Qbank4 Flashcards
what vaccines are conjugated? why?
vaccines of the encapsulated organisms… AKA hemophilus, neisseria, strep pneumo. Their virulence is via capsule, which is best counter acted by antibodies…thus a protein toxin is conjugated to activate T cells/B cell interaction for Ab isotype switch
what kind of vaccine is varicella?
live attenuated
what kind of vaccine is BCG?
live attenuated
what is homeodomain genes?
hox genes.
early diastolic snap with rumbling at heart apex
mitral valve stenosis
fixed split
ASD
Pt with mitral valve stenosis. what’s the probable cause?
rheumatic heart disease (chronic)
which sun screen protects against UVB?
PABA; zinc
which sun screen protects against UVA?
avobenzone, zinc
unconjugated bilirubin is insoluble…what is it attached to?
albumin
virulence factors of Pseudomonas
A (exotoxin A-EF ribosylation), Collagenase/Phospholipase C, DNase, Elastase, Fibrinolysin
urinary incontinence in diabetic? sx and associations
can’t feel urge to urinate
overflow incontinence due to loss of efferent and afferent nerves
increased urination at night due to relaxation of pelvic muscles
burning feet and GI distress. what vitamin is missing?
vitamin B5; CoA
what structures are supplied by the PCA?
visual cortex, corpus callosum/splenium, thalamus, cranial nerves III and IV
when do you use ADP receptor blockers?
PCI, unstable angina/nonSTEMI
when do you use Heparin?
in pt prevention of DVT/PE
name the top 3 possibilities of pituitary secretive tumor
prolactin, ACTH, GH
harsh systolic crescendo, decrescendo murmur
HCM (or it could be aortic stenosis)
Pt with calcium stones…which diuretic is good for them?
thiazides, because it increases passive calcium reabsoprtion… thus less calcium is dumped into the kidneys…thus less stones
what is the mechanism by which thiazides lead to less calciuria
- It inhibits Na/Cl transporter… thus less Na is in the tubular cell… Na then flows into the cell more readily in exchange for Ca pumped out to the blood… thus more calcium reabsorption.
- hypovolemia created by the thiazides induces PT to reuptake more Na and thus Calcium follows
pelvic fracture is likely to injur which part of the urethra in men?
membranous portion
straddle injury is likely to injure which aprt of the urethra?
the proximal portion of the penile urethra
what are some signs of tumor lysis syndrome? how do you treat it?
Tumor lysis syndrome you will have 1. Increased intracellular electrolyte leakage… like K and P. 2. You will have increased uric acid.
Thus complications include arrythmias, renal failure, gout.
Treat with Allopurinol/Pegloticase
what does carbidopa do. what symptoms are lessened when used with levodopa; what symptoms will not better/worsen?
carbidopa inhibits Levodopa activity in the periphery and thus concentrates it in the brain.
This lessens N/V symptoms; but worsens agitation/anxiety
low potency antipsychs are which? what are their SE?
Chlorpromazine and Thioridazine;
SE include: anti cholinergic, antihistamine, antialpha andrenergic
what shoud you not give in digoxin tox?
calcium gluconate
HFE on intestine epithelium detects what and what does it do?
it interacts with transferrin…if low iron then will increase iron absorption by increasinf divalent metal transporter… n decreasing hepcidin…
mut leads to inability to detect transferrin…leading to hemachromatosis
hemophilus travels to brain to cause meningitis via what route?
lymphatics
myxomatous changes in blood vessel
medial degeneration; marfan
what is cacipotriene?
vit D analog
what vitamin can you use to treat psoriasis?
vit D analogs
CD34 is what marker?
endothelial
what might a pt with abetaliproproteinemia have symptom wise? waht about histologically in the jejunal lumen?
sx: ataxia, malabsorption of fat soluble vitamins, steatorrhea.
