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From Flashcardlet > 5/23 > Flashcards

5/23 Flashcards

1
Q

What does an elevated ACh level in utero indicate?

A

It indicates a Neural Tube Defect (same as an elevated AFP) = failed fusion to take place

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2
Q

What are the symptoms of narcolepsy?

A 
loss of muscle tone upon strong emotion
low cerebrospinal fluid levels of hypocretin-1
shorter REM
Hallucinations before sleep
Sleep paralysis
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3
Q

What type of analogue are Penicillins?

A

They are D-ala-D-ala analogues working by inhibiting transpeptidase. These enzymes (PCPs) catalyze the final crosslinking step in peptidoglycan cell wall formation.

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4
Q

What is the MOA of isoniazid?

A

It blocks mycolic acid synthesis in TB. BUT FIRST must be activated/processed by mycobacterial Cat+ peroxidase in order to be a functional drug

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5
Q

What is the MOA of Pyrazinamide?

A

Lowers the pH in TB to kill them. This drug must be activated by pyrazinamidase in order to be active

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6
Q

What is the progression of distribution of general anesthetics like Thiopental?

A

It is IV barbiturate that is rapidly taken up by the brain –> it then gets redistributed to muscle and fat, resulting in rapid recovery from anesthesia

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7
Q

What R’s does rabies virus attach to?

A

ACh nicotinic R’s on peripheral nerve and travels retrograde to the CNS (1 week or so after infection)

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8
Q

What enzyme is activated in the pathogenesis of acute pancreatitus?

A

Inappropriate activation of pancreatic trypsinogen –> Trypsin and also activates the other pancreatic enzymes

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9
Q

How does Propranolol stop a thyroid storm?

A

It blocks B R’s from doing damage, but also decreases the peripheral conversion of T4 to T3

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10
Q

What is the mechanism that accounts for gynecomastia, decreased body hair, spider angiomatas, and teste atrophy in Alcoholics?

A

Increased estrogen due to:

Decreased catabolism of estrogens in the liver, and also an increase in sex hormone binding globulin (decreases free testosterone to estrogen ratio)

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11
Q

What anti-platelet drug causes neutropenia? What is its MOA?

A

Ticlopidine.

This is an ADP R blocker (same as Clopidogrel) so it blocks the synthesis of Gp2b/3a and thus tops platelets from aggregating

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12
Q

What is a skin artifact that may be found in a primary or secondary biliary cirrhosis pt?

A

Xanthomas

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13
Q

Kidney changes due to malignant HTN vs Non malignant HTN?

A

Malignant - hyperplastic arteriosclerosis with onion-like thickening of walls of arterioles

Non-Malig or DM = homogenously thickend and pink H&E stained arterioles

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14
Q

Aside from chronic hepatitis, what is the most severe side effect of Wilson Dz?

A

Basal Ganglia Atrophy (You go crazy)

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15
Q

What are the levels of cholesterol, bile acids, and phosphatidylcholine (phospholipids) in gallstone formation?

A

High Cholesterol

Low Bile acids and Phosphatidylcholine

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16
Q

What is the pathogenesis of “moldy” grains leading to liver CA?

A

Moldy grains = aspergillus, an aflotoxin, which increases p53 mutations and is a big risk factor for liver CA

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17
Q

What is the treatment for nephrogenic diabetes incipidus?

A

HCTZ - helps to concentrate urine

Amiloride - blocks Na channels

Indomethacin - decrease PGE and decreases blood flow to the kidneys

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18
Q

What is the difference between a slowly adapting and rapidly adapting sensory receptor?

What are the slow and rapid R’s in the superficial skin?

Deep layers of skin (dermis)?

A

Slow = continuous electrical signal sent throughout a continuous stimulus (long touching)

Rapid = electrical signal sent at beginning and end of a continuous stimulus

Superficial: Slow adapting = Merkel, Rapidly = Meissner

Deep: Slow adapting = Ruffini, Rapidly = Paccini

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19
Q

What do free nerve endings sense?

