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S-UW Flashcards

1
Q

Cardiac tissue conduction velocity

A

Purkinje system -> atrial muscle -> ventricular muscle -> AV node

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2
Q

Globus hysterecticus

A

Sensation of “lump in the throat”

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3
Q

DNA Laddering

A

Appearance of DNA fragments in mutiples of 180 bp’s on electrophoresis d/t endonucleases; indicates apoptosis

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4
Q

Anticholinergic SE’s

A

Antihistamines, antipsychotics, tricyclic antidepressants

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5
Q

Popliteal injury

A

Penetrating trauma: tibial nerve injury

Dislocation of knee joint: popliteal artery (fixed deep in the fossa)

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6
Q

Light’s Criteria

A

Pleural fluid protein/Serum protein > 0.5

Pleural flud LDH/Serum LDH > 0.6, PF LDH > 2/3 normal serum LDH

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7
Q

Myasthenia Gravis

A

Associated with thymoma

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8
Q

Intraventricular hemorrhage

A

Prominent cause of brain injury in premature infants (

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9
Q

Palmitoylation

A

Process by which FA’s are covalently anchored to plasma membranes –> increased hydrophobicity

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10
Q

Bacterial drug resistance

A

Antibiotic efflux pumps are commonly driven by a H+ gradient

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11
Q

Pulmonary Embolism

A

Causes hypoxemia 2ndry to V/Q mismatch –> hyperventillation

ABG: increased pH, decreased PaCO2, Decreased PaO2

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12
Q

Platelet Activating Factor (PAF)

A

?

Activates platelets via Gq -> PLC -> calcium release

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13
Q

Whipple Disease

A

Infection with Tropheryma whipplei (G+)
PAS + foamy macrophages in intestinal lamina propria
Cardiac, Arthralgias, Neuro sx’s (Foamy whipped cream in a CAN)

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14
Q

Unmyelinated nerve fibers

A

Heat, slow pain, olfaction, autonomic postganglionic nerves

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15
Q

Aseptic meningitis

A

Enteroviruses (part of the picornavirus family): poliovirus, coxsackie A/B, echovirus, enterovirus, hepatitis A

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16
Q

Symptoms of anemia

A

Weakness, fatigue, headache, irritability, glossal pain, dry mouth, atrophy of tongue papillae, alopecia

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17
Q

Lichen Sclerosus et atrophicus

A

Autoimune; atrophic white macules/patches that begin with “cigarette paper” quality; cause pain, pruritis, dyspareunia, dysuria

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18
Q

Imperforate hymen

A

One of the most common obstructive lesions of thte female GU
Presents as absent menses in an eugonadotropic female
Hematocolpos –> vaginal distension, back pain, difficulty urinating

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19
Q

Increased risk or osteoporosis

A

Anticonvulsants that induce CYP450 (incr. vitamin D catabolism)
Aromatase inhibitors, Medroxyprogesterone (decr. Estrogen)
GnRH agonists (decr. T/estrogen), PPI’s (decr. Calcium absorption)
Glucocorticoid, heparin, thiazolidinedione (Decr. Bone formation)

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20
Q

VIPoma

A

Causes watery diarrhea, hypokalemia, achlorhydria

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21
Q

Influenza vaccine

A

Injectable variant is killed - induces neutralizing Ab’s against the HA antigen preventing binding to sialylated receptors + endocytosis

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22
Q

Fat embolism

A

Classic triad: respiratory distress, neurlogical sx’s, petechial rash

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23
Q

Functional regurgitation

A

Volume overload -> LV dilation -> functional mitral regurgitation; Reduction of LV preload w/diuretics –> disappearance of murmur

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24
Q

Secondary bacterial pneumonia

A

Patients > 65 are prone to 2 bacterial pneumonia after the flu
Pathogens: S. pneumo, S. aureus, H. influenzae

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25
Q

Liver clearance

A

Drugs w/high intrinsic hepatic clearance have high VOD, high lipophilicity (reabsorbed at kidney, easily enter hepatocytes)

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26
Q

Tumor grading

A

Bromodeoxyuridine is a thymidine analog that is taken up in high amounts during the S phase by high-grade tumors

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27
Q

Serotonin syndrome

A

Neuromuscular excitation, autonomic stimulation, AMS

Antidote: cyproheptadine (5-HT2 receptor antagonist)

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28
Q

Methemoglobinemia

A

Nitrates can oxidize ferrous iron (Fe2+) to ferric iron (Fe3+)
Methemoglobin cannot bind O2; causes a left shift on the O2 curve

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29
Q

Cachexia

A

TNF-_ from M_ is main mediatior of paraneoplastic cachexia (also causes fever, septic shock, acute-phase protein release)

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30
Q

Inheritance patterns

A

Structural abnormalities are generally autosomal dominant (hered. spherocytosis), enzyme deficiencies are autosomal recessive

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31
Q

Nucleosome

A

Histone H1 binds segments of DNA between nucleosomes, forms more compact structures (not part of the nucleosome)

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32
Q

Conn’s syndrome

A

Aldosterone-secreting adrenal adenoma –> HTN, hypokalemia (muscle weakness), metabolic alkalosis (paresthesias)

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33
Q

Ethylene glycol poisoning

A

Metabolized to glycolic acid (toxic to renal tubules) and oxalic acid (precipitates as calcium oxalate crystals) –> anion gap metabolic acidosis, osmolar gap

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34
Q

Henoch-Schonlein purpura

A

Childhood post-infectious vasculitis; often follows URI
Palpable purpura on butt/legs, arthralgias, abdominal pain
Associtaed with IgA nephropathy (Berger disease)
Develops in 2-3 days vs. 2-3 weeks for post-infectious nephritis

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35
Q

Chemoreceptors

A

Central: respond to decr. pH in CSF (H+ generated by incr. PaCO2)
–> decreased sens. in COPD (O2 sup. affects periph -> decr. resp.)
Peripheral: stimulated by decr. PaO2, incr. PaCO2/blood pH

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36
Q

Estrogen effect on TBG

A

High estrogen states increase TBG by decreasing catabolism –> increased total T4 but normal free thyroid hormone

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37
Q

Nursemaid’s elbow

A

Traction on outstretched arm -> Radial head subluxation -> annular ligament tear; most common elbow injury in children

