3/28 MSK, Pulm, immuno Flashcards Preview

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Flashcards in 3/28 MSK, Pulm, immuno Deck (127):
1

Mutation in hereditary spherocytosis

Ankyrin, band 3, protein 4.2, spectrin

small round RBCs
splenomegaly

2

Bacterial transformation

taking up naked DNA (from cell lysis) from environment

SHiN
S. pneumoniae
H. influenza type B
Neisseria

3

What doe deoxyribonuclease do to bacteria?

degrade naked DNA so see no transformation

4

viral/bacterial Transduction

Use of phage
Generalized--> lytic phage packages bacterial DNA into viral capsid that can then infect another bacterium
Specialized--> lysogenic phage infects bacterium--viral DNA incorporates into bacterial chr. Excised phage DNA takes flanking genes with it

5

What drug activates antithrombin?

Heparin--> decreases action of IIa (thrombin) and factor Xa

6

where are the metastasis coming from if show osteoblastic lesions in the bone?

Prostate

7

Z line is what

the place where actin attaches to structural proteins (titin and alpha actinin)

sarcomere is defined as the distance between two Z lines

8

What calculation for a case control study

Odds ratio

9

Salicyate effect on ABG

Early--> Respiratory alkalosis

Late--> Anion gap metabolic acidosis

10

what nerve controls protrusion of the tongue

Hypoglossal XII

11

functions of the glossopharyngeal

somatic: stylopharyngeous muscle (elevates larynx)
Parasympathetic: parotid gland secretions
General sensory: tympanic membrane, tonsillar region, posterior third of tongue, upper pharynx (afferent gag reflex)
carotid body and sinus
Taste: posterior 1/3 of tongue

12

MOA morphine

mu agonist--> G protein--> increased potassium efflux
Close Ca channels

13

Host defense against candida

T lymphocytes--> prevent superficial infection (HIV)

Neutrophils--> prevent hematogenous spread (immunocompromised)

14

Bipolar I vs. Bipolar II

Bipolar I--> just mania +/- depression and hypomania

Bipolar II-->Hypomania + depression

15

Hypomania vs. mania

Hypomania: less severe, no psychotic features, >4 days

Mania: SEVERE, marked impairment in social or occupational function may require hospitalization. Psychotic features

16

SIADH body fluid and plasma osm

normal body fluid (increased body fluid--> RAAS--> excretion of sodium)

Low plasma osm

17

Tx for DKA

Regular insulin
30min start
peak 2-4hr
lasts 5-8

18

Role of glutathione peroxidase

detoxify free radicals (H2O2)

19

Role of glutathione reductase

Regenerates reduced glutathione to continue detoxifying free radicals

uses NADPH

20

Where does CN V3 come out?

Foramen ovale

21

Where does CN V2 come out?

Foramen rotundum

22

what goes through the foramen spinosum?

Middle meningeal artery

23

Cyclosporine

inhibits NFAT--> modulates transcription activity--> decrease release of IL-2

tx for psoriasis

24

pearly mass behind the tympanic membrane in the middle ear

cholestetomas
collection of squamous cell debris

cause hearing loss from erosion of auditory ossicles

cause: congenital, infection, trauma, surgery

25

MOA colchicine

inhibit micro tubular polymerization
disrupts chemotaxis, phagocytosis and degranulation

also reduces the formation of LTB4

SE: nausea, ab pain, diarrhea

26

Zileuton

inhibits 5-lipoxygenase and inhibits leukotriene formation

tx for asthma and allergic rhinitis

27

Cause of prepatellar bursitis

repeat anterior knee trauma from kneeling

Gardeners, mechanics, plummers, carpet layers

28

Causes of suprapatellar bursitis

direct blow to the distal thigh or prolonged quadriceps activity (running)

29

Churg-Strauss vs. PAN

Similar histologically but churg-Strauss effects smaller vessels and has granulomas with eosinophilic necrosis

PAN--fibrinoid necrosis with transmural inflammation

30

when do you get graft vs. host dz?

Allogenic bone marrow txt
organs rich in lymphocytes (liver)
transfusion of non-irradiated blood

pts severely immunocompromised

31

MOA in GVHD

immunodeficient host
immunocompetent donor T cells from graft attack host MHC antigens

32

Features of GVHD

maculopapular rash (palms and soles)
jaundice
diarrhea
hepatosplenomegaly

33

Precursor vitamin for synthesis of NAD+ coenzyme

Niacin

If deficient can make up for it with tryptophan

34

What is arginine the precursor to?

