QUIZ 61 Flashcards
Where does HSV-1 remain latent?
Trigeminal root ganglion
Where does V1 exit the skull?
Superior orbital fissure
Where does V2 exit the skull?
Foramen rotundum
Where does V3 exit the skull?
Foramen ovale
What is the MOA of cinacalcet?
Calcimimetic agent - increases the sensitivity of calcium-sensing receptor CaSR on chief cells; causes a reduction in PTH
What is the MOA of pamidronate?
Inhibits osteoclastic activity
What virulence factor of S aureus inhibits opsonization?
Protein A - binds to the Fc portion of IgG
What does Protein A helps S. aureus with?
Avoid opsonization (and therefore phagocytosis)
What is the characteristic triad of Wiskott-Aldrich syndrome?
Thrombocytopenia, immunodeficiency, eczema
In Wiskott-Aldrich syndrome, are IgM, IgE, and IgA increased or decreased?
IgM low; IgE and IgA increased
What is the inheritance pattern on Wiskott-Aldrich syndrome?
X-linked recessive disease
What is the mutation that occurs in Wiskott-Aldrich syndrome?
WASP gene mutation - functions in reorganizing actin cytoskeleton
Malignant hyperthermia can results from what drug?
Succinylcholine (and inhaled anesthetic)
What is dantrolene used for?
Malignant hyperthermia
What is the MOA of dantrolene?
Ryanodine receptor blocker - reduced release of calcium from SR
What happens to the sleep cycle in a patient with major depressive disorder?
Increased REM sleep
What neoplasia are seen in MEN 1?
Parathyroid, pituitary, pancreatic islet cells
What affect does a prolactin secreting tumor have on gonadotropins?
Suppresses them
What is seen on a biopsy of temporal arteritis?
Focal granulomatous inflammation with giant cells
What can be seen on a biopsy of polyarteritis nodosa?
Fibrinoid necrosis
What nerve lies on the anterior surface of the anterior scalene?
Phrenic nerve
What innervates the cricothyroid muscle?
Superior laryngeal nerve
What are pigment gallstones made of?
Calcium bilirubinate
What are the risk facrots for pigment gallstones?
Hepatic cirrhosis, hemolytic anemia, liver fluke infection ( Clonorchis sinesis)
Clonorchis sinensis is usually found where and can cause what?
Found in Asia; risk factor for pigment gallstones
What is clonorchis sinensis transmitted?
Freshwater snails to fish to humans
FNA of thyroid nodule reveals atypical uniform polygonal neoplastic cells; what is the most likely diagnosis?
Medullary carcinoma - derived from parafollicular cells
What cell type are medullary carcinomas of the thyroid derived from?
Parafollicular C cells
Baby born with small jaw, prominent occiput, low set ears, short neck, rocker-bottom feet, clenched hands with overlapping fingers, what is the disease?
Trisomy 18 - Edwards syndrome
Baby born with holoprosencephaly, cleft lip and palate, and small eyes, what is the disease?
Trisomy 13 - Patau syndrome
What is Loeffler endocarditis?
Endomyocardial fibrosis with hypereosinophilia syndrome - restrictive heart disease that causes endomyocardial fibrosis with associated eosinophilia
Patient presents with watery diarrhea, and some blood-tinged stool with abdominal cramping and fever. Organism is microaerophilic, oxidase-positive, gram-negative, curved rod with polar flagella. What is it?
C jejuni
How is one infected with C jejuni usually?
Contaminated poultry
What is gram stain and morphology of C jejuni?
Gram negative curved rod with polar flagella; also oxidase positive and microaerophilic
What drug class is used for the treatment of ulcerative colitis?
5-aminosalicylates (eg mesalamine)
What is the MOA of mesalamine?
Its an aminosalicylate - anti-inflammatory
What aminosalicylates are used to treat ulcerative colitis?
mesalamine, olsalazine, and sulfasalazine
What is an act of commission?
Doing something wrong that could potentially lead to undesirable outcome or AE
What is a medical error classified as an act of omission?
Failing to do the right thing
What affects does 21-hydroxylase deficiency have on blood glucose, potassium, sodium?
