Quiz 63, 64, 65 Flashcards
What type of acid base disorder is seen with high doses of theophylline?
Respiratory alkalosis
What type of acid/base status is seen in chronic lung disease?
Respiratory acidosis
What is the acid/base status seen in opioid overdose?
Respiratory acidosis
What is the presentation of Wiskott-Aldrich syndrome?
Recurrent infections, thrombocytopenia with HSM, and eczema
What are the immunoglobulin levels in Wiskott-Aldrich syndrome?
Elevated IgA and Ig E in the absence if IgM
What is the inheritance pattern of Wiskott-Aldrich syndrome?
X linked recessive
What drugs can cause SIADH?
Antidepressants (fluoxetine, TCAs, MAOIs), antipsychotics, anticonvulsants, antineoplastics
What is the MOA of buspirone?
5-HT1A partial agonist and moderate antagonist at dopamine receptors
What nerve arises from the lateral cord of the brachial plexus?
Musculocutaneous and part of the median nerve
What cords give rise to the median nerve?
Lateral and medial cord
What nerves does the posterior cord give rise to?
Axillary and radial nerve
What cord does the ulnar nerve come from?
Medial cord
Single thyroid nodule with normal colloid follicles, surrounded by bands of fibrous tissue without capsular or vascular invasion describes what?
Follicular adenoma
How does a diffuse nontoxic goiter present?
Diffuse glandular enlargement, or with multiple nodules of varying size; patients commonly found to be iodine deficient or taking lithium
A painful, granulomatous inflammation of the thyroid with subsequent enlargement describes what?
Subacute (De Quervain) thyroiditis
What disease does urine turn black upon standing?
Alkaptonuria
What are the symptoms of alkaptonuria?
Arthritis at a young age, with negative RF; ochronosis (blue-black pigmentation in ears, nose, cheeks)
What enzyme is deficient in alkaptonuria?
Homogentisic oxidase
What is the inheritance pattern of alkaptonuria?
Autosomal recessive
Deficiency in homogentisic oxidase results in what disease?
Alkaptonuria
What form the external ear canal?
First pharyngeal cleft
What forms middle-ear cavity and auditory tube?
First pharyngeal pouch
If the second pharyngeal cleft remains patent, what forms?
Lateral cervical cyst - forms on the lateral side of the neck and is not mobile
Cytomegalovirus infection in utero results in what findings?
“Blueberry muffin disease;” thrombocytopenia purpura, intracerebral calcifications, jaundice, hepatosplenomegaly
What are the consequences of rubella infection in utero?
PDA, pulmonary stenosis, cataracts, microcephaly, deafness
In utero infection with toxoplasmosis results in what consequences?
Retinochoroiditis, intracerebral calcifications, hydrocephalus
What is the “window period” in Hep B infection?
Negative for HBsAg and HBsAb
What is present in the serum during the “window period” of HBV infection?
Positive for HBcAb and HBeAb
Patient presents with RUQ, serum shows presence of HBcAb and HBeAb, but negative for HBsAg and HBsAb, what is the diagnosis?
Window period of HBV infection
Patients requiring multiple blood transfusions are at risk for what?
Hemosiderosis - acquired iron overload
What is beta thalassemia major?
Failure to produce beta chains of hgb
What are antibodies directed against in Graves disease?
Thyroid stimulating hormone receptor
What type of HSR is Graves disease?
Type II noncytotoxic
When does one hear a pericardial knock?
Constrictive pericarditis
Crohn’s disease is associated with what dermatological lesion?
Erythema nodosum
What is erythema nodosum?
Inflammation os subcutaneous fat, typically on anterior lower extremities
What organism can produce chronic diarrhea and megaloblastic anemia, commonly found in Scandinavia and the great lakes region?
Diphyllobothrium latum
What geological location is Diphyllobothrium latum infection acquired?
Great Lake region and Scandinavia
How does Diphyllobothrium latum present?
Megaloblastic anemia in Great Lakes region after consumption of poorly cook fish
What is the beef tapeworm?
Taenia saginata
What is the pork tapeworm?
Taenia solium
What artery runs in the radial groove?
