3/28 MSK, Pulm, immuno Flashcards
(127 cards)
1
Q
Mutation in hereditary spherocytosis
A
Ankyrin, band 3, protein 4.2, spectrin
small round RBCs
splenomegaly
2
Q
Bacterial transformation
A
taking up naked DNA (from cell lysis) from environment
SHiN
S. pneumoniae
H. influenza type B
Neisseria
3
Q
What doe deoxyribonuclease do to bacteria?
A
degrade naked DNA so see no transformation
4
Q
viral/bacterial Transduction
A
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
Q
What drug activates antithrombin?
A
Heparin–> decreases action of IIa (thrombin) and factor Xa
6
Q
where are the metastasis coming from if show osteoblastic lesions in the bone?
A
Prostate
7
Q
Z line is what
A
the place where actin attaches to structural proteins (titin and alpha actinin)
sarcomere is defined as the distance between two Z lines
8
Q
What calculation for a case control study
A
Odds ratio
9
Q
Salicyate effect on ABG
A
Early–> Respiratory alkalosis
Late–> Anion gap metabolic acidosis
10
Q
what nerve controls protrusion of the tongue
A
Hypoglossal XII
11
Q
functions of the glossopharyngeal
A
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
Q
MOA morphine
A
mu agonist–> G protein–> increased potassium efflux
Close Ca channels
13
Q
Host defense against candida
A
T lymphocytes–> prevent superficial infection (HIV)
Neutrophils–> prevent hematogenous spread (immunocompromised)
14
Q
Bipolar I vs. Bipolar II
A
Bipolar I–> just mania +/- depression and hypomania
Bipolar II–>Hypomania + depression
15
Q
Hypomania vs. mania
A
Hypomania: less severe, no psychotic features, >4 days
Mania: SEVERE, marked impairment in social or occupational function may require hospitalization. Psychotic features
16
Q
SIADH body fluid and plasma osm
A
normal body fluid (increased body fluid–> RAAS–> excretion of sodium)
Low plasma osm
17
Q
Tx for DKA
A
Regular insulin
30min start
peak 2-4hr
lasts 5-8
18
Q
Role of glutathione peroxidase
A
detoxify free radicals (H2O2)
19
Q
Role of glutathione reductase
A
Regenerates reduced glutathione to continue detoxifying free radicals
uses NADPH
20
Q
Where does CN V3 come out?
A
Foramen ovale
21
Q
Where does CN V2 come out?
A
Foramen rotundum
22
Q
what goes through the foramen spinosum?
A
Middle meningeal artery
23
Q
Cyclosporine
A
inhibits NFAT–> modulates transcription activity–> decrease release of IL-2
tx for psoriasis
24
Q
pearly mass behind the tympanic membrane in the middle ear
A
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
