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Step One Pharmacology > Will's random shit > Flashcards

Will's random shit Flashcards

1
Q

Baker Cyst

A

Site is at popliteal artery (Associated with arthritis) = outpouch swelling behind knee of synovial pouch/fluid

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2
Q

Most common peripheral artery aneurism

A

popliteal artery at popliteal fossa

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3
Q

Winter’s Formula What is it used for? what is the formula?

A

Used to evaluate respiratory compensation during metabolic acidosis. Answers the question, is there a concurrent respiratory alkalosis/acidosis? PaCO2= (1.5xbicarb) + 8 +- 2

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4
Q

Superior gluteal nerve damage cause s.s

A

cause: L4-S1; posterior hip dislocation or polio Innervates gluteus medius, minimus, and tensor fascia lata Trendelenburg sign; while walking patient hip will drop to unaffected side cannot abduct thigh

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5
Q

Obturator nerve damage Cause s/s

A

L2-4, anterior hip dislocation Innervates medial thigh. Will have troble with thigh adduction and medial skin sensory

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6
Q

Femoral nerve damage Cause S/s

A

L2-4; pelvic fracture Supplies muscles to anterior thigh and skin (some medial leg) Damage: cannot flex thigh to body or extend leg from knee. -absent patellar reflex

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7
Q

Common peroneal vs tibial nerve cause s/s

A

Both supplied by sciatic (posterior thigh splits into peroneal and tibial) dmg:lateral leg fibular dmg PED: Peroneal, Everts, Dorsiflexes -> Dmg = foot dropPED dmg: knee/tibial trauma TIP: Tibial, Inverts, Plantar flex -> Dmg = cannot stand on TIPtoe

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8
Q

Inferior gluteal cause s/s

A

posterior hip dislocation cant jump, climb stairs, rise from seat…. can’t push down

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9
Q

serratus anterior damage and innervation

A

innervated by long thoracic nerve attatched lateral ribs 1-8 and medial border of scapula dmg -> winging of scapula; holds it in place in order to abduct arm

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10
Q

cancellous bone =?

A

cancellous = spongiosa/spongy bone = trabecular bone

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11
Q

cortical bone

A

hard, supporting bone, most of the peripheral limb bones

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12
Q

osteopetrosis

A

normal bone marrow is filled with spongy bone, bones are harder but more brittle

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13
Q

HLA subtype associated with disease HLA-A3

A

Hemochromatosis HLE gene assoc with C282Y chromosome 6

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14
Q

HLA subtype associated with disease HLA-B27 (4)

A

Psoriasis, Ankylosing spondylitis, Inflammatory Bowel Disease, Reiter’s sundrome(reactive arthritis)

PAIR: seronegative spondyloarthropathies

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15
Q

HLA subtype associated with disease HLA-DQ2/DQ8

A

Celiac disease

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16
Q

HLA-DR2 (4)

A

MS, hay fever, SLE, goodpastures, UC

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17
Q

HLA subtype associated with disease HLA-DR3 (2)

A

DM I, Graves disease

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18
Q

HLA-DR4 (2)

A

RA, DM I

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19
Q

HLA-DR5

A

Pernicious anemia Hashimoto’s thyroiditis

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20
Q

HELLP syndrome associations and acronym

A

Hemolysis (microangiopathic) Elevated Liver enzymes (likely as above) Low Platelets (part of activated coag cascade) -associated with pre-eclampsia

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21
Q

Pre-eclampsia risk factors (4) and definition

A

DFN: HTN, Proteinuria, edema post 20wks up to 6 wks after delivery (occurs in 7% of women) RISKS: HTN, DM, CKD, Autoimmune problems Tx; delivery, bed rest, tx htn, Iv mag if seizures

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22
Q

Gardeners syndrome

A

FAP (chrom 5q, Aut Dom, tumor suppressor) + with osteomas and soft tissue tumors, congenital hypertrophy of retinal pigment

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23
Q

Turcot’s Syndrome

A

FAP + malignant CNS tumors (medulloblastoma/glial cell) Turcot = Turban

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24
Q

Trisomy 18

A

Edwards Syndrome (Election age at 18) 2nd most common trisomy in LIVE births S/S low set ears, clenched fist, prominent brow, microcephally (and basically any neural tube defect), rocker bottom feet, (E)dwards has low Estradiol **death in a year

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25
Q

Trisomy 13

A

Patau’s syndrome (Puberty at 13) S/S prosencephally, polydactyly, omphalocele, NUCHAL TRANSLUCENCY **DOES NOT HAVE clenched hands/overlapping fingers ***Death in a year

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26
Q

47 XXX

A

typically clinically silent

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27
Q

Congenital microdeletion of 5p

A

Cri-du-chat chr5 short arm deletion, S/S microcephaly, mental retardation, high pitch cry/mewing, VSD

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28
Q

Williams syndrome

A

Chr.7 deletion (includes elastin S/S elven facies, intellectual disability, hypercalcemia (increased Vit D sensitivity), well developed verbal skills, too friendly with others. CVD problems

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29
Q

Tumor marker PSA

A

Follow prostate carcinoma. may be elevated in BPH. Questionable as screening tool

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30
Q

Tumor marker Prostatic acid phosphatase

A

Prostate carcinoma. remember that tumor markers shold not be used as primary tool for diagnosis. Have to do histology

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31
Q

Tumor marker CEA

A

nonspecific, but produced by 70% colorectal and pancreatic CA may also be in gastric, breast, medullary thyroid carcinoma

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32
Q

Tumor marker alpha fetoprotein

A

hepatocellular carcinoma nonseminomatous germ cell tumors (yolk sac)

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33
Q

Tumor marker b-hcg

A

hyadidiform mole choriocarcinoma

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34
Q

Tumor marker ca-125

A

Ovarian cancer

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35
Q

Tumor marker s-100

A

melanoma, neural tumors, schwannoma

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36
Q

alk phosphatase

A

metastases to bone, liver, pagets disease of bone

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37
Q

bombesin

A

neuroblastoma, lung, gastric cancer

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38
Q

TRAP

A

hairy cell B cell leukemia

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39
Q

CA 19-9

A

pancreatic adenocarcinoma

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40
Q

calcitonin

A

medullary carcinoma of the thyroid (c cells)

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41
Q

Charcot-Bouchard microaneurysm What are they? Where?

A

Small < 1mm diameter aneurisms in basal ganglia, internal capsule, thalamus Associated with long standing HTN. **They’re intrparenchymal

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42
Q

Multiple intraparenchymal hemorrhages in an elderly person Cause?

A

B-Amyloid cerebral angiopathy. Not associated with systemic amyloidosis or alzheimers.

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43
Q

Berry aneurysm/saccular aneurysm

A

Occurs at bifercations of circle of willis (most commonly ACA). -> subarrachnoid hemorrhage RISK: ADPKD, ehlers danlos, marfan, smoking, htn

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44
Q

end plate potential

A

The voltage change at the site of NMJ interaction (the immediate response to acetylcholine binding)

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45
Q

CD31

A

PECAM-1: expressed on endothelial cells. Helps migration/diapedesis. ** Can be used to differentiate tumor origin

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46
Q

CD 16

A

Fc receptor

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47
Q

CD18

A

Integrin

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48
Q

CD 14

A

LPS PAMP on macrophages

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49
Q

munro microabscesses = ?

A

Neutrophils in stratum corneum in psoriasis

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50
Q

parakeratosis

A

hyperkeratosis with retention of keratinocyte nuclei in stratum corneum (psoriasis)

psoriasis also causes acanthosis (stratum spinosum hyperplasia)

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51
Q

specialized vs generalized transduction

A

Lysogenic cycle: virus just chilling specialized is when bacterial gen ends up in viral capsid what was close to the viral insertion point in the DNA Lytic cycle: virus kills cell Generalized is when the cell bursts and random DNA is incorportated during cell death

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52
Q

Melanoma common mutation? Tx?

A

Common BRAF kinase mutation Tx; excision 2nd vemurafenib (BRAF kinase inhib) if BRAF +

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53
Q

Achondroplasia mutation inheritance

A

mutation is activation of FGFR3 which inhibits chondrocytes inherited AD, but usually sporatic mutation, associated with advanced PATERNAL age

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54
Q

Osteogenesis Imperfecta Inheritance how blue sclera?

A

AD usually collagen type I Blue sclera from thin sclera, you can see the choroidal veins (which are part of the vascular network btw the sclera and retina

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55
Q

Osteomyelitis seeding children? adults?

A

Children bacteria seed the metaphysis Adults the epiphysis is most commonly seeded

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56
Q

Causes of aseptic necrosis of bone

A

Trauma/fx (most common) #steroids #Caisson disease (decompression sickenss with nitrogen occluding bone vasculature

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57
Q

Osteomyelitis causes (6)

A

Staph aureus; most common (90%) N gonnorrhoeae- sex Salmonella- sickle cell pseudomonas- diabetics/drug users Mycobacterium tb- pott’s disease (vertebrae)

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58
Q

invasive gastroenteritis organisms

A

salmonella, shigella, campylobacter, EIEC, + enameoba histolytica

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59
Q

suprachiasmic nucleus

A

hypothalamic nuclei: regulates sleep

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60
Q

what’s the most commonly injured ankle ligament

A

from INVERSION injury and tear of ATFL, anterior talofibular ligament “always tear first ligament” 2nd: calcaneofibular ligament 3rd: posterior talofibular ligament

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61
Q

What is the medial ankle ligament?

A

deltoid ligament

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62
Q

dorsal interosseous muscles do what? palmar interosseous muscles do what?

A

DAB: Dorsal abduction PAD: palmar adduction

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63
Q

Tumors that like to metastasize to bone

A

Prostate -> blastic lesions*** Renal Cell Carcinoma Testicular/Thyroid Lung -> lytic lesions Breast -> lytic/blastic “Permanently Relocated Tumors Like Bone” ***most are lytic except prostate

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64
Q

Tuberous Sclerosis findings

A

HAMARTOMAS Hamartoma’s of CNS and skin

Adenoma sebaceum (cutaneous angiofibromas)

Mitral regurgitation

Ash-leaf spots

Rhabdomyoma (cardiac, benign)

Tuberous sclerosis dOminant (autosomal)

Mental retardation

Angiomyolipoma (renal)

Seizures variabille expressivity, incomplete penetrance hamartin or tuberin protein mutation

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65
Q

Pseudogout What deposition and where Diagnosis Tx

A

Deposition of calcium pyrophosphate in joint space usually of larger joints (knee)

Basophilic thomboid crystal weak positive birefringence blue on parallel light (vs gout which is yellow on parallel light)

Tx; NSAIDS, steroids, colchicine

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66
Q

Actinic keratosis

A

precursor to squamous cell carcinoma (dysplastic)

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67
Q

keratoacanthoma

A

Squamous cell carcinoma that grows rapidly (4-6 weeks) and may regress spontaneously. characterized by keratin cup filling the center.

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68
Q

What is the most common cancer from immunosuppressive therapy?

A

Squamous Cell carcinoma

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69
Q

Which type of sunlight is the worst for cancer dmg? Which type is responsible for sunburns? How about tanning

A

UVB -> cancer and sunburns

UVA -> less cancer, tanning

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70
Q

What enzyme in the kidney inactivates 25-dihydroxy vitamin D?

A

24-hydroxylase in the kidney may inactivate it -> 24,25-dihydroxy vitamin D

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71
Q

What are the two ligands for osteoclast differentiation? Where do they come from? What cell lineage do osteoclasts come from?