Profunda brachii artery
What artery is immediately medial to the tendon of the biceps brachii?
Brachial artery
What organism can continue to cause reinfection because of antigenic variation and phase variation of the pili?
N. Gonorrhoea
What is the gram stain and morphology of N. gonorrhoea?
Gram negative diplococcus
What can happen to a patient being treated for syphilis within the first 24 hours of treatment initiation?
Jarisch-Herxheimer reaction
Infant presents to the ER after being abandoned with cleft palate, desquamating maculopapular rash and has a positive RPR test. Treatment with penicillin is begun. What do signs/symptoms do you need to watch for in the next 24 hours? What is this reaction called?
Jarisch-Herxheimer reaction - signs of endotoxic shock due to release of endotoxin from T. Pallidum upon treatment (death of bacterium)
Radiation exposure is a major risk factor for what type of thyroid cancer?
Papillary thyroid carcinoma
What are the major pathologic features of papillary thyroid carcinoma?
Ground-glass, clear nuclei (Orphan Annie eyes), nuclear grooves, papillary fronds with fibrovascular cores, psammoma bodies
What cancers can you see psammoma bodies in?
Serous papillary cystadenocarcinoma of the ovary, meningioma, malignant mesothelioma, papillary thyroid carcinoma
What is Sezary syndrome?
Leukemic form of a type of cutaneous T cell lymphoma
What are Tingible body macrophages? When do you see them?
Macrophages containing debris from ingested lymphocytes; can see them in benign reactive lymphadenitis
What is the MOA of alteplase?
Tissue plasminogen activator - bind plasminogen –> plasmin –> plasmin degrades fibrin and fibrinogen
The ligamentum teres hepatis is an embryologic remnant of what?
Umbilical vein
Patient presents with nontender, stony hard thyroid that does not move with swallowing. Marked fibrous reaction is seen on pathologic examination. What is the diagnosis?
Riedel thyroiditis
What is the presentation of Riedel thyroiditis? What is seen on biopsy?
Rock hard painless goiter; destructive thyroid fibrosis
What is the gram stain and morphology of H. Influenzae?
Gram negative pleomorphic coccobacilli
What is necessary to culture H. Influenzae?
Chocolate agar with factor V and X
What are bacterial causes of conjunctivitis?
H influenzae, S aureus, S pneumoniae, Moraxella spp.
What is the most common fungal meningitis of immunocompromised individuals in the US?
Cryptococcus neoformans
Patient with HIV presents with low grade fever and progressive headache. What is the likely causal organism?
Cryptococcus neoformans
What are the CSF findings in a fungal infection?
Lymphocytes, decreased glucose, increased protein, and moderately elevated opening pressure
Encapsulated budding yeasts
Cryptococcus neoformans
Budding yeasts resembling a wheel with spokes
Paracoccidioides brasiliensis
Intracellular yeasts within macrophages
Histoplasma capsulatum
Septate hyphae at 45 degree angles
Aspergillus
What is the Charcot triad? What is it indicative of?
Fever, jaundice, RUQ pain; indicative of cholangitis
Increased alkaline phosphatase is characteristic of what?
Biliary tract obstruction
What physical exam finding helps differentiate between a stone within the cystic duct vs. a stone in the common bile duct?
Stones within the cystic duct do not cause jaundice, whereas stones in the common bile duct produce jaundice
What is familial primary hypoparathyroidism?
Inherited condition resulting from gain of function mutation in calcium-sensing receptor
What is the pathophysiology of familial primary hypoparathyroidism?
Gain of function mutation in calcium sensing receptor –> constant “occupancy” signal –> decreased PTH secretion even when Ca levels are low
What labs are seen in familial primary hypoparathyroidism?
Low PTH, high Phosphorous, low calcium
How can familial primary hypoparathyroidsim present?
Low calcium causing seizures, tetany and muscle twitching/cramps
What are the 5 “Rs” of medication safety?
Right patient, right dose, right drug, right route, right time
What type of amyloid is deposited in a patient with rheumatoid arthritis?
Secondary amyloidosis - AA type
Long term hemodialysis results in deposition of what type of amyloid?
