test #28 4.19 Flashcards
1
Q
examples of delayed-type hypersensitivity reactions
A
(1) contact dermatitis
(2) granulomatous inflammation
(3) tuberculin skin test
(4) candida extract skin reaction
2
Q
delayed-type HSR mediated by..
A
T-lymphocytes (not Ab or complement).
reaction takes 1-2 days, bc antigen taken up by dendritic cells, present to CD4+ cells on MHC II.
Th1 cells secrete IFN-gamma, recruit & stimulate macrophages –> monocytic infiltrate.
[also occurs when ‘walling off’ TV
3
Q
increased WBC post-corticosteroids
A
falsely elevated. due to demargination (release from vascular walls) of cells
4
Q
2 disorders of mast cells
A
urticaria pigmentosum. systemic mastocytosis
5
Q
what two factors drive angiogenesis
A
VEGF and FGF
- vascular ENDOTHELIAL growth factor
- fibroblast growth factor
VEGF: angiogenesis in variety of tissues: normal, chronically inflammed, healing, neoplastic. increases endothelial cell motility and proliferation –> new capillaries.
FGF-2: made by many cells. significantly involved in (1) promotion of endothelial cell proliferation, migration, and differentiation. also: impt in (2) embryogenesis (stimulating angioblast production)
[FGF: angiogenesis, embryonic develoment, hematopoiesis, wound repair]
6
Q
somatomedin C
A
IGF-1
synthesized by growth-hormone influenced hepatocytes. stimulate cell growth and multiplication.
7
Q
barrier to angiogenesis
A
laminin in basement membranes
8
Q
non-viral-dependent nucleotides analogues
A
cidofovir (activated by cellular kinase) & tenofovir
9
Q
rx for thymidine kinase-deficient (acyclovir-resistant) varicella?
A
fosacarnet: (PYROPHOSPHATE analog viral DNA polymerase inhibitor)
cidofovir: broad spectrum NUCLEOTIDE. analogue of cytidine monophosphate (activated by CELLULAR kinase)
10
Q
factitious disorder vs. malingering
A
both CONSCIOUSLY creates symptoms.
factitious: for 1’ gain (sick role/medical attn)
malingering: for 2’ gain (avoid work, compensation)
11
Q
munchausen syndrome
A
chronic factitious disorder
12
Q
conversion disorder
A
unconscious; somatic.
post-stressor.
sudden neurological symptoms (loss of sensory/motor) with NO physical evidence.
13
Q
somatic disorder vs. factitious & malingering
A
somatic disorder syndromes (i.e. conversion, hypochondriaisis, somatization) are UNCONSCIOUS
factitious & malingering: CONSCIOUS
14
Q
somatization disorder (vs. conversion disorder)
A
somatoform disorder, several symptoms
usu begins <30 y/o. impact social/occupation.
4 pain
2 GI
1 sexual
1 neuro
with no physical exam / imaging evidence
(differs from conversion, which has specific NEURO and POST-STRESSOR)
15
Q
hypochondriasis
A
somatoform disorder
preoccupation/fear of having serious illness despite medical evaluation & assurance.
often, mistinterpretation of normal bodily symptoms (gas = colon cancer). associated w/ Dr. shopping
16
Q
body dysmorphic disorder
A
think body is pathologically flawed, when in fact, it is not.
17
Q
chromosome 3p deletion
A
VHL
18
Q
von-Hippel Lindau
A
autosomal DOMINANT.
cerebellar hemangioblastomas, clear cell renal carcinoma, and pheochromocytoma.
RCC develops in 40% of patients.
tumor supressor
19
Q
cerebellar hemangioblastoma, clear cell renal carcinoma, pheochromocytoma
A
VHL (tumor supressor chr. 3)
20
Q
location of RB
A
chr. 13
osteosarcoma and retinoblastoma
21
Q
location of NF-1
A
chr. 17
22
Q
WT-1 location
A
chr. 11
23
Q
location of chemoreceptor trigger zone (area postrema)
A
dorsal surface of medulla, caudal end of fourth ventricle.