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38
Q

Medial pontine lacunar stroke

A

Anterior pontine infarcts can affect corticospinal, corticobulbar and cerebellar tracts tracts; trigeminal nerve exits at this level

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39
Q

Overflow incontinence

A

D/t impaired detrusor contractility or bladder outlet obstruction; diabetic autonomic neuropathy or tumor/prostate obstruciton
Complications: nocturla enuresis, incr. postvoid residual volume

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40
Q

AV shunts/fistulas

A

Abnormal communication between artery/vein bypasses capillary resistance –> incr. cardiac preload, decr. Afterload

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41
Q

Nephrotic syndrome

A

Pathogenesis: increased permiability of glom to protein -> decreased plasma oncotic pressure -> fluid shift into interstitum -> increased aldosterone/ADH/liver protein synth. -> hyperlipidemia

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42
Q

Antimuscarinic side effects

A

Atropine, tricyclic antidepressants, H1 antagonists, neuroleptics, antiparkinsonian drugs

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43
Q

Lyonization

A

X-inactivation: 1 copy is condensed into heterchromatin, consisting of heavily methylated DNA and deacetylated histones –> low level of transcriptional activity

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44
Q

Diabetic neuropathy

A

Non-enzymatic glycosylation –> endoneural areriole hyalinization
Intracellular hyperglycema –> osmotic damage

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45
Q

Primary Myelofibrosis

A

JAK2 mutataion -> atypical megakaryocyte hyperplasia -> fibroblast activation -> replacemnet of marrow space by collagen deposition
Pancytopenia -> extramedullary hematopoesis -> dacrocytes

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46
Q

Causes of aplastic anemia

A

Carbamazepine, chloramphenicol, sulfonamides, PTU, methimazole

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47
Q

Bosentan

A

Endothelin-receptor antagonist that acts to vasodilate lung vasculature and block endothelial proliferation; treat PAH

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48
Q

Kallman syndrome

A

Congenital deficiency of GnRH: presents with anosmia

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49
Q

Demyelination

A

Leads to decrease in length constant: how far an impulse can prop.; results from increased charge dissipation along the axon
Increase in time constant: time for a change in potential to occur; results from decreased membrane capacitance

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50
Q

Cheyne-Stokes respiration

A

Cyclic breathing with apnea followed by incr./decr. tidal volumes
d/t slow respiratory feedback loop, enhanced response to PaCO2
Cause: cardiac disease (CHF), neurologic disease

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51
Q

Pancytopenia + splenomegaly

A

Ddx: B12/folic acid deficiency, aleukemic leukemia, myelodysplatic syndrome (aplastic anemia)

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52
Q

Thionamide toxicity

A

Methimazole/PTU carry the risk of developing agranulocytosis; patients taking these meds when presenting with fever/sore throat should be evaluated with a CBC w/diff and drugs should be stopped

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53
Q

Thyrotoxicosis

A

Propranolol contributes to decreased sympathetic outflow/_ blockade, as well as decreased peripheral conversion T4 -> T3 through inhibition of iodothyronine deiodinase

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54
Q

Ataxia-telangietasia

A

Triad: Cerebellar ataxia (poor smooth pursuit), telangiectasias, increased risk of sinopulmonary infections (IgA deficiency)
Autosomal recessive mutataion in ATM: DNA break repar

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55
Q

Tetrahydrobiopterin (BH4)

A

Cofactor in the synthesis of tyrosin/dopa and serotonin

Deficiency results in a form of PKU

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56
Q

S3 Heart sound

A

Ventricular gallop, d/t LV systolic failure; blood rushing into partially filled or very stiff ventricle; best heard in the LL decubitus position, and at the end of expiration

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57
Q

Hepatitis E

A

Enteric, expectant mothers epidemic; High mortaility in pregnant women; unenveloped RNA virus (not destroyed by gut)

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58
Q

Scabies

A

D/t infestation by Sarcoptes scabiei mite; type IV hypersensitivity
Causes rapidly spreading pruritic rash w/erythematous papules/ excoriations, linear burrows, crusting on the extremities/hands

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59
Q

Hereditary angioedema

A

Caused by C1 esterase inhibitor deficiency
C1EI suppresses actiation of complement, inactivates kallikrein
Ace inhibitors are a contraindication (cause angioedema)

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60
Q

Psoriasis histology

A

Hyperparakeratosis, acanthosis, rete ridge elongation, mitotic activity above basal cell layer, reduced/absent stratum granulosum, dilated BV’s above the dermal papillae, clustered neutrophils

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61
Q

DRESS

A

Drug reaction with eosinophilia and systemic symptoms: occurs 2-8 weeks post exposure - anticonvulstants, allopurinol, sulfonamides, antibiotics

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62
Q

_-blocker overdose

A

Antidote: Glucagon - Activates Gs receptors on cardiac myocytes -> incr. intracellular cAMP, calcium release to inrc. SA node firing

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63
Q

Sound transduction

A

TM vibration -> oval window vibration via ossicles -> movement of perilymph in scala vestibuli -> transmit to scala tympani -> basilar membrane vibration -> bending of hair cell cilia -> high frequency transmission at base, low at apex (helicotrema) of cochlea

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64
Q

Acetylation

A

Polymorphism in drug metabolizing capacity leads to 2 distinct groups w/I in the population: fast and slow acetylators; this leads to a bimodal distribution of drug metab. for drugs such as isoniazid

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65
Q

JG Cells

A

Modified smooth muscle cells with renin-containing zymogen granules located in the wall of the afferent arteriole; hypertrophy/ hyperplasia with renal hypoperfusion

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66
Q

Crohn’s Disease

A

Terminal iluem commonly involved: decr. bile acid reabsorption -> loss in feces -> impaired fat absorption -> incr. calcium excretion -> decreased oxalate excretion -> oxalate kidney stones

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67
Q

Payment Plans

A

Capitation: physicians are paid a fixed amount per enrollee, not per service; carries incentive to contain costs/provide preventative care

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68
Q

MELAS

A

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes; presents with seizure disorder, stroke-like episodes, lactic acidosis. Can demonstrate heteroplasmy

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69
Q

Sorbitol metabolism

A

Polyol pathway: aldose reductase followed by sorbitol dehydrog. convert glucose -> sorbitol ->fructose, predominantly in seminal vessicles, lense; with prolonged hyperglycemia sorbitol accumuliates increasing osmotic pressure -> cataract formation

