uWorld 49 Flashcards
hyper IgM is inherited in what pattern
X-LINKED RECESSIVE
problem in class switching (CD40-CD40L interaction)
sinopulmonary, GI, and opportunistic infections (Pneumocystis, Cryptosporidium)
what changes in B cell class switching
SPACING out DNA coding for different types of the HEAVY CHAIN CONSTANT REGION until the desired isotope is reached. the VARIABLE REGION, and therefore the antigenic specificity of the antibody, the the same
exceptions to confidentiality include what
suspected child or elder abuse
knife or gunshot wounds
diagnosing reportable communicable disease
threats to hear self or others and reasonable ability to carry out the threat in the near future
what happens to hormone levels in menopause
FSH INCREASED due to resistant ovarian follicles and lack of feedback inhibition
menopause is lack of menses for 12 months (average age is 51)
associated with HYPOESTROGENIC SYMPTOMS (hot flashes, vaginal dryness)
what are the main factors influencing CEREBRAL BLOOD FLOW
SYSTEMIC BLOOD PRESSURE
- above 150 causes ↑ cerebral BLOOD FLOW and ↑ ICP
- below 50 causes hypo perfusion and potential cerebral ischemia
ARTERIAL BLOOD GASS LEVELS
- DROP in PCO2 due to hyperventilation causes VASOCONSTRICTION, increasing VASCULAR RESISTANCE and reducing cerebral blood flow
- lowering PCO2 is one of the measures to REDUCE ICP in MECHANICALLY VENTILATED patients with CEREBRAL EDEMA
inducing sedation and therapeutic hypothermia can decreased BRAIN METABOLIC DEMAND, exerting what kind of effect
NEUROPROTECTIVE and improving ICP by reducing cerebral blood flow
what is the thecal sac
sheath of dura mater surrounding the spinal cord that contains CSF
increased ICP can cause displacement of CSP form the brain into the thecal sac
pCO2 has what effect on the brain
POTENT VASODILATOR of cerebral VASCULATURE
TACHYPNEA causes HYPOCAPNIA and cerebral VASOCONSTRICTION, thereby decreasing cerebral blood flow and intracranial pressure
what is seen histologically in reflux esophagitis
elongation of papillae
basal cell hypertrophy
intraepithelial eosinophils
fever, jaundice, anorexia, and IV drug use suggests what
VIRAL HEPATITIS
what is seen histologically in viral hepatitis
pan lobular lymphocytic infiltrates, ballooning hepatocytes, hepatocyte necrosis and hepatocyte apoptosis
apoptotic heptoctes form round ACIDOPHILIC bodies known as COUNCILMAN BODIES or apoptotic bodies
whats the only specific therapy known to reduce pulmonary vascular resistance
NITRIC OXIDE
what is the only ligament of the uterus that extends posteriorly
UTEROSACRAL ligament
pelvic splanchnic nerves run on top of it
what causes infertility in CF patients
ABSENT VAS DEFERENS bilaterally (AZOOSPERMIA)
what could cause the liver to appear shrunken and atrophies on autopsy in a patient who recently had surgery in a foreign country
DRUG-INDUCED LIVER INJURY from inhaled anesthetic (HALOTHANE, used in foreign countries still)
HEPATOCELLULAR PATTERN OF INJURY0 can range from mild asymptomatic ↑ LFT to FULMINANT HEPATITIS (50% mortality rate)
extensive haptocellular damage can cause the liver to rapidly atrophy and appear SHRUNKEN on autopsy
widespread CENTRILOBULAR NECROSIS and inflammation of the PORTAL TRACTS and PARENCHYMA are obsessed, making the condition indistinguishable from fulminant viral hepatitis
thought to be a hypersensitivity reaction to the drug that causes and immune-mediated attack against hepatocytes
fever, anorexia, nausea, myalgia, arthralgias, ↑ LFTS, PROLONGED PROTHROMBIN TIME, leukocytosis, eosinophilia
what happens to albumin levels in acute liver injury
NOTHING (20 day half life)
what drugs are associated with osteoporotic fractures
anticonvulsants that induce CYP450 (phenobarbital, phenytoin, carbamazepine)- ↑ Vitamin D catabolism
aromatase inhibitors, medroxypregestrerone- ↓ estrogen
GnRH agonists- ↓ testosterone and estrogen
PPIs ↓ calcium absorption
glucocorticoids, unfractioned hep, thiazolidinediones- ↓ bone formation
what defines a pathologic fracture
fracture due to a force significantly less than that required to fracture a normal bone
PROXIMAL TUBULAR cell BALLOONING and VACUOLAR DEGENERATION in a patient with acute renal failure is consistent with what
ACUTE TUBULAR NECROSIS
presence of OXALATE CRYSTALS in the tubular lumen is highly suggestive of what
ETHYLENE GLYCOL poisoning thus the damage and renal failure is due to TOXIC RENAL INJURY
what is hepatorenal syndrome
advanced liver disease with portal hypertension and ascites may causing renal failure
hallmark of this condition is RENAL VASOCONSTRICTION
histologically the kidney is NORMAL and function goes back to normal once the liver is transplanted
what is seen in ethylene glycol poisoning
TOXIC, acute tubular necoriss with VACUOLAR DEGENERATION and BALLOONING of the PROXIMAL TUBULAR cells
high anion gap metabolic acidosis
increased osmolar gap
calcium OXYLATE CRYSTALS in urine