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UWorld > 2015.04.04 > Flashcards

2015.04.04 Flashcards

1
Q

What conditions are associated with Renal Papillary Necrosis?

A
  1. Sickle cell disease or trait - causes obstruction of small kidney vessels, predisposing to ischemia.
  2. Analgesic nephropathy - NSAIDS inhibit renal blood flow by decreasing prostaglandins synthesis.
  3. Diabetes mellitus - compromised renal vasculature
  4. Acute pyelonephritis and urinary tract obstruction - compression of medullary vasculature
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2
Q

Renal Papillary Necrosis Findings

A

Gray-white or yellow necrosis of tips or distal 2/3 of renal pyramids.

Coagulative infarct necrosis with preserved tubule outlines. Scars can be seen on cortical surfaces later on.

Dark, rust-colored or bloody urine.

Acute, colicky flank pain.

Hematuria or passage of tissue fragments in urine.

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3
Q

Hemolytic Uremic Syndrome Triad

A

microangiopathic hemolytic anemia

thrombocytopenia

acute renal failure

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4
Q

CMV in immunocompetent patient

A

Mononucleosis-like syndrome (F, malaise, myalgia, atypical lymphocytosis, elevated liver transaminases) that is Monospot negative.

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5
Q

CMV in immunocompromised patients

A

Retinitis

Pneumonia

Esophagitis

Colitis

Hepatitis

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6
Q

Carcinoid Tumors

A

Minimal to no variation in shape and size of tumor cells.

Glands, nests, rows, or sheets may be formed.

Eosinophilic cytoplasm with oval-to-round stippled nuclei.

EM: multiple dense-core granules in cytoplasm with secretory products of the tumor cells.

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7
Q

Intestinal carcinoids

A

Malignant transformations of enterochromaffin (endocrine) cells of the intestinal mucosa.

Most are located in ileum, appendix, and rectum.

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8
Q

Intestinal Adenocarcinomas origin

A

Due to Intestinal epithelial cells (both absorptive and mucus secreting)

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9
Q

Pseudomonas aeruginosa

A

oxidase +

non-lactose fermenting

gram - rods

Commonly found in water sources.

Production of pigment on culture (pyocyanin, pyoverdin)

“Hot tub folliculitis” = superficial and self-limited P. aeruginosa

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10
Q

Phenotypic mixing

A

Co-infection of a host cell by two viral strains, resulting in progeny virions that contain nucleocapsid proteins from one strain and the genome of the other strain.

No genetic change in viral genome.

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11
Q

Reassortment

A

host cells are co-infected with two segmented viruses that exchange whole genome segments

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12
Q

Transformation

A

Upatke of naked DNA by a prokaryotic or eukaryotic cell.

In virology, this term may also be used to describe the incorporation of viral DNA into a host cell chromosome.

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13
Q

Vaginal Agenesis (Müllerian aplasia)

A

No upper vagina and variable uterine development.

Primary amenorrhea.

Patients are XX females with normal ovaries and secondary sexual characteristics.

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14
Q

Congenital Adrenal Hyperplasia

A

21-hydroxylase deficiency.

Variable presentation depending on the severity of the enzyme deficiency.

Neonates: Virilization and life-threatening hyponatremia (salt-wasting).

Late onset: hirsutism, oligomenorrhea, and acne

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15
Q

47, XXX

A

Slightly decreased IQ scores

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16
Q

Androgen Insensitivity Syndrome

A

46, XY males who appear phenotypically female due to an androgen receptor defect.

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17
Q

Kallmann syndrome

A

Decreased synthesis of gonadotropin-releasing hormone (GnRH)

(Hypogonadotropic hypogonadism)

Females are rarely affected, but will present: primary amenorrhea, no secondary sexual characteristics, and olfactory sensory defect.

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18
Q

Klinefelter syndrome

A

47, XXY affects males

Tall stature, poorly developed secondary sexual characteristics, atrophic testes, and infertility.

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19
Q

Turner Syndrome

A

45, X

Common cause of primary amenorrhea.

