Week 2 Review Deck Flashcards
hematuria, periorybital edema, cola-colored urine, HTN; Anti-DNase and Anti-streptolysin O titers, with decreased C3 concentration and normal C4
poster-strep glomerular nephritis
Name the 6 types of nephritis
PSGN, RPGN, Alport Syndrome, MPGN, IgA nephropathy, Diffuse Proliferative Glomerulonephritis (SLE)
Name the 5 types of Nephrotic syndrome
minimal change disease, FSGS, membranous nephropathy, Amyloidosis, Diabetic glomerulonephropathy
Hematuria with hemoptysis
Goodpasture Syndrome (Anti-GBM antibodies with linear IF due to Antibodies on GBM)
Common statistical test that checks the differences between means of 2 groups
T-Test
Common statistical test that checks difference between means of 3 or more groups
ANoVA/ Analysis of Variance
Common statistical test between two or more percentages OR proportions of categorical outcome (i.e. Comparing the percentages of members of 3 different ethnic groups who have essential HTN.
Chi Squared Test
What branch of the facial nerve supplies taste to the anterior 2/3 of the tongue
Chorda Tympani N
What nerve provides sensation to the anterior 2/3 of the tongue
Mandibular branch (V3) of the Trigeminal N.
What nerve supplies taste and sensation to the posterior 1/3 of the tongue?
Glossopharyngeal nerve (IX)
Two bacterial species that cleave IgA
S pneumo (IgA dimer shield) and N Gonorrhea cleave IgA protease (Ace Card)
Function of Protein A in Staph Aureus
Cleaves the Fc portion of IgG preventing complement activation, opsonization, and phagocytosis
refractory ulcers in the distal duodenum, abdominal pain, diarrhea and positive secretin stimulation test; associated with MEN1
ZES
Water diarrhea, achlorhydria, hypokalemia; Associated with MEN1
VIPoma
Hunger center in the hypothalamus
Lateral Nucleus
Satiety center of the hypothalamus
ventromedial nucleus
Cooling center of the hypothalamus; loss of function leads to hyperthermia
anterior nucleus
heating center of the hypothalamus; loss of function leads to hypothermia and poikilotherm (snake) skin
posterior nucleus
Nucleus in the hypothalamus responsible for production and release of ADH Oxytocin, CRH and TRH release
paraventricular nucleus (neurohypophysis)
Nucleus in the hypothalamus responsible for ADH and Oxytocin production and release.
Superoptic nucleus
Nucleus in the hypothalamus responsible for circadian rhythm
Suprachiasmatic
When should a 5HT3 Blocker be administered as an antiemetic
Ondansetron should be used in cases of diarrhea with nausea and vomiting caused by chemo, recent infection that lead to GI inflammation, or obstruction
When should D2 Receptor blockers be used as an anti-emetic
Metoclopramide and prochlorperazine should be used in the causes of nausea associated with migraine
When should H1 histamine blockers and mAChR blockers be used in the treatment of nausea and vomiting?
Should be used in cases of vestibular nausea (motion sickness) Diphenhydramine, meclizine; scopolamine; Promethazine can also be used
When should an NK-1 Receptor blocker be used in the treatment of Nausea and vomiting?
Aprepitant should be used basically for chemo and radiation only (inhibits Substance P binding to the NK-1 R)
Side effects and MOA of Daptomycin
Depolarizes cellular membrane by creating transmembrane channels (Taser); rhabdomyolysis and myopathy, elevated CPK
rhino sinusitis, peripheral eosinophilia, asthma, skin nodules or purpura; Can affect the GI, heart and kidneys; cause p-ANCA glomerulonephritis
Churg Strauss/ Eosinophilic Granulomatosis with Polyangitis (small vessel vasculitides)
5 bacterial toxins coded in a lysogenic phage
1) A strep erythrogenic toxin 2) Botulinum Toxin 3) Cholera Toxin 4) Diphtheria exotoxin 5) Shiga Toxins (ABCD’S)
DNA repair mechanism affected in xeroderma pigmentosa
DNA single stranded, nucleotide excision repair
DNA repair mechanism associated with HNPCC/ Lynch
DNA mismatch Repair
DNA repair mechanism defective in ataxia telangiectasia and Fanconi Syndrome
Nonhomolygous end joining (DS breaks)
DNA repair mechanism defective in breast/ ovarian cancer
BRCA1/2 causes defective homologous recombination
Experiencing the self as either all bad or as all good
splitting
Channeling an unacceptable impulse into an appropriate behavior (Wanting to fight someone but signing up for boxing instead)
sublimation
Common infection seen in diabetic patients causing a sinus infection that rapidly spreads to involve the orbit and brain
Rhizopus causing mucormycosis
Fungal infection that causes fever, hemoptysis, chest pain and dyspnea, also growing mold.