A Beta 2 M
By what mechanism does S pneumoniae evade the immune response in the respiratory mucosa?
Production of IgA protease
What organism has a hyaluronic acid capsule?
S pyogenes
Gram positive coccus, bacitracin resistant and CAMP+ beta hemolytic
S. Agalactiae
What is the MOA of probenecid?
Inhibits proximal tubule reabsorption of urate
What is the MOA of colchicine?
Binds tubulin, decreasing microtubular polymerization, decreasing LTB4, and decreasing leukocyte and granulocyte migration
What is the MOA of allopurinol?
Prodrug - suicide substrate/ converted to alloxanthine by xanthine oxidase; alloxanthine inhibits xanthine oxidase
Testicular tumor with elevated placental alkaline phosphatase and normal hCG and alpha-fetoprotein is seen in what tumor?
Seminoma
The majority of the secretions in the sublingual gland are what?
Mucous
The majority of secretions from the submandibular gland are what?
Mixed mucous and serous
What majority of secretions form the parotid gland are what?
Serous
Polyarteritis nodosa is associated with what viral infection?
Mostly Hep B
Hepatitis B infection has been related to what vasculitis disease?
Polyarteritis nodosa
What is polyarteritis nodosa?
Vasculitis of small and medium sized vessels; shows segmental necrotizing vasculitis; affects all organs except the lungs
What forms the most anterior wall of the heart?
Right ventricle
What forms the most posterior wall of the heart?
Left atrium
Describe the anatomic location of the left atrium
Most of the diaphragmatic surface of the heart (lies on the diaphragm); forms the most left boarder of the heart
Describe the anatomic location of the right atrium
Forms the most right border of the heart; its anterior surface is on the right side of the sternum from approx. thrid to sixth rib
Penetrating wound to the left fourth intercostal space just lateral to the sternum will most likely injure what structure?
Right ventricle
What is transmitted by the sand fly?
Leishmaniasis
What is the treatment for cutaneous leishmaniasis?
Sodium stibogluconate
Soldier returns from his service in Afghanistan complaining of an erythematous ulcerated lesion on his left hand that will not heal. He says he was bitten on his hand by a sandfly. What is the most likely diagnosis?
Cutaneous leishmaniasis
Histologically, what are leiomyomas characterized by?
Whorls of spindle shaped smooth muscle cells
What type of channel is GABAa?
Chloride ion channel macromolecular complex
What are the symptoms of congenital toxoplasmosis?
Hydrocephalus, intracranial calcifications, retinochoroiditis
Low oxygen tension is necessary for the growth of microaerophiles. What organisms are these?
C jejuni, Helicobacter, Borrelia
An encapsulated budding yeast is characteristic of what?
Cryptococcus neoformans
Cytosolic citrate does what to phosphofructokinase and acetyl CoA carboxylase?
Negative allosteric regulator of PFK I, and positive allosteric regulator of acetyl CoA carboxylase
What is the rate limiting step for fatty acid synthesis?
Acetyl CoA carboxylase
Why does the pulse pressure widen with anemia?
Increased CO with a simultaneous decrease in systemic vascular resistance
Medullary thyroid carcinoma is associated with what MEN syndrome?
MEN 2A; MEN 2B
What neoplasias are associated with MEN 2A?
Medullary thyroid carcinoma, pheochromocytoma, parathyroid tumor
Ret oncogene is associated with what MEN syndrome?
MEN 2A and MEN 2B
What neoplasia are seen in MEN 2B?
Medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas and marfanoid habitus
What neoplasm are associated with MEN 1 syndrome?
Parathyroid tumor, pituitary tumor, pancreatic endocrine tumor
What test is used to detect IgG anti-Rh Ab circulating in the mother’s blood?
Indirect Coombs test
What test is used to diagnose a child at risk for development of hemolytic disease of the newborn?
Direct Coombs test
What type of infections are patients with Wiskott-Aldrich more susceptible to?
Recurrent opportunisit infections with organisms that have polysaccharide capsules
What immunoglobulin is decreased in patients with Wiskott-Aldrich?
