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Step 1 > QB - DISEASES > Flashcards

QB - DISEASES Flashcards

1
Q

Burkitt lymphoma

A

t(8;14)
c-myc

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2
Q

CML

A

t(9;22) - Philadelphia chromosome
bcr-abl “enable things to occur rapidly = increase TYROSINE KINASE activity”

tyrosine kinase = initiator of many processes

ELEVATED WBCs and platelets

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3
Q

Mantle cell lymphoma

A

t(11;14)

cyclin D1 - promoter of G1 to S-phase transition of cell cycle (cancer!!)

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4
Q

CLL

A

Deletion of 13q

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5
Q

AML

A

M3 variant of AML
Auer rod
t(15;17)

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6
Q

Follicular lymphoma

A

t(14;18)
BCL2 - antiapoptosis

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7
Q

Li-Fraumeni

A

Autosomal dominant
mutation of p53 (tumor suppressor gene)
Sarcomas
Tumors = breast, brain, adrenal cortex

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8
Q

Wiskott-Aldrich (triad)

A
  1. eczema
  2. Recurrent infections
  3. Thrombocytopenia
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9
Q

Hemolytic Uremic Syndrome (HUS) symptoms; what organisms cause HUS?

A
  1. Microangiopathic hemolytic anemia (conjunctival pallor = anemia)
  2. Thrombocytopenia
  3. Acute renal failure

Due to Shiga toxin-producing organisms: Shigella dysenteriae or E. coli O157:H7

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10
Q

Aplastic anemia

A

Bone marrow damaged - deficiency in all 3 blood cell types

Chloramphenicol use
Sickle cell disease (parvovirus B19)

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11
Q

DiGeorge syndrome

A

Maldevelopment of 3rd & 4th pharyngeal pouches
Hypoplasia of thymus & parathyroids
Cardiac & aortic arch abnormalities
Characteristic facies

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12
Q

Chediak-Higashi syndrome

A

Oculocutaneous, hair, skin albinism

Peripheral neuropathy

Immunodeficiency (phagocyte-phagosome-lysosome fusion defect) –> recurrent pyogenic infections

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13
Q

Ataxia-telangiectasia syndrome

A

Progressive ataxia w/ telangiectasia + immunodeficiency (combined defect of B&T-lymphocytes)

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14
Q

CO poisoning

A

No effect on PaO2 (partial pressure of oxygen dissolved in plasma)

Reduces O2 unloading from Hgb and prevents O2 binding to Hgb

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15
Q

Multiple Myeloma

A

Plasma cells infiltrate bone marrow - “clock face” nuclear chromatin

Features:
1. Anemia (due to infiltration of plasma cells and inadequate hematopoiesis)
2. Bone resorption (IL-1 activates osteoclasts), IL-6
3. Hypercalcemia (due to bone destruction)
4. Susceptibility to infection (M protein, Ig light chains BENCE JONES protein); Hyperimmunoglobulinemia –> Rouleaux formation –> increased ESR
5. AL amyloid (“apple-green birefringence w/ Congo red stain)
6. Renal failure (deposition of amyloids in kidney tubules, heart, tongue, nervous system)

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16
Q

Diarrhea (parasitic – eosinophilia seen)

A
  1. Strongyloides
  2. Ancylostoma
  3. Ascaris
  4. Toxicara
  5. Trichura
  6. Trichinella
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17
Q

Diarrhea (bacterial)

A

EIEC or Shigella – pus + RBC
EHEC (O157:H7) – NO pus - ONLY RBC!

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18
Q

Mycoplasma pneumoniae

A

“Walking pneumonia”
Anemia due to RBC lysis via COLD agglutinins (share antigens similar to RBCs)
Stevens-Johnson syndrome + joint pain sequelae
Requires cholesterol to grow (doesn’t have peptidoglycan layer)
Chest CT looks like severe pneumonia even though patients don’t seem as sick

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19
Q

CMV

A

DS-DNA enveloped virus
Opportunistic
Transplant patient

Enlarged, centrally located epitherlial cell + INTRANUCLEAR CYTOPLASMIC inclusions

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20
Q

Haemophilus influenza

A

Require Factor X (hematin) and V factor (NAD+) to survive
Can be grown on medium w/ S. aureus or on chocolate agar

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21
Q

Diff. btwn Staph and Strep

A

Catalase + –> STAPH

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22
Q

Corynebacterium diphtheriae

A

AB exotoxin
Toxin-mediated disease

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23
Q

E. coli

A

Conjuation via bacterial pili
Grows on MacConkey and EMB (eosin methylene blue) agar
Gram -

Neonatal meningitis (K-1 antigen)

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24
Q

Group B Strep (GBS)

A

1 Cause of neonatal meningitis

Others:
Listeria
Klebsiella
H. influenzae (type b)
E. coli

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25
Q

Enterobius vermicularis

A

Scotch tape test
Perianal itching (at night)
Albendazole/Mebendazole
Pyrantel pamoate (pregnant pts.)

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26
Q

Loa loa
Wuchereria bancrofti (lymphatic filaris)

A

Diethylcarbamazine

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27
Q

Strongyloides sterocoralis (strongyloidiasis)
Onchocerca volvulus (onchocerciasis)

A

Ivermectin

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28
Q

Trypanosoma cruzi (Chagas disease)

A

Nifurtimox

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29
Q

Schistosoma (schistosomiasis)
Clonorchis sinensis (clonorchiasis)
Paragonimus westermani (paragonimiasis)

A

Praziquantel

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30
Q

Hemolytic Uremic Syndrome (HUS)

A

E. coli 0157:H7
Occurs in children UNDER 10
Shiga like toxin
Contaminated ground BEEF
Bloody diarrhea

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31
Q

Diarrhea (FOOD consumption)

A

S. aureus - custard/mayo/processed salted meats
Preformed toxins - WATERY diarrhea (not bloody) - RAPID symptoms due to preformed toxins (resolves in 24hrs)

Bacillus cereus - fried rice

Vibrio parahaemolyticus - raw oysters - HIGH VOLUME, WATERY diarrhea (like cholera)

Salmonella - raw egg/raw chicken

Clostridium botulinum - improperly canned foods

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32
Q

Histoplasmosis in HIV patient

A

Pulmonary infiltrates w/ HILAR LYMPHADENOPATHY
Oval/round yeasts within macrophages (bone marrow slide)
Sabouraud’s agar = hyphae
HEPATOSPLENOMEGALY = likes reticuloendothelial system

Histoplasmosis - Mississippi & Ohio River Valley

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33
Q

Coccidioides immitis

A

Southwest US (Arizona) - San Joaquin Valley fever
Spherules rupture –> release endospores
Lung disease -> meningitis (HIV pts.)

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34
Q

Cryptococcus neoformans

A

Pigeon droppings
MENINGITIS + pulmonary infections (HIV pts.)
Budding yeasts w/ thick capsules
Stains red on mucicarmine stain - use bronchopulmonary washings
Opportunistic

CSF findings w/ India ink - confirms diagnosis
Peripheral clearings “halos” due to think polysaccharide capsules

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35
Q

Aspergillus fumigatus

A

Colonize old lung cavities (TB patients)
Hemoptysis

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36
Q

Opportunistic mycoses

A

Candida albicans
A. fumigatus
Mucor & Rhizopus

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37
Q

Clostridium perfringens

A

Gram + lives in soil
Anaerobic environment
Toxin = phospholipase that attacks cell membranes
Myonecrosis - GAS GANGRENE
Late-onset food poisoning: Transient watery diarrhea

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38
Q

Polyarthritis

A

Gonorrhea
Rheumatic fever
Strep pyogenes (group A)

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39
Q

Meningitis

A

M. tuberculosis
Acanthamoeba
Cryptococcus neoformans

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40
Q

Strep penumoniae

A

Lobar consolidation on CXRay

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41
Q

Klebsiella pneumoniae

A

Alcoholic coughing up “currant jelly sputum”

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42
Q

L. pneumophilia

A

Needs L-cysteine-supplemented agar

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43
Q

Coxiella burnetii

A

Q fever
Mild pneumonia symptoms
Contaminated animal hides

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44
Q

Pneumocystis jiroveci

A

Fungus in HIV+ patients
Ground glass infiltrates on CXRay

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45
Q

Herpes simplex 2

A

Multinucleated giant cells
Pinkish-purple intranuclear inclusions (Cowdry type A bodies)

Treat w/ Acyclovir, Valacyclovir, Famciclovir

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46
Q

Treponema pallidum

A

Gram - spirochete
Chancre that heals without treatment within few weeks

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47
Q

Haemophilus ducreyi

A

Tender, red papule on external genitals - PAINFUL!

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48
Q

Chlamydia trachomatis

A

Lymphogranuloma venerum (LGV)
PainLESS ulcers –> painful inguinal lymphdenopathy & ulceration (later progression)

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49
Q

Actinomyces israelii

A

Cervicofacial actinomycosis following dental procedure (oral trauma)
Slow growing/firm feeling abscess in face/neck region
Forms “sulfur granules”
Penicillin + surgical debridement

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50
Q

Rocky Mountain Spotted Fever

A

Palmoplantar erythematous macules - petechial eruption
Headache, fever, conjunctival hyperemia
Doxycycline

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51
Q

Cutaneous anthrax

A

Local edema + papule at inoculation site
Painless necrotic wound + black eschar
Ciprofloxacin

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52
Q

Pasteurella multocida

A

Oral flora of cats + dogs (humans get infected w/ cat bite)

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53
Q

Strep penumoniae (virulence factors)

A

MAJOR: polysaccharide capsule that INHIBITS phagocytosis by macrophages + PMN leukocytes
“Quellung reaction” - antibodies to capsule causes capsules to swell –> destruction of capsules renders S. pneumonia NONvirulent

Additional factors: pneumolysin - suppresses phagocyte’s oxidative burst; adhesin

Alpha-hemolytic (incomplete “green” hemolysis on blood agar)

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54
Q

Aspergillus fumigatus

A

Mucormycosis - diabetes mellitus + diabetic ketoacidosis
Immunocompromised (opportunistic infection)

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55
Q

Herpes simplex 1 (HSV-1)

A

CHILDREN - 1 to 3 yrs
Gigivostomatitis (swollen gums, ulcerative lesions)
Lymphadenopathy
Intranuclear inclusions
Enveloped DS DNA virus

Measles also infect this age group and lesions also have intranuclear inclusions but have BLUISH-GRAY KOPLIKE spots on buccal mucosa

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56
Q

IntraAbdominal abscess

A

B. fragilis
E. coli
—-
S. aureus - abscess on skin
Actinomyces - abscess in cervicofacial region/abdominal cavity
Candida albicans - perforation of proximal bowel (peptic ulcer)
E. histolytica - amebic liver abscess

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57
Q

Borrelia burgdorferi

A

Lyme disease - Ixodes tick
Red macules that are ring-shaped w/ CENTRAL clearing - ERYTHEMA CHRONICUM MIGRANS

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58
Q

Treponema pallidum

A

Condyloma lata - generalized macular eruption

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59
Q

Leptospira interrogans

A

Weil’s syndrome: hepatic dysfunction –> conjugated hyperbilirubinemia, renal dysfunction, thrombocytopenia, bleeding

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60
Q

Bartonella henselae

A

Cat scratch fever
Lymphadenopathy, malaise, fever

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61
Q

Antibiotic resistance

A

Penicillin binding protein (PBP) - MRSA
Resistance including penicilinase-stable penicillins (oxacillin, nafcillin, methicillin)

Mutation in RNA polymerase - Rifampin resistance

Decrease in levels of drug accumulation (decreased uptake/increased efflux) = Tetracycline + Sulfonamides

Mutation in DNA gyrase = quinolone resistance

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62
Q

Clostridium botulinum

A

Spore forming ANAEROBIC bacillus
Botulinum toxin prevents presynaptic release of Acetylcholine (Ach) –> muscular relaxation
Toxin used as therapy to treat focal dystonias, achalasia (lower esophageal sphincter), and muscle spasms

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63
Q

Hypervariable pili

A

Neisseria meningitidis
N. gonorrhoeae

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64
Q

Staph aureus

A

IgG binding outer membrane protein (protein A)
Protein A binds Fc portions of IgG –> prevents opsonization, phagocytosis, complement fixation

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65
Q

Corynebacterium diphtheriae

A

Intracellular polyphosphate granules

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66
Q

Respiratory tract infections (CHILDREN)

A
  1. Nasopharyngitis (Rhinovirus, Influenza, Coronavirus)
    Congestion, discharge, sneezing, sore throat
  2. Laryngotracheitis/Croup (Parainfluenza)
    Barking cough, stridor
  3. Diphtheria (Corynebacteriu diphtheriae)
    Pseudomembrane
  4. Epiglottitis (H. influenzae)
    Dysphagia, drooling
  5. Bronchiolitis (RSV)
    Wheezing
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67
Q

Togavirus

A

German measles (Rubella)
Eastern & Western equine encephalitis

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68
Q

Parvovirus

A

Aplastic crises in sickle cell anemia
Erythema infectiosum (5th disease)
Huydrops fetalis

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69
Q

Calicivirus (Norwalk virus)

A

Viral gastroenteritis

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70
Q

Parainfluenza virus

A

Brassy, BARKING cough (CROUP)
Viral laryngotracheitis
Paramyxoviridae

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71
Q

Toxoplasma gondii

A

Obligate intracellular
HIV patients
Encephalitis - multiplenecrotizing brain lesions
Ring-enhancing lesions in both hemispheres
Pyrimethamine & sulfadiazine

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72
Q

HIV - gag, pol, env

A

gag = nucleocapside proteins p24 and p7
pol = reverse transcriptase
env = envelope and gp120 and gp41

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73
Q

CMV vs EBV

A

EBV = mononucleosis
Symptoms: fever, malaise, myalgia, atypical lymphocytosis, elevated liver transaminases, heterophil antibodies (causes RBC to agglutinate)

CMV = similar symptoms to EBV except…
Don’t see heterophil antibodies

CMV in immunocompromised:
Severe retinitis, pneumonia, esophagitis, colitis, and/or hepatitis.