A

RANKL and M-CSF (macrophage colony stimulating factor), comes from osteoblasts, the lineage is from mononuclear cells

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72
Q

osteoblast cell lineage? chondrocyte cell lineage?

A

Both come from mesenchymal stem cells

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73
Q

What are you thinking if you have a fat tumor with lipoblasts?

A

lipoblasts= Liposarcoma (most common malignant soft tissue tumor in adults), vs lipoma which is most common benign.

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74
Q

What is most common malignant soft tissue tumor in children?

A

Rhabdomyosarcoma classic site is vagina in female (grape like protrusion)

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75
Q

Dermatomyositis S/S Labs associations tx;

A

proximal muscle weakness with skin symptoms (malar rash, gottron’s papules (papules on nuckles), heliotrope rash (eyelids). “mechanic hands, shawl and face rash” CD4+ t cell perimysial inflammation and atrophy. Labs: Increased CK, positive ANA, positive anti-jo-1 *associated with malignancy (often gastric) Tx; steroids **This condition is in contrast to polymyositis that’s endomysial, increased MHC I, no skin involvement. Similar labs and Tx. Not associated with malignancy

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76
Q

What is urushiol?

A

a small substance that acts as a hapten (must attach to random protein to become allergenic) -poison oak, sumac, and Ivy all have urushiol type Iv

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77
Q

What does Alpha 1 antitrypsin stain?

A

Stains purple with PAS (periodic acid schiff) Smoking makes the disease worse by oxidizing and inactivating the antitrypsin at a methionine residue

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78
Q

3 causes of HIV esophagitis

A

1) candida 2) HSV-1 vesicles -> punched out erosions 3) CMV linear ulcer/erosions

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79
Q

HLA DR1

A

Chrohn’s predisposition

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80
Q

femoral neck fracture most commonly injures which vessel

A

the medial circumflex femoral bc it supplies the majority of the blood supply to head and neck (injury = avascular necrosis)

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81
Q

What artery supplies the SA and AV nodes?

A

RCA

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82
Q

If you have increased AFP in serum/amniotic fluid, what’s a helpful confirmatory test for neural tube defect?

A

Elevated AChE **these elevations are from failure of neural tube(spinal canal) to close and a persistent connection with the amniotic cavity.

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83
Q

signs of anencephaly risks

A

increased AFP, AChE, polyhydramnios (lost swallowing center in brain) –brain develops normally but acidic amniotic fluid destroys it RISKS: maternal DM I, and low folate

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84
Q

Risks of holoprosencephaly

A

patau’s (trisomy 13), fetal alcohol syndrome Sonic Hedgehog mutations

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85
Q

GFAP

A

astrocyte marker (intermediate filament) used to ID tumors ie: glioblastoma benign pilocytic astrocytoma

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86
Q

Microglia response to HIV infection in cns

A

become multinucleated giant cells

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87
Q

Large clear fired egg appearance found in (3)

A

oligodendrocytes koilocytes of HPV infection Seminoma

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88
Q

guillan-Barre S/S Damage to what? Risks

A

S/S ascending bilateral plegia/paresis/paresthesia (hands and feet) Damage to schwann cells Risk: campylobacter or CMV infection

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89
Q

Bilateral acoustic neuroma

A

Neoplasm of schwann cells NF-2

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90
Q

Who does reactive gliosis?

A

Astrocytes (the support cells with fibroblast like scar tissue repair)

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91
Q

what embryologic origin are ependymal cells derived from?

A

Neural ectoderm

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92
Q

wallerian degeneration

A

dmg to axon with proximal retraction and distal degeneration

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93
Q

Fenestrated regions of BBB

A

area postrema -> vomiting esp after chemo) OVLT- osmotic sensing (organum vasculosum of the lamina terminalis) hypothalamic input and output permeat BBB such as part of neurosecretory product: ADH, oxytocin

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94
Q

location of NE production in brain what lvls associated with anxiety and depression?

A

locus ceruleus (pons) increased in anxiety decreased in depression

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95
Q

location of dopamine production in brain lvls assoc with schizo, parkinsons, depression

A

ventral tegmentum in midbrain (-> cortex or -> limbic)

SNc -> neostriatum

schizo is increased dopamine mesolimbic (positive symptoms) vs decreased mesocortical (negative symptoms),

parkinsons is decreased,

depression is decreased

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96
Q

Serotonin location and association with anxiety and depression

A

raphe nucleus (pons) decreased in anxiety and depression

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97
Q

ACh CNS location and assoc with alzheimers, huntingtons, REM sleep

A

ACh is basal nucleus of meynert alzheimers decreased (meynert degeneration) huntingtons decreased REM sleep increased

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98
Q

GABA location and assoc with anxiety and huntingtons

A

Nucleus accumbens (reward center), decreased in anxiety and huntingtons (causes choreoform from excess muscle excitation)

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99
Q

Glycine neurotransmitter

A

main inhibitor in spinal cord GABA is main in CNS

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100
Q

Reticular Activating System does what?

A

mediates attentiveness and consciousness

its in midbrain and above

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101
Q

Schizophrenia dopamine issues

A

you have increased dopamine in limbic system -> positive symptoms you have decreased dopamine in cortex -> negative symptoms

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102
Q

What is the bundle of bilateral nerves that link broca’s area in the frontal cortex to wernicke’s area in the temporal lobe?

A

Arcuate fascicles

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103
Q

Where does the vagus nerve run in the neck?

A

Within the carotid sheath with the common carotid and internal jugular vein

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104
Q

blood supply to brain stem and cerebellum?

A

basalar artery (also pontine aa supply pons) and vertebral arteries,

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105
Q

Conduction aphasia

A

poor repetition (cannot repeat no ifs ands or buts) can comprehend and speak fluently dmg; arcuate fasciculus

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106
Q

global aphasia

A

nonfluent aphasia with impaired comprehension. Broca(nonfluent) and wernicke’s(fluent) fucked up

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107
Q

Dysprosody dmg result

A

damage is non dominant hemisphere brocas: cannot express emotions/inflection wernicke’s: can’t understand emotion/inflection

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108
Q

Gerstmann syndrome

A

lesion to dominant angular gyrus (left sided parietal lobe) -agraphia (inability to write) -acalculia (bad math) -R/L disorientation -finger agnosia (can’t tell difference)

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109
Q

Hemispatial neglect

A

lesion to nondominant parietal lobe (draw clock on one side, don’t shave)… usually right sided

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110
Q

Frontal cortex lesion

A

disinhibition, poor judgement, primitive reflexes

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111
Q

prefrontal cortex

A

poor executive function

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112
Q

Frontal eye field lesion (which is in cortex/controls eye movement)

A

lesion wil deviate eyes ipsilateral to lesion

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113
Q

PPRF lesion: paramedian pontine reticular formation pontine area

A

eyes will deviate contralateral to lesion it’s in the medial pons near MLF

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114
Q

Superior colliculus lesion (parinaud’s syndrome) in brainstem

A

paralysis of upward gaze (they look downward)

can occur from pineal gland germ cell tumor or stroke

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115
Q

RAS damage

A

stupor and coma

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116
Q

hippocampus lesion bilaterally limbic system

A

anterograde amnesia (cannot make new memories)

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117
Q

mamimillary body lesion limbic system

A

wenicke korsakoff: eyes, lies capsize confusion, confabulation, ataxia, memory loss (anterogrand and retrograde amnesia) Don’t give glucose without B1 to B1 deficient patient (may precipitate condition

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118
Q

amygdala limbic system

A

bilateral amygdala lesions kluver bucy syndrome: hyperorality (likes putting things in mouth), hypersexual, disinhibited behavior (not afraid), docile, extreme curiosity HSV 1 association

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119
Q

Hemiballismus

A

lesion of subthalamic nucleus lesion involuntary flailing of one arm

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120
Q

what cerebellar lesion could produce dysarthria?

A

cerebellar vermis lesion

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121
Q

Nuclei locations of CN’s

A

1 2 forebrain 34 midbrain 5678 pons “5 6 7 8 cheer with pom pons” 9 10 12 medulla 11 spinal cord

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122
Q

homonymous hemianopsia

A

lesion of optic tract (not nerve) with one sided visual loss

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123
Q

lesion of center of visual field

A

lesion of macula (ie macular degeneration)

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124
Q

homonymous hemianopsia with macular sparing

A

lesion of posterior cerebral artery. Macula is spared bc it gets collateral from middle cerebral (its important)

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125
Q

myopia

A

near sighted, predispose to retinal detatchement. retinal detatch also associated with diabetic traction and inflammatory effusions

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126
Q

What conditions can cause a facial nerve palsy?

A

ipsilateral FULL FACIAL paralysis vs motor cortex contralateral lesion of just lower face “Lovely Bella Had An STD” -Lyme disease -Bells palsy = idiopathic -HSV and zoster (likely termed idiopathic) -AIDS -sarcoidosis -tumors -diabetes

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127
Q

The second arch contributes to what in the human?

A

facial nerve muscles (muscles of facial expression) and cnVII

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128
Q

Describe motor cortex lesion of face (like in a stroke)

A

motor cortex contralateral lesion of just lower face bc lower facial muscle is just innervated by contralateral side. Upper face is innervated by both sides of motor cortex So in acute presentation of face check eyebrows!!! if can move it’s probably a stroke, if not, likely facial nerve palsy

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129
Q

CN V (trigeminal) exit from skull

A

“Standing Room Only” -superior orbital fissure (w/3,4, 5, 6 -Rotundum -ovale

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130
Q

VII-XII exit

A

In posterior cranial fossa (temporal or occipital bones) VII-VIII internal auditory meatus IX,X,XI through jugular foramen XII hypoglossal canal

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131
Q

vagus nerve damage, uvula will deviate which direction?

A

To the opposite side of damage. Because the vagus elevates the soft papate

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132
Q

Nucleus Ambiguous innervation

A

aMbiguous: MOTOR innervation to pharynx, larynx, upper esophagus. SWALLOW AND SPEECH vaGUS from ambiGUUS IX, X cortical lesions affect both sides, no deviation

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133
Q

For hypoglossal lesion, what is the deficit?

A

CN XII is intrinsic tongue movement. tongue licks the lesion. deviate toward lesion cortical lesions affect both sides, no deviation

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134
Q

gag reflex test

A

CN IX, X IX is afferent, X efferent

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135
Q

cavernous sinus lesions

A

CN III, IV, VI pass through (opthalmoplasia with double vision) + V1 -> pain upper opthalmic branch V2 also passes through going down and medial: 3,4,V(1),V(2),6 internal carotid and postganglionic sympathetics also present there

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136
Q

Tongue sensation and movement

A

movement: XII somatosensation: trigeminal mandibular branch along with gums (anterior 2/3), post 1/3 is glossopharyngeal taste: ant 2/3 facial, post 1/3 glossopharyngeal, very back vagus

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137
Q

Nucleus Solitarius

A

A vagal nuclei VII, IX, X Sensory: taste, baroreceptors (carotid IX, aortic X), gut distension

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138
Q

where do the dorsal columns decussate?

A

The medulla, becoming the medial lemniscus

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139
Q

Vagal Dorsal motor nucleus

A

X sends parasympathetic to heart, lungs, upper GI

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140
Q

Where is the inferior olivary nucleus?

A

medulla

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141
Q

what artery supplies antero-medial part of medulla?

A

anterior spinal

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142
Q

what artery supplies the nucleus ambiguus?

