#3 3/8 Flashcards Preview

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Flashcards in #3 3/8 Deck (110):
1

describe a koilocyte

sign of HPV infection; immature squamous cell w/ dense, irregularly staining cytoplasm, perinuclear clearing. enlarged nucleus w/ undulating 'rasinoid' membrane, perinuclear vacuoles. pynknotic

2

HPV infection presentation (3 possibilities)

1. skin warts (verruca vulgaris) HPV 1-4
2. genital warts (condylomata acuminatum) HPV 6,11
3. Intraepithelial neoplasia of cervix (CIN) and vulva: HPV 16, 18, 31, 33, 35

3

describe endometrial cells

resemble histiocytes: small dark nuclei, no perinuclear clearing

4

describe parabasal cells in Pap smear

epithelial cells: round with a basophillic cytoplasm & finely granular chromatin in nuclei, no visible nucleoli, high N/C ratio. predominate in Pap from post-menopausal and post-partum women

5

describe glandular endocervical cells in Pap smear

indicate good sample: columnar with prominent cell borders. cluster = honeycomb

6

how much atherosclerotic blockage is needed for stable angina? unstable angina?

>75% for stable angina. >90% for unstable angina

7

4 conditions associated w/ Down's syndrome

1. Alzheimer's (extra copy of APP)
2. acute leukemia: AML and ALL
3. congenital heart disease: endocardial cushion defects
4. GI defects: duodenal atresia and Hirschsprung

8

clinical presentation of Creutzfeldt-Jacob disease

rapidly progressive dementia and myoclonic jerks

9

Nesiritide

recombinant brain natriuretic peptide (BNP). used in patients w/ decompensated left ventricle dysfunction leading to CHF. activate guanylyl cyclase. vasodilate, diuresis/natriuresis, decrease BP. counteract sympathetics, endothelin, and ANG II

10

where is endorphin made?

endogenous narcotic, made by corticotrophs in

11

three effects of TGF-beta

1. inhibition of cell cycle
2. promotion of angiogenesis
3. stimulation of fibroblasts

12

bradykinin; where is it made, what does it cause?

kidney, locally constricts veins and dilates arterioles (increase renal perfusion). implicated in angioedema (rx: ace inhibitors)

13

3 possible causes of acute orchitis

1&2 in young pts: c. trachomatis & n. gonorrhea. 3 in older: e. coli

14

predisposition to testicular torsion

congenitally-horizontal positioning of testes "bell-clapper deformity"permits rotation of testes around spermatic cord

15

hypospadias caused by..
epispadias caused by..

- incomplete closure of urethral folds
- faulty positioning of the genital tubercle

16

t-sample T test

determine if the means of 2 populations are equal/not.

need two means, sample variance, and sample size. calculate T-statistic and then p-value

17

linear regression

relationship between dependent and independent variable

18

correlation coefficient

measure of strength and direction of a linear relationship

19

meta-analysis

epidemiological method of analyzing pooled data from several studies, increasing statistical power beyond that of individual studies

20

generalized anxiety disorder criteria

excessive and uncontrollable worry w/ 3+ non-worry symptoms (irritability, disturbed sleep, poor concentration, muscle tension, easy fatiguability, restlessness)

for at least 6 months

21

classic presentation of acute intermittent porphyria (AIP)

abdominal pain, neurpsychiatric manifestations, and colour change in urine upon standing (excess prophyrinogen in urine --> light-induced formation of porphyrins)

22

where is heme produced (2)

85% in bone marrow erythroid cells for hemoglobin. 15% in liver for cytochrome p450 detox enzyme system

23

enzyme deficiency in acute intermittent porphyria & toxic agents (2)? Rx?

porphobillinogen deaminase (hydroxymethylbilane synthase) deficiency. accumulation of ALA and PBG, which are toxic to human tissue

Rx: intravenous heme preps and glucose --> inhibits ALA synthase activity

24

distinguish enzyme deficiency in early steps of porphyrin synthesis vs. latter steps (after condensation of porphobilinogen)

early (AIP): neurologic abnormalities w/o photosensitivity, darkening of urine when standing, increased urinary ALA and PBG

later: photosensitivity.

