6.29.16 Flashcards
(132 cards)
1
Q
hypoCa: ssx
A
- muscle cramp
- perioral paresthesia
- hypotension
- NM hyperexcitable
2
Q
cavernous sinus thrombosis: ssx
A
- HA
- fever
- proptosis
- ipsilat deficits in CN III, IV, VI, V (ophthalmic & maxillary br)
3
Q
what is: washout period
A
crossover study: period of no tx bw trtmt intervals to limit confounding effects of prior tx
4
Q
adenine at end of tRNA: fx
A
aa binding site
5
Q
xanthelasma: assoc dz
A
1ary, 2ndary hyper/dys-lipidemia
6
Q
clomiphene: MOA
A
estrogen receptor modulator –> decrease neg feedback inh on hypothalamus by circulating estrogen –> increase gonadotropin (FSH & LH) production –> ovulation
7
Q
LA enlarge –> leads to?
A
compress esophagus –> dysphagia
8
Q
Dandy Walker malformation: clinical presentation
A
infant:
- dev delay
- progressive skull enlrg
- cerebellar dysfx
- non-communicating hydrocephalus
9
Q
pulm HTN: comp
A
cor pulmonale (RV fail)
10
Q
opportunistic infections in HIV –> toxoplasma gondii –> prophylactic? when?
A
TMP/SMX
11
Q
MVP: #1 cause
A
mitral valve CT protein defect –> predispose to myxomatous degen of mitral leaflets & chordae tendinae
12
Q
PCOS pt –> desire fertility –> tx?
A
clomiphene
13
Q
ubiquitin proteasome pathway: fx in immune response
A
degrade foreign intracell proteins –> viral particles –> antigen presentation on MHC class I
14
Q
pyruvate kinase def: pathophys
A
insuff ATP production –> cannot maintain RBC struct –> hemolytic anemia
splenic parenchyma –> increase work to remv deformed RBCs –> splenic hyperplasia
15
Q
what is the most common indicator of obesity-related dz? what else might you find?
A
reduced ERV –> reduce FRC
decreased: FEV1, FVC, TLC
16
Q
release of sarcoplasmic Ca stores following NM Ach stim allows?
A
synchronization of skeletal muscle contraction & glycogen brkdown –> provide energy necess for anaerobic muscle contract
17
Q
toxic megacolon: what dx studies are CI?
A
- barium contrast
- colonoscopy
- -> risk for perforation
18
Q
VSD: onset
A
neonatal period after pulm vasc resistance has declined –> enable L-to-R shunting
19
Q
where is the descending aorta?
A
post to esophagus & LA
20
Q
what is: case-ctrl study
A
1) select pts w dz (case)
2) no dz (ctrl)
- -> determine previous exposure status
21
Q
what aa play an important role in transporting N throughout body?
A
- alanine
- glutamine
22
Q
toxic megacolon: ssx
A
- abd pain/ distention
- bloody diarrhea
- fever
- signs of shock
23
Q
renal cell CA: cell of origin
A
epithelial cells of proximal renal tubules
24
Q
retinal artery occlusion –> leads to?
A
acute, painless, monocular vision loss
25
opportunistic infections in HIV --> mycobact avium complex --> prophylactic? when?
azithromycin
26
what is: expiratory reserve vol
max vol of air that can be expired after normal tidal expiration
27
viral bronchiolitis: ssx
- low grade fever
- cough
- tachypnea
- increased work of breathing --> retractions
- diffuse wheezes, crackles
28
ophthalmic V injury: ssx
impaired venous drainage:
- proptosis (eye protrusion)
- chemosis (conjunctival swelling)
29
what should you do if you suspect a VSD?
echocardiography --> confirm size & location
30
how are proteins marked to go to lysosome?
phosphotransferase enzyme --> phosphorylate specific mannose residues --> ensure proper transit thru Golgi apparatus
31
viral bronchiolitis: most common cause
RSV
32
how is acid primarily excreted in urine?
in the form of NH4+ & titratable acids (H2PO4-)
33
what can lead to a C diff infection?
absence of normal intestinal microbial flora
34
lobar pneumonia --> resolution: key features
microscopic: enzymatic digestion of exudate
gross: restoration of normal architecture
35
hairy cell leukemia: how dx?
- BM bx
| - flow cytometry (has replaced tartrate-resistant acid phosphatase (TRAP) activity testing)
36
what are the 2 categories of ssx of hypoglycemia?