A

PICA

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143
Q

Z = what for the 95% CI and 99% CI

A

Z= 1.96 Z= 2.58

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144
Q

what is the corticobulbar/corticonuclear tract?

A

brings motor from cortex to brainstem, carrying the non-oculomotor CNervs

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145
Q

What does the posterior internal capsule carry?

A

Most of corticospinal tracts and somatic sensory, visual, and auditory fibers

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146
Q

what does the anterior internal capsule carry?

A

some of the thalamocortical fibers

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147
Q

where is the substantia nigra?

A

midbrain ventral tegmentum is there too (midline midbrain assoc with reward pathways)

http://what-when-how.com/wp-content/uploads/2012/04/tmp15F10_thumb.jpg

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148
Q

dopamine is increased or decreased in reward pathways?

A

It’s increased (as in drugs of abuse) in the mesolimbic pathway (same area of positive symptoms of psychosis)

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149
Q

Leber hereditary optic neuropathy

A

A mitochondrial inherited disease (heteroplasmy) leads to bilateral vision loss

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150
Q

Myoclonic epilepsy with ragged red fibers

A

Heteroplasmy inherited: myoclonic seizures and myopathy associated with excercise. Skeletal muscle biopsy shows ragged red fibers

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151
Q

Mitochondrial encephalopathy with lactic acidosis and stroke like epilepsy (MELAS)

A

Heteroplasmy: stroke like episodes, muscle weakness, increased serum lactate post exercise and at rest

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152
Q

UC difference in crc from sporatic

A

1) progress from flat nonpolypoid dysplasia 2) early p53 mutation 3) proximal colon involvement 4) mucinous w/signet ring 5) multifocal 6) affect younger pts

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153
Q

thymoma differential

A

1) pure red cell aplasia (or parvo or some lymphocytic leukemia’s) autoantibodies 2) myasthenia gravis

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154
Q

Rule of 4’s

A

1) 4 medial structures with M -motor (corticospinal) -> contralateral motor -medial lemniscus -> contralateral sensory -medial longitudinal fasciculus (MLF) -> ipsilater internuclear opthalmogplegia -motor cranial nerves (as below) 2) 4 lateral with S -spinocerebellar (coordinates movement ipsilateral) -> ips ataxia -spinothalamic tract (pain/sense) -> contralateral affected -sensory nucleus CN V -> ipsilateral pain/temp on face -sympathetic pathway -> ipsilateral horners 3) 12 34 5678 9,10,12 11 4) The medial motor CN nuclei divide into 12: 3,4,6,12

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155
Q

Wallenberg syndrome

A

PICA syndrome Lateral medullary lesion: 9 10 12 (some of V) spinothalamic: contralateral pain/temp trigeminal nucleus (huge) : ipsilateral face pain/temp Nucleus ambiguous: difficulty swallowing/hoarse voice descending sympathetic: ipsilateral horners vestibular nucleus: vertigo/nystagmus inferior peduncle (spinocerebellar tract) -> ataxia

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156
Q

What does PICA supply?

A

Lateral medulla

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157
Q

What does AICA supply?

A

Lateral pons

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158
Q

What does anterior spinal artery supply in brainstem?

A

middle medulla

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159
Q

Basal artery supplies?

A

middle pons; , more specifically the paramedian branches of basalar artery

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160
Q

MLF syndrome causes (2)

A

located in pons, helps eyes track adducting medial rectus palsy in ipsilateral MLF & contralateral abduction lateral gaze nystagmus cause: medial pontine stroke and MS

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161
Q

Locked in syndrome causes

A

only move eyes # stroke of medial pons # central pontine myelinolysis with rapid hyponatremia Na correction => find increased signal intensity in pons

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162
Q

Weber syndrome

A

anterior midbrain stroke from occlusion of paramedian branches of posterior cerebral artery infarct peduncles (corticospinal and corticobulbar tracts) -may affect CN III

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163
Q

What AA are modified in golgi? and in RER lysosome trafficking?

A

Golgi: O-oligosaccharides SERINE THREONINE +asparagine: N-oligosaccharides RER: N-oligosaccharides Asparagine glutamine: Lysosome trafficking from golgi of mannose-6-phosphate. DEFECT = I cell disease

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164
Q

Limbic system control

A

“primitive” part of brain + learning 5 Fs Feeding, fleeing, fighting, feeling, fucking

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165
Q

anterior hypothalamus nuclei

A

A/C = anterior cooling -> thermoregulation Damage => hyperthermia

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166
Q

suprachiasmatic nuclei

A

in hypothalamus regulates circadian rhythm “need sleep to be charasmatic”

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167
Q

Preoptic area

A

hypothalamus: secrete GnRH

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168
Q

supraoptic nucleus

A

anterior hypothalamus water balance: ADH damage: central DI

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169
Q

paraventricular nucleus

A

In anterior hypothalamus oxytocin: oxys= quick, tocos = birth +CRH, TRH

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170
Q

posterior hypothalamus

A

if you zap it you become a poikilotherm = cold-blooded, no heat production

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171
Q

lateral hypothalamic nucleus

A

hunger. destruction -> anorexia (shrink laterally). Inhibited by leptin

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172
Q

ventromedial hypothalamic nucleus

A

satiety. stimulated by leptin. damage=obesity. (grow ventrally) also savage behavior if damaged

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173
Q

melatonin secretion? derived from?

A

pineal gland secretes melatonin from seratonin follows circadian rhythm inhibits sex drive

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174
Q

kluver bucy syndrome

A

bilateral amygdala lesions kluver bucy syndrome: hyperorality (likes putting things in mouth), hypersexual, disinhibited behavior (not afraid), docile, extreme curiosity

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175
Q

psuedotumor cerebri

A

RISK: young obese women, ppl using vitamin A daily

pulsatile headache,

-retrooccular pain worse on movement

N/V

papilledema (increased ICP) but no hydrocephalus)

vision loss

NO TUMOR

NO dilation of VENTRICLES

LP -> ICP elevated

Tx; weight loss, acetazolamide, serial LP,

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176
Q

CSF generation where?

A

choroid plexus in the ventricles reabsorbed by arachnoid granulation

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177
Q

Normal pressure hydrocephalus vs hydrocephalus ex vacuo

A

Normal pressure has dilated ventricles that compress corona radiata -> wacky wobbly wet Hydrocephalus ex vacuo no increased ICP, just apparent bc of brain atrophy (alzheimers, HIV, Pick’s disease)

NORMAL PRESSURE HYDROCEPHALUS IS REVERSIBLE

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178
Q

elevated ICP usually damages what CN?

A

CN III -> palsy -> down and out eye presentation

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179
Q

spinal cord ends

A

L1-2

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180
Q

LP

A

L3/4 or 4/5 in children L4/5 L5/S1 L4 vertebra at iliac crest

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181
Q

intraventricular hemorrhage of newborn

A

most common in premature < 32wks and low birthweight neonates. occurs in first 72hrs of life originates in subgerminal matrix subependymal all newborns < 32 weeks should be screened by US for this

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182
Q

thrombolytic cutoff

A

4.5 hrs (max 6)

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183
Q

carotid sinus carotid body what monitor? what nerve?

A

carotid sinus = baroreceptor carotid body = chemosensation CNIX watches these

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184
Q

sturge weber syndrome

A

underlying vascular problems with Port wine stain in opthalmic V1 distribution

glaucoma, seizures, hemiparesis, intellectual disability

AVM from ipsilateral leptomeningeal angiomatosis

STURGE

stain, sporatic, unilateral portwine stain, glaucoma/GNAQ inactivation, epilepsy

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185
Q

what controls the parasympathetic system? sympathetic?

A

anterior hypothalamus -> parasympathetic

posterior hypothalamus - > sympathetic

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186
Q

Tx tension headache

A

NSAIDS: naproxen

Bilateral, nonpulsatile, over 30 minutes, steady pain without photophobia or phonophobia

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187
Q

Tx migraine headaches

A

-triptans sumatriptan

Unilateral, pulsating, +-aura, photophobia and/or phonophobia, made worse by foods with tyramine

increased risk stroke

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188
Q

-triptan

MOA

USE

SE

A

serotonin agonist

cause vasoconstriction modulate trigeminal nerve neurotransmission

USED: take as soon as start/aura migraine (PO) ,

2ndline cluster(IV)

SE: contraindicated CAD, prinzmetal, pregnancy

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189
Q

Tx cluster headache

A

100% O2 NRB: may abort in 5min, use for 15min

2nd line triptan

*nerve block, steroids

**more common in men, unilateral, ptosis, miosis, smokers

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190
Q

What conditions will tyramine make worse?

A

Cause a HTN crisis in MAOi takers

migraines

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191
Q

Where are VLCFA broken down?

A

In peroxisomes. Vs in the mitochnodria with LCFA and MCFA. branched chain FA are also broken down here (alpha oxidation)

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192
Q

calcified cystic mass in brain?

A

craniopharyngioma, often filled with brown fluid with cholesterol. lined by stratified squamous epithelium. Rathke’s pouch origin

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193
Q

length constant of neurons?

A

how far along an axon an electrical impulse can travel

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194
Q

time constant of neurons?

A

how long it takes for neurons to depolarize, myelin decreases time constant

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195
Q

Hageman factor actions?

A

Factor XII: proinflammatory protein produced by liver 1) Activated upon exposure to subendothelial/tissue collagen which leads to -coagulation cascade -complement activation (through kinin system) -XII @ kallikrein (kinin) -> @bradykinin -> pain and vasodilation, some vascular permeability

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196
Q

what is a population study?

A

an ecological study; vs a cross sectional study would use a disease and collect data at a PARTICULAR POINT IN TIME

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197
Q

what optic radiation goes through meyers loop?

A

Meyers loop passes through the temporal lobe and will give you a contralateral upper field defect (goes to lower part of occipital lobe)

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198
Q

calcarine fissure

A

divides visual fields in occipital lobe (upside down and R/L reversed

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199
Q

Metastatic cancers to brain location

A

multiple well circumscribed at grey-white junction Many TOP: Lung, Breast, Kidney

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200
Q

meningioma cell

A

more in adults (female) arachnoid cell, often present with seizure, compress but doesn’t invade whorled cells EXPRESSES ER receptor

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201
Q

glioblastoma multiforme cell

A

astrocyte, butterfly glioma, very malignant, GFAP positive with pseudopallisading located cerebral hemisphere

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202
Q

Pilocytic asrocytoma

A

benign tumor of astrocytes in children (most common tumor in children) “nodule growing on cyst wall” GFAP positive

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203
Q

Medullaroblastoma cells

A

malignant, most commonly in children, arising from neuroectoderm

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204
Q

salivation from parotid gland

A

Glossopharyngeal nerve IX

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205
Q

brain tumors adults

A

Metastasis 50% Glioblastoma (astrocytes) Meningioma (arachnoid) Schwannoma + Oligodendroglioma (frontal lobe usually) MGM StudiOs arranged in most common

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206
Q

homer wright rosette in what CA

A

medulloblastoma

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207
Q

Perivascular pseudorosette in what cancer

A

ependymoma

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208
Q

Brain tumors pediatrics

A

pilocytic Astrocytoma (GFAP_ medulloblastoma (high grade benign neuroectoderm) ependymoma (ependymal) AME arranged in most common

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209
Q

uncal herniation symptoms

A

CN III compression, outside: parasympathetic dmg -> mydriasis inside: motor dmg -> down and out -contralateral homonymous hemianopsia

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210
Q

what is ApoE4 associated with?