A

Pain and temperature

alpha delta = fast (prickling pain or cold temps)

C = slow (dull burning pain or warm)

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20
Q

What do Meissners corpuscles sense? Where are they found

What do pacinian corpuscles and merkels discs sense? Where?

Where are Ruffini fibers found?

A

Meissners = 2pt discrimination, fine/light touch - found on hairless skin

Pacinian = vibration/pressure - found deep and in ligaments/joints

Merkels = Pressure/static touch. Found at hair follicles (also looks like a melanocyte)

Ruffini fibers are found at the soles of the feet

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21
Q

What do you palpate to deliver a pudendal nerve block?

Lumbar puncture?

A

Pudendal nerve block - ischial spine

Lumbar Puncture = iliac crest

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22
Q

What are some sequelae of Guillain Barre?

What do labs look like?

A

Can cause cardiac irregularities, hyper or hypotension

Labs: increased CSF protein, but normal cell count –> can lead to increased H2O reabsorption and papilledema

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23
Q

What is destroyed in PML?

What is the cause?

A

Destruction of oligodendrocytes

Caused by JC virus

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24
Q

What is acute disseminated (postinfectious) encephalomyelitis?

A

Perivenular inflammation and demyelination after infection (measles of VZV) or vaccinations (rabies or smallpox)

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25
Q

Metachromatic Leukodystrophy vs Krabbe Disease?

A

ML = AS lysosomal storage dz due to arylsulfatase A def. –> build up of sulfatides and impaired production of myelin sheath

Krabbe = AR lysosomal storage dz due to galactocerebrosidase def –> build up of galactocerebroside destroys myelin sheath

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26
Q

Charcot-Marie-Tooth Dz

A

Hereditary motor and sensory neuropathy –> defective production of proteins involved in structure/fxn of nerves or myelin sheath

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27
Q

What are the main causes of otitis media?

Tx?

A

S. Pneumo
H.flu (non-typeable B)
Moraxella Catarrhalis

Tx: 
Amoxicillin
Amox + Clavalanic Acid
Cephalosporins
Tymanostomy Tubes
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28
Q

What are the main causes of Otitis Externa?
(swimmers ear)

(pulling on the ear will be painful!)

A

Pseudomonas Aeruginosa
S.A.

Tx:
Irrigation
Topical ABs

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29
Q

Central Vertigo vs Peripheral Vertigo

A

Peripheral = Inner ear etiology, more common type. Can be due to menieres disease or vestibular nerve infection/
Exam shows delayed horizontal nystagmus

Central = Brainstem/Cerebellar/Vestibular nuclei or posterior fossa tumor. Exam will show nystagums in any direction (and can change directions)

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30
Q

Rhine Test

A

Conductive block = louder sound on bone than in air

Neuro block = louder sound in air than on bone (normal response)

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31
Q

Which pts are wacky, wet, and wobbly?

A

Normal Pressure Hydrocephalus

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32
Q

What disorders are associated with FGFR3 and FMR1?

A

FGFR-3 = Achondroplasia

FMR1 = Fragile X syndrome

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33
Q

What are the layers of the epidermis? How do they get their blood supply?

What layers are changed in psoriasis?

A

Supplied via diffusion (no direct supply)

C: Corneum
L: Lucidum
G: Granulosum
S: Spinosum
B: Basale (stem cells here)

Psoriasis will decrease the granulosum and increase the sponosum

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34
Q 
Tight Junctions
Adherens Junctions
Desmosomes
Gap Junctions
Hemidesmosomes
A

Tight Junctions: (zona occludens) - prevents paracellular movement of solutes. Made of claudins and occludins.

