U world/ true learn review 6/19/23 Flashcards
what causes the webbing of the neck and swelling og the hands and feet in turner syndrome (45XO)
A female with primary amenorrhea, wide-set nipples, broad chest, and a short stature should be worked up for possible Turner syndrome
congenital lymphedema
A 14-year-old female presents to the office for a well-child exam. She states that she has not yet had her first period. Vitals reveal a blood pressure of 149/95 mmHg in the right arm and 110/65 mmHg in the left arm, a heart rate of 70/min, a respiratory rate of 14/min, and a temperature of 37°C (98.6°F). Her weight is 45.4 kg (100 lb) and her height is 1.35 m (4’5”). Physical examination reveals a shortened fourth metacarpal bone and an III/VI systolic murmur. The most likely karyotype of this patient
what is the most common cause of congenital primary hypogonadism
klinefelters syndrome (46 XXY)
This is the karyotype of a patient with Klinefelter’s syndrome. This is the most common cause of congenital primary hypogonadism (1/1000 births). Phenotypically male, affected patients have a tall stature, long arms and legs, mild mental retardation, and often cryptorchidism. Further workup will reveal testosterone deficiency and increased FSH and LH. These patients have an increased risk of breast cancer, autoimmune disease (systemic lupus erythematosus), and extragonadal germ cell tumors.
the vagus nerve exits the occiput via the
jugular foramen and carrier parasympathetic fibers to visceral structures in the chest and abdomen
tissue texture changes for SA node dysfunction would be expected where
T1-T5 on the right
Myocardium and AV node tissue texture changes would be seen where
T1-T5 on the left
what are the two most important causes of tick borne relapsing fever in north america
Borrelia Hermsii and Borrelia Recurrentis
what are the symptoms of Borrelia hermsii
high fever for 3 days followed by an afebrile period of 7 days
extra: malaise, abdominal pain, macular rash (petechiae), gi symptoms
what causes the relapsing fever in borrelia hermsii
the rapid alteration of surface antigens by bacteria preventing long lasting protective immunnity
treatment of tick borne relapsing fever
first like: tetracycline
second line: erythromycin
babesia microti
tick borne illness that causes babesiosis with influenza like symptoms, hemolytic anemia, hepatosplenomagly, hemoglobinuria and hemosiderinuria
periopheral blood smear shows intraerythrocytic rings/maltese cross
colorado tick fever
viral infection spread by dermacentor tick that causes conjunctival injection, pharyngeal erythema, and cervical lymphadenopathy.
peripheral blood would show atypical lymphocytes
colorado tick fever
viral infection spread by dermacentor tick that causes conjunctival injection, pharyngeal erythema, and cervical lymphadenopathy.
peripheral blood would show atypical lymphocytes
what is the pathophysiology of NSAID exacerbated respiratory disease
inhibition of cyclooxygenase 1 leads to increased leukotriene production
what drugs cause NSAID exacerbated respiratory disease
aspirin and other NSAIDs that inhibit COX-1 like naproxen or ibuprofen
what is the presentation of NASID exacerbated respiratory disease
QUICK ONSET (20 mins-3 hours) wheezing, gives, nasal congestion, coughing, swelling of lips, upper or lower respitatory bronchospams
triad: asthma, nasal polyps and chronic rhinosinusitis
treatment of NSAID excerbated respiratory disease
avoid COX-1 inhibiting NSAIDS
short acting beta adrenergic receptor agonists for bronchospasm
leukotriene receptor antagonists
desensitization
primary site of metabolism for NSAIDs
the liver
what is cromolyn sodium
a mast cell stabalizer used to control inflammation in asthma and to prevent excercise induced bronchospam
works by inhbiiting degranulation of mast cells
mast cells contain _ granules
basophilic
a forced expiratory volume in 1 second less that 0.80 is diagnostic for
airflow obstruction
HIV binds _ cells
CD4+ T cells
bilobed nuclei
eosinophil
helminth and parasitic infections
multiloped nuclei
neutrophils
large round densely staining nucleus with minimal amounts of pale cytoplasm
lymphocytes
pretibial myxedema
thickening of the skin over the anterior tibia seen in graves disease
graves disease
an autoimmune disease caused by increased stimulatino of TSH receptors by thyroif stimulating immunoglobulin (thyroid stimulating antibody)
receptor antibodies
Thyroid stimulating immunoglobulin may cross react with _ cells that contain TSH receptors
connective tissue cells
myxedema is caused by infiltration of _ and deposition of _ into the dermis
antibody cross reactivity with fibroblasts in the extremities
lymphocytes
glycosaminoglycans (HA)
orbitopathy as well
signs of graves disease
pretibial myxedema, goiter, onycholysis, thinning of hair, tremors, lid lag, sweating, heat intolerance
labs for graves
increased TSI and T4/T3
decreases TSH and HDL
hyperglycemia
treatment of graves disease
thianomides (methimazole and propylthiouracil)
radioactive iodine
thyroidectomy
type 1 collagen is found where ?
