Quiz 57 Flashcards
1
Q
Acid-fast fecal oocysts in patient with AIDs
A
Cryptosporidium
2
Q
How does cryptosporidium parvum cause diarrhea?
A
Direct lysis of cells of the brush border
3
Q
Blistering rash with flaccid bullae and epithelial cell separation (acantholysis) is seen in what disease?
A
Pemphigus vulgaris
4
Q
Positive Nikolsky sign is seen in what autoimmune blistering disease?
A
Pemphigus vulgaris
5
Q
What are the antibodies against in pemphigus vulgaris?
A
Desmosomal proteins
6
Q
Subepidermal, tense blisters that do not easily rupture (negative Nikolsky sign) is seen in what blistering disease?
A
Bullous pemphigoid
7
Q
What are the antibodies directed against in bullous pemphigoid?
A
Hemidesmosomes
8
Q
What disease has autoantibodies to desmosomes?
A
Pemphigus vulgaris
9
Q
What organism is characterized by “box-car” large gram positive, spore forming rod?
A
C. Perfringens
10
Q
What is the toxin associated with C. Perfringens and the myonecrosis?
A
Alpha toxin - lecithinase
11
Q
What is the gram stain and morphology of C. Perfringens?
A
Gram positive rod - spore forming and anaerobic
12
Q
Positive Nagler’s reaction for lecithinase is seen in what organism?
A
C. Perfringens
13
Q
What is transplant rejection, immunologically?
A
Host immune system attacks the foreign tissue
14
Q
What is GVHD?
A
Graft vs host disease - donor leukocytes consider recipient foreign and attack host tissue
15
Q
What is a normal, non-pathologic form of intrinsic apoptosis?
A
Menstruation
16
Q
Brain tumor with necrosis and hemorrhage; tumor cells are pleomorphic and frequently bizarre in appearance
A
GBM
17
Q
What is seen histologically in GBM?
A
Necrosis, hemorrhage, and tumor cells that are pleomorphic with a bizarre appearance
18
Q
A well differentiated variant of astrocytic tumor?
A
Fibrillary astrocytomas
19
Q
Fried egg appearance is characteristic of what brain tumor?
A
Oligodendrogliomas
20
Q
Nuclei surrounded by clear cytoplasm is seen in what type of brain tumor?
A
This is the fried egg appearance seen in oligodendrogliomas
21
Q
Rosenthal fibers are a classic finding in what brain tumor?
A
Pilocytic astrocytoma
22
Q
What patient population and where in the cranium do pilocytic astrocytomas form?
A
In children, usually located in the cerebellum
23
Q
GBM form in what region in adults?
A
Cerebral cortex
24
Q
Where do GBM form in children?
A
Brainstem
25
What is seen histologically in pilocytic astrocytoma?
Rosenthal fibers - "eosinophilic corkscrew fibers"
26
What portion of the collecting system resorbs the most water in the kidney?
Proximal convoluted tubule
27
What remains intact in a patient with locked in syndrome?
Vertical eye movements and blinking
28
What is delusional disorder?
Psychotic disorder involving one or more non-bizarre delusions in absence of other significant psychopathology
29
Partial glucocorticoid resistance can result in what PE and lab findings?
Increased BP, acne, hirsutism, hypokalemia, decreased renin
30
What is graft vascular disease?
Graft arteriosclerosis, a result from chronic transplant rejection
31
What can result from chronic transplant rejection?
Graft vascular disease
32
What is seen histologically in graft vascular disease?
Intimal and medial thickening or coronary arteries without associated atheroma formation
33
Patient with history of transplant dies, on autopsy there is intimal and medial thickening of the coronary arteries w/o association atheroma formation, what is the diagnosis?
Graft vascular disease
34
RBCs that lack the normal central pallor and concave shape
Spherocytes
35
What is the inheritance pattern of hereditary spherocytosis?
Autosomal dominant
36
What is defective in hereditary spherocytosis?
Cytoskeletal proteins - most commonly spectrin and ankyrin
37
Infection with what can cause red cell aplasia? Who is more likely to be affected?
Parvovirus B19; patients with pre-existing marrow disease (sickle cell anemia, HS)
38
What type of anemia is hereditary spherocytosis?
Normocytic and intrinsic hemolytic
39
How is hereditary spherocytosis diagnosed?
Osmotic fragility test
40
RBCs with heinz bodies and bite cells is seen in what disease?
G6PD
41
What disease can commonly cause hemolytic anemia in newborns?