- neurogenic (autonomic)
| - neuroglycopenic
37
what is: xanthelasma
type of xanthoma --> yellowish macule/papule on medial eyelid --> dermal accumulation of macrophages containing chol & TG
38
renal cell CA: gross appearance
golden yellow mass d/t high lipid content in cells --> "clear cell"
39
esophagus is in closest proximity to what part of the heart?
LA
40
free ammonia: fx
excreted into urine by kidney for acid-base reg
41
1ary biliary cirrhosis --> can lead to?
hyperchol
42
lobar pneumonia --> red hepatization: key features
day 2-3
microscopic: alveolar exudate --> RBC, neutrophil, fibrin
gross: red, firm --> liver-like consistency
43
Lyme dx: tx? use?
- doxycycline --> erythema chronicum migrans
| - PCN-type abx --> ceftriaxone --> prevent progress to late Lyme dz
44
what part of the spleen undergoes hyperplasia in pyruvate kinase def?
red pulp --> reticuloendothelial cells in red pulp involved in remval of damaged RBCs
45
hairy cell leukemia --> BM fail --> pathophys?
infiltrate BM --> cytokine --> fibrosis --> BM fail --> pancytopenia
46
C diff infect: #1 RF?
abx tx
47
thyroid surg --> can injure what N? why?
recurrent laryngeal N
close proximity to inf thyroid A
48
opportunistic infections in HIV --> histoplasma capsulatum --> prophylactic? when?
itraconazole
49
hypoglycemia: neurogenic (autonomic) ssx
sympathoadrenal activation:
- NE/Epi: tremulous, palpitation, anxiety/arousal
- ACh: sweat, hunger, paresthesia
50
VSD: clinical presentation
depend on size of defect:
- small --> asympt holosystolic murmur
- lrg --> HF
51
viral bronchiolitis: onset
52
what is: crossover study
subject randomly allocated to seq of 2 or more tx given consecutively
53
increased cGMP --> leads to?
decrease intracell Ca --> decrease myosin light chain kinase activity --> myosin light chain dephosphorylate --> vasc SM relax
54
adult --> painless hematuria --> suspect?
GU malig
55
CN III palsy: ssx
- ptosis
| - mydriasis
56
what is: Kartagener synd
triad:
- situs inversus
- chronic sinusitis
- bronchiectasis
57
PCOS: clinical features
- obesity
- menstrual irreg
- hirsutism
- enlarged ovary
- increase risk of DM, endometrial hyperplasia
58
CN III, iV, VI injury: ssx
ocular muscle paralysis
59
ubiquitin ligase: fx
recog specific protein substrate --> attach ubiquitin tag --> ubiquitin proteasome pathway
60
colchicine: AE? why?
disrupt microtubule --> impair GI mucosal fx --> diarrhea, N/V, abd pain
61
transesophageal echocardiography best visualizes what struct?
- LA
| - descending aorta
62
what forms the majority of the post surface of the heart?
LA
63
what is: functional residual capacity
RV + ERV
64
what part of the body extracts the most O2?
myocardium
65
what is the most common indolent non-Hodgkin lymphoma in adults?
follicular lymphoma
66
Lyme dz --> late: ssx
- chronic asymm lrg jt arthritis
| - encephalopathy
67
MVP: murmur
midsystolic click & mid-late systolic murmur of mitral regurg
68
hairy cell leukemia: charact
- BM fail
- infiltration into reticuloendothelial system --> massive splenomegaly
- dry tap
- lymphocytes w cytoplasmic projections
69
Lyme dz --> early: ssx
- flu-like ssx
| - erythema chronicum migrans
70
how is phosphorylase kinase (PK) activated in liver?
liver --> Epi, glucagon --> bind Gs --> increase cAMP --> PKA --> phosphorylate PK
71
glucose-alanine cycle: fx
help remv excess N
72
protein catabolism: major steps
1) protein --> alanine
2) amino grp --> transfer to a-ketoglutarate --> form glutamate
3) liver --> process glutamate --> urea
73
what codon initiates protein syn?
AUG
74
acute gouty arthritis: 2nd line tx? MOA?
colchicine
leukocyte: inh tubulin polymerization --> inh microtubule formation --> reduce neutrophil chemotaxis & migration to sites inflamed by monosodium urate xl deposition
75
recurrent laryngeal N injury: ssx
vocal cord paralysis
76
follicular lymphoma: ssx
painless waxing & waning LAD
77
Dx: muscle cramp, perioral paresthesia, hypotension, NM hyperexcitable
hypoCa
78
ant wall MI: comp? when?