bones, skin, tendons, dentin, fascia, and cornea
type _ collagen is involved in late wound repair
1
osteogenesis imperfecta
type 3 collagen is found where
aka reticulin
found in the skin, blood vessels, uterus, fetal tissue and granulation tissue
ehlers danlos
type 4 collagen is found where
in the basement membrane
alport syndrome
alport syndrome
hereditary nephritis, deafness (x-linked dominant)
subacute thryoiditis
painful thyroid
thyrotoxicosis
usually has a normal thyroid examination
toxic multinodular goiter
discrete thyroid nodules
beta blocker overdose can cause
slow heart rate, hypotensions, hypoglycemia, and fatigue
how do you reverse beta blocker overdose
give glucagon
aspirin overdose symptoms
tinnitus, fever, respiratory alkalosis that turns into metabolic acidosis
Aspirin is an irreversible inhibitor of cyclooxygenase that reduces thromboxane and platelet aggregation. An overdose of aspirin activates the medulla’s respiratory center, increasing the rate of breathing and alkalosis, due to a loss of bicarbonate. Later, there is an uncoupling of oxidative phosphorylation leading to a loss of fluid and metabolic acidosis. This is managed by ionizing the urine with sodium bicarbonate. In addition, the patient would present with ringing of the ears with a salicylate toxicity and this patient is not experiencing this effect.
antidote for apirin overdose
sodium bicrobonate
ionizes the urine
acetaminphen overdose symptoms
RUQ pain, centrilobular necrosis of the liver
antidote for acetaminophen overdose
N-acetylcysteine
dabigatran overdose symptoms
bleeding (nose, stool, urine)
oral anticoagulant that inhibits clotting by binding to thrombin
dabigatran overdose antidote
idarucizumab
warfarin or rat poisoning overdose symptoms
blocks vitamin K epoxide reductase
bleeding (nose, stool, urine)
elevated PT
warfarin / rat poisoning overdose antidote
vitamin K for minor bleed
FFP
calcium channel blocker overdose symptoms
bradycardia
hypotension
hyperglycemia
dizziness
(tachycardia for dihydropyridines)
treatment of calcium channel blocker overdose
IV calcium
insulin
glucagon increases _
cAMP
increase HR and cardiac contractility
increases glycogen conversion to glucose in the liver
hemophilia A is a def in
factor VIII
(elevated PTT time)
what is the treatment and prophlaxis for hemophilia A
desmopressin (DDVAP)
what does desmopressin do
it is a synthetic analog of vassopressin that promotes endothelial release for factor VIII, vone willebrand factor and tissue plasminogen
also a treatment for central diabetes insipidus
what increases stroke volume and therefore cardiac output in pregnancy
increased serum estrogen will increase the plasma volume and increase preload and SV
progesterone will dialte the vessels and result in a decrease SVR (afterload)- how much you have to contract against
cardiac output =
HR X SV
how is there an increased GFR in pregnancy
there is decreased systemic vascular resistance which inreaces renal plasma flow
low serum creatinine in pregnancy
how does insulin resistance occur in pregnancy
an increase in human placental lactogen can lead to hyperglycemia and gestational diabetes
insulin antagonists
also causes maternal lipolysis and fatty acid metabolism
why does anemia occur in pregnancy
an increase in plasma volume (estrogen) results in a dilutional anemia
decreased hemoglobin and hematocrit
cholestasis in pregnancy is caused by
decreased gall bladder contraction due to progesterone relaxation
reduced biliary transport of bile mediated by estrogen
pruritis, cholelithiasis, and cholecystitis
PFTs in a pregnant woman will show
decreased expiratory reserve volume, residual volume and functional residual capacity
due to acute and rapidly evolving nature of necrotizing fasciitis, _ treatments are contrainticated as they could increase the spread of infection
lymphatic treatments
treatment of necrotizing fascitis
debriedment and IV antibiotics
phenytoin MOA
used in generalized and focal seizures
slows the rate of recovery of voltage activated Na+ channels from inactivation
it induces CYP3A4
zero order elimination
sodium channel blocker
side effects of phenytoin
gingival hyperplasia, CNS effects (ataxia), osteomalacia, excessive hair growth (hirtuism) , megaloblastic anemia
what virulence factor allow H pylori ti inhabit the stomach
urease
cleaves urea into ammonia and carbon dioxide
(ammonia neutralizes the stomach acid and raises the pH allowing for colonization of H. Pylori)
