Quiz 52, 53 Flashcards
1
Q
What amino acid is a biological precursor to catecholamines?
A
Tyrosine
2
Q
What amino acid is the precursor to nitric oxide?
A
Arginine
3
Q
What is the common presentation of ischemic bowel disease?
A
Usually seen in older patients (F>M), presents with acute or intermittent cramping abdominal pain and bloody diarrhea
4
Q
What is the most common location of ischemic colitis?
A
Splenic flexure
5
Q
What is a common cause of ischemic colitis?
A
Atherosclerosis, occlusion, hypoperfusion
6
Q
What type of amyloid accumulates from chronic inflammation?
A
SAA - serum amyloid A
7
Q
What are systemic manifestations of AA amyloidosis?
A
Nephrotic syndrome and organomegaly
8
Q
Patients with nephrotic syndrome are predisposed to forming thromboses, why?
A
Decreased antithrombin III and increased fibrinogen
9
Q
What type of thrombosis is associated with nephrotic syndrome?
A
Renal vein thrombosis is most common
10
Q
What is seen on histologic examination of amyloidosis?
A
Apple-green birefringence with polarization of congo red stain
11
Q
What cranial nerves emerge from the brainstem at the cerebellopontine angle?
A
CN VII (facial nerve) and CN VIII (vestibulocochlear)
12
Q
What is a common causative organism of neonatal conjunctivitis? How is it prevented?
A
Chlamydia trachomatis; prevented by erythromycin eye drops
13
Q
Neonatal conjunctivitis followed by pneumonia
A
C. Trachomatis
14
Q
What is mycosis fungoides?
A
A cutaneous T cell lymphoma
15
Q
What is the appearance of mycosis fungoides?
A
Itchy, erythematous plaques and nodules
16
Q
Cytoplasmic inclusions in the epidermal cells is pathognomonic for what?
A
Molluscum contagiosum
17
Q
Poarakeratosis, hyperkeratosis, acanthosis is seen in what skin lesions?
A
Psoriasis
18
Q
Weak peripheral pulses is associated with what cardiac disease?
A
Aortic stenosis
19
Q
Heaves is associated with what cardiac disease?
A
LVH (heard at apex) or RVH (heard on L side)
20
Q
Deceased S2 heart sound is associated with what heart disease?
A
Aortic stenosis
21
Q
Loud S3 heart sound is associated with what cardiac finding?
A
Rapid ventricular filling - seen in congestive heart failure
22
Q
What is the formation of microtubules in cilia/flagella?
A
9 peripheral pairs and 2 central
23
Q
What direction does dynein travel along the microtuble, minus or plus end?
A
Minus end
24
Q
What type of HSR is contact dermatitis?
A
Type IV
25
What tissues is GLUT4 found in?
Cardiac muscle, skeletal muscle, fat
26
What tissues is GLUT1 found on?
Most tissues; esp brain and red blood cells
27
Describe GLUT1 response to insulin
No responsive to insulin; tissues therefore take up glucose independently of insulin/plasma glucose levels
28
Where is GLUT2 found?
Liver, pancreatic beta cells, basolateral surface of small intestine
29
Where is GLUT3 found?
Most tissues, neurons, placenta and testes
30
Where is GLUT5 found? What is its function?
Small intestine, testes and sperm; fructose transporter
31
What type of brain bleed can have symptoms present several days to weeks following a traumatic head injury?
Subacute subdural hematoma
32
What is the cause of bleeding in subdural hematomas?
Rupture of bridging veins
33
What is the appearance of subdural hematoma on CT?
Crescentic hematoma
34
What type of bleed results in "lens-shaped" on CT scan?
Epidural bleeds
35
What is the cause of bleeding in an epidural hematoma?
Middle meningeal artery
36
Intraventricular bleed is seen in what type of brain bleed?
Subarachnoid hemorrhage
37
Rupture of bridging veins results in what type of brain bleed? What is seen on CT?
Subdural hematoma; crescent shape on CT
38
What brain bleeds cross suture lines? Which do not?
