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From Flashcardlet > 6/2 > Flashcards

6/2 Flashcards

1
Q

70 y.o. hx of 2mo left flank pain w/ tenderness over the low back. Normo Normo anemia, Lytic bone lesions. 5.3-cm defect in the upper pole of the left kidney

Biopsy: clear cells with perinuclear halos

A

Renal Cell Carcinoma

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2
Q

Enzyme defect where an amino acid is switched from serine –> alanine will disrupt what>?

A

Phosphorylation of the enzyme

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3
Q

Lower Motor Neuron injury (weakness and atrophy of intrinsic muscles of left hand.) Where is the defect?

A

ipsilateral Anterior Horn Cells

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4
Q

Cirrhosis will cause HTN in what vein?

A

Short Gastric (feeds off the splenic)

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5
Q

child presents with sudden difficulty breathing while playing. No fever, decreased air movement on the right, with wheezes

A

Foreign Body Aspiration

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6
Q

A measure taken to ensure that your study can be generalized to the general population

A

External Validity

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7
Q

Second generation antiphsycotic and partial dopamine agonist

A

Aripiprazole

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8
Q

MOA of hydroxyurea in the tx of sickle crises and transfusion requirements

A

Increases hemoglobin F concentration

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9
Q

What travels through the optic canal?

A

CN II
Opthalmic Artery
Central Retinal Vein

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10
Q

What travels through the Superior Orbital Fissure?

A

CN III
CN IV
CN V1
CN VI

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11
Q

What travels through the cavernous sinus?

A

CN III
CN IV
CN V1, V2
CN VI

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12
Q

Hearing loss due to sudden loud noises

A

Tympanic membrane rupture and damage to stereocilliated cells in the organ of Corti

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13
Q

Sclerosis and decreased elasticity causing a decreased change in focusing ability during accommodation.

A

Presbyopia

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14
Q

Sudden, painless monocular vision loss

Exam = retinay whitening with cherry red spot

A

Central Retinal artery occlusion

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15
Q

Which glaucoma drug is contraX in a pt who presents with a sudden, painful loss of vision, a rock hard eye, and frontal headache?

A

This is acute Closure Glaucoma –> dont use epinephrine (a1 agonist that is typically used to tx glaucoma) b/c of its myadriatic effects

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16
Q

rapidly progressing dementia with a startle myoclonus

Pt. ate some suspicious cow brains

Histo = spongiform cortex (holes) or round vacuoles

A

Creutzfeldt Jakob disease - prions (B-pleated sheets)

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17
Q

Progressive lack of proper speaking, dementia, and some parkinsons like features

Change in personality

Histo: Frontotemporal atrophy w/ sparing of the parietal and posterior 2/3 of the superior temporal gyrus.

Ballooned neurons with dark nuclei are seen

A

Pick’s dz

Pick bodies look like candy corn with ballooned/parachuted clear spaces

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18
Q

Defect in lewy body dementia

A

a-synuclein defect

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19
Q

Monoclonal, humanized Ab targeting a4-integrin

Used to tx Crohns and MS

A

Natalizumab

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20
Q

Ascending paralysis w/ increased CSF protein but normal cell count

Papilledema

A

Autoimmune (t.4) of Schwann Cells due to molecular mimicry associated with:

Guillen-Barre (acute inflammatory demyelinating polyradiculopathy)

Caused by c. jejuni or CMV. Most ppl recover ok

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21
Q

Destruction of oligodentrocytes –> demyelination of CNS seen in an AIDS pt

rapidly progressive, fatal

Due to reactivation of a latent infection

A

Progressive Multifocal Leukoencephalopathy (PML) due to JC virus

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22
Q

Lysosomal Storage dz leading to a build up of sulfatides and impaired production of the myelin sheath

A

Metachromic Leukodystrophy (AR arylsulfatase A def)

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23
Q

Lysosomal Storage dz leading to buildup of galactocerebrosides and destruction of myelin sheath

A

Krabbe’s dz (AR def of galactocerebrosidase)