H. pylori will colonize the gastric surface using urease but damage is mediated by?
urease byproducts
mucinase, vaculoating cytotoxin A, cytoxin associated gene A, phophorubosylanthranilate isomerase
treatment of H. pylori infection
amoxicillin + clarithromycin + PPI
which ulcers are better with eating
duodenal
what drug is used for psuedomonas in burn victims
aminoglycosides (bind to the 30s ribosome subunit)
-bacteriocidal
-mycin suffix
antibiotics effective against Puedomonas
penicillins, cephalsporins, monobactams, carbapenems, aminoglycosides
hypertensive emergency
> 180/120
nitroprusside side effects
kidney injury, lactic acidosis, cyanoid toxicity, and hypotension
MOA of nitroprusside
activates guanylate cyclase in the vascular s mooth muscle and leads to increased cGMP allowing calcium to move from the cytoplasm into the endoplasmic reticulum causing venule and arterial vasodilation
how does nitroprusside cause lactic acidosis
when it is metabolized it produces 1 product of cyanmetheglobin and 4 cyanide ions that can accumulate and cause renal dysfunction, metabolic acidosis and elevated lactate levels
what drugs are used in a hypertensive emergency
nitroprusside
nifedipine/clevidipine
fenoldopam
labetalol
esmolol
phentolamine
nifedepine/clevidipine MOA and side effects
inhibits the dihydropyridine calcium channel and relaxes arterioles
SE: tachycardia, hypotension, edema
fenoldopam MOA and side effects
peripheral dopamine -1 receptor agonist that maintains renal perfusion
SE: flushing, hypotension, headache
labetalol MOA and side effects
blocks alpha 1, beta 1 and beta 2 receptors
SE: worsens asthma and COPD, AV block and bradycardia
esmolol MOA and side effects
beta 1 adrenergic receptor antagonist
class II antiarrythmic
SE: hypotension
phentolamine MOA and side effects
nonselective alpha adrenergic receptor antagonist used for overdose of catecholamine excess
SE: tachycardia, flushing, headache
monitoring for _ is required for people taking ace inhibitors
hyperkalemia
multiple myeloma
malignancy of plasma cells that produce abnormal antibodies that cause kidney problems, bone lesions, hypercalcemia, anemia and fatigue
elevated protein gap
total serum protein measures both _ and _ when the difference beyween protein and albumin is greater than _ it is called a protein gap
immunoglobulin
albumin
> 4.5
lytic lesions in multiple myeloma is caused by
activation of osteoclasts that lead to pathological fractures and compression fractures
(elevated Alkaline phosphatase)
hypercalcemia in multiple myeloma is caused by
breakdown of the bone releases calcium
why does MM have bence jones proteins
people in MM lose monoclonal immunoglobulines called bence jones protein - they are not losing albumin so a dipstick will often be negative
bence jones proteins can infiltrate the kidney tubular cells
-protein creatine ratio will be elevated
how do you correct the calcium levels in multiple myeloma
its based on albumin level
corrected calcium= (4-albumin)X 0.8 + measured calcium)
what are the symptoms of multiple myeloma (CRAB)
calcium >11
renal insufficency (creatinine >2 or renal clearance less than 40)
anemia (hemoglobin <10)
bone lesions
patients with MM have tumors that metastaize to bone (ribs and spine) and _ will elicit a sharp pain response
percussion
NSAID induced nephropathy causes
intersitial nephritis, and papillary necrosis
papillary necrpsos presents as
painless gross hematuria
microscopy evaluation of a wet mount specimen from vaginal fluid is diagnoistic for what 3 conditions
Trichomoniasis: Motile, flagelleted protozoa is characteristic of trichomonas. Although very specific, the sensitivity of this test is only 60% and may be even less in asymptomatic women.