NO, urea, ornithine, agmatine and creatine

35

skin slipping off with gentle pressure (Nikoldky's sign), epidermal necrolysis, fever, and pain associated with skin rash

Staph scalded skin syndrome

caused by exfoliatin exotoxin

blistering only the superficial epidermis

36

Pityriasis versicolor

Malassezia species of yeast

Hypo, hyper pigmented or erythematous macule or patches on upper body

hot humid climates and move visible after tanning

37

Diagnosis of Malassezia

KOH prep of skin

Spaghetti and meatballs

hyphae have short cigar-butt appearance

38

How is androgenic alopecia inherited?

Polygenic inheritance with variable expressivity

(similar to epilepsy, glaucoma, HTN, ischemic heart dz, schizophrenia, DMII)

39

Junctional nevis vs. compound nevis

Junctional--> dermoepidermal junction
flat black to brown pigmented macule with darker coloration in the center

Compound--> extend into dermis
raised papule with uniform brown to tan pigment

40

Out patient tx for non purulent cellulitis

Cephalexin to cover both beta hemolytic strep and MSSA

41

empiric Tx for UTI in child

Third generation cephalosporins and AGs

42

Most common organism in spontaneous bacterial peritonitis

E. Coli

43

How and how long to treat community acquired pneumonia?

third generation cephalosporin plus a macrolide or Doxycycline

5-7 days

44

Pneumocystis jiroveci labs

Elevated LDH

also occurs CD4 count

45

Watery non-bloody diarrhea with WBCs

invasive diarrhea

46

How to diagnose subcutaneous emphysema?

Fiberoptic bronch

47

presents with the abrupt onset of colicky abdominal pain, knee flexing, emesis, and bright red blood per rectum.

intussusception

Exam: sausage shaped mass in upper right quadrant

Diagnosis: ultrasound see "Target sign"

48

Treatment for HSV

Acyclovir

49

Fever, hemolytic anemia, thrombocytopenia, renal dz and change in mental status

Thrombotic thrombocytopenic purpura (TTP)

inhibition or deficiency of ADAMTS 13 (vWF metalloprotease)--> decreased degradation of vWF multimers

increased large vWF multimers--> increased plt adhesion --> increase plt aggregation and thrombosis

50

TTP labs

Schistocytes
increased LDH

microangiopathic hemolytic anemia

51

MOA TTP and symptoms

ADAMTS 13 deficiency or inhibition--> increase vWF--> more plt aggregation

FAT TN
Fever
Anemia
Thrombocytopenia
Renal dz
Neuro dysfunction (change in mental status)

52

Initial treatment for persistent a fib

start warfarin

after 3 weeks of warfarin cardiovert

53

Lead time bias

early detection is confused with increased survival

correction: measure "back-end" survival (adjust for severity of dz at time of diagnosis)

54

Tanner stages for boys

2--pubic hair just appears, testicles 4cc and penis just starts to enlarge

3--more, darker pubic hair, elongation of penis, 10 cc scrotum

55

Severe bacterial and viral infections in infancy, chronic diarrhea, thrush

Severe combined immunodeficiency

absent thymic shadow, germinal centers, and T cells

56

craniofacial abnormalities, conotruncal cardiac anomalies, hypoplastic thymus, hypocalcemia

DiGeorge syndrome

57

where do you aspirate when lying down?

Posterior segment of the upper lobes and superior segment of the lower lobes

58

Effects of PE on ABG

Respiratory Alkalosis

Hypoprofusion->V/Q mismatch --> R to L shunting

Hypoxemia--> increased respiratory drive--> hyperventilation

59

which cells are involved in creating granulomas in the lungs?

CD4 T cells activate Macrophages that can form Langhans giant cells (horseshoe shaped)

60

where is the highest resistance in the bronchial tree?

Medium sized bronchi

drops further on because there is a large net cross sectional area

61

How to treat asthma that is resistant to inhaled steroids and long acting beta 2 agonists?

Omalizumab (anti-IgE Ab)

62

what are the carotid bodies? what do they respond to?

Peripheral chemoreceptors

sensitive to PaO2 and stimulated by hypoxemia

63

what kind of channel is CFTR?

ATP-binding transmembrane ion transporter pumps Cl ions out of epithelial cells (pump in in sweat glands)

64

What is Dihydrorhodramine (DHR) flow cytometry?