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74
Q

Parvovirus

A

Erythema infectiosum (fifth disease) in children
Bright red rash on cheeks 5-7 days after fever

In adults: arthritis resembing rheumatoid arthritis – but it resolves spontaneously

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75
Q

Rheumatic fever

A

migratory pain/swelling in large joints
fever, carditis, choreaform movements, erythema marginatum

occurs a few weeks after STREP pharyngitis

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76
Q

SLE

A

Malaise, weight loss
MALAR facial rash
arthralgias in young women

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77
Q

Anthrax

A

Widened mediastinum (hemorrhagic mediastinitis)
Wool-sorting business
Gram + rods
Antiphagocytic D-glutamate capsule
Serpentine/medusa head on appearance

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78
Q

Intracellular polyphosphate granules
Loeffler medium stain w/ methylene blue

A

Corynebacterium diphtheriae

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79
Q

Pertrichous flagella

A

Proteus mirabilis

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80
Q

Cat Scratch disease

A

Bartonella henselae
Focal lymphadenopathy
Bacillary angiomatosis in immunocompromise pts. (red-purple papular skin lesions)

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81
Q

Hemolytic Uremic Syndrome (HUS)

A

E. coli O157:H7
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal insufficiency

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82
Q

Reiter’s syndrome

A

HLA-B27 positive reactive arthritis
Urethritis
Conjunctivitis

Chlamydia, Salmonella, Shigella, Yersinia, Campylobacter infections

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83
Q

Condylomata acuminata

A

Genital warts
HPV 6 + 11

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84
Q

Xeroderma pigmentosum

A

Pigmented dry skin
Lack of DNA excision repair - can’t repair DNA in skin following UV damage
Erythema, scaling, hyperpigmnetation, lentigo (pigmented papules)

Related: Fanconi anemia, Bloom syndrome (hypersensitivity to UV damage and chemo agents)

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85
Q

Granulomatous diseases (10)

A
  1. Mycobacterium tuberculosis
  2. Histoplasmosis, Coccidiodomycosis
  3. Treponema pallidum (syphilis)
  4. M. leprae (leprosy)
  5. Bartonella henselae (Cat scratch disease)
  6. Sarcoidosis
  7. Crohn’s disease
  8. Granulomatosis with polyangiitis (Wegener’s)
  9. Churg-Strauss syndrome
  10. Berylliosis, silicosis
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86
Q

Granulomatous disease mechanism

A

TH1 cells –> gamma-interferon secretion –> activates macrophages –> produces TNF-alpha –> granuloma formation

Anti-TNF drugs cause sequestering granulomas to break down –> disseminated disease

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87
Q

Tuberous Sclerosis

A

Facial angiofibroma
Seizures
Mental retardation

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88
Q

Tuberous Sclerosis (associated neoplasms)

A

Giant cell astrocytoma
Renal angiomyolipoma
Cardiac rhabdomyoma

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89
Q

Small cell lung carcinoma

A

Paraneoplastic syndrome
Cushing’s (ACTH), ADH (SIADH), Anti-Ca2+ channels (Lambert-Eaton)

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90
Q

PKU

A

Mental retardation
Hypopigmentation (skin, eyes, basal ganglia – substantia nigra, locus ceruleus, vagal nucleus dorsalis)
“Mousy” or musty odor

Phenylalanine cannot be converted to tyrosine; lack of phenylalanine hydroxylase or cofactor tetrahydrobiopterin (BH4)

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91
Q

Accumulation of phenylalanine in brain

A

Mental retardation
Seizures

Disease seen in PKU (fair skinned, blonde hair, blue eyes, musty odor pt.)

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92
Q

Chvostek’s sign

A

Facial muscle contraction elicited by tapping on facial nerve (anterior to ear) – occurs when Ca2+ levels LOW (less than 7.0mg/dL)

Primary hypoparathyroidism = loss of parathyroid tissue during thyroidectomy

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93
Q

Polycystic ovarian syndrome

A

PERSISTENTLY elevated estrogen, androgen, LH levels
Hyperandrogenism, Anovulation, Oligomenorrhea, multple ovarian cysts
Theca cell hyperplasia –> excess androgens (acne, hirsutism, male pattern balding, virilization)
Obesity, insulin resistance, dyslipidemia –> increase risk of diabetes and cardiovascular disease
Excess estrogen - thickened endometrium - increase risk of developing endometrial hyperplasia & carcinoma
Treatment w/ weight loss & oral contraceptives

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94
Q

Addison’s disease

A

Primary defect in adrenal coritosl – NO feedback inhibition of anterior pituitary pro-opiomelanocortin (POMC)

POMC continues to make ACTH and MSH (melanocyte stimulating hormone) –> hyperpigmentation

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95
Q

TRH (thyroid releasing hormone) defect

A

Lack of TSH and prolactin

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96
Q

Lechithinase (alpha toxin)

A

C. perfringens
destroys lecithin (cell phospholipid membrane)
destruction of cells –> necrosis/hemolysis, cell death

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97
Q

Gestational diabetes mellitus

A

HUMAN PLACENTAL LACTOGEN

Similar to GH and prolactin - causes INCREASE in insulin resistance to increase serum glucose; increase serum glucose shunted to developing fetus for increasing energy requirements

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98
Q

Fracture of midshaft of humerus

A

Radial nerve + deep brachial artery damage
Loss of extensors in forearm and at wrist

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99
Q

Fracture to surgical neck of humerus

A

Axillary nerve + Anterior circumflex humeral a.

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100
Q

Fracture to supracondylar humerus

A

Brachial artery

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101
Q

Primary adrenal insufficiency vs. Secondary/Tertiary (pituitary/hypothalamus)

A

Primary - hyponatremia, hyperkalemia, hypochloremia, metabolic acidosis
Secondary/Tertiary - do NOT have hyperkalemia or metabolic acidosis; WILL respond with serum cortisol production when exogenous ACTH is administered

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102
Q

Hyponatremia, hypokalemia, hypochloremia w/ metabolic alkalosis

A

Diuretic use (contraction alkalosis – increased bicarb absorption)

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103
Q

Positive Trendelenburg

A

Superior gluteal n. = weakness in gluteus medius and minimus; walk w/ waddling gait/characteristic limp

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104
Q

Difficulty rising from seated position
Difficulty climbing stairs

A

Inferior gluteal nerve (gluteus maximus)

Lambert-Eaton myasthenic syndrome and myasthenia gravis also have proximal muscle weakness

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105
Q

Deficit in thigh adduction

A

Obturator nerve

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106
Q

Loss of knee reflex (extension of leg at knee)
Loss of anterior thigh sensation

A

Femoral n.

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107
Q

Knee flexors (hamstrings)

A

Sciatic n.

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108
Q

21-hydroxylase deficiency

A

MOST COMMON congenital adrenal hyperplasia

Can’t make aldosterone or cortisol (get buildup of 11-deoxycorticosterone and 11-deoxycortisol)

ACTH is elevated bc there’s not feedback inhibition from cortisol (cortisol isn’t being made)

Test for 17-OH progesterone (buildup of precursor products)

Accumulating aldosterone and cortisol precursors shunted to androgen pathway –> females have AMBIGUOUS genitalia (VIRILIZATION)

Males have normal genitalia - have symptoms later w/ SALT-WASTING or precocious puberty

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109
Q

Desmolase

A

Conversion of cholesterol to pregnenolone (absence of this enzyme results in complete absense of steroid hormones) = INCOMPATIBLE w/ life

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110
Q

17-hydroxylase deficiency

A

Can’t make androgens - everything diverted to make mineralcorticoids (aldosterone)

Salt retention –> HTN

ALL phenotypically “FEMALE” due to impaired androgen synthesis

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111
Q

Deficiency of DHT (in utero)

A

Androgen insensitivity syndrome

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112
Q

PTH

A

Increase osteoclastic bone resorption
Increase DISTAL tubular absorption of calcium
Increase formation of 1,25-dihydroxy vitamin D (via upregulation of 1-alpha hydroxylase)
1,25-dihydroxy vitamin D increases GI absorption of Ca2+

SECONDARY hyperparathyroidism:
Patients w/ RENAL FAILURE – DECREASED formation of 1,25-dihydroxy vitamin D –> decreased absorption of Ca2+
RENAL FAILURE - elevated phosphorous (can’t be excreted) –> increase PTH hormone “secondary hyperparathyroidism” bc PTH is antagonistic to phosphorous (will cause elimination of phosphorous)

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113
Q

PTH-independent hypercalcemia

A

Humoral hypercalcemia of malignancy
Vitamin D toxicity
Excessive ingestion of Ca2+
Thyrotoxicosis
Immobilization (Ca2+ is resorbed from inactive bones)

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114
Q

Adrenal crisis

A

“Shock-like state”
Hypotensive, tachycardic, hypoglycemic
Adrenal insufficency (vomiting, abdominal pain, weight loss, hyperpigmentation due to MSH overstimulation)

Patients w/ adrenal insufficiency - can’t make glucocorticoids essential for cardiovascular + metabolic adaptations during stressful situations

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115
Q

Inactive FSH receptors

A

Lack of spermatogenesis and inhibin B production

LH release testosterone from Leydig cells (testosterone feeds back to inhibit LH)

FSH releases inhibin B from Sertoli cells (inhibin feeds back to inhibit FSH)

FSH does NOT make testosterone but is responsible for ANDROGEN-BINDING protein which binds testosterone and elevates local testosterone that is necessary for spermatogenesis

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116
Q

Lambert-Eaton myasthenic syndrome (LEMS)

A

1/2 patients have associated malignancy: SMALL CELL lung cancer

Similar symptoms to myasthenia gravis: diplopia, ptosis, dysarthria, dysphagia

Differences:
LEMS - hyporeflexia/areflexia, autonomic symtpoms, classic incremental response to repetitive stimulation

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117
Q

Myasthenia gravis

A

Thymoma & thymic hyperplasia (appears as ANTERIOR mediastinal mass)

Autoimmune condition - weakness of facial, periocular, bulbar, and pelvic girdle muscles

Ascending muscle weakness (demyelination) - T lymphocyte and macrophage infiltration

Campylobacter infection

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118
Q

Polymyositis

A

Idiopathic inflammatory myopathy
Bilateral proximal weakness
Elevated creatine kinase (CK)

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119
Q

Polymyalgia rheumatica (PMR)

A

Sudden onset stiffness, pain, tenderness of musculature (shoulders, hips, neck, torso)
Elevated ESR

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120
Q

ALS

A

UMN involvement (hyperreflexia, spasticity) coupled w/ LMN involvement (atrophy, fasiculations)

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121
Q

Multiple sclerosis

A

Autoimmune: 20-30yr old females

Increased IgG in CSF

Demyelinating lesions in brain/spinal cord

Optic neuritis: sudden loss of vision w/ painful eye movements

Cerebellar damage: intention tremor

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122
Q

Guillan-Barre

A

Acute postinfectious polyneuropathy
Nonspecific prodromal malaise/nausea FOLLOWED by progressive ascending paralysis

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123
Q

Bitemporal hemianopsia (endocrine effect)

A

Pituitary tumor - PROLACTINOMA
Prolactin inhibits entire GnRH-LH/FSH axis
Impotence in men/Amenorrhea in women (hypogonadtropic amenorrhea)
Men = decreased GnRH, decreased FSH, decreased LH, decreased testosterone

Dopamine inhibits prolactin via D2 dopamine receptor on lactotrophs (damage to hypothalamus –> hyperprolactinemia)

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124
Q

Sheehan syndrome

A

Postpartum hemorrhage (hypotension) –> ischemic necrosis to pituitary (that enlarged and became more vascular during pregnancy)

Panhypopituitarism:
Woman can’t lactate - prolactin deficiency
Hypothyroidism = excessive weight loss and malaise
Hypocortisolism