A

Late onset alzheimers chr.19

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211
Q

3 mutations associated with early onset alzheimers = <60y/o

A

APP chr21 Presenilin 1 chr 14 Presenilin 2 chr 1

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212
Q

What is ApoE2 associated with?

A

protective against alzheimers chr.19

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213
Q

Ebstein’s anomaly

A

atrialized right ventricle from downward displacement of tricuspid valve. from lithium ingestion early in pregnancy

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214
Q

sciatic nerve roots

A

L4-S3 branches into common peroneal and tibial

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215
Q

subluxation

A

is the incomplete/partial dislocation of a joint

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216
Q

ristociton

A

the test for vWF deficiency. causes vwf to clot platelets (unless you dont have any)

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217
Q

somatomedin C is what?

A

IGF-1

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218
Q

most common cause of aseptic meningitis?

A

1 is cocksackie virus enteroviruses (picornoviruses) = + sense ssRNA, naked PERCH: polio, echovirus, rhinovirus, cocksackie A (handfootmouth,B (pericarditis), hep A

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219
Q

Werdnig-hoffman disease

A

AR: Inherited degeneration of anterior motor horn. *SPINAL MUSCLULAR ATROPHY -Presents as floppy baby, death occurs within a few years

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220
Q

Differentiation btw ALS and syringomyelia

A

syringomyelia will involve the spinothalamic (pain and temperature) ALS is only LMN UMN

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221
Q

ALS occurance

A

Mostly sporatic Familial= Zinc-copper SOD mutation with free radical injury to neurons.

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222
Q

degeneration of cerebellum and spinal cord tracts with hypertrophic cardiomyopathy

A

mutation in Frataxin (essential for mitochondrial iron regulation -> free radical damage)

Friedreich’s Ataxia

Expansion GAA

  • cerebellar degen - > ataxia
  • multiple spinal tract degeneration -> sensation/vibration losses, muscle weakness, loss DTR.
  • presents in childhood -> wheelchair bound within a few years

**Associated with hypertrophic cardiomyopathy

223
Q

How does meningitis cause hydrocephalus, hearing loss, seizures?

A

All through healing and scarring process, can occlude CSF drainage (like arachnoid granulations), can affect nerve, may cause disturbance in conduction pathways through scarring.

224
Q

Ratio of CSF to Blood glucose

A

0.6 (2/3)

225
Q

cortical laminar necrosis

A

A type of global ischemia/infarction of vulnerable regions of pyramidal neurons of cortex 3,5,6,

226
Q

vulnerable areas from global ischemia

A

cortical layers 3,5,6 hypocampus(temporal lobe): learning long term purkinje layer of cerebellum: integrates sensory perception with motor control

227
Q

embolic vs thrombotic stroke macroscopic histology

A

thrombotic will be pale stroke (bc thrombus isn’t lysed) embolic will be hemorrhagic bc the clot will eventually be lysed

228
Q

ischemic lacunar stroke locations

A

typically from lenticulostriate vessels coming off of MCA internal capsule (pure motor) thalamus (pure sensory) RISKS of HTN, DM vs basal ganglia for charcot bouchard (can be more diffuse)

229
Q

earliest change in stroke

A

Red Neurons (12 hrs)

230
Q

xanthochromia and blood on inferior brain

A

Subarachnoid hemorrhage. yellow is from heme breakdown

231
Q

why is berry aneurism caused so easily?

A

It’s at branch point and lacks media layer (which is present before and after branch point)

232
Q

uncal herniation s/s

A

compression CN III (down and out) # compression posterior cerebral artery (contralateral homonymous hemianopsia) #rupture of paramedian (pontine) arteries -> duret brainstem hemorrhage.. They basically get torn off **uncus is involved with olfaction and memory of smells

233
Q

arylsulfatase A deficiency

A

lysosomal storage disease central/peripheral demyelination -> ataxia/dementia

234
Q

Krabbe’s disease

A

lysosomal storage disease galactocerebrosidase deficiency #peripheral neuropathy, developmental delay, optic atrophy, GLOBOID CELLS

235
Q

oligoclonal IgG bands, lymphocytes, myelin basic protein on LP

A

MS “very high elevation of proteins in CNS”

may see lipid laden macrophages that ate the myelin

236
Q

JC virus infection in immunocompromised

A

PML: progressive multifocal leukoencephalopathy #rapidly progressive neurological signs leading to death

237
Q

Progressive, debilitating encephalitis leading to death. from virus in infancy

A

Subacute sclerosing panencephalitis from measles -viral inclusions in gray and white matter

238
Q

striatum

A

putamen (motor) + caudate (cognitive)

239
Q

lentiform

A

putamen (motor) + globus pallidus

240
Q

subthalamic nucleus does what?

A

inhibits movement (stimulates GPi)

241
Q

depigmentation of substantia nigra

A

lewy body accumulation (alpha synuclean eosinophilic intracellular inclusions) with decrease in dopamine and melanin production. melanin as part of that pathway

242
Q

meperidine

A

demerol (opioid) MPTP -> MPP(from MAO metabolism) byproduct causes parkinsons through dmg SN from inhibition complex I ETC

243
Q

CD80/86

A

B7 on dendritic cells

244
Q

what supplies anterior spinal artery?

A

the aortic artery

245
Q
A
246
Q

Amyloid plaque

A

Called a neuritic plaque

seen in alzheimers disease.

Is an extracellular accumulation of ABeta amyloid with entangled neuritic processes

247
Q

neurofibrillary tangle

A

intracellular phosphorylated tau protein = insoluble cytoskeleton (microtubule organizer); they correlate with degree of dementia

Alzheimers

248
Q

Picks disease

A

picks picks the frontal and temporal

early behavioral and language problems

findings of ROUND tau protein in neurons that stain with SILVER, they don’t survive neuronal death

249
Q

lewy body dementia

A

EARLY dementia with Parkinsonian features. The alpha synuclein eosinophilic lewy bodies are in the cortex (vs SNpc in Parkinsons)

-parkinsonism with dementia and HALLUCINATIONS and possibly repeated syncope

250
Q

corona radiata stretching is classic to

A

normal pressure hydrocephalus

wacky wobbly wet

increased CSF without increased ICP

251
Q

spike wave complex on EEG

A

Creutzfeldt jakob disease (prion)

also assoc with rapid dementia (death within year), startle myoclonus, ataxia

252
Q

familial fatal insomnia

A

inherited prion disease with startle reflex and insomnia

253
Q

cowdry type A inclusion

A

HSV encephalitis

254
Q

lewy bodies stain with what?

A

show up as alpha synuclein stained by PAS and ubiquitin (intracellular in parkinsons)

255
Q

pseudodementia

A

dementia (memory problems) associated with depression

The patient often KNOWS they’re having difficulty with memory (vs a patient with true dementia)

256
Q

magnetic gait

A

normal pressure hydrocephalus

257
Q

Screens to rule in dementia

A

RPR (for syphillis)

HIV

TSH (hypothyroid)

Vitamin B12

MRI brain (multiple infarcts/NPH)

258
Q

most common causes of delerium

A

drugs (esp think about acetylcholine antagonists)

UTI

259
Q

lesch nyhan enzyme deficiency

A

hypoxanthine-guanine phosphoribosyltransferase

tx; Allopurinol (xanthine oxidase inhibitor)

s/s spasticity, choreathetoid movements, self mutilation

260
Q

does uremia cause exudative or transudative pleural effusions?

A

exudative

261
Q

GGT

A

serum gamma-glutamyltransferase

specific indicator of liver damage, sensitive in alcohol use

262
Q

hypocretin 1

A

neuropeptie only produced in lateral hypothalamus that is low/undetectable in narcolepsy

263
Q

cataplexy

A

brief loss of muscle tone preceded by strong emotion

264
Q

jaundice occurs at what bilirubin lvl?

A

>2.5mg/dL

265
Q

kernicterus bilirubin build up where?

A

basal ganglia

266
Q

what is required for de novo pyrimidine production?

A

aspartate and glutamine

267
Q

cori cycle

A

the glucose -> pyruvate -> lactate

to

lactate -> pyruvate -> glucose

cycle in muscle/rbc -> liver

268
Q

alanine cycle

A

the alanine - pyruvate -> glucose cycle to recycle ammonia

269
Q

ITP

what is it?

where is the Ab produced?

A

autoimmune destruction of platelets

Ig aimed at GpIIbIIIa

Ab is produced in spleen, macrophages eat platelets in spleen.

tx; steroids, IVIG, splenectomy as last resort

270
Q

Undercooked beef will classically give you…

A

E Coli O157H7

-> HUS, especially in children

verotoxin damages endothelial cells and possibly also ADAMSTS13

271
Q

what does uremia do to clotting?

A

disrupts adhesion (gpIb) and aggregation (gpIIbIIIa and fibrinogen) of platelets

272
Q

3 steps to activate coagulation (not adhesion/aggregation)

A

1- activating substance (collagen/thromboplastin)

2- calcium

3-phospholipid membranes

273
Q

most common inherited coag disorder

A

VWB disease

autosomal dominant

vwb stabilizes factor VIII

abnormal ristocetin

PTT changes but no real problems with secondary hemostasis (coagulation

274
Q

ristocetin

A

aggregates platelets that requires vwf

if vwb disease, will not aggregate (unknown mechanisms), but if add vwf (plasma mixing) -> platelets will aggregate

vs

bernard soulier syndrome, mixing will NOT improve aggregation

275
Q

cryoprecipitate

A

given in DIC

contains

fibrinogem , VWF, factor VIII and XIII

276
Q

where is tPA?

A

in endothelial cells

though kallikrein can also activate plasmin (through hageman factor)

277
Q

plasmin action

A

destroys fibrin and fibrinogen

destroys coag factors

blocks platelet aggregation

**alpha 2 antiplasmin inactivates plasmin

278
Q

disorders of increased plasmin -> bleeding

A

urokinase in radical prostatectomy

liver cirrhosis; reduced production of alpha 2 antiplasmin

no d-dimer, normal platelets

d-dimer = split fibrin, not fibrinogen

Tx; aminocaproic acid (blocks plasmin)

279
Q

lines of zahn

A

present in thrombus that was present before death in area of higher blood flow

characterized by lines of fibrin alternating with RBC’s

can help determine cause of death

280
Q

most common inherited hypercoagulable state

A

factor V leiden: protein C cannot cleave it

281
Q

prothrombin 2010a

A

point mutation in prothrombin 3’ UTR -> increased gene expression x2

282
Q

if you give heparin and PTT doesn’t rise, what’s the problem?