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24
Q

22q12 mutation in the tumor supressor gene causing bilateral acoustic schwannomas

Histo: uniform spindle cells (palisading areas (verocay bodies))

A

NF-2

NF-1 is also a tumor suppressor (inhibits RAS)

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25
Q

Germ cell layers involved in a GNAQ gene mutation leading to port-wine stain on face in V1 distribution

A

Neural crest cell derived (meso and ectoderm)

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26
Q

Brain lesion in the retina/brain stem/cerebellum that secretes EPO

in a pt with bilateral renal cell carcinomas

Brain Histo: high vascular with foamy cells and thin walled capillaries with hyperchromatic nuclei

A

Hemangioblastoma - VHL syndrome (a mutation in a tumor suppressor which leads to constitutive expression of HIF –> angiogenic growth factors)

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27
Q

Brain lesion with concentrically arranged spindle cells in a whorled pattern

Located near the surface of the brain

A

Meningioma (those are psammoma bodies)

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28
Q

Kid brain tumor w/ solid cystic appearance

Histo = eosinophilic wavy fibers

Located in the cerebellum/posterior fossa

May be supratentorial

A

Pilocytic Astrocytoma (GFAP+)

Good prognosis, benign

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29
Q

Kid brain tumor compressing 4th ventricle causing hydrocephalus

Histo: Circular clusters of small blue cells surrounding a fibrinoid center

Gross = Solid

Can send drop mets down to spinal cord

A

Medulloblastoma (these are Homer-Wright rosettes)

Neuroectodermal tumor

seen in Turcots syndrome

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30
Q

Kid brain tumor found in the 4th ventricle, can cause hydrocephalus

Histo: Cells containing fragments surrounding nucleus clustered around blood vessels

A

Ependymoma (perivascular pseudorosettes)

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31
Q

Most common child supratentorial brain tumor

A

Craniopharyngioma

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32
Q

MOA of opioids

A

Bind mu, delta, kappa Receptors to open K channels, Close Ca channels –> decrease synaptic transmission

leads to a decrease in release of NE, 5HT, ACh, glutamate, and Sub P

mu = morphine
delta = enkephalin
kappa = dynorphin
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33
Q

Opioid agonists used to tx diarrhea

A

Loperamide

Diphenoxylate

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34
Q

Mu partial agonist and Kappa agonist used as an analgesic

Can produce withdrawal symptoms if used with full opioid agonist (morphine) due to COMPETITION FOR RECEPTORS

A

Butorphanol

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35
Q

Weak opioid agonist that also BLOCKS serotonin and NE reuptake

Used for chronic pain

A

Tramadol

“Tramadol does it all”

36
Q
  1. The only epileptic drug that is DOC for partial simple, partial complex, and tonic clonic seizures AND trigeminal neuralgia
  2. DOC for Tonic clinic and prophylaxis of status epilepticus
  3. DOC for Partial seizures and tonic clonics in kids
  4. DOC for Absence seizures
A
  1. Carbamazapine (increases Na channel inactivation)
  2. Phenytoin
  3. Phenobarbital
  4. Ethosuximide
37
Q
  1. Epileptic drug that causes agranulocytosis, aplastic anemia, SIADH, and Induction of P450
  2. Epi drug that causes megaloblastic anemia, gingival hyperplasia, SLE-like symptoms, P450 induction
  3. Epi drug that cweight gainauses spina bifida (NT defects), hepatotoxicity
  4. Two epi drugs that cause fetal microcephalus, dysmorphic craniofacial features, and poor limb development
A
  1. Carbamazepine
  2. Phenytoin
  3. Valproic acid
  4. Carbamazapine and Phenytoin
38
Q

The short acting and addictive benzos

A

TOM

Triazolam
Oxazepam
Midazolam

39
Q

The only inhaled anesthetic not to cause malignant hyperthemia

A

NO

40
Q

Effect of an inhaled anesthetic on cerebral metabolic demand

A

Decreases cerebral metabolic demand (increases cerebral blood flow)

41
Q

Common benzo used for endoscopy anesthetic

A

Midazolam

42
Q

Order of blockage in local anesthetics?