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125
Q

Autoimmune hypophysitis (inflammation of pituitary)

A

Acute presentation: headaches, visual field deficits
Also low cortisol
Occurs late pregnancy or early postpartum

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126
Q

Pituitary apoplexy

A

Hemorrhage in preexisting pituitary adenoma - emergency!!
Acute, severe headache, ophthalmoplegia, altered sensorium

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127
Q

Vascular deposition of circulating immune complexes

A

SLE, Rheumatoid arthritis, connective tissue

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128
Q

Type I hypersensitivity

A

IgE mediated
IgE produced by B lymphocytes + plasma cells
Specific for allergens (IgE) – crosslinking of IgE molecules on surface of basophils and mast cells –> degranulation of HISTAMINE

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129
Q

SIADH

A

Hyponatremia + lung mass (small cell carcinoma of lung**)

SIADH –> excessive water reabsorption –> HYPERVOLEMIA renin/angiotensin stimulates natriuretic peptides –> excrete Na+ in urine (hyponatremia)

Patients have normal body fluid volume but LOW plasma osmolality (euvolemic hyponatremia)

Low plasma sodium & osmolality, inappropriately concentrated urine (even though there’s no Na+ around to cause concentration of urine), increased urinary sodium, and normal body fluid volume

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130
Q

Estrogen effect on T4

A

Estrogen increases amount of TBG (thyroid binding globulin) –> increase level of total T4 and T3

Free thyroid hormones = stay SAME so patients are euthyroid w/ normal TSH

Increases in circulating T4 seen in pregnancy, oral contraceptives, hormone replacement therapy

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131
Q

Psoriasis

A

Hyperparakeratosis, acanthosis, rete ridge elongation
Mitotic activity above basal cell layer
Reduced/absent stratum granulosum

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132
Q

Dermatitis herpetiformis

A

Pruritic vesicles/plaques on extensor surfaces

Gluten enteropathy

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133
Q

Erythema nodosum

A

Painful, reddish nodules on shins

Oral contraceptives, Strep pharyngitis, IBS, Sarcoidosis

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134
Q

Fracture of femoral head & neck

A

Medial femoral circumflex artery damage –> avascular necrosis of femoral head

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135
Q

Recurrent nosebleeds, swollen gums, ecchymoses, hyperkeratosis, ulcer on lower extremity

A

Vitamin C deficiency (scurvy) = decreased connective tissue strength

Vitamin C needed to hydroxylate proline + lysine via prolyl and lysyl hydroxylases

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136
Q

PID

A

Chlamydia/gonorrhea
PID –> ectopic pregnancy

Increase changes of ectopic pregnancy due to previous abortions, exposure to DES

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137
Q

Yeast infection risk factors

A

Antibiotic use recently
Diabetes

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138
Q

Kid w/ SORE THROAT + rash

A

Strep infection causing scarlet fever
PYROGENIC toxin
—
Endotoxin: Gram - sepsis
M protein: Rheumatic fever*
Alpha toxin: C. perfrigens

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139
Q

Crohn’s disease in relation to bladder

A

Causes fistula w/ bladder

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140
Q

Umbilicated, flesh-colored papules in kid (red dot in middle of cell)

A

Molluscum contagiosum
Pox virus

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141
Q

Otitis externa (tenderness when tugging on outside of ear)

A

Pseudomonas - “blue green” - wet
Associated w/ water (hot tubs, burns)

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142
Q

CSF pathway through ventricles

A

Lateral –> 3rd ventricle via FORAMINA OF MONRO
3rd –> 4th ventricle via CEREBRAL AQUEDUCT (of Sylvius)
4th ventricle –> subarachnoid space via FORMINA of LUSCHKA (lateral)/MAGENDIE (medial)
CSF return to venous circulation via ARACHNOID VILLI (granulations)

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143
Q

Types of hydrocephalus

A

Communicating - blockage in subarachnoid space (fibrosis); no blockage in brainstem
Normal pressure - CSF NOT absorbed
Hydrocephalus ex vacuo - increase CSF VOLUME
Pseudotumor cerebri: overweight young females - decreased CSF outflow at arachnoid villi

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144
Q

Coarctation of aorta

A

Turner syndrome, bicuspid aortic valves

BP elevated proximal to coarctation, BP decrease distal to coarctation

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145
Q

Duodenal atresia

A

Down syndrome
Bilious vomiting without abdominal distention - 1st day of life! (duodenal lumen fails to recanalize)
Polyhydramnios

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146
Q

Renal agenesis in utero

A

Potter syndrome
Oligohydramnios/facial dysmorphism
Pulmonary hypoplasia

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147
Q

Ebstein’s anomaly

A

ATRIALIZED right ventricle (downward displacement of tricuspid valve)

maternal exposure to LITHIUM*

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148
Q

Failure of neural tube fusion

A

a-fetoprotein (AFP) + acetylcholinesterase levels ELEVATED

ANTERIOR neuropore:
- encephalocele (herniation of brain tissue through cranial defect)
- anencephaly (absence of brain/calvarium)

POSTERIOR neuropore (more common):
- spina bifida occulta
- meningocele
- meningomyelocele

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149
Q

Vertical vs. Horizontal diplopia

A

Vertical diplopia (walking downstairs): CN IV (trochlear)
Horizontal diplopia: CN VI (abducens) – also have esotropia (inward deviation of eye)

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150
Q

Lesion of medial longitudinal fasciculus (MLF)

A

Internuclear ophthalmoplegia
Impaired horizontal eye movement; weak ADDUCTION of affected eye w/ simultaneous nystagmus of CONTRA eye (trying to compensate)

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151
Q

Progressively weakening diaphragmatic contractions on inspiration

A

Neuromuscular junction pathology - MYASTHENIA GRAVIS
Rapid diaphragmatic muscle fatigue - restrictive lung/chest wall disease

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152
Q

Guillain-Barre

A

Acute demyelinating disease (following infection, immunization, allergic reaction)

Antibodies to some infectious agent that contain gaglioside-like substance cross-react w/ ganglioside components of MYELIN –> SEGMENTAL DEMYELINATION & ENDONEURAL INFLAMMATORY INFILTRATE

Ascending muscle weakness (following respiratory or GI infection)
Campylobacter jejuni
Absence of deep tendon reflexes (DTRs)
Paralysis of respiratory muscles - fatal!
CNVII - Bell’s palsy (if cranial nerves affected)

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153
Q

Werdnig-Hoffman

A

LMN
“floppy child” syndrome

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154
Q

Lambert-Eaton

A

Resembles myasthenia gravis
Associated w/ small cell lung carcinoma
Autoantibodies w/ presynaptic Ca2+ channels – no release of Ach

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155
Q

Differentiate Myasthenia gravis & Lambert-Eaton

A

Both weakness of proximal muscles

MG:
Ptosis, Diplopia
Thymoma risk
Antibodies against ACh receptors
Nerve stimulation studies - DECREASE response
Weakness of muscles WORSE w/ exertion

L-E:
Pre-existing malignancy
Antibodies against pre-synaptic Ca2+ channels
Nerve stimulation studies - INCREASE response
Weakness of muscles BETTER w/ exertion and exercise (better at the end of the day)

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156
Q

Subacute combined myelopathy

A

Vitamin B12 deficiency
DORSAL COLUMNS + LATERAL CEREBROSPINAL tracts affected

loss of position/vibration sensation, spastic paresis, ataxia

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157
Q

Primary CNS tumor in AIDS patients

A

CNS lymphoma (diffuse large B-cell lymphoma) - CD20 + CD79a
EBV related - poor diagnosis

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158
Q

Meningiomas

A

Adjacent to brain surface + attached to dura mater

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159
Q

Craniopharyngiomas

A

Suprasellar region - can be CALCIFIED
Endocrinopathies (hypopituitarism)

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160
Q

Intracranial schwannomas

A

Cerebellopontine angle
CN VIII compression symptoms (hearing loss, tinnitus, loss of balance)

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161
Q

Fragile X syndrome

A

mild, severe mental retardation (second most common cause of mental retardation; #1 is Down Syndrome)
long thin face, prominent forehead + jaw
macroorchidism (large testes!)

FMR-1 gene (familial mental retardation gene-1)
CGG trinucleotide repeat
hypermethylation of CYTOSINE bases – gene inactivated

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162
Q

DNA mismatch repair gene DEFECT

A

Lynch syndrome
increased risk of hereditary non-polyposis colorectal cancer (HNPCC)

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163
Q

Chromosomal instability disorders

A
  1. Xeroderma pigmentosum
  2. Ataxia-telangiectasia
  3. Fanconi’s anemia
  4. Bloom syndrome
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164
Q

Fulminant meningococcemia

A

Waterhouse-Friderichsen syndrome
bilateral adrenal hemorrhage –> adrenal insufficiency –> hypotension –> death
DIC, shock

N. meningitidis
pharynx –> blood –> choroid plexus –> meninges

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165
Q

Route of infection for:
H. influenzae
S. pneumoniae
S. aureus
M. tuberculosis

A
  1. H. influenzae: pharynx –> lymphatics –> meninges (infants/children)
  2. S. pneumoniae: middle ear –> contiguous tissues –> meninges
  3. S. aureus: skull trauma –> leaking CSF –> meninges (get abscess)
  4. M. tuberculosis: lung focus –> blood –> meninges
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166
Q

Rabies encephalitis

A

Restlessness, agitation, dysphagia –> progressing coma –> death
Vaccine: KILLED rhabdovirus strains
Rabies virus = -ssRNA

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167
Q

PKU

A

Lack of phenylalanine hydroxylase
Inability to convert phenylalanine to tyrosine
TYROSINE becomes an essential aa

excess phenylalanine inhibits tyrosinase (synthesis of melanin from tyrosine) –> fair skinned people

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168
Q

Lead poisoning (enzymes affected)

A
  1. d-Aminolevulinate dehydratase
  2. Ferrochelatase

d-ALA (d-aminonlevulinic acid) and protophorphyrin IX accumulates

d-Aminolevulinate synthase (rate limiting reaction in HEME BIOSYNTHESIS)

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169
Q

Deficiency in uroporphyrinogen I synthase

A

Acute intermittent porphyria
Abdominal pain + neuropsychiatric symptoms

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170
Q

Deficiency in uroporphyriongen decarboxylase

A

Most common porphyria: Porphyria cutanea tarda (PCT)

Uroporphyrinogen accumulates in urine; mild photosensitivity

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171
Q

Bilirubin glucuronyl transferase

A

Conjugation of bilirubin

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172
Q

Niemann-Pick

A

deficiency of sphingomyelinase –> sphingomyelin accumulates in phagocytes –> “foamy histiocytes”
loss of previously acquired motor capabilities
cherry-red macular spot (similar to Tay Sachs)
hepatosplenomegaly

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173
Q

Tay Sachs

A

deficiency in hexosaminidase A –> GM2 ganglioside accumulation

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174
Q

Hurler syndrome

A

deficient in alpha-L-iduronidase
accumulation of heparan sulfate + dermatan sulfate

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175
Q

Gaucher disease

A

deficient in glucocerebrosidase
accumulation of glucocerebroside in phagocytes

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176
Q

Von Gierke disease

A

deficiency in glucose-6-phosphatase

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177
Q

Pompe disease

A

deficiency in lysosomal alpha-1,4-glucosidase

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178
Q

Fabry disease

A

deficiency in alpha-galactosidase A –> accumulation of ceramide trihexoside
Progression to RENAL failure

Angiokeratomas
Hypohidrosis
Acroparesthesia (burning neuropathic pain in extremities)

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179
Q

Lesch-Nyhan syndrome

A

deficiency of hypoxanthine guanine phosphoribosyl transferase (HGPRT)
disorder in uric acid metabolism

Spasticity
Choreoathetoid movements (involuntary movement spasms + writhing movements)
SELF MUTILATION

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180
Q

Neuroblastoma

A

located in adrenal medulla
non-rhythmic conjugate eye movements w/ myoclonus
increased N-myc gene copies
retroperitoneal mass

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181
Q

Hypothalamic nuclei (functions)

A
  1. Ventromedial - satiety (leptin stimulated)
  2. Ventrolateral - hunger
  3. Anterior - cooling
  4. Posterior - heating
  5. Arcuate - dopamine secretion (inhibits prolactin); GHRH and gonadotropin release
  6. Paraventricular - ADH and oxytocin releasing, CRH, TRH
  7. Supraoptic - secretion of ADH and oxytocin
  8. Suprachiasmatic - circadian rhythm, pineal gland function
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182
Q

CN IV lesion

A

internal rotation, depression, abduction
lesion – vertical & torsional diplopia, eye deviates upwards

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183
Q

CN VI lesion

A

abduction
lesion – horizontal diplopia, eye deviates medially

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184
Q

Hydrocephalus in infants

A

Increased head circumference, enlarged ventricles

Muscle hyperreflexia and hypertonicity due to UMN damage due to stretching of periventricular pyramidal tracts

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185
Q

Chronic granulomatous disease (CGD)

A

X-linked
inability of phagocytes to synthesize NADPH oxidase - can’t have lysosomal oxidative burst
pts. suffer recurrent infections from catalase-positive organisms: staphylococci

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186
Q

Alzheimer disease

A

Decreased acetylcholine level (lack of choline acetyltransferase)

areas affected:
basal nucleus of Meynert - memory/cognition
Hippocampus - formation of new memories

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187
Q

Locus ceruleus

A

Panic attacks, panic disorders
Caudal pontine central gray matter - contain NE

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188
Q

Nucleus caudatus (atrophy)

A

Huntington’s
NMDA receptors depleted in striatum

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189
Q

Raphe nuclei

A

Serotonergic

Anorexia, depression, sleep disorders

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190
Q

Global cerebral ischemia

A

due to cardiac arrest –> cessation of blood flow –> severe hypoperfusion
Ischemia >5mins causes irreversible damage to neurons

Watershed areas of anterior, middle, and posterior cerebral aa.

