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From Flashcardlet > 5/22 > Flashcards

5/22 Flashcards

1
Q

What is an anterior mediastinal mass in an MG pt?

A

Thymus tissue - derived from the 3rd branchial pouch (along with the inferior parathyroid glands)

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2
Q

What cofactors do mycoplasma and legeonella need to grow?

A

Mycoplasma = needs cholesterol

Legeonella = needs cysteine

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3
Q

Which diuretics lead to a release of PGE?

A

Loops

This can increase renal blood flow and enhanced drug delivery via an increased GFR

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4
Q

Where are lipids digested and where are they absorbed?

A

Digested in the duodenum, and absorbed in the jejunum

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5
Q

What do the prefix xi and zu mean?

What do the suffixes nib, cept, and mab mean?

A

xi = chimaric

zu = humanized

nib = kinase inhibition

cept = receptor molecule

mab = monoclonal antibody

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6
Q

What is the main cause of septic shock coming from a GnR? (e.coli)

A

Lipid A, a component of LPS

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7
Q

If a study has a “washout” period, what type of study is it?

A

Crossover study

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8
Q

What Ab is the target of enterococci acentylation, adenylation or phosphation?

A

Aminoglycosides

They transfer these chemical groups andimpair the Ab binding to ribosomal subunits

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9
Q

Why doesnt ceftriaxone kill chlamydia?

A

Chlamydia lacks peptidoglycan (aka no muramic acid in the cell wall either) thus Cef cant kill it.

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10
Q

HLA-B27 predisposes you for what?

A

Ank Spond

But also, reactive arthritis’ after an infection with chlamydia, camp, salmonella, shigella, or yersinia

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11
Q

Difference between a pilocytic astrocytoma and a medulloblastoma?

A

Both are common in kids and the cerebellum, but pilocytic astrocytoma has a cystic and a solid component (white and black portion on T1) Also, pilocytic is the most common in kids (medullo is second)

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12
Q

What does ethylene Glycol ingestion look like histologically?

A

Ballooning and vacuolar degeneration of proximal renal tubules and multiple oxalate crystals observed in lumen

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13
Q

What are the most common causes of aspiration pneumonias?

A

Fusobacterium, Peptostrepto, Bacteroides (oral cavity bugs)

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14
Q

What is the DOC for trigeminal neuralgia?

A

Carbamazepine

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15
Q 
What are the dermatomes that supply the:
umbilicus:
genitals:
knee:
pinky toe:
butthole:
A

umbilicus: T10
genitals: S2,3,4
knee: L3/4
pinky toe: S1
butthole: S5

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16
Q 
What actions do the following nerves innervate and what would be a cause of injury?
Femoral:
Superior Gluteal:
Inferior Gluteal:
Sciatic:
Tibial:
Obturator:
Common/Deep Peroneal:
A

Femoral: provides thigh flexion and leg extension w/ sense to anterior thigh and medial leg. Injury = Pelvic Fracture

Superior Gluteal: MED/MIN; provides thigh abduction and medial thigh rotation. Injured = Posterior hip dislocation (Causes trendelenburg sign; contra hip drop when standing on injured leg)

Inferior Gluteal: MAX; provides hip extension and lateral thigh rotation. Injured = Posterior hip dislocation (causes inability to jump, climb stairs, or rise from seated position)

Sciatic: provides hip extension and knee flexion

Tibial: (TIP) provides foot inversion and plantarflexion/toe flexion w/ sense to sole of foot. Injured = knee trauma

Obturator: provides thigh adduction w/ sense to medial thigh. Injured = Anterior Hip Dislocation

Common/Deep Peroneal: (PED) provides foot eversion and dorsiflexion/toe extension w/ sense to anterolateral leg and dorsal foot. Injury = fibula neck fracture or compression (can cause foot drop)

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17
Q

What is the indication and MOA of Dantrolene?

A

Indx: Malignant Hyperthermia caused by anesthetic oopsy or congenital problem

MOA: Blocks the ryanodine R on Sarcoplasmic Reticulum and prevents Ca release –> decreased skeletal muscle contractions

When you mix N2O and succinylcholine you can cause this syndrome.