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70
Q

Heart failure cells

A

Golden/yellow/brownish cytoplasmic granules in the alveoli that turn dark blue with Prussian blue staining = hemosiderin-laiden macrophages (“heart failure cells”) that result from L heart failure

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71
Q

Respiratory Epithelium

A

Anterior epiglottis/upper 1/2 of posterior epiglottis/vocal folds are stratified squamous epithelium; majority of the respiratory tract is pseudostratified, columnar, mucus-secreting epithelium

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72
Q

Fragile X Syndrome

A

Full mutations of > 200 CGG repeats on the FMR1 gene result in hypermethylation of the FMR gene, leading to gene inactivation; X-chromosome appears thin or “fragile” when karyotype

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73
Q

SIADH

A

Incr. ADH -> incr. H20 absorption -> suppression of renin-aldosterone -> natriuresis -> clinically normal body fluid volume + low plasma osmolality

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74
Q

Pacemaker potential

A

Adenosine/acetylcholine act on phase 4: reduce rate of spontaneous depolarization in pacermaker cells via activation of K+ channels (which opposed iNa+), prolonging time taken to reach threshold

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75
Q

Readioactive iodine exposure

A

Tx: Potassium iodide; High serum levels of non-radioactive iodide can competitively inhibit entry into thyroid follicular cells; also,
Wolff-Chaikoff effect: high iodide level inhibits iodine organification

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76
Q

Hematogenous osteomyelitis

A

Predominantly affects children, affets the metaphysis d/t slow-flowing sinusoidal vasculature; microbial seeding -> bone ischemia -> necrosis -> osteomyelitis
Suspect in a child who refuses to use a limb, signs of infection

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77
Q

Thiopental

A

Short-acting barbiturate/general anesthetic; highly lipid soluble: equilibrates in brain tissue w/I 1 min, causes LOC; Redistribution into fat/skeletal muscle (not metabolism) -> recovery

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78
Q

Adrenal crisis

A

Response to stress in patients with adrenal insufficiency -> shock- like state; present with hypotension, tachycardia, hypoglycemia
Tx: Corticosteroid
Hx: vomiting, abdominal pain, weight loss, hyperpigmentation

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79
Q

Mu opioid analgesics

A

Can cause contraction of smooth muscles in the sphincyer of Oddi leading to increased pressure, biliary colic

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80
Q

Acute acalculous cholecystits

A

Acute inflammation in the absence of gallstones; seenin hospitalized patients with severe injuries/conditions; arises secondary to stasis and ischemia; Tx: antibiotics, cholecystectomy

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81
Q

Vitamin D Deficiency

A

Classic presentation: bony prominence at costochondral junctions, “rosary chest”, bowed legs;Histology: increased unmineralized osteoid around trabeculae, widening between osteoid seams

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82
Q

PCWP

A

RA: 0-8, RV: 4-25, PA: 9-25, LA: 2-12, LV: 9-130, Aorta: 70-130

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83
Q

Amphotericin B

A

Nephrotoxicity is the most dangerous adverse effect; increase in permeability of DT -> hypokalemia/hypomagnesemia -> weakness, arrhythmias (flat T wave, ST depression, U waves, PVCs)

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84
Q

Polymyalgia Rheumatica

A

Bilateral stiffness of shoulders/pelvic girdle, fever, weight loss, ESR
Associated with temporal arteritis

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85
Q

TCA’s

A

Inhibit fast sodium channel conduction resulting in arrhythmias; Vfib most common cause of death in TCA toxicity
Tx: fluid resuscitation, hypertonic sodium bicarb

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86
Q

Familal Chylomicronemia

A

LPL deficiency; normally bound to heparin sulfate moieties on vascular endothelium - heparin admin causes release allowing for acitvity level to be measured; presents with milky plasma/creamy supernatant, hypertrigs, acute pancreatitis, lipemia retinalis

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87
Q

Huntington Disease

A

Transcriptional repression is a proposed mechanism of mutated huntington protein: inhibition of histone acetyltransferase -> histone deacetylation -> prevention of transcription/gene silencing; also involves a deficiency in GABA, increased dopamine

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88
Q

Elastase

A

Both macrophages and nuetrophis secrete elastase; macrophage elastase is inhibited by TIMP, neutrophil by _1-antitrypsin; each elastase can degrade the other’s inhibitor -> additive destruction

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89
Q

IFN_/_

A

Synthesized in response to viral infection –> suppress viral replication/induce apoptosis of infected cells; induce infected neighboring cells to halt protein synthesis in presence of dsRNA
Also induce MHC I expression, stimulate NK/Cytotoxic T-cells

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90
Q

Acute leukemia

A

Patients typically present with sx’s of pancytopenia

Anemia: fatigue; Leukopenia: oppostunistic infections; Thrombocytopenia: bleeding

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91
Q

Ischemia

A

Ischemia -> deplation of intracellular ATP stores -> NA+/K+ ATPase dysfuntion -> dissipation of resting transmembrane potential -> extracellular K+/intracellular Ca2+ accumulation

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92
Q

Mcardle Disease

A

Glycogen storage disease type V; deficiency in muscle glycogen phosphorylase: muscle pain on exertion, rhabdomyolysis -> myoglobinuria; Tx: Vitamin B6

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93
Q

Hypokalemia EKG changes

A

QT prolongation, U-waves, ST depression, potentially torsades

94
Q

Kluver-Bucy Syndrom

A

Primarily involves the amygdala; inappropriate sexual activity, oral fixation, hyperphagia, aphasia, loss of anger/fear reactions, etc.
Associated with HSV-1 encephalitis

95
Q

Tradive dyskinesia

A

Results from upregulation of central dopamine receptors, decrease in cholinergic activity in the striatum

96
Q

Bone remodeling

A

Osteoclasts resorb bone via carbonic anhydrase

Osteoblasts deposit hydroxyapetite via alkaline phosphatase

97
Q

Renal artery clamp

A

Decreased perfusion pressure -> large decreased RPF + small decrease in GFR -> increased filtration fraction
GFR partially preserved via constrx. of efferent arteriole by R/A

98
Q

Mumps orchitis

A

Significant swelling of the testes -> seminiferous tubule atrophy -> infertility/Leydig cell atrophy -> decreased testosterone production
Sexual dysfunction tx: exogenous testosterone