Bilateral wedge-shaped bands of necrosis over cerebral convexities, lateral to interhemispheric fissure

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191
Q

Irreversible injury in neuron

A

“red neuron”
12-24 hours after injurious event
shrinkage of cell body
eosinophilia of cytoplasm
pyknosis of nucleus
loss of Nissl substance

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192
Q

Syringomyelia

A

Cyst in spinal cord
- lateral spinothalamic tract (bilateral loss of P&T)
- motor neurons of anterior horns: LMN (flaccid paralysis, atrophy of intrinsic muscles)

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193
Q

Lateral corticospinal tract lesion vs. Anterior horn involvement (spinal cord)

A

Lateral corticospinal tract: UMN lesion
Anterior horn: LMN
ALS (amylotrophic lateral sclerosis) has BOTH!

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194
Q

Anterior spinal artery syndrome

A

Compression/occlusion of artery

COMPLETE loss of strength below level of injury
Loss of pain & temperature
STILL has vibratory senses

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195
Q

Increased AFP

A

Neural tube defects

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196
Q

Down’s syndrome

A

Decreased AFP
Excessive skin at posterior neck
VSD and duodenal atresia
endocardial cushion defect
TE fistula
Slanted palpebral fissues,
Single transverse palmar crease
Flat facies

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197
Q

Edwards syndrome vs. Patau syndrome

A

Edwards - 18- prominent occiput, microagnathia (small jaw), low set ears, small mouth, overlapping fingers-clenched hands, severe mental retardation (usually die by 1yr)

Patau - 13 - ENTIRE HEAD affected (microcephaly - small head!), polydactyly, umbilical hernia, holoprosencephaly (forebrain doesn’t divide into 2 hemispheres), cleft lip – occurs secondary to nondisjunction during meiosis I

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198
Q

“Common cold”

A

Coronavirus, rhinovirus, adenovirus

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199
Q

Achondroplasia

A

Fibroblast growth factor receptor 3 (FGF-3)
Autosomal dominant
Spontaneous mutations w/ advanced paternal age
Shortened limbs, normal face and normal torso
1/3 chance normal baby from 2 affected parents (2/3 chance baby has symptoms)

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200
Q

Aseptic meningitis

A

Enteroviruses - coxsackievirus, echovirus, poliovirus, enterovirus

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201
Q

Bacterial meningitis (adults)

A

S. pneumoniae, N. meningitidis
Alterations in mental status/seizures

Neutrophilic pleocytosis, LOW glucose, HIGH protein

202
Q

Alcoholic given IV dextrose before thiamine

A

Wernicke’s encephalopathy can occur bc THIAMINE is coenzyme for PYRUVATE DEHYDROGENASE in glucose metabolism

Pt. given glucose with no thiamine –> glucose not metabolized –> necrosis of brain = MAMILLARY BODIES (emotion and memory via Papez circuit)

203
Q

Thalamic syndrome

A

Vascular lesion –> damage to thalamic VPL and VPM nucleus –> CONTRA sensory loss (lower and upper extremities, face)

Proprioceptive defects –> unsteady gait + falls

204
Q

Caudate nucleus lesion

A

Transient hemiparesis (weakness on one side of body)

Frontal lobe symptoms (inattentiveness, forgetfulness)

205
Q

Internal capsule lesion

A

Posterior limb separates globus pallidus and putamen from thalamus

Carries corticospinal MOTOR and somatic SENSORY fibers + visual and auditory fibers

206
Q

Pons lesion

A

Coma
Bilateral paralysis

207
Q

Huntington’s

A

CAG trinucleotide repeats
Anticipation (offspring develop diseases earlier)
Autosomal dominant
Atrophy of caudate nucleus

208
Q

Parinaud syndrome

A

Tumor of pineal gland
GERMINOMAS most common tumor of pineal gland
Children/adolescents - mostly MALEs

  1. precocious puberty (B-hCG production)
  2. Obstructive hydrocephalus (due to tumor compressing aqueduct)
  3. Parinaud syndrome: PARALYSIS of upward gaze and convergence
209
Q

Pontine hemorrhage/tumor

A

“locked in” syndrome = spastic quadriplegia and paralysis of most cranial nerves

210
Q

Lesions of medulla

A
  1. Lateral medullary syndrome:
    Wallenberg:
    - CONTRA loss of pain & temp
    - IPSI paralysis of CNV, IX, X, XI
  2. Medial medullary syndrome:
    - CONTRA spastic paralysis
    - IPSI flaccid paralysis of tongue (CN XII)
211
Q

Organophosphate poisoning

A

Inhibits cholinesterase in both muscarinic and nicotinic receptors

EXCESSIVE CHOLINERGIC STIMULATION!

“DUMBELS” - muscarinic effects
diarrhea, diaphoresis
urination
miosis
bronchospasm
emesis
lacrimation
salivation

nicotinic effect - muscle fasciulations –> muscle PARALYSIS

ATROPINE reverse muscarinic symptoms - pts. still at risk of muscle paralysis

Pralidoxime - reverses BOTH muscarinic and nicotinic receptors

212
Q

Von Hippel-Lindau

A

capillary hemangioblastomas in retina/cerebellum

congenital cysts in kidney, liver, pancreas

increased risk of renal cell carcinoma

213
Q

NF1

A

PERIPHERAL nervous system
neurofibromas
optic nerve gliomas
Lisch nodules (pigmented nodules of iris)
caf_ au lait spots (hyperpigmented cutaneous macules)

214
Q

NF2

A

bilateral cranial nerve VIII schwannomas
multiple meningiomas

215
Q

Sturge-Weber syndrome

A

cutaneous facial angiomas, leptomeningeal angiomas
neurocutaneous disease
ophthalmic (V1) and maxillary (V2) distributions of trigeminal nerve
“tram track” calcifications on skull**

216
Q

Tuberous Sclerosis

A

Kidney, liver, pancreatic cysts

cortical and subependymal hamartomas

cutaneous angiofibromas (adenoma sebaceum)
renal angiomyolipomas & cariac rhabdomyomas

217
Q

Osler-Weber-Rendu syndrome

A

hereditary hemorrhagic telangiectasia

rupture of telangiectasias - epistaxis, GI bleeding, hematuria

218
Q

Maple syrup disease: defective breakdown of which branched chain aa

A

Leucine
Isoleucine
Valine

Accumulation of leucine = neurotoxic

219
Q

Maple syrup urine disease

A

Lack branched chain a-ketoacid dehydrogenase: requires several cofactors: “Tender Loving Care For Noone!”
Thiamine pyrophosphate
Lipoate
Coenzyme A
FAD
NAD
Some patients improve on high dose THIAMINE therapy

pyruvate dehydrogenase and a-ketoglutarate dehydrogenase also require same 5 cofactors

220
Q

Krabbe disease

A

lack of galactocerebrosidase (no galactocerebroside for myelin)

muscle tone abnormality in infants, developmental delay/regression

221
Q

Pyridoxine (vitamin B6)

A

Treats sideroblastic anemia & hyperhomocysteinemia

222
Q

VIPoma

A

intractable diarrhea
metabolic ACIDOSIS
HYPOkalemia
HYPOtensive (dehydration and vasodilatory effects of VIP)

223
Q

VPL

A

Spinothalamic tract (pain + temperature)
Medial lemniscus (position + proprioception)

Transmit to primary somatosensory cortex

224
Q

VPM

A

Trigeminal + gustatory

Transmit to primary sensory cortex

225
Q

Lateral geniculate

A

Vision
Optic radiations
Visual cortex (calcarine sulcus)

226
Q

Medial geniculate

A

Auditory
Superior olivary nucleus, inferior colliculus (pons)
Temporal lobe

227
Q

Tuberous sclerosis

A

a. dominant
Cortical tubers
Subependymal hamartomas (brain) –> seziures/retardation

  • bilateral renal angiomyolipoma (blood vessels, smooth muscle, fat)
  • Cardiac rhabdomyomas
  • Facial angiofibromas
  • Leaf-shaped patches (ash leaf patches)
228
Q

NF1 vs NF2

A

NF1: a. dominant
optic gliomas
Lisch nodules (pigmented nodules of IRIS)
caf_-au-lait spots

NF2: a. dominant
bilateral acoustic neuromas
meningiomas, gliomas, ependymomas of spinal cord

229
Q

Von Hippel-Lindau

A

cerebellar hemangioblastomas
retinal hemangiomas
liver cysts

risk of RENAL CELL carcinoma

230
Q

Sturge-Weber syndrome

A

Facial port-wine stain
Leptomengineal capillary-venous malformation

231
Q

Osler-Weber-Rendu syndrome

A

Hereditary hemorrhagic telangiectasia - telangictasias of skin + mucosa

recurrent epistaxis
GI bleeding (melena)

232
Q

Membranoprofliferative glomerulonephritis (MPGN)

A

Basement membrane splitting

Similar to Alport syndrome:
deafness, ocular manifestations

233
Q

Focal segmental glomerulosclerosis (FSGS)

A

IgM* and C3 deposits

234
Q

Goodpasture’s syndrome

A

Anti-GBM antibodies react to alpha3-chain of collagen IV

Pulmonary hemorrhages –> hemoptysis (due to damage of alveoli BM)

RPGN
IgG and C3
Crescent formation
RBC casts

235
Q

Post-streptococcal glomerulonephritis (PSGN)

A

RBC casts, oliguria
hypercellular glomeruli - “starry sky”
“humps and bumps”
anti-streptolysin O
low C3
periorbital edema, HTN

236
Q

Wegener’s

A

Anti-neutrophil cytoplasmic antibodies (c-ANCA)
“necrotizing granulomatous vasculitis”
granulomatosis + polyangiitis

triad:
1) pulmonary symptoms (cough/hemoptysis – focal necrotizing granulomas in lungs)
2) upper respiratory tract (chronic sinusitis, mucosal ulceration of nasopharynx)
3) renal disease – RPGN (crescentic)

237
Q

Kimmelstiel-Wilson disease

A

Nodular glomerulosclerosis

Diabetic nephropathy - ESRD
Glomerular hyperfiltration –> increase mesangial matrix/thickening of GBM
K-W nodules
diffuse glomerulosclerosis
hyaline arteriosclerosis

use ACE inhibitors, ARBs - prevent progression of diabetic nephropathy

238
Q

Presence of petechiae (bleeding disorder)

A

Platelet dysfunction

239
Q

CML vs leukemoid reaction

A

WBC count increase (leukocytosis >50,000)
left shift - immature forms of cells - bands, metamyelocytes, myelocytes, VERY LITTLE -blast cells

differentiate btwn CML and leukemoid reaction:
alkaline phosphatase ELEVATED = leukemoid
alk phosp decrease = CML

240
Q

Sickle cell anemia patient (infections)

A

Septicemia (Strep pneumoniae or H. influenza) due to asplenia (more prone to encapsulated organisms)

Osteomyelitis (Salmonella; also S. aureus & E. coli)

241
Q

Obligate intracellular bacteria

A

Rickettsia
Legionella
Chlamydia

242
Q

Stains:
1. Giemsa
2. PAS
3. Ziehl-Neelsen
4. India ink
5. Silver stain

A

1.Giemsa - Chlamydia, Borrelia, Rickettsiae, Trypanosomes, Plasmodium
2. PAS - Whipple’s disease
3. Ziehl-Neelsen - Acid fast organisms (Mycobacterium)
4. Indian ink - Cryptococcus neoformans
5. Silver stain - Fungi (Pneumocystis), Legionella, H. pylori

243
Q

Obligate anaerobes

A
  1. Clostridium
  2. Bacteroides
  3. Actinomyces

Aminoglycosides have no effect on anaerobes.

244
Q

Encapsulated bacteria

A

“SHiNE SKiS”

Strep pneumo
H. influenzae type b
Neisseria
E. coli
Salmonella
Klebsiella
group B Strep

Asplenic patients should be vaccinated!
Strep pneumo, H. influenzae, Neisseria.

