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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
Q

what is the only CN that cannot develop a schwanoma

A

CN II optic nerve!

covered by oligodendrocytes

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26
Q

what are CN myelinated by? exception

A

normally schwann cells (PNS)

except CN II optic: oligodendrocytes

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27
Q

histology of psoriasis

A 
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

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28
Q

signs of portal HTN w/ normal liver biopsy suggests

A

presinusoidal process (aka not budd chiari)

must be portal vein thrombosis

unlikely to see ascites bc obstruction is presinusoidal

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29
Q

differentiating portal HTN due to budd chiari vs portal vein thrombosis

A

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

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30
Q

acetaminophen overdoses causes what type of liver histology

A

centrilobular hepatic necrosis and failure in 24-48 hrs after ingestion

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31
Q

kussmaul sign

A

paradoxical increase in JVP with insipiration

suggests constrictive pericarditis

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32
Q

causes of constrictive pericarditis

A

usu chronic

  • idiopathic/viral
  • cardiac surgery/radiation therapy
  • tuberculosis (in endemic areas)
33
Q

hemodynamic signs of constrictive pericarditis

A
  • increased JVP
  • kussmaul sign
  • pulsus paraoxous
  • pericardial knock
34
Q

pericardial knock vs. S3

A

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
Q

most common liver neoplasm

A

metastasis

36
Q

if see multiple hypodense masses in liver

A

think mets

37
Q

causes of hepatic adenoma

A

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
Q

hepatic angiosarcoma associated w.

A

exposure to vinyl chloride, thorotrast, or arsenic

aggressive and associated w/ poor prognosis. most die within 1 year.

39
Q

hepatoblastoma

A

most common liver neoplasm in kids.

associated with FAP and beckwith-Wiedemann syndrome

fatal within a few years if not surgically resected.

40
Q

cholangiocarcinoma

A

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
Q

superior sulcus

A

lung groove formed by subclavian vessels

location of pancoast tumors

42
Q

another location name for pancoast tumors

A

superior sulcus tumors

43
Q

local invasion of pancoast tumor can cause..

A
  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
Q

mediastinal mass can cause..

superior sulcus mass can cause..

A

mediastinal: SVC syndrome: headache, face plethora

superior sulcus: compression of subclavians: arm edema

45
Q

2 centrally located lung cancers

A

squamous cell

small cell

46
Q

warty brown plaques that look like can be peeled off

A

seborrheic keratosis

47
Q

discoid lupud erythematous

A

thick scaly discoid plaques that erupt on unexposed skin, may result in scarring.

no systemic disease is present in 90%

48
Q

when are macroscopic changes first seen post ischemic infarct to brain

A

12 hours

49
Q

red neurons

A

sign of irreversible damage

during first 48 hours

50
Q

demyelination of peripheral nerves

A

Guillan-Barre

acute demylelinating disease after infxn, immunization, allergic rxn

51
Q

pathogenesis of guillan-barre

A

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
Q

ascending muscle weakness after a respiratory or GI illness.

no DTR

A

esp camplyobacter jejuni

guillan barre

can ascend to cranial n.

worry: paralysis of respiratory muscles -> fatal

53
Q

werdnig-hoffman

A

anterior horn cell damage

lower motor neuron signs “floppy child”

54
Q

b12 deficiency neuro presentation

A

subacute combined degeneration

degeneration of DORSAL COLUMN and LATERAL corticospinal (can also be spinocerebellar) tracts

55
Q

neuro beri beri

A

can cause demylelination too, but NO perineural inflammation.

usu: weakness, areflexia, pain & parathesia. usu distal lower limb

56
Q

most common cause of spontaneous nipple discharge

A

intraductal papilloma

bloody or serosanguinious

57
Q

breast cancer associated w/ peau de orange?

A

inflammatory breast cancer

lymphatic obstruction and tissue swelling –> collections of neoplastic cells plugging dermal lymphatic channels

58
Q

presentation of inflammatory breast cancer

A

-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
Q

3 phases of wound healing

A
  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
Q

keloid vs. hypertrophic scar

A

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
Q

what vessels are affected by atherosclerosis

A

large elastic: aorta, carotid iliac

large/medium muscular:coronary, popliteal

rank:

  • ABDOMINAL AORTA, near renal ostia
  • coronary
  • popliteal
  • internal carotid
  • circle of willis
62
Q

hypoxemia defined as

A

drop in PaO2 below 80mmHg

63
Q

normal A-a gradient

A

< 20mmHg

(10-15) normal

64
Q

causes of hypoxemia with normal A-a gradient (2)

A
  1. hypoventillation
  2. low pO2 (high altitude)

hypoventilation: suppressed respiratory drive, i.e. sedative overdose, sleep apnea, or decreased inspiratory capacity: myasthenia, obesity

65
Q

how does decreased alveolar ventillation affect PaO2

A

will have LOWER alveolar gas
normal A-a gradient
hypoxemia

66
Q

how does a right-to-left shunt affected PaO2

A

will have increased A-a gradient (>15-20)

alveolar gas = normal
but hypoxemia

67
Q

how does V/Q mismatch affect PaO2?

A

poor ventilation of perfused alveoli -> physiologic right-left shunt.

increased A-a gradient

pneumonia, obstructive pulmonary disease, PE

68
Q

what part of gI tract is affected in Crohn’s

A

anything from mouth to anus!

classically: ileocecal region

69
Q

sarcoidosis produces elevated

A

vitamin D –> HYPERCALCEMIA

&

ACE

70
Q

what types of patients frequently develop hypercalcemia / hypercalciuria

A

granulomatous disorders!

sarcodosis, TB, hodgkin’s disease, non-hodgkins

granuloma giant cells have 1-alpha-hydroxase, activating vitamin D

71
Q

carcinoid syndrome is associated w/ decreased

A

niacin!

tryptophan all consumed to make sertotonin, less for niacin production

72
Q

TB tissue damaged caused by

A

T-cell delayed HSR
Th1 stimulation of both CD8+ T cells and macrophages

bacteria itself does not cause tissue damage

73
Q

histology of s. pneumoniae pneumonia

A
  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
Q

intracellular fungus in macrophage

A

histoplasma

75
Q

features of disseminated histoplasmosis (3)

A
  1. hepatosplenomegaly
    - loves mononuclear phagocyte system
  2. ulcerated lesions of tongue
  3. usu pulmonary disease
76
Q

chest x-ray of disseminated histoplasma

A

hilar adenopathy

can resemble pulmonary TB (cavitary lesions in upper lobe, calcified nodes)

77
Q

histology of coccidiodes immitis

A

thick walled spherules containing endospores

don’t confuse w/ histo: macrophage filled w/ yeast

78
Q

vitamin E deficiency presentation

A

neuromuscular disease
DORSAL COLUMN, SPINOCEREBELLAR

-skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy

hemolytic anemia

UWorld mixed (60 decks)

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