Test for CGD
assess the production of superoxide radicals--> measure conversion of DHR to rhodamine (a green compound)

if cell is deficient NADPH oxidase then will not have as much green

Can also use nitroblue tetrazolium testing

65

Which bugs have vaccines with capsular polysaccharide conjugated with a toxoid?

S. pneumonia
N. meningitides
H. flu

all are encapsulated bacteria with conjugate vaccines

66

defense mechanism of inhaled particles in the terminal bronchioles

Mucociliary clearance (from the trachea to proximal resp bronchioles)

67

Where are goblet cells in the lungs?

from trachea to the larger bronchioles

NOT in terminal bronchioles

68

Defense in the distal terminal bronchioles?

Macrophages

69

what is the main indication of total alveolar ventilation?

The inverse of the PaCO2

ex: Hypocapnia implies alveolar hyperventilation

70

decreased breath sounds, hemithorax opacification on one side and tracheal deviation to that same side

collapsed lung dure to bronchial obstruction

appears opaque because can not get air into lung because it is collapsed.

usually after mainstream bronchus obstruction (central lung tumor)

71

BMPR2 gene

Pulmonary HTN

plexiform lesions
intimal fibrosis
medial hypertrophy

72

red hepatization

2-3 days

alveolar exudate continuing erythrocytes, neutrophils, and fibrin

73

Gray hepatization

4-6 days

RBCs disintegrate
alveolar exudate contains neutrophils and fibrin

74

what allows elastin to stretch?

interchain cross-links involving lysine

uses lysol oxidase

75

Where does the right ovarian vein drain to?

IVC

76

What is a preventable medical error

harm to patient by act of commission or omission due to failure to follow evidence based best practice guidelines

77

columnar mucin-secreting cells that line alveolar spaces and do not invade stroma or vessels

Adenocarcinoma in situ of the lungs (Bronchioloalveolar carcinoma)

Most common cancer in nonsmokers

KRAS, EGFR, ALK

78

pathophys of a Meckel diverticulum

failed obliteration of the vitelline (omphalomesenteric) duct

current jelly stools, painless GI bleed

99mTc-pertechnetate --> tests for parietal cells of gastric mucosa

79

99mTc pertechnetate scan

Looking for Meckel diverticulum

affinity for parietal cells of stomach

80

what would you see on a EBV blood smear?

Cytotoxic CD8 T cells

they multiply to try to kill virally infected B cells

81

prenatal tx for Group B strep

intrapartum Penicillin or ampicillin

Screening at 35-37 weeks

82

MOA Caspofungin

block 1,3-beta-D- Glucan synthesis

Echinocandins suppress fungal cell wall synthesis

83

increased peripheral metabolic rate and hypercapnia has what effect on CO2 transport

Chloride shift

More CO2 converted to H2CO3 by CA then H and HCO3

HCO3 transported out of RBC in exchange for Cl-

84

Restrictive lung disease on pulmonary function test (TLC, FEV1, FVC, RV, DLCO)

All decreased

85

Neuromuscular weakness on pulmonary function test (TLC, FEV1, FVC, RV, DLCO)

decreased TLC, FEV1, FVC

increased RV

normal DLCO

86

hypercapnia leads to the build up of what enzyme in the lungs?

Carbonic anhydrase

87

First line treatment for strep pneumo

amoxicillin or penicillin
if resistant then vanco

88

HLA DR2

MS, hay fever, SLE, Goodpastures

89

HLA DR3

DM I, SLE, Graves, Hashimoto

90

HLA DR5

Pernicious anemia
Hashimotos

91

TNF alpha function

Mediate septic shock
Causes vascular leakage
induces leukocyte recruitment
helps form and maintain granulomas

92

Neutropenia, hypergammaglobulinemia, anemia with recurrent UTIs and skin abscesses

CGD
x-linked recessive

93

Pathophys of ARDS

Initial insult to alveoli from neutrophils, coagulation cascade and free radicals--> increase alveolar cap perm.--> exudate into alveoli and noncardiogenic pulm edema

intra-alveolar hyaline membranes
fluffy lung infiltrate
Widespread destruction of both type I and II pneumocytes

94

Back pain that is improved by leaning forward and with rest, diffuse weakness in legs bilaterally, numbness that travels down legs.