A

deficiency in ATIII

2,7,9,10,11,12

283
Q

dyspnea, neurologic abnormalities (AMS,seizures), and petechiae over skin, especially the chest,head,neck,axilla

A

fat embolus in pulm vasculature

after bone fx or orthopedic procedure

may see retinal fat globules

284
Q

acute intermittent porphyria

s/s

deficiency

tx

A

5p’s Autosomal Dominant

port wine urine: darkens on exposure to air/light bc of oxidation

painful abdnomen

precip by drugs (p450 inducers)

psych disturbances

polyneuropathy

def; porphobilinogen deaminase (hydroxybmethylbilane synthase)

tx; glucose and heme to inhibit ALAS

285
Q

alkaptonuria

s/s

deficiency

A

aut recessive benign

defect in homogentisic acid oxidase which tyrosine -> fumurate

s/s dark connective tissue, brown pigmented sclera, urine turns BLACK on prolonged exposure to air

may have arthralgias

286
Q

binding sites

HIV

EBV

Parvovirus B19

A

HIV: CD4 gp120

EBV CD21 gp350 (the c3d complement receptor)

Parvo -> erythrocyte P antigen (globoside)

287
Q

iron deficiency anemia findings

A

anemia, koilonychia, pica

koionychia is spoon shaped nails

increased FEP: free erythrocye protoporphyrin

and then all the basics

RBC should = nucleus of lymphocyte

288
Q

hepcidin

A

sequesters iron in storage sites (enterocytes, liver, macrophages)

AND

decreases EPO

289
Q

parietal cells

A

pink (chief cells are more blue)

assoc with pernicious anemia

proton pump

290
Q

tongue in megaloblastic anemia

A

glossitis (poor turnover)

but remember in plummer vinson it can also have glossitis (iron deficiency, glossitis, esoph webs)

291
Q

reticu count in anemia with proper nutrients and capacity

A

corrected >3%

but have to correct for total RBC

correct with retic% x Hct/45

*45 being a normal hct

292
Q

reticular endothelial system

A

spleen, liver, lymph nodes

293
Q

13q deletion

A

associated with CLL

294
Q

abnormal 5 maleimide binding test

A

hereditary spherocytosis

autosomal dominant

295
Q

LDH in hemolytic anemia

A

increased; duh RBC’s use a lot of that

296
Q

can macrophages activate naive T cells?

A

no, only mature active effectors and memory t cells, and then, only if the macrophages have been induced to (prob with IFN-gamma)

297
Q

gardos (calcium dependent) channel blocker

A

prevents erythrocyte dehydration by blocking potassium/water efflux from cells

this prevents sickling in HbSS

298
Q

CO affect on cells

(carboxyhemoglobin)

A
  1. binds to hgb and prevents O2 from binding
  2. prevents o2 release (left shift of dissoc curve)
  3. inhibits complex 4 of ETC (which cyanid does too)
299
Q

carbaminohemoglobin is what?

A

CO2 on hgb

300
Q

metabisulfate

A

will sickle any cells with HgbS, even in trait

301
Q

hemosiderinuria

A

occurs days after intravascular hemolysis

302
Q

What are PNH patients at risk of?

A

10% dvlp AML

also iron deficiency anemia

303
Q

stain for heinz bodies with heinz preparation

confirmatory test?

A

shows precipitated hgb

to do enzyme conirmatory test, must wait until after the acute episode bc all the current cells will have g6pd

304
Q

cold agglutinin infectious disease causes

A

Infectious mononucleosus

mycoplasma pneumonia

305
Q

basophilia

A

associated with CML

306
Q

lymphocytic leukocytosis

A

viral

bordetella pertussis: lymphocytosis promoting factor(blocks lymphs from entering lymph node)

307
Q

leukemia

A

>20% blasts

large, low cytoplasm, high nuclear

punched out nucleolus

308
Q

tdt +

A

lymphoblast

ALL

t or b

309
Q

MPO+

A

myeloblast

tdt is absent: tdt is a dna polymerase only present in immature lymphocytes

310
Q

cd10

A

present on B cells

think B-ALL

311
Q

B-ALL translocation

A

Age <15y/o: peripheral blood and bone marrow involved

t12 21

t9;22 less common, poor prognosis (usually that’s the translocation in CML)

tdt+, CALLA +

GOOD PROGNOSIS, responsive to therapy

down syndrome > 5y/o

312
Q

acute monocytic leukemia

A

an AML that lacks MPO and involves gums of patient ->bleeding gums

313
Q

CLL markers

A

CD5 and CD20 (CD 5 is usually only on t cells, but here its’ on B)

smudge cells

-> SLL if lymph node involved

may transform to large B cell lymphoma -> present with enlarging spleen or lymph node

314
Q

LAP (leukocyte alkaline phosphate)

negative

positive

A

negative in CML

positive in leukemoid rxn

315
Q

lots of platelets in blood

differential

A

essential thrombocythemia (a type of myeloproliferative disorder)

OR

iron deficiency anemia

316
Q

acute megakaryoblastic leukemia vs myelodysplastic syndrome vs myelofibrosis vs essential thrombocythemia

A

myelodysplastic syndrome: precursor to AML, characterized by <20% blasts in blood

acute megakaryoblastic leukemia: an AML disorder, proliferation of megakaryoblasts. arises in down syndrom often before age of 5

myelofibrosis: myeloproliferative disorder with mostly megakaryocytes, JAK2 assoc, PDGF -> marrow fibrosis

essential thrombocythemia: a myeloprolif disorder JAK2 assoc, but pretty much a bunch of platelets

317
Q

sponataneous hemarthroses in vwf disease

A

DOES NOT OCCUR despite increased PTT

318
Q

shine delgarno

kozac sequence

A

shine delgarno is prokaryotic translation start sequence

kozac is sequence assoc with eukaryotic translation starting. requires purine (A or G) 3 base paires up from AUG to work well

319
Q

Birbeck granule

A

tennis racket on EM of pt with langerhans cell histiocytosis

also have S-100

320
Q

reed sternberg cell

A

CD15 and 30

multilobed nuclei

prominent nucleoli

a B cell, but not CD20+

hodgkins often has abundant IL5 and eosinophils

321
Q

what monoclonal antibody does multiple myeloma make?

ie M spike

A

usually IgG

can be IgA

322
Q

monoclonal IgM macroglobullnemia

A

B-cell lymphoma

Waldenstrom Macroglobulinemia

visual and neurologic problems: stroke, retinal bleeding

increased risk of bleeding/thrombosis

323
Q

henoch schonlein purpura vs churg strauss

A

henoch schonlein:

IgA deposition following URI: palpable purpura, arthralgia, GI symptoms/bleeding. Self limited.

churg strauss

IgE, eosinophils, granulomas, pANCA

heart, lung kidney invovement

has asthma, sinusitis, palpable purpura, peripheral neuropathy

324
Q

renal artery stenosis in young female

A

fibromuscular dysplasia

-> HTN

325
Q

branchial cleft, arch, pouch

A

cleft is ectoderm

arch is mesoderm

pouch is endoderm

326
Q

4 branchial pouches

A

ears, tonsils, bottom to top

1st pouch: endoderm of middle ear and proximal

2nd pouch: epithelial tonsils

3rd pouch: bottom parathyroids and thymus

4th pouch: superior parathyroid

327
Q

1st arch

A

Muscles of Mastication

Maxillary/Mandibular V nerve

Maxillary artery

328
Q

2nd arch

A

Stapedial artery

Smile with CN VII

Facial expression

329
Q

3rd arch

A

Common Carotid

don’t Choke with CNIX

stylopharyngeus

330
Q

4th/6th arch

A

CN X

swallow and speak

cartilage and shit of neck

331
Q

developmental Clefts

A

1st = external auditory meatus

2,3,4 obliterated

if persistant = branchial cleft cyst in lateral neck (doesn’t move with swallowing like a thyroid cyst)

332
Q

embryo

vitelline veins

cardinal veins

umbilical veins

A

vitelline -> portal system

cardinal veins -> systemic veins

umbilical veins -> degenerate to round ligament as part of falciform of liver

333
Q

plaque formation

A

1) endothelial damage (toxins, HTN) -> increased permeability
2) lipid deposition
3) macrophage entry
4) platelet, endothelial, macrophage PDGF

combined PDGF (GF for fibroblasts, smooth muscle, endothelium)

5) TGF from platelets -> fibroblast growth factor
6) battle btw macrophage collagenase and collagen from smooth muscle/fibroblasts
7) plaque rupture/thrombosis via coag

334
Q

TGF-alpha

TGF Beta

PDGF

Fibroblast growth factor (FGF)

VEGF

A

TGF-A: epithelial and fibroblast growth

TGF-B: fibroblast growth

PDGF: GF for endothelium, smooth muscle, fibroblasts

FBF: angiogenesis

VEGF angiogenesis

335
Q

Fick’s principle

A

CO = rate of O2 consumption/ arterial O2 content - venous O2 content

336
Q

laplace law for heart wall tension

A

wall tension: Pressure x r / (2xwallthickness)

337
Q

papillary muscle rupture

anterior

posterior

A

anterolateral is less common bc it is supplied by LAD and circumflex

posterior is supplied by PAD (usually from RCA)

338
Q

dressler syndrome

A

antibody to pericardium -> pericarditis

arises 1-2months after MI

339
Q

most common congenital heart defect

and often why?

A

VSD

fetal alcohol syndrome

340
Q

most common ASD

most common with down syndrome

A

most common = osteum secondum

down syndrome = osteum primum

341
Q

PDA associated with congenital infecions

A

Rubella

342
Q

boot shaped heart

A

tetralogy of fallot

343
Q

transposition of the great vessels risk factor

A

maternal diabetes

344
Q

what does glucose do to the lac operon

A

It decreases cAMP -> decreases promotor activity on lac operon

the regulator makes a repressor for the operator, lactose binds to and releases the reperssor

345
Q

NO vs adenosine

artery vs arteriole dilation

A

coronary artery responsive to NO, arteriole more to adenosine

346
Q

what auscultative finding correlates with severity of mitral regurge?

A

An S3

bc the murmer may be less with larger regurge orifice and louder with a smaller orifice, but not always and is variable

347
Q

ejection click =

A

aortic stenosis with crescendo decrescendo systolic ejection a littl after S1

348
Q

midsystolic click

A

mitral valve prolapse, with crescendo murmur loudest right before S2

349
Q

Opening snap

A

mitral stenosis abrupt halt in leaflet motion. delayed rumbling late diastolic murmer (a little bit after you hearS2)

350
Q

roth’s spot

A

white spot on retina surrounded by hemorrhage

associated with bacterial endocarditis

351
Q

janeway lesions

A

small, painless, erythematous lesions on palms and soles.

associated with bacterial endocarditis septic emboli

Vs Osler’s are painful and raised lesions

352
Q

anti-DNAse titer

A

used to diagnose strep pyogenes infection

also not ASO as well

353
Q

aschoff bodies with anitchkow cells

A

Occur in rheumatic fever around myocytes of heart

Aschoff body is granuloma with giant cells

anitschkow are wavy looking activated histiocytes

Myocarditis is what kills people in acute phase of rheumatic fever

354
Q

S4 in older adult

A

sign of less compliance, not always pathological.

In younger adult it is ALWAYS pathalogical

355
Q

S3 sound

A

in younger adults S3 can be normal.

In older adults S3 is basically always pathological

356
Q

hyperplastic arteriolosclerosis cause

A

malignant hypertension

onion skinning of small arteries.

Different from fibromuscular dysplasia in women

357
Q

most common heart tumor?

in adults?

in kids?