24
Q
adhesion molecules
A
integrin, cadherin, selectin, Ig superfamily members
25
laminins bind to
collagen, fibronectin, laminin in ECM
26
fibronectin
large glycoproteins produced by fibroblasts & some epithelial cells. binds to integrin, matrix collagen, glycosaminoglycans. mediations cell adhesion
27
heparan sulfate
proteoglycan component of ECM.
associated w/ reticular fibers and basal laminae. helps w/ endothelial cell attachment to BM.
does not bind to cell surface integrins.
28
hyaluronic acid
glucuronic-acid containing glycosaminoglycan in ECM.
contributes to water retention in ECM -> lubricant properties. viscous, gel-like consistency.
29
elastic fibers
core of elastin protein surrounded by fibrillin
30
keratan sulfate
galactose-containing glycosaminoglycan. role in maintaining type I collagen fibril organization in cornea.
31
aromatase deficiency
present early:
- mom virilization (androgens)
female:
- ambiguous/male genitalia
- primary amenorrhea & tall (no estrogen to fuse epiphyseal plate
male
- tall w/ osteoperosis
32
aromatase rxns (2)
androstenedione -> estrone
| testosterone -> estrogen
33
aromatase deficiency vs. 21-b hydroxylase deficiency in girls
aromatase deficiency
- has mom virilization
- no hypotension w/ salt wasting & hyperkalemia
34
auscultation site determined by..
position closest to where sound waves reverberate. NOT at position of valve
35
glomerular splitting of basement membrane (2)
MPGN II and Alport syndrome
36
Alport syndrome
triad:
1. glomerulonephritis
2. sensorineural deafness
3. eye problems
mutation in alpha-side chain of collagen type IV.
thinning and splitting of basement membrane
X-linked dominant.
37
nasal mucosal ulcerations "saddle nose" w/ glomerulonephritis
granulomatosis w/ polyangiitis (wegner's)
38
HSP 4 signs
```
IgA / C3 deposits everywhere
1. palpable purpura
2. abdominal pain
3. arthralgia
usu self-limiting, but can get..
4. glomerulonephritis & end-stage renal failure
```
usu post-infectious
39
drugs w/ negative chronotropic effects
(1) b-blockers
(2) non-DHP calcium blockers
(3) digoxin (independent vagal effects)
(4) amiodarone
(5) sotalol (class III w/ b-blocking effects)
(6) cholinergic agonists
40
what cell type exerts master control over iron metabolism?
HEPCIDIN, made by liver parenchymal cells
41
fate of Fe2+ in GI system
absorbed via DMT-1 channel in duodenum, bind to intracellular FERRITIN..
(1) stay in enterocyte, and pass in stool when sloughed off
(2) exist basolaterally via FERROPORTIN -> bind to transferrin in blood -> taken up by cells via transferrin receptor
PATH determined by hepcidin!
42
hepcidin
acute phase reactant. binds to ferroportin in enterocytes & macrophages & degrades it.
BLOCKS release of Fe2+. prevents iron overload.
43
anemia of chronic disease
increased levels of hepcidin (from liver) down regulate ferroportin. trap Fe2+ in macrophages and enterocytes.
44
filtered load =
GFR x Px
45
excretion rate =
V x Ux
46
RPF estimated w/
PAH clearance -- fully cleared
47
GFR estimated w/
creatinine clearance (similar to inulin)
48
normal filtration fraction
20% (GFR/RPF)
49
when does glucose begin to appear in urine? when are glucose transporters maximally saturated?
- begin at 200mg/dL
| - saturated at 375mg/dl
50
normal GFR
100ml/min
| 180L/day
51
when GFR is normal (100ml/min), large decreases in GFR, causes ___ in serum creatinine
small increases in serum creatinine
52
when GFR is very low (<60ml/min), small changes in GFR causes ___ in serum creatinine
LARGE increases in serum creatinine
53
serum creatinine can be normal after loss of how much GFR
even after 50% loss!