Pyruvate kinase def.
42
What is the antibiotic of choice for pseudomembranous colitis?
Metronidazole
43
What is the mechanism of action of metronidazole?
Forms toxic free radical metabolites in the bacterial cell that damage DNA
44
What is an adverse effect of metronidazole?
Disulfiram-like reaction
45
What is seen in the labs of a patient with familial hypocalciuric hypercalcemia?
Increased serum calcium, decreased urine calcium, high levels of PTH
46
What is the defect in familial hypocalciuric hypercalcemia?
Defect in C coupled calcium sensing receptors
47
What is the genetic mutation in familial hypocalciuric hypercalcemia?
Autosomal dominant mutation of CaSR gene
48
Mutation in AIRE can cause what characteristic findings?
Autoimmune hypoparathyroidism; mucocutaneous candidiasis with hypocalcemia
49
What two arteries does CN III pass through?
Superior cerebellar artery and posterior cerebral artery
50
What region of the brain does the posterior cerebral artery supply?
Medial midbrain
51
A stroke involving the posterior cerebral artery causes what symptoms?
Contralateral hemianopia with macular sparing
52
Compression of CN III can cause what symptoms?
Mydriasis and inability to adduct the eye
53
What is the function of CN IV? What does it innervate?
Depression of the eye from the adducted position; innervates superior oblique muscles
54
Patient with ptosis and down and out gaze has a damage to what CN?
CN III
55
What muscle is responsible for abduction of the eye? What is its innervation?
Lateral rectus; supplied by CN VI (abducens n.)
56
Why is there an increased cardiac afterload in a patient with nocturnal hypoxia?
Increased pulmonary and vascular resistance
57
What is the inheritance pattern of G6PD?
X-linked recessive
58
What is Leber hereditary optic neuropathy?
Acute/subacute vision loss, especially in young men
59
What is the inheritance patter of Leber hereditary optic neuropathy?
Mitochondrial inheritance pattern
60
What is the inheritance of neurofibromatosis?
Autosomal dominant
61
What is the inheritance pattern of sickle cell anemia?
Autosomal recessive
62
What is the inheritance pattern on Tay-Sachs?
Autosomal recessive
63
Prolonged exercise (greater than a few hours) uses what metabolism to supply energy?
Hepatic gluconeogenesis
64
What does hepatic glycogenolysis occur in regards to exercise?
First few hours of exercise
65
Half life of a drug can be determined using what equation?
T 1/2 = (0.7 x Vd) / Cl
66
How long does it take to reach steady state?
4-5 half lives
67
(0.7 x volume of distribution) / clearance can be used to calculate what?
Half life
68
Protein extracted from cells is subjected to electrophoresis, then transferred to a filter and exposed to labeled DNA. This describes what type of technique?
Southwestern blotting
69
What is southwestern blotting used for?
Can be used to identify transcription factors
70
What interactions are involved in a Southwestern blot?
DNA-protein interactions
71
What technique is helpful in determining which tissues express the gene for a specific protein?
Northern blotting
72
What technique can be used to compare DNA samples for genetic relatedness?
Southern blot
73
What symptoms are seen in a patient on PCP?
Reckless behavior, horizontal or vertical (mostly) nystagmus, hypertension, tachycardia, diaphoresis
74
What is a Marcus-Gunn pupil?
An afferent pupillary defect - Decreased sensitivity of the affected eye to light
75
How can a Marcus-Gunn pupil be diagnosed?
Swinging light test
76
What will you see in a Marcus-Gunn pupil upon the swinging flashlight test?
Stimulation of the unaffected eye leads to pupillary constriction in both eyes, stimulation of affected eye can lead to relative dilation of both eyes
77
What type of T cells cause the development of IgE antibodies?
Th2
78
What is responsible for isotype switching to IgE?
Th2 secretion of IL-4
79
What cytokine is important in isotype switching to IgA?
IL-5
80
Amyotrophic lateral sclerosis results in degeneration of what?
UMN and LMN
81
Patient with UMN signs and LMN signs, what is on the top of your DDx?
ALS
82
In ALS, what regions of the spinal cord are affected?
Corticospinal tract (UMN) and ventral anterior horn (LMN)
83
Are fasciculations seen in LMN lesions or UMN lesions?
LMN lesions
84
Damage to the caudate nucleus is seen in what disease?
Huntington disease
85
What is damaged in Parkinson disease?