Subdural hematomas cross suture lines; epidural hematomas do NOT cross suture lines
39
What type of brain bleed is seen with a middle meningeal rupture?
Epidural hematoma
40
What is a freshwater amoeba that can result in primary amebic meningoencephalitis?
Naegleria fowleri
41
Young boy presents with loss of smell after swimming in nearby lake, what organism could he be infected with?
Naegleria fowleri
42
What is seen on examination of CSF in a patient with Naegleria fowleri?
High PMNs, glucose low, protein elevated, CSF pressure high
43
What is the microscopic appearance of Naegleria fowleri?
Motile flagellated trophozoite
44
Creating a shunt between the portal system and a vein of the caval system would help relieve what?
Portal hypertension
45
What does the splenic vein drain into?
Hepatic portal vein
46
What vein does the left renal vein drain into?
IVC
47
What is the cause of an aspergilloma?
Growth of Aspergillus fumigatus in preexisting cavitary lesions of the lung (tuberculosis, bronchiectasis)
48
Appearance of aspergillus fumigatus?
Monomorphic filamentous fungus that shows dichotomous branching of septate, hyphae typically at 45 degrees
49
How is aspergillus fumigatus treated?
Voriconazole
50
Radical mastectomy results in loss of muscle?
Pec major
51
What is the cause of psuedomyxoma peritonei?
Rupture of mucinous cystadeoma or mucinous cystadenocarcinoma
52
What are the most common type of tumor in the appendix?
Carcinoid
53
Pearly papules on sun exposed skin is pathognomonic for what?
Basal cell carcinoma
54
What is seen on pathologic examination of basal cell carcinoma?
Clusters of dark, basal cell-like tumor cells with palisading nuclei at the periphery
55
What cancer can arise from actinic keratosis?
Squamous cell carcinoma
56
What is the presentation of staphylococcal scalded skin syndrom in an infant?
Generalized severe erythema and flaccid bullae (+ Nikolsky sign)
57
Old man presents with bone pain and his hate doesn't fit. What is on the differential?
Paget disease
58
What virus may cause Paget disease?
Paramyxovirus - infects osteoclasts
59
Why can one see high-output cardiac failure in Paget disease?
Increased marrow arteriovenous shunts
60
What cancer are patients with Paget disease at increased risk for?
Osteosarcoma
61
What type of reactive T cells (CD8+ T Cells) are seen in mono?
Downey type II cells
62
What cells are infected by EBV?
B cells via CD21
63
What shift occurs in the oxygen-hemoglobin dissociation curve due to CO poisoning?
Left shift
64
What happens to oxygen carrying capacity of the blood with CO poisoning?
Decreased
65
What is the defense mechanism identification?
Modeling of behavior on another individual; mechanism of reducing pain from separation or loss
66
What is an error of omission?
Failing to do the right thing
67
What is error of commission?
Doing something wrong
68
What enzyme is affected by lead poisoning?
Aminolevulinate dehydratase and ferrochelatase
69
What is the treatment for lead poisoning?
Chelation with EDTA, dimecaprol, succimer
70
What type of anemia is seen in lead poisoning?
Microcytic, hypochromic anemia
71
What does lead compete with in the renal tubules? What does this result in?
Competes with uric acid; results in hyperuricemia
72
What antibodies are found in CREST syndrome?
Anticentromere antibody
73
What are the three branches of the celiac artery?
Spenic artery, left gastric artery, common hepatic artery
74
Distinct inclusions in RBCs seen on peripheral smear after starting course of TMP-SMX?
Heinz bodies due to G6PD def.
75
Heinz bodies are what?
Denature Hgb in RBCs seen in acute hemolysis and are related to oxidative stress
76
What are transponsons?
Mobile genetic elements; "jumping genes"
77
What genetic material plays an important role in building multi-drug resistance plasmids?
Transposons
78
What is a prophage?
Temperate phage DNA insterted into a bacterial chromosome
79
What type of G protein are alpha 1 receptors coupled to?
