Random III Flashcards
what virulence factor of staph aureus causing necrotizing pneumonia
leukocidin
side effects of selective arteriolar vasodilators
examples
sodium and fluid retention from activation of RAAS system
hydralazine, minoxidil
where does a stanford type B aortic dissection usually originate
close to left subclavian a.
what two ions contribute to resting membrane potential
mostly potassium and some sodium
elevated CEA levels are associated with what
colon cancer
higher levels associated with worse prognosis
failure to normalize after surgery indicates residual disease
what is the path of an embolus to the retinal artery
atherosclerosis in the internal carotid –> ophthalmic a. –> retinal a.
what are the antibodies directed against in goodpasture syndrome
alpha 3 chain of type IV collagen
symptoms of rapidly progressive glomerulonephritis
hypertension, edema, acute renal failure, hematuria, proteinuria
what is the function of the smith protein
anti-smith antibodies in SLE
complexes with small nuclear RNA (snRNA) in cytoplasm to form snRNPs –> become a part of the spliceosome and remove introns
what is directive counseling
where only a single treatment option is recommended to a patient
(when there is only 1 medically reasonable treatment option)
in melanoma, describe what the color variations mean:
- red areas
- brown or black
- white and gray
red: vessel ectasia and local inflammation
brown or black: advancing, neoplastic melanocytes
white and gray: cytotoxic T cells recognize tumor antigens and induce apoptosis (melanocyte regression)
symptoms of retinitis pigmentosa
poor night vision
visual field loss
funduscopic changes (pigment accumulation, optic disc pallor, retinal vessel attenutation) - bone spicule-shaped deposits
what is retinitis pigmentosa
genetic disease characterized by progressive dystrophy of the retinal pigmented epithelium and photoreceptors (cones and rods)
sudden cardiac death due to coronary artery disease normally occurs in the setting of _____
malignant ventricular arrhythmia (v fibv, tach)
in the setting of exercise, how does minute ventilation, V/Q perfusion, mixed venous oxygen content change
minute ventilation: increases (increase in RR and tidal volume)
V/Q: increases (alveolar ventilation increases more than blood flow)
Mixed venous oxygen content: decreased (the fraction of arterial oxygen extracted by skeletal muscle markedly increases)
what is chediak higashi syndrome
defect in NK cells and neutrophil phagosome lysosome fusion
–> causes giant lysosomal inclusions seen in neutrophils and macrophages
cilostazol MOA
reduces platelet activation by inhibiting platelet phosphodiesterase
also acts as an arterial vasodilator
why does tachyphylaxis occur with alpha-adrenergic agonists used for nasal decongestion? (rebound rhinitis needing increased dosage)
receptor internalization
cause of vitiligo
partial or complete loss of melanocytes
describe the pathogenesis of tuberculoid leprosy
development of strong TH1 mediated response (IL-2, IFN-y, IL-12) in affected tissues –> activation of macrophages that kill M. leprae organisms, limiting the disease extent
in a cystic fibrosis patient, how do PPIs affect fat absorption
increase fat absorption
(CF patients take pancreatic enzyme replacements with lipase, amylase, and protease - lipase is inactivated by the acidic environment of the stomach –> PPIs increase lipase activity)
how does C1 esterase inhibitor deficiency affect bradykinin levels
causes unregulated activation of kallikrein –> increases bradykinin
(causes bradykinin associated angioedema)
what determines potency of an inhaled anesthetic
MAC
etanercept MOA
indications
decoy receptor for TNF-a (TNF-a inhibitor)
severe RA, especially in patients who have failed methotrexate therapy
compare confounding error and effect modification
confounding error:
the exposure-related dz relationship is muddled by the effect of a confounding variable that is association with both exposure and disease
(students w/ bigger shoe sizes have higher level of intelligence, but really this is because of age not shoe size)
no difference when analysis performed based on stratification (RR and p values will be similar)
effect modification:
when an external variable positive or negatively impacts the observed effect of a risk factor on dz status
(aspirin use is association with Reye syndrome in children but not adults - age modifies the effect of aspirin on reye syndrome development)
large difference when analysis performed based on stratification
what gross changes occur in the LV of the heart in athletes
eccentric hypertrophy –> increases LV cavity size and muscle mass
describe the development of pulmonary hypertension in heart failure
left heart failure –> higher diastolic filling pressure –> pressure transmitted backward to left atrium and pulmonary veins –> pulmonary venous congestion –> pulmonary hypertension
when is autism spectrum disorder usually diagnoses
around age 2, before age of 5
sx of autism in toddlers
- impaired joint attention (lack of pointing or bringing objects to others)
- motor stereotypies (hand flapping, spinning)
- hyperreacticity or hyporeacticity to sensory input (extreme responses to sounds or textures, indifference to pain)
- lack of social engagement
- speech delay
- repetitive play
what is the pathogenesis of MG
autoantibody-mediated T cell dependent attack on acetylcholine receptors of postsynaptic NMJ –> reduces # of AChRs
compare graft vs host disease and host-mediated rejection
GVHD:
- involvement of other organs
- most often involves skin, liver, and GI tract
- diffuse maculopapular rash with predilection for palms and soles
- T cells
Host-mediated:
- graft failure without significant involvement of other organ systems
- T cells
is pseudomonas motile
does it ferment lactose
yep
nope
describe factor V Leiden
autosomal dominant mutation (guanine –> adenine DNA point mutation –> Arg506Gln)
cause hyper-coagulability
resistant to inactivation by protein C