Substantia nigra
86
What is seen on a EEG during an absence seizure?
3-Hz spike and wave complex
87
Dynein does what in nerves?
Retrograde transport ( toward minus end)
88
Chlamydophila pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae have what in common?
Cause atypical or walking pneumonia and do not gram stain
89
What is the gram stain and morphology of H. Influenzae?
Gram negative coccobacilli
90
What is required for growth of Legionella pneumophila?
Charcoal yeast extrac medium with iron and cysteine
91
What is the gram stain and morphology of Moraxella catarrhalis?
Gram negative diplococcus
92
What is a key genetic marker of neuroblastoma?
Amplification of N-myc oncogene (poorer prognosis)
93
What is opsoclonus-myoclonus?
Opsoclonus - rapid, involuntary horizontal and vertical conjugate fast eye movements; myclonus - brief, involuntary twitching of muscles
94
In a patient with a neuroblastoma, what is elevated in the serum and urine?
Homovanillic acid and VMA
95
Young child with abdominal mass that crosses the midline, uncontrolled movement on lower limbs and eyes?
Neuroblastoma
96
What is the most common cause of GI obstruction in children 3 months to 6 years?
Intussusception
97
6 month old male presents with sudden onset of vomiting with reddish and gelatinous stool, what is the most likely underlying condition?
Intussusception
98
What is the mechanism of action of lactulose in the treatment of hepatic encephalopathy?
Degraded by gut flora to lactic acid, which acidifies the gut lumen. Acidification of the gut lumen favors conversion of NH3 (ammonia) to NH4 (ammonium) - NH4 cannot cross intestinal lumen
99
What are two other important treatments in hepatic encephalopathy besides lactulose?
Low protein diet and rifaximin (kills intestinal bacteria)
100
What is the drug classification of hydroxyzine?
First generation H1 antihistamine
101
Name 4 second generation H1 receptor antagonists
Fexofenadine, cetirizine, loratadine, desloratadine
102
What regions of the brain are most commonly affected by kernicterus?
Basal ganglia and brainstem nuclei involved in oculomotor and auditory function
103
Child with opisthotonos, high pitched cry, and abnormal Moro reflex is seen in what disease?
Kernicterus
104
What is a common antibiotic that can cause of kernicterus in newborns?
Sulfonamide antibiotics
105
During what stage of pregnancy should sulfonamide antibiotics be avoided? Why?
2nd and 3rd trimester; can cause kernicterus in newborns
106
What antibiotic is associated with gray baby syndrome?
Chloramphenicol
107
What is the MOA of chloramphenicol?
Blocks peptidyltransferase at 50S ribosomal subunit
108
What is the acronym for metabolic acidosis?
MUDPILES
109
What does the acronym MUDPILES stand for?
Methanol, uremia, DKA, propylene glycol (paraldehyde, paracetamol, phenformin), iron/isoniazid, lactic acidosis, ethylene glycol, salicylates (late)
110
What is seen in the urine of a patient with ethylene glycol poisoning?
Oxalate crystals - calcium oxalate
111
What enzyme metabolizes ethylene glycol?
Alcohol dehydrogenase
112
What can be used as an antidote to ethylene glycol poisoning? Why?
Fomepizole - inhibits alcohol dehydrogenase
113
What acid/base pathophysiology is seen with severe aspirin poisoning?
Early-primary respiratory alkalosis (stimulates resp drive); Late-metabolic acidosis (due to ASA metabolites
114
What nerve pierces the coracobrachialis?
Musculocutaneous
115
What nerve pierces the pronator teres?
Median
116
What nerve pierces the supinator?
Radial
117
What nerve pierces the flexor carpi ulnaris?
Ulnar nerve
118
What muscle does the median nerve pierce?
Pronator teres
119
What muscle does the musculocutaneous nerve pierce?
Coracobrachialis
120
What nerve, artery and vein exit the greater sciatic foramen above the piriformis?
The superior gluteal nav
121
What does the superior gluteal nerve innervate?
Gluteus medius and gluteus minimus
122
What is the function of the gluteus medius and gluteus minimus?
Major abductors at the hip
123
What is the function of the gluteus maximus?
Extensor and lateral rotator of the hip
124
What innervates the gluteus maximus?
Inferior gluteal nerve
125
Eosinophilic cytoplasmic inclusions seen in alcoholic liver disease
Mallory bodies
126
What are Russell bodies?
Cytoplasmic inclusions of antibody in plasma cells