Candida albicans: Pseudohyphae and budding yeast would readily be seen on wet mount prep.
Bacterial vaginosis (BV): Clue cells (coccobacilli on vaginal epithelial cells) with a fishy odor when KOH prep is applied is characteristic of BV.
NAAT also works
in polymyositis the cellular infiltrate is predominately within the
fascicle with inflammatory cells invading the muscle fiber
endomysial infiltration
pathogenesis of polymyositis
anti-jo1 antibodies in polymyositis have a CD8+ T cell and macrophage infiltrate in the endomysium, capillaries. And increased connective tissue due to muscle fiber necrosis .
CD8+ mediated
polymyositis symptoms
insidious proximal muscle weakness in the upper and lower extremities (inability to comb hair, walk up and down the steps)
muscle pains, pain and myalgia can fluctuate, weakness of the chest wall muscles
polymyositis can cause _ dysfunctions of the rib cage
exhalation
labs for polymyositis
elevated creatine kinase, lactate dehydrogenase, aldolase, anti-jo-1 antibodies
**muscle biopsy is definitive
treatment for polymyositis
prednisone
dermatomyosistis pathogenesis and clinical features
immune complex deposition with Cd4+ T cells and B cells in the perimysium and perifascicular regions
symmetric proximal muscle weakness with gottron papules, shawl sign, mechanics hands
elevated CK, lactate and aldolase, anti-jo-1 antibodies
inclusion body myositis
inflammation and endomysial infiltrates of CD8+ T cells and marcophages
more common in men older than 50
distal weakness starting at the fingers and wrist
usually asymmetric
(loss of finger dexterity and grip strength)
polymyalgia rheumatica is associated with
giant cell arteritis
what is polymyalgia rheumatics
myalgias of the hip and shoulder girdles with NO weakness
stiffness, difficulty rising from chair or raising arm above head
ESR > 40
sarcoidosis is an inflammatory disease that predominately affects which organs
lungs and intrathoracic lymph nodes
noncaseating granulomas
-fever, anorexia, arthralgias, SOB, dyspnea, erythema nodosum, anterior uveitis
labs in sarcoidosis
elevated calcium due to secretion of 1,25 vitamin D by the noncaseating granuloma
plain film radiograph of sarcoid
bilateral hilar lymphadenopathy
antisocial personaility disorder stems in childhood as _ disorder
conduct
conduct disorder
pattern of behavior that violates basic rights of others or deviates from societal norms that leads to imapirment in social academic or occupational functionnig
agreession to people and animals
destruction of property
deceitfulness or theft
serious violations of the rules
antisocial personalitis disorder cannot be diagnosed below the age of
18 years old
antisocial personaility disorder criteria
3 or more occuring since age 15
repeated acts that are grounds for arrest
lack of remorese
lack of planning ahead
decietfulness for personal profit
aggressiveness
inability to assume responsibility
disregard for safety of others or self
disruptive mood dysregulation disorder
frequent temper outbursts out of proportion that can lead to verbal rages or physical aggression in those under 18 years old
diagnosis of oppositional defiant disorder requires
6 month period of being hostile and defiant
with 4 or more criteria or loss of temper, arguing with adults, defying adults, deliberately annoying people, anger, spitegulness, blaming others, and easy annoyance.