Invasive Pulmonary Aspergillosis seen in immunocompromised.
Causes of pill-induced esophagitis
NSAIDs, bisphosphonates, tetracyclines, potassium chloride, ferrous sulfate.
Endoscopy with histology showing elongation of the lamina propria, basal zone hyperplasia, and scattered eosinophils and neutrophils
GERD
Bronchoscopy shows fibrosis, egg shell calcifications and bifringent particles
Silica
pt with SOB and co-workers who share similar sx; Bronchoscopy shows non-caseating granulomas with no associated particulate
berylliosis
Variety of bodily complaints lasting for months to years, associated with persistent thoughts and anxiety about symptoms. May co-occur with an illness- Tx with recurrent office visits
Somatic Symptom Disorder
Histology of liver shows microvesicular steatosis(small fat vacuoles in cytoplasm); Nausea, vomiting, abnormal LFTs, increased PT and PTT; Hyperammonia leading to encephalopathy
Reyes Syndrome
de novo mutation MCEP2 of the x-chromosome; causes regression of cognitive, motor, and verbal ability in girls between the ages of 1-4. Also include growth failure, ringed hand movements, seizures and Ataxia
Rett Syndrome
Coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movement, claw hand deformity, kyphoscoliosis, increased plasma levels of lysosomal enzymes; typically a fatal disease
I cell Disease
Deficient Enzyme in lysosomal storage disease and MOA
N_acetylglucosaminyl-1-phosphotransferase; deficiency results in failure of the golgi apparatus to phosphorylate mannose residues leads to proteins getting secreted extracellularly instead of being transported to the lysosome.
SAEs of Cephalosporins
Autoimmune, Hypersensitivity reaction, hemolytic anemia, disulfiram like reaction, Vitamin K deficiency, Increase nephrotoxicity of aminoglycosides
Causes of spherocytosis
Hereditary spherocytosis (ankyrin, spectrin, band 3 protein, etc), drug and infection induced hemolytic anemia
triggers of vasospastic angina
dihydroergotamine (migraine drug that causes vasoconstriction) via stimulation of alpha-adrenergic and serotonin receptors; cigarette smoke, cocaine, amphetamines, triptans (migraines)
Initiating event of acute appendicitis
obstruction first (fecalith) infection later.
+ Cyanide-nitroprusside test and aminoaciduria on urinalysis
Cystinuria
Autosomal recessive defect in Sodium independent amino acid transporters on the apical membrane of intestinal and PCT cells preventing absorption of dibasic Amino acids (cysteine, ornithine, lysine, Arginine (COLA))
Cystinuria
myxomatous changes with pooling of proteoglycans in the media layer of large arteries predispose you to what conditions
aortic aneurysms, and aortic dissection
Hyperplastic arteriolosclerosis is associated with proliferation of what that produces onion skinning
intimal smooth muscle hyperplasia
inheritance pattern of G6PD Deficiency
X-linked Recessive
Patient receives medication and develops jaudince, dark urine, hemolytic anemia on labs, decreased haptoglobin and blood cells show dark inclusion bodies; there is also a history of these type of events
G6PD deficiency
older patient (in 70s), post-prandial epigastric pain that is not relieved with antacids, weight loss, food aversion along with a significant medical history of CABG, etc
colonic mesenteric ischemia
+ niklosky sign (sloughing of skin on manual light touch) characterized by fever and sloughing of the skin that heals completely
Scaled Skin syndrome caused by staph aureus
cell-mediated hypersensitivity is what kind of hypersensitivity reaction
Type IV Hypersensitivity Reaction mediated by Th1 cells
Lactase deficiency presents with what manifestations
In addition to indigestion and steatorrhea, you get decreased stool pH because bacteria convert lactulose to FA–> acidification of the stool, increase stool osmolality due to excess water in stool, and increased hydrogen gas on a breath test because it a byproduct of bacterial fermentation of lactulose.
