Set 4 (Hepatic) Flashcards
1
Q
Fluke infection of biliary tree
A
Brown pigment stones
2
Q
Thiamine: cofactor for?
A
Transketolase
alpha-ketoglutarate dehydrogenase
pyruvate dehydrogenase
3
Q
Pyruvate –> acetyl CoA
A
Pyruvate dehydrogenase
4
Q
Rate limiting step of TCA
A
Isocitrate dehydrogenase
isocitrate –> alpha-ketoglutarate, FIRST NADH produced
5
Q
Alpha-ketoglutarate dehydrogenase
A
a-ketoglutarate –> succinyl-CoA
second NADH
6
Q
Alpha-ketoglutarate dehydrogenase: cofactors
A
Thiamine
Lipoic acid
CoA
FAD, NAD
7
Q
Succinyl CoA –> Succinate
A
Succinyl CoA synthetase
substrate level phosphorylation, GTP produced
8
Q
Succinate dehydrogenase
A
Succinate –> fumarate
production of FAD
9
Q
Malate dehydrogenase
A
Malate –> Oxaloacetate
Third NADH
10
Q
Chloroquine: most serious long-term A/E
A
retinopathy
11
Q
Chloroquine
A
Eliminates suceptible ERYTHROCYTIC forms of ALL plasmodia species.
12
Q
Primaquine
A
Added to tx of P. vivax and ovale to eradicate INTRAHEPATIC stage (prevent relapse)
13
Q
PANlobar lymphocytic infiltrate
Ballooning hepatocytes
Hepatocyte necrosis and apoptosis (Councilman bodies)
A
Acute viral hepatitis
14
Q
Budd-Chiari syndrome
A
Hepatic vein thrombosis
Centrilobular congestion and fibrosis
15
Q
Acetominophen toxicity: liver biopsy
A
CENTRIlobular hepatic necrosis
16
Q
Portal HTN: hepatic histology
A
NO CHANGE!
17
Q
Liver disease and associations:
IDA
Basal ganglia atrophy
Fat malabsorption and osteoporosis
A
IDA: untreated sprue or celiac syndrome.
BG atrophy: Wilson’s disease.
Fat malasorption, osteoporosis: cholestasis
18
Q
Wilson’s disease: tx
A
Penicillamine (chelation therapy)
19
Q
Lactulose: tx for?
A
Cirrhosis-related hepatic encephalopathy
20
Q
Lead poisoning (encephalopathy, abdominal colic w/o hepatits or cirrhosis): tx
A
Dimercaprol, DETA (chelating agents)
21
Q
Pathogenesis of alcohol induced hepatic steatosis
A
Decrease in free fatty acid oxidation
(2/2 EXCESS NADH production by alcohol and aldehyde dehydrogenase)
(also: impaired lipoprotein assembly, increased peripheral fat catabolism)
22
Q
Mutation in hemochromatosis
A
HFE (HLA class 1 like molecule) on chrom6 C282Y (Cysteine --> Tyrosine)
23
Q
m/c/c of acute hepatitis in YOUNG ADULTS
A
HepA
24
Q
Pyruvate carboxylase
A
Gluconeogenesis
Pyruvate –> oxaloacetate (MITOCHONDRIA)
Biotin = cofactor
Acetyl CoA=allosteric activator
25
Ornithine transcarbamoylase
Urea cycle
| Ornithine + carbamoyl phosphate --> citrulline (MITOCHONDRIA)
26
HYPERammonemia
Mental retardation
a/w what enzyme deficiency
Ornithine transcarbamoylase
27
TCA: location
MITOCHONDRIA!
28
HMG CoA results from?
Leucine (ketogenic amino acid)
| HMG CoA synthase
29
HMG CoA lyase
Ketogenesis from HMG CoA
| MITOCHONDRIA
30
Occur exclusively in MITO
```
b-oxidation
Ketogenesis
TCA
Parts of urea cycle (carbamoyl phosphate synthetase 1, ornithine transcarbamoylase)
Pyruvate carboxylation
```
31
Reactions that occur in CYTOplasm of liver
pentose phosphate pathway
| transketolase; cofactor=thiamine
32
Impaired faty acid transport into MITO
| Restricted ketone body production
```
Carnithine deficiency
(Myoglobinemia, weakness following exercize, elevated muscle TG, HYPOketonemia)
```
33
Beta-oxidation of FA produce
Acetyl-CoA
| which --> acetoacetate --> one of the 3 primary ketone bodies
34
Acetoacetate
ketone body
35
Suppresses cholesterol 7a-hydroxylase activity
Fibrates
| reduce cholesterol --> Bile acid, increase cholesterol stones!
