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UWorld mixed > test #49 5.6 > Flashcards

test #49 5.6 Flashcards

1
Q

phagocyte dysfxn immunodeficiency present with..

A

recurrent abscesses

can’t kill what they phagocytose

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2
Q

candida skin test

A

tests for cell-mediated immunity, since we have all been exposed to candida, we should mount a response to it

via macrophages, CD4+, CD8+, NK cells

absence of response suggests SCID

type 4 HSR

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3
Q

most common causes of spontaneous intracerebral hemorrhage (3)

A
  1. arteriovenous malformations
  2. ruptured cerebral aneursyms
  3. abuse of sympthatomimetic drugs (cocaine)
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4
Q

cause of death in adult-type coarctation of aorta

A

HTN-related complications

left ventricle failure, ruptured dissecting aortic aneursym, intracranial hemorrhage (bc increased blood flow tere)

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5
Q

typical site of pathology w/ crohn’s disease

A

terminal ileum

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6
Q

why may crohn’s have increased gallstones?

A

bc loss of bile acid reabsorption in terminal ileum

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7
Q

sharp pull on outstretched hand while forearm is pronated and elbow is extended

A

radial head subluxation (nursemaid elbow)

most common elbow injury in children

tear annular ligament that holds radius to ulna at elbow

will hold in that position

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8
Q

which antipsychotics help treat negative symptoms of schizophrenia

A

atypicals!

emotional range, poverty of speech, loss of interest, loss of drive

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9
Q

rx for prevention of GBS meningitis in neonate

A

intrapartum ampicillin

rx earlier still leaves mom susceptible at time of birth

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10
Q

V2 vasopressin increases CD permeability to (2)

A
  1. water (aquaporins)

2. urea

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11
Q

two ways of regulating lac operon expression

A

negatively: bind repressor protein to operon locus
positive: cAMP-CAP binding upstream promoter

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12
Q

receptors w/ Gq activation

A 
a1, m1, m3
oxytocin
V1 ADH (vascular)
angiotensin II
GHRH
TRH
GnRH

think: 
'vasoconstrictors'
adh V2, ang II, histamine
&
hypothalamic reproductive
GnRH, oxytocin
& TRH
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13
Q

calcipotriene, calcitriol, tacalcitol

A

topical vitamin D analog
used to treat psoriasis

activate vitamin D receptor nuclear transcription factor, inhibits keratinocyte proliferation & stimulates differentiation

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14
Q

utekinumab

A

human monoclonal antibody used in psoriasis, targets IL-12 and IL-23.

inhibits differentation and activation of CD4+ Th1 and Th17 cells

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15
Q

aortic regurg murmur

A

VERY EARLY diastole.

listen carefully, might sound like systole

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16
Q

hypertrophic cardiomyopathy murmur

A

definitely LVOT
can ALSO have mitral regurg bc of impaired valve closure

both systolic murmurs

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17
Q

alcoholic w/ megaloblastic anemia

A

likely folate deficiency

  1. poor intake
  2. poor absorption, utilization, enterohepatic recycling

(not B12)

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18
Q

rx for acute coronary syndrome, angina

A

aspirin
clopidogrel (irreversible ADP block)
ticlopidine

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19
Q

considerations before giving metformin

A

kidney fxn!

worry about lactic acidosis

contraindicate in any condition that might raise lactic acid levels: liver dysfunction, heart failure, alcoholism, sepsis

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20
Q

where does inferior mesenteric vein drain?

A

into SPLENIC vein, which joins SMA –> portal vein

note: different from arterial supply

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21
Q

what component of meningococcus correlates w/ patient morbidity & mortality

A

LPS equivalent: outer membrane lipooligosaccharide

in serum

leads to sepsis, petechiae, waterhouse-friederichson

[note: not the capsule]

