UW 2/8-2/14 Flashcards
Why do athletic women miss periods?
Reduced Leptin levels inhibit pulsatile GnRH
A fetal autopsy reveals fused cerebral hemispheres with an absent forebrain fissure and a single intracranial ventricle. What is the disease? What is the mechanism of these findings?
Disease: Holoprosencephaly
(may have proboscis)
Mechanism: Developmental Field Defect
What is an Association Defect? Give some examples
Multiple anomalies without a known cause that occur together frequently.
Examples VACTERL Vertebral defects. Anal Atresia Cardiac Defects Tracheoesophageal fistulas Renal Anomalies Limb Abnormalities
What is a deformation? Give examples
Fetal structural anomalies due to extrinsic mechanical forces.
Low amniotic fluid levels can cause bone growth abnormalities.
What is Dysplasia with regards to development? Give an example of dysplasia.
Abnormal organization of cellular architecture in a tissue.
OI- Defective type 1 collagen
What is the treatment for improperly controlled asthma (SABA use currently)?
How can you prevent the major side effect of ICS?
Long acting inhaled cortical steroids.
Oral rinsing and using a spacer on the inhaler help prevent ORAL CANDIDIASIS
What are the symptoms of a Manic Episode?
DIGFAST Distractibility Impulsivity/Indiscression Grandiosity Flight of Ideas Activity Inc Sleep Dec Talkativeness
Can a patient be Bipolar 1 without major depressive episodes?
YES
How do you differentiate Brief Psychotic Disorder from Bipolar I with Psychotic features?
Prominent mood symptoms (DIGFAST) occur more in Bipolar I, not BPD.
What is schizophreniform disorder? How is it different from schizophrenia and Brief Psychotic Disorder?
Schizophreniform disorder lasts 1-6 months. It shares features of BPD and schizophrenia (psychosis, disturbed behavior, decline in function.)
BPD is less than 1 month
-phrenia is more than 6 months
Male Pattern Baldness has what kind of inheritance pattern? What are a couple other notable examples of diseases with the same inheritance?
Polygenic
it depends on androgens, and other key genes.
Ischemic Heart Disease
Diabetes
Epilepsy
Why is a single shot of hCG given to people trying to conceive? What is administered before hCG?
It mimics the LH surge. Menotropins (FSH analogs)
How do fibrates work? What other treatment has similar MOA?
They activate PPAR-Alpha and LPL activity.
This primarily lowers Triglyceride levels.
Fish oil dec VLDL production.
Why do mycobacteria grow as “serpentine” cords on enriched media?
Due to cord factor (virulence), a mycoside.
Cord factor inhibits neutrophils, mitochondrial destruction and induced release of TNF.
What 3 paracrine signals stimulate Gastric Acid Secretion?
Histamine (from ECL cells)
Gastrin (G Cells)
AcH (Vagus Nerve)
A man has fatigue, rashes, flushing and abdominal cramps for a few months. His rash gets worse in a hot shower and with itching. He has clusters of mast cells on biopsy. What is going on?
Histamine secretion due to mast cell proliferation (SYSTEMIC MASTOCYTOSIS).
In addition to these symptoms a patient would also have increased gastric acid secretion as histamine is secreted by ECL cells to stimulate GA.
Which disease is associated with excessive mast cell proliferation and increased histamine release?
Systemic Mastocytosis. Usually have mutated KIT gene
What is Hemaglobin C?
Mutation in B-globin chain that causes glutamate to be replaced by lysine.
What is the most common cause of pericarditis causing a holosystolic murmur in young kids?
Group A Strep–> Acute Rheumatic Fever.
What is a Aschoff body and for which disease is it pathognomonic?
It is an interstitial myocardial granuloma (lymphocytes and macrophages in myocardium)–> Acute Rheumatic fever.
How can you tell the difference between viral and bacterial myocarditis caused by ARF?