25

coronary steal phenomenon

collateral blood flow and maximal vasodilation in ischemic areas allows for maintenance of perfusion (low pressure drives flow through collaterals). normal myocardium has normal vascular size

selective coronary vasodilators (adenosine & dipyridamole) vasodilate blood flow to normal myocardium, but can't vasodilate vasculature to ischemic tissue anymore. blood flow through collaterals reduce. hypoperfusion, worsening ischemia.

26

explain the use of selective coronary vasodilators in myocardial perfusion studies

ADENOSINE and DIPYRIDAMOLE:
simulate coronary steal phenomenon. reveal changes that would occur w/ exercise (vasodilation of normal coronary vasculature --> ischemia in regions w/ collateral flow / obstruction

27

burkitt lymphoma translocation

typically t(8,14) c-myc w/ IgG heavy chain enhancer
but can be t(8,2) w/kappa light chain
or t(8,22) w/ lambda light chain

28

CML translocation

t(9,22) bcr-abl fusion protein

29

follicular lymphoma

t(14,18) bcl-2 (anti-apoptotic) and IgG heavy chain enhancer element

30

mantle cell lymphoma

t(11,14) CD-1 with IgG heavy chain enhancer

31

Erb2, HER2, neu are all the same name for..

epidermal growth factor over expressed in many breast cancers

32

Li-Fraumeni syndrome

autosomal dominant cancer syndrome caused by inherited mutation in p53. p53 inactivation often occurs as one of the two 'hits' in human malignancies

33

tibial collateral ligament (medial collateral ligament)

spans medial femoral epicondyle to medial condyle of tibia. attaches to medial meniscus

34

anterior cruciate ligament

attaches ANTERIOR portion of tibia (intercondylar) to posteriormedial side of LATERAL femoral condyle. prevents anterior movement of tibia

35

posterior cruciate ligament

attaches POSTERIOR part of intercondylar area of tibia and anterolateral surface of MEDIAL epicondyle of femor.

36

transverse genicular ligament

attaches medial and lateral menisci anteriorly on proximal articular surface of tibia

37

patellar ligament

spans from patella to tibial tuberosity. continuation of quadriceps femoris tendon

38

pasturella, borrelia, treponema rx:

penicillin, can get the little peptidoglycan that is there

39

drugs used for MRSA (3)

(1) Vancomycin, (2) Daptomycin (depolarization of cellular membrane), (3) Linezolid (inhibit bacterial protein synthesis by binding to 50s)

40

side-effects of daptomycin (1)

(1) myopathy w/ CPK elevation
note: it is inactivated by pulmonary surfactant (not good for pneumonia or gram negs)

41

side effects of linezolid (3)

(1) thrombocytopenia (2) optic neuritis (3) serotonin syndrome

42

micturition reflex (3 centers of regulation)

(1) sacral micturition center - S2-S4, responsible for bladder contraction. parasympathetic fibers travel from S2-S4 ventral white matter within pelvic nerves, stimulate cholinergic receptors in bladder wall
(2) pontine micturition center - pontine reticular formation. coordinates relaxation of of external urethral sphincter w/ bladder contraction in voiding
(3) cerebral cortex -- inhibits sacral micturition center

43

which brain regions are affected by normal pressure hydrocephalus (& which 3 are not)

corona radiata in of cerebral cortex. spares: cerebellum, basal ganglia (despite being right next to ventricle), pontine reticular formation

44

long thoracic nerve 1. enervation and 2. damage causes..?