A

Most common is metastasis

primary Adult = myxoma: tumor of mesenchyme, presents with syncope bc ball and valve obstruction

primary kid = rhabdomyoma

358
Q

Hypertrophic cardiomyopathy inheritance

A

autosomal dominant

sarcomere protein

usually B myosin heavy chain

also assoc with friedreich’s ataxia mutation (not inherited)

359
Q

loeffler syndrome

A

eosinophillic infiltrate with endomyocardial fibrosis. Often in setting of parasitic invasion

360
Q

lymph node drainage

upper rectum

lower rectum above pectinate line

below pectinate line

A

upper rectum- pararectal nodes

lower rectum above pectinate line- internal iliac

below pectinate line- superficial iliac

361
Q

normal vital capacity volume

normal tidal volume

normal total lung capacity

normal residual capacity

A

4.2 L

500mL

6L

1.2L

362
Q

Dead space equation

this is the Bohr equation

A

V(dead space) = Tidal volume x (PaCO2 - PexpiredCO2)/PaCO2

“the volume of inspired air that does not take part in gas exchange”

**As PeCO2 approaches PaCO2 -> less dead space

363
Q

what is the pressure of the airway/alveoli at FRC

A

pressure is 0

intrapleural pressure is negative

364
Q

compliance change in emphysema/normal aging

compliance change in pulm fibrosis/pneumonia/edema

A

C= V/P

compliance increases with emphysema and normal aging

decrease with pulm fibrosis/pneumonia/edema

365
Q

Diffusion equation for lungs (and whatever else i guesS)

A

Vgas diffusion = Area/thickness x diffusionconstant(P1-P2)

A decreases in emphysema (but emphysema is more a V/Qmm… increased blood flow for decreased area it encounters)

T increases in pulmonary fibrosis

Both lead to less diffusion => make O2 diffusion limited (partial shunt)

366
Q

pulm HTN diagnosis

A

>25mmHg or >35 during excercise

367
Q

alveolar gas equation

A

PAO2 = PIO2 - PaCO2/R

Or

PAO2 = 150 - PaCO2/0.8

A-a gradient = PAO2 - PaO2 = 10-15 normal

Cause of increased Aa: shunt, V/Qmm, diffusion

368
Q

Causes of hypoxemia (

normal A-a gradient

increased A-a gradient >15

A

Normal A-a: high altitude, hypoventilation

Increased A-a:

V/Qmm (PE)

diffusion limitation (fibrosis/emphysema)

R/L shunt (VSD/pulm edema/asthma)

369
Q

Haldane effect

A

Haldane has halitosis (lung effect)

In lungs, oxygenation of Hb dissociates H+ from Hb. All that bicarb that you’ve transported is split into H20 and CO2. CO2 is released.

aka shifts equilibrium toward CO2 formation

370
Q

Bohr Effect

A

The H+ from metabolism (glycolysis mostly as well as conversion of CO2 with H20 to bicarb) shifts dissociation curve to right -> unload oxygen

371
Q

Tx of methemoglobinemia

A

methylene blue and Vitamin C acutely

Cimetidine (H2 blocker) can be used chronically in a patient that must be on a methgbemia type drug like dapsone

372
Q

normal PaO2/FiO2

A

300-500

less than 300 indicates gas exchange problem

373
Q

hypoxia causes

A

ischemia (low blood flow from low cardiac output, impeded arterial flow, reduced venous drainage, shock, embolis)

hypoxemia (low inspired O2, hypoventilation, V/Q mismatch, Diffusion problem, R/L shunt)

Decreased O2 carrying capacity (CO poison, anemia)

374
Q

Floppy baby with congenital anterior horn degeneration (LMN)

A

Werdnig Hoffman disease

Autosomal Recessive. Median death at 7months

375
Q

what will hypocapnia cause?

A

low CO2 -> bronchoconstriction

low CO2 in the blood will cause vasodilation in pulmonary vessels

376
Q

type II pneumocyte lamellar body

A

is the membrane bound intracellular inclusions of cell membrane material loaded with dipalmitoyl phosphatidylcholine

377
Q

hyperammonemia

what diseases?

MOA of ammonia damage?

S/S

tx

A

diseases: liver disease or hereditary (urea cycle def)

MOA:

  • excess NH4 -> depletes ketoglutarate -> inhibtion of TCA cycle
  • NH4 damages lipids (encephalopathy)
  • and others

S/S: tremor (asterixis), slurring speech, blurred vision, lethargy -> seizure -> coma->death

Tx; benzoate or phenylbutyrate bind amino acids -> secretion

OR

lactulose (nondigestable sugar) to acidify GI tract and trap NH4 bc bacteria ferment it and broduce lactate

378
Q

Down syndrome quad screen

AFP, B-hCG, Estriol, Inhibin A

A

Decreased AFP

increased B-hCG

decreased inhibin A -> decreased Estriol (through lower FSH)

+increased nuchal translucency in first trimester

379
Q

Edward syndrome quad screen

AFP, B-hCG, Estriol, Inhibin A

A

AFP decreased, B - hCGH decreased, estriol decreased, NORMAL inhibin A

trisomy 18 (election age)

clenched hands

380
Q

Patau’s syndrome

quad screen

B-hCG, PAPP-A, nuchal translucency

A

low B-hCG, decreased PAPP, increasewd nuchal translucency

trisomy 13 (puberty)

polydactyly, holoprosencephally

381
Q

Myxoma S/S, why?

A

S/S syncope, positional dyspnea. bc of ball and valve issues.

emboli (from easily friable materia)

mid diastolic rumble (mitral stenosis type, but the problem is the ball rolling around and causing turbulence during atrial emptying)

IL-6 production -> constitutional symptoms

382
Q

radial nerve damage

A

fracture of spiral groove of humerous

radial nerve extends arm and provides dorsal skin innervation

C7 mostly

383
Q

nasal polyp differential

A

repeated bouts of rhinitis

cystic fibrosis

aspirin intolerant asthma

384
Q

angiofibroma vs nasopharyngeal carcinoma

A

angiofibroma is recurrent epistaxis, benign tumor of nasal mucosa

nasopharyngeal carcinoma: assoc with EBV, biopsy with keratin positive epithelial cells poorly differentiated on background of lymphocytes

385
Q

laryngeopapilloma in adults and children

A

both from HPV 6,11

adults = single papilloma

children = multiple nodules

386
Q

HPV high risk serotypes

why?

A

16,18,31, 33,45 ect

E2 normally suppresses E6/7

E6 suppresses p53

E7 suppresses Rb

E2 is not active in high risk serotypes

these are EARLY (E) expressed proteins by HPV

387
Q

phases of lobar pneumonia

A

1) congesion
2) red hepatization: exudate, neutrophils, hemorrhage
3) gray hepatization: degredation of red cells
4) resolution:

388
Q

coxiella burnetti infection

A

vets and farmers

atypical pneumonia caused by spores deposited by ticks on cattle and cattle placenta

Q fever (high fever, vs atypicals are often low fever)

It is a rickettsial organism but is different in that it causes pneumonia, doesnt cause rash, and doesnt need arthropod vector

389
Q

mycoplasma pneumonia

A

most common cause atypical pneumonia

IgM cold hemolytic anemia

erythema multiforme

no cell wall

390
Q

ghon focus

A

often just below the pleural lining -> subpleural

tb focus of fibrosis and calcification

391
Q

miliary tb

A

widespread in lungs and diseeminated tb

392
Q

when tb involves meninges, where is it classically?

A

base of the brain

393
Q

alpha 1 antitrypsin deficiency

A

codominant; if homozygous -> cirrosis from accumulation in RER of liver.

more severe in lower lobe vs upper lobe in smokers

panacinar vs centriacinar in smoker

394
Q

charcot leyden crystals

A

show up in asthma = eosinophil production of major basic protein

395
Q

curschmann spirals

A

Curschmann’s spirals refers to a finding in the sputum of asthmatics which are spiral shaped mucus plugs from subepithelial mucous gland ducts or bronchiole

396
Q

bronchiectasis

what is it?

who gets it?

s/s

A

Occurs from necrotizing inflammation/infection of the broncioles/bronchi -> increased dead space

Who gets it: CF, kartageners, tumor, necrotizing infection, allergic bronchopulmonary aspergillous (chronic inflammatory dmg)

s/s cough, dyspnea, foul smelling sputum (poor ciliated function, inflammatory crap, necrotic and rotting)

complication = hypoxemia with cor pumonale and scondary amyloidosis (from inflammation)

IT IS AN OBSTRUCTIVE DISEASE

397
Q

allergic bronchopulmonary aspergillosis

what does it cause?

who gets it?

A

leads to bronchiectasis from chronic allergic inflammation with eosinophil involvement

found in pts with asthma or cystic fibrosis

398
Q

caplan syndrome

A

pneumoconiosis + rheumatoid arthritis

the pneumoconiosis (coal, silica, asbestos) increases risk of RA

399
Q

Anthracosis

A

Pneumoconiosis = restrictive lung disease, risk of cor pulmonale and caplan syndrome

anthracosis is coal laden macrophages

coal miners lung

affects upper lobes

400
Q

silicosis

A

Pneumoconiosis = restrictive lung disease, risk of cor pulmonale and caplan syndrome

sandblasting and mines

upper lung (think TB)

silica disrupts phagolysosome -> increased susceptability to TB (ONLY ONE) and to getting bronchogenic carcinoma

eggshell calcifications of hilar lymph nodes

401
Q

asbestosis

A

Pneumoconiosis = restrictive lung disease, risk of cor pulmonale and caplan syndrome

Ivory white pleural plaques and asbestos fibers (golden brown fusiform rods look like dumbells, have iron on them)

Affects lower lobes

associated with bronchogenic carcinoma > mesothelioma

“plaque of lung, plaque of pleura, cancer of lung, cancer of pleura”

402
Q

asteroid body

A

characteristic of sarcoidosis (granuloma of lung, hilar lymph nodes, other tissues of body), it’s within the granuloma

sarcoidosis can also give uveitis, skin nodules and erythema nodosum, can look like sjogren’s. can be in any tissue

increased ACE, increased Vit D 1alpha hyrdocylase -> calcium

tx with steroids

403
Q

uvea layers

A

iris: opening of pupil

ciliary body : controls shape of lense and aquous humor production

choroid: vascular layer of eye

404
Q

hypersensitivity pneumonitis

A

cheese washer, composter, coffee grinder ,pigeon breeders lung, there are others

granulomatous inflammation due to hypersensitivity (high eosinophils)

presents fever, cough, dyspnea hours after exposure, resolves if taken away from exposure

chronically can produce intersitial pneumonitis

405
Q

plexiform lesion

A

a consequence of pulmonary htn = grouping of blood vessels

Other associations; hypertrophied smooth muscle, some intersitial fibrosis, RVH

406
Q

ARDS mechanism and complication on recovery

A

underlying theme is neutrophilic activation and free radical damage destroying type I and II pneumocytes

MANY CAUSES

end up with fluid, neutrophils, hyaline membrane, alveolar collapse

Recovery may be complicated by intersitial fibrosis bc stem cell (type II pneumocyte) has been knocked out

407
Q

NRDS associated with 3 syndromes

A

prematurity, c section, maternal diabetes (insulin inhibits lecithin production)

408
Q

attributable risk percent

A

ARP = 1-RR/RR

409
Q

calcitriol

A

1,25 hydroxyvitamin D

1,25 hydroxycholecalciferol

410
Q

ergocalciferol

A

D2 ingested from plants

411
Q

cholcalciferol

A

Vit D3

412
Q

urinary acid buffers

A

NH3-> NH4+

HPO4 (2-) -> H2PO4 (-)

both are used to keep the pH from dropping too much in the urine

413
Q

adenocarcinoma of the lung

A

Peripheral mostly

most common cancer of nonsmokers and females (smoker or not)

K-ras mutation

bronchioalveolar subtype (not assoc with smoking, good prognosis, grows along alveola septa (thickening of walls)

414
Q

Squamous cell carcinoma

of lung

A

Central

cigarettes (most common lung tumor for male smoker)

Hilar mass

cavitation

hyperCalcemia (PTHrP) production

Keratin pearls and intercellular bridges

415
Q

small cell (oat) carcinoma

A

Central (male smokers)

undifferentiated -> VERY aggressive

may produce: ACTH, ADH, Antibodies (lambert eaton). Amplification of myc oncogens

inoperable (all the others generally are)

This is a NEUROENDOCRINE TUMOR. kulchitsky cells = small dark blue cells

chromogrannin +

416
Q

large cell carcinoma

A

Peripheral

highly anaplastic and undifferentiated

poor prognosis

Large cell is the name given if the tumor doesnt have keratin pearls/mucinous glands/ intercellular bridges

surgical removal.