Adherens Junctions: (zona adherens) connects actin with cadherins (w/ Ca+). Loss of E-cadherin promotes metastasis

Desmosomes: (macula adherens) are structureal proteins w/ keratin. (Auto ABs = Pemphigus Vulgaris)

Gap Junctions: channels w/ connexons permit electrical and chemical communication btwn cells (Think Myocytes)

Hemidesmosomes: Connects keratin in basal cells to BM. Auto Abs = Bullous Pemphigoid

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35
Q

What dz will show both hyperkeratosis and parakeratosis?

What dz shows Acantholysis

What dz shows Acanthosis

A

Hyperkeratosis (increased thickness of corneum) and Parakeratosis (retention of nuclei) = PSORIASIS

Acantholysis: (seperation of epidermal cells) = PEMPHIGUS VULGARIS

Acanthosis: (Epidermal Hyperplasia - mostly spinosum) = ACANTHOSIS NIGRICANS

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36
Q

What causes Melasma?

What causes Vitiligo?

A

Melasma = mask of pregnancy/OCP use

Vitiligo = irregular areas of depigmentation due to decreased melanocytes

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37
Q

What is the cause of necrotizing fasciitis?

A

Group A Strep

Will feel crepitus due to methane and CO2 under the skin

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38
Q

What is the cause of a painless white patches on the tongue that cant be scraped off?

A

EBV (hairy leukoplakia)

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39
Q

What can a Leser-Trelat sign indicate?

A

= spontaneous growth of lots of SKs –> indicatie of GI malignancy (stomach CA)

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40
Q

What are the main causes of Impetigo?

A

This is HIGHLY CONTAGIOUS = S.A. or S. Pyogenes

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41
Q

Where in the epithelium does Staph Scalded Skin syndrome attach?

A

Stratum Granulosum

42
Q

Pemphigus Vulgaris vs Bullous Pemphigoid

A

PV = desmosomal/desmoglein Abs immunoflourescing in a netlike pattern w/ acantholysis (sep of epi). Also seen in ORAL MUCOSA (Pos Nikolsky sign)

BP = Abs to hemidesmosomes w/ linear immunoflour. and eosinophils w. tense blisters. Less sever than PV and doesnt involve the oral mucosa

43
Q

What dz is associated with IgA at tips of dermal papillae?

A

Dermatitis Herpetiformis (Celiac Dz)

44
Q

What is the cause of erythema Multiforme?

A

Drugs (sulfas, B-lactams, phenytoin)

Mycoplasma, HSV

The rash looks like targets w/ multiple rings and dusky centers

45
Q

What is Toxic Epidermal Necrolysis?

A

Destruction of the E-D junction due to adverse drug rxn (SJ syndrome) that is covering more than 30% of the body

46
Q

What is the tx for AK’s?

A

5-FU

47
Q

Erythema Nodosum

A

Inflammatory lesions of subcutaneous fat (anterior shin)

Due to SARCOID, coccidiodomycosis, histoplasmosis, TB, Crohns

48
Q

What is the histo involved with Lichen Planus?

What liver dz is it associated with?

A

Sawtooth infiltrate of lymphocytes at the E-D junction

HCV

49
Q

Pityriasis Rosea

A

Christmas Tree pattern of plaques that resolves in 8 wks

50
Q

Histology of Basal vs Squam Cancer?

A

Basal = Palisading Nuclei

Squam = Keratin Pearls

51
Q

What is the mutation in melanoma? Marker? Tx?

A

BRAF mutation
Marker - S-100
Tx: Vemurafenib (BRAF kinase blocker)

52
Q

What are the three main, opportunistic yeasts? What are their pathogenology?

A

Candida = white plaque, if scraped will make you bleed. Can create satellite lesions or give you yeast infections (likes acidic environment.) Histo = budding yeast/germ tubes.

Cryptococcus: encapsulated (india ink, sabourauds agar, or latex agglutination test) found in bird poop, soil, and gives AIDS pts meningitis. Tx = amphoteracin and Flucytosie to start, then move to fluconazole

Pneumocystis Jirovecii: PCP pneumonia in AIDS pts. Inhaled. Histo: disk-shaped yeast on silver stain, or ground glass in CXR. Tx = TMP-SMX (just give to any AIDS pt <200 CD4)

53
Q

What are the 2 main opportunistic molds> What are their pathogenology?