1. serratus anterior 2. winged scapula

45

describe axonal reaction (when axon is severed- 3)

enlargement of cell body, movement of nucleus to periphery, dispersion of Nissl

46

describe acute neuronal injury (transient severe insult i.e. ischemia, hypoxia, toxicity, hypoglycemia, that is irreversible) -- red neuron (4 things)

12-24 hr post injury. shrinkage, pyknosis, loss of Nissl, eosinophilic cytoplasm

47

Niemann-Pick disease type A, inheritance, common demographic, clinical presentation

autosomal recessive, infants, ashkenazi jewish descent. loss of previously acquired motor capabilities (after normal development) --> progress to hypotonia and blindness by 1y/o. death by 3 y/o

cherry-red macular spot )also seen in tay-sachs & hepatosplenomegaly

48

Niemann-Pick disease

deficiency of sphingomyelinase. sphingomyelin accumulation within phagocytes. accumulate 'foamy histiocytes' in liver, spleen, and skin, and gradually in CNS (neurodegeneration).

49

which two diseases have cherry-red macular spot

tay-sachs and niemann-pick disease

niemann-pick also has hepatosplenomegaly

50

tay sachs enzyme deficiency

hexosaminidase A (causes GM2 ganglioside accumulation)

51

Hurler syndrome

mucopolysaccharidosis
deficiency of alpha-L-iduronidase.
heparan sulfate and dermatan sulfate accumulate.

52

gaucher disease

deficiency of glucocerebrosidase
glucocerebroside accumulates within phagocytes

53

von gierke disease

glycogen storage disease; deficiency of glucose-6-phosphatase

54

pompe disease

glycogen storage disease; deficiency of lysosomal-alpha-1,4-gluosidase

55

fabry disease

deficiency of alpha-galactosidase A, causes ceramide trihexoside to accumulate. disease manifestation: angiokeratoma, acroparesthesia, hypohidrosis, renal failure

56

lesch-nyhan

deficiency of HGPRT (hypoxanthine guanine phosphoribosyl transferase), disorder of uric acid metabolism

57

describe two ways CO causes hypoxemia

1. CO 220x more affinity for hemoglobin than O2 (occupies oxygen binding spot)
2. when bound, forms carboxygemoglobin, alters hemoglobin conformation to relaxed state, which has high affinity for oxygen (leftward shift of oxygen dissociation)

rx: 100% or hyperbaric oxygen

58

timeframe of postpartum blues, postpartum depression, postpartum psychosis

1. postpartum blues: 2-3 days, resolves within 10
2. postpartum depression: 2wks-12months
3. postpartum psychosis: days to 6wks postpartum

59

thiamine deficiency syndromes (3)

-infantile beri beri
-adult beri beri (dry or wet)
-wernicke-korsakoff syndrome in alcoholics

60

infantile beri beri presentation (thiamine deficiency)

appear between 2-3 months, include fulminant cardiac syndrome: cardiomegaly, tachycardia, cyanosis, dyspnea, vomitting

61

adult beri beri (dry vs wet) thiamine deficiency

dry: symmetrical peripheral neuropathy w/ sensory & motor impairments, esp distal extremities

wet: this neuropathy + cardiac involvement (cardiomegaly, cardiomyopathy, CHF, peripheral edema, tachycardia)

62

vitamin A deficiency

night blindness, xeropthalmia, vulnerability to infxn (esp measles)

63

vitamin B2 (riboflavin) deficiency

cheilosis, stomatitis, glossitis, dermatitis, corneal vascularization, ariboflavinosis

64

pyridoxine (vit B6) deficiency

cheilosis, glossitis, dermatitis, peripheral neuropathy

65

niacin deficiency

pellagra (dementia, dermatitis, diarrhea, and death)

66

ascorbic acid (vit C) deficiency

scurvy (hemorrhages, bleeding into joint spaces, gingival swelling, impaired wound healing, weakened immune system to local infxn)

67

classic presentation of pernicious anemia

older, mentally slow woman of northern European descent who is "lemon-coloured" anemic & icteric, smooth shiny tongue indicative of atrophic glossitis, shuffling broad-based gait.