lithium toxicity side effects (HEAT)
HEAT
hypothyroidism
edema
acne
tremor (hyperreflexia, ataxia)- neurological
narrow theraputic index
most common ECG finding in lithium toxicity
T wave flattening
what 3 drug classes potentiate lithium toxicity
diuretics, angiotensin converting enzyme inhibitors, and NSAIDS
thyroid problems are most common associated with a _ lesion of T_
flexion lesion of T2
lithium can cause _ diabetes insipidus
nephrogenic
inhibits ADH action on the distal renal tubule
la crosse virus
a bunyaviridae family virus; helical nucelocapsid
negative sense circular RNA virus that is enveloped in 3 segments that is transmitted through the bite of an aedes triseritaus mosquito
prodomal stage, fever somnolence and metal status changes.
focal neurological deficits : aphasia, incoordation
eastern equine encephalitis
togavirdae family
enveloped positive sense, linear single stranded RNA virus with icosahedral nueclocapsits
st louis encephalitis
flavivirdiae family
positive sense enveloped linear single stranded icoshaedral nucleocapside
west nile encaphalitis
flavivridae family
positive snese, linear single stranded RNA enveloped icosahedral nucleocapsid
western equine encephalitis
Western equine encephalitis is caused by an alphavirus genus member of the Togaviridae family. These viruses are enveloped with a positive sense, linear, single-stranded RNA genome with icosahedral nucleocapsids. Western equine encephalitis is transmitted by the mosquitos of the Culex and Culiseta genera.
which atypical antidepressant can be used for smoking cessation and can cause weight loss
bubropion
bupriopion MOA
norepinephrine and dopamine reuptake inhibitor
what are the agents used to help with smoking cessation
bubropion, nicotine replacement therapy and varenicline
containdications to useing burprion
seizure or eating disorders (lowers seizure threshold)
MOA of nicotine replacement therapy
stimulation of nicotine receptors and reduces cravings
varenicline MOA
partial nicotinic acetylcholine receptor agonist
avoid in suicidal patients, can cause abnormal dreams
adductor pollicis is inervated by _ and it can be tested with the _ sign
ulnar nerve
froment sign (paper between thumb and index finger–> hyperflexion of the interphalangeal joint due to compensatory engagement of the flexor pollicus longus
the 1st and 2nd lumbicals are innervated by the
median nerve
3rd and 4th lumbricals are innervated by
ulnar nerve
lumbicals function to
flex the metacarpophalangeal joint and extend the interphalangeal joint
abductor pollicis brevis is innervated by
median nerve
abduction of the thumb and opposition
extensor digiti minmi is innervated by
posterior interosseous nerve from the raidal nerve
extendion of the wrist and 5th digit
humeral shaft fracture (wrist drop)
portal hypertension can cause anorectal varices with increased pressure where
within the superior rectal vein (portal system) and inferior rectal vein (systemic system)
dilated veins engorged with blood
-bleeding from butt
esophageal varices due to portal hypertension occurs between what anastamoses
left gastric vein and azygous vein
caput medusa from portal hypertension is an anatomosis between
paraumbilical vein (portal) and superficial epigastric vein
aniocytosis
variety of size in any cell type
anisocytosis is synonymous with
red blood cell distribution width (RDW)
an increased RDW is specific for _ anemia
iron deficiency
In women of child-bearing age who present with symptoms of anemia, suspect iron deficiency caused by blood loss. Typical laboratory findings include a decreased MCV, decreased serum iron, increased RDW, increased TIBC, decreased ferritin, and increased apoferritin.
increased mean corpuscular hemoglobin content decribes
hereditary spherocytosis
a condition in which a protein vital to the red blood cells concave structure is missing, resulting in a spherical shape. The mean corpuscular hemoglobin content refers to the red blood cell’s increased volume and capacity to store hemoglobin. A peripheral blood smear will reveal loss of the biconcave shape of the red blood cells. Patients typically present with intermittent jaundice, splenomegaly, and bilirubin gallstones. The most accurate test is an osmotic fragility test. This patient had a normal physical examination. Due to the positive history for menorrhagia, iron deficiency should be high on the differential.