245
Q

Catalase-positive bacteria

A

“CAtaLaSES!”

Listeria
Aspergillus
Candida
E. coli
S. aureus
Serratia

246
Q

Culture for H. influenzae

A

Chocolate agar
Factor V (NAD+) and Factor X (hematin)

247
Q

Culture for Neisseria

A

VPN media

Vancomycin (Gram +)
Polymixin (Gram -)
Nystatin (fungi)

248
Q

Culture for lactose fermenting enterics

A

Pink colonies on MacConkey’s agar
E. coli also on EMB agar (green metallic sheen)

249
Q

Culture for Legionella

A

Charcoal yeast extract agar

250
Q

Pigment-producing bacteria:
1. Actinomyces israelii
2. S. aureus
3. Pseudomonas aeruginosa
4. Serratia marcescens

A
  1. Actinomyces - yelllow “sulfur” granules
  2. S. aureus - yellow
  3. Pseudomonas - blue-green
  4. Serratia - red
251
Q

Protein A

A

Binds Fc region of Ig
Prevents opsonization & phagocytosis

S. aureus

252
Q

IgA protease

A

Cleaves IgA in order for organism to colonize respiratory mucosa

“SHiN”
S. pneumoniae
H. influenza
Neisseria

253
Q

M protein

A

Prevents phagocytosis

group A Strep
Rheumatic fever

254
Q

Mesolimbic-mesocortical pathway

A

Regulates behavior
Schizophrenia

255
Q

Nigrostriatal pathway

A

Coordination of voluntary movements
Parkinsonism

256
Q

Tuberoinfundibular pathway

A

Controls prolactin secretion
Hyperprolactinemia

257
Q

Excessive aldosterone

A

Na+ retention
HTN
Hypokalemia
Metabolic alkalosis

258
Q

“Aldosterone escape”

A

High aldosterone causes increased renal Na+ and H2O absorption –> increase renal blood flow and GFR –> increase rate of sodium excretion from renal tubules

259
Q

Tumor lysis syndrome

A

Develops during chemo for cancers w/ rapid cell turnover (poorly differentiated lymphomas and leukemias)

Hyperphosphatemia, Hyperkalemia, Hyperuricemia, HYPOcalcemia

260
Q

Sarcoidosis

A

African American
bilateral hilar adenopathy
non-caseating granulomas

261
Q

Squamous cell lung carcinoma vs. lung adenocarcinoma

A

Squamous cell: keratin-containing malignant cells; SMOKER

Adenocarcinoma: glandular differentiation w/ atypia; NON-SMOKER

262
Q

Hodgkin’s lymphoma (common subtype)

A

Nodular sclerosis subtype

Nodular growth pattern, surrounding fibrous bands, lacunar variant REED-STERNBERG cells

263
Q

Carcinoid syndrome

A

RIGHT sided endocardial fibrosis –> pulmonic stenosis/restrictive cardiomyopathy

Skin flushing, abdominal cramping, naseau/vomiting/diarrhea – due to serotonin, kallikrein, bradykinin, histamine, prostaglandins, and/or tachykinins

Test serotonin levels in plasma
Urinary levels of 5-hydroxyindoleacetic acid (serotonin metabolite)

264
Q

Vanillylmandelic acid

A

EPI and NE metabolite

265
Q

Elevated levels of homocysteine

A

Arterial and venous thrombosis
Development of atherosclerosis

266
Q

Elevated phenylalanine

A

phenylalanine hydroxylase deficiency –> CNS damage/mental retardation

PKU

267
Q

Acute pyelonephritis (bacterial)

A

E. coli
Klebsiella
Proteus
Enterococci
**all are Gram - rods

Due to vesicoureteral junction issue - urine backflow!

268
Q

Describe descending path of voluntary muscles

A

1st order neurons = premotor & motor cortex (frontal lobe - Brodmann’s areas 4 & 6)

Neurons travel through internal capsule –> midbrain –> pons –> PYRAMIDS (medulla)

Fibers decussate @ medulla –> LATERAL CORTICOSPINAL TRACT
(fibers that don’t decussate descend –> ANTERIOR corticospinal tract)

2nd order neurons = anterior horn (fibers synapse)

UMN = lesions above anterior horn
LMN = lesions below anterior horn

269
Q

UMN symptoms and disease

A

muscle weakness
increased tone (spasticity)
clasp-knife rigidity
positive Babinski
hyperreflexia, clonus

270
Q

LMN symptoms and disease

A

flaccid paralysis
areflexia
atrophy
fasiculations

Poliomyelitis, Werdnig-Hoffman

271
Q

Tetralogy of Fallot (maneuver to improve cyanosis and dyspnea)

A

Squatting –> increase systemic vascular resistance

Increase pressure in systemic circulation allows less RIGHT –> LEFT shunting to occur –> more blood in pulmonary circulation to get oxygenated

272
Q

Vascular defect associated w/ berry aneurysms of Circle of Willis

A

Coarctation of aorta (due to HTN in branches) leads to:
1) subarachnoid hemorrhage
2) ruptured dissecting aortic aneurysm
3) LV failure

Seen in young adults that die suddenly due to brain hemorrhage

273
Q

Syringomyelia

A

upper extremity LMN lesion + loss of P&T
lower extremity UMN lesion
kyphoscoliosis

274
Q

Superior vena cava syndrome (SVC syndrome)

A

Small cell lung carcinoma

facial & upper extremity edema
dilated veins of upper torso

275
Q

Excessive use of ASA

A

upper GI bleed (loss of gastric cytoprotection)
impaired platelet aggregation

276
Q

Dermatomyositis

A

Inflammatory myopathy + cutaneous involvement

Proximal muscle weakness (difficulty climbing stairs, rising from sitting position, combing hair)
+
Gottron papules (flat-topped papules over bony prominences) + heliotrope rash

anti-Jo1 antibodies (specific)
ANA (nonspecific)

elevated CK levels

277
Q

Macular degeneration
dry MD vs wet MD

A

Age related (can progress to blindness)
Deposition of fatty tissue (drusen) behind retina (dry MD)
Neovascularization of retina (wet MD)

278
Q

Patients w/ COPD has chronic hypercapnia (too much CO2 in blood); why should supplemental oxygen be given with caution?

A

PaO2 is the only respiratory drive stimulator
Too much supplemental oxygen too rapidly –> respiration is inhibited (body thinks there’s already too much O2)

Patients don’t respond to PaCO2 anymore (b/c there’s constant excess of CO2)

279
Q

Male patients suffering from liver cirrhosis - why is there also gynecomastia?

A

Hyperestrinism due to:
decreased catabolism of estrogen
+
increased sex hormone-binding globulin (binds testosterone, decrease free testosterone:estrogen ratio)

imbalance –>
gynecomastia, testicular atrophy
decreased body hair
spider angiomata (dilation of superficial capillaries)

280
Q

Anti-centromere antibodies present

A

CREST syndrome
Calcinosis - subcutaneous Ca2+ deposits
Raynaud’s
Esophageal dysmotility - fibrosis of distal esophagus
Sclerodactyly - thickening of skin of hands/feet
Telangiectasias

281
Q

Anti-DNA topoisomerase (Scl-70)

A

Diffuse scleroderma

Progressive systemic sclerosis –> chronic restrictive interstitial fibrosis

282
Q

Anti-dsDNA

A

Malar “butterfly” rash

283
Q

Anti-histone antibodies (4)

A

Drug-induced Lupus

Hydralazine
Procainamide
D-penicillamine
Isoniazid

284
Q

Anti-Ro/SSA
Anti-La/SSB

A

Sjogren syndrome

keratoconjuctivitis (dry eyes)
xerostomia (dry mouth)

associated w/ increased risk of non-Hodgkin lymphomas

285
Q

Anti-phospholipid antibodies

A

Antiphospholipid antibody (also SLE)

Antiphospholipid antibody syndrome:
Hypercoagulable state
Recurrent miscarriages
(paradoxical increase in PTT)

286
Q

Carpal tunnel syndrome (associated diseases that can cause syndrome)

A

Compression of median nerve
Pain & paresthesias (pins and needles)
Weakness of thumb abduction and thenar atrophy
Tinel’s sign, Phalen’s sign (tap on flexor surface of wrist)

Associated w/
hypothyroidism (fluid retention)
diabetes mellitus
rheumatoid arthritis
dialysis-associated amyloidosis (deposition of B2-microglobulin)

287
Q

Overstimulation of a2-adrenergic receptors

A

Increase release of NE & insulin

288
Q

Overstimulation of b2-adrenergic receptors

A

Bronchodilation, vasodilation
Uterine relaxation

289
Q

Derivatives of pharyngeal arch 1

A

Trigeminal (CNV)

290
Q

Derivatives of pharyngeal arch 2

A

Facial (CNVII)

291
Q

Derivatives of pharyngeal arch 3

A

Glossopharyngeal (CNIX)
Common carotid a.
Internal carotid a.

292
Q

Derivatives of pharyngeal arch 4

A

Superior laryngeal - Vagus (CNX)
Subclavian aa

293
Q

Derivatives of pharyngeal arch 6

A

Recurrent laryngeal - Vagus (CNX)
Pulmonary aa.
Ductus arteriosus

294
Q

Excessive secretion of Somatomedin C

A

somatomedin C = insulin-like growth factor-1 (IGF-1)
directly inceased when GH secreted
Results in gigantism in child

unlike excessive estrogen which can cause premature closure of epiphyseal plates in child

295
Q

Centriacinar emphysema

A

Upper lung predominant
Associated w/ smoking
Macrophages and neutrophils

296
Q

Panacinar emphysema

A

Lower lung lobes
a1-antitrypsin deficiency –> excess neutrophil elastase inside alveoli

297
Q

Compensatory hyperinflation vs obstructive hyperinflation

A

Compensatory hyperinflation - compensation for collapsed lobes or surgically removed

Obstructive hyperinflation - fixed or ball valve obstruction (mucus plug, bronchogenic carcinoma) of bronchiles/bronchus

298
Q

Patient w/ UC history presents w/ fever, diarrhea, signs of shock (decrease BP, increase HR); possibe complication?

A

Toxic megacolon - cessation of neuromuscular activity –> rapid colon distention –> rupture likely (life threatening perforation)

Diagnosis w/ plain abdominal X-ray

Barium constrast studies & colonoscopy contraindicated (could potentiate rupture)

299
Q

Lung cancer associated w/ women & nonsmokers

A

Adenocarcinoma

300
Q

Lung cancer associated w/ smoking

A

Small cell carcinoma (central) - associated w/ Cushing syndrome, siADH, Lambert-Eaton syndrome (other neuroendocrine diseases)

Squamous cell carcinoma (necrosis & cavitation, central) - associated w/ hypercalcemia

301
Q

Muscles responsible for abduction at hip

A

Gluteus medius
Gluteus minimus

302
Q

Muscles responsible for adduction at hip

A

Adductor brevis, longus, magnus

303
Q

Muscles reponsible for flexion at hip

A

Iliopsoas
Sartorius
Rectus femoris
Tensor fascia lata

304
Q

Muscles reposible for extension at hip

A

Gluteus maximus
Semitendinous
Semimembranous
Biceps femoris (long head)

305
Q

Muscles important for sitting up from supine position (without hands)

A

External abdominal obliques
Rectus abdominis
Hip flexors (iliopsoas = psoas major, minor & iliacus)

306
Q

Cystic hydroma - what is it, what associated disease?

A

cystic hydroma = neck mass (tumor) apparent at birth in Turner’s syndrome

45XO
Streak ovaries (primary amenorrhea)
Coarctation of aorta
lymphedema (swelling of hands and feet)

307
Q

Primary amenorrhea; high arched palate, inverted, widely spaced nipples

A

Turner syndrome

308
Q

Primary amenorrhea & hirsutism

A

Polycystic ovarian syndrome

309
Q

Cri du chat (5p-) syndrome features

A

round face
cat-like cry
microcephaly

310
Q

Congenital adrenal hyperplasia - most common cause

A

21-hydroxylase deficiency
Salt wasting
Ambiguous genitalia (females only)

311
Q

Testicular feminization syndrome

A

Androgen insensitivity syndrome

Defect in testosterone receptors
46XY karyotype - appears FEMALE
Blind-ended vaginal pouch
Absence of uterus

312
Q

Ductus arteriosus

A

Shunts oxygenated blood from pulmonary artery –> descending aorta (to rest of systemic circulation) – bypasses lungs (since lungs aren’t mature)

313
Q

Adult remnant of ductus arteriosus

A

ligamentum arteriosum

314
Q

Path of oxygentated blood from placenta to fetus

A

Umbilical vein –> liver –> ductus venosus (bypass hepatic circulation) –> IVC –> right heart –> could go to lungs or go through foramen ovale –> left heart –> systemic circulation

315
Q

Adult remnant of umbilical vein

A

ligamentum teres

316
Q

Origination of umbilical arteries

A

Fetal internal iliac aa. (carry deoxygenated blood back to placenta)

317
Q

Allows blood from placenta to bypass hepatic circulation to get to fetal heart

A

Ductus venosus (in liver)
Blood from umbilical veins go directly to IVC (most O2 content available)

318
Q

Red pulp vs. White pulp in spleen

A

Red - filters/destroys old RBCs
White - splenic macrophages present antigens to B and T cells

Spleen - site of extramedullary hematopoiesis
Antibody synthesis

319
Q

Why are asplenic patients more susceptible to encapsulated organisms?