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22
Q

how do nitrates cause vasodilation

A

NO, stimulate guanylate cyclase, convert GTP -> cGMP

  • decreases intracellcular Ca2+
  • decreases myosin lightchain kinase

–> myosin light chain dephosphorylation & smooth muscle relaxation

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23
Q

histology of schwanomma

A

spindle cells

biphasic:
antoni A pattern: highly cellular
antoni B pattern: myxoid areas of low cellularity

antoni A areas may form “palisading” patterns like a picket fence

S-100 positive

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24
Q

impt S100 tumors

A

melanoma
schwanoma

both neural crest derivatives

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25
what is the only CN that cannot develop a schwanoma
CN II optic nerve! | covered by oligodendrocytes
26
what are CN myelinated by? exception
normally schwann cells (PNS) except CN II optic: oligodendrocytes
27
histology of psoriasis
``` hyperparakeratosis acanthosis (increased spinosum) elongation of rete ridges mitotic activity above epidermal basal cell layer reduced/absent stratum granulosum ``` epidermal layer above dermal papillae = thinned & contained dilated vessels --> pinpoint bleeding-- AUSPITZ sign neutrophils may form clusters in superficial dermis & parakeratotic stratum corneum --> MUNRO MICROABSCESSES
28
signs of portal HTN w/ normal liver biopsy suggests
presinusoidal process (aka not budd chiari) must be portal vein thrombosis unlikely to see ascites bc obstruction is presinusoidal
29
differentiating portal HTN due to budd chiari vs portal vein thrombosis
liver biopsy. if it was budd-chiari (occlusion of hepatic vein, which drains hepatic & portal circulation into systemic circulation), would see centrilogular congestion & fibrosis in liver. see nothing w/ portal vein thrombosis
30
acetaminophen overdoses causes what type of liver histology
centrilobular hepatic necrosis and failure in 24-48 hrs after ingestion
31
kussmaul sign
paradoxical increase in JVP with insipiration suggests constrictive pericarditis
32
causes of constrictive pericarditis
usu chronic - idiopathic/viral - cardiac surgery/radiation therapy - tuberculosis (in endemic areas)
33
hemodynamic signs of constrictive pericarditis
- increased JVP - kussmaul sign - pulsus paraoxous - pericardial knock
34
pericardial knock vs. S3
S3: sudden deceleration of incoming blood as it reaches an elastic limit (reduced INSTRINSIC) ventricular compliance pericardial knock: reduced ventricular compliance via an EXTERNAL force. sharper, more accentuate sound heard earlier in diastole
35
most common liver neoplasm
metastasis
36
if see multiple hypodense masses in liver
think mets
37
causes of hepatic adenoma
uncommon, benign epithelial tumors associated w/ oral contraceptives, or anabolic steroid use presentation: upper abdominal pain, or incidental can rupture and cause intraabdominal hemorrhage
38
hepatic angiosarcoma associated w.
exposure to vinyl chloride, thorotrast, or arsenic aggressive and associated w/ poor prognosis. most die within 1 year.
39
hepatoblastoma
most common liver neoplasm in kids. associated with FAP and beckwith-Wiedemann syndrome fatal within a few years if not surgically resected.
40
cholangiocarcinoma
rare, from intra / extrahepatic bile ducts. intrahepatic: grossly like tree-like mass along biliary system. typically resulting in extensive intrahepatic metastasis. risk: primary sclerosing cholangiitis, fibropolycystic liver disease, infxn w/ liver flukes in endemic areas. poor prognosis
41
superior sulcus
lung groove formed by subclavian vessels location of pancoast tumors
42
another location name for pancoast tumors
superior sulcus tumors
43
local invasion of pancoast tumor can cause..
1. pain in shoulder that radiates to axilla / scapula: most common, brachial plexus. also paraesthesia, etc 2. horner's 3. upper extremity edema: compression of subclavian 4. spinal cord compression/paraplegia if extend into intervertebral foramina
44
mediastinal mass can cause.. superior sulcus mass can cause..
mediastinal: SVC syndrome: headache, face plethora superior sulcus: compression of subclavians: arm edema
45
2 centrally located lung cancers
squamous cell | small cell
46
warty brown plaques that look like can be peeled off
seborrheic keratosis
47
discoid lupud erythematous
thick scaly discoid plaques that erupt on unexposed skin, may result in scarring. no systemic disease is present in 90%
48
when are macroscopic changes first seen post ischemic infarct to brain
12 hours
49
red neurons
sign of irreversible damage during first 48 hours
50
demyelination of peripheral nerves
Guillan-Barre acute demylelinating disease after infxn, immunization, allergic rxn
