaglandins, Bradykinin
Adenosine: vasodilatory in small coronary arterioles
NO: major regulator of flow-mediated vasodilation in large and pre-arteriolar vessels - increase cGMP causing smooth muscle relaxation

38
Q

Amniotic markers for neural tube defects

A

Increased AFP and increased acetylcholinestersase inhibitor levels

39
Q

Diphenhydramine & toxicities

A

First generation H1 blocker - antimuscarinic effects, sedation (CNS effects) and anti alpha-adrenergics = vasodilation = blurry vision

40
Q

Phenylzine

A

MAO inhibitor - used for atypical depression

41
Q

Sx of atypical depression

A

Mood reactivity, hypersomnia, weight gain, leaden paralysis (heavy feeling in arms and legs) - treat with MAOI and SSRI

42
Q

Delirium

A

ACUTE ONSET - causes global memory impairment, along with fluctuations in consciousness described as “waxing and waning” - reversible = onset can be riggered by infection, electrolyte distrubance etc.

43
Q

3 most common causes of metabolic ALKALOSIS

A
  1. Loss of H+ ions from body (vomiting and nasogastric suction)
  2. Thiazide and loop diuretics (increase renal losses of Na - followed by Cl excretion)
  3. Increased aldosterone secretion seen in primary hyperaldosteronism (Conn syndrome)
44
Q

Saline-responsive metabolic alkalosis

A

Loss of H+ ions via vomiting or NG suction = lose NCl which causes low Cl levels = associated with volume loss but can be corrected with repletion with isotonic saline

45
Q

Contraction alkalosis

A

Thiazide & loop diuretics - lose Na and Cl, reabsorb bicarb to maintain electric neutrality - loss of volume stim. aldosterone which inc. Na and water reabs from distal tubule - wastes K+ and H+ in urine - fix with saline

46
Q

Saline-resistant metabolic alkalosis

A

Conn syndrome - aldosterone inc. Na reabsorption with loss of K+/Cl-/H+ and increase in bicarb (due to H+ loss)

Admin of chloride will not correct the alkalosis

47
Q

Define transference

A

unconscious shifting of emotions associated with one person to another -maybe that person reminds you of someone else from your past

48
Q

Minute ventilation vs. Alveolar ventilation

A

Minute (L/min) = Tidal volume x breaths/min - this includes physiologic deadspace (areas not participating in gas exchange)
vs.
Alveolar ventilation = (tidal volume - physiologic dead space) x breaths/min
Only accounts for lung colume participating in gas exchange

49
Q

ABPA

A

Allergic bronchopulmonary aspergillosis - Aspergillus fumigatus may colonize bronchial mucosa and complicate asthma or CF via hypersensitivity rxn - have high IgE levels, eosinophilia, Abs to aspergillus

50
Q

Which virus can form polyproteins from single precursor polypeptide

A

Echovirus

51
Q

FRC and emphysema

A

FRC = ERV + RV - in emphysema you have increased RV and TLC - you’ll see increased FRC value

52
Q

Central chemoreceptors respond to

A

decrease pH (inc. H+ ions) DIRECTLY and an increased PaCO2 indirectly (turns into H+ once it crosses the BBB because H+ cannot cross BBB directly)

53
Q

Peripheral chemoreceptors (name both) sense…

A

Carotid bodies & aortic body - sense hypoxemia (low PaCO2)

54
Q

Respiratory effect of PE

A

Acute pulmonary V/Q imbalance which results in hypoxemia - leads to hyperventilation and respiratory alkalosis (see decreased PaO2 and PaCO2)

55
Q

MOST COMMON CAUSE OF BACTERIAL MENINGITIS

A

STREP PNEUMO!!!! See Lancet-shaped, Gm+ cocci in pairs

56
Q

Dobumtamine

A

Relatively selective beta-1 adrenergic agonist that increases HR, contractility, conduction velocity, and myocardial oxygen consumption

57
Q

Which cells release elastase in lungs

A

Protease - contained in macrophage lysosomes and also neutrophils

58
Q

What inhibits elastase

A

Alpha 1 antitrypsin

59
Q

What is used to treat serotonin syndrome

A

Cyproheptadine (antihistamine with anti-serotonergic properties)

60
Q

Which drug class has STRONGEST and most predictable effects on the inflammatory component of asthma

A

Corticosteroids

61
Q

Cold agglutinins

A

Antibodies produced in respone to M. pneumo infection - directed against antigens in the cell membrane

Also associated with EBV infection

62
Q

Localized amyloidosis confined to cardiac atria is due to deposition of…

A

abnormally folded ANP-derived proteins - this is a form of senile cardiac amyloidosis which may increase the risk of atrial fibrillation

63
Q

Delta F508 mutation

A

CFTR gene - most common mutation in CF patients - leads to abnormal protein folding and failure of glycosylation - so CFTR protein degraded before it reaches cell surface

64
Q

What supplies inferior surface of heart

A

Posterior descending (majority of times comes off Right main coronary)

STEP Flash Cards (14 decks)

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