Gq
80
What does Gq activate? Then what products are formed?
PLC; PIP2 and DAG
81
Isolated lifestyle, has no longing for others, loner
Schizoid
82
Weird, eccentric behavior, magical thinking
Schizotypal
83
What is the cause of cat scratch fever?
Bartonella henselae
84
What vein drains the majority/medial side of the leg?
Long saphenous vein
85
Lymph drainage of the medial leg/foot goes where?
Inguinal lymph nodes
86
What vein drains the lateral side of dorsum of the foot?
Short saphenous vein
87
Where does lymph drain from the lateral aspect of the dorsum of the foot?
Lymph nodes behind the popliteal fossa
88
What pathologic changes are seen in fibromuscular dysplasia?
Thickening of tunica media and collagen formation
89
What pattern is seen on angiography in fibromuscular dysplasia?
Beads on a string
90
What interaction causes strong adhesion necessary for extravasation?
Interaction between LFA-1 on WBCs and ICAM-1 on endothelial cells
91
What are the four key indicators of DIC?
Decreased fibrinogen levels, elevated fibrin degradation products, D-dimers, prolonged bleeding time
92
How can when decipher between cirrhosis related coagulopathy and DIC?
D-dimers and fibrin degradation products - both are elevated in DIC
93
What is the key difference between FDPs and D-dimer?
FDPs can be generated from degradation of fibrinogen or fibrin; D-dimer derives exclusively from fibrin
94
Spindle-celled vascular neoplasm
Kaposi sarcoma
95
What is the appearance of Kaposi sarcoma on physical exam?
Red-violet plaques or nodules disseminated across the oral cavity, face, extremities, and trunk
96
What is acetylcholines affect on pupil diameter?
Decreases (constricts)
97
What muscle does acetylcholine act on in the pupil? What is its affect?
Acts on pupillae sphincter muscle (M3 receptors) and causes pupillary constriction
98
What muscarinic receptors are found in blood vessels?
M3
99
What is acetylcholines affect on blood vessels?
Acts on M3 receptors to release nitric oxide, causing vasodilation
100
What is the MOA of phenylephrine?
Alpha 1 agonist
101
What is phenylephrines affect on pupil diameter?
Pupillary dilation
102
What is atropines affect on pupil diameter and heart rate?
Blocks M3 receptors in pupil leading to pupil dilation; blocks M2 receptors in the heart leading to increased heart rate
103
What is the MOA of phentolamine?
Non-selective alpha antagonist
104
What receptors cause pupillary dilation? Constriction?
Alpha 1 receptors cause pupillary dilation; M3 receptors cause constriction
105
What is the MOA of tricyclic antidepressants?
Block reuptake of serotonin and norepinephrine
106
What are SEs of TCAs?
Antimuscarinic effects - dry mouth, tachycardia, urinary retention, IOP, and sedation, QT prolongation, Torsades, AV block
107
What drug class is doxepin in?
TCA
108
What is the MOA of galantamine? What is it used for?
Blocks acetylcholinesterase; used in Alzheimer disease
109
What cancer can cause SIADH?
Small cell carcinoma
110
Small cell carcinoma cell are derived from what?
Neuroendocrine cells
111
What oncogene is associated with small cell carcinoma?
L-myc
112
What is seen microscopically in small cell carcinoma? What immunohistochemical stains confirm it?
Uniform, polygonal blue cells with little cytoplasm; neuron specific enolase (NSE) and chromogranin
113
What paraneoplastic syndromes are associated with small cell carcinoma?
SIADH, cushing syndrome (secretes ACTH), and Lambert-Eaton myasthenic syndrome
114
What type of tumor form glandular structures that may contain intracytoplasmic mucin?
Adenocarcinoma
115
Serotonin-secreting tumor of neuroendocrine cell origin
Carcinoid tumor
116
What type of tumor secretes parathyroid hormone-related protein (PTH-rp)?
Squamous cell carcinoma
117
What are the symptoms of carcinoid syndrome?