skin manifestation associated with celiac disease
dermatitis herpetaformis
Biggest complication of psoriasis
psoriatic arthritis; seronegative spondyloathropathy
Severe headache, pan-hypopituitarism (decreased libido,etc), bitemporal hemianopsia, ophthalmoplegia
Pituitary apoplexia/ hemorrhage
S-100 + malignancies
melanoma, Schwannoma, Langherhans Histiocytosis (presents as a lytic bone lesion in children- Langherhans cells are functionally immature and don’t stimulate T cells)
Hypospadias
below the penis; failure of the urethral fold to fuse
Epispadias
Hole on top; Failure of the genital tubercle to position itself properly
Manifestrations of Chlamydia with strains L1-L3
Lymphogranuloma venerum
Manifestations of Chlamydia with strains A-C
Chronic infection, cause blindness due to follicular conjunctivitis
Severe, acute pain testicular pain with absence of cremasteric muscle reflex and high riding testicles
Testicular torsion
causes of Congenital Hydrocele
caused by incomplete obliteration of the process vaginalis
Schiller duvall bodies, elevated AFP, tumor seen in children
Yolk sac tumor
GnRH Analog used to treat prostate cancer
Leuprolide
Androgen Receptor Inhibitor used to treat prostate cancer
Flutamide
Alpha-1 Antagonist with anti-hypertensive properties used to treat BPH
Terazosin
Alpha-1 Antagonist used to treat BPH in normotensive patients
Tamsulosin
PDE inhibitor used to treat BPH and erectile dysfunction
Sildenafil
Class IA Anti-arrythmic’s
Disopyramide, Quinadine, procainamide (Curtain pulled and tilted mic) (prolong phase 0 upstroke, and the refractory period– increased duration of AP)
Class IB Anti Arrhythmic’s
Mexlitine, Phenytoin, lidocaine (Decrease AP duration; prolong phase 0 upstroke)
Class IC Anti Arrhythmic’s
Flecanide, Propafone (No change in AP duration, prolong phase 0)
Supplementation for Breast fed infants
Vitamin D and Fe
Port wine stains, painful abdomen, polyneuropathy, psychological disturbances, precipitated by drugs (alcohol or starvation)
Porphobilinogen deaminase deficiency- Acute intermittent porphyria
Blistering cutaneous photosensitivity predominately affecting the hands; exacerbated by alcohol and associated with Hep C
Uroporphyrinogen Deaminase (most common)- Porphyria cutanea tarda
microcytic anemia, basophilic stippling of RBCs, ringed sideroblasts, GI and Kidney disease; presents with mental deterioration in children; in adults it presents with headache, memory loss, demyelination
Lead poisoning (inhibits ferroketolase and ALA Deaminase)
Treatment of Acute Intermittent prophyria
Heme and glucose inhibit Ala Synthase
Ringed siderblasts; Anemia can be inherited (X-linked), acquired (myelodysplastic syndrome), and reversible (Vitamin B6 deficiency, Cu deficiency, lead, isoniazid, chloramphenicol)
Sideroblastic Anemia (deficient ALA Synthase)
Features of hypomania
last greater than 4 days, patients are a lot more productive, they need less sleep; No psychotic features marked enough impairment to merit hospitalization
Features of Mania
> /= 1 week; distractibility, impulsivity, indiscretion– seeks pleasure without regard to consequence, grandiosity (inflated self-esteem), flight of ideas (racing thoughts), increased goal directed activity/ psychomotor agitation, decreased need for sleep and talkativeness/ pressured speech
POMC
ACTH, beta endorphin MSH
Obstructive hydrocephalus (nausea, vomiting, papilledema) due to aqueduct stenosis; vertical gaze palsy, pupillary light-near dissociation (pupils that react to accommodation but not to light), lid-retraction (collier sign), and convergence-retraction nystagmus
Parinaud Syndrome caused by pineal gland tumor
Bradycardia, diarrhea, muscle weakness, seizures, coma
Organophosphate poisoning
Treatment for organophosphate poisoning
Atropine (mAChR antagonist)
1st neuron lesions that cause horner syndrome
1) syringomyelia 2) Bernard- Sequard 3) pontine hemorrhage 4) Spinal cord lesion about T1
2nd neuron lesions that causes horner syndrome
Pancoast tumor
3 rd neuron lesion that causes horner syndrome
carotid dissection, carotid endardectomy
Anti-mitochondrial Antibody
Primary Biliary Cirrhosis/ Sclerosis
Anti-dsDNA, Anti-sm, anti-phospholipid antibodies
SLE
HPV 6 and 11 has a predilection for what part of the respiratory tract?