36
Estrogen and Cholesterol stones
Estrogen increase HMG-CoA reductase activity (more cholesterol production)
37
Neonatal hepatitis w/ cholestasis; suspicious for?
A1AT deficiency
38
Utilize glycerol produced by degradation of TG by hormone sensitive lipase
ONLY the liver!
| use glycerol for triacylglycerol synthesis, gluconeogenesis, intermediate in glycolysis
39
Necessary for definitive diagnosis of acute calculous cholecystitis
Positive HIDA scan (cystic duct obstruction)
40
Serum-sickness like prodrome
| fever, fatique, joint pain, skin rash
Hepatitis B
41
Herpes virus: envelope?
YES, bud through and acquire enveloped from host cell NUCLEAR membrane.
42
Adenovirus: envelope?
NOPE
43
HPV: envelope?
NOPE
44
Lipoic acid: cofactor for?
PDH (deficiency=lactic acidosis)
alpha-ketoglutarate DH
branched-chain ketoacid DH (maple syrup urine disease)
45
Statin: A/E
Liver toxicity
| Myopathy
46
Aldolase B deficiency
Hereditary fructose intolerance
47
Galactosemia: deficiency in?
Aldolase reductase
48
HepE
high mortality in PREGNANT women
fecal-oral transmission
UNenveloped, ssRNA virus
49
Primary means of HBV transmission
Blood
| semen, saliva, sweat, tears, milk, effusions
50
Acute aclaculous cholecystitis
Acute inflammation of gallbladder in absence of gallstone
| hospitalized, severely ill
51
Severely malnourished
Paresthesias and dysesthesias ("burning feet syndrome")
GI distress
Pantothenic acid deficiency
52
Panthothenic acid active form
Coenzyme A
| Binds oxaloacetate in TCA --> citrate --> succinyl CoA
53
Superior rectal vein drain into?
Portal circulation (via inferior mesenteric vein)
54
Inferior rectal vein drain into?
Systemic circulation (via internal pudental veins)
55
Middle rectal vein drain into?
Systemic circulation (via internal iliac vein)
56
Pneumobilia (air in biliary tract)
Gallstone ileus
57
CYP450 INDUCERS
Rifampin
Griseofulvin
Barbiturates, Carbamazepine, Phenytoin
58
CYP450 INHIBITORS
TMP
Isoniazid
Azole antifungals
Cimetidine, SSRI, Amiodarone
59
Raltegravir
Integrase inhibitor (tx of HIV)
60
Zidovudine
Nucleoside reverse transcriptase inhibitor
(tx of HIV)
Incorporated into viral genome as thymdidine analog w/o 3'OH group (making 3'-5' phosphodiester bond formation impossible)
61
Hydatid cyst
Echinococcus
| Eggshell calcification
62
Translocation
Ribosome advance to next mRNA codon to be translated
| Elongation factor G (energy from GTP)
63
Peptidyltransferase (prokaryote)
23S rRNA in 50S ribosomal subunit
| Facilitate peptide bond formation in protein translation
64
Prokaryote 16S rRNA
Found in 30S ribosomal subunit
Contain sequence complementary to Shine-Dalgarno sequence of mRNA (binding of the two seq necessary for initiation of translation)
65
```
Dilated pupils
Piloerection
Hyperactive bowel sounds
LACRIMATION
YAWNING
```
Opioid withdrawal
| ex: heroin
66
Heroin
Opioid
67
Withdrawal leads to tachycardia and seizures
Alcohol
| Benzodiazepine
68
Intense psychomotor retardation
Severe depression ("crash")
Withdrawal sx from?
Stimulants
| ex: cocaine, amphetamines
69
Hydrocephalus in infants: presentation
Macrocephaly
Irritability, Poor feeding
muscle HYPERtonicity, HYPERreflexia (UMN damage by stretching of periventricular pyramidal tracts0
70
LE HYPOreflexia
Damage to LMN of LE
| Poliomyelitis, Werdnig-Hoffman disease
71
DEPRESSED PATIENT W/ HTN CRISIS after WINE/CHEESE PARTY
MAO INHIBITOR-TYROSINE CRISIS
| Ex: Phenelzine
72
Posterior wall of external auditory canal: sensation
Vagus n. (small auricular branch)
73
Most of external auditory canal: sensation
Trigeminal n. (mandibular division auriculotemporal br)
74
Inner surface of tympanic membrane: sensory innervation
Glossopharyngeal n.