Viral myocarditis lacks Aschoff bodies
What are the hallmarks of Pure Red Cell Aplasia and what is the pathogenesis of it?
Hypoplasia of Erythroid cells with normal granulopoesis and thrombopoesis.
Associated/Caused by THYMOMAS, lymphocytic leukemias and B19 Parvovirus
Do Renal Cell Carcinomas selectively suppress erythroid precursors in bone marrow?
No.
What do Entacapone and Tolcapone do in the setting of parkinsons? Which is Central acting, which is peripheral?
Inhibit Catechol-O-Methyl Transferase (which degrades L-Dopa)
Entacapone is peripheral only
Tolcapone is both central and peripheral.
What are 3 drugs that prevent the breakdown of L-Dopa?
Carbidopa (dopa decarboxylase inhibitor)
Entacapone ( COMT in hibitor)
Tolcapone (COMT)
Which drug used in the treatment of Parkinsons increases endogenous dopamine effect?
Amantadine (inc synth/release dec reuptake)
Which nerves enter the orbit through the Superior Orbital Fissure?
III, IV, V1, VI
The Superior ophthalmic vein also runs here.
V2 and V3 enter via the Foramen Rotundum and Ovale respectively.
What do IL 1-6 do?
1-Fever 2-Stims T Cell 3- Stim Bone marrow 4- IgE switch 5- IgA 6- aKute phase reactants Hot T-Bone stEAK
What does interferon Gamma do?
Stimulates Macrophages (from helper T cells)
What is the main vascular concern for pts with marfans? What gene is defective?
Aortic Aneurism
Fibrillin-1 (AD inheritance)
Which connective tissue disease is associated with Berry Aneurisms?
Ehlers-Danlos (type 3 collagen disorder)
What is Myxomatous degeneration
Pathologic weakening of connective tissues
What are the effects of CFTR mutation on Respiratory/intestinal epithelia, and sweat glands?
Respiratory/intestinal: Decreased Cl- SECRETION into lumen
Sweat: Decreased ABSORPTION of Cl back to body. (body doesn’t want to lose all its salt)
What two types of infections can lead to poststreptococcal glomerulonephritis? What is seen on immunochemistry staining?
Streptococcal infections of SKIN or pharynx.
Think of impetigo.
Lumpy bumpy immune complexes (IgG, IgM, C3) on the epithelial side of the BM.
What is the histological finding of Rapidly progressive glomerulonephritis?
Fibrin deposition
What is the classic histological findings of Diabetic nephropathy?
GBM thickening and Kimmelstiel-Wilson Nodules (due to Hyaline deposition)
Rapidly progressive glomerulonephritis may be caused by deposition of Anti GBM-IgG antibodies. What is the name of this syndrome and what kind of hypersensitivity reaction is it?
Goodpasture’s
Type II hypersensitivity
*differentiate between II vs III= 2- is Tissue specific 3= is free to roam body.
What is pancreatic divisum? What are the origins of the structures involved?
Main pancreatic duct fails to form. It is derived from the Ventral pancreatic bud.
The Dorsal bud forms the majority of pancreatic tissue including MOST of the head.
What type of RBC forms with a pyruvate kinase deficiency? Why is splenomegaly seen in pts with this?
Echinocyte (urchin like) RBCs–>inc hemolysis by splenic reticuloendothelial cells–>Red Pulp hyperplasia
When does passive splenic congestion occur?
In the setting of portal hypertention or anything that backs up blood.
Track the descent of the testes through the abdominal wall to the scrotum. Name the structures it passes and their origins:
Deep Inguinal Ring (transversealis fascia)
Inguinal Canal: many things
Superficial inguinal ring (external oblique apo)
Scrotum
What CD cell markers are present on reed sternburg cells?
CD15 and 30.
2x15=30
Hodgkins lymphoma (owl eye cells)
What cells have CD 16?
NK, neutrophils, and macrophages
16 year olds are innate killers.
Describe the Hawthorne effect with reguards to studies.