99
Q

Incretins

A

Glucagon-like peptide-1, gastric inhibitory peptide: GI hormens that stimulate pancreatic insulin secretion in response to sugar-containing meals; response independent to insulin

100
Q

ACE inhibitor fetopathy (AIF)

A

Occurs secondary to ACE-I therapy in pregnant women: ATII is required for fetal renal devo.; Presents w/oligohydramnios, pulm. hypoplasia, limb hypoplasia, growth retard., hypoplasia of the skull

101
Q

PCI w/drug-eluting stent

A

Paclitaxel prevents microtubule breakdown causing arrest of the cell cycle in the M phase; this prevents intimal hyperplasia/ restenosis

102
Q

GPCRs

A

Composed of seven transmembrane _-helical domains

103
Q

VHL

A

Pheochromocytoma, Renal cell carcinoma, Cerebellar/retinal hemangioblastoma

104
Q

Dysplastic nevus syndrome

A

Architect./cytologic atypia: nests of nevomelanocytes w/ angulated, hyperchromic nuclei and bridging w/ nests; have the potential to evolve into melanoma: CDKN2A on chromosome 9p21 encodes CDK inhibitor 2A which inhibits CDK4, allows advance of cell cycle

105
Q

Leucine zipper

A

Short _-helix protein fragment with leucine residues at every 7th position that binds DNA/acts as a transcription factor
Other DNA-binding domains: helix-loop-helix, zinc finger motif, etc.

106
Q

Anaphylaxis

A

Mediated by mast cells: tryptase is a specific marker

Degranulation is activated by IgE crosslinking/receptor aggregation

107
Q

Tumor Lysis Syndrome

A

Develops during chemotherapy for high-grade cancer; cell destruction -> release of K+, PO4-, nucleic acids -> arrhythmias, obstructive uropathy (hyperuricemia), acute renal failure
Tx: aggressive hydration, allopurinol or rasburicase

108
Q

Pulsus Paradoxis

A

Decrease in systolic blood pressure > 10 mmHg w/inspiration; In conditions that impair expansion into pericardial space, increased RV volume d/t increased return during inspiration pushes IV septum toward the left, decreasing LV EDV/SV –> dereased BP during insp.

109
Q

Kussmaul’s Sign

A

Increase in JVP on inspiration; Impaired filling of the RV d/t fluid in pericardial space or poorly compliant myocardium -> increased bloodflow during inspiration to back up into venous system

110
Q

CREST syndrome

A

Excessive tissue fibrosis d/t fibroblast proliferation; Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia;
E.D. presents as heartburn, regurgitation, dysphagia

111
Q

Myocardial energy

A

Source: fatty acid oxidation (60%), glucose oxidation (30%), glycolysis (5%); Fatty acid oxidation produces more ATP but has a high oxygen utilization

112
Q

Hypercalcemia + Nephrogenic DI

A

PTHrP from squamous cell carcinoma -> hypercalcemia -> dehydration via downregulation of aquaporins -> resistance to vasopressin -> one form of DI

113
Q

Mitral Regurgitation

A

Best indicator of severe MR with LV volume overload is the presence of an S3 gallop: reflects increased rate of LV filling d/t a large volume of regurgitant flow re-entering the ventricle during diastole

114
Q

Cardiac Tamponade

A

Beck’s triad: hypotension, distended neck veins, distant or muffled heart sounds; combined with tachycardia and pulsus paradoxis is indicative of tamponade

115
Q

Insulin Resistance

A

TNF-_ activates serine kinases which phosphorylate insulin receptor serine residues, inhibiting tyrosine phosphorylation by insulin as well as downstream signaling; similar mechanism of action for catecholamines, glucocorticoids and glucagon

116
Q

Neurophysin

A

Carrier protein for oxytocin (paraventricular) and ADH (supraoptic nuclei) from the site of their production to the postieror pituitary

117
Q

Pancreatitis

A

Acute interstitial: digestion of adipose by lipase -> fatty acids bind Ca2+, precipitate as insoluble calcium salts + necrosis
Acute necrotic: activation of trypsin -> autodigestion -> hemorrhage into necrosis, fat necrosis can spread into abdominal cavity

118
Q

Vertical transmission of HIV

A

Presents as oral thrush, interstitial pneumonia, severe lymphopenia during the 1st year of life; Risk of transmission w/no prenatal care is ~40%; prophylaxis with zidovudine (NRTI) reduces risk by 2/3

119
Q

Carcinoid Tumor

A

Commonly appear in ileum, appendix, rectum; Eosinophilic cytoplasm, oval/round nuclei, minimal to no variation in shape/size of tumor cells; form glands, nests, rows, sheets; dense core granules seen on EM; malig. transformation of enterochromaffin cells

120
Q

de Quervain’s thyroiditis

A

2ndary to viral infection; initially causes thyrotoxicosis without increased readioactive iodine uptake d/t release of stored thyroid hormone; followed by hypothyroid; Histology: mixed cellular infiltrate w/occasional multinucleated giant cells

121
Q

Central DI

A

Isolated damage to the posterior pituitary gland produces only transient central DI; damage to hypothalamic nuclei will cause permanent central DI

122
Q

von Willebrand disease

A

Often present with a lifelong history of mucosal bleeding; normal platelet count, prolonged bleeding time; Can present with a microcytic anemia caused by iron deficiency d/t bolod loss

123
Q

P450 monooxygenase

A

Pro-carcinogens are metabolized by P450 monooxygenase in hepatic microsomes or the ER of other tissues; This renders most substances soluble and easier to excrete; can also convert pro-carcinogens

124
Q

Status Epilepticus

A

Treatment: IV lorazepam followed by phenytoin (prevent recurrent seizures); Still seizing: phenobarbital, followed by general anesthesia

125
Q

Causes of myopathy

A

Glucocorticoids: proximal muscle weakness/atrophy without pain; Polymyalgia rheumatica: pain/stifness in shoulders/pelvis; Poly/Dermatomyositis: proximal weakness, rash, arthritis, increased CK; Statins: proximal weakness/pain, increased CK; Hypothyroid: proximal pain/weakness, myoedema, decreased reflexes, incr. CK