75
Chorda tympani
Facial n.
| carries taste from anterior 2/3, and innervates submandibular and sublingual salivary glands
76
All sensory pathways except __________have relay nuclei in thalamus.
Olfaction (smell)
77
VPL
```
Spinothalmic tract (pain, temperature)
Medial lemniscus (position, proprioception)
```
78
VPM
Trigeminal pathway
| Gustatory pathway
79
Lateral geniculate bodies
Visual relay nuclei
80
Medial geniculate bodies
Auditory relay nuclei
81
Wound --> neuron axons --> salivary glands
```
Rabies virus
(motor neuron -->cerebellum, brainstem, hippocampus --> salivary gland)
```
82
Fibrinous exudate --> systemic circulation --> cortical neuron
Diphtheria toxin
83
Food --> systemic circulation --> meninges
```
Listeria monocytogenes (Gram+ food born pathogen)
(Meningitis in neonates, IMC-)
```
84
Food --> systemic circulation --> peripheral nerves
Botulinum toxin
| Adult food born botulism
85
Wound --> motor neuron --> spinal cord
Tetanospasmin (C. tetani)
| inhibit inhibitory interneurons --> tetany
86
Jaw stiffness
Trismus
Risus sardonicus
Opisthotonos
Tetanus
87
Ventricles above obstruction enlarged
| Ventricle below obstruction normal
NON-communicating hydrocephalus
(ventricle --> subarachnoid space CSF flow disrupted)
ex: aqueductal stenosis, Arnold-Chiari, Dandy-Walker.
88
All ventriculi symmetrically enlarged
```
Communicating hydrocephalus
(dysfunction/obliteration of subarachnoid villi)
```
89
```
Hydroxyzine
Promethazine
Chlorpheniramine
Diphenhydramine
Fexofenadine
```
Anti-histamines
| Fexofenadine is the ONLY second-gen listed
90
1st gen anti-histamine (H1 histamine receptor): A/E
Muscarinic (blurry vision, dry mouth, urinary retention)
Serotonergic (appetite stimulation)
Alpha-adrenergic (postural dizziness)
91
Carbamazepine: used for?
Seizures
| Trigeminal neuralgia
92
Zolpidem
NON-benzodiazepine hypnotic (for insomnia)
93
Rx Tx of narcolepsy
Psychostimulants:
First line = modafinil (non-amphetamine stimulant)
Second line = amphetamine
94
Modafinil
Non-amphetamine stimulant
| First line for narcolepsy
95
Homebox genes
DNA binding TF that play role in MORPHOGENESIS (formation and placement of tissues/organs)
HIGHLY conserved DNA seq (180 nucleotides)
96
Phenobarbital is used for?
Generalized tonic-clonic seizures
97
DOC for trigeminal neuralgia
Carbamazepine
| inhibit neuronal high-frequency firing by reducing ability of Na channel to recover from inactivation
98
Carbamazepine: A/E
Aplastic anemia
| p450 INDUCER
99
MOA of penicillins and cephalosporins
IRREVERSIBLE binding to PBP (ex: transpeptidases)
100
Transmembrane efflux pumps confer resistance to these antibiotics
Tetracyclines
| Macrolides
101
Inherited condition w/ onset in middle-age
Conductive hearing loss
Bony overgrowth of footplate of stapes
Otosclerosis
102
Tinnitus
Vertigo
Sensorineural hearing loss
Meniere's disease
| Weber: lateralization to healthy side
103
Increased volume and pressure of endolymph in vestibular apparatus
Meniere's disease
104
Low potency vs. high potency 1st gen anti-psychotics
Low potency: NON-neurological a/e (sedation, anti-cholinergic, orthostatic hypotension)
High potency: NEUROLOGIC a/e (extrapyrimidal sx due to potent D2 antagonist in nigrostriatal pathway)
105
Chlorpromazine
| Thioridazine
Low potency antipsychotics
106
Haloperidol
| Fluphenazine
High potency antipsychotics
107
Rapid recovery from anesthesia is from?
Redistribution into skeletal and adipose tissue
108
Thiopental
Short-acting barbiturate anesthetic
| Increase inhibitory potential of GABA receptor
109
TOC of listeria
Ampicillin
| NOT sensitive to cephalosporins
110
Ceftriaxone: cover listeria?
NO, ampicllin does.
