Set 25 Flashcards
What does the Eustachian (auditory) tube connect? What is its purpose? What drug is commonly prescribed for Eustachian tube dysfunction?
Connects the middle ear to the nasopharynx
Makes the pressure in the middle ear the same as the atmosphere pressure
Intranasal steroid
What is the most common renal malignancy in adults? What is the associated gene deletion with this malignancy?
Renal cell carcinoma (hematuria, flank pain and palpable flank mass)
Gene deletion on chromosome 3 (RCC = 3 letters) sporadic or von Hippel-Lindau syndrome
A pediatric patient presents with a noticeable right flank mass. The patient’s mother also reports blood in the patient’s urine. What malignancy would be most likely in this scenario? What is the WAGR complex?
Wilm’s tumor (nephroblastoma): most common renal malignancy of early childhood (ages 2-4). Contains embryonic glomerular structures. Presents with huge, palpable flank mass and/or hematuria
“Loss of function” mutations of tumor suppressor genes WT1 or WT2 on chromosome 11. May be part of Beckwith-Wiedemann syndrome or WAGR complex: Wilm’s tumor, Aniridia, GU malformation and mental/motor Retardation (intellectual disability)
A 24-year-old young man is fired from his job, and when explaining the chain of events to his roommate, he says that “it doesn’t really matter. I didn’t even need that job.” His roommate is perplexed, wondering how they will pay their rent. Of which immature ego defense could this be an example?
Rationalization - proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame
What is the definition of tidal volume, residual volume, and vital capacity?
Tidal volume: air that moves into lung with each quiet inspiration, typically 500 mL *tide comes in (normal breath)
Residual volume: air in lung after maximal expiration; cannot be measured on spirometry *what resides
Vital capacity: TV + IRV (extra air that you can breath in after TV) + ERV (air that can be breathed out after max expiration) maximum volume of gas that can be expired after a maximal inspiration OR maximum amount of air you can take into your lungs minus the RV
A 22-year-old man who recently immigrated from a developing country is seen at the county health clinic with a complaint of a chronic but recently worsening productive cough and sinusitis symptoms (i.e., headache). He also mentions to you privately that he and his wife have not been able to have children despite trying for two years. While you note this last complaint, you order a CXR out of concern this man may have TB given his immigration status. The CXR appears backwards on the display, but you realize this man’s heart is actually on the opposite side of his chest. What is the primary defect in this syndrome, and what are the characteristic symptoms/signs?
Kartagener syndrome (primary ciliary dyskinesia): immotile cilia due to dynein arm defect. Results in male and female infertility due to immotile sperm and dysfunctional fallopian tube cilia. Increased risk of ectopic pregnancy. Can cause bronchiectasis, recurrent sinusitis, and situs inversus (e.g., dextrocardia on CXR)
A mutation in which proto-oncogene is most commonly associated with Hirschsprung disease?
RET gene mutation
RET codes for proteins that assist cells of the neural crest - later become ganglion cells
When screening a population for a particular disease, would you rather have a high sensitivity or a high specificity? What test is used to screen for HIV? What test is used to confirm a positive HIV screen?
High sensitivity (catch more)
Presumptive diagnosis made with ELISA (sensitive, high false + rate and low threshold, rule out test)
Positive results are confirmed with Western blot assay (specific, high false-negative rate and high threshold, rule in test)
How do primary and secondary hyperaldosteronism differ in their effect on plasma renin levels? What agent is used to treat primary hyperaldosteronism?
Primary: caused by adrenal hyperplasia or an aldosterone-secreting adrenal adenoma (Conn syndrome), resulting in HTN, hypokalemia, metabolic alkalosis, and low plasma renin (negative feedback). Normal Na+ due to aldosterone escape = no edema due to aldosterone escape mechanism. May be bilateral or unilateral Treatment: surgery to remove the tumor and/or spironolactone, a K+-sparing diuretic that acts as an aldosterone antagonist
Secondary: renal perception of low intravascular volume results in an overactive RAS. Due to renal artery stenosis, CHF, cirrhosis or nephrotic syndrome. Associated with high plasma renin. Treament: spironolactone
Amyloidosis and sarcoidosis are associated with which cardiomyopathy? What are some other diseases or conditions associated with this cardiomyopathy?
Restrictive/infiltrative cardiomyopathy: major causes include sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, (thick fibroelastic tissue in endocardium of young children), Loffler syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate), and hemochromatosis (dilated cardiomyopathy can also occur). Diastolic dysfunction ensues. Can have low-voltage ECG despite thick myocardium (especially amyloid)