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3/24 - UW 21 Flashcards

1
Q

What are the 3 most common brain tumors in children?

A
  1. Pilocytic astrocytomas
  2. Medullobalstomas
  3. Ependymomas
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2
Q

What is the most common location for pilocytic astrocytomas?

A

Cerebellum

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3
Q

A child presenting with a cerebellar mass with both solid and cystic components, showing Rosenthal fibers on microscopy is indicative of what tumor?

A

Pilocytic astrocytoma

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4
Q

What is the most common location for Medulloblastomas?

A

Cerebellum (vermis) almost exclusively

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5
Q

What is the most common malignant brain tumor in children?

A

Medulloblastoma

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6
Q

What brain tumor in children shows sheets of small blue cells with hyperchromatic nuclei and scant cytoplasm in the cerebellum?

A

Medulloblastoma

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7
Q

Where are Ependymomas found?

A

In the ependymal lining of the ventricles, may obstruct CSF flow

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8
Q

What is absorbed primarily in the ileum?

A

Bile, B12

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9
Q

What proteins facilitate the “Rolling” phase of leukocyte accumulation?

A

L-selectin on neutrophils, E- or P-selectin on endothelial cells

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10
Q

How do the “Tight adhesion and crawling” phases of leukocyte accumulation happen?

A

Neutrophils use by [CD18beta2 integrins (Mac-1/LFA-1)]
to attach to
[Intercellular adhesion molecule-1 (ICAM-1)] on endothelial cells

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11
Q

What molecule facilitates the “Transmigration” (final) phase of leukocyte accumulation?

A

Platelet endothelial cell adhesion molecule 1 (PECAM-1)

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12
Q

What type of inheritance are the 3 leukocyte adhesion deficiency (LAD) syndromes?

A

Rare, AR

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13
Q

What causes leukocyte adhesion deficiency (LAD) syndrome?

A

CD18 defect, no pus, delayed umbilical detachment

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14
Q

What complication of subarachnoid hemorrhage can present 4-12 days later with new onset confusion/focal neuro deficit?

A

Vasospasm due to impaired brain autoregulation

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15
Q

How do you prevent vasospasms post-subarachnoid hemorrhage

A

Nimodipine (selective Ca channel blocker)

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16
Q

Why would you hyperventilate a patient with cerebral edema?

A

Hyperventilation causes hypocapnea, which decreases cerebral blood flow

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17
Q

Unexplained medical symptoms with excessive health care use are characteristic of what?

A

Somatic symptom disorder

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18
Q

What is the best first step in management of Somatic Symptom Disorder?

A

Regular scheduled visits with the same PCP

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19
Q

What is the TTAGGG repeat at the 3’ end of chromosomes?

A

Telomeres, added by Telomerase

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20
Q

What is the RNA template used by telomerases?

A

TERC template (built into the telomerase enzyme)

21
Q

What type of cells have active telomerases?

A

Stem cells (e.g. embryonic, epidermal, bone marrow)

22
Q

What does the proto-oncogene Ras encode?

A

G protein that activates the MAPK pathway, affecting downstream transcription

23
Q

What is the mechanism for nitrite antidote for CN?

A

Nitrites convert Hgb to metHgb, which is worse for O2 carrying, but better for CN sequestration, preventing it from damaging the mitochodrial ETC

24
Q

What is kinesin?

A

Microtubule associated motor protein that functions in anterograde transport of intracellular vesicles towards the (+) end

25
Q

What is the mechanism for nitrate induced smooth muscle relaxation?

A

Nitrate converted to NO. NO stimulates GTP conversion to cGMP, which decreases [Ca]. Decreased Ca dephosphorylates myosin light chain, relaxing the smooth muscle cell.

26
Q

Tricyclic anti-depressants can mimic what class of antiarrhythmics?

A

Quinidine (class IA): QRS and QT prolongation

27
Q

What to give for TCA-induced cardiotoxicity?

A

Hypertonic sodium bicarb (corrects QRS prolongation, reverse hypotension, treat ventricular disrhythmias

28
Q

What side effects of opioids do not exhibit tolerance?

A

Constipation and miosis

29
Q

What vitamin should be avoided with levodopa administration?

A

B6, which increases peripheral metabolism of levodopa

30
Q

What causes ataxia, nystagmus, opthalmoplegia, and anterograde amnesia in an alcoholic?

A

Thiamine deficiency induced Wernicke’s encephalopathy

31
Q

What brain structure is most affected in thiamine deficiency?

A

Mammillary body

32
Q

What fetal abnormality can be seen with Valproate?

A

Neural tube defects (due to inhibition of intestinal folic acid absorption)

33
Q

What is Ebstein’s anomaly?

A

Congenital “atrialized right ventricle” due to downward displacement of tricuspid valve, seen in maternal Lithium use

34
Q

What fetal cardiac abnormality is seen in maternal Lithium use?

A

Ebstein’s anomaly, where the tricuspid is downwardly displaced

35
Q

What is the maintenance (oliguric) phase of acute tubular necrosis (ATN)?

A

After the initial insult (initiation phase), GFR stabilizes at low level, oliguric. Lasts for 1-2 weeks. Shows granular casts in tubular lumina, and epithelial necrosis with denudation of basement membrane on microscopy

36
Q

What is seen in the recovery phase of ATN?

A

Re-epithelization of tubules. Polyuria and GFR normalization.

37
Q

Hypersegmented neutrophils with neurologic deficits = ???

A

B12 deficiency!

38
Q

What is the difference in joint involvement between gout and pseudogout?

A

Gout: 1st metatarsophalangeal jt

Pseudogout: knee

39
Q

What crystals are seen in pseudogout?

A

Rhomboid-shaped calcium pyrophsphate, birefringent (blue parallel, yellow perp)

40
Q

DVT tx in pregnancy??

A

Heparin!

41
Q

What anticoagulant is not used in pregnancy? Why?

A

Warfarin, due to teratogenicity

42
Q

What anticoagulant might you give for CAD, PVD, or cerebrovascular disease?

A

Clopidogrel

43
Q

Clopidogrel MOA?

A

Inhibition of ADP mediated platelet aggregation

44
Q

What neoplasm shows KERATIN PEARLS on microscopy?

A

Squamous cell carcinoma

45
Q

What neoplasm shows “ground glass” nuclei in cuboidal cells covering a fibrovascular stalk?

A

Papillary thyroid carcinoma

46
Q

What type of angina is episodic, transient, nocturnal, with temporary ST elevation?

A

Prinzmetal’s (variant) angina

47
Q

What causes Prinzmetal’s angina?

A

Vasospasms near atherosclerosis causing transient transmural ischemia

48
Q

What is the best diagnostic test for Prinzmetal’s angina?

A

Ergonovine test (ergot alkaloid that stimulates alpha and 5HT receptors causing vascular smooth muscle constriction)

49
Q

What do you use Ergonovine to test for?

A

Prinzmetal’s angina

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