111
m/c/c of meningitis in adult
Strep pneumo
112
m/c/c of neonatal meningitis, sepsis, pneumonia
GBS (agalactiae)
113
Acute stress disorder: time line
4 weeks)
114
Gram+ rod w/ tumbling motility
| Grows in cold enrichment
Listeria monocytogenes
115
Listeria: population it affects
Neonates, Elderly, IMC-
| contaminated food
116
GFAP +
```
Astrocytoma
Oligodendrogliomas
Glioblastoma multiforme
Ependymoma
Peripheral neural sheath tumor
(Collectively: gliomas)
```
117
Synaptophysin
Presynaptic vesicle of neuron, neuroendocrine, neuroectodermal cells
CNS tumors of neuronal origin stains +
118
```
Cerebellar ataxia
Loss of position and vibratory sense
Kyphoscoliosis
Hypertorphic CM
Foot abnormalities
DM
```
Friedreich ataxia
| AR, trinucleotide repeat
119
Loss of anterior horn of spinal cord occurs in?
Poliomyelitis
ALS
(flaccid paralysis, atrophy, areflexia, muscle fasciculations)
120
Tracts involved in Friedreich ataxia
```
Spinocerebellar tracts (gait ataxia)
Dorsal columns, DRG (loss of position and vibratory sensation)
```
121
Neisseria meningitidis: transmission
Direct contact w/ contaminated respiratory secretion or airborne droplets
122
Neisseria meningitidis: prophylaxis
Rifampin
(followed by ceftriaxone)
Only these eliminate NASAL carriage.
123
Bupropion
Mixed dopamine and NE reuptake inhibitor
| tx: depression, smoking addiction
124
Acute mania: tx
```
Mood stabilizer (lithium, vaproate, carbamazepine)
+
Atypical antipsychotic (olanzapine)
```
125
SSRi in acute mania?
NO, can precipitate manic episode.
| CI!
126
Status epilepticus: tx
First line: Benzodiazepines (Lorazepam = DOC)
Simultaneous admin Phenytoin (prevent recurrence)
If still fail: phenobarbitol
If still fail: intubate, give general anesthesia
127
Phenytoin: MOA
Inhibit neuronal high freq firing by reducing ability of Na channel to recover from inactivation
128
DOC for absence seizures
Ethosuximab
| Blocks T-type calcium channel in thalamic neurons
129
Benzodiazepines
Barbiturates
Alcohol
MOA
Bind to GABA(A) receptor component: ligand gated CHLORIDE channel --> enhance inhibitory action of GABA and increase chloride current.
130
Valproic acid: MOA
Reduce abnormal electric activity in brain by blocking NMDA receptors and affecting K+ current.
Also affect Na+ channel and GABA receptors.
131
HyperSNT of DNA to x-linking agents
Fanconi anemia
132
DNA HyperSNT to ionizing radiation
Ataxia-telangiectasia
133
Generalized chromosomal instability
Bloom syndrome
134
HNPCC occurs due to?
Defect in DNA mismatch-repair enzyme
135
Posterior column involvement seen in?
VitB12 deficiency
| Syphilis
136
Cerebellar ataxia (cerebellar atrophy) in early life
Repeated sinopulmonary infections
Increased incidence of malignancy
Oculocutaneous telangiectasis
Ataxia-telangiectasia
| AR, defect in DNA-repair genes
137
Serotonin release neurons ONLY found in?
Raphe nuclei of brainstem
| brainstem, pons, medulla
138
NE-secreting neurons found in?
Nucleus ceruleus
| Dorsal pons
139
Red nucleus
Anterior midbrain
| Motor coordination of UE
140
Striatum=
Caudate + Putamen
| （陈佩-斯）
141
House cell bodies of CHOLINERGIC neurons
Nucleus basalis of Meynert
142
```
Intracranial HTN (papilledema)
Skin changes (alopecia, dry skin)
HSM
```
VitA overuse
143
Niacin deficiency called?
Pellagra
144
```
Older, mentally slow women
Northern EURO
"Lemon colred"
Smooth, shiny tongue (atrophic glossitis)
Shuffling, broad-based gait
```
VitB12 (cobalamin) deficiency
145
Large dose of VitC
False- stool guaiac test
| Diarrhea, abdominal bloating
146
Major a.a. responsible for transferring nitrogen to liver for disposal
Alanine
| alanine --> amino group to alpha-ketoglutarate -->glutamate --> urea
147
Hyperacusis
Paralysis of stapedius muscle (Facial n.)
148
Only 2 skeletal muscle that participates in transmission of sound from tympanic membrane to inner ear.
```
Stapedius (Facial n.)
