3/23 GI and Renal Flashcards Preview

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Flashcards in 3/23 GI and Renal Deck (104):
1

Hemophagocytic lymphohistocytosis (HLH)

AR defect in perforin-related genes or linked to EBV infection.

Over active immune system attacks bone marrow, liver and brain in little kids

see macrophages engulfing RBCs

2

Signs and symp of Diffuse liver injury with no signs of cirrhosis

JAUNDICE
Steatosis, acute inflammatory infiltrate
accumulation of eosinophilic material in hepatocytes

3

During thoracentesis why insert needle on the lower margin of the intercostal space

To avoid stabbing the intercostal a, n, v

4

Mutation in Duchenne muscular dystrophy

X linked FRAMESHIFT
(out of frame)
dystrophin gene (usually anchors muscle fibers to extra cellular matrix

5

Mutation in Becker muscular dystrophy

x-linked NON frameshift (in-frame deletions)

6

Myotonia, muscle wasting, cataracts, testicular atrophy, frontal balding

Myotonic type 1
AD
CTG repeat

MY Tonia My testicles, My toupee, My ticker (arrhythmias)

7

Drugs that cause malignant hyperthermia

Sevoflurane, Desflurane, isoflurane, succinylcholine

tx: dantrolene

8

IV drug user with leukopenia, diffuse powdery interstitial infiltrates and + Methenamine silver stain

Pneumocystis jirovecii

9

Tx for pneumocystis jirovecii

Trimethoprim-sulfamethoxazole

MOA: Block folate synthesis at pteridine and PABA nucleotide formation

10

Forehead lesion with palisading nuclei

Basal cell carcinoma

11

What does basal cell carcinoma look like

Pink, pearly nodules with telangiectasis, rolled borders and central crusting

12

SE of haloperidol

EPS
Acute dystonia (first several hrs)
Akinesia (first several days)
Akathisia (weeks)
Tardive dyskinesia (mo)

13

Acute respiratory acidosis

Low pH
High pCO2
normal or slightly elevated HCO3 (

14

inheritance of classical galactosemia

AR

15

inheritance of lesch-Nyhan

x-linked recessive

16

X linked recessive disorders

Be Wise, Fool's GOLD Heeds Silly HOpe

Burton agammaglobulinemia
Wiskott-Aldrich
Fabry
G6PD
Ocular albinism
Lesch-nyhan
Duchenne (and Becker)
Hunter syndrome
Hemophilia A and B
Ornithine transcarbamylase def

17

Where is the majority of water reabsorbed in the kidneys?

PCT (60%)

(depending loop-20%; DT and CD 20%)

18

Where is K+ reabsorbed?

66% in the PT
25-30% thick ascending loop

19

where is K+ levels regulated?

Alpha intercalated cells of the collecting tubules
(H+/K+ ATPase)

Depletion of K+ stimulates alpha intercalated cells to reads K+

Increased K load stimulated principal cells to secrete K+

20

Who gets IgA nephropathy?

children (hence-schonlein purpura)

Episodic hematuria with RBC casts

21

Triad and cause of HSU

Triad: anemia, Thrombocytopenia, acute renal failure

Due to micro thrombi forming on damaged endothelium

With GI illness

22

Thrombocytopenia thrombotic purpura-HUS

A thrombotic microangiopathy

Fever, neuro symptoms, renal failure, anemia, thrombocytopenia w/ GI illness

Normal PT and aPTT

23

Thrombotic microangiopathy syndromes

TTP-HUS and DIC

Put activation in arterioles and caps
diffuse microvascular thrombosis (brain, kid, heart)
microangiopathic hemolytic anemia with schistocytes
thrombocytopenia

24

What is the most important poor prognostic factor for PSGN?

Increased age of onset

Also pre-existing kidney disease

25

Eosinophilic glassy casts

MM

(or chronic pyelonephritis but they resemble thyroid tissue)

26

Cause of acute interstitial nephritis

Penicillin, NSAIDs, PPI, sulfonamides, diuretics

See eosinophils in pee, fever, rash, acute renal failure

27

Gross painless hematuria in an older adult

Urinary tract cancer (urothelial or RCC)

28

Renal cell carcinoma histology

Clear cells--> filled with glycogen and lipids

29

Lipid peroxidation associated with...

inflammation, atherosclerosis and tumorigenesis

30

how is PAH secreted?

Carrier protein mediated process so it can be saturated at high blood concentrations

31

membranous nephropathy, flank pain, gross hematuria, right-sided varicocele, elevated lactate dehydrogenase

Renal vein thrombosis

32

What does a isolated right-sided varicocele indicate?

IVC occlusion by a malignant tumor or thrombus

33

Antithrombin deficiency

Inherited--> only a problem if give heparin (increased PTT)

Acquired--> renal failure/nephrotic syndrome--> antithrombin loss in urine--> decreased inhibition of factors IIa and Xa

34

Risk factor for calcium kidney stones?