IgM
What immunoglobulin(s) are elevated in Wiskott-Aldrich?
IgA and IgE
What is the life expectancy of Wiskott-Aldrich? What causes death?
Usually die before second decade of life, from infection or non-Hodgkin lymphoma
What is the defect in Wiskott-Aldrich syndrome?
WAS protein - critical role in actin cytoskeleton rearrangement
What is the inheritance pattern on hyper-IgM syndrome?
X linked
What is the defect in hyper-IgM syndrome?
CD40L on activated TH cells
What lab findings are associated with nephrogenic DI?
Increased serum sodium and serum osmolality, decreased urine osmolality and increased ADH
What stage of syphilis do you see a gumma?
Tertiary
What stage of syphilis do you see tabes dorsalis?
Tertiary
What stage of syphilis do you see a maculopapular, bronizing rah and condylomata lata?
Secondary syphilis
What part of the spinal cord does tertiary syphilis affect?
Dorsal columns and dorsal roots
What tapeworm competes with the host for Vitamin B12?
Diphyllobothrium latum
How does one get Diphyllobothrium latum?
Eating poorly cooked fish
What is a Prussian blue stain used for?
Staining for liver deposition
What can Prussian blue stains help differentiate between?
Iron deposition in hemochromatosis and lipofuscin “wear and tear”
What is the MOA of propylthiouracil?
Inhibits thyroid peroxidase
What does thyroid peroxidase do?
Oxidizes iodide to iodine, iodination of tyrosyl residues (organification) on thyroglobulin, and coupling
What are the side effects of propylthiouracil?
Agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia
Patient in New Mexico develops sudden chills, high fever, malaise, n/v and headache. Additionally he develops cough and blood tinged sputum with patchy infiltrates on CXR. What is the likely causal organism?
Yersinia pestis
Infection with yersina pestis can cause what?
Many forms: mild LAD, bubonic plague (hemorrhagic LAD), and pneumonic plague (sudden onset illness with blood tinged sputum)
What is brucellosis?
Infection with brucella abortus - undulating fever, LAD, HSM
When does one see tularemia?
Infection with Francisella tularensis - caused by rabbits and shit
What is visual agnosia?
Inability to recognize familiar objects despite the ability to see
Visual agnosia is caused by what type of lesion?
Temporo-occipital association cotex
What are the signs and symptoms of hypoparathyroidism?
Severe hypocalcemia and hyperphosphatemia; Tetany, Carpopedal spasms, muscle and abdominal cramps, tingling of lips and hands
What is the MOA of triptans?
5HT agonist
What is the function of Subscapularis muscle?
Internal rotation of the arm?
What is the innervation of the subscapularis?
Upper and lower subscapular nerves
What is the function of the teres minor?
External rotation of the arm
What is the innervation of the teres minor?
Axillary nerve
What is the equation for half life?
T1/2 = (0.7 x Vd)/Cl
What is the mechanism of metoclopramide?
D2 antagonist
Where does metoclopramide exert its antiemetic effect?
Area postrema
What is metoclopramide used for?
Antiemetic; can be used for chemo
What is the MOA of meclizine? What is it used for?
H1 antagonist; motion sickness
What is the MOA of ondansetron?
5-HT3 antagonist
What is the MOA of scopolamine?
Antimuscarinic agent
3
Child with T1D has tonsillectomy. One week later presents with numerous small yellow granules that are gram + and have numerous non-acid fast branching filaments at the periphery. Whats the organism?
Actinomyces israelii
Abscesses with gram positive filamentous rods in sulfur granules is knee jerk for what?
Actinomyces israelii
What is the genetic defect associated with neuroblastoma?
Amplification of MYCN gene
Amplification of MYCN gene results in what?
Neuroblastoma
Palpable, nontender, right intra-abdominal mass that crosses the midline in a child is suggestive of what?
Neuroblastoma
What is elevated in the serum of a patient with neuroblastoma?
Homovanillic acid
Translocation of MYCC gene results in what tumor?
Burkitt lymphoma
What genetic issue is associated with Burkitt lymphoma?