A

Splenic opsonizing antibody –> clearance of encapsulated species (S. pneumoniae, H. influenzae, N. meningitidis)

320
Q

Young female w/ venous thrombosis; PTT time unchanged despite activated protein C administration; why?

A

Factor V Leiden mutation

Factor Va remains activated –> hypercoagulable state –> abnormal venous thromboses (in young patient w/ no risk factors)

321
Q

Antiphospholipid antibody syndome

A

Hypercoagulability
Lupus anticoagulant and/or anticardiolipin antibodies

prolonged aPTT – Lupus anticoagulant most prevalent

322
Q

Folic acid deficiency (heme related effect)

A

Hyperhomocysteinemia –> prothrombotic state

323
Q

Strongest risk factor for cervical intraepithelial neoplasia (CIN)

A

Multiple sex partners; first intercourse at young age, prostitution

all increase risk of HPV 16 & 18 –> severe cervical dysplasia or carcinoma in situ

324
Q

Hospitalized patient with recent surgery develops tachypnea, tachycardia, cought, chest pain; cause?

A

Pulmonary embolism – pulmonary obstruction increase pulmonary resistance –> increases right ventricular afterload (can’t pump out as much to lungs because of increased pressure in lungs) –> right heart failure

Ventilation/perfusion mismatch = appropriate air going into alveoli but obstruction results in less blood supply to all areas of lung –> insufficient gas exchange

325
Q

Diffusion impairment - hypoxemia; what patients suffer this?

A

Pulmonary fibrosis
Hyaline membrane disease

326
Q

A-a gradient in hypoventilation

A

A-a gradient normal because both arterial and alveolar PO2 are low

327
Q

Pure RBC aplasia (in setting of normal granulopoiesis & thrombopoiesis)

A

Marrow falure associated with:
thymoma
lymphocytic leukemias
parvovirus B19 infection

328
Q

Acute intermittent porphyria

A

Acute abdominal pain
Peripheral neuropathy
Hyponatremia

329
Q

Macula densa (location)

A

junction of ascending loop and distal tubule (regulates GFR)

330
Q

Conjunctival pallor in fatigued female

A

Anemia

331
Q

Level of transferrin in iron deficiency anemia

A

Liver makes more transferrin (to increase efficiency at “grabbing” any Fe available)

TIBC increase (bc more transferrin is made) - body tries to increase likelihood of attaining as much Fe as possible in Fe depleted conditions (anemia)

332
Q

Hypersegmened neutrophils + elevated MCV; what deficiencies?

A

Folic acid or vitamin B12

333
Q

Delayed afterdepolarizations; causes & complications?

A

High intracellular Ca2+ or high EPI/NE –> hyperexcitability –> delayed afterdepolarizations

could lead to ventricular tachycardia –> death

334
Q

Effect of decreased action potential duration

A

decreased action potential duration –> decreased refractory period –> cell depolarizes more frequently –> a. fib

335
Q

Acute nausea from systemic chemotherapy - what are of brain is responsible?

A

Stimulation of chemoreceptor trigger zone in area postrema (dorsal medulla near 4th ventricle)

336
Q

What important CN and tracts run through the ventral pons?

A

CN V-VIII
corticospinal tract
medial lemniscus
lateral spinothalamic tract

337
Q

Inflamatory retinitis in HIV patient w/ CD4+ <50cells/uL; cause and Rx?

A

CMV

Treat w/ ganciclovir (targets CMV DNA polymerase) to prevent retinal detachment

338
Q

Platelets aggregate normally in response to ADP, poorly with addition to ristocetin; deficiency?

A

vWF deficiency

decrease platelet adhesion (since vWF binds gpIb on platelet –> helps attach platelet to subendothelial collagen)

vWF carries factor VIII (impairs an important factor in coagulation pathway)

Results in:
prolonged PTT (coagulation pathway defect)
Increased bleeding time (platelet)

339
Q

Treatment of vWF deficiency

A

Desmopressin (DDAVP) –> stimulates vWF release from endothelium

340
Q

Glanzmann thrombasthenia

A

deficiency of gpIIb/IIIa –> increased mucocutaneous bleeding
platelet aggregation decreased w/ addition of ADP

341
Q

Deficiency of thromboxane A2 - possible cause?

A

ASA treatment - irreversible inactivation of COX in platelets

342
Q

Congenital deficiency of XII (Hageman); symptoms?

A

Asymptomatic

Incidental finding bc it causes PTT prolongation

343
Q

Hyperammonemia effects on brain

A

Hepatic encephalopathy

depletion of a-ketoglutarate –> inhibition of Krebs cycle
lack of glutaMATE = impaired excitatory neurotransmission

excessive ammonia –> depletes glutaMATE (excitatory neurotransmitter) converted by glutamine synthetase to glutaMINE–> accumulation of glutamine–> astrocyte swelling & dysfunction

344
Q

Impaired beta-oxidation of fatty acids to acetyl-coA; possible lifestyle?

A

high alcohol consumption

CARNITINE responsible for transport of FA into mitochondria for beta-oxidation

345
Q

Lactate level in patient w/ liver cirrhosis?

A

Elevated lactate (esp. in situations w/ elevated production – sepsis, tissue hypoperfusion)

decreases hepatic lactate disposal –> accumulation of lactate

346
Q

Idiopathic pulmonary fibrosis causes

A

Environmental exposure
Sarcoidosis
Collagen vascular diseases
Idiopathic

progressive disease, may require lung transplatition

347
Q

IPF features

A

Intersitial fibrosis causes alveoli walls to collapse –> cystic spaces lined by type II pneumocytes

Bronchiolar epithelium (honeycomb fibrosis)
Insidious-onset progressive exterional dyspnea, restrictive pulmonary symptoms, cystic airspace enlargement (honeycomb lung)

348
Q

Churg-Strauss (pulmonary symptoms)

A

severe asthma, obstructive features
necrotizing vasculitis
granulomas & infiltration of vessels/perivascular tissue by eosinophils

349
Q

Goodpasture’s syndome (pulmonary symptoms)

A

Focal necrosis in alveolar walls & intra0alveolar hemorrhages –> hemoptysis

350
Q

Characteristics of TOF (4)

A

Pulmonic stenosis
VSD
RVH
Overriding aorta (straddling VSD)

351
Q

Why is there varying severities of hypoxemia in patients w/ TOF?

A

Pulmonic stenosis increases pressure in RV so that it is sometimes equal to LV pressure

Degree of pulmonic stenosis determine whether blood is shunted from L–>R or R–> L
when blood is shunted L–>R, there’s no cyanosis

352
Q

Painless hematuria (“coca cola urine”) 2-3 days after URI in child/young adult
Deposition of substance found in mesangium

A

IgA nephropathy (Berger disease)

353
Q

IgA nephropathy;
purpuric lesions on extensor surfaces (arms, legs, butt);
abdominal pain/vomiting/intestinal bleeding/intussusception

A

Henoch-Schonlein disease

354
Q

Differences btwn IgA nephropathy and Post-Strep GN

A

IgA nephropathy:
develops few days after infection
IgA mesangial deposition

Post-Strep GN:
develops WEEKS after infection
C3 levels low

355
Q

VIPomas

A

excess water, Na+, and K+ loss in stool
inhibits gastric acid secretion

watery diarrhea
hypokalemia
achlorhydria

356
Q

Why are patients w/ Crohn’s more susceptible to gallstones?

A

Terminal ileum reabsorbs bile acids – in Crohn’s, the terminal ileum most often affected –> no reabsorption of bile

Ratio of cholesterol:bile acid increases –> cholesterol precipitates in bile of the gallbladder as gallstones

357
Q

Retroperitoneal hematoma from MVA - possible organs involved?

A

Abdominal aorta, inferior vena cava (rapid blood loss –> hemorrhagic shock)

Pancreas (except tail), kidneys, adrenal glands
parts 2, 3, and portion of 4 of the duodenum
ascending & descending colon, rectum
ureters, bladder

358
Q

Intraperitoneal structures that can cause hemoperitoneum

A

transverse colon, liver, spleen

359
Q

Cardiac defect in Turner’s

A

Bicuspid aortic valve

early systolic, high frequency click heard over cardiac apex
can progress to aortic stenosis/regurg

360
Q

Cardiac defect in Down syndrome

A

ASD
fixed splitting of second heart sound

VSD
holosystolic murmur

361
Q

Cardiac defect in rheumatic heart disease

A

mitral stenosis
mid-diastolic, low-pitched rumbling murmur (may begin w/ opening snap)

362
Q

Cardiac defect in Marfan and Ehlers-Danlos

A

MVP
Mid-systolic click, late systolic murmur

363
Q

Cardiac defect in premature infants w/ respiratory distress syndrome

A

PDA

364
Q

Trousseau’s sign; what is it an indication of?

A

Migratory superficial thrombophlebitis – superficial venous thromboses appearing in multiple sites and resolving

Indicates visceral cancer - esp. adenocarcinoma of pancreas, colon, lung

365
Q

Prinzmetal’s (variant) angina – treatment?

A

Coronary artery vasospam

Nitroglycerin (or other vasodilators)

366
Q

Acute transmural myocardial infarction (MI)

A

peaked T waves (localized hyperkalemia)
ST segment elevation
Q waves

anterior: V1-V3
I, aVL: lateral

367
Q

Stable angina

A

Stable atheromatous lesion WITHOUT thrombus
Obstructs greater than 75% of coronary artery lumen

368
Q

“Bronze diabetes”

A

Skin hyperpigmentation
Diabetes mellitus
Pigment cirrhosis w/ hepatomegaly

Associated w/ late stage hemochromatosis

369
Q

Hemochromatosis

A

High iron GI absorption

Hepatomegaly
Skin hyperpigmentation (sun exposed areas)
Diabetes mellitus (secondary to pancreatic islet destruction)
Arthropathy
Cardiac dysfunction & enlargement

Elevated plasma iron, serum ferritin, >50% transferrin saturation

370
Q

Wilson’s disease

A

Pt. younger than 30 yrs. old
Unexplained chronic hepatitis
Low serum ceruloplasmin
Increased urinary copper excretion
Kayser-Fleischer rings

371
Q

Budd-Chiari syndrome

A

Thromboti occlusion of hepatic veins and/or the intra/suprahepatic inferior vena cava

Sinusoidal pressure increae –> portal HTN, ascites, hepatomegaly, splenomegaly

372
Q

Presystolic sound immediately preceding first heart sound - what condition?

A

S4 gallop is presystolic sound immediately before S1

373
Q

Best location to hear left vs right sided S4 gallop

A

Left sided S4 - cardiac apex with pt. in left lateral decubitus position

Right sided S4 - lower left sternal border (tricuspid area) w/ patient in supine position

374
Q

Why does S4 arise?

A

Sudden rise in end diastolic ventricular pressure –> atrial contrac against a stiff ventricle (RVH or LVH)

ventricular hypertrophy decreased ventricular compliance –> diastolic dysfunction

375
Q

What does S1 and S2 represent?

A

S1 = closing of AV valves
S2 = closing of semilunar valves (pulmonic and aortic)

376
Q

Cutaneous melanoma gene mutation

A

Mutated BRAF gene (protein kinase) –> activate signaling pathways –> melanocyte proliferation, metastasis

Substitute a glutamic acid for valine (correct) at position 600

Main risk factor for cutaneous melanoma = UV exposure

377
Q

Glioblastoma causes overexpression of:

A

growth factors (PDGF, EGFR, IGF, TGF)

378
Q

Taste & sensory sensation to anterior 2/3 and poster 1/3 of tongue?

A

anterior 2/3:
Sensory (pain) - CNV3 (mandibular branch of trigeminal)
Taste - CNVII (facial)

posterior 1/3:
sensory & taste - CNIX

379
Q

Hydrocele development - cause?

A

Fluid-filled peritoneal sac within scrotum due to incomplete obliteration of processus vaginalis

processus vaginalis is projection of peritoneal cavity that accompanies descending testis into scrotum

380
Q

Bright red central papule w/ outwardly radiating vessels that blanch w/ pressure and refill on release; what are they and what are they dependent on?

A

Spider angiomas

Dependent on estrogen

381
Q

Soft, blue compressible masses - appears on skin, mucosa, deep tissues, viscera; have dilated vascular spaces with thin-walled endothelial cells; based in dermis – found in brain and viscera - associated with what disease?