A

small myelinated > small unmyelinated > large myelinated > large unmyelinated

Pain > temp > touch > pressure

43
Q

Local anesthetic that causes cardiotoxicity

A

Bupivicaine

44
Q

Tx for Parkinsons

A

BALSA

B= bromocriptine
A = amantadine
L = L-dopa (converted to DOPA in CNS
S = selegaine (MAO-B blocker) or entacapone/tolcapone (COMT inhibitors) to decrease dopamine breakdown
A = antimuscarinics (Benztropine)
45
Q

Headache med contraX in pts with CAD or prinzmetals angina

A

Sumatriptan

46
Q

What ligament can be cut to access the lesser sac in the abdomine?

A

Gastrohepatic ligament

47
Q

Which section of the SI has the most goblet cells?

Where are brunners glands found?

A

Ileum

Duodenum

48
Q

Where is a TIPS procedure performed?

A

between the portal vein and hepatic vein

49
Q

What side of hepatocytes face bile canaliculi?

A

Apical surface face bile canaliculi

Basolateral surface face sinusoids

50
Q

What makes up the boarders of the femoral triangle?

A

Sartorius
Adductor longus
Inguinal ligament

51
Q

The leading cause of bowel incarceration

A

Femoral hernia (more common in women)

52
Q

What must occur in the duodenum in order for activated pancreatic enzymes to function correctly?

A

The duodenum must be neutralized of gastric acid by HCO3 (released by the pancreas in response to secretin from S cells in the duodenum)

53
Q

Motilin receptor agonist used to stimulate peristalsis

A

erythromycin

54
Q

What converts pepsinogen to pepsin?

A

H+

55
Q

What is the primary route of gastric acid secretion stimulation?

A

G Cells of the antrum push Gastrin into circulation

Gastrin stimulates ECL cells (located in gastric pits) to secrete histamine –> stimulates parietal cells to secrete acid

56
Q

What receptors and pathways do these activities use?

  1. ACh stimulation of parietal cells
  2. Gastrin stimulation of parietal cells
  3. Histamine stimulation of parietal cells
  4. Prostaglandin inhibition of parietal cells
  5. Somatostatin inhibition of parietal cells
A
  1. M3 receptors –> Gq path
  2. CCKb receptors –> Gq path
  3. H2 receptors –> Gs path
  4. Gi path
  5. Gi path
57
Q

What do B-Cells in the germinal centers of Peyers Patches differentiate into?

Where do they ultimately reside?

A

IgA secretors

They ultimately reside in the lamina propria

58
Q

What process is 7a hydroxylase the rate limiter for?

A

Bile production

A bile salt is made of a bile acid and a glycine/taurine - makes it water soluble

59
Q

esophageal dysmotility w/ low pressure proximal to LES

A

CREST or Scleroderma

60
Q

Achalasia is a risk factor for what type of esophageal cancer?

A

SqCC of the esophagus

61
Q

Fatty Diarrhea

Folate deficiency

Histo: Blunting of villi, crypt hyperplasia, and lymphocytes in the lamina propria seen in the entire SI

A

Tropical Sprue

(Celiac Dz looks just like this, and can also cause folate def, but only affects the distal duodenum or proximal jejunum)

62
Q

Fatty Diarrhea

macrophages in the lamina propria, cardiac symptoms, arthralgias, neurologic symptoms

Labs: PAS+

A

Whipples Disease (caused by gram + tropheryma whipple)

fatty diarrhea due to macs compressing lacteals, thus fat malabsorption

63
Q

A ruptured gastric ulcer on the lesser curve of the stomach creates bleeding from where?

A

Left Gastric Artery

64
Q

A ruptured ulcer on the posterior wall of duodenum creates bleeding from where?