Short stature, webbed neck, shielded chest, “streaked” (fibrotic) ovaries.

Usually do not develop secondary sexual characteristics.

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20
Q

Treatment of Gonococcal Urethritis vs. Nongonococcal Urethritis (NGU)

A

Ceftrixone - gonococcal urethritis (Penicillins and cephalosporins which target cell walls)

Azithromycin - NGU (Macrolides and tetracyclines that are antiribosomal antibiotics)

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21
Q

NonGonococcal Urethritis

A

Chlamydia Trachomatis

Ureaplasma urealyticum

Mycoplasma, Trichomonas

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22
Q

Chlamydia Trachomatis

A

Intracellular pathogen that has cell wall, but lacks peptidoglycan (resistance to penicillins and cephalosporins).

Gram - but does not show up on gram stain.

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23
Q

Ureaplasma Urealyticum

A

Lacks cell wall altogether.

Does not gram stain.

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24
Q

Gallstone ileus

A

Passage of a large gallstone through a cholecystenteric fistula into the small bowel where it causes obstruction at ileocecal valve.

Gas seen within gallbladder and biliary tree on X-ray due to presence of fistula.

Patients present with signs of small bowel obstruction.

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25
Q

Choledocolithiasis

A

Obstruction of the cystic duct or common bile duct by a gallstone.

Biliary colic, jaundice, cholangitis.

Fever, RUQ pain, inspiratory pause during RUQ palpation (Murphy’s sign)

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26
Q

Median Nerve Injury

A

Due to carpal tunnel syndrome or fractures of supracondylar humerus.

Lose sensory innervation of palmar and dorsal 1st - 3rd digits.

Motor deficits: extrinsic finger flexion, thumb movement, pronation.

Flattening of thenar eminence.

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27
Q

Radial Nerve

A

Innerves extensor compartment of forearm.

Injury causes wrist drop.

Lose sensation of: posterior arm + forearm, small portion of distal thumb

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28
Q

Musculocutaneous nerve injury

A

Loss of sensation: lateral forearm

Paralysis: forearm flexors at the elbow

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29
Q

Axillary Nerve Injury

A

Due to fracture of surgical neck of humerus or other shoulder trauma.

Lose sensation: lateral upper arm.

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30
Q

Heart circulation vs. Skeletal muscle and viscera

A
  1. Heart muscle is perfused during diastole and consumes ~5% of cardiac output.
  2. Myocardial oxygen requirement is high - extracts more oxygen from blood than muscles.
  3. Coronary flow is regulated by local metabolic factors, including hypoxia and adenosine accumulation.
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31
Q

Coronary sinus

A

Where the left and right coronary venous blood drains into in the right atrium.

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32
Q

Lipid Digestion and Absoprtion

A

Digested in DUODENUM

Absorbed in JEJUNUM (requires bile acids)

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33
Q

Cholecystectomy

A

Absence of gallbaldder causes an increase in rate of enterohepatic circulation as there is no storage place for bile, so it is constantly released into the duodenum.

Patients are less likely to tolerate large fatty meals at one sitting.

34
Q

Pulmonary Vascular Resistance (PVR) is lowest when?

A

Functional residual capacity.

Increased lung volumes increase PVR due to longitudinal stretching of alveolar capillaries by the expanding alveoli.

Decreased lung volumes also increase PVR due to decreased radial tract from adjacent tissues on the large extra-alveolar vessels.

35
Q

Mycobacterium avium complex (MAC)

A

Opportunistic pathogen that causes disseminated disease in HIV+ patients.

Patients with CD4 counts <50cells/uL should be administered prophylactic azithromycin.

Different from M tuberculosis because: optimum growth at 41C, widespread involvement of the reticuloendothelial system.

