Quiz 62 Flashcards
Wernicke Korsakoff syndrome results from deficiency in what vitamin?
B1 - thiamine
What is the clinical triad of wernicke encephalopathy?
Encephalopathy, oculomotor dysfunction (nystagmus, lateral rectus palsy, conjugate gaze palsy) and gait ataxia
In Wernicke encephalopathy, what is administered for treatment?
Thiamine - must be given PRIOR to glucose
Is Korsakoff syndrome before or after Wernicke encephalopathy? Which of the two is reversible?
Korsakoff is late stage and is irreversible; Wernicke is reversible
What areas of the brain are thought to be affected by Korsakoff syndrome?
Thalamus (dorsomedial nuclei) and mammillary bodies
What is the MOA of trihexyphenidyl?
Muscarinic antagonist
What are the side effects of antimuscarinic meds?
Flushing, dry skin and mucous membranes, mydriasis, delirium, hyperthermia due to decreased sweating
What is the MOA of benztropine?
Muscarinic antagonists
The caudate nucleus comprises part of what ventricle?
Wall of lateral ventricle
Tumor in lateral ventricle can affect what nucleus?
Caudate nucleus
What is genetic shift?
Shuffling of segments of genomic RNA so new genetic combinations can be produced
What is genetic drift?
Minor antigenic changes from the accumulation of point mutations
What viruses can undergo genetic shift?
Orthomyxovirus, Bunyavirus, Arenavirus, Reovirus
BORA
What is seen histologically of a liposarcoma?
Pleomorphic lipocytes, with a cytoplasm filled with lipid vacuoles (positive for fat stains)
Deficiency in UMP synthase results in a buildup of what?
Orotic acid
How can one differentiate between ornithine transcarbamoylase def. and UMP synthase def?
Both will have orotic aciduria, but UMP synthase def. results in megaloblastemia
What is the oval window in the ear?
It separates the air-filled middle ear and fluid-filled inner ear
What is the scala tympani?
A perilymphatic chamber in the cochlea
What is the scala vestibuli?
A perilymphatic chamber in the cochlea
What is the composition of perilymph?
High sodium and low potassium (similar to extracellular fluid)
What is the scala media?
Cochlear duct that forms the endolymph
What is the composition of endolymph?
Similar to intracellular fluid - high potassium and low sodium
What contains the sensory epithelium or hair cells of the ear?
Organ of corti
What patient population and symptoms are seen with mucormycosis?
Ketoacidotic diabetic and neutropenic patients; headache, fever, sinusitis, black necrotic eschar on face/nose
What is the cause of mucormycosis? What is seen on microscopy?
Mucor or Rhizopus spp. - see hyphae branch at 90-degree angles and have irregular width
Type I diabetic presents with HA, fever, nasal congestion, swelling of R eye with black necrotic nodule in nasal cavity. What organism is the most likely cause? What is seen microscopically?
Mucor or Rhizopus spp. See hyphae branching at 90-degree angles with irregular width
What artery supplies the distal end of the lesser curvature of the stomach?
R gastric artery
What artery supplies the proximal end of the lesser curvature of the stomach?
L gastric artery
What is the right gastric artery a branch of?
Proper hepatic artery
What arteries supply the lesser curvature of the stomach?
L and R gastric arteries - anastomose
What is often the source of bleeding in a duodenal ulcer?
Gastroduodenal artery
What arteries does the gastroduodenal artery give rise to?
Right gastroepiploic artery and superior pancreaticoduodenal artery
The gastroduodenal artery is a branch of what artery?
Common hepatic artery
What artery supplies the proximal portion of the greater curvature of the stomach?
Left gastroepiploic artery
What artery supplies the distal portion of the greater curvature of the stomach?
Right gastroepiploic artery
The left gastroepiploic artery is a branch of what artery?
Splenic artery
What arteries supply the fundus of the stomach?
Short gastric arteries
What happens to progesterone in the zona glomerulosa?
Undergoes 21 hydroxylation for the pathway of aldosterone synthesis
What are the most common causes of travelers diarrhea?
ETEC, shigella and C. Jejuni (later two produce bloody diarrhea)
If necessary, what antibiotics are used to treat travels diarrhea?
Fluoroquinolones (ciprofloxacin, ofloxacin, norfloxacin)
What blood vessels have the highest resistance?
Arterioles
The pressure point of aortic valve opening is equal to what pressure?
Diastolic blood pressure
Microscopic examination of the brain infected with HSV-1 encephalitis shows what?