68

most important cause of thrombocytopenia in hospitalized patients

heparin (heparin induced thrombocytopenia HIT) -- leading to paradoxical thrombosis

69

name 3 direct thrombin inhibitors. used for?

hirudin, lepirudin, agratroban. drug of choice for HIT

70

aspirin mechanism & indication

- irreversibly acetylates platelet cyclooxygenase I, leading to decreased foramtion of thromboxane A2.
- primary and secondary prevention of MI and stroke

71

ticlopidine and clopidogrel mechanism & indication (3)

- block ADP receptors (block aggregation)
- percutaneous coronary intervention (PCI), treatment of unstable in unstable angina and non-Q-wave myocardial infarction

72

dipyridamole and cilostazol

inhibit phosphodiesterase activity, increase cAMP, inhibit platelet aggregation

73

glycoprotein IIb/IIIa inhibitors (name & indication [1])

abciximab, eptifibatide, tirofiban; use post percutaneous intervention in acute coronary syndrome (PCI)

74

cardiac tissue conduction velocity

fastest to slowest: purkinje system, atrial muscle, ventricular muscle, AV node (park at ventura avenue)

75

pentazocine mechanism

opioid narcotic, partial agonist activity and weak antagonist activity at mu receptors. when used in combination w/ opiods, act as antagonist --> withdrawal symptoms

76

how much perfusion of myocardial capillaries of LV occurs during systole?

10%

77

neurophysins are..? where is ADH made? oxytocin?

carrier proteins for oxytocin and vasopressin (ADH), produced in paraventricular and supraoptic nuclei, respectively

78

mechanism for autosomal dominant hereditary hypothalamic diabetes insipidus

neurophysin II might shuttle/package vasopressin through ER and golgi into neurosecretory granules.

point mutation in neurophysin II, result in abnormal protein folding, removal from ER (along w/ bound vasopressin), decreasing availability of vasopressin for neurosecretory release.

79

Addison's disease primary defect

in adrenal cortisol production (of the adrenal cortical neurons, low cortisol is the only one needed to spike ACTH)

80

ACTH and MSH are derivived from which common protein

POMC (pro-opiomelanocortin)

81

corticosteroids

demargination of leukocytes (neutrophils)

82

visual impairment in an HIV-infected patient

secondary to CMV-retinitis

83

rx: CMV retinitis

ganciclovir, foscarnet, cidofovir

84

side effects of foscarnet

pyrophosphate analog that can chelate Ca++. nephrotoxic renal Mg+ wasting, and reduction in the release of PTH (further hypocalcemia)

85

acyclovir toxicity

crystal nephropathy and neurotoxicity (delirium and/or tremor)

86

ganclicovir side effect

severe neutropenia

87

indinavir (protease inhibitor side effects)

fat redistribution, insulin resistance (hyperglycemia) and hypertriglyceridemia, kidney stones

88

lamivudine side effects (though rare)

peripheral neuropathy and lactic acidosis

89

common causes of UTI

e. coli, s. saprophyticus, p. mirabilis, klebsiella, and eneterococci

90

after ligating coronary artery, how long does it take for myocardium to stop contracting? when does ischemia become irreversible?

ischemia --> cessation of aerobic glycolysis & initiation of anaerobic glycolysis. inadequate production of ATP & creatine phosphate, build up deleterious metabolites inclu lactate.

although total ATP levels remain relatively normal during first few minutes of ischemia, ATP is rapidly depleted from areas with high metabolic demand (cytosol surrounding contraction fibers and electrolyte transport pumps).

loss of contractility within about 60 seconds

ischemia that lasts less than 30min, restoration of blood flow leads to reversible contractile dysfunction (myocardial stunning) w/ contractility gradually returning to normal over the next several hours to days.

irreversible after 30min

91

hypoglycemia; presentation and rx in a nonmedical or medical setting

pallor and sweaty skin, can progress to bizarre behavior, convulsions, and unconsciousness.