36
Q

Pneumocystis jirovecii

A

Opportunistic infections in HIV

CD4 count < 200cells/uL

Oropharyngela candidiasis

Prophylaxis: Trimethoprim-sulfamethazole

37
Q

Toxoplasma gondii

A

Opportunistic infections in HIV

CD4 count <100cells/uL

Positive Toxoplasma IgG antibody

Prophylaxis: Trimethoprim-sulfamethoxazole

38
Q

Histoplasma capsulatum

A

Opportunistic infection in HIV

CD4 count <150cells/uL

Endemic area (Ohio and Mississippi river valleys)

Prophylaxis: Itraconazole

39
Q

Hyponatremia + lung mass is suggestive of what?

A

Sydrome of inappropriate ADH (SIADH)

Small cell carcinoma of the lung commonly presents symptoms related to ectopic hormone production (paraneoplastic effects)

40
Q

SIADH

A

Low plasma sodium and osmolality, inappropriately conecntrated urine, increased urinary sodium, and clinically normal body fluid volume.

(ADH is increased, but other volume-regulating hormones - aldosterone and natriuretic peptides - are activated by renin-aldosterone axis, causing excretion of sodium.

41
Q

Cheyne-Stokes Respiration

A

Cyclic breathing in which apnea is followed by gradually increasing tidal volumes, and then gradually decreasing tidal volumes unti the next apneic period.

Seen in advanced congestive heart failure and neurologic disease.

42
Q

Kussmaul Breathing

A

Deep, labored breathing pattern associated with severe metabolic acidosis (esp, diabetic ketoacidosis)

43
Q

Wernicke Syndrome

A

Ophthalmoplegia, ataxia, and confusion. Lethal in 10-20% of patients.

Foci of hemorrhage and necrosis in the mamillary bodies and periaqueductal gray matter.

Due to chronic thiamine deficiency, common in alcoholism.

44
Q

Thiamine (Vitamin B1) is a cofactor for what enzymes?

A

Glucose metabolsim

  1. Pyruvate dehydrogenase: converts pyruvate (end-product of glycolysis) into acetyl CoA (which enters the citric acid cycle)
  2. a-ketoglutarate dehydrogenase: enzyme of citric acid cycle
  3. Transketolase: enzyme of hexose monophosphate pathway. Converts pentoses to glyceraldehyde 3P (intermediary of glycolysis)
45
Q

Bitemporal hemianopsia

A

Pituitary Tumor should be suspected (compresses optic chiasm)

Most common pituitary tumor is a prolactinoma; causes impotence in men and amenorrhea in women.

46
Q

Henoch-Schönlein Purpura

A

Most common small vessel vasculitis in children.

Antigen from infection stimulates production of IgA antibodies and forms immune complexes that deposit on vessel walls.

  1. GI tract - abdominal pain, bleeding
  2. Kidneys - like IgA nephropathy - mesangial proliferation and crescent formation.
  3. Skin - palpable purpura on buttocks and lower extremities
  4. Joints - migratory arthralgias and arthritis
47
Q

Helicase

A

Unwinds DNA at replication fork.

Initial separation of dsDNA at the origin of replication is facilitated by DnaA protein and Strand binding proteins (SSB)

48
Q

Utilization of Ketone Bodies for Energy

A

Erythrocytes and other cells lacking mitochondria cannot utilize ketone bodies for energy.

Hepatocytes contain mitochindria, but cannot utilize ketone bodies because they lack succinyl CoA-acetoacetate CoA transferase (thiophorase) for conversion: acetoacetate to acetoacetyl CoA.

49
Q

Lynch Syndrome

A

Autosomal dominant

Abnormal nucleotide mismatch repair.

MSH2 and MLH1 which code for components of the human MutS and Mut L homologs (mismatch detection)

50
Q

Schilling test

A

Diffferentiates between dietary deficiency of vitamin B12, pernicious anemia and malabsorption syndromes.

Phase I - radiolabeled B12 and B12 - detects dietary deficiency

Phase II - radiolabeled B12 and IF - detects pernicious anemia

If absorption of cobalmin is not correctable by IF, it indicates malabsorption syndrome - ileal disease, pancreatic insufficiency or bacterial overgrowth

51
Q

Causes of Urethritis

A

Neisseria gonorrhoeae or Chlamydia Trachomatis

Both cause dysuria and mucopurulent urethral discharge.