A

Gastroduodenal artery

65
Q

inflammatory bowel disease associated with p-ANCA’s

A

Ulcerative Colitis

66
Q

Cause of pneumaturia in an old man with stool occult blood/hematochezia, LLQ pain and fever

A

Diverticulitis creating a fistula with the bladder!

ps, pneumaturia is air in your pee! You will see bubbles

67
Q

Persistence of the vitelline duct

Cystic Dilation of the vitelline duct

A

Mechels diverticulum

Omphalomesenteric cyst

68
Q

Failure of recanalization of small bowel

Pt also has down syndrome

A

Duodenal atresia

69
Q

Small bowel obstruction with well-demarcated necrotic zones

Forms after surgery

Fibrous band of scar tissue

A

Adhesion

70
Q

Microvesicular fatty change in a liver of a young kid

Pt had a flu, which the mom treated

A

Reye’s Syndrome

Aspirin metabolites decrease B-oxidation by inhibiting Mitochondrial enzymes

71
Q

mACROVESICULAR fatty change in a college kid after patriot day

A

Hepatic Steatosis - reversible with etoh cessation

72
Q

Varices, visable abdominal and back veins, hepatosplenomegaly and ascities w/ absence of JVD

A

Budd-Chiari (IVC or hepatic vein occlusion)

Can be caused by hypercoagulable state, pregz, or polycythemia vera or liver cancer

73
Q

What are the 3 parameters for gallstone formation?

A
  1. Stasis
  2. Increased cholesterol and bilirubin
  3. Decreased bile salts (this can occur from BABRs!)
74
Q

Anti-Cholenergic SM relaxer used to decrease pain caused by biliary colic

A

Dicyclomine

75
Q

65 yo smoker with abdominal pain radiating to the back, weight loss, migratory thrombophlebitis, and painless jaundice

A

pancreatic CA

Palpable non-tender gallbladder and increased CA 19-9 and CEA

76
Q

Anti-acid drug that can cause increased risk for c.diff and hip fractures

A

PPI’s

77
Q

What happens when IL-2 is withdrawn from a proliferating cell population?

A

Intrinsic pathway apoptosis (decreased Bcl-2 and increased Bax –> increased mitochondrial permeability and cytochrome C destruction!)

Same outcome would occur if the cells were exposed to hypoxia, toxins, or radiation

78
Q

Pale infarcts

Red infracts

A 
Pale = heart, kidney, spleen
Red = liver, lungs, GI (and any reperfusion due to free radicals)
79
Q

What causes an increased ESR?

A

aggregation of RBCs due to increased fibrinogen and other products of inflammation

RBCs fall faster tomorrow

80
Q

Sick kid comes in with gastric bleeding

Histo shows cell death due to peroxidation of membrane lipids.

Cause?

A

Iron poisoning

one of the leading causes of fatality from toxicologic agents in kids

81
Q

Term for fibrous tissue formation in response to neoplasm

A

Desmoplasia

82
Q

What two cancers do you depend on the Grade for a prognosis?

A

Prostate CA

Chondrosarcomas

83
Q

What gene products are associated with:

  1. c-myc
  2. c-erbB2 (HER2/neu)
  3. ras
  4. L and N-myc
  5. ret
  6. c-kit
A
  1. Transcription factor (Burkitts)
  2. Tyrosine Kinase (breast CA)
  3. GTPase (colon CA)
  4. Transcription Factors (lung CA and neuroblastoma)
  5. Tyrosine Kinase (MENs, pap, medullary CA)
  6. Cytokine Receptor (GIST)
84
Q

What gene products are associated with:

  1. NF1
  2. BCRA 1/2
A
  1. RAS GTPase activating protein

2. DNA repair proteins

85
Q

1 cancer killer in both men and women. Has decreased for men, but stayed steady for women

A

Lung CA

86
Q

drug to give to stop premature orgasms

A

Paroxetine (or any of the SSRIs as they cause anorgasmia and decreased libido as side effects)

87
Q

Low T4 with a painless, enlarged thyroid. Feels tired

Histo = lymphocytic infiltrate w/ germinal centers and pink hurthle cells

A

Hashimoto’s thyroiditis

anti-thyroid peroxidase Abs

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