Histo: large foamy intestinal epithelium because no betalipoprotein =no chylomicron/VLDL/LDL thus the absoprbed fats cann’t enter bloodstream and remains in the cells
what’s the difference between plasmin over activation and DIC?
both will have increased bleeding and factor deficiency…
However, only DIC will have ddimer
PTT does not rise when Heparin is given…dx?
ATIII deficiency
leukemias by age
ALL 60
what are the three causes of megalocytic anemia?
Folate/B12 deficiency
Orotic aciduria
what are causes of macrocytic-nonmegalocytic anemia?
liver disease
alcoholism
reticulocytosis
why are reticulocytes blue hued?
because they have RNA
number 1 cause of death in sickle cell adults?
acute chest syndrome; usually occurs post pneumonia
what are lysed in PNH? what are complications of PNH
RBC, WBC, and platelets are destroyed in PNH due to complement activation;
Thus this leads to anemia/iron deficiency, AML deveopment potentially/infections, and THROMBOSIS due to bursting of platelet contents.
Pt with PNH dies, what is the likely cause?
thrombosis
how do you treat autoimmune hemolysis?
Steroids, IVIG to make the macrophages eat the IG instead of the IG on the RBC
what are CD34 cells
hematopoeitic stem cells
Eosinophilia is seen in waht malignancy
Hodgkins
lymphocytosis is seen in what bacteria infection
bordetella
alkylating chemotherapy is associated with what blood cancer?
myelodysplastic syndrome; AML
carribean patient with rash and lytic bone lesions
adult T cell lymphoma
suprachiasmatic nuclei
circadian rhythm
anterior nucleus of hypothalamus lesion
hyperthermia
Spongiosis of epidermis is seen in what?
eczema
what do you seen for skin biopsy for urticaria
dermal edema. no epidermal changes
urge incontinence in MS. where is the lesion?
frontal lobe thus decreasing in CNS inhibition of micturition center.
Where does micturitiion urge come from?
S2-S4. spinal micturition center
Fatigue, proximal weakness, myoedema with percussion to muscle, elevated CK
Hypothyroidism
why does an infection of the biliary system lead to brown stones?
bacteria injure hepatocytes…releasing beta glucuronidase…thus hydrolyzing conjugated bilirubin and precipitating stones
nasal ulcer, oliguria
Wengener CANCA
ether can destroy what kind of viruses?
enveloped
N acetylmuranic acid and N acetylglucosylamine are components of what?
peptidoglycan precursor
D-ala-D-ala is a structural component of waht
pepetidoglycan precursors that is bound by transpeptidases… Penicillins are analogs of these
why does Hep C have such large antigenic variation to its envelope?
Because it doesn’t have 3’-5’ exonuclease proof reading to the Viral coded RNA pol
Why do you see cataracts in galactokinase deficiency?
galactokinase deficiency prevents galactose conversion to galactose 1 phosphate… thus it will be acted upon by aldoase reductase and transformed to galacitol and build up in the lens
what kind of receptors are GABAa, b, and c?
A and C are chloride channels
GabaB is a Gi protein
What is GABA synthesized from?
Glutamate
What vitamin is needed in synthesis and catabolism of GABA?
B6
What is the cause of stress incontinence?
weakened sphincter or pelvic floor
how is resistance against penicillins achieved
mutation of PBP or penicillinase
How is resistance against Aminoglycosides achieved?
acetylation or other modification of the abx
How is resistance against tetracyclnes achieved?
changing the ribosomal structure or efflux pump
How is resistance against floroquinolones achieved
changing gyrase structure
decreased FEV1/FVC
obstructive
increased FEV1/FVC
restrictive
the time period between starting to take vitamin E to seeing the clinical benefits of vitamin E is called?
latency period.
This can also apply to pathogens
What is the rare disease assumption?
when i disease is rare… OR approximates RR
schiling test with elevated urine cobalamine indicates what’s the issue?
decreased dietary intake of cobalamine… since clearly Intrinsic factor is there and the ileum is intact to intake it
bradycardia post MI in leads II, III, AVF. what vessel is occluded?