126
Q

HUS-TTP

A

Opposite ends of a spectrum; HUS: microangiopathic hemolytic anemia following bloody diarrhea; TTP: fever, neurological sx’s, renal failure, thrombocytopenia, microangiopathyic hemolytic anemia

127
Q

Acid Buffers

A

Utilized by the kidney to trap H+ and allow the excretion of larger amounts of acid in acioditic states; 2 most important: HPO4 and NH3

128
Q

Hearing loss

A

Prolonged exposure to noises > 85dB can cause distortion/fracture of sterocilia d/t shearing forces against the tectorial membrane in the organ of Corti

129
Q

Primary CNS Lymphoma

A

Most frequent CNS tumor in immunosuppressed patients; universally associated w/EBV; appears as dense cellular aggregates of unifor, atypical lymphoid cells, commonly B-cells; Diffuse large B-cell lymphoma is the most common subtype

130
Q

Acute Hemolytic Reaction

A

Both AHR and hemolytic disease of the newborn are type II antibody-mediated hypersensitivity reactions d/t preformed anti-ABO antibodies fixing complement –> complement mediated cell lysis

131
Q

Seratnin Syndrome

A

Sx’s: neuromuscular excitation, autonomic stimulation, AMS

Caused by: SSRIs, SNRIs, MOAIs, Tricyclics, tramadol, 5-HT3 antagonists (ondansetron), Linezolid, Triptans

132
Q

Pineal Germinoma

A

Most common tumor of the pineal gland; Originate from embryonic germ cells, secrete _-hCG; present w/parinaud syndrome (impaired upward gaze), precocious puberty, obstructive hydrocephalus

133
Q

Obstructive Sleep Apnea

A

In patients w/OSA peritubular cells in the renal cortex sense hypoxia and respond by releasing erythropoietin: 2ndary polycythemia in the presence of chronic hypoxia (OSA, COPD, R->L shunt, high altitude)

134
Q

Toxoplasmosis

A

Tx: Pyrimethamine + sulfadiazine + leucovorin

135
Q

Pure Red Cell Aplasia

A

Presents as low erythrocyte count w/low percentage of reticulocytes and low Hb + WBC/platelets within normal limits; Pathogenesis: inhibition of erythropoietic precursors by IgG/CTL; when thymoma is present, removal can occasionally cure; also caused by Parvo B19

136
Q

Nitroprusside toxicity

A

AMS, seizures, cardio. collapse, lactic acidosis, bright red venous blood, dusky colored skin; d/t cyanide poisoning: mitochondrial toxin that binds Fe3+ in cytochrome c oxidase, inhibiting the ETC; Antidote: Sodium thiosulfate (sulfur donation) sodium/amyl nitrite (methemoglobinemia), hydroxocobalimin (direct binding)

137
Q

Acute Calculous Cholecystitis

A

Most common complication of cholelithiasis; results from chemical irritaion/inflammation caused by stones in the gallbladder which disrupt protective mucus layer, allow for damage from bile salts/PGs -> ischemia, bacterial invasion

138
Q

Smooth ER

A

Contains enzymes for steroid/phospholipid biosynthesis; high concentration in cells of the adrenal cortex, e.g.
Also involved in detoxification of drugs (hepatoytes), specializes as sarcoplasmic reticulum in striated muscle cells

139
Q

Schwanoma

A

Tumor of the PNS; appear biphasic with highly cellular areas (Antoni A - spindle cells) intermixed with myxoid regions of low cellularity (Antoni B); S-100 + d/t neural crest cell origin

140
Q

Hydrocephalus

A

Long term complications include irritability, poor feeding, muscle hypertonicity and hyperreflexia –> d/t upper motor neuron damage caused by stretching of the periventricular pyramidal tracts

141
Q

Elevated AFP

A

Most common cause is underestimation of gestational age

Also associated with neural tube/abdominal wall defects

142
Q

Blood Transfusion

A

Large volume transfusions can lead to hypocalcemia d/t elevated plasma levels of citrate, which is added to stored blood as an anticoagulant; Citrate chelates calcium/magnesium -> parasthesias

143
Q

Galstones in pregnancy

A

Estrogen increases cholestrol synthesis by upregulating hepatic HMG-CoA reducatse -> supersaturation of bile; Progesterone induces gallbladder hypomotility

144
Q

Neonatal hypoglyemia

A

Poor glucose control in mother -> increase BG in fetal circulation -> increased insulin release -> beta cell hyperplasia -> overproduction of insulin in the neonate, macrosomia

145
Q

Anti-nausea/emesis

A

Visceral nausea (GI insults): 5-HT3 antagonists
Vestibular nausea: Antigistamines/anticholinergics
Nausea assocaited w/migraines: Dopamine antagonists

146
Q

Respiratory Compensation

A

PaCO2 = (1.5 x HCO3-) + 8 +/- 2

147
Q

Hemachromatosis

A

HFE protein mutataions are most common cause; Inactivation –> decreased hepcidin synthesis by hepatocytes (stored Fe regulation), increased DMT expression by enterocytes (intestinal absorption)

148
Q

Hemolytic Uremic Syndrome

A

Caused by shiga toxin producing organisms; endothelium injury -> platelet activation/aggregation -> microthrombi -> AKI, microangiopathic hemolytic anemia

149
Q

Arteriovenous Shunt

A

Abnormal connection between artery/vein; congenital, trauma related, aneurysm rupture, etc.; decreased TPR –> increased CO, decreased afterload, increased prelaod (d/t shunting of blood)

150
Q

Area postrema

A

Responsible for vomiting that resuts from administration of systemic chemotherapy; located on the dorsal surface of the medulla at the base of the 4th ventrical where it can sample circulating chemicals

151
Q

Digoxin toxicity

A

Fatigue, blurry vision, changes in color perception, nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, confusion, hyperkalemia, delerium, bradycardia, vtach

152
Q

Resistance in parallel

A

1/R = 1/R1 + 1/R2 + 1/R3 + € 1/Rn

153
Q

Menopause

A

Average age = 52; Ovarian failure –> decreased estrogen production, therefore elevated FSH d/t loss of feedback inhibition is diagnostic

154
Q

Glucagonoma

A

Presents with dermatitis, diabetes, DVT, depression; dermatitis = necrolytic migratory erythema –> erythematous papules/plaques on face, perineum, extremities that coalesce forming a bronze-colored central indurated area w/peripheral blistering and scaling