54
general rule of thumb with changes in GFR & serum creatinine
everytime GFR halves, serum creatinine doubles.
55
increase in cardiac output during exercise
5 L/min to 20 L/min
56
early in exercise, how is CO maintained?
increase BOTH HR and SV
57
late in exercise, how is CO maintained
increase only HR
| stroke volume maxes out
58
pulse pressure is directly related to? inversely related to
PP = systolic - diastolic
directly related to CO
inversely related to arterial compliance
59
three sympathetic hemodynamic effects in exercise.
why does MAP only increase 2-40mmHg?
(1) increased CO
(2) venoconstriction to increase preload
(3) vasoconstriction to muscles not participating in exercise
only modest increase in MAP bc of MAJOR decrease in SVR due to...
local vasodilation in skeletal muscle (via adenosine, adenosine, K+, ATP, CO2, lactate)
in exercise, skeletal muscle can get 85% of CO
60
infection of liver capsule w/ violin string adhesions of peritoneum to liver.
Fitz-Hugh-Curtis syndrome, resulting from PID
61
manifestation of pelvic inflammatory disease
endometritis, salpingitis, tubo-ovarian abscesses, pelvic peritonitis
can result in infertility
62
how does pregnancy increase risk of gallstones?
ESTROGEN: increase HMG-CoA reductase activity, bile = SUPERSATURATED w/ cholesterol
PROGESTERONE: reduce bile acid secretion, slow gall bladder emptying = HYPOMOTILE
together: ppt cholesterol crystals
63
staphylococcus bacteremia associated with..
intravascular devices
| i.e. indwelling central venous catheters
64
in dehydration, fluid is primary reabsorbed by..
always PCT (~65% reabsorption), even in dehydration
| collecting ducts can take ~20% free water
65
Fenoldopam
SELECTIVE D1 agonist.
vasodilate most ARTERIAL beds (esp coronary, renal, splanchnic, peripheral)
overall decreased SVR.
increased flow to kidney allows for Na+ and H20 excretion
ONLY drug to reduce BP while increasing blood flow to KIDNEY
66
rx for HTN emergency w/ concomittant renal insufficiency
fenoldopam
67
diazoxide
anti-HTN
K+ activator, relax smooth muscle --> ARTERIAL vasodilation
68
mechanism of hydralazine. must be given w/?
increase cGMP -> smooth muscle relaxation
arterioles > vein. afterload reduction
must give w/ beta-blocker, as it causes reflex increased contractility, HR, & fluid retention
69
first-line rx for HTN in pregnancy?
hydralazine (increase cGMP) with methyl-dopa (a2 agonist)
70
methyl-dopa
HTN in pregnancy. alpha-2 agonist
71
use of hydralazine & diazoxide
though arteriole vasodilator, often cause significant increase in HR and contractility & Na+ and fluid retention
72
nimodipine
DHP calcium channel blocker, used for post-subarachnoid hemorrhage (to prevent vasospasm)
73
nicardipine
DHP calcium channel blocker. vasodilates arterioles & myocardium.
can cause tachycardia
74
ways to get EHEC 0157:H7
- eating undercooked contaminted ground beef.
- person-to-person
- raw unpasterized milk
- swimming in / drinking sewage contaminated water
75
1st line disease modifying for rheumatoid arthritis?
methotrexate.