increased urinary levels of methylmalonic acid describes
megaloblastic anemia due to B12 def
poikilocytosis means
abnormal shapes and sizes from intravascular hemolysis
subfalcine herniation
medial aspect of the frontal lobe the cingulate cyrus herniates across the midline under the free edge of the anterior falx and may compress the anerior cerebral arteries
ACA supplies
medial portion of the frontal lobe and superior portion of the parietal lobe
ACA occulsion/lesion
contralateral lower extremity weakness withOUT sensory loss
dysfunction of the frontal lobe causes abulia, akinesa, mutism, slowless, and frontal release signs: rooting reflex and sucking reflex
subdural hemorrhage occurs due to tearing of
bridging veins
increased intracranial pressure
hydrocephalus ex vacuo
enlarged brain ventricles due to loss of parenchyma
tonsillar herniation
increased posteiror fossa pressure causes the cerebellar tonsils to displace down through the foramen magnum can compress the brainstem and spinal cord leading respiratory arrest, cardiac arrest, compress the medulla and cause coma
transcalvarial herniations
portions of brain matter herniate through disruption in the skill
(head trauma, skull fracture_
uncal transtenorial herniations
medial part of the temportal lobe the uncus herniates over the edge of the tenrotium
can compress the PCS, oculomotor nerve or cerebral peduncle , duret hemorrhages
oculomotor and cerebral peduncle –> ipsilateral dilated pupil and contralateral hemiparesis
kerhans notch
down and out eye
caudal displacement of the brainstem caused by central transtentorial herniation causes
paramedial basilar artery rupter and duret hemorrhages (fatal )
antibodies in graves
IgG antibodies stimulate thyroid stimulating hormone receptors to create more thyroif hormone
thyroid stimulating immunoglobulins (IgG)
graves is a type _ HSR
type II
radioactive iodine uptake scan in graves
diffuse evenly distrubited uptake
what onfection can be a potential triggering event for graves disease
yersinia entercolitica
acetaminophen toxicity causes necrosis where in the liver
centrilobular
N-acetylcysteine (NAC) should be administered as soon as possible, preferably within 8-10 hours of overdose. This drug donates sulfhydryl groups, and decreases free radical damage. In addition, activated charcoal can be given if ingestion is within 4 hours.
stages of acetaminophen toxicity
stage 1: N.V, CNS disturbances
Stage 2: RUQ pain
Stage 3: hepatic dysfunction
N-acyetlcysteine should be adminstered when
within 8-10 hrs of acetaminophen overdose
portal vein thrombosis is most commonly causes by
oral contraceptive pills/estrogen
extensive microvesicular lipid accumulation inside hepatocytes describes
reye syndrome
Reye syndrome is caused by salicylate use, commonly aspirin, in the pediatric population.
the spinal dura attaches where
foramen magnum
posterior aspect of the C2 dens
posterior aspect of C3 body
posterior aspect of S2 body
posterior aspect of the coccyx
the filum terminale is an extension of the
pia matter
henoch-schnlein purpura
small vessel vasculitits
type III hypersenitivity
IgA immune complex deposition leading to : palpbable purpura on the buttocks and lower extremities with non pitting edema and aarthralgias and abdominal pain
can deposit in the kidney, gi tract leading to hematuria or mesenteric ischemia
henoch scholein purpura typically follows
upper respiratory tract infection (group A strep)
complications of henoch schonlein purpura
instussception
leukocyte invasion of medium sized blood vessel walls causing transmural necrotizing inflammation
polyarteritis nodosa
This vasculitis generally occurs secondary to either hepatitis B, hepatitis C, or hairy cell leukemia. The tetrad for diagnosis is fever, hypertension, abdominal pain with melena, and renal disease, which are absent in this patient.
what is the PERC criteria for pulmonary embolism assessment
age older than 50
heart rate greater than 100
02 sat less than 95%
hemoptysis
unilateral leg edema
recent surgery
history of DVT
hormone therapy
negative means no cirteria was fulfilled
if they are low risk check d dimer level
high risk or positive d-dimer—> Chest CT scan with angiography CTA
oxacillin resistant=
methicillin resistant
treatment for phenochromocytoma
phenoxybenzamine (irreersible alpha blockers)
phentolamine (reversible)
alpha blockers must be give before beta blockers
what are the two instances where you must give an alpha blocker. before. a beta blocker
cocaine toxicity and pheochromocytoma (urinary VMA)
the aortic valve opens _ in hypertension
later
isovolumetric contraction is _ in hypertension
longer (reduced coronary blood flow for longer)