Translocation 8;14 - resulting in translocation of MYCC gene
8;14 translocation is seen in what disease?
Burkitt Lymphoma
What is Conn syndrome?
Primary aldosteronism - a syndrome of aldosterone hypersecretion
Why is there yearly revaccination against influenza?
Genetic drift - minor antigenic changes in surface antigens
What is the most common cause of intraparenchymal hemorrhage?
Hypertension
Where do most intraparenchymal hemorrhages occur?
Internal capsule and basal ganglia
Charcot-Bouchard aneurysms can rupture what vessels?
Lenticulostriate vessels of the basal ganglia
What type of crystals are found in joint aspiration of pseudogout?
Calcium pyrophosphate dihydrate crystals
Rhomboid crystals on joint aspiration are associated with what?
Psuedogout
What is seen when crystals are arranged parallel to the axis of polarized light in pseudogout?
Blue - positive birefringence on polarization
What cells in the ovarian follicle produce estrogen during the follicular phase?
Granulosa cells
What secretes estrogen during the luteal phase?
Corpus luteum
When does formation of the notochord begin?
Third week
What is gastrulation?
Converts two layer embryo into a three layer embryo
When is organogenesis complete?
By the end of the eighth week
The notochord is derived from what cells?
Epiblast cells
Measles belongs to what family?
Paramyxoviridae
Rubella is part of what virus family?
Togovirus
Mumps is part of what virus family?
Paramyxoviridae
Fluid in the peritoneal cavity accumulates where in a woman?
The rectouterine space (pouch of Douglas)
Where is the rectouterine space?
Located between the uterus and rectum with a close relationship to the posterior fonix
What is the MOA of vincristine?
Inhibits microtubule polymerization (formation)
What phase of the cell cycle is affected by vincristine?
M phase
What is the MOA of vinblastine?
Inhibits microtubule polymerization
What are the SEs of vinblastine?
Bone marrow suppression, alopecia, diarrhea
What SE is vincristine “known for”?
Peripheral neuropathy
What is the MOA of paclitaxel?
Prevents depolymerization of microtubules
What is the MOA of doxorubicin?
DNA intercalation - DNA strand breaks
Waht is the MOA of cyclophosphamide?
Alkylating agent - attacks guanine N7 - dysfunctional DNA
What is used to protect patients from hemorrhagic cystitis with the use of cyclophosphamide?
Mensa - traps acrolein and its protective
What is the MOA of bleomycin?
Complexes iron-forming ROS and intercalates into DNA
What plasmodium causes a severe form of malaria resulting in very severe anemia, pulmonary edema, renal failure and shock?
P. Falciparum
What transmits malaria?
Anopheles mosquitoes
What malarial infection can cause cerebral malaria?
P falciparum
Chloroquine resistance is a problem with what malarial infection?
P falciparum
What malarial infections can cause relapse? Why?
P ovale and P vivax - both have persistent hypnozoites
How do you treat P vivax infection?
Chloroquine then primaquine
How do you treat P ovale infection?
Chloroquine then primaquine
How do you treat P malariae?
Chloroquine (no radical cure necessary)
Patient has likely malarial infection with a fever that spikes every 72 hours; what is the most likely organism?
P malariae
What is Bowen disease?
In situ penile squamous cell carcinoma
How does Bowen disease present?
Gray-white plaque on penis (form of carcinoma in situ)
How does Bowenoid papulosis present?
Multiple reddish-brown papular lesions on the penis (form of carcinoma in situ)
How does Erythoplasia of Queyrat present?
Soft red plaque on penis; form of carcinoma in situ
Opaque, gray-white flat penile plaque on the shaft of the penis; biopsy shows dysplastic squamous epithelium. Topical ointments have not helped this plaque. What is the most likely diganosis?
Bowen disease - in situ carcinoma
What calcium channel blocker has been associated with an accelerated progression to / exacerbation of heart failure?
Verapamil
What calcium channel blockers are used in patients with CHF?
Amlodipine and felodipine
What antihypertensive drugs are protective against diabetic nephropathy?
ACE inhibitors and ARBs
What drugs are indicated for HTN with HF?