A

Cavernous hemangiomas - associated w/ von Hippel-Lindau disease

382
Q

Lymphatic cysts lined by thin endothelium - benign tumors present at birth located on neck and lateral chest wall; what disease associations?

A

Turner syndrome
Down syndrome

383
Q

Cherry hemangioma vs. Strawberry hemangiomas

A

Cherry - in adults - increase in number w/ age – proliferation of capiallaries and post-capillary venules in papillary dermis

Strawberry - in children – present in first weeks of life - regress spontaneously by 5-8yrs

384
Q

Treatment for diabetic ketoacidosis

A

IV hydration with normal saline & insulin

Insulin decreases lipolysis, decrease production of ketone bodies (increase plasma bicarbonate), decrease K+, decrease glucose, decrease osmolality

Increases sodium and serum bicarbonate

385
Q

Symptoms of DKA

A

mental status changes, dehydration, abdominal pain, tachypnea, fruity odor in breath

hyperpnea (Kussmaul respirations) - deep slower breathing to have compensatory respiratory alkalosis (due to metabolic acidosis condition)

increased anion-gap metabolic acidosis

386
Q

Opioid antagonists uses

A

treats opioid overdoses –> respiratory acidosis due to hypoventilation

387
Q

Winter’s formula

A

PaCO2 = (1.5 x HCO3-) + 8 +- 2

388
Q

Winter’s formula (when to use it?)

A

Used to evaluate respiratory compensation when there is metabolic acidosis (diabetic ketoacidosis)

PaCO2 > predicted: concurrent respiratory acidosis

PaCO2 < predicted: concurrent respiratory alkalosis

If PaCO2 persists above range given by Winter’s formula –> patient unable to compensate - has mixed acid-base disturbance consisting of metabolic and respiratory acidoses –> respiratory failure

389
Q

Elevated AFP

A

Hepatocellular carcinoma (HCC)

390
Q

Elevated CEA

A

Colorectal cancer

391
Q

Elevated CA-125

A

Ovarian cancer

other cancers:
endometriosis
lung
breast
pancreatic* cancer

392
Q

Acid phosphatase elevation

A

Secondary prostate tumor marker antigen

also in patients w/ active osteoclast-initiated bone resorption

393
Q

hCG

A

suspected gestational trophoblastic disease

394
Q

Physical manifestations of Marfan’s

A

spinal scoliosis and/or kyphosis
lens dislocation
cystic medial degeneration of aorta –> aortic dissection (cause of death)

defect in glycoprotein fibrillin-1

395
Q

p53 gene inactivation – 2 hits necessary for malignancy; what is disease w/ inherited mutation in p53 (1 hit already, increasing risk of potentially knocking out both p53)

A

Li-Fraumeni syndrome

several cancers appear
cancers occur at young age
cancers appear several times throughout lifetime

396
Q

Follicular lymphoma

A

Bcl-2 (proto-oncogene) overexpression –> antiapoptosis of tumor cells (immortality)
t(14;18)

397
Q

CML

A

Bcr-abl
t(9;22) Philadelphia chromosome

398
Q

Burkitt’s lymphoma

A

EBV
C-myc overexpression
t(8;14) – heavy chain on chromosome 14
High mitotic index w/ high cell death rate
Benign macrophages engulf cellular debris –> clear spaces around macrophages = “starry sky appearance”
adolescents and young adults

African form: jaw lesion
Endemic form: pelvis or abdomen involved

399
Q

Patient hospitalized for acute MI dies 3-7 days after onset of MI; why?

A

LV free wall rupture (complication)
Occurs when coagulative necrosis + neutrophil infiltration have weaked infarcted myocardium = wall is damaged and more likely to rupture

symptoms: profound hypotension & shortness of breath; jugular venous pressure elevation

LV hypertrophy and prior MI decreases chance of free wall rupture

400
Q

Most common cause of in-hospital death due to MI

A

LV failure/cadiogenic shock

401
Q

Frequent complication of cornary artery fibrinolysis (to get rid of clot)

A

Systemic bleeding, especially intracranial hemorrhage

402
Q

Joint pain + cardiac murmur

A

rheumatic heart disease

antibodies against M-proteins of Streptoccocci

403
Q

Nasal ulcer + hematuria

A

Wegeners’s (granulomatosis w/ polyangiitis)

upper resp. tract (sinusitis, nasal ulceration)
lower resp. tract (hemoptysis)
kidneys (RPGN)
c-ANCA
pauci-immune: no anti-GBM antibodies or immune complexes

404
Q

malar rash + pleural effusion

A

SLE

circulating immune complex nephritis
dsDNA & anti-Sm

405
Q

dysphagia & sclerodactyly

A

CREST syndrome

calcinosis, Raynaud’s, esophageal dysmotility, scerodactyly, telangiectasia

anti-centromere antibodies

406
Q

Pt. w/ choking spells, dysphagia, coughing; recurrent pneumonia; what could be cause of choking spells?

A

Cricopharyngeal muscle dysfunction – diminished relaxing of pharyngeal mm. during swallowing –> increased pressure in pharynx eventually causes mucosal to herniate out = Zenker diverticulum (false)

diverticulum palpated as lateral neck mass
food retention in diverticulum –> regurgitation occurs days later –> aspiration pneumonia

407
Q

Congenital hydrocele

A

Processus vaginalis remains patent –> fluid from peritoneum accumulates in scrotum

normal development: testis descends through inguinal canal; peritoneal tissue also descend = processus vaginalis

408
Q

Young black woman; malaise, cough, cutaneous findings (including erythema nodosum - painful shin nodules); bilateral hilar lymphadenopathy; non-caseating granuloma

A

Sarcoidosis

elevated ACE levels
chronic restrictive granulomatous interstitial lung disease

409
Q

Cellular immunity

A

T -cell response (NOT B-cell response)

Vaccines generally stimulate B-cells –> memory B lymphocytes & humor immunity

410
Q

Wrist drop – radial nerve mononeuropathy; causes?

A

Compression
Trauma
Diabetic vasculopathy
Vasculitis

411
Q

Antibodies against neutrophil myeloperoxidase

A

p-ANCA (perinuclear staining antineutrophil cytoplasmic antibodies)

microscopic polyangiitis or Churg-Strauss vasculitis

412
Q

Churg-Strauss

A

idiopathic systemic vasculitis
adult-onset asthma
eosinophilia
mono or polyneuropathy
migratory/transient pulmonary infiltrates
paranasal sinus abnormalities

413
Q

Mesothelioma

A

Person works in shipyard - exposure to asbestos
neoplasm of plerua/peritoneum
hemorrhagic pleural effusions & pleural thickening

EM gold standard for diagnosis: numerous long slender microvilli & abundant tonofilaments

414
Q

Bronchioalveolar carcinoma

A

type of adenocarcinoma
PERIPHERY of lung (peripheral mass) - pneumonia like consolidation
distribution along alveolar septa

415
Q

Small cell carcinoma

A

Major bronchi
hilar mass
Neuroendocrine markers - chromogranin & synaptophysin+

416
Q

Squamous cell carcinoma

A

hilar mass
keratinization & intercellular bridges
cavitary lung lesion

417
Q

Mantle cell lymphoma

A

t(11;14)
Immunoglobulin heavy chain (IgH) is on 14
cyclin D1 – promoter of G1 to S-phase transition

418
Q

Mutations of DNA repair enzymes

A

Breast cancer
Ovarian cancer
Lynch syndrome
Ceroderma pigmentosum
Fanconi anemia

419
Q

Hemophilia A

A

X-linked (affects males)
factor VIII deficiency
prolonged PTT
hemorrhage into joints (hemarthrosis); prolonged bleeding after surfical procedures

420
Q

Hemophilia B

A

factor IX deficiency
Christmas disease
prolonged PTT

421
Q

Protein C deficiency

A

Lack of protein C –> procoagulation
Suffer from recurrent deep venous thromboses

422
Q

Deficiency in factors II, V, VII, X, & fibrinogen; effect seen in PT or PTT?

A

PT prolongation
Warfarin – blocks coagulation factors –> also causes PT prolongation

423
Q

Mucocutaneous bleeding (recurrent epistaxis, gingival hemorrhage); what type of blood disorder?

A

Defect in platelets –> bleeding time prolongation

also seen in vWF disease and NSAIDs

424
Q

What does thrombin time measure?

A

rate of conversion of fibrinogen –> fibrin
thrombin time prolonged when there is deficiency/defective fibrinogen

425
Q

Low haptoglobin is an indication of?

A

Hemolytic anemia

426
Q

Hirschsprung disease

A

Neural crest cells migrate caudally –> rectum and anus always involved if neural crest cells cease to move in development; sigmoid colon involved 75% of time

Absence of parasympathetic ganglion cells = bowel lumen smaller due to inability to relax

Newborns fail to pass meconium - intestinal obstruction –> bilous vomiting, abdominal distension; tone of anal sphincter usually increased

427
Q

Pseudogout vs. gout

A

Pseudogout:
Knee joint
Rhomboid-shaped positive birefringent
Calcium pyrophosphate crystals

Gout:
1st metatarsophalangeal joint
Monosodium urate (salt of uric acid)

428
Q

Calcific tendonitis

A

Calcium hydroxyapatitie crystals in periarticular soft tissue (esp. tendons)

Rotator cuff usually affected

429
Q

Xanthomas

A

Soft tissue deposits of cholesterol
Hyperlipidemia

Yellow papules on knees, elbows, tendon insertion sites

430
Q

Reye syndrome

A

Salicylates given to patients 5-14yrs old.

Hepatic dysfunction – vomiting & hepatomegaly
Microvesicular steatosis
Increased levels of ALT, AST, ammonia, bilirubin, prolonged PT and PTT

Encephalopathy - hyperammonemia –> cerebral edema

431
Q

The only disease in which ASA is administered to children under 16yrs

A

Kawasaki disease

Vasculitis of medium-sized arteries (affects children)

Conjunctivitis
Cervical lymphadenopathy
Periungal desquamation (fingers)
Mucocutaneous changes (strawberry tongue)

432
Q

Centrilobular congestion

A

Occurs in liver of patients w/ right sided heart failure

433
Q

Primary biliary cirrhosis

A

Autoimmune destruction of intrahepatic bile ducts; granulomatous inflammation: infiltration of macrophages, lymphocytes, plasma cells, eosinophils

Cholestasis

Middle aged woman w/ PRURITUS (more severe at night), PALE stool, xanthelasma (suggestive of cholestasis)

Hepatosplenomegaly

434
Q

Male w/ UC presents w/ fatigue, high alkaline phosphatase

A

Primary sclerosing cholangitis

435
Q

Preload

A

The end volumetric pressure that stretches the right/left ventricle of the heart - initial stretching of cadriomyocytes prior to contraction (related to sarcomere length at end of diastole)

VOLUME in heart after LV filling

436
Q

Afterload

A

Tension or stress developed in the wall of left ventricle during ejection (load against which heart has to contract to eject blood) – PRESSURE that heart LV has to pump against and overcome to eject blood

437
Q

Why is the pO2 in the left atrium lower than in the pulmonary capillaries?

A

Bronchial arteries return deoxygenated blood (blood that has traveled to supply bronchi and bronchioles) to the pulmonary veins – this results in venous admixture in the pulmonary veins of deoxygenated blood from bronchial arteries & oxygenated blood from the lungs

438
Q

Determining acid-base disturbance; normal pCO2; normal HCO3-?

A

pH > 7.45 alkalosis
pH < 7.35 acidosis

pCO2 normal = 40
HCO3- normal = 24

439
Q

Effect of heroin overdose on blood gases?

A

Heroin suppresses respiratory centers –> hypoventilation w/ rentention of CO2 (acute phase)

In chronic respiratory acidosis - kidneys compensate by excreting H+ and reabsorbing HCO3-

440
Q

When does contraction alkalosis occur? Lab findings?

A

Overuse of diuretics –> volume loss –> increase in aldosterone –> increase rention of Na+ and H2O –> loss of K+ and H+ in kidneys –> loss of H+ causes metabolic alkalosis (contraction alkalosis) bc H+ is traded for HCO3- reabsorption –>

lab findings: high pH, high HCO3-, high pCO2 (CO2 retained to compensate for alkalosis)

441
Q

Blood gas findings in diabetic ketoacidosis?

A

low pH, low HCO3- (to neutralize accumulated acidic products) leading to metabolic acidosis, low pCO2 (hyperventilation or Kussmaul breathing to compensate for acidosis)

442
Q

How does brown fat generate heat?

A

Have several intracytoplasmic fat droplets
Contain more mitochondria than white adipose

Uncouples oxidative phosphorylation with protein thermogenin

443
Q

Restrictive cardiomyopathy

A

reduced LV compliance – diastolic dysfunction –> CHF
restrictive cardiomyopathies = amyloidosis, sarcoidosis, metastatic cancer, products of inborn metabolic errors

contrast with:
dilated cardiomyopathy – systolic dysfunction
viral myocarditis, alcohol toxicity, diphtheritic myocarditis,

doxorubicin (adrianmycin) & daunorubicin – chemo agents also cause dilated cardiomyopathy

444
Q

Oral thrush - what types of popn. suffer from this infection?