true vocal cords because these have stratified squamous epithelium which it can infect (also found in the vagina, anal canal, and cervix)
Key difference between Anorexia and bulimia
bulimics tend to maintain their weight at or above normal level; anorexics tend to binge and purge or restrict until there is significant physiological changes including hairless, osteoporosis, decreased heart size, etc.
K+ sparing diuretics
Epleronone (apple) spironolactone (apple)
weird SAEs of corticosteroids
Sleep disturbances, hypomania, psychosis, neutrophilia (inhibit demmargination) peptic ulcer disease, GI bleeding (decrease PG), proximal muscle weakness, and hypogonadism
Fracture of the femoral head or neck can create insufficiency in which branch of the femoral artery leading to avascular necrosis
medial femoral circumflex artery
Saline microscopy
Wet mouth; Trichamonis and Gardnerella
Passive immunity/ available antitoxins- short span antibodies that have rapid onset
tetanus toxin, botulinum toxin, HBV, Varicella, Rabies Virus, diphtheria,
Streptolysin O function in strep
lysis RBCs and leukocytes (beta-hemolysis); responsible for the Anti-ASO titers that occur after strep infection
DNase function in Strep
DNase is an enzyme that catalyzes plasminogen to plasmin allowing spread through infected tissues (this is why its used as an anti-thrombotic agent)
Function of M proteins in Strep
antigen; anti-phagocytic virulence factor and prevents activation of compliment
Consequences of malrotation of the gut
Malrotation is typically asymptomatic but can cause volvulus later in life; this cause ischemic necrosis of the bowel; sigmoid volvulus in elderly, midgut in children
heparin induced thrombocytopenia treatment
protamine sulfate
Inherited mutation associated with ALS
Superoxide Dismutase I;
Gene mutated in Spinal Muscular Atrophy (Werdnig-Hoffmann Disease); how does it present
SMN1: Anterior horn–> therefore LMN in infant
Presentation of ALS
SPARES SENSORY AND BLADDER/BOWEL; dysarthria, dysphagia asymmetric limb weakness, atrophy, fasciculations; pseudo bulbar palsy, spastic gait, clonus ;
Mutation and chromosomal association of Friedriech Ataxia
AR on Chromosome 9; GAA repeat in the Frataxin Gene which is an iron binding protein in mitochondria
Child with a staggering gait, kyphoscoliosis, nystagmus, dysarthria, pes cavus, hammer toes, diabetes mellitus, and hypertrophic cardiomyopathy which is often the cause of death
Friedriech Ataxia
Rapid correction of hypernatremia
Cerebral edema/ herniation
Rapid correction of hyponatremia
Cerebral pontine Myelinosis (osmotic demyelination); dysphagia, dysarthria, diplopia, loss of consciousness (locked-in syndrome)
lower extremity weakness and sensory deficits with foot deformities (pes cavus, hammer toe)
Charcot-Marie-Tooth Disease
Mutations associated with Charcot marie tooth disease
Autosomal Dominant- CMT1A and PMP22
post wine stain (nevus falmmeus; CNV1/V2 distribution), ipsilateral leptomeningeal angioma which causes epilepsy/ seizures, intellectual disability, and episcleral hemangioma which causes increased introcular pressure leading to early onset glaucoma
Sturge Weber Syndrome
Mutation associated with Sturge Weber
congenital, non inherited (sporadic) developmental anomaly of neural crest derivatives due to somatic mosaicism –> an activating mutation in GNAQ gene affecting small arteries
hemangioblastomas in the retina, brain stem, cerebellum, spring; angiomatosis (cavernous hemangioma in the skin, mucosa, organs), bilateral RCC, pheochromocytoma.