Ceftriaxone - N. gonorrhea

Doxycycline or Azithromycin (Macrolides) - C. trachomatis (since they have no cell wall, beta-lactam based antibiotics like cephalosporins are not effective)

52
Q

Sheehan Syndrome

A

HIgh estrogen levels during pregnancy stimulate growth of the pituitary, causing it to enlarge and become more vascular.

If significant hypotension occurs while pituitary is still enalrged, ischemic necrosis of the pituitary occurs.

Panhypopituitarism follows this ischemia. (Hypoprolactin, hypothyroidism, hypocortisolism)

53
Q

Craniopharyngiomas

A

Calcified cystic tumors that arise from remnants of Rathke’s pouch (evagination of the ectoderm that lines the fetal oral cavity).

Headaches, growth failure, and bitemporal hemianopia.

54
Q

How does PTH battle low serum calcium?

A
  1. Increasing bone resoprtion
  2. Increasing GI absorption of calcium by creating the active form of calcium-absorbing vitamin D
  3. Increasing renal absorption of calcium
55
Q

Lead poisoning

A
  1. Colicky abdominal pain, constipation, headaches, impaired concentration and deficits in short-term memory.
  2. Bluish pigmentation at the gum-tooth line.
  3. Wrist drop or foot drop due to peripheral neuropathy.
  4. Microcytic hypochroic anemia and basophilic stippling on peripheral smear.
56
Q

Iron Poisoning

A

4 separate stages.

  1. ND, abdominal pain, hemorrhage, hypovolemia, and shock.
  2. GI symptoms resolve and patient appears better.
  3. Metabolic acidosis, hepatic dysfunction and hypoglycemia.
  4. Scarring of recovering GI tract
57
Q

Meningococci

A

Attach to and colonize the pharynx via pilus-mediated adherence to mucosal epithelial cells.

Invade the epithelium and gain access to vasculature where they can spread hematogenously.

Vaccines directed against Neisseria pili are hard to develop due to extensive antigeneic variation. It also produces IgA protease that destroys antibodies that can inihibit bacterial attachment and penetration.

Current vaccines target the polysaccharide capsule.

58
Q

Insulin Secretion receptor stimulation

A

Increase insulin secretion: Beta-2 adrenergic, Glucagon-like peptide-1

Decrease insulin secretion: alpha-2 adrenergic, somatostatin 2

(alpha-2 adrenergic inhibition is dominant)

59
Q

Gingivostomatisis, fever, lymphadenopathy with intranuclear inclusions

A

HSV-1 infection. (Enveloped, dsDNA virus)

Measles also have intranuclear inclusions, but tends to produce Koplik spots.

60
Q

What is unique to the duodenum?

A

Deep to the muscular mucosae is the submucosa, which is occupied by compound tubular Brunner’s glands. These glands secrete alkaline mucous into ducts that track upward through the muscularis mucosae and into the crypts of Lieberkühn for release into the lumen.

61
Q
A
62
Q

Streptokinase

A

Thrombolytic agent that converts plasminogen into plasmin, which subsequently degrades fibrin, fibrinogen and factors V and VII.

Most common side effect: hemorrhage.

Derived from beta-hemolytic Streptococci and can induce hypersensitivity reactions.

63
Q

Anterior cerebral artery occlusion

A

Supplies the medial portions of the frontal and parietal lobes.

Occlusion causes contralateral motor and sensory deficits of the lower extremities, behavioral changes, and urinary incontinence.

64
Q

Occlusion the middle cerebral artery

A

Motor control of hand, face/mouth, and throat.

Broca aphasia (dominant hemisphere), anosognosia (non-dominant hemisphere), conjugate gaze deviation toward the side of the stroke, contralateral homonymous hemianopsia, and spatial neglect of the contralateral side.

65
Q

Friedrich ataxia

A

autosomal recessive

protein “frataxin” essential for normal mitochondria function.