76
Leflunomide and TNF-alpha inhibitors for rheumatoid arthritis
also disease modifying agents, can use in combo w/ methotrextate
leuflunomide -- decreases pyrimidine synthesis
77
methotrexate side effects
stomatitis (painful mouth ulcers) and hepatotoxicity (hepatitis, cirrhosis)
78
hydroxychloroquine
unclear mechanism. accumulates in cell, and increases pH, reducing fxn.
antimalarial and used in SLE
79
impt side effect of hydroxychloroquine
RETINAL DAMAGE
80
formula for volume of distribution
amount of drug given (mg) / plasma concentration of drug (mg/L)
81
what causes a drug to stay in blood (low volume of distribution) (3)
large molecular weight
bound extensively to plasma proteins
highly charged
(~3-5L)
82
if drug has small molecular weight, but hydrophillic
will also distribute to interstitial space (~15L)
83
if drug has small molecular weight, and uncharged
can also cross cell membranes -- ~41 volume of distribution
84
Vd for drugs that are avidly bound in tissues?
higher than total body water (>40L)
85
G. lambia in stool
O&P (smear w/ iodine stain)
ellipsoidal cysts w/ smooth defined walls and 2+ nuclei
86
loperamide
opiate antimotility drug, can be used in traveller's diarrhea w/ no fever / blood in stool
87
rx for inflammatory traveler's diarrhea (stool w/ mucus & blood)
ciprofloxacin
88
rx for ancylostoma, ascaris, enterobius?
mebendazole
89
rx for tapeworms (cestode) echinococcus granulosa
albenzadole
90
mechanism of enfuvirtide
binds to gp41, blocks conformational change needed for fusion
91
side effects of nnrtis (nevirapine, efavirenz, delavirdine)
hepatic failure (first 6 wks). also steven-johnsons
92
propionyl-CoA made from catabolism of...
VOMIT
| valine, odd-chain fatty acids, methionine, threonine, isoleucine, threonine
93
propionyl-CoA carboxylase deficiency
build up proprionyl-CoA
poor feeding, vomiting, hypotonia, lethargy, dehydration
exacerbated by VOMIT:
valine, odd chain fatty acids, methionine, isoleucine, threonine & cholesterol
94
L-asparaginase therapy
antineoplastic, gets rid of asparagine in serum (so rapidly dividing leukemic cells can't use it, as their synthesis of asparagine is impaired)
95
histidine metabolism
deaminated to urocanic acid, converted to N-forminino-glutamate (FIGlu). forimino group donated to THF to form glutamate and forminino-THF.
oxidative decarboxylation of histidine forms histamine --> released by mast cells in type I HSR
96
proline is a nonessential amino acid oxidized into..
glutamate
97
prognosis of minimal change disease
rapid response to corticosteroids
98
rx for all symptoms organophosphate poisioning?
pralidoxime (restore AchE)
atropine only stops muscarcinic effects, not nicotinic.
99
bronchi differences in chronic bronchitis due to smoking vs. asthma?
both have: thickening of bronchial epithelium, basement membrane, and bronchial walls, as well as edema, inflammatory infiltrates, submucosal mucous gland enlargement, and bronchial smooth muscle hypertrophy
smoking: patchy squamous metaplasia & neutrophil infiltrate
asthma: eosinophil / mast cell infiltrate
100
rupture of chordae tendineae can occur with..
endocarditis or MI
101
diseases that cause myocardial fibrosis
dermatomyositis, muscular dystrophy, carcoidosis, scleroderma
102
vegetations associated w/ bacterial endocarditis represent..
FIBRIN & PLATELET deposition at site of bacterial colonization.
often at site of endothelial damage
103
myxomatous degeneration of valve
often mitral valve in MVP.
in the setting of CT diseases, like Marfan's.
can predispose to endocarditis.
104
coarctation of aorta in infants pre-ductal pr post-ductal? cyanotic?
preductal. though there is right-to-left shunting, not enough to cause cyanosis.