A

Aspergillis: fungal ball, CF or asthma pts. Branch at 45* angles. Tx = Voriconazole or lipid Ampho B

Mucor/Rhizopus: infects DKA or leukemia pts as 90* branched molds. Can cause rhonocerebral infection w/ a black eschar (due to it living in blood vessels and necrosing tissues) Tx = surgery + Ampho B

54
Q

What causes Tinea Versicolor?

What is the cuase of foot, groin, ringworm, or fingernail fungi?

A

Tinea Versicolor = Malassezia FurFur. Seen in beach/summer as hypopigmented patches. Histo = spaghetti and meatballs on KOH prep. Tx = miconazole or selenium blue

Ringworm Bugs = Microsporum, Trichophyton, or Epidermophyton:

Foot - tinea pedis, 
cruris = groin
corporis = ringworm
capitis = scalp, 
fingernail = onchomycosis
55
Q

What are the 5 dimorphic fungi? Patho?

A

Tx for ALL: local = fluconazole or itroconazole. Systemic = Ampho B

Histoplasmosis = Ohio/Mississippi River Valley - bats/bird poop. will hide within macrophages (smaller than RBC)

Blastomycosis = Chicago/Great lakes. Forms Broad Based Buds (same size as RBC)

Coccidioidomycosis = Southern USA. Barral Arthrocinidia outside body, Spherule inside body. Can cause rash or rheumatic joint pain

Paracocciodi: Latin America, budding yeast looks like a captains wheel

Sporothrix Schenckii = Roses or moss. Look like cigars. Spread upward along lymphatics. Tx = itraconazole or Potassium Iodide (pot some roses)

56
Q

Ash-leaf spots is indicative of?

A

Tuberous Sclerosis

At risk for 3 cancers: Cardiac Rhabdomyoma, Astrocytoma, or Angiomyolipoma

57
Q

What artery has hemorrhaged:

Eye looks down and out
Bilateral loss of lateral visual fields
Broca or Wernicke Aphasia
Unilateral lower extremity sensory/motor loss
Unilateral facial and arm sensory/motor loss

A

Eye looks down and out = PCA
Bilateral loss of lateral visual fields = ACA
Broca or Wernicke Aphasia = MCA
Unilateral lower extremity sensory/motor loss = ACA
Unilateral facial and arm sensory/motor loss = MCA

58
Q

What are the side effects of Amiodarone?

A

Photosensitivity, Corneal deposits

Check your LFTs, TFTs, and PFTs (liver ,thyroid, and pulmonary fibrosis)

59
Q

What is dysarthria? Where would a lesion be?

What lesion would cause Poor Repetition?

A

Difficulty speaking b/c cant move mouth muscles

Cerebellar vermis lesion

Poor repetition = Arcuate Fasciculus lesion

60
Q

What do the sounds Ki Ki Ki, La La La, and Ku Ku Ku test?

A 
Ki = CN 7
La = CN 12
Ku = CN 10
61
Q

What are hyperopia, myopia, astigmatism, presbyopia?

A

Hyperopia = light is focused BEHIND the retina (eye too short for refractive power of cornea/lens

Myopia = light focused in FRONT of the retina (eye too long for refractive power of cornea and lens

Astigmatism = Abnormal curve to cornea –> different refractive powers at different axes

Presbyopia: Sclerosis and decreased elasticity –> decreased change in focusing ability during accomidation

62
Q

Uveitis vs Retinitis vs Central retinal artery occlusion

A

Uveitis = uveal coat inflammation (iris, ciliary body, or choroid) –> due to sarcoid, RA, arthritis, TB, PAIR (B27 conditions)

Retinitis = retinal edema and necrosis that can scar. Mostly viral (CMV, HSV, HZV) or immunosuppression

CRA occlusion = acute, painless, loss ov fision in one eye. Histo = retina whitening and cherry-red spot

63
Q

What are the main receptors in the eye and where are they located?