Pleomorphic giant cells

417
Q

Bronchial carcinoid tumor

A

excellent prognosis, low metastatic rate.

Symptoms from mass effect or occasionally seratonin syndrome.

these are neuroendocrine cells chromogranin positive

418
Q

coin lesion in lung differential

A

lung cancer

granuloma (Tb, sarcoidosis, histoplasma)

bronchial hamartoma (often calcified, with lung parenchyma AND cartilage)

419
Q

bronchioalveolar subtype

A

bronchioalveolar subtype (not assoc with smoking, good prognosis, grows along alveola septa (thickening of walls), starts in small airways

arises from clara cells

pneumonia like consolidation

420
Q

UNIQUE site of lung metastasis

A

adrenal gland

421
Q

ziehl-neelsen

carbolfuchsin stain

(aniline dye)

A

this is the acid fast stain of mycobacterium and nocardia

422
Q

silver stain

A

stains fungi, legionella, helicobacter

423
Q

india ink stain

A

stains cryptococcus neoformans

424
Q

crystal violet dye

A

gram stains things positive

425
Q

safranin or fucshin (not carbolfuchsin)

A

counterstain for gram negatives

426
Q

giemsa

A

Certain Bugs Really Try my Patience

Chlamydia, Borrelia, Rickettsiae, Trypanosomes, Plasmodium

427
Q

dihydrorhodamine flow cytometry

A

another way other than nitroblue tetrazolium to test for NADPH oxidase deficiency

will flouresce green

CGD is X linked

428
Q

cystic fibrosis inheritance

A

Autosomal recessive

429
Q

mallory body

A

damaged intermediate filament inclusions in liver

these would be in hepatitis diseases

430
Q

councilman bodies

A

an apoptotic eosinophillic swelling hepatocyte from viral hepatitis

431
Q

eosin is acidic and stains basic things that are acidophillic

A

haematoxylin is basic and stains acid structures that are basophillic

432
Q

minute ventilation

A

minute ventilation = tidal volume x RR

433
Q

reid index

A

normal mucus glands <40% wall thickness

Bronchitis is >50%

obstruction is caused by lumenal narrowing because of increased thickness, and mucus production

434
Q

dysplastic kidney

A

noninherited with renal parenchyma composed of cysts and abnormal tissue (like cartilage)

can be unilateral (most common) or bilateral

Sue to abnormal interaction btw ureteric bud and metanephric mesenchyme

435
Q

medullary cystic kidney disease

A

inherited autosomal dominant cysts in kidney

bilateral

cysts are MEDULLARY, vs PKD wich is CORTEX AND MEDULLA

436
Q

infant with worsening renal failure, htn, portal hypertension

A

autosomal recessive PKD with hepatic fibrosis

in general PKD causes cysts in kidneys, liver, brain (berry aneurisms)

437
Q

acute interstitial nephritis

A

intrarenal azotemia

causes: NSAIDs, PCN, diuretics

s/s: oliguria, fever, rash, eosinophilic infiltrate (HSR)

renal pallillary necrosis

**can become chronic, but is often still reversible

438
Q

horseshoe kidney

location

association

A

located about L3 under IMA vs normal L1/L2

associated with Turner Syndrome (XO)

predisposed to renal stenosis, uretopelvic junction(last plce to fuse), hydronephrosis

occurs 1/500 autopsies

439
Q

what barrier is lost in nephrotic syndrome?

A

the charge barrier -> leak of proteins normally repelled

440
Q

filtration fraction

A

GFR/RPF

RPF usuing PAH clearance

441
Q

filtered load

A

GFR x Px

excreted load = filtered - reabsorbed or filtered + excreted

excretion rate = V x Ux

442
Q

glucosuria begins at ?

Saturation at?

max absorption/min?

A

glucosuria begins at

160mg/dL BGL

saturated transporters (Tm)

350mg/ddL

max absorption = 200mg/min @Tm

443
Q

hartnup disease

A

deficiency of neutral amino acid reabsorption (tryptophan)

-> pellagra (diarrhea, dementia, dermatitis)

tryptophan -> B3 with B6 help

444
Q

cystic bone spaces filled with brown firbous tissue with bone pain

A

osteitis fibrosa cystica = stones, groans, bones

due to primary hyperparathyroidism

445
Q

neurofibromatosis type I

s/s

A

s/s cafe au lait spots, lisch nodules (hamartoma of iris with pigmentation), neurofibroma of skin

optic glioma, pheochromocytoma,

Autosomal dominant

100% penetrant, variable expression

Mutated NF1 gene

446
Q

RPF

A

Using PAH usually

RPF = RBF x (1-hct)

447
Q

metabolic alkalosis differential

A

resp alkalosis (low PCO2)

-hyperventilation, salicylates (early)

Metabolic

  • loop diuretics, thiazides (saline responsive)* high urine chloride
  • antacid
  • vomiting (saline responsive)* low urine chloride
  • hyperaldosteronism (not saline responsive): high urine chloride

**ones that correct with saline bc of volume loss

448
Q

increasing renal afferent resistance on GFR

A

initially increases until the point where reduced volume due to hydrostatic pressure -> leads to increased oncotic pressure within the capillary. NO more increase GFR

449
Q

ANP

BNP

A

secreted by atria and ventricles respectively in response to stretch/volume overload

increase GFR without increasing Na resorption => net loss of sodium and water

450
Q

shifts of potassium

digitalis

hyper/hypoosmolity

insulin

cell lysis

acidosis

B adrenergic agonist/antagonist

A

Dig= K out of cell (block Na/K) = hyperkalemia

K follows water = hyperosm -> hyperK

Insulin increases Na/K= K into cell = hypokalemia

Lysis - K out of cell = hyperkalemia

Acidosis: H/K exchange: hyperkalemia

B agonist: increase Na/Katpase = hypokalemia

451
Q

hypercalcemia

A

stones(kidney), bones (pain), groans (abd pain), psych overtones(AMS, anxiety)

452
Q

hypermagnesemia

A

decreased DTR, bradycardia, hypotension, cadiac arrest, hypocalcemia

=> hyperpolarize cell

453
Q

RBC cast

A

glomerulonephritis, ischemia, malignant htn

454
Q

wbc casts

A

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

455
Q

fatty casts

oval fat bodies

A

nephrotic syndrome

456
Q

granular “muddy brown” casts

A

acute tubular necrosis

etiology: renal ischemia (shock, sepsis), crush injury (myoglobinuria), drugs, toxins (lead, aminoglyosides

457
Q

waxy casts

A

advanced renal disease, chronic renal failure

458
Q

hyaline casts

A

nonspecific. can be normal, esp in dehdrated patients

459
Q

Focal segmental glomerulosclerosis

A

A “worse” minimal change disease

EM effacement of foot process, LM sclerosis/hyalinosis.

NO IF

Most common nephrotic syndrome of (esp.hispanics/AAmerican)

HIV, heroin, CKD, sickle cell

460
Q

membranous nephropathy

LM

EM

IF

A

LM: diffuse thickening of CAPILLARY AND GBM

EM: spike and dome

IF granular subepithelial deposits

most common in caucasian adults

“bugs drugs tumors rheum”

idiopathic, NSAIDS, infections, SLE, tumor

461
Q

minimal change disease

A

most common in kids

LM normal

EM foot process effacement

Loss of ONLY albumin, not globulins

Triggered often by recent infection,immunization, atopic disorders… or “immune stimulus.” Responds to corticosteroids. Associated with cytokines and Hodgkin’s lymphoma

462
Q

only nephrotic syndrome with excellent response to steroids

A

minimal change disease

463
Q

every membranous nephrotic syndrome IF

A

will be granular with IC deposition

464
Q

spike and dome vs lumpy bumpy renal problem

A

spike and dome = membranous nephropathy, granular IF, subepithelial deposits

lumpy bumpy = nephritis, PSGN, subepithelial deposits

465
Q

tram track appearance

A

membranoPROLIFERATIVE glomerulonephritis type I (subendothelial) or II (intramembranous)

466
Q

C3 nephritic factor association

A

Type II (intramembranous) membranoproliferative glomerulonephritis

C3 nephritic factor stabilized C3 convertase –> inflammation

disease is IC deposits

decreased C3

467
Q

alport syndrome

A

Mutation type IV collagen, x linked

-> split basement membrane (don’t confuse with membranous glomerulonephritis)

*glomerulonephritis, deafness, ocular disturbances

468
Q

goodpastures syndrome

A

type II hypersensitivity

antibodies against GBM and alveolar BM

linear IF

**inflammation, C3 deposition, and fibrinoid necrosis occurs with fibrin leaking through into GMB and bowmen’s capsule => RPGN with cresents made up of macrophages and fibrin (not collagen!)

469
Q

ceruloplasm

A

the copper binding agent that is often low in Wilson’s disease

Note that wilson also can’t secrete copper in bile

Aurosomal recessive chr.13q mutation ATP7B

**liver and neuropsychiatric problems

*renal tubular acidosis (proximal bicarb handling)

470
Q

ceramide trihexoside accuulation

A

Fabry’s disease. Peripheral burning sensation of hands/feet (acroparesthesia)

angiokeratomas (dark nonblanching papules/macules btw knee and umbilicus)

cardiovascular/renal disease

hypohidrosis (diminished sweating)

Enzyme deficiency = alpha galactosidase (X-recessive)

may treat with enzyme replacement therapy

471
Q

renal plasma flow stays normal over what ranges (due to autoregulation)

A

100-200mmHg

472
Q

scarring of cortex in upper and lower poles

A

characteristic of cesicoureteral reflux and chronic pyelonephritis with scarring and fibrosis

473
Q

thyroidization of kidney

A

atrophic tubules with eosinophillic proteinaceous materia looks like colloid of thyroid

SEEN IN chronic pyelonephritis/VUR

waxy casts too

474
Q

calcium oxalate stone association to disease

A

crohns! increased resorption of oxalate

475
Q

two stones that precipitate in alkalinized urine

A

calcium phosphate

ammonium magnesium phosphate

476
Q

radioluscent kidney stone

A

Uric acid stone

UUUUric acid stone is radioLUUUUUcent

477
Q

staghorn calculi

in adult

in kid

A

adult: urease +: proteus or klebsiella
kid: cystinuria (failure to resorb cysteine)

478
Q

osteomalacia

A

when you don’t mineralize new osteoid layed down by osteoblasts

479
Q

cysts in shrunken kidney risk of cancer

A

increased risk of renal cell carcinoma in patients with renal failure on dialysis.