155
Q

Rheumatoid Arthritis

A

Cartilage components serve as autoantigens that activate CD4+ T-cells, which in turn stimulate B-cells to secrete rhematoid factor –> IgM Ab specific for the Fc component of self IgG

156
Q

Marcus Gunn Pupil

A

Afferent pupillary defect cause by a lesions involving the optic nerve; a relative afferent pupillary defect can occur due to a lesion of the optic tract, as the nasal portion of the retina contribues more input to the pretectal nucles than the temporal portion

157
Q

Chemotherapeutic resistance

A

Human multidrug resistance (MDR1) gene –> P-glycoprotein: transmembrane protein, ATP-dependent efflux pump; normally expressed in intestinal/renal tubular cells, blood/brain barrier

158
Q

Topical steroids

A

Decrease the production of extracellular matrix collagen/ glycosaminoglycans -> atrophy of dermis, loss of dermal collagen, drying/cracking of the skin, telangiectasias, ecchymoses, striae

159
Q

M™llerian Agenesis

A

Causes vaginal agenesis: no upper vagina development, combined with variable uterin development; patients have normal ovaries and thus develop 2nd sexual character.s, but are unable to menstruate

160
Q

Friedreich Ataxia

A

Autosomal recessive mutation in the frataxin gene on chromosome 9; Presentation: Spincerebellar tract degeneration (ataxia), Dorsal column/DRG degeneration (position/vibration loss), kyphoscoliosis and foot abnormalities, hypertrophic cardiomyopathy, DM

161
Q

Malignant Hyperthermia

A

D/t hypersensitivity of skeletal muscles to inhalation anesthetics + succinylcholine; autosomal dom. defect of ryanodine receptors causing incr. release of Ca2+ during muscle contraction; Excess free Ca2+ is taken up via ATP, consumption generates heat and induces muscle damage; Tx: Dantrolene -> inhibits ryanodine receptors

162
Q

PCOM stroke

A

Common site of saccular aneurysm; causes CN III palsy: eye is “down and out” with ptosis and mydriasis

163
Q

Acetaminophen Toxicity

A

Acetaminophen has three pathways for metabolism: glucuronidation, sulfation, formation of NAPQI –> toxic byproduct: mst be conjugated by glutathione for elimination; alcoholics have depleted glutathione which increases risk for acetaminophen toxicity

164
Q

Aspergillus flavus

A

Fungi grows on grains/foodstuffs with high humidity/temperature; high levels of aflatoxin consumption assocatied w/a G:C -> T:A transversion in codon 249 of p53; increases risk for HCC

165
Q

Congenital Hypothyroidism

A

6 P’s: pot-bellied, pale, puffy-faced child with protruding umbilicus, protuberant tongue, poor brain development; Also include jaundice, constipation, hypotonia, hoarse cry, myxedema, coarse facial feature

166
Q

Traumatic aortic rupture

A

Caused by rapid deceleration, i.e. MVA; the most common site of injury is the aortic isthmus: tethered by the ligamentum arteriosum, fixed and immobile compared to descending aorta

167
Q

Halogenated inhaled anesthetics

A

Can cause severe liver damage; hepatitis presents in 2 days to 4 weeks after surgery under general anesthesia; liver tenderness, hepatomegaly, increased LFTs; widespread centrilobular hepatic necrosis; shrunken liver on autopsy; 80% mortality rate

168
Q

Nitrates

A

Around the clock administration rapidly results in development of tolerance; nitrate-free interval must be provided every day; patients don’t take a night-time dose;

169
Q

Ischemic insult

A

Myocardial stunning: ischemia-induced reversible loss of contractile function that takes hours to days to recover; Hibernation: persistent or repetitive ischemia/stunning that can be reversed by reperfusion (reverses upon perfusion)

170
Q

Necrotizing enterocolitis

A

Occurs in preterm infants secondary to GI/immunologic immaturity; enteral feeding intrduces bacteria into bowel where they proliferate excessively; impaired mucosal barrier function –> ischemic necrosis, intramural gas collections: pneumatosis intestinalis

171
Q

Lupus

A

Circulating antiphospholipid Ab’s cause aPTT prolongation in vitro, but act in vivo to produce hypercoagulable state; cause false-positive results on VDRL test; incr. risk for DVT, PE, TIA, recurrent miscarriage

172
Q

Primary Hyperaldosteronism

A

Mineralocorticoid excess -> increased Na+ reabsorption -> incr. fluid retention, hypertension -> increased ANP, pressure naturesis -> limited increase in extracellular fluid volume w/o hypernatremia (aldosterone escape)

173
Q

Melanoma

A

Commonly presents with a mutation in BRAF V600E: involved in activation of proliferation signals (Ras pathway); responds to Vemurafenib

174
Q

Nongonococcal urethritis

A

Most commonly caused by chlamydia trachomatis or ureaplasma urealyticum; Azithromycin is treatment of choice: chlamydia lacks muramic acid/peptidoglycan in cell wall, ureaplasma lacks cell wall entirely; thus, anti-cell wall antibiotics are ineffective

175
Q

Psoriasis treatment

A

Calcipotriene/calcitriol/tacalcitol are topical vitamin D analogs that active the vitamin D receptor: inhibits keratinocyte proliferation, stimulates differentiation, inhibits T cell proliferation; Other tx: cyclosporin, etanercept, methotrexate, ustekinumab

176
Q

Atheroembolic disease

A

Cyanotic toe discoloration + renal failure in elderly patient following invasive vascular procedure is characteristic of atheroembolic disease of the renal arteries causing cholesterol emboli

177
Q

Lung transplant rejection

A

Acute: CD8+ T-cell mediated vascular damage; presents w/dyspnea, dry cough, low-grade fever
Chronic: Inflammation/fibrosis of small bronchiolar walls –> narrow/ obstruction; presents w/dyspnea, non-productive cough, wheezing

178
Q

SVT Treatment

A

Vagal stimulation: valsalva maneuver, carotid massage –> increase refractory period in the AV node, prevent reentrant circuits; If these fail, administration of adenosine

179
Q

Lung abscess formation

A

Pulmonary abscess: local suppurative collection within parenchyma, causes necrosis of surrounding tissue; If connected to air passage –> air-fluid level seen on radiograph; d/t release of lysosomal enzymes by neutrophils/macrophages

