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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
Why don't calcium channel blockers work on skeletal muscle?
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
26
How calcium is released from cardiac muscle
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
Smooth muscle calcium release
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
Alcohol affect on arrhythmias - and what you'll see on ECG
Can cause atrial fibrillation - will see absent p waves!
29
What causes RVH
Cor pulmonale due to pulmonary HTN
30
Formula for odds ratio (OR)
OR = ad/bc
31
How does digoxin affect HR
Decreases it! via increased parasympathetic tone by stim. vagus nerve - leads to decreased rate of AV conduction
32
digoxin affect on contractility
INC.
33
CXR for acute LV failure
pulmonary edema, cardiomegaly, pleural effusions, Kerley B lines (represents edema), increased vascular shadowing bilaterally
34
Cardiac consequence of lithium
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
First line of treatment to manage VTach
Amiodarone
36
NItrate agent with the highest bioavailability if given orally
``` (Least amt of first-pass metabolism in liver) Isosorbide mononitrate (nearly 100%!!) ```
37
Local factors influencing coronary blood flow
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
Amniotic markers for neural tube defects
Increased AFP and increased acetylcholinestersase inhibitor levels
39
Diphenhydramine & toxicities
First generation H1 blocker - antimuscarinic effects, sedation (CNS effects) and anti alpha-adrenergics = vasodilation = blurry vision
40
Phenylzine
MAO inhibitor - used for atypical depression
41
Sx of atypical depression
Mood reactivity, hypersomnia, weight gain, leaden paralysis (heavy feeling in arms and legs) - treat with MAOI and SSRI
42
Delirium
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
3 most common causes of metabolic ALKALOSIS
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
Saline-responsive metabolic alkalosis
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
Contraction alkalosis
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
Saline-resistant metabolic alkalosis
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
Define transference
unconscious shifting of emotions associated with one person to another -maybe that person reminds you of someone else from your past
48
Minute ventilation vs. Alveolar ventilation
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
ABPA
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
Which virus can form polyproteins from single precursor polypeptide
Echovirus
51
FRC and emphysema
FRC = ERV + RV - in emphysema you have increased RV and TLC - you'll see increased FRC value
52
Central chemoreceptors respond to
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
Peripheral chemoreceptors (name both) sense...
Carotid bodies & aortic body - sense hypoxemia (low PaCO2)
54
Respiratory effect of PE
Acute pulmonary V/Q imbalance which results in hypoxemia - leads to hyperventilation and respiratory alkalosis (see decreased PaO2 and PaCO2)
55
MOST COMMON CAUSE OF BACTERIAL MENINGITIS
STREP PNEUMO!!!! See Lancet-shaped, Gm+ cocci in pairs
56
Dobumtamine
Relatively selective beta-1 adrenergic agonist that increases HR, contractility, conduction velocity, and myocardial oxygen consumption
57
Which cells release elastase in lungs
Protease - contained in macrophage lysosomes and also neutrophils
58
What inhibits elastase
Alpha 1 antitrypsin
59
What is used to treat serotonin syndrome
Cyproheptadine (antihistamine with anti-serotonergic properties)
60
Which drug class has STRONGEST and most predictable effects on the inflammatory component of asthma
Corticosteroids
61
Cold agglutinins
Antibodies produced in respone to M. pneumo infection - directed against antigens in the cell membrane Also associated with EBV infection
62
Localized amyloidosis confined to cardiac atria is due to deposition of...
abnormally folded ANP-derived proteins - this is a form of senile cardiac amyloidosis which may increase the risk of atrial fibrillation
63
Delta F508 mutation
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
What supplies inferior surface of heart
Posterior descending (majority of times comes off Right main coronary)

STEP Flash Cards (14 decks)

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