Qbank 2 Flashcards
Location of neurotransmitters:
- Serotonin
- Dopamin
- Ach
- GABA
- NE
- Serotonin: raphe nuclei in pons, medulla, midbrain
- Dopamine: ventral tegmentum and substantia nigra pars compacta
- Ach: basal nucleus of Meynert
- GABA: nucleus accumbens
- NE: locus ceruleus (pons)
derivatives of the ventral and dorsal pancreatic buds?
- ventral: main pancreatic duct and uncinate process (portion of pancreas head)
- dorsal: accessory pancreatic duct, body, tail, isthmus
What epithelium lines the true vocal folds?
-stratified squamous. Most other parts of respiratory tract are pseudo stratified columnar mucus secreting epithelium, except the pharynx (where air and food passes, is stratified squamous)
Treatment for narcolepsy?
Modafinil
The thymus is derived from what branchial pouch?
- 3rd. With the inferior parathyroids
- ear, tonsils, bottom, to top
For restrictive lung disease, describe FEV1/FVC, compliance, elastic recoil, lung volumes.
- there is restricted filling of lungs. Decrease compliance, and increased elastic recoil/radial traction because of fibrosis
- FEV1/FVC is greater than 80%
- lung volumes are decreased: decreased TLC and FVC
- there is super normal expiratory flow rate
Mullerian agenesis vs androgen insensitivity syndrome
- Mullerian agenesis: normal secondary sex characteristics, hypo plastic or absent uterus, no upper vagina XX
- AIS: breast present, no uterus, pubic/axillary hair XY
Describe glycogen regulation involving glucagon/epinephrine.
- Glucagon
- activates glucagon receptor->adenylate cyclase->cAMP->protein kinase A->glycogen phosphorylase kinase->glycogen phosphorylase–>breakdown of glycogen to glucose - Epinephrine: activates alpha receptor->->Ca release->activates Glycogen phosphyrlase kinase->activates glycogen phosphorylase
Vit E deficiency presentation.
-presents like B12 but without the megaloblastic anemia. mUscle weakness, peripheral neuropathy, hypotonia
Recurrent skin infections without pus. Delayed detachment of umbilical cord. Poor wound healing. Disease and mechanism of disease?
- Leucocyte adhesion deficiency
- deficiency of CD18. Inability to synthesize integrins.
Tredelenburg gait. What nerve is damaged?
Superior gluteal nerve. The damage is on the side that person is standing on that causes hip drop on the opposite leg.
What processes of collagen synthesis occur in the extracellular matrix?
- cleavage of N and P pro peptides by peptidases to form tropocollagen
- tropocollagen fibers assemble into fibrils and lysyl oxidase deamininates lysine and hydroxylysine residues, forming reactive aldehydes that form covalent crosslinks
Mechanism of spread of N. meningitidis
- nasopharynx, blood, to choroid plexus, to meninges
- H. flu spread from pharynx to lymphatics to meninges
What are the formulas for t1/2, loading dose, and maintenance dose?
t1/2= (Vd x 0.7)/Cl
Loading dose= (Vd x Cp)/F
maintenance dose= (Cl x Cp x dose interval)/F
Define reaction formation, displacement, suppression, repression.
- reaction formation: doing something opposite of your desire to cover it up. Homosexuals being homophobic and denouncing homosexuality
- displacement: taking out anger on scapegoat -yelling at dog when angry at wife
- suppression: consciously putting thoughts out of mind
- repression: unconsciously putting out of mind
hyperthyroidism following flu like illness. What is disease? histology? findings?
- tender thyroid
- increased ESR
- granulomatous inflammation, may see giant cells. Mixed cellular infiltrate.
Histology of Hashimoto thyroiditis.
- lymphoid aggregate with germinal centers, Hurtle cells. Mononuclear infiltrate.
- increases risk of non hodgkin lymphoma
Which secreted Ig forms a dimer?
IgA
-particular important in colostrum, first secreted milk by mom, provides infant with passive immunity.
antidote for beta blocker overdose
glucagon
-increases cAMP of cardiac myocytes, and increases intracellular calcium
Mechanism of Cromolyin and nedocromil. Uses?
-inhibits mast cell degranulation 2nd line for allergic rhinitis and bronchial asthma
List the overdose/poisoning for which the following antidotes are for:
- amyl nitrate
- dimercaprol
- methylene blue
- deferoximine
- EDTA
- penicillamine
- trientine, oral zinc
- amyl nitrate: cyanide
- dimercaprol: arsenic or lead
- methylene blue: methemaglobinemia
- deferoximine: iron
- EDTA: lead
- penicillamine: copper
- trientine, oral zinc: copper
Contents of crescent in RPGN.
- abundant fibrin
- macs, monocytes, proliferated glomerular parietal cells
Thoracentesis, which ribs to go between?
- mid clavicular: 5th and 7th (6-8 intercostal space)
- mid axillary: 7th and 9th (8-10)
- paravertebral: 9th and 11th (10-12)
Cystic tumor in cerebellum of child with Hair like glial processes. What is the tumor and what other histological features seen?
pilocytic astrocytoma
-spindle cells, rosenthal fibers and eosinophilic bodies
mechanism of enterococci resistance of aminoglycosides?
- produce enzymes that transfer acetyl group (or other modifying groups) to aminoglycoside, decreasing ability for antibiotic to bind to ribosome
- acquired by plasmids or transposons
What is the most common benign liver tumor?
cavernous hemangioma
What free radical scavenging agent is used with cisplatin to minimize nephrotoxicity?
-amifostine
Most common cause of viral acute hemorrhage cystitis in children?