180
Q

Thoracocentesis

A

Pleural borders: Midclavicle - 7th rib; paravertebral - 12th rib; midaxillary - upper border of 10th rib (right), lower border of 10th rib (left); Lower border of the lung is 2 intercostal spaces above the pleural border; thus, thoracocentesis should be performed above 7th, 9th, or 11th rib respectively

181
Q

Opoid Tolerance

A

Mechanism: activation of NMDA receptors by glutamate -> phosphorylation of opioid recetors; Ketamine is an NMDA blocker, can be used to decrease morphine tolerance

182
Q

Cholesterol stones

A

Estrogen -> incr. HMG-CoA reducatse -> incr. biosynthesis of cholesterol; Suppression of cholestrol 7a-hydroxylase by fibrates reduces cholesterol to bile acids –> cholesterol stone formation

183
Q

RDS complications

A

Temporary local hyperoxia in the retina d/t O2 supplimentation -> upregulation of VEGF upon return to RA -> neovascularization/retinal detachment (retinopathy of prematurity)

184
Q

Myasthinia Gravis

A

Associated with abnormalities of the thymus: thymoma, thymic hyperplasia; embryologically derived from the 3rd pharyngeal pouch

185
Q

Paraneoplastic Cerebellar Degen.

A

Small cell lung cancer, brest, ovarian, uterine: progressively worsening dizziness, limb/trunk ataxia, dysarthria, visual disturbances; tumor cells cross-react with Purkinje neuron antigens; Anti-Yo, anti-P/Q, anti-Hu are sometimes detectable

186
Q

Ankylosing spondylitis

A

HLA B27 assiated; presents as low back pain in a young man; progressive course with exaserbation/remission: inflammation at tendon insertion, hypoventilation d/t decr. Chest expansion, ascending aortitis, uveitis; routinely monitor chest expansion

187
Q

Verapamil

A

Cardiac muscle specific; skeletal muscle contraction occurs via membrane depolarization causing physical RyR opening in the SR -> intracellular calcium release: this is not associated with extracellular Ca2+ influx; In cardiac muscle calcium-induced Ca2+ release occurs

188
Q

Osteitis fibrosa cystica

A

Most characteristic skeletal manifestation of 1 hyperpara: subperiosteal resorption with cystic degeneration; presents with bone pain,subperiosteal erosions affecting the phalanges, “salt-and-pepper skull”, brown tumor bone cysts

189
Q

Juvenile Myoclonic Epilepsy

A

Form of idiopathic geeralized epilespy that may be familial; presents with moyclonic seizures: sudden-onset jerking movements involving both arms e.g.; Aggravated by sleep depreivation, no loss of consciousness; Tx: Valproic acid

190
Q

Systemic Mastocytosis

A

Abnormal proliferation of mast cells, increased histamin seretion; foci within the gstric mucosa –> hastric hypersecretion

191
Q

Atherosclerosis

A

Release of PDGF by locally adherent platelets, endothelial, cells, macrophages promotes proliferation/migration of smooth muscle cells from media into the intima

192
Q

Neonatal narcotic withdrawal

A

Sx’s: puplliary dilation, rhinorrhea, sneezing, nasal stuffiness, diarrhea, nausea, vomiting, chills, tremors, jittery movements, seizures; Tx: tincture of opium, followed by tapering

193
Q

Glands

A

Apocrine: secrete membrane bound vessicles into hair folicles; secretions can become malodorus d/t bacterial decomposition
Holocrine: entire secretory cells break down to release product
Eccrine/Merocrine: secrete sweat directly to skin surface
Paracrine: secretions reach target cells by diffusion

194
Q

Uremic bleeding

A

Significant renal dysfunction –> uremic toxin buildup in the circulation –> impiared platelet aggregation – qualitative disorder –> prolonged bleeding time

195
Q

Vitamin E Deficiency

A

Manifests as hemolytic anemia, neuromuscular disease: skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy; d/t incr. oxidative damage to axons and erythrocytes; mimics Friedreich ataxia (degeneration of posterior columns/spinocerebellar tracts)

196
Q

Cystic Fibrosis CFTR

A

Respiratory/gastric glands: secretes Cl- ions into the lumen, inhibits Na+ reabsorption –> increased salt/water content of mucus
Sweat glands: absorbs lumenal Cl-, increases Na+ abosrption –> reduced salt content of sweat

197
Q

Opportunistic prophylaxis

A

P. jirovecii: TMP-SMX when CD4+ count

198
Q

Colorectal Carcinoma

A

In contrats to spontaneous CRC, CRCin IBD is more likely to: affect younger patients, progress from flat/non-polypoid dysplasia, appear mucinous/signet ringed, develop early p53 and late APC gene mutations, affect the proximal colon, be multifocal in nature

199
Q

Serum Sickness

A

Type III hypersensitivity: immune complex deposition –> decreased serum C3; fever, pruritic skin rash, arthralgias, lymphadenopathy, proteinuria 7-14 days after exposure; Histology shows small vessel vasculitis w/fibrinoid necrosis and intense neutrophil infiltration

200
Q

Native Valve Bacterial Endocarditis

A

Most often involve mitral valve: prolapse is most common predisposing abnormality; Platelet + fibrin deposition occus spontaneously acting as a nidus; High velocity blood streams and turbulant flow contribute microinjury promoting infection

201
Q

Lead Poisoning

A

Exposure: batteries, ammunition, mining, chemical processing, etc. Presentation: “lead colic”, constipation, headaches, short-term memory loss, “lead lines” on the gums, wrist/foot drop, anemia, basophilic stipling

202
Q

Iron Poisoning

A

Stage 1: nausea, diarrhea, abdominal pain, hemorrhage, hypovolemia, shock; Stage 2: apparent recovery; Stage 3: metabolic acidosis, hepatic dysfunction, hypoglycemai; Stage 4: scarring of the GI tract

203
Q

Abetalipoproteinemia

A

Impaired formation of apoB: causes accumulation of lipis in intestinal villi; autosomal recessive mutataion in MTP gene; presents as malabsorption, low plasma TG/cholesterol, lack of chylomicrons, VLDL’s, apoB; fat-soluble vitamin deficiency; acanthocytes