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18
Q

Which type of muscle fibers relies on anaerobic glycolysis?

A

Type 2 (fast, white fibers.) These lack mitochondria and myoglobin.

This is what grows in weight lifting

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19
Q

What do the MHAIZ lines refer to on the muscle contraction picture?

A

M: Middle band
H: Only contains myosin (thick filaments) - gets smaller when contracted
A: Thee entire length of the myosin
I: only contains actin (thin filaments) - gets smaller when contracted
Z: end line, connected to actin

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20
Q

Endochondral ossification vs Membranous ossification

A

Endo = axial skeleton and base of skull. Cartilaginous model is made by chondrocytes –> blasts/clasts replace woven bone and remodel to lamellar bone

Memb = face and calvarium bones. Woven bone is formed directly w/o cartilage. This is later remodeled to lamellar bone

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21
Q

Where do blasts and clasts derive from?

A 
Blasts = mesenchymal stem cells
Clasts = monocytes/macrophages
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22
Q

Low levels of PTH vs High levels of PTH

A

Low = can exert anabolic effects (builds bone) by directly increasing blasts and indirectly clasts

High = catabolic effects (osteitis fibrosa cystica)

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23
Q

What is the deficiency in achondroplasia? Risk factor?

A

AD ACTIVATION mutation of the FGFR3 receptor which will INHIBIT chondrocyte proliferation leading to failure of endochondral ossification (decrease long bone formation but membranous ossification is ok)

Higher risk with an old dad

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24
Q

What are the histological findings of osteoporosis

How do you Dx?

A

Histo - trabecular bone loses mass and interconnections. Normal mineralization and Ca/PO4 levels and PTH and Alk phos

Dx: DEXA scan @ hip or lumbar spine

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25
Q

What are the histological findings with osteopetrosis?

Lab values?

A

Histo: thick, dense bones that are prone to fracture due to a MUTATION OF Carbonic Anhydrase II –> defective Clasts.

Xray will show a flask shaped bone in bone appearance.

Labs: pancytopenia, extramedullary hematopoiesis, low Ca, high alk phos

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26
Q

What do the labs look like for Osteomalacia?

A

Low Vit D, Hi PTH, low Ca, low phosphate, high Alk Phos (blasts need alkaline environment)

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27
Q

What is the suffix and MOA of bisphosphonates?

A

“-Dronates”

Inhibit Clasts.

Sdx: can cause esophagitus, so dont take at bed time or with jaw surgery

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28
Q

What is Osteitis Fibrosis Cystica?

A

Bony disorder caused by hyperPTH

causes high serum Ca, low Phos, and high Alk Phos, low bone mineral density

Creates “Brown Tumors” where cystic spaces are lined with osteoclasts filled with fibrous stroma and blood

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29
Q

Where is new bone formation taking place in long bones?

A

Epipheseal Plate

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30
Q

What is the cause of Pagets dz?
Clx?
Histo?

Long term risks?

A 
Increased remodeling (both blast and clast hyper activity)
Will present as a man with an increased hat size or hearing problems (narrowing of auditory foramen)

Histo: mosaic (woven) pattern of bone w/ chalk stick fractures

Risks: AVM shunts or high output heart failure, risk of osteogenic sarcoma

Labs: Everything normal except a high Alk Phos

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31
Q 
What is the age group, location, and characteristic finding of benign bone tumors:
Giant Cell (osteoclastoma)
Osteochondroma
A

Giant Cell (osteoclastoma): 20-40to, Epiphysieal; knee or distal femur area, soap bubble on xray w/ spindle and multinuc giant cells

Osteochondroma: <25yo, Metaphysis, Cartilaginous Cap (mushroom)

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32
Q

What is the age group, location, and characteristic finding of malignant bone tumors:

Osteosarcoma
Ewings Sarcoma
Chondrosarcoma

A

Osteosarcoma: M>F 10-20yo, Metaphysis, Codmans triangle/sunburst. Often related to Pagets dz, radiation, or Rb in family. Tx w/ surgery + chemo

Ewings Sarcoma: M <15yo, Diaphysis, ribs, pelvis, scapula, aggressive small blue cells tx with chemo. Look like onion skin. t 11:22 translocation.

