u world 8/6

Question 0

What can occur as the result of gallbladder hypermobility? What are the risk factors for hypermobility (5)?

Answer 0

• billiary sludge
• risk factors:
  1. Pregnancy
  2. Rapid weight loss
  3. Prolonged use of total parenteral nutrition
  4. Prolonged use of octreotide (somatostatin)
  5. High spinal cord injuries

Question 1

What is usually necessary for the development of acute pyelonephritis?

Answer 1

-anatomic or functional vesicourethral reflux!

Question 2

When are brown pigment stones seen in the gallbladder?

Answer 2

-with biliary tract infection

Question 3

Common presentation for SCID?

Answer 3

• recurrent infections caused by bacteria, viruses, fungi, and opportunistic infections in the first year of life
• failure to thrive
• chronic diarrhea

Question 4

What 4 cell types are involved in the cell-mediated responses, such as to candida skin test?

Answer 4

1. Macrophages
2. CD4+ T cells
3. CD8 + T cells
4. T-lymphocytes
5. NK cells

Question 5

What is commonly used to treat secretory diarrhea?

Answer 5

-octreotide

Question 6

Diphenoxylate: MOA? Clinical use? Low doses? High dises?

Answer 6

• binds to mu opiate receptors in the GI tract and slows motility, structurally related to meperidine
• anti-diarrheal opiate
• low doses are good for reducing diarrhea
• high doses can cause euphoria and physical dependence, so the drug is mixed with small amnts of atropine, so that at high doses it will cause blurry vision, dry mouth, etc.

Question 7

What four organisms can cause diarrhea @ only small amnts of bacteria?

Answer 7

1. Shigella
2. Campylobacter jejuni
3. Entamoeba histolytica
4. Giardia lambia

Question 8

What are leydig cells stimulated by? What do they make?

Answer 8

• stimulated by Lh

- make testosterone

Question 9

What are sertoli cells stimulated by? What do they make?

Answer 9

• stimulated by FSH

- make inhibin B

Question 10

Where do neonatal intraventricular hemorrhages normally occur? What increases the risk?

Answer 10

• the germinal matrix
• increased risk with decreased birthweight and decreased age –> common complication of prematurity that can lead to long-term neurodevelopmental impairment

Question 11

What regulates the body’s total iron content? What are its effects?

Answer 11

• hepcidin

- effects absorption of dietary iron by the epithelial cells and the release of iron by the macrophages

Question 12

Where is the lesion in marcus gunn pupil?

Answer 12

-optic tract

Question 13

What 3 things decrease an atheroscleoritc plaques stability?

Answer 13

1. Thin fibrous cap
2. Rich lipid core
3. Active inflammation

Question 14

What is the biggest risk factor for developing an aortic dissection?

Answer 14

-HTN

Question 15

Which TB drug causes body fluids to turn red-orange? What is it’s MOA? What is the MOA for resistance?

Answer 15

• rifampin
• MOA: inhibits DNA-dependent RNA polymerase
• resistance: modificationof the rifampin binding site on bacterial DNA-dependent RNA polymerase

Question 16

What is the treatment of choice for Malignant hyoerthermia? What is its MOA?

Answer 16

• DANTROLENE!

- blocks ryanodine receptors and prevents release of Ca into the cytoplasm

Question 17

What 2 things is dantrolene used to treat?

Answer 17

1. Malignant hyperthermia

2. Neuroleptic malignant syndrome

Question 18

What is subacute sclerosing encephalitis? When is it seen? Pathogenesis? Prognosis?

Answer 18

• a rare complication of measles
• occurs several years after an apparent recovery from the initial infection
• antibodies to the measles virus are found in the CsF of these patients –> antibodies to the M component of the measles component is absent
• this is a slowly progressive, but fatal complication!

Question 19

What is a “porcelain gallbladder”? Ssx? Tx? Risk for?

Answer 19

• gallbladder calcification that can develop in pts with chronic cholecystitis
• usually asymptomatic, but can present with right upper quadrant pain, or firm, nontender mass
• bluish, brittle, calcium-laden gallbladder, seen as a rim of calcium deposits that outline the gall bladder on a radiograph
• increases risk for gallbladder carcinoma, so usually gallbladder is removed!

Question 20

What 2 malignancies is EBV associated with in normal immune pts?

Answer 20

1. Burkitts lymphoma

2. Nasopharyngeal carcinoma

Question 21

Most common location for colon cancer?

Answer 21

-retrosigmoid colon

Question 22

What is the most common non-hodgkin lymphoma in adults? How does it present? Tumor marker?

Answer 22

• follicular lymphoma = B-cell origin
• presents with “waxing and waning” lymphadenopathy
• associated with t(14;18) = overexpression of bcl-2 oncogene

Question 23

How is mucormycosis diagnosed?

Answer 23

• via histologic examination of a mucosal bx

- see nonseptate hyphae with right angle branching

Question 24

What is seen in the CSF of viral meningitis?

Answer 24

• elevated protein
• normal glucose
• lymphocytic predominance

Question 25

What is seen in the CSF of bacterial meningitis?

Answer 25

-low glucose, high protein, and neutrophilic predominance

Question 26

What are anaplastic tumor?

Answer 26

• undifferentiated
• bear no resemblance to the tissue of origin
• composed of pleomorphic cells with large, hyperchromatic nuclei that grow in a disorganized fashion
• also contain numerous, abnormal mitoses and giant tumor cells

Question 27

” Spherules that contain endospores”

Answer 27

• coccidioides immitis

- southwest US

Question 28

What virus is associated with primary CNS lymphoma? Who is this typically seen in?

Answer 28

• associated with EBV

- usually seen in HIV pts

Question 29

What are crescents diagnostic of? What do they contain? Progression?

Answer 29

• diagnostic for rapidly progressive glomerulonephritis
• consist of glomerular parietal cells, monocytes, macrophages, and lots of fibrin
• the crescents eventually become sclerotic and obliterate bowman’s space –> decrease glomerular function

Question 30

Where are most duodenal ulcers found?

Answer 30

-in the duodenal bulb = first portion of the duodenum

Question 31

What are duodenal ulcers found in the distal duodenum suggestive of?

Answer 31

-zollinger-ellison syndrom pe

Question 32

What is metyrapone used to test for? What is a normal result?

Answer 32

• it blocks cortisol synthesis by inhibiting enzyme 11-beta-hydroxylase (converts DOC to cortisol)
• so giving metyrapone should reduce cortisol secretion –> causes an increase in ACTH –> stimulates the zonula fasiculata, but since Cortisol formation is blocked, get a high production of DOC
• high production of DOC is measured as 17-hydroxycorticosteroid in the urine

Question 33

What does tabes dorsalis affect? Ssx?

Answer 33

• affects the dorsal columns and the dorsal roots of the spinal cord
• ssx: loss of position and vibratory sense + severe lancinating pains, can also have an absence of peripheral reflexes

Question 34

What is seen grossly in communicating hydrocephalus? Pathogenesis?

Answer 34

• symmetrically enlarged ventricles

- usually due to dysfunction or obliteration of subarachnoid villi

Question 35

What is an important prognostic factor in poststreptococcal glomerulonephritis?

Answer 35

• AGE!

- 95% of kids, but only 60% of adults recover completely

Question 36

What do you use steroids to treat? Post strep glomeruloneph or minimal change dz?

Answer 36

-minimal change dz!!

Question 37

What is used for quick symptom relief in RA?

Answer 37

-corticosteroids!

Question 38

What is dystonia?

Answer 38

-prolonged repetitive muscle contractions