204
Q

Infarction

A

Cerebral amyloid angiopathy: d/t alzhemiers, most common cause of spontaneous lobar hemorrhage; Charcot-Bouchard aneurysm: d/t chronic HTN, causes hemorrhage in deep brain structires; Hypertensive arteriolar sclerosis: d/t chronic HTN, causes ischemic lacunar infarcts in deep brain structures

205
Q

Microscopic polyangitis

A

Assocaited with antibiotic use: small vessle vasculitis that results from a type III immune reaction to a medication such as penicillin

206
Q

Caudal Regression Syndrome

A

Presents with agenesis of the sacrum/lumbar spine, flaccid paralysis of the legs, dorsiflexed foot contracture, urinary incontincence; d/t poorly controlled maternal diabetes

207
Q

Lipotoxicity

A

Induction of insulin resistance and beta cell dysfunction caused by free fatty acids/triglycerides; lowering FFA’s impreoves beta cell function and insulin resistance

208
Q

Anesthetic Potency

A

Potency: 1/MAC
Onset of action: 1/blood-gas partition coefficient
Onset of action: arteriovenous concentration gradient
Incr. AV concentration gradient means incr. uptake by peripheral tissues, thus longer time to saturation
Clearance: rate of exhalation (or hepatic metabolism for halothane)

209
Q

MRSA treatment

A

Vancomycin: blocks glycopeptide polymerization, causes nephrotoxicity/red man syndrome; Daptomycin: depolarizes cell membrane, causes myopathy; Linezolid: inhibits 50S subunit, caues optic neuritis, thrombocytopenia, serotonin syndrome

210
Q

Osmotic diuresis

A

Mannitol is an osmotic diuretic used to manage cerebral edema /increased intracranial pressure; Increased intravascular volume can exaserbate pulmonary edema in patients w/preexisting condition –> dilutional hyponatremia, metabolic acidosis, hyperkalemia, death

211
Q

First Dose Effect

A

ACEIs reduce venous return to the heart which activates Bezold- Jarisch reflex, causing vagally mediated hypotension and bradycardia; predisposing factors include hyponatremia, hypovolemia, low BP, high renin/aldosterone, renal impairment, HF; caution in patients taking thiazide or loop diuretics

212
Q

Alcohol + Acetaminophen

A

Alcohol induces CYP 2E1 which activates acetaminophen to a hepatotoxic metabolite (NAPQI); N-acetylcysteine regenerates gluatione (GSH) which metabolizes NAPQI to a non-toxic form

213
Q

16S RNA

A

Only piece of rRNA found in the prokaryotic 30S subunit; essential for initiation of protein synthesis:expresses a sequence complementary to the Shine-Dalgarno sequence in all prokaryotic mRNA (located 10 bp upstream from the start codon)

214
Q

Hepatic Encephalopathy

A

Occurs d/t failure of the liver to metabolize ammonia; GI bleeding leads to incr. nitrogen delivery to the get in the form of hemoglobin; converted into ammonia and absorbed into the bloodstream

215
Q

Angisarcoma

A

Infiltration of the dermis with slit-like abnormal vascular spaces; risk factors include chronic lymphedema, radical mastectomy with axillary lymph node dissection; poor prognosis

216
Q

Neurotransmitter Nuclei

A

Nucleus ceruleus: NE; Raphe nuclei: Serotonin; Nucleus basalis of Meynert: ACh; Substantia nigra: dopamine

217
Q

Bone Descriptions

A

Osteoid matrix accum. around trabeculae: Rickets/Osteomalacia
Trabecular thinning with fewer interconnections: Osteoporosis
Subperiosteal resorption with cystic degeneration: Hyperparathyroid
Lamellar bone structure resembling a mosaic: Paget’s Disease
Spongiosa in medullary canal w/o mature trabeculae: Osteopetrosis

218
Q

Mushroom Toxins

A

Amatoxins are found in a variety of poisonous mushrooms e.g. death cap mushrooms; potent inhibitors of RNA polymerase II, halthing mRNA synthesis

219
Q

Pauci-Immune RPGN

A

Associated with granulomatosis with polyangiitis: high serum level of c-ANCA is diagnostic, no Ig or complement deposits found by immunofluorescent studies

220
Q

Crohn’s Disease

A

Assocaited with HLA-DR1, mutations in NOD2: triggers the NF-kB pathway –> cytokine production

221
Q

Pompe Disease

A

Deficiency of acid _-glucosidase/acid maltase: responsible for breaking down glycogen w/i acidic environment of lysosomes; cardiac and skeletal muscle are particularly susceptible: interfere w/contractile function

222
Q

Neuroblastoma

A

Develops from neuroblasts in the adrenal medulla; presents with non-rhythmic conjugate ee movements associated with myoclonus (opsoclonus-myoclonus syndrome); histology: aolid sheets of small cells with dark nuclei and scant cytoplasm

223
Q

MELAS

A

Mitochondrial encephalopathy with stroke-like episodes and lactic acidosis

224
Q

Drug Induced Lupus

A

Anti-histone Ab’s commonly seen; occurs with agents that are metabolized by liver acetylation; slow acetylators are at greater risk

225
Q

Gancyclovir + Zidovudine

A

Neutropenia

226
Q

Calcium Oxalate Stones

A

Tx: Thiazide diuretics; decrease urine Ca2+ excretion

227
Q

Hemolytic Uremic Syndrome

A

Classic triad: microangiopathic hemolytic anemia, acute renal failure, thrombocytopenia; presents in a 5-year old male with fever, abdominal pain, bloody diarrhea, pallor, oligura

228
Q

RPGN

A

Type 1: anti-GBM Ab’s; linear deposits; Goodpasture syndrome
Type 2: immune-complex mediated; “lumpy bumpy” deposits; post-strep, SLE, IgA, Henoch-Schonlein
Type 3: Pauci-immune; no Ig or complement; Wegner’s

229
Q

Lithium Toxicity

A

Drigs that increase lithium levels: thiazide diuretics, ACE inhibitrs, NSAIDs

230
Q

Micturition

A

Sacral micturition center: S2-S4, bladder contraction; Parasymp. fibers travel w/pelvic nerves -> cholinergic receptors on bladder wall
Pontine micturition center: PRF, relaxes external urethral sphincter
Cerebral cortex: inhibits sacral micturition center

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