A

B R’s - on the ciliary epithelium
M3 R’s - on the sphicter
a1 R’s - on the dilator portion of the iris

64
Q

Open vs Closed Angle Glaucoma

A

Glaucoma due to blockage of canal of schlem –> increased IOP

Open = starts slow - peripheral than central vision loss, increased IOP, Increased optic disc-cup ratio (disc atrophy). Increased risk in black DMs

Closed = Lens grows or moves forward against central iris leading to obstruction of aqueous flow through pupil, IOP builds up behind iris, and pushes iris against conrea –> flow is blocked through trabecular meshwork

If acute, can be an emergency. sudden loss of vision and halos of light around a rock hard eye. DONT GIVE EPI (mydriatic effect)

65
Q

What is the pathogenesis behind cataracts?

A

bilateral opacification of the lens due to sun, smoking, alcohol, sorbitol/galactosemia, or rubella while in utero

66
Q

Papilledema

A

Optic disc swells (bilat) due to increased ICP (hydrocephalus) leading to an enlarged blind spot and blurred optic disc visualization

67
Q

What 3 things will compress the optic chiasm?

A
  1. Pituitary Adenoma
  2. Craniopharyngioma
  3. Aneurysm of ACA

These will all lead to a bitemporal hemianopia

68
Q

What is unique about the pathway of sympathetic (mydriasis) control of the eye?

A

3 neurons are involved and they go down to T1 before going up to control the eye

69
Q

What is the anatomy of CNIII?

A

It controls parasympathetic stuff on the outside of the nerve (huge pupil will be 1st sign of CNIII damage via an uncus, or PCOM aneurysm etc)

It controls motor stuff on the inside (eye will point down and out as a final sign of CNIII damage

70
Q

What are the clinical signs of a retinal detachment?

A

flashes and floaters followed by a curtain down effect.

This is due to a separation of neurosensory layer of retina (the layer w/ rods and cones) from the outermost pigmented epithelium

71
Q

Dry vs Wet Age related macular degeneration

A

Dry = nonexudative w/ yellow extracellular material beneath retinal pigment epithelium (Tx with vitamins and antioxidants)

Wet = exudative and rapid loss of vision due to bleeding (caused by choroidal neovascularization.) Tx w/ anti-VEGF or lasers

72
Q

What are the Ross stages of grief?

A 
Denial
Anger
Bargaining
Grieving
Acceptance
73
Q

What Neurotransmiter changes are seen in Alz, Huntingtons, Parkinsons, Anziety, Mania, Depression?

A 
Alz = decreased ACh 
Huntingtons = decreased ACh and GABA
Park = decreased DA, increased ACh and 5HT
Anxiety = increased NE and decreased GABA
Mania = increased NE and Serotonin
Depression = decreased NE, 5HT and GABA
74
Q

What are neurophysins?

A

They are carrier proteins that carry ADH and oxytocin down from the hypothalamus (where they are made) to the post pit for release

75
Q

What does insulin release do to Na levels in the kidneys?

A

It increases Na levels in the kidneys

76
Q

What two things control prolactin release?

What 3 things does prolacin release influence?

A

DA will inhibit prolactin, TRH will increase prolaction

Prolactin will inhibit GnRH, and increase milk production and DA production

77
Q

What is the mechanism that cortisol regulates BP?

A

It upregulates a1 receptors on arterioles –> increased sensitivity to NE and Epi

78
Q

What are some common ways to be hypo-magnesium? What does this cause?

A

Alcoholic, aminoglycosides, diarrhea, diuretics

Low Mg will cause an increase in PTH secretion

REALLY low Mg will cause DECREASED PTH secretion

79
Q

What do low phosphate levels cause?

A

They will trigger the kidney to increase 1a-hydroxylase to create more active vitamin D –> pulls in more phos from gut reabsorption and releases phos from bones

80
Q

What kind of Vit D do you get from sun? from plants?