Wheezing, flushing, diarrhea, tachycardia
118
Urinary tract calcium stones can be associated with what type of cancer?
Squamous cell carcinoma - secretes PTH-rp
119
What is conjugation?
Transfer of genetic material from one cell to another via cell-to-cell contact
120
In transfer of a plasmid, what region is transferred first? Transferred last?
OriT is first, tra is last
121
What is Hfr?
High frequency recombination - F+ plasmid can become incorporated into bacterial chromosomal DNA
122
What is transferred during Hfr x F- conjugation?
Transfer of leading part of plasmid and a few flanking chromosomal genes; ie not entire chromosome/plasmid is transferred - F- cell remains F-
123
What is generalized transduction?
"A packaging event." Lytic phage infects bacterium, bacterial DNA is cleaved, bacterial DNA may be packaged into phage capsid
124
What is specialized transduction?
"An excision event." Lysogenic phage infects bacterium; viral DNA incorporates into bacterial chromosome. When phage DNA is excised, flanking bacterial DNA is also excised.
125
What bacterial toxins are encoded in lysogenic phage?
Cholera toxin, O antigen from salmonella, botulinum toxin, erythrogenic toxin from Group A strep, diphtheria toxin, shiga toxin
126
What bacteria can be contracted by consuming raw oysters?
Vibrio vulnificus and V. Parahaemolyticus
127
What is the morphology of Vibrio sp?
Gram negative, comma-shaped rods what are isolated on alkaline media (TCBS)
128
How can one contract V. Vulnificus?
Swimming in brackish waters, shucking oysters, consumption of undercooked/raw sea food
129
How does one contract V. Parahaemolyticus?
Consumption of undercooked/raw seafood
130
What are the symptoms of V. Parahaemolyticus?
Watery diarrhea with cramping abdominal pain
131
How does one contract Campylobacter jejuni?
Eating poultry
132
What infectious agent might one acquire from eating salads, unwashed fruits and hamburger?
E. Coli
133
How does one acquire salmonella? What is its morphology?
Eating poultry; gram negative rod, non-lactose fermenters, H2S positive
134
What is the morphology of C. Jejuni?
Gram negative curved rods that grow at 42 C (107.6 F)
135
What is the inheritance pattern of acute intermittent porphyria?
Autosomal dominant
136
What enzyme is deficient in acute intermittent porphyria?
Porphobilinogen deaminase (aka hydroxymethylbilane synthase)
137
What substrates become elevated in acute intermittent porphyria?
Porphobilinogen and delat-aminolevulinic acid (ALA)
138
What are the symptoms of acute intermittent porphyria?
Episodic; 5Ps: peripheral neuropathy, painful abdomen, pink urine, pyschiatric sequelae (depression, hallucinations), paralysis. Can also see leukocytosis and microcytic anemia
139
What precipitates acute intermittent porphyria?
Drugs that induce Cyp450 (eg phenobarbital) and sulfonamide (even though these inhibit Cyp450)
140
What can be used in treatment of acute intermittent porphyria?
Heme and glucose - inhibit ALA synthase activity
141
What enzyme in heme synthesis is inhibited by lead?
ALA dehydratase
142
Liver reveals evidence of hemorrhage and necrosis in the centrilobular regions of the liverparenchyma, what is the possible underlying condition?
Chronic congestive heart failure
143
What is congestive hepatopathy?
Blood stasis due to CHF in the centrail veins and sinusoids of hepatic lobules leads to central hemorrhagic necrosis
144
The classic gross appearance of "nutmeg liver" is seen in what condition?
Congestive heart failure
145
Councilman bodies are seen in what disease?
Viral hepatitis
146
Viral hepatitis produces necrosis where?
In the hepatocytes of the periportal areas
147
Hepatocyte necrosis and formation of mallory bodies is seen in what disease?
Alcoholic hepatitis
148
What is the affect of ACE inhibitors on serum K?
Serum K increases due to the decreased in AG II and therefore decreased in aldosterone; aldosterone potentiates urinary secretion of K
149
What are the side effects of ACEi?