Hypercalciuria
Idiopathic but maybe:
Increased GI abs
increased mobilization from bone
Decreased renal tubular Ca reabs

Other risks: hyperoxaluria, hyperuricosuria, low urine volume, hypocitraturia

35

Why patients with calcium stones remain normocalcemic

intact regulation of serum Ca by Vit D and PTH

36

Associations with renal papillary necrosis

SAAD
Sickle cell dz and trait
Acute pyelo
Analgesics (NSAIDs)
DM

37

Difficulty starting and maintaining stream of urine + nocturnal enuresis and daytime uncontrolled voiding w/o feeling a full bladder

Overflow incontinence
impaired detrusor contractility or bladder outlet obstruction

can be due to DM neuropathy

38

Which fluids increase in concentration along the proximal tubule? which decrease?

increase: PAH, creatinine, insulin, urea

Decrease: Bicarb, glucose, aa

39

primary virulence factor of E. coli causing UTIs

P fimbriae
allows adhesion to uroepithelium

40

ApoE

Found on chylomicrons and VLDLs--> responsible for up take

NOT on LDL

deficiency--dysbetalipoproteinemia (palmar xanthomas and premature atherosclerosis)

41

Extrinsic clotting pathway factor

VII

42

alcoholic who has increased PT and no improvement from K+ supplement

Liver disease: Inability to make VII because of liver cirrhosis

43

HPV viral protein E6 and E7 roles

E6--degrades p53
E7--inhibits Rb gene

44

Inactivated flu vaccine effect

inducing neutralizing Ab against HA antigen--> inhibit viral entry into cell by inhibiting HA binding to salivated receptor membranes

45

Tumor markers for Small cell carcinomas

Neuroendocrine markers
Neural cell adhesion molecule (CD56)
Enolase
chromogranin
synaptophysin

46

where does the left temporal hemiretina send visual signal?

Left lateral geniculate body of the thalamus

47

Merocrine

Secretion via exocytosis

Salivary glands
Eccrine sweat glands

48

Apocrine

Cells secrete via membrane bound vesicles

Mammary glands

49

Holocrine

Cell lysis releases entire content of the cytoplasm and cell membrane

Sebaceous glands
meibomian glands

(acne)

50

Pure red cell aplasia

marrow failure (rare)
sever hypoplasia of marrow erythroid elements with normal granulopoiesis and thrombopoiesis

associated with thymoma, lymphocytic leukemias, parvovirus B19

51

what happens to sickle cell pt spleens?

early adult: repeated splenic infarctions--> scaring, fibrosis and atrophy

Infants will get splenic sequestration crisis--> enlarged spleen + Hbg decrease + hypovolemic shock

52

anemia with high MCV low reticulocyte index

Folate or B12 deficiency

low RI--Not making enough blood

Extramedullary erythropoiesis less likely b/c that would have high RI

53

Signs and symptoms of biliary track obstruction

Jaundice
dark urine (bilirubinuria)
pale stools
pruritis
Hypercholesteremia with xanthomas
steatorrhea + malnutrition

54

Alteplase

Binds fibrin in thrombus
converts trapped plasminogen to plasmin

55

Shigella and SL toxin

inactive 60s ribosome--> remove adenine from rRNA

56

aa needed for purine synthesis

Glutamate, glycine, aspartate

57

what type of lung disease develops in sarcoidosis

Interstitial lung dz
restrictive

58

Pathophys of sarcoidosis

Dysregulation of CD4+ Th

59

Why hypercalcemia in pts with sarcoid?

increase of 1 alpha hydroxylase mediated vitamin D activation in macrophages--> increased absorption of Ca and phos from the GI tract (down reg PTH)

60

Paclitaxel

Chemo-microtubule inhibitor
hyper stabilize polymerized microtubules in M phase so they CANNOT break down

ovarian and breast carcinoma

61

what to monitor after starting heparin?

aPTT and plt count (risk of Heparin induced thrombocytopenia (HIT))

62

Causes of calcium oxylate stones

Ethylene glycol
vit C abuse
hypocitraturia
malabsorption (Crohns)

63

testing for syphilis

Serology
Nonspecific VDRL/RPR-->Cardiolipin testing (found in inner mitochondrial membrane)

Specific: FTA-ABS

64

osteogenesis imperfect leads to

brittle bones
blue sclera
Tooth abnormalities
hearing loss

problem forming collagen triple helix

65

Where are class II MHC

On antigen presenting cells

66

normal looking female with little sexual hair and no uterus

Androgen insensitivity syndrome (46 XY)

67

primary amenorrhea in a female with fully developed secondary sexual characteristics, short vagina and underdeveloped uterus

Mullerian aplasia (46, XX)

defective development or congenital absence of uterus

normal ovaries

68

Infertility in primary ciliary dyskinesia vs. CF

Primary ciliary dyskinesia-->immotile spermatozoa (situs inversus)

CF--> absent vas deferens bilaterally (azoospermia)

69

what decreases a pts risk of ovarian neoplasm?