A 
sun - D3
plants - D2
Both are converted to 25-OH in the liver
Converted to 1,25 OH2 in the kidney (active, bitch)
It will eventually shut itself off
81
Q

What layers of the adrenal glands does addisons dz affect?

A

all three cortical layers, spares the medulla

82
Q

What oncogene mutation is seen in a neuroblastoma? What is the breakdown product?

A

-N-myc oncogene mutation

HVA (DA breakdown product) is seen in the urine

**Look for VMA (breakdown product of epi and NE) in pheochromocytoma

83
Q

What is cabergoline and what is the indication?

A

It is a Dopamine agonist (like bromocriptine) and is used to treat hyper prolactinoma

84
Q

What are some causes of nephrogenic DI?

A

Lithium, hypercalcemia, demoxlocycline (ADH antagoninst)

85
Q

What are some causes of central DI?

A

Pituitary Adenoma, trauma, surgery, or histiocytosis X (a langerhaans dz)

86
Q

What would the labs show with SIADH?

A

hyponatremia, high urine osmolarity (salty pee), low serum osmolarity, near normal volume status (due to body’s adjustment of low aldosterone levels

LOW SODIUM LEVELS CAN CAUSE SEIZURES - CORRECT SLOWLY

87
Q

What are some causes of SIADH?

A

ectopic ADH secretion (Small Cell Lung Cancer)
Pulmonary Dz
Cyclophosphamide

88
Q

What does increasing PPARg gene do?

A

Increases sensitivity to insulin and levels of adiponectin

89
Q

Live attenuated vs killed flu vaccine

A

Live attenuated = oseltamivir (blocks NA and thus the flu cant leave the cell)

Killed vaccine = blocks HA and thus blocks virus entry

90
Q

What does the FTA-ABS test for?

What clinical signs will be seen with this?

A

Test for syphilis

You will see tertiary syphilis and can see mediastinal widening or dilation of the aortic valve ring.

First thing to go is vasa vasorum

91
Q

What are the short, medium, and long acting Benzos. What side effects correlate with these?

A

Short = Alprazolam, Triazolam, Oxazepam (severe withdrawals but low sleepy/fall risk

Medium = Estazolam, Lorazepam, Temazepam. medium side effects

Long = Chlordiazepoxide, Chlorazepate, Diazepam, Flurazepam. Higher risk of sleepy, lower risk of addiction

92
Q

Once ischemia is induced, what happens to the contraction of the muscle fibers in the area and the levels of ATP

How long before ischemia of a cardiac muscle is irreversible?

A

Cells stop functioning right away and thus the muscle will stop contracting. However, ATP levels will remain high for a little while. This is misleading b.c this ATP cant be used to generate cell fxn

Cardiac muscle can be reversed (myocardial stunning) up to 30 min of ischemia

93
Q

Which anti-arrythmic prolong the QRS?

A

Class 1C (also bind the longest)

94
Q

What disease has atrophy of the caudate nucleus?

A

Huntington Dz

95
Q

What is the function of T Tubule spacing?

A

They are spaced to uniformally distribute Ca into cells to make contractions of myofibrils coordinated.

96
Q

Which receptors make your eyes wide, and what receptors make your uterus stop contracting?

A

Uterus tocolysis = B2 agonists

Dilated pupils - a1 agonist

97
Q

Endometriosis vs Adenomyosis

A

Endo = endo glands outside the uterus (chocolate cysts) and the uterus is normal size

Adeno = endo glands in the myometrium and the uterus is enlarged.

Both dz are associated with painful menses and painful intercourse

98
Q

What can cause chronic interstitial nephritis?

A

NSAID overuse

99
Q

What is the cause of kidney problems/blood in urine in a sickle cell pt?

A

Papillary necrosis

100
Q

What causes a lung abscess post pneumonia?

A

The tissue damage is a result of lysosomal dumping of the macs and neutrophils

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