No aldosterone or cortisol = low blood glucose, increased potassium, low sodium
What affects does a 21 hydroxylase deficiency have on 46,XX genitalia?
Ambiguous - increased 21 hydroxylase substrate goes to production of androstenedione, dihydrotestosterone, and testosterone = virilization
What will be markedly elevated in the serum of a patient with 21 hydroxylase deficiency?
17-OH progesterone
Male fetus with normal differentiation of internal reproductive tract, but external genitalia is feminized. What is the enzyme deficiency?
5-alpha reductase
5 alpha reductase deficiency results in what phenotype of a 46, XY fetus?
Normal internal male reproductive tract; external genitalia is feminized
Team STEPPS is a teamwork system that promotes what four skills?
Leadership, communication, situation monitoring, mutual support
What is the presentation of congenital toxoplasmosis?
Chorioretinitis, hydrocephalus, intracranial calcifications
What causes congenital toxoplasmosis?
Toxoplasma gondii
How is congenital toxoplasmosis treated?
Pyrimethamine and sulfadiazine
What is the mechanism of action of pyrimethamine? What is it used to treat?
Inhibits dihydrofolate reductase; used to treat toxoplasmosis
What is the mechanism of action of sulfadiazine?
Inhibits dihydropteroate synthetase
Isolated high alkaline phosphatase can be seen in what diseases? (Name 6)
PBC, sclerosing cholangitis, granulomatous hepatitis, abscesses, tumor infiltration, bone disease
What is a Virchow’s node? What is it a sign of?
Enlarged left supraclavicular lymph node; may be first presentation of intra abdominal cancer (usually stomach)
Bladder rupture into peritoneum results in what lab findings of the fluid?
High urea, creatinine, ammonia; amylase and lipase are low
Fluid from ascites results in what lab findings?
High ammonia and alkaline phosphatase; low creatinine and urea
How does one differentiate from bladder rupture fluid and ascites?
Ascites has low creatinine and urea; bladder rupture has high creatinine and urea
Methemoglobinemia in a new born with hypertension is due to what drug administration?
Excessive nitric oxide
How is methemoglobinemia treated?
Methylene blue and increased oxygen
What is the MOA of methylene blue?
Facilitates conversion of methemglobin back to hemoglobin by NADH-methemglobin reductase
What is EDTA? What is it used for?
Chelating agent; used to bind and clear heavy metals such as lead
What can be used to treat cyanide ingestion?
Nitrite
In a negative skew, which way is the tail?
Left
In a positive skew, which way is the tail?
Right
High-pitched, blowing, early-diastolic murmur, most intense at left sternal border.
Aortic regurg
Widened pulse pressure and “water-hammer pulse” occur in what murmur?
Aortic regurg
What is used in the treatment of Wilson’s disease?
Penicillamine and trientine (copper chelating agents)
What is penicillamine?
Copper chelating agent
What is trientine?
Copper chelating agent
What is succimer used to treat?
Lead, arsenic, mercury overdose/toxicity
What can be used to treat arsenic?
Dimercaprol, penicillamine, or succimer
What can be used to treat iron toxicity?
Deferoxamine
What can be used to treat lead poisoning?
EDTA, dimercaprol, succimer
What can be used to treat mercury poisoning?
Dimercaprol, penicillamine, succimer
What can dimercaprol be used to treat?
Lead, arsenic, mercury
Locked in syndrome is due to a lesion where?
Ventral pons
Rheumatoid arthritis is commonly associated with what HLA?
HLA-DR4
Psoriatic arthritis is associated with what HLA?
HLA-B27
Inflammatory bowel disease is associated with what HLA?
HLA-B27
Reactive arthritis is associated with what HLA?
HLA-B27
Graves disease is associated with what HLA?
HLA-DR3
What HLA is SLE associated with?
HLA-DR2, HLA-DR3
What chemotherapeutic drug can cause chronic pneumonitis that can progress to pulmonary fibrosis?
Bleomycin
What is the MOA of bleomycin?
Intercalating agent that complexes with iron (forming ROS) and induces DNA strand breaks