early: mild to moderate rx: 15-30grams of fast-acting carbohydrates
when severe enough to be unconscious, need parenteral treatment

rx: glucagon intramuscularly or subcutaneously. corrects hypoglycemia by increasing hepatic glycogenolysis and gluconeogenesis. return to consciousness 10-15 min

IM glucagon can be done by a friend or relative
hospital --> IV glucose

92

low dose aspirin? high does?

low dose, irrev acetylates cox1 alone.
high dose, irrev acetylates cox 1 and cox 2

93

rofecoxib

selective cox2 inhibitor (cox 2 preferentially expressed at sites of inflammation, cox 1 constitutively expressed in platelets and in the GI tract where it is impt for normal physiological functioning)

94

cox 1 and cox 2 expression

cox 2 preferentially expressed at sites of inflammation.
cox 1 constitutively expressed in platelets and GI tract. impt for normal physiological fxn

95

glut transporter in skeletal muscle and adipocytes

glut4

96

glut transporter in liver, small intestine, kidney and pancreas

glut 2

97

when are MAOi used (i.e. phenelzine or tranylcypromine) [2]

1. atypical depression
2. treatment-resistant depression

98

describe atypical depression (4 features)
what makes it different from typical major depression?

- mood reactivity
- leaden fatigue (patients arms and legs feel extremely heavy)
- rejective sensitivity (overly sensitive to slight criticism)
- reversed vegetative signs of increased sleep and appetite

main diff from MDD -- MOOD REACTIVITY; atypical depression will have improvement in mood in response to something positive.

99

describe lung transplant rejection (hyperacute, acute, chronic). how is it different from renal rejection?

1. hyperacute: graft blood vessel spasm and diffuse DIC w/ resultant ischemia. "white graft" rejection
2. acute: vascular damage, perivascular and peribronchial lymphocytic infiltrates
3. chronic rejection: inflammation of the small bronchioles --> BRONCHIOLITIS OBLITERANS. inflammation and fibrosis

vs. chronic rejection in renal transplant --> vascular obliteration

100

granuloma formation (i.e. for TB)

Th1 releases IFNy
1. formation of phagolysosome (harsh bactericidal acids) in infected macrophages
2. release of iNOS (inducible nitric oxide synthase), ultimately produce reactive nitrogen intermediates and free radicals.

IFN-y activates macrophages, which then produce TNF
1. recruits monocytes that differentiate into epithelioid histiocytes, which cluster in a circular fashion around TB, hemming in. limits spread. caseating granuloma

101

leukotriene C4, D4, E4 (3 things)

vasoconstriction, increased vascular permeability, bronchospasm

102

thromboxane A2

platelet aggregator and vasoconstrictor

103

platelet activating factor

platelet aggregation, vasoconstriction, bronchoconstriction, increased leukocyte adhesion to endothelium

104

C3a

anaphylotoxin, from C3. stimulates mass cell histamine release. increased vascular permeability and vasodilation

105

IL-4

Th2 differentiation, B cell growth, isotype switching, IgE formation

106

IL5

B cell differentiation, eosinophil activation, igA formation

107

which nerve is at risk during a thyroidectomy? which muscle would be affected?

external branch of superior laryngeal nerve, as it travels with the superior thyroid artery and vein. innervates cricothyroid muscle (the only muscle of the larynx not served by recurrent laryngeal)

108

describe branches of the vagus nerve innervation to larynx

superior laryngeal n and recurrent laryngeal n.
- recurrent laryngeal: all laryngeal muscle except cricothyroid, and sensory below vocal cords

superior laryngeal
-external branch: cricothyroid
-internal branch: sensory above cords

109

possible progression of CIN

1. frank cervical cancer
2. most cases -> spontaneously resolve, immune survellience

110

OCP has what effect on the risk of ovarian and endometrial cancer

decreased risk, bc suppression of ovulation