Oral contraceptives
multiparty, breastfeeding
tubal ligation, sapling-oophorectomy

70

what increases a pts risk of ovarian neoplasm?

Infertility, nulliparity
endometriosis
genetics (BRCA1 or BRCA2, Lynch syndrome)
Postmenopausal

71

Marker for ovarian epithelia

CA-125

72

Treatment for PCOS

Estrogen receptor modulation (clomiphene)

if not wanting to be pre: estrogen-progestin OCP

Weight loss

73

Clomiphene

Antagonist at estrogen receptors in hypothalamus--> blocking negative feedback

increase LH and FSH production

tx for PCOS

74

risk of prostatectomy

Erectile dysfunction from damaging the prostatic plexus and cavernous nerves

75

dysmenorrhea, menorrhagia, uniformly enlarged soft globular uterus

Adenomyosis --> extension of endometrial tissue into uterine myometrium

Tx: GnRH agonist (leuprolide)
hysterectomy

76

The deep inguinal ring is an opening in what?

Transversals fascia

77

The superficial inguinal ring is formed by an opening in...

The external oblique muscle aponeurosis (above and medial to pubic tubercle

78

Causes of polyhydramnios

impaired fetal swallowing: anencephaly, GI obstruction

Increased fetal urination: high fetal CO (alloimmunization, parvovirus, fetomaternal hemorrhage)

79

47 chromosomes, male, behavioral issues, mild intellectual disability

Klinefelter syndrome (47, XXY)
Meiotic nondisjunction
Primary testicular failure (atrophy)--> increased FSH and LH low T
eunuchoid body shape
tall
long extremities
gynecomastia
developmental delay

80

post hysterectomy fever and flank pain

Ureteral injury

Have to ligate the uterine vessels that run in cardinal ligament during hysterectomy

81

presentation of a sertoli-Leydig ovarian tumor

adnexal mass with amenorrhea and virilization (hirsutitism etc)

increased T from sex-cord tumor

usually young women

82

Central chemoreceptors response

Respond to pCO2 changes

drop in pCO2-->vasoconstriction--> increasing vascular resistance and decreasing CBF

83

are the delusions always accompanied by mania or depression?

Yes-->major depressive disorder or bipolar disorder wth psychotic features

no--> Schizoaffective disorder

84

What is the pathogenesis of TB in the first week?

TB enters lungs and gets gobbled up by Macs where they use sulfatide virulence factor to proliferate inside the mac. Then they lyse the mac and continue the process.

Week 2-4 involved interferon secretion by activated T lymphocytes

85

Primary polydipsia on a water deprivation test

Serum Na LOW
urine osm after water deprivation: increased
after addition of vasopressin: no additional increase

86

Where does Hep C get its envelope?

Budding through the plasma membrane of the host cell

87

where does CMV get its envelope?

Budding through the host cell nuclear membrane

88

How is metabolic acidosis compensated?

Respiratory alkalosis

Calculate compensation using winter's formula

if have respiratory acidosis on top of metabolic acidosis-->respiratory failure

89

Where and what do enhancer sequences bind?

Where: upstream, downstream or w/in transcribed genes

bind to activator proteins

90

Where are promoter regions?

25-75 bases upstream and initiate transcription

91

where is a poly A tail found?

on mature mRNA 3' end

92

In skeletal muscle what is the thin myofilament? What band is it the only part of?

Actin

I band (containing the Z line)

93

In skeletal muscle what is the thick myofilaments? what band is it the only part of?

Myosin

H band (straddles the M line)

94

Dystonia

sustained, involuntary muscle contractions

Most common: spasmodic torticollis (cervical dystonia)

second most common: blepharospasm (closure of the eyelids)

95

Myoclonus

sudden brief, sometimes severe (shock-like) muscle contraction

96

lab findings in lupus

ANA
Anti-dsDNA
Anti-Smith
decreased C3, C4 and CH50

97

post giving birth hypoxia, hypotensive shock and DIC

Amniotic fluid embolism

see fetal squamous cells in pulmonary vasculature

98

Where does thoracic outlet syndrome occur?

W/in scalene triangle
(anterior + middle scalene+ first rib)

brachial plexus and subclavian artery pass between anterior and middle scalene

99

Consequences of fibroids (leiomyoma)

Uterine enlargement

reproductive issues (submucosal or intramural)
Prolonged menstrual bleeding
Subserosal can lead to bulk-related symptoms (constipation if posterior down and obstructive urinary if posterior and pushing up)

100

Pelvic pressure, constipation, normal uterus

Posterior vaginal wall prolapse (rectocele)

101

Location of osteomyelitis in children

metaphysis

from transient bacteremia

102

Location and cause of osteomyelitis in adults

epiphysis

open-wound trauma

103

Ewing sarcoma

Boys

104

what is caudal regression syndrome associated with?

Poorly controlled maternal diabetes