Angioedema, dry hacking cough, hyperkalemia
150
What are the affects of ACEi on sodium?
Increased urinary excretion of sodium; due to decreased aldosterone
151
What is the MOA of Aliskiren?
Direct renin inhibitor
152
Essential tremor commonly affects what parts of the body?
Upper extremities, head, and voice
153
What are the first line therapies for essential tremor?
Propranolol (non selective beta antagonist) and primidone (barbiturate anticonvulsant)
154
In what disease do you seen neurofibrillary tangles?
Alzheimer disease
155
What regions of the brain are neurofibrillary tangles found in AD?
Frontal and temporal lobes
156
Gliosis of the caudate nucleus is found in what disease?
Huntington disease
157
What are Lewy bodies? What disease are they commonly seen in?
Eosinophilic intracytoplasmic spherules; seen in Parkinson disease
158
In Parkinson disease, there is loss of pigmention in what region of the brain?
Substantia nigra
159
What are neurofibrillary tangles?
Hyperphosphorylated tau protein
160
In what disease does one seen granulovacuolar degeneration and Hirano bodies?
Alzheimer disease
161
What are Hirano bodies?
Rod-shaped, crystal-like, and eosinophilic intracellular aggregates of actin
162
What is a positive Trendelenburg sign?
Pelvis tilts because weight bearing leg cannot maintain alignment of pelvis through hip abduction
163
What is the cause of a positive Trendelenburg sign?
Weakness of the abductors of the hip (gluteus medius and gluteus minimus)
164
Patient with a disc herniation has a positive Trendelenburg sign, at what level(s) might the disc herniation have occured?
L4-S1
165
What nerve innervates the gluteus medius?
Superior gluteal nerve
166
What nerve innervates the adductor magnus?
Obturator nerve
167
What nerve innervates the medial compartment of the thigh?
Obturator nerve
168
What innervates the gluteus maximus?
Inferior gluteal nerve
169
What innervates the gluteus minimus?
Superior gluteal nerve
170
When a patient stands on his right foot, and the hip on the left side drops, what muscle(s) are damaged?
Right gluteus medius and/or right gluteus minimus
171
During which phase of the cell cycle does a trinucleotide expansion occur?
S phase
172
During which phase of the cell cycle does mismatch repairs take place?
G2
173
Slippage of the DNA polymerase results in what genetic mutation?
Trinucleotide repeat expansion
174
What is the embryonic failure in a Meckel diverticulum?
Vitellin duct fails to atrophy completely
175
What is the anatomical difference between infantile and adult coarctation of the aorta?
Infantile-constriction is proximal (preductal) to the ductus arteriosus; adult-constriction is distal (postductal) to the ductus arteriosus
176
Infantile coaractation of the aorta is associated with what other cardiovascular defect?
PDA
177
Tumor that grows from the walls of the lateral ventricles and contains large ganglioid cells is characteristic of what tumor?
Subependymal giant cells astrocytoma
178
Subependymal giant cell astrocytomas is associated with what disease?
Tuberous sclerosis
179
Mutations in what genes cause tuberous sclerosis? Including what chromosome?
TSC1 and TSC2; chromosome 16
180
What is the inheritance pattern of tuberous sclerosis?
Autosomal dominant
181
Cafe-au-lait spots are found in what disease(s)?
Neurofibromatosis type I and neurofibromatosis type II; and McCune-Albright syndrome
182
What is the origin of a hemangioblastoma? Where does it commonly develop?
Vascular origin; develops in cerebellum, spinal cord and retina
183
What disease is hemangioblastoma associated with?
Von-Hippel-Lindau syndrome
184
Hypopigmented "ash-leaf" spots are associated with what disease?
Tuberous sclerosis
185
What are Lisch nodules? What disease are they associated with?
Small, pigmented iris harmatomas; associated with NF1
186
Renal angiomyolipomas and cardiac rhabdomyomas are associated with what disease?
Tuberous sclerosis