Chondrosarcoma: M: 30-60, diaphysis, pelvis, spine, scapula, humeris, legs. Can stem from an osteochondroma. Glistening mass within medulalry cavity

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33
Q

What hormones work via Tyrosine Kinase second messengers?

A

Insulin, Insulin like GF, PDGF, FGF, PROLACTIN, GH

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34
Q

What artery supplies the Parathyroid gland?

A

Cervical ganglion (sympathetic)

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35
Q

Where in the kidney does PTH work to change Ca and P levels?

What does it do to osteoblasts?

A

Ca = more is reabsorbed in the DCT

P = less is reabsorbed in the PCT

More PTH = increased M-CSF and RANK-L on blasts –> more clasts

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36
Q

Besides Ca, what other ion can increase PTH levels?

A

low Mg can lead to high PTH

37
Q

Primary vs Secondary vs 3* Hyper PTH

A

1* = adenoma causing high PTH (can be seen in osteitis fibrosa cystica (cystic bones) (hi Alk Phos seen)

2* = RF causing Vit D def (causing low Ca and HIGH phos p.c kidneys cant get rid of it) and also High PTH (hi Alk Phos seen)

3* = refractory high PTH due to RF (very high PTH and high Ca now)

38
Q

What are the findings in Hypo PTH?

A

Chvosteks sign (facial nerve twitch)

Trousseau Sign - occlusion of brachial artery with BP cuff causes carpel spasm

39
Q

What is Pseudohypo PTH?

A

Albrights hereditary Osteodystrophy

AD disorder where kidney is unresponsive to PTH –> causes low Ca.

Shortened stature and shortened 4th and 5th digits

40
Q

What are the main causes of Hypo PTH?

A

DiGeorge, Surgery accident, Autoimmune destruction

41
Q

What nerves are responsible for:

inability to wipe ass
loss of forearm flexion
weak lateral rotation of arm
unable to raise arm above horizontal

A

inability to wipe ass: Thoracodorsal n
loss of forearm pronation: median
weak lateral rotation of arm: suprascapular n
unable to raise arm above horizontal: Spinal accessory and LTN

42
Q

What are chondrocytes?

What cell line do they come from?

What do they do?

A

They are the only cell type found in cartilage

They come from mesenchymal stem cells

They synthesize extracellular matrix of collagen and proteoglycans

43
Q

What 3 cell types are derived from mesenchymal stem cells?

A

CAO

Chondrocytes
Adipocytes
Osteoblasts

44
Q

What types of joints are:

Arm
Neck
Metatarsals
Thumb

A 
Arm = hinge
Neck = pivot
Metatarsals = Gliding
Thumb = Saddle
45
Q

What injuries make up the unhappy triad?

A

Lateral force –>

MCL, ACL, and Lateral or Medial Meniscus breaking

46
Q

What is the most common ligament injured in an ankle sprain?

A 
Anterior Talofibular Ligament
>
Calcaneofibular ligament
>
Posterior Talofibular ligament
(All are on lateral ankle, right side has deltoid ligaments which are very strong and resist sprains
47
Q

Which muscle in the rotator cuff is responsible for:
Abduction the first 15*
Lateral Rotation of arm
Medial Rotation of arm

A

Abduction the first 15* = Suprascap
Lateral Rotation of arm = Teres Minor and Infraspinatous
Medial Rotation of arm = Subscapularis

48
Q

Which class of Abs can cause tendon rupture?

A

Flouroquinolones

49
Q

What are the three uses for N-acetylcysteine?

A
  1. Mucus reducer used in CF (breaks S bonds)
  2. Tx for Acetomenophen OD
  3. Protects RF kidneys from contrast dye
50
Q

How do NSAIDs cause renal dz?