Adenovirus
Treatment of choice for Listeria?
Ampicillin
-not sensitive to cephalosporins
Mechanism and use of foscarnet?
- viral DNA/RNA inhibitor and HIV reverse transcriptase inhibitor. doesn’t require activation by viral kinase
- use for CMV retinitis when ganciclovir fails and acyclovir resistant HSV
when can serum hCG and urine hCG be detected if fertilization occurred?
serum: 8 days after ovulation (implantation takes place ~ 6 days after fertilization)
urine: 14 days after ovulation
majority of water absorption occurs where in the kidney?
- proximal tubule, regardless of volume status of patient. Reabsorbs 60% of water.
- up to 20% can be reabsorbed in the collecting ducts with ADH
Describe steps of leucocyte trafficking and the proteins involved.
- margination
- Rolling:
PMNs: siayl lewis
endothelium: P/L- selectin - tight adhesion and crawling:
PMNS: CD 11/18 integrins (LFA-1, MAC-1)
endothelium: I-CAM - transmigration/diapedesis
-PMNS: PECAM
-endothelium: PECAM-1
Where does the synthesis and assembly of ribosomal components occur?
-in the nucleolus
What type of cells are juxtaglomerular cells?
modified smooth muscle cells of afferent arteriole that secrete renin
Mechanism of oseltamavir.
-neuraminidase inhibitor: prevents viral particle release from host cell
Abdominal discomfort, greasy stool, weight loss. Arthralgias. Intestinal biopsy shows macrophages with PAS stained granules (foamy macs).
Whipple disease, caused by gram positive actinomycete Tropheryma whippelli. Can also have psych and cardiac problems.
What is a secondary effect of loop diuretics that is inhibited by NSAIDS?
-loop diuretics also stimulate prostaglandin release, causing vasodilation of afferent arteriole. Increases renal blood flow and increases GFR, enhancing drug delivery and diuretic response.
Treatment for treating acute heroin/opioid withdrawal in neonates.
Tincture (extract) of opium
-should not give naloxone (antagonist) to patient in withdrawal.
Which step in the TCA cycle generates GTP?
succinyl-coA to succinate, catalyzed by succinyl-CoA synthetase
Which steps of the TCA cycle generate NADH? FADH2?
- isocitrate to a-ketoglutarate by isocitrate dehydrogenase
- a-ketoglutarate to succinyl-coA by a-ketoglutarate dehydrogenase
- Malate to oxaloacetate by malate dehydrogenase
FADH2
-succinate to fumarate by succinate dehydrogenase
Child with abdominal dissension and firm irregular mass. Also with opsoclonus-myoclonus “dancing eyes dancing feet”.
Neuroblastoma of the adrenal, originating from neural crest cells.
-there are increased secretions of catecholamines in urine: VMA, HVA
What can be given to help prevent kidney stone formation? pH that different stones precipitate at?
- hydration
- citrate: binds free calcium
- calcium oxalate, uric acid, and cysteine stones precipitates at low pH, so alkalization of urine can help. Except calcium phosphate and struvite stones precipitates at high pH.
Chemotactic factors for neutrophils?
Il-8, C5a, LTB4
How to calculate renal plasma flow, renal blood flow, and Filtration fraction?
- RPF=U(pah)xV/P(pah)
- RBP=RPF/(1-Hct)
- FF=GFR/RPF
Describe reactions in polyol pathway.
- glucose to sorbitol by aldose reductase
- NADPH->NADP+ - Sorbitol to fructose by sorbitol dehydrogenase
- NAD+ to NADH
- retina, renal papilla, and Schwann cells have less sorbitol dehydrogenase activity and are more susceptible to damage by sorbitol in diabetes
- lens can be overwhelmed in hyperglycemia–>cataracts
What cytokine activates Eosinophils?
Il-5
secreted by Th2 helper cells
How is Cryptococcal neoformans acquired?
-found in soil and pigeon droppings. Is inhaled with hematogenous dissemination to meninges
Which features of Wierneke-Korsakoff syndrome are permanent?
- memory loss, learning abnormalities, confabulation are permanent
- Wiernicke: oculomotor abnormalities, ataxia, and confusion. Are reversible.
Microscopic findings in Reye’s syndrome?
- LM: microvesicular steatosis. No inflammation or necrosis.
- mechanism: aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzymes
Mechanism of canagliflozin? Side effects?
- SGLT-2 inhibitors. Blocks reabsorption of glucose in PCT.
- adverse effects: glucosuria, UTIs, vaginal yeast infections
NO is synthesized from what amino acid?
arginine
What kind of virus is rubella?
Togavirus
Which viruses have an envelop that resembles nuclear membrane?
-Herpesvirus
In attacks of acute intermittent porphyria, what is there a buildup of?
-delta-aminolevulinic acid and porphobilinogen
Treatment of cryptococcal meningitis?
induction with flucytosine, then amphotericin B.
-maintenance by fluconazole.
Effects of isoproterenol ?
b1 and b2 agonist.
-increases cardiac contractility, decreases TPR (bp)
Side effects of phenytoin
- CNS: nystagmus, ataxia
- gingival hyperplasia due to activation of PDGF
- fetal phenytoin syndrome
- interferes with folate metabolism, leading to megaloblastic anemia
- induction of cypp450
What markers are elevated in neural tube defects that can be detected in amniotic fluid?
- AFP
- acetylcholinesterase because of leakage of fetal CSF fluid into amniotic fluid
Precision vs. reliability vs. accuracy?
- precision =reliability
- accuracy=degree measurement matches gold standard measurement