Diuretics, ACE inhibitors/ARBs, beta blockers (only in compensated HF), and aldosterone antagonists
What are the three most common causes of otitis media in a child?
S pneumo, H influenzae, M catarrhalis
What is the second most common cause of bacterial pneumonia in a patient with COPD?
M catarrhalis (behind nontypeable H influenzae)
What is the gram stain and morphology of H pylori? What other characteristics are important?
Gram negative rod, urease +, oxidase +, catalase +, microaerophilic
What is the gram stain and morphology of C jejuni? What other important characteristics?
Gram negative rod, urease negative, microaerophilic, oxidase positive, grows at 42 C, microaerophilic
How can one get C jejuni infection?
Undercooked poultry (or meat), unpasteurized milk, or infected animals (cats, dogs, pigs)
How can one estimate a type II error? (Use an equation)
1 - Power = Type II error
What is HER-2? What disease is it associated with? What is used in treatment?
Epidermal growth factor 2 - tyrosine kinase receptor; breast cancer; trastuzumab
RET protooncogene encodes what?
Receptor tyrosine kinase
What does the gene ATM encode? What disease is this gene associated with?
ATM encodes a protein in the IP3 kinase family; mutated in ataxia telangiectasia
Hereditary nonpolyposis CRC is associated with what type of mutation?
DNA repair gene mutation involved in post-replication repair
Xeroderma pigmentosum is associated with what type of mutation?
DNA repair gene mutation - specifically pyrimidine dimer repair
By what mechanism does cryptosporidium parvum cause diarrhea?
Intracellular replication in the brush border of the intestine
What is the toxin produced by pseudomonas aeruginosa?
Exotoxin A - ADP ribosylates and inhibits EF-2
What is the gram stain and morphology of Bacillus anthracis?
Large, boxcar-shaped gram positive rod; aerobic and spore forming
Describe the appearance of crytpococcus neoformans
Monomorphic, encapsulated yeast
What CSF findings are indicative of fungal infection?
100-1000 cells, mostly lymphocytes, glucose < 45, and proteins >50
What stain is used to visualize Pneumocystis jirovecii?
Methenamine silver
What type of transduction results in clones of bacteria acquiring new and distinct genetic traits?
Generalized transduction
What infections are transmitted by Ixodes tick?
Anaplasma phagocytophilum, babesia, borrelia burgdorferi
Ehrlichiosis presents with what? What is seen microscopically?
Headache, fever, and rash with cytoplasmic morulae in a monocyte
Drescribe the gram stain and morphology of Ehrlichia. What cell does it infect?
Gram negative bacilli; forms morulae in monocyte
What is seen microscopically with an Anaplasma infection?
Morulae in granulocytes
St louis encephalitis virus is part of what virus family?
Flavivirus
How does cryptosporidium cause diarrhea?
Infects brush border of small intestine and causes direct cell lysis
What bugs invade the submucosa of the intestine?
Entamoeba histolytica and shigella dysenteriae
What is the mechanism of the shiga toxin?
Activates 60S ribosomal subunit
What is the mechanism of the enterotoxigenic E. coli?
Ribosylates Gs
Thick walled, spherical yeast with multiple buds encircling the central cell
Paracoccidioides
What is used in the treatment for toxoplasmosis in immunecompetent patients?
Sulfadiazine + pyrimethamine (and leucovorin folinic acid rescue)
What is the MOA of pyrimethamine?
Inhibits DHFR
What is used for the treatment of typranosoma brucei?
Suramin for blood borne and melarsoprol for CNS penetration
What does trypanosoma brucei cause?
African sleeping sickness
What transmits T. Brucei?
Tsetse fly - painful bite
What is the treatment for T. Cruzi?
Benznidazole or nifurtimox
What is the treatment for leishmaniasis?
Sodium stibogluconate
What is the MOA of permethrin? What is it used to treat?
Inhibits sodium channels in parasites; antimite/louse therapy
What is the MOA of malathion? What is it used to treat?
Acetylcholinesterase inhibitor; anti mite or louse therapy
What is the MOA of lindane?
Blocks GABA channels