105
5T's of congenital cyanotic diseases
(1) tetrology of fallot
(2) tricuspid atresia
(3) total anomalous pulmonary return
(4) truncus arteriosus
(5) transposition of the great vessels
106
what is tricuspid atresia?
congenital cyanotic heart disease.
one ventricle feeds both aorta & pulonary artery
107
pulmonary alveolar proteinosis (PAP) (presentation & histology)
presents: gradually worsening of dyspnea and productive cough
histology: bilateral patchy pulmonary opacification due to intraalveolar accumulation of protein & phospholipid (constituents of surfactant)
108
characterestic presentation of idiopathic pulmonary fibrosis
insidious-onset progressive exertional dyspnea, pulmonary function tests w/ restrictive profile
surgical biopsy: extensive interstitial fibrosis, paraseptal and subpleural cystic airspace enlargement (honeycomb lung)
109
restrictive pulmonary function test
FVC low
| FEV1/FVC normal (>80%)
110
routes of hepatic abscess in US? in developing nations
1. portal vein
2. arterial supply
3. ascending biliary tract infection
4. direct invasion from adjacent source
5. penetrating injury
developing nations: parasitic infxn
111
most likely cause of hepatic abscess in US
hematogenous spread of staph aureus
112
valve abnormality in turner's
bicuspid
113
nonstenotic bicuspid aortic valve murmur
aortic ejection sound. early systolic, high frequency click over cardiac apex and/or right second interspace
114
most common cardiac abnormality in Turner's?
bicuspid aortic valve. can also have coarctation
115
calcitonin
decreases serum Ca2+ levels.
decreases bone resorption of Ca2+ by osteoclast inhibition, but not a dominant hormone
levels increase when given exogenous Ca2+
116
PTH regulates Ca2+ by.. (3)
(1) release from bone
(2) increased vitamin D to reabsorb more in gut
(3) increased renal absorption
117
vitamin D under control of..
high PTH mainly.
also low Ca2+ and low PO4-
118
when are calcitonin levels LOW?
when serum Ca2+ is low
119
xeroderma pigmentosum has mutation in what type of enzyme
UV-specific ENDOnuclease
| not EXOnuclease
120
NADPH is required for..
fatty acid, cholesterol, and steroid synthesis
121
parinaud syndrome
paralysis of conjugate vertical gaze due to lesion in superior colliculi (i.e. pinealoma)
(pineal gland is anterior-superior to superior colliculi)
122
erythematous, papulovesicular, weeping, encrusted lesions that may evolve into thickened scaly plaques
eczematous dermatitis.
prone to bacterial superinfection -- yellow crust
5 types:
1. allergic contact dermatitis
2. atopic dermatitis
3. drug-related eczematous dermatitis
4. photo-eczematous dermatitis
5. primary irritant dermatitis
123
spongiosus
seen in exzematous dermatitis (i.e. contact dermatitis)
epidermal accumulation of edematous fluid in intercellular spaces.
intercellular bridges become distinctive. epidermis = spongy.
edema can become so marked --> intraepidermal vesicles by tearing desmosomes apart
124
acanthosis
increase in thickness of stratum SPINOSUM.
associated w/ psoriasis
125
dyskeratosis
abnormal, premature keratinization of individual keratinocytes. strongly eosinophilic and may have small basophilic nuclear remnant.
found in squamous cell carcinoma
126
hyperparakeratosis
retention of nuclei in stratum corneum (suggests incomplete keratinization)
normal on mucus membrane, but abnormal (actinic keratosis) in other areas
127
hypergranulosis
excessive granulation in stratum granulosum of epidermis. seen in lichen planus
128
lesser omentum
composed of hepatogastric and hepatodudenal ligament (along lesser curvature --> liver)
129
greater omentum
along grater curvature
130
adjustable gastric banding must pass through
lesser omentum, to enclose cardia
131
falciform ligament of liver
attaches liver to anterior body wall (contains ligamentum teres)
132
what ligament must be divided to have access to posterior stomach and anterior pancreas
gastrocolic ligament (connects greater curvature of stomach to transverse colon)
part of the greater omentum
133
what is contained in splenorenal ligament (2)
(2) splenic artery & vein
| (3) tail of pancreas