Causes degeneration of neural tracts and peripheral nerves:

  1. Gait ataxia - degeneration of ascending and descending spinocerebellar tracts
  2. Loss of position and vibration sensation.
  3. Kyphoscoliosis and foot abnormalities.
  4. Hypertrophic cardiomyopathy and CHF
  5. Diabetes mellitus.
66
Q

Loss of neurons in anterior horn of spinal cord

A

Poliomyelitis - flaccid paralysis, atrophy, areflexia, and muscle fasciculation.

Amyotrophic lateral sclerosis.

67
Q

Familial chylomicronemia syndrome

A

Type 1 hyperlipoproteinemia

Lipoprotein lipase (LPL) deficiency.

Hypertriglyceridemia, recurrent acute pancreatitis, lipemia retinalis (milky-appearing retinal vasculature), eruptive xanthomas (small yellowish papules surrounded by erythema found on extensor surfaces)

68
Q

Familial Hypercholesterolemia

A

Type IIA

Defects in LDL receptor it is ligand, ApoB-100.

High LDL concentrations.

Increased risk of accelerated coronary artery disease, ischemic chest pain, tendon xanthomas (nodular lipid deposits in tendons), xanthelasmas.

69
Q

Familial dysbetalipoproteinemia

A

Type III

Deficiency of ApoE

Elevated chylomicron and VLDL remnants.

Premature coronary artery disease & PVR; tuboeruptive & palmar xanthomas

70
Q

Familial hypertriglyceridemia

A

Type IV

Deficeincy of Apo A-V

Elevated VLDL

Increased pancreatitis risk; associated with obesity & insulin resistance

71
Q

Buproprion

A

Antidepressant medication that does not cause sexual dysfunction.

Side effects: agitation, insomnia, seizures.

Acts on norepinephrine transmission.

Also effective for treatment of nicotine dependence.

72
Q

Trazodone

A

Highly sedating anti-depressant useful for patients with insomnia.

Causes priapism and other sexual side effects.

73
Q

Low-potency First-generation antipsychotics

A

Chlorpromazine, Thioridazine

Non-neurolgoic side effects:

Sedation (histamine block)

Anticholinergic side effects

Orthostatic hypotension (alpha-1 block)

74
Q

High-potency first-generation antipsychotics

A

Haloperidol, Fluphenazine

Side effects: extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism) due to D2 antagonism

75
Q

Non-neoplastic polyps

A

Hyperplastic polyps: well-differentiated mucosal cells that form glands and crypts.

Hamartomatous polyps: mucosal glands, SM, CT; Peutz-Jeghers syndrome or juvenile polyposis

Inflammatory polyps: UC and Crohn disease. Regenerating intestinal mucosa.

Lymphoid polyps: children, intestinal mucosa infiltrated with lympocytes.

76
Q

Rhematoid arthritis

A

autoimmune disease triggered by unknown antigen.

Cartilage components serve as autoantigens that activate CD4+ T-cells, which stimulate B-cells to secrete rheumatoid factor (IgM antibody against Fc component of self IgG)

77
Q

Burkitt Lymphoma

A

Maxillary or mandibular mass with intermediate-sized lymphocytes with round nuclei.

Benign macrophages phagocytize the resulting cellular debris causing a “starry sky” appearance.

t(8;14) resulting in c-myc oncogene and production of transcription activator controlling cell proliferation, differentiation, and apoptosis.

78
Q

t (14;18)

A

Follicular Lymphoma

Chromosome 18 has bcl-2 gene (apoptosis inhibitor)

79
Q

t (9;22)

A

Philadelphia chromosome in Chronic myelogenous leukemia (CML)

Bcr-abl encodes a protein that inhibits apoptosis while promoting mitogenesis and increased tyrosine kinase activity.

80
Q

t (11;14)

A

Mantle cell lymphoma

Cyclin D1 on chromosome 11 with IgH chain on 14.

Increased production of cyclin D1, promotes G1 to S-phase transition.

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