51
pathogenesis of guillan-barre
some infectious agents contain ganglioside-like substance in LPS. antibodies form, cross-react w/ ganglioside in myelin. segmental demyelination & endoneural inflammation on light microscope.
52
ascending muscle weakness after a respiratory or GI illness. no DTR
esp camplyobacter jejuni guillan barre can ascend to cranial n. worry: paralysis of respiratory muscles -> fatal
53
werdnig-hoffman
anterior horn cell damage lower motor neuron signs "floppy child"
54
b12 deficiency neuro presentation
subacute combined degeneration degeneration of DORSAL COLUMN and LATERAL corticospinal (can also be spinocerebellar) tracts
55
neuro beri beri
can cause demylelination too, but NO perineural inflammation. usu: weakness, areflexia, pain & parathesia. usu distal lower limb
56
most common cause of spontaneous nipple discharge
intraductal papilloma bloody or serosanguinious
57
breast cancer associated w/ peau de orange?
inflammatory breast cancer lymphatic obstruction and tissue swelling --> collections of neoplastic cells plugging dermal lymphatic channels
58
presentation of inflammatory breast cancer
-breast tenderness -skin discoloration (pale pink to deep red brown to purple) -rapidly progressive underlying mass peau d;orange: putting edema in subcutaneous break tissue w/ skin thickening around exaggerated follicles. plugging of lymphatic channels
59
3 phases of wound healing
1. inflammatory: - within 1 day: neutrophils - 2-3day: macrophages 2. proliferative: - 3-5days: fibroblasts and endothelial vascular cells -> vascular granulation tissue 3. maturation phase: - after 1 wk: active fibroblasts make collagen, elastin, etc. replace type III w/ type I collagen. 6-8 wks: scar complete, 30-40% of tensile strength. mature for several months, increasing tensile 70-80% in 3 months
60
keloid vs. hypertrophic scar
excessive collagen formation during tissue repair. keloid: - extend beyond borders, - don't regress, - recur after resection - collagen fibers DISORGANIZED hypertrophic: - limited to area of wound, - can regress. - collagen fibers PARALELL
61
what vessels are affected by atherosclerosis
large elastic: aorta, carotid iliac large/medium muscular:coronary, popliteal rank: - ABDOMINAL AORTA, near renal ostia - coronary - popliteal - internal carotid - circle of willis
62
hypoxemia defined as
drop in PaO2 below 80mmHg
63
normal A-a gradient
< 20mmHg | (10-15) normal
64
causes of hypoxemia with normal A-a gradient (2)
1. hypoventillation 2. low pO2 (high altitude) hypoventilation: suppressed respiratory drive, i.e. sedative overdose, sleep apnea, or decreased inspiratory capacity: myasthenia, obesity
65
how does decreased alveolar ventillation affect PaO2
will have LOWER alveolar gas normal A-a gradient hypoxemia
66
how does a right-to-left shunt affected PaO2
will have increased A-a gradient (>15-20) alveolar gas = normal but hypoxemia
67
how does V/Q mismatch affect PaO2?
poor ventilation of perfused alveoli -> physiologic right-left shunt. increased A-a gradient pneumonia, obstructive pulmonary disease, PE
68
what part of gI tract is affected in Crohn's
anything from mouth to anus! classically: ileocecal region
69
sarcoidosis produces elevated
vitamin D --> HYPERCALCEMIA & ACE
70
what types of patients frequently develop hypercalcemia / hypercalciuria
granulomatous disorders! sarcodosis, TB, hodgkin's disease, non-hodgkins granuloma giant cells have 1-alpha-hydroxase, activating vitamin D
71
carcinoid syndrome is associated w/ decreased
niacin! tryptophan all consumed to make sertotonin, less for niacin production
72
TB tissue damaged caused by
T-cell delayed HSR Th1 stimulation of both CD8+ T cells and macrophages bacteria itself does not cause tissue damage
73
histology of s. pneumoniae pneumonia
1. congestion: fluid extravasation into alveolar space 2. red hepatization: extravasated PMN and RBC in alveolar space 3. grey hepatization: deposition of fibrinous material in alveolar space 4. elimination, histologic resolution
74
intracellular fungus in macrophage
histoplasma
75
features of disseminated histoplasmosis (3)
1. hepatosplenomegaly - loves mononuclear phagocyte system 2. ulcerated lesions of tongue 3. usu pulmonary disease
76
chest x-ray of disseminated histoplasma
hilar adenopathy can resemble pulmonary TB (cavitary lesions in upper lobe, calcified nodes)
77
histology of coccidiodes immitis
thick walled spherules containing endospores | don't confuse w/ histo: macrophage filled w/ yeast
78
vitamin E deficiency presentation
neuromuscular disease DORSAL COLUMN, SPINOCEREBELLAR -skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy hemolytic anemia

UWorld mixed (60 decks)

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