A

They block PGE’s which are needed to keep the flow to kidneys

51
Q

Why is acetomenophen the DOC for OA?

A

The dz is non-inflammatory and doesnt have systemic symptoms, thus tylenol is safe in moderate doses

52
Q

What HLA is associated with RA?

A

HLA-D4

53
Q

What are the clinical signs of Sjogrens?

Labs?

A

Dry Eyes, Dry Mouth, Arthritis

Parotid Enlargement (lymphocytic infiltration of exocrine glands), increased risk of B-Cell lymphoma, and cavities

Labs: SS-A or SS-B

54
Q

Compare gout crystals to pseudogout crystals?

A

Gout = needle shaped monosodium urate crystals with a (-) biofringence and yellow tint when parallel with polarized light

Pseudo = Rhomboid shaped Ca Pyrophosphate crystals with a (+) biofringence and blue tint when parallel with polarized light (YELLOW WHEN PERP) <–stupid

55
Q

Why can alcohol cause an acute gouty attack?

A

Alcohol and Uric acid compete for same excretion sites in the kidney, thus EtoH wins and uric acid stays in blood and builds up

56
Q

What are the 3 main bugs of infectious arthritis?

How do you Dx?

A

S.A.
N. Gon
Strep

Dx: Joint Aspiration

57
Q

What are the seronegative spondyloarthropathies? What HLA are they associated with?

A

PAIR - associated with HLA B27. Tx all with NSAIDS, DMARDs, or Anti- TNFa’s

P: Psoriatic Arth = psoriasis + joint pain (dactylitis and pencil in cup deformity on x-ray at DIPs)

A: Ank Spond: Sacroilial pain/fusing in a young man that gets better with exercise. Can also cause conduction abnormalities or aortic regurg. Xray shows Bamboo Spine (Ca deposits outlining spine)

I: IBD

R: Triad of Dry eyes, Urethritis, and Arthritis following a Chlamydia infection or Diarrhea bug (shig, sal etc.)

58
Q

What is the most common death in an SLE pt?

A

Nephritis/RF.

Histo = wire loops (thickened BM in the shape of circles) and depositions of immune complexes

59
Q

What are some of the markers for SLE?

A

Antinuclear Abs (ANA) - Sensitive but not specific (GOOD SCREEN)

Anti dsDNA Abs - bad prognosis :(

Anti Smith Abs - Specific, but not prognostic

Anti Histone Abs - Signals Drug Induced SLE (SHIPP drugs)

Antiphospholipid/Cardiolipin Abs: Sign of hypercoagulability ***can create a false (+) syphilis test b.c of cross reactivity for the RPR/VDRL for cardiolipin

60
Q

What are some Tx for SLE?

A

NSAIDS, Steroids

Hydroxychloroquine, Cyclophosphamide (esp in renal cases)

61
Q

What will the labs be for polymyalgia rheumatica?

What is the tx?

A

Increased ESR and normal CK

Tx = low dose of Corticosteroids

62
Q

What is the main cause of death in Scleroderma pts?

A

Pulmonary sclerosis

63
Q

Diffuse vs CREST scleroderma?

A

Diffuse - much worse, rapid progression, Anti SCl-70 Ab and Anti-Topo1 Ab

CREST - more beningn. Anti Centromere Ab

64
Q

Polymyositis and Dermatomyositis

A

Proximal muscle weakness w/ endomysial inflammation and CD8 (poly) or CD4 (dermato) infiltration

Labs will show increased CK, ANA, and anti-Jo-1 Abs

Dermato will have rash on face, neck, or hands

65
Q

MG vs Lambert-Eaton

A

MG = post-synaptic ACh channel blockade by Abs causing muscle weakness that gets worse throughout the day. Can treat with ACHase blockers

Lambert = pre synaptic Ca+ channel blockade by Abs causing proximal muscle weakness that gets better with use. Cant tx with AChase blockers. Also associated with small cell lung cancer, dry mouth, and male impotence

66
Q

What are the manifestations of Gardner syndrome?