480
Q

s/s renal cell carcinoma

pathogenesis

A

triad: hematuria (most common), flank pain, palpable mass

can be associated with paraneoplastic symptoms: EPO, renin, ACTH, PTHrH

fever and weight loss

patho: VHL loss (tumor suppressor)

481
Q

beckwith wiedmann syndrome

A

wilms tumor (most common in children)

neonatal hypoglycemia

muscular hemihypertrophy

organomegaly (esp tongue)

another syndrome is WAGR: wilms tumor, aniridia (absence of iris), genital abnormalities, mental/motor Retardation

482
Q

aniridia

A

aniridia = absence of iris = WAGR syndrome

wilms tumor, aniridia, genital abnormalities, mental/growth Retardation

483
Q

adenocarcinoma of bladder

A

only really occurs from urachal (allantois) remnant on the superior aspect of bladder (dome)

or bladder extrophy with exposure of bladder to outside world

often occurs with epispadius

or metaplasia from longstanding inflammation

484
Q

aldosterone secretion control

A

1) ATII
2) hyperkalemia
3) ACTH (a little)

485
Q

RPGN

3 types

A

1) Goodpastures with IgG and C3 deposits
2) “lumpy bumpy:” PSGN, SLE, IgA nephropathy += Henoch Schonlein purpura
3) pauci immune: wegeners,

and maybe churg strauss, microscopic polyangiitis

characterized by macrophage infiltrate, fibrin leak, fibroblast proliferation, and parietal cell proliferation

486
Q

immune complex deposition activation of complement

A

the alternative pathway is activated, which spares C1 and C4 => low C3 but higher C1/C4

487
Q

hereditary angioedema

A

sporatic attacks of swelling

lack c1 esterase inhibitor

so c1 esterase breaks down C4 and activates compliment

Autosomal Dominant

488
Q

pyrogenic exotoxin 3

A

antigen implicated in PSGN from strep pyogenes

489
Q

verrucae

A

warts

caused by HPV

490
Q

condyloma acuminatum

A

condyloma “knuckle” refers to genitals

condyloma acuminatum = genital warts

491
Q

dermatitis herpetiformis

A

IgA deposits at the tips of dermal papillae cause herpetic type vesicles

associated with celiac disease, from epidermal tissue transglutaminase

492
Q

erythema multiforme

A

targets with multiple rings and dusky center

associations

HSV, mycoplasma pneumonia, drugs (sufas), lupus

493
Q

steven johnson syndrome

s/s

associations

A

seperation of DERMAL/EPIDERMAl junction

fever, bulla formation, necrosis, sloughing of skin, HIGH MORTALITY RATE

may appear as erythema multiforme but progress

if >30% skin = toxic epidermal necrolysis

association with medication rxn (lamotragine and others)

494
Q

lymph drainage

below pectinate line

above pectinate line

sigmoid colon

lower 1/3 vagina

upper 2/3 vagina

A

below = superficial inguinal

lower rectum above pectinate= internal iliac

sigmoid colon = colic -> IMA

lower 1/3 vagina -> superficial inguinal

upper 2/3 -> internal iliac

495
Q

invasive cervical cancer death through?

A

will often block ureters -> renal failure

bores through anterior uterine wall -> bladder

pap smear great for scc, not adenocarcinom

quadravalent vaccine only lasts 5 yrs: still need pap smear

496
Q

lichen sclerosis

A

thinning of epidermis,

fibrosis of underlying dermis

leukoplakia (white patch) that’s parchment like

benign but small risk of scc, post-menoposal

497
Q

lichen simplex chronicus

A

leukoplakia that is thick/leatherlike hyperplasia of squamous epithelium

CHRONIC irritation and scratching

benign (NO INCREASED RISK SCC)

498
Q

vulvar leukoplakia differential

A

lichen simplex chronicus

lichen sclerosis

vulvar carcinoma (HPV or lichen sclerosis related)

499
Q

paget’s vs melanoma

A

pagets (mamillary or vulva)

PAS+, keratin+, S100-

melanoma (may be vulva)

PAS-, keratin-, S100+

**Both these are intraepithelial, random cells in the epithelium

500
Q

Adenosis

A

persistance of columnar epithelium in vagina

happened with DES (diethylstilbestrol),

leads to clear cell adenocarcinoma of vagina

-> also related to ectopic pregnancies in DES daughter (smooth muscle problems)

501
Q

thalidomide

A

used for morning sickness, caused limb malformation (phocomelia)

502
Q

p21

A

cdk inhibitor upregulated by p53

503
Q

HPV high risk infection

A

smoking and immunodeficiency

504
Q

asherman syndrome

A

2nd amenorrha from basalis destruction

from overaggressive DnC

Asher

505
Q

chronic endometritis characteristic cell

A

plasma cell must be present for dx

506
Q

chocolate cyst

A

endometriosis in ovary (most common site)

accumulation of multiple cycles grow/shed

in soft tissue = gunpowder lesion

507
Q

adenomyosis

A

presence of endometrium in myometrium

508
Q

endometrioid carcinoma

A

arises from unopposed estrogen and endometrial hyperplasia (> 50s)

in contrast to sporatic (p53 mutation) serous papillary endometrial carcinoma arrising from atrophic endometrium ( >70y/o ==> psammoma bodies

509
Q

psammoma bodies

A

papillary carcinoma of thyroid

meningioma

papillary serous carcinoma

mesotheliom

510
Q

multiple defined white whorly masses

A

leiomyoma = fibroids

premenopausal (usually asymptomatic but may lead to bleeding)

vs leiomyosarcoma: single, often hemorrhage/necrosis, postmenopausal… ARISES DENOVO. NOT FROM Leiomyoma’s

511
Q

ovarian follicle

A
512
Q

PCOS

LH:FSH

A

LH:FSH >2

3:1 = diagnostic

lots of LH, less FSH

high androgen (theca cells)

high estrogen (fat aromatization)

estrogen feedback inhibits LH & FSH

513
Q

increased AFP

schiller duval bodies (resemble glomeruli)

A

germ cell tumor

yolk sac tumor

endodermal sinus tumor

514
Q

increased hCG

increased LDH

associated with turner syndrome

A

dysgerminoma (ovarian germ cell tumor)

equivalent to male seminoma

515
Q

increased hCG

early hematogenous spread

NO chorionic villi

A

choriocarcinoma, malignancy of trophoblastic tissue

516
Q

90% of germ cell tumors

mature and immature

A

teratoma: females generally benign

mature = teeth/hair ect = mostly benign

immature: atypical cells, malignant

517
Q

struma ovarii

A

a teratoma with functional thyroid tissue -> hyperthyroidism

518
Q

normal histology

endometrium

fallopian tube

ovary

endocervix

A

endometrium - endometrial cells

fallopian - serous columnar

ovary- cuboidal from coelomic epithelium

endocervix- mucinous columnar

**surface epithelial tumors are most common (more than germ cell)

endometial tumor is MOST COMMON

519
Q

benign teratoma in women

A

mature teratoma has to have ALL mature tissue.

can have somatic malignancy within mature tissue. most commonly squamous cell

immature teratoma (such as containing neuroectoderm is malignant)

cystic teratoma is most common germ cell tumor

520
Q

classic BRCA1 ovarian tumor

A

SEROUS cystadenocarcinoma

**also at risk for breast cancer and fallopian tube

521
Q

brenner tumor

A

contains urothelium

benign and bilateral

522
Q

most common germ cell tumor women

A

cystic teratoma

dysgerminoma is most common malignant germ cell tumor

523
Q

reinke crystals

A

sertoli-leydig cell tumor: androgen production

reinke crystals in leydig cells

524
Q

meig’s syndrome

A

ovarian fibromas, pleural effusions, ascites

525
Q

intraperitoneal accumulation of mucous (jelly belly)

A

pseudomyxoma peritonea

can be from ovarian or appendiceal tumor, likely a metastasis from appendix

526
Q

placenta accreta

A

placental invasion into myometrium -> diffiulty delivering placenta after birth -> hysterextomy

527
Q

choriocarcinoma

gestational vs sporatic

response to chemo

A

gestational responds well (will have chorionic villi): will melt away

sporatic does not (no chorionic villi) will be in ovary (germ cell tumor)

528
Q

urogenital folds make?

A

male urethra/ventral shaft

female labia minora

529
Q

labioscrotal swelling make?

A

scrotum or labia majora

530
Q

prostate comes from what ?

A

urogenital sinus (also makes the male glands of cowper

and

female bartholin/skene glands

531
Q

genital tubercle makes what?

A

male: glans penis, corpus cavernosum (fill with blood baby) and spongiosum(around urethra)
female: glans clitoris and vestibular bulbs (erectile tissue of vestibule)

532
Q

vessels in suspensory ligament

A

suspensory ligaments of the ovaries

ovarian vessels (ligate when ovarian removal)

also contains lymphatics and nerves

533
Q

vessels in cardinal ligament (transverse ligament)

A

Uterin vessels

care for ureter injury (goes under uterine vessels)

534
Q

mesosalpinx

A

broad ligament covering everything

535
Q

round ligament of uterus

A

contains artery of sampson -> travels through inguinal canal

536
Q

estriol is a marker of what?

A

it increases 1000fold in pregnancy, indicates fetal well being

produced by the placenta

537
Q

best test for menopause

A

way increased FSH

moderately (and later) increase in LH

increased GnRH

538
Q

how does menopause lead to osteoporosis

A

estrogen inhibits osteoclasts. when low -> osteoclast haven

539
Q

quellung test

A

positive capsule swells when specific anticapsular antisera is added along with methylene blue to make it swell

halo appears

the SHiNE SKiS are positive

540
Q

red on mucicarmine stain

A

cryptococcus neoformans

541
Q

cord factor = mycoside

A

correlates with virulence of mycobacterium tuberculosis

If lacking they don’t cause disease

appearance of serpentine cords on growth medium is diagnostic

542
Q

sulfatides from mycobacteria

A

inhibit phagosome fusion with lysosomes in macrophages

virulence feature of mycobacterium tb

543
Q

what bacteria have IgA protease?

A

H. Flu, Neisseria meningitis, Strep pneumonia

544
Q

where do DNA viruses replicate?

exception?

A

nucleus (except pox); they need the cells polymerases (except pox and HBV.. and HBV is still in nucleus)

545
Q

Where do RNA viruses replicate?

exception?

A

cytoplasm (use of ribosomes)

-except influenze and retroviruses(bc it integrates, duh)

546
Q

where does herpes virus get it’s unique phospholipid envelope?

A

The nucleus of the cell

(all the herpes viruses)

547
Q

naked viruses

A

Give a PAPP and CPR to naked Hepe

PAPP CPR Hepe

Parvo

adeno

polyoma (JC)

papilloma

RNA: calici (noro), picorno, reo(rota), hepe (HEV)

548
Q

only dsRNA

A

reovirus = rotavirus

linear dsRNA

549
Q

paramyxovidiridae

A

enveloped, ss -, nonsegmented

parainfluenza - croup,

rsv- bronchiolitis (no H or N)

measles, mumps

550
Q

klebsiella

A

enteric

non-motile gram negative urease positive, lactose fermenting, catalase negative

nosocomial sepsis

BAD lobar pnemonia (of sick and alcoholics)

551
Q

vaccines

attenuated

inactivated

adjuvant

conjugant

A

attenuated: live; small yellow chickens, MMR sabin, IN influenza + typhoid and BCGtb
inactivated: heat/chemical killed
adjuvant: PAMP added to increase immune system response
conjugate: covalent link of protein to promote IgG class switch

552
Q

23 valent vs 13 valent pneumococcal vaccine

A

23 valent( PPSV23) is only polysaccharide

only B cell IgM response

13 valent is conjugated to diptheria => IgG response/memory

**neisseria meningitis and H flu also have polysaccharide (not conjugated) vaccines

553
Q

where is the site of most lipid absorption?

A

jejunum

Step One Pharmacology (6 decks)

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