Tensor tympani (Trigeminal V3)
```
149
Accumulation of GM2 ganglioside
Tay-Sachs disease
| AR, deficiency of Beta-hexosaminidase A
150
Cherry-red macula
Niemann-Pick (HSM)
| Tay-Sachs (NO HSM)
151
m/c/c of aseptic meningitis
Enterovirus (coxsackievirus, echovirus)
152
Immediate source of nitrogen for urea in urea cycle
Aspartate
153
Hypothalamic nucleus that regulate circadian rhythm
Suprachiasmatic nucleus
154
VM nuclei of hypothalamus
Satiety
| Stimulated by leptin
155
Lateral nuclei of hypothalamus
Hunger
| Inhibited by leptin
156
Anterior nuclei of hypothalamus
Heat dissipation via PNS
157
Posterior nuclei of hypothalamus
Heat conservation via SNS
158
Arcuate nuclei of hypothalamus
Secrete dopamine, GHRH, GnRH
159
Paraventricular nuclei of hypothalamus
Oxytoxin
Thyrotropin-releasing hormone
Corticotropin-releasing hormone
160
Supraoptic nuclei of hypothalamus
ADH
161
Hep B or Hep C: integration into DNA
Hep B
162
Hepatic encephalopathy appears 2/2?
Increased level of AMMONIA in circulation
| NOT BUN, which = renal failure
163
Hepatocellular cytoplasm filled w/ spheres and tubules
| Finely granular, eosinophilic appearance (ground glass)
HepB infection
164
Hemochromatosis: inheritance
AR
165
m/c benign liver tumor
```
Cavernous hemangioma
(do NOT biopsy!)
```
166
Thyroidization of kidney
Chronic pyelonephritis
167
Brown pigment stones
Infection of biliary tract --> release of Beta-glucuronidase --> increased UCB.
(vs. Black pigment stones=hemolysis)
168
Desmolase
Catalyzes formation/destruction of carbon-carbon bonds.
169
7-alpha-hydroxylase
Cholesterol --> bile acids
170
Hepatoblatoma
m/c liver neoplasm of CHILDREN
| a/w FAP and Beckwith-Wiedemann syndrome
171
Vinyl chloride
Arsenic
Thorotrast
Hepatic angiosarcoma
172
G6PD important for?
HMP shunt: generation of NADPH.
| cholesterol and fatty acid synthesis
(Reducing glutathione)
173
Hepatitis vaccine
A, B only
| HepC envelope has too many antigenic variety
174
Transmission of Entamoeba histolytica
Foodborne exposure
175
Hepatic abscess (developed country) usually from?
Staph aureus: hematogenous seeding
| Enteric bacteria: ascending biliary infection/direct invasion from adj. area
176
Hepatic abscess (developing country) usually from?
Parasitic infection:
Amebic
Echinococcal
177
Basal ganglia atrophy: seen w/ this metal?
Copper (Wilson Disease)
178
Hypertrophic cardiomyopathy: inheritance
AD (cardiac sarcomere)
179
Centrilobular congestion in liver a/w
Right HF
180
Histological finding of Reye syndrome
MICROvesicular steatosis of hepatocyte
(NO necrosis or inflammation)
(EM shows decreased # of mito and glycogen depletion)
181
PBC a/w what AI disease?
Sjogren's
Scleroderma
Thyroid dz
Celiac dz
182
Hepatocyte accumulation of epinephrine metabolite in lysosomes
Increased CB
Dubin-Johnson syndrome
| black liver, defect excretion of CB across canalicular mem
183
Isoniazid is metabolized by?
Acetylation
| Hydralazine, Procainamide, Dapsone as well
184
No thymic shadow, Hypocalemic tetany
Cleft palate, mandibular deformity, low set ear
Aortic arch abnormality
DiGeorge
185
3rd branchial arch
9th CN
Stylopharyngeus
Portion of Hyoid
Posterior 1/3 of tongue
186
4th branchial arch
Superior laryngeal br of CN10 (vagus)
| Soft palate and pharynx m. (EXCEPT tensor veli palatini, stylopharyngeus)
187
Tensor veli platini
CN5 (1st branchial arch)
188
Liver: outpouching of?
FOREgut
189
Most important mediator of coronary vascular dilation in LARGE arteries and pre-arteriolar vessels
NO
| synthesized from arginine and oxygen
190
NO: MOA
Vascular smooth muscle relaxation via:
| cGMP second messenger
191
Adenosine
Vasodilatory element in small coronary arterioles
192
Direct arteriolar vasodilator: A/E
Reflex sympathetic activation --> tachycardia, edema