VHL Disease
Mutation associated with VHL
Deletion of VHL gene on chromosome 3p; AD; pVHL ubiquitinates hypoxia inducible factor 1a (HIF)
stool sample of strongy will show what findings?
Larva
Child undergoes fasting >24hrs, becomes lethargic and develops a seizure. Labs show 0 ketones, elevated LFTs, and low glucose. Enzyme deficient?
Acetyl-CoA Dehydrogenase; This is not a glycogen storage issue (glycogen is depleted in 6-8 hours), hypoketonia indicates fatty acid oxidation issue.
People that carry MRSA are most likely to be infected where?
The Anterior nares
peripheral Blood smear showing enlarged red blood cells that stain blue with Wright Giemsa Stain
rRNA in reticulocytes
What segment of the colon is always involved in Hirschsprung’s Disease?
The rectum, sigmoid colon is involved only 75% of the time
Antibody Dependent Cell Mediated Toxicity
Parasitic infections (parasite is bound by IgE and IgG–> binds Fc portion on Eosinophil–> degranulation–> released of major basic protein and O2 species for destruction) similar to NK cell killing in TII HS Rxn
Pt w/ a hx of gastrectomy presents with positive romberg, loss of vibration and sense, atrophic gastritis (smooth tongue) and symmetrical loss of strength in the proximal extremities
Vit B12 deficiency
Unilateral facial pain that worsens with chewing, hearing loss, headache and eye discomfort
Temporomandibular disorder that arise from motor dysfunction of the Mandibular nerve (V3 or Trigeminal) More specifically, TMJ damage can affect the tensor tympani (muscle in ear) because its innervated by V3 motor fibers
Cytokines involved in the systemic inflammatory response
TNF-alpha, IL-1, IL-6
Neutrophilic chemotactic factors
LTB4, C5a, C3a,
Charcot Bouchard Micro-aneurysm (HTN)
Intracerebal hemorrhage
Sudden HA, Xanthochromia on LP, bleed on bottom of the brain, Berry/ Saccular Aneurysm
Subarachnoid Hemorrhage
Defect in a berry/ Saccular aneurysm (why do they burst)
They lack a media layer
Duret hemorrhages or posterior cerebral artery compression (visual defects)
Transtentorial herniation
Down and out eye with mitosis
CNIII- Uncal herniation
Herniation resulting in cardio-pulmonary arrest
cerebellar tonsil herniation
Anterior cerebral artery compression herniation
Cingulate gyrus under the faux cerebri
Dgx of tumor if Histo shows: pleomorphic tumor cells bordering areas of central necrosis, hemorrhage and/ or microvascular proliferation.
GBM
CNS tumor: abundance of whorled cells with hypervascularity (Adults) and psammoma bodies
meningioma
CNS Tumor: spindle cells alternating with hypo cellular, myxoid areas
Schwannoma
CNS Tumor: round cells with blue nuclei and a rim of clear cytoplasm(adults)
Oligodendroglioma
CNS Tumor: Astrocytes with thick eosinophilic processes also called rosenthal fibers (child)
Pilocytic astrocytoma
CNS Tumor: small, round cells with homer wright rosettes (child)
Medulloblastoma
CNS tumor: Perivascular rosettes (child)
Ependymoma
CNS tumor: bitemporal hemianopsia in a child
Craniopharyngioma (Rathke’s pouch remnant)