RCA
which is worse. arnold chiari I or II
II… this one both vermis and medulla are in the foramen magnum and there will be meningomyelocele
What’s the vitamin most likely needing parenteral replacement?
B12, since people who are deficient are usually deficient due to atrophic gastritis… (unless they’re strict vegetarians)
what makes green sputum?
neutrophil Myeloperoxide (contains heme)
eye lesion in HIV pt. What’s the CD4 count?
less than 50. this is CMV
Squamous cell carcinoma of the bladder…what’s the cause?
Schistomiasis hematobium
what’s ethambutol’s mechanism? side effect?
Mechanism: inhibition of D arabinose crosslinking thus inhibiting the cell wall. Side effect: Green/red color blindness
why is warfarin used for prophylaxis post mechanical valves and not heparin?
because heparin is ONLY IV
which cytokine is responsible for cachexia seen in cancer?
TNFa
glycogen phosphorylase is activated by what?
epinephrine and glucagon… leading to increased Calcium and PKA…thus phosphorylating glycogen phosphorylase kinase
what do you use to treat WPW?
procainamide, amiodarone
how many seconds are in a small box of ECG
0.04s
how many seconds are in a large box on ECG
0.2s
Afib treatments. How to rhythm control; how to rate control? what to do if the arrythemia is more than 48 hours?
if less than 48 hours: rate control with digoxin, beta blocker, calcium channel blocker
rhythm control with sotalol and amiodarone
If it’s more than 48 hours you must start on heparin and warfarin
what is first degree AV block?
PR interval will be more than .2s
what heart abnl can lyme disease cause?
first and third degree heartblock
what is second degree AV block
mobitz I=wenckebach: longer longer drop
mobitz II=random drop
what is third degree AV block?
no correlation between atrial and ventricular beats
which way is R axis deviation toward? and which side is L axis deviation towards?
L is toward AVL
R is toward III
how to calclulate HR?
1500/small boxes
estimate by 300-150-100-75-60-50
what are the key features of afib on EKG?
no p waves; irregularly irregular QRS
torsade with deafness?dx
Jervall and lange neisen
breast lesion with abundant lymphocytic infiltrate
medullary carcinoma (invasive)
what is comedonecarcinoma?
subset of DCIS characterized by central necrosis and no invasion
most common cause of death due to MI?
V fib within hours of the initial event
distended macrophage in lamina propria of small bowel would indicate what disease?
whipple
secreting tumor of the appendix…what should you think of?
carcinoid syndrome or another neuroendocrine tumor.
uniform rosette like glandular cells in the appendix with eosinophilic cytoplasm
neuroendocrine cells/carcinoid tumor
slightly larger RBC with blue hue.. what is it and why is it blue?
reticulocyte; mRNA remnant.
strawberry hemangioma; what’s the growth pattern
at first grows with the child… then will regress within a couple of years
patient with bleeding demonstrates prolonged bleeding time and PTT. what is the dx?
vonwillebrand; autosomal dominant
prolonged TT, PT, PTT. bleeding time is normal
dysfibrinogenemia
delayed bleeding; normal PT and PTT
factor XIII deficiency… factors in cascade are not missing but can’t crosslink fibrin
what’ the effect of polycythemia vera on EPO?
EPO is decreased by feedback
what are key sx of churg strauss?
asthma, wrist/footdrop, heart, GI, kidney problems
what do you see on histo with churg strauss?
necrotizing granulomas; eosinophilia. high IgE
Name the small vessel vasculities?
Wengener’s, micrscopic polyangiitis, churg strauss, henoch scholein
palpable purpura …what do you think of?
vasculitis
which of the small vessel vasculities have granulomatous necrosis?
Wengener; churgstrauss
treatment for small vessel vasculities?
cyclophosphomide/corticosteroids
polyarteritis nodosa is associated with what infection seromarker?
hepB positive in 30%
what organs does polyarteritis nodosa effect and what organ does it not effect?
it affects skin, kidneys, brain, GI, heart
SPARES LUNGS