A

Denture wearers
Diabetics
Immunosuppressed patients (HIV)
Steroid use
Antibiotics, chemotherapy

445
Q

Luekoplakia

A

Precancerous lesions w/ white patches that can’t be scraped off

contrast w/ candida infection (oral thrush) – contains white patches that CAN be scraped off

446
Q

Animal contact – fungal infection

A

Microsporum species causing dermatophytosis

447
Q

Varicose veins - causes and complications?

A

Cause: incompetent venous valves, venous stasis/congestion, edema, increased thrombosis

Complications: painful thromboses, stasis dermatitis, skin ulcerations, poorly healing wounds, superficial infections
NO pulmonary embolism – this is only seen in DEEP venous thromboses (not superficial!)

448
Q

Cavernous hemangiomas

A

Soft blue compressible masses
on light microscopy – large dilated vascular spaces

449
Q

Presence of schistocytes

A

Microangiopathic hemolytic anemia (TTP, HUS, DIC)
Mechanical damage (prosthetic valve)

450
Q

HUS vs. TTP; similarities and differences?

A

Similar symptoms: fever, neurologic manifestations, renal failure, thrombocytopenia, microangiopathic hemolytic anemia

TTP: adults - neurological symptoms predominate

HUS: children - renal involvement predominate

451
Q

K+ sparing diuretics; location of action?

A

Spironolactone
Amiloride
Triamterene

K+ sparing diuretics work at collecting duct

452
Q

Right-sided endocarditis

A

S. aureus – in IV drug users

Perforations to heart valves, rupture of chordae tendinae, septic emboli to lung

453
Q

Patient w/ mitral stenosis develops low grade fever & negative blood cultures

A

Rheumatic fever history left patient with mitral stenosis –> now has another acute case of rheumatic fever

454
Q

Strep bovis infection; what other conditions is patient most likely suffering from?

A

Colonic cancer (or other GI malignancy)
Bacteremia
Endocarditis

455
Q

Culture-negative endocarditis; valvular vegetations present; organisms don’t grown on standard blood culture

A

HACEK organisms

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

456
Q

Symptoms of S. aureus caused bacterial endocarditis

A

Shaking chills (rigors), high fever, dyspnea on exertion, malaise

Right sided endocarditis –> septic embolization into lungs –> pulmonary abscess

Left sided endocarditis –> heart failure, sepsis, septic embolization to brain & end organs

457
Q

What conditions prevent gallstone formation?

A

Low cholesterol levels
High bile acid levels

Phosphatidylcholine – allows cholesterol to be more soluble

Obtain cholesterol by 1) absorption & 2) hepatic synthesis of cholesterol via HMG-CoA reductase

458
Q

How is cholesterol transformed to soluble bile and excreted?

A

Free cholesterol converted to cholic and chenodeoxycholic acids (bile acids)

Bile acids conjugated –> glycine or taurine –> bile salts –> secreted into bile canaliculi

Phosphatidylcholine makes cholesterol more soluble

Gallbladder hypomotility & more cholesterol –> precipitation of gallstones

459
Q

Transmural inflammation in Crohns leads to?

A

Strictures: due to chronic inflammation –> edema & fibrosis –> narrowed lumen (strictures)

Fistulas: inflammation + necrosis –> ulcer formation –> ulcer penetrates entire intestinal wall (transmural) –> formation of fitula

*Ulcerative colitis: damage limited to mucosa and submucosa

460
Q

Toxic megacolon: complication of Crohn’s, UC, both?

A

Toxic megacolon affects both Crohn’s and UC; neuromuscular degeneration of intestinal wall –> rapid dilation –> bowel perforation

461
Q

Worst prognostic factor for patient suffering from alcohol-induced liver damage?

A

Hypoalbuminemia & prolonged prothrombin time (PT)
both indicate decrease in hepatic function = liver failure

alcoholic steatosis & alcoholic hepatitis (reversible)
alcoholic cirrhosis (irreversible)

cirrhosis = hepatocellular injury + loss of hepatic function

462
Q

Elevated alkaline phosphatase seen in bone disease; where else in GI/renal disorders?

A

Biliary disease has elevated alkaline phosphatase
use serum GGT to determine biliary disease (as opposed to bone disease)

463
Q

Liver fibrinogen synthesis increase/decrease in liver failure?

A

Liver fibrinogen is coagulation factor and acute phase protein – increase in response to infection/acute inflammation

Liver failure failure = loss of hepatic function to make coagulation factors = LOW liver fibrinogen

464
Q

Idiopathic membranous nephropathy - what molecular markers is it associated w/?

A

IgG4 antibodies to phospholipase A2 receptor (found in podocytes)

465
Q

Minimal change disease; mechanism of pathogenesis?

A

abnormal T cell production –> glomerular permeability –> fusion of foot processes –> proteinuria

466
Q

Mixed cryoglobulinemia

A

IgM deposition in glomerulus –> basement membrane thickening & cellular proliferation

467
Q

Renal disease caused by multiple myeloma

A

Deposition of light chains (cast nephropathy)

468
Q

SLE results in what type of glomerular disease?

A

Membranous GN

469
Q

Hypocalcemia: what happens to PTH, Calcitonin, 1,25-dihydrocholecalciferol (active vit D)?

A

Increase PTH
Decrease calcitonin
Increase 1,25-

470
Q

Chronic renal disease: what happens to PTH, Calcitonin, 1,25-dihydrocholecalciferol (active vit D)?

A

“Secondary hyperparathyroidism”

Increase PTH
Increase calcitonin (kidneys can’t excrete calcitonin)
Decrease 1,25-

471
Q

Hypoparathyroidism: what happens to PTH, Calcitonin, 1,25-dihydrocholecalciferol (active vit D)?

A

Decrease PTH
Decrease calcitonin
Decrease 1,25-

472
Q

Administer calcium gluconate: what happens to PTH, Calcitonin, 1,25-dihydrocholecalciferol (active vit D)?

A

Decrease PTH
Increase calcitonin
Decrease 1,25-

473
Q

Autosplenectomy

A

Sickle cell anemia patients

Vaso-occlusive crises –> repeated splenic infarctions –> shrunken, discolored, fibrotic spleen

Brownish discoloration (hemosiderosis) due to extensive sickled RBCs by splenic macrophags (extravascular hemolysis)

474
Q

Symptoms of sickle cell crises

A

abdominal pain resolved w/ analgesics + hydration
acute chest syndrome – vaso-occlusive crisis localized to pulmonary vasculature (precipitated by pulmonary infection)

475
Q

Intrasplenic lipid accumulation

A

Lysosomal lipid storage disorders (Gaucher’s disease)

476
Q

Ischemic ATN is most likely a result of damage to which parts of renal tubules?

A

Proximal tubules
Thick ascending limb of loop of Henle

Ischemic ATN = most common cause of intrinsic renal failure (acure renal failure) in hospitalized pts.

Muddy brown casts seen

477
Q

Relationship btwn pt. hospitalized after MI and muddy brown casts seen in urine soon after?

A

Low cardiac output (cardiac arrest) –> ATN –> increased BUN and creatining & oligouria

Proximal tubules & thick ascending limb of loop of Henle most susceptible to ischemia (ATP-consuming activities of ion transport)

478
Q

Histology of ATN

A

Flattening of epithelial cells; loss of brush border in proximal tubular cells –> cell necrosis –> denudation of tubular basement membrane

479
Q

Renal papillary necrosis: disease associations

A

Diabetes
Analgesic nephropathy
Sickle cell disease
Severe obstructive pyelonephritis

480
Q

Hemolytic anemia + vasoocclusion in sickle cell anemia; what symptoms do you see w/ hemolytic anemia?

A

Jaundice - due to unconjugated hyperbilirubinemia (yellow sclera)
Pigmented gallstones
Depressed RBC indices

Painful crises – bone ischemia/necrosis –> Staph & Salmonella osteomyelitis

481
Q

Autosplenectomy - predisposed to infections w/ encapsulated organisms: which are?

A

GBS
H. influenzae
S. pneumoniae
M. meningitidis
S. typhi

482
Q

Splenic sequestration

A

Young children w/ sickle cell
Vasooclussion –> splenic pooling of RBCs

Medical emergency!!
Marked decrease in Hgb, rapidly enlarging spleen, possible hypovolemic shock

483
Q

Pt. with sickle cell shows marked macrocytosis; why?

A

Megaloblastic anemia – impaired DNA syntheis
Lack of folic acid or vitamin B12

Hemolytic anemias predisposed to develop folic acid deficiency b/c of increase RBC turnover (use up all folic acid for DNA synthesis to make new RBCs)

Low folic acid –> impaired DNA synthesis BUT RNA synthesis is not affected –> cytoplasmic contents accumulate (cells swell and get bigger) but can’t divide (bc lack DNA material) –> macrocytosis

484
Q

Most common hepatobiliary disease in sickle cell patients

A

Pigmented gallstones

Liver-associated macrocytosis = alcoholic liver disease

485
Q

26 yr old Caucasian female w/ diplopia - resolves spontaneously; has problems adducting left eye when patient looks right; disease association?

A

Internuclear ophthalmoplegia (MLF syndrome) – MULTIPLE SCLEROSIS

loss of coordination of lateral conjugate gaze
decreased/blurred vision, central scotoma, monoocular blindness, painful eye movements

Sensory loss, arm/leg weakness, cerebellar symptoms (clumsiness, ataxia) also seen

486
Q

Pathogenesis of multiple sclerosis

A

Sclerotic plaques – appear anywhere in the white matter

Plaques form due to demyelination of axons

Changes of white matter seen inside plaques:
Axon demyelination
Depletion of oligodendrocytes (can’t make more myelin)
Accumulation of lipid-laden macrophages (chew up products of myelin breakdown)
Fibrillary astrocytosis (astrocyte proliferation reaction to injury)
Infiltration by lymphocytes & monocytes

487
Q

Synaptic transmission failure

A

Myasthenia gravis

Autoantibodies to Ach receptors

488
Q

Rapidly growing mass in liver of Australian immigrant; mass is damaged during surgery - what is patient at risk for; what is Rx?

A

Anaphylaxis

Mass is due to Echinococcus granulosus –> forms hydatid cysts
Rupture of cyst contents –> anaphylactic shock
Aspiration of cysts contraindicated.

Larvae implant in capillaries –> inflammatory rxn –> monocytes and eosinophils

Hydatid cyst is encapsulated & calcified; contains flui and budding cells

Rx: surgery, chemo, mebendazole/albendazole

489
Q

Flat yellow spots on inner surface of aorta; what are these? What can these spots progress to?

A

Fatty streaks: lipid-filled foam cells that have entered intima through injured, leaky endothelium; foamy appearance due to intracellular lipid-containing phagolysosomes

(foam cells derived from macrophages & smooth muscle cells that have engulfed LDL)

fatty streaks can be seen in aortas of children <1yr old – can progress to form atheromatous plaques, but NOT ALL progress to advanced atherosclerotic plaques

490
Q

Alternate pathway for blood to return to heart bypassing the IVC

A

Hemiazygous vein
Azygous vein
Accessory hemiazygous vein

491
Q

Urease activity test to detect what organism?

A

H. pylori –> duodenal ulcer
Uses urease to degrade urea into CO2 and NH3

492
Q

Best detection of congenital heart diseases (VSD, patent foramen ovale)

A

Echocardiogram

493
Q

Best detection of bronchiectasis

A

High resolution chest CT

494
Q

Patient has hyperacusis; pathology?

A

Stapedius n. (CNVII) innervates stapedius m. –> paralysis of m. allows wider oscillation of stapes –> increased sensitivity to sound

495
Q

Prolonged exposure to loud noises causes loss of hearing; how?

A

Damage to stereociliated hair cells of organ of Corti

496
Q

Damage to what structures causes conductive hearing loss?

A

Rupture of tympanic membrane
Defects of middle ear ossicles

497
Q

Pathway of sound transmission to organ of Corti

A

Sound –> middle ear via tympanic membrane

Vibration –> oval window via ossicles

Oval window vibration –> basilar membrane vibration –> hair cell cilia bends against tectorial membrane

Hair cells bending –> oscillating hyperpolarization & depolarization of auditory nerve

498
Q

Carotid sinus baroreceptors & Aortic arch baroreceptors – what innervates them? What occurs once receptors stimulated?

A

Carotid sinus - Glossopharyngeal n.
Aortic arch - Vagus n.

Stimulation of stretch receptors –> vasodilation, decrease in HR and contractility, decrease in BP

499
Q

Spoon nails, dysphagia; what deficiency is present?

A

Iron deficiency anemia

esophageal web = Plummer-Vinson
microcytic hypochromic RBCs

rx: give iron preparation

500
Q

Deficiency in vitamin B12 or folic acid – what kind of anemia occurs?

A

Megaloblastic anemia

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