symptoms of vitamin E deficiency
neuromuscular disease (skeletal myopathy, spinocerebellar ataxia, polyneuropathy)
hemolytic anemia
involvement of dorsal columns
what medications are associated with the phenomenon of tachyphylaxix
a-adrenergic agonists
nitroglycerine
pralidoxime MOA and indications
cholinesterase reactivating agent (when you have too much acetylcholine)
organophosphate toxicity
what is physostigmine used for
anticholinergic toxicity (when you have not enough acetylcholine)
absence of glutathione reductase causes what
inability to use NADPH to reduce glutathione –> clinically similar to G5PD deficiency
quick clinical tests to assess attention and concentration
- counting down from 100 by intervals of 3 or 7
- reciting months of the year backwards
- spelling “world” backwards
clinical tests to assess comprehension
following multistep commands
bronchoalveolar lavage results in hypersensitivity pneumonitis
lymphocyte predominant
features of normal aging that impair response to heat
1) tonic contraction of peripheral vasculature which limits heat transfer to skin
2) reduced sweat gland density
3) loss of rete pegs and dermal capillaries (reduces effective epidermal area available for heat transfer)
compare purulent and non-purulent cellulitis
purulent:
- skin warmth, edema, erythema, NO fluctuant nodules
- beta hemolytic strep
non-purulent:
- painful, fluctuant nodule in dermis or subcutaneous tissue w/ or w/o surround erythema
- staph aureus (strains that express virulence factor Panton-Valentine leukocidin are likely to cause skin abscesses)
protocol for intimate partner vilence
assess for immediate safety and give additional resources (info about a domestic violence program)
who should acquire informed consent
best obtained by attending physician performing the procedure
what drugs have anticholinergic side effects
- TCAs
- first generation H1 receptor antagonists
what is a “case series” observational study
where a small group of patients with a similar diagnosis or treatment are described at a point in time or followed over a certain period of time
what is a cross sectional study
an observational study that assesses a population of interest at a single point in time
findings on a tzanck smear in VZV
intranuclear inclusions in keratinocytes and multinucleated giant cells
what is the earliest clinical sign of PKD
hypertension
what is hydronephrosis
swelling of a kidney due to build up of urine (due to blockage or obstruction)
what is epidermolysis bullosa
group of inherited disorders caused by mutations in intra-epidermal and dermo-epidermal adhesion complexes in the basement membrane
most common: mutations in keratin genes that impair assembly of keratin into filaments
- presents early in life with friction-induced blisters at palms and soles, oral blisters
causes epithelial fragility –> bullae, erosions, ulcers
what fragments need to be known to perform PCR
the sequence of the regions flanking the target region to make the primers necessary to start PCR
what is the treatment for methemoglobinemia
methylene blue
what is the treatment for arsenic poisoning
dimercaprol
chelating agent that increases urinary excretion of heavy metals
antidote for cyanide poisoning
hydroxycobalamin
CaNa2EDTA is used to treat what
lead poisoning
describe the pathway of multi-compartment drug distribution
immediately: drug levels high in the central compartment (plasma
quickly distributed to the well-perfused peripheral compartment (brain, liver, kidneys, lungs)
over time, occurs through the central compartment into the poorly perfused peripheral compartment (skeletal muscle, fat, bone) which has the highest volume of distribution for lipophilic agents
what is the effect of taking fluconazole with methadone
fluconazole inhibits CYP3A4 which can increase plasma methadone concentration and lead to opioid toxicity
describe myopia
near-sightedness
a refractive error caused by an increased anterior-posterior diameter of the eye
the focal point of a refracted image lies anterior to the retina
most common form of renal cell carcinoma
clear cell carcinoma
why is renal clear cell carcinoma “clear”
clear cell carcinoma originates from proximal tubular epithelial cells and contains copious amounts of intracellular glycogen and lipids –> glycogen and lipid accumulation –> clear cell
what is a randomized control trial
participants are randomly allocated to 2 or more groups to assess the effect of specific interventions
what causes black biliary stones
- chronic hemolysis (sickle cell, spherocytosis) –> increases circulating levels of free bilirubin –> taken up by liver and excreted into bile
- altered enterohepatic circulation of bilirubin
what causes brown biliary stones
biliary tract infection (E. coli, liver flukes) –> release of microbial B-glucuronidases
what is diabetic diarrhea
long standing hyperglycemia –> cross-linked glycosylated serum proteins in vasa nervorum –> inflammation and damage to peripheral nerves
most commonly results in symmetric polyneuropathy of feet, can also damage sympathetic and parasympathetic nerves, leading to autonomic dysfunction (disordered motility of the intestines)
MOA theophylline
indications
adenosine receptor antagonist and phosphodiesterase inhibitor (increases cAMP –> bronchodilation)
asthma and COPD
drugs commonly affected by CYP450 interactinos
theophylline
antiepileptics
warfarin
macular lesions cause what visual defect
central scotoma
unintentional ureteral ligation causes waht
obstruction with hydronephrosis and flank pain
what happens to the skin in acute eczematous dermatitis
spongiosis (accumulation of edema fluid in intercellular spaces of the epidermis)
what markers is melanoma positive for
S-100 and HMB-45
how do you distinguish between tuberculoid and lepromatous leprosy
tuberculoid:
- indurated nodule with lepromin skin test due to strong TH1 response
- TH1 response elements (IL-2, IFN-y, IL-12)
lepromatous:
- nonreactive to lepromin skin test
- TH2 response elements (IL-4, IL-5, IL-10)