A

FAP (familial adenomatousis polyposis - APC related colorectal cancer

Osseous and Soft Tissue Tumors

Hypertrophy of retinal pigment epithelium (looks like a huge black mole on eye exam)

67
Q

What are the CNS tumors seen in Turcot’s syndrome?

A

Medulloblastoma (check the cerebellum!)

68
Q

How does the body normally get rid of copper?

A

Excreted into bile by hepatocyte copper transporting ATPase (ATP7B)

Def in this process leads to Wilsons Dz (tx with penicillamine)

69
Q

What are the main side effects of the antacids?

AlOH
MgOH
CaCarbonate

A

All can cause hypokalemia

AlOH: constipation and seizures
MgOH: diarrhea, heart attacks
CaCarbonate: hyper calcemia, chelation of Tetracyclines

70
Q

What is the MOA and clinical use of Metaclopramide?

Sdx?

A

Indx: Antiemetic or gastroparesis in DM or post surgery

Works by blocking the D2 R and increasing resting tone, contractility and LES tone and motility. DOES NOT influence colon transport

Sdx: Increase parkinsons and depression. Dont give to Park pts or ppl with bowel obstruction

71
Q

What congenital disorders are associated with tetralogy of fallot and coarctation of aorta?

A

Tetralogy = Digeorge

Coarctation = Turners (will see notching of ribs)

72
Q

Repression vs Supression

A

Repression = unconscious removal

Supression = intentional removal

73
Q

What nerve innervates the stapedius muscle? What does this muscle do?

A

CN VII

Stapedious controls the stapes and dampens sound.

Ligation would lead to unable to tolerate sound

74
Q

What does a cavernous hemangioma look like histologically?

A

Blood in the vascular spaces. This is a common benign tumor. Dont biopsy or you can bleed

75
Q

What step of the TCA uses FAD as a cofactor?

A

Succinate –> Fumarate via succinate dehydrogenase

76
Q

How do you calculate RPF from RBF?

A

RPF = (1-Hct)*(RBF)

77
Q

What receptors are involved in Tight Binding, Leukocyte Transmigration, and PMN Rolling?

A

TIght Binding = ICAM and LFA-1 (integrin)

Transmigration = PECAM and PECAM

Rolling = E and P selection and Sialyl-Lewis

78
Q

What do AV shunts do to preload and afterload?

A

Increase Preload and decrease afterload

79
Q

What does Membranous Glomerulopathy look like histologically>?

A

Spike and Dome on meth silver stain w/ granular deposits on immunoflourescence

80
Q

Statins + Fibrates causes?

A

Risk of myopathy (much more of a risk than statin + ezetimibe) and elevated CKs

81
Q

What do elevated HBc Ab and HBs IgG Abs mean?

A

An acute infection of Hep B has been resolved

82
Q

Where are the 3 leads of a pacemaker placed?

A

RA, RV, and the coronary sinus in the atrioventricular groove (to control the LV)

83
Q

What is the cause of fatty deposits in a liver exposed to alcohol induced hepatic steatosis?

A

Decreased FFA oxidation 2/2 excess NADH production by Alcohol breakdown

84
Q

Why do reticulocytes show up in iron deficiency anemia once it is treated? Why are they blue?

A

They are making a lot of new RBCs with their new iron. They are blue b/c they lack a cell nucleus by have a ton of rRNA (blue on Wright Geimsa Stain)

85
Q

Why does Clear cell carcinoma (RCC) appear clear?

A

The cells are packed with glycogen and lipid and appear clear due to the stain

86
Q

What is the DOC to prevent cerebral vascular spasm following SAH?

A

Ca Channel blockers

87
Q

What the DOC in treating hyperaldosteronism? (Conns syndrome)

A

Eplerenone (Aldosterone Agonist and K sparing diuretic) > Spironolactone

88
Q

What effect do opioids have on sphincter of oddi?

A

They contract the SM in the sphincter leading to an increase in pressures in the bile duct and gallbladder –> biliary colic (pain)

89
Q

What can sarcoidosis do to the liver?

A

Noncaseating granulomas

From Flashcardlet (32 decks)

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