Lumbar spinal stenosis

signs of neurogenic claudication

Vertebral body compression fractures mainly pain not as many neuro signs

95

Lennox-gastaut

childhood epilepsy syndrome characterized by frequent and difficult to control seizures of different types and developmental delay

multifocal slow spike and wave on EEG

96

Lennox-gastaut on EEG

Multifocal slow spike and wave

97

Benign childhood epilepsy on EEG

may just be normal

98

how to prevent worsening of non proliferative retinopathy in a DM?

control blood sugar better (give insulin)

99

Two toxins of B. anthracis

Edema factor--> increases AC thus cAMP--> edema and disruption of innate immunity

Lethal factor--> inactivates MAP kinase pathway leading to rapid cell death

100

Treatment for status epilepticus

Benzos
phenytoin
phenobarbital (third line)

if continue then use general anesthesia such as propofol

101

Treatment for DKA

1. normal saline
2. IV regular insulin

102

tests for muscle inflammation

creatine phosphokinase
aldolase
AST ALT
lactic acid dehydrogenase

103

Tuberous sclerosis

HAMARTOMAS
Hamartomas in CNS and skin
Angiofibromas
Mitral regurg
Ash-leaf spots
cardiac Rhabdomyoma
Tuberous sclerosis
autosomal dOminant
Mental retardation
renal Angiomyolipoma
Seizures
Shagreen patches

104

Perianal pain that is constant and progressive

Ischiorectal abscess

105

persistant anal pain that is worse with defecation

Anorectal fistula

106

Treatment for hip dysplasia in an infant

place in a harness

diagnosis via ortolani or barlow maneuver

107

Function of cysteine

forming disulfide bonds
ex: forming insulin

108

What do mast cells release during anaphylaxis?

Histamine, bradykinin, tryptase

Tryptase is specific to mast cells and can be used for diagnosis of anaphylaxis

109

Calcitonin is a marker of...

produced by C cells of thyroid gland

marker of medullary thyroid carcinoma

110

Pathophys of Anaphylaxis

Type I hypersensitivity rxn

antigen binds to high affinity IgE receptor on mast cells and basophils--> cross linking receptors--> aggregation--> activates non-receptor TK-- degranulation

111

Macrophage surface markers

CD14, CD40, B7, MHC-II, Fc and C3b receptors

112

Anti-U1-RNP

Mixed connective tissue disease

113

Anti-Scl-70

Diffuse type scleroderma
Anti-DNA topoisomerase I

114

Anti-centromere

Limited type scleroderma (CREST)

115

Anti cardiolipin

Syphilis and SLE
antiphospholipid

also Anti-Beta2 glycoprotein I
Lupus anticoag

116

What kind of hypersensitivity rxn is eczema?

Type I

117

what type of graft is best for pts with Hodgkin lymphoma?

Autograft
from self-->no immunosuppression needed

118

role of Sargramostim (GM-CSF) and Filgrastim (G-CSF)

Stimulate myeloid stem cells to produce more granulocytes

use: treat neutropenia and thrombocytopenia from chemo

119

Presentation of Acute leukemia

anemia (fatigue), Thrombocytopenia (bleeding), neutropenia (infection)

symptoms due to "crowd out" in bone marrow

120

repeated staph infections, papulovesicular dermatitis, coarse facial features

AD hyper IgE syndrome (job syndrome)

High IgE
red hair
staph abscess
retained primary teeth

due to low IFN gamma
deficiency of Th17 cells (STAT3 mut)

121

hemolytic anemia, fever, thrombocytopenia purpura, renal failure and neurologic abnormalities

TTP

122

how does intrinsic factor work?

B12 bound by R-proteins in the stomach and transported to duodenum. B12 then binds to intrinsic factor in duodenum and transported to terminal ilium

123

Shillings test

Test for pernicious anemia

see if B12 is being absorbed

1: radiolabled oral B12
--high amt in urine-->dietary deficiency
2. B12* + oral intrinsic factor
--high B12*--> pernicious anemia
3. B12* + oral antibiotics
--High B12*-->bacterial overgrowth
4. B12* + pancreatic enzymes
-->high B12*-->pancreatic insufficiency

124

Widespread rash and intractable diarrhea after transplant

GVHD

125

Clinical use for IFN-alpha

Chronic hep B and C, Kaposi sarcoma, malignant melanoma

126

Clinical use for IFN-beta

MS

127

Clinical use for IFN-gamma

CGD