Cowdry type A inclusions
When does one see Cowdry type A inclusions in the neurons and glia?
Herpes simplex infection (herpes encephalitis)
Examination of CSF with viral encephalitis shows what?
Lymphocytes, normal glucose, elevated proteins
What does microscopic examination show in progressive multifocal leukoencephalopathy?
Greatly enlarged oligodendrocyte nuclei with glassy amorphic viral inclusions
If greaty enlarged oligodendrocyte nuclei with glassy amorphic viral inclusions are seen on brain biopsy, what is the diagnosis?
Progressive multifocal leukoencephalopathy
Microglial nodules containing multinucleated giant cells on brain biopsy is characteristic of what?
Chronic HIV encephalitis
Extension of the thumb is controlled by what muscles?
Extensor pollicis longus and brevis
What nerve controls extension of the thumb?
Radial
What nerve innervates extensor pollicis longus and brevis?
Radial nerve
What affect does the radial nerve have on the thumb motion?
Extension
What muscles of the thumb does the median nerve innervate?
The thenar muscles - responsible for flexion, abduction, and opposition
What muscle adducts the thumb?
Adductor pollicis
What nerve innervates the adductor pollicis?
Ulnar
Adduction of the thumb is mediated by what muscle? What is its innervation?
Adductor pollicis; ulnar
What disease is associated with anticentromere antibodies?
CREST syndrome (limited systemic sclerosis)
What disease is associated with anti-DNA topoisomerase?
Diffuse systemic sclerosis; antibody is also called anti-Scl 70
What disease is associated with anti-RNPs?
Sjogren
What antibodies do you seen in diffuse systemic sclerosis?
Anti-DNA topoisomerase (anti-Scl 70)
What antibodies do you see in limited systemic sclerosis?
Anticentromere
When do you see Anti-Scl 70 antibodies?
Diffuse systemic sclerosis
What disease is associated with antimitochondrial antibodies?
Primary biliary cirrhosis
What disease is associated with anti-TSH receptor antibodies?
Graves disease
What is used pharmacologically for the treatment of OCD?
1st - SSRIs; if unresponsive the TCA clomipramine
What is the class of buspirone?
Nonbenzo anxiolytic
What is chlorpromazine?
Antipsychotic; selectively antagonizes dopamine D2 receptors
What TCA is used to treat OCD?
Clomipramine
What is the inheritance pattern of G6PD?
X linked recessive
What are common adverse reactions to heparin?
Bleeding and drug induced thrombocytopenia
What is the drug of choice in a patient with heparin induced thrombocytopenia?
Bivalirudin
What is the MOA of bivalirudin?
Direct inhibitor of thrombin
What is seen on ECG in a subendocardial infarction?
May show ST segment depression or flattening on various leads
What is seen on ECG in transmural infarction?
ST elevation
What are the aminopenicillins?
Amoxicillin and ampicillin
What is the unique pattern of ABGs in salicylate toxicity?
Initially respiratory alkalosis (ASA directly stimulates the resp center), then metabolic acidosis with anion gap (salicylates interfere with Krebs cycle)
What is the mechanism behind fever in ASA toxicity?
Uncoupling of the electron transport chain
What type of acid/base disorder is seen in HCTZ?
Metabolic alkalosis (excretion of H+ ions)
What are the four characteristics of MEN2B?
Medullary thyroid cancer, pheochromocytoma, mucosal neuromas (small nodules on lip) and marfanoid habitus
What gene is responsible for MEN2B?
Ret gene
What are the tumors of MEN1?
Parathyroid tumor, pituitary tumor (prolactinoma), pancreatic endocrine tumor
What gives rise to the smooth part of the right ventricle?
Bulbus cordis
What gives rise to the smooth part of the left ventricle?
Bulbus cordis
What gives rise the the smooth part of the right atrium?
Sinus venosus
What does the primitive atrium give rise to?
The trabeculated parts of the right and left atria
What gives rise to the ascending aorta and pulmonary trunk?
Truncus arteriosus
What is the root cause of renal osteodystrophy?
Kidney fails to excrete sufficient phosphate, causing a rise in PTH
Increase CaSR Ca2+ sensitivity does what to PTH?
Suppresses it
What is cinacalcet?
A calcimimetic - increases the sensitivity of the calcium-sensing receptor, decreasing PTH secretion
What are the four main neoplasmas associated with Psammoma bodies?
Papillary carcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, meningioma, mesothelioma
What type of gene is APC?
Tumor suppressor gene