Children playing together during an experiment begin to share more once they learn they are being observed.
What is Berkson’s Bias?
Selection bias created by selecting hospital patients.
What is the Pygmalion effect?
Researchers belief in the efficacy of intervention can affect outcome. ie Randomly selected Gifted and Talented students perform better on exams because teachers help them more unconsciously.
How does Mumps present?
Fever Malaise, headaches, myalgias–> Parotid gland swelling within 48 hours.
What is an L/S ratio and when would you expect it to be 2:1 or higher?
L/S is the Lecithin (aka phosphatidylcholine) to sphingomyelin ratio.
When lung is maturing the utero (at around 35 weeks) the ratio is 2:1 or higher.
What is the presentation of a Krukenburg tumor? What other ovarian tumor may be bilateral?
Early satiety, gastric thickening on CT, adenexal masses (most often bilateral!!!)
The following histological findings are indicative of which kinds of cancer?
A. Bilobed nuclei and inclusion-like nucleoli
B. Intercellular Bridges and Keratin pearls
C. Mucin secreting signet cells
D. Epithelial Cells with abundant clear cytoplasm
E. Sebaceous glands and keratinaceous debris
A. Hodgkin Lymphoma (these are reed-sternburg cells)
B. Squamous Cell Cancer
C. Primary gastric Cancer (signet cells are full of mucus with nucleus pushed to the side.
D. Renal Cell Carcinoma, (Clear cell type)
E. Teratoma (hair and skin glands)
Which type of hypersensitivity reaction is Poststreptococcal GN classified as? Why? How is it different from Goodpastures?
It is a Type III HS reaction.
M-protein complexes with IgG antibodies and DEPOSITS in basement membrane.
Goodpastures (TII rxn) has autoantibodies against the BM.
A patient is given a card full of different potential allergens. It is taped to his skin and he is asked to return to the office in 2 days. After his return he has some rashes under certain samples. What is happening? What type of hypersensitivity is this?
Contact Dermatitis
Type 4 HS.
Foreign molecules detected by Antigen Presenting cells which stimulate T cells.
How do you think of Type II vs III hypersensitivity reactions in general?
Type II is 2-issue specific
Type III is general.
Which sex chromosome disorder is associated with Macroorchidism, large jaw, and intellectual disability? Inheritance pattern?
Pts with Fragile X.
“Big Balls mean not enough X chromosome”
X linked Dominant
Which genetic disorder is characterized by short stature, hypotonia, intellectual disability, hyperphagia and obesity?
Prader Willi
Matt Prader is the fattest kid on the football team.
Defect in Paternal gene 15q 11-13.
How can you tell the difference between a clue cell and a koilocyte? Which infections do each represent?
Clue Cells have Rod shaped bacteria adhering to their cell membrane. -Gardnella Vag.
Koilocyte:Dense irregular staining cytoplasm. Raisin shaped nuclei. HPV
What is the action of interferon gamma?
Inc MCH I and II on antigen presenting cells.
What are the signs of organophosphate poisioning?
Inc Parasympathetic Activity DUMBELSS Diarrhea Urination Miosis Bronchospasms/Bradycardia Excitation of skeletal muscle Lacrimation Sweating/Salivation
What is the difference between suppression and repression in psychology?
Supression is a MATURE defense, where someone decides to not let something bother them.
Repression is when thoughts/actions are suppressed subconsciously (ie woman doesn’t want sex bc she was violently raped as a kid)
Give an example of reaction formation.
A person worried about failing step 1 is overly confident in his interactions with others.
What does a 99MTc-pechnetate test look for?
Gastric Parietal Cells.
Used to ID atopic gastric mucosa such as a meckel diverticulum.
What are the 3 main causes of hypoglycemia in Diabetic type I patients?
Insulin OD, Dec food intake, Exercise.
What are somethings that can increase blood sugar levels other than food intake?
Infection, Sleep depravaiton, pain/stress
All trigger cortisol/catecholamine release.