5-14 day after --> LV free wall rupture --> hemopericardium, cardiac tamponade --> profound hypotension, shock --> rapid progress to pulseless electrical activity --> death
79
what is: hibernating myocardium
- reduced coronary blood flow at rest --> chronic myocardial ischemia --> LV systolic dysfx --> decrease contractility
- partially, completely reversible by coronary revascularization
80
PCOS: charact
- elevated LH
- excess androgen production
- insulin resistance
81
what is used to degrade proteins for antigen presentation?
ubiquitin proteasome pathway
82
vitK def --> can lead to?
life-threatening bleeding diathesis:
- intracranial hemorrhage
- profuse bleeding from GI, umbilicus, surg sites
83
what are signs of NM hyperexcitability?
- Chvostek sign
| - Trousseau sign
84
pyruvate kinase: rxn
glycolysis: PEP --> pyruvate + ATP
85
ulcerative colitis: comp
- toxic megacolon
| - carcinoma
86
PCOS: tx? effect?
- wt loss --> reverse insulin resistance, restore normal ovulatory fx
- OCP (not want to become preg) --> minimize endometrial prolif, reduce androgenic ssx, prevent unwanted preg
87
xanthelasma: #1 cause
LDL receptor abnormality
88
C diff overgrowth --> leads to?
- transient diarrhea
| - pseudomembranous colitis
89
what are the 4 stages of lobar pneumonia?
1) congestion
2) red hepatization
3) gray hepatization
4) resolution
90
retinal artery occlusion: cause
atherosclerosis --> thromboembolism --> travel from internal carotid A --> ophthalmic A --> retinal A
91
phosphorylase kinase (PK): fx
phosphorylate glycogen phosphorylase --> activate
92
opportunistic infections in HIV --> pneumocystis jirovecii --> prophylactic? when?
TMP/SMX
93
pyruvate kinase def: ssx
- hemolytic anemia
| - splenic hyperplasia
94
tRNA --> what serves as the aa binding site?
adenine residue at 1 end of the mole
95
phosphoprotein phosphatase: fx
dephosphorylate glycogen phosphorylase --> inactivate
96
Epi: fx in glucose metab
- limit glucose use by insulin-sens tissues
| - stim hepatic glycogenolysis, gluconeogenesis
97
what is: hairy cell leukemia
middle age M --> indolent B cell neoplasm
98
location: degraded protein coupled to MHC class I
ER
99
neonatal vitK def: RF
- parental refusal of vitK prophylaxis at birth
| - exclusive breastfeeding
100
acidotic state: what happens to bicarb?
completely resorbed from tubular fluid
101
what are the opportunistic infections in HIV?
- pneumocystis jirovecii
- toxoplasma gondii
- mycobact avium complex
- histoplasma capsulatum
102
1ary ciliary dyskinesia: pathophys
AR --> proteins resp for normal flagellar & ciliary struct/fx (dynein, assembly proteins)
103
1ary ciliary dyskinesia: clinical manifestation
- situs inversus
- chronic sinusitis
- bronchiectasis
- infertility
104
what toxins does C diff produce?
- enterotoxin (toxin A)
| - cytotoxin (toxin B)
105
H2PO4-: fx in acid-base balance
titratable acid: metab acidosis --> excreted in urine
106
glycogen phosphorylase: fx? how is it regulated?
brkdown glycogen
phosphorylated --> active state
dephos --> inactive state
107
toxic megacolon: what imaging?
plain abd XR --> reveal colonic dilation
108
what is: inclusion cell (I-cell) dz
AR lysosomal storage disorder --> defect in protein targeting
109
what happens to urine pH in metab acid? why?
decrease
increase excrete free H+, NH4+, H2PO4-
110
CD4 tx? for what?
prophylactic azithromycin for mycobact avium complex (MAC)
111
what drugs should be used with caution in DM? why? what should be used instead?
nonselective BB:
- exacerbate hypoglycemia
- mask its adrenergic ssx mediated by NE, Epi
if BB is necess --> selective B1 ant
112
how is N disposed from the body?
- urea
| - free ammonia
113
lobar pneumonia --> congestion: key features
24hr
microscopic:
- vasc dilation
- alveolar exudate --> mostly bact
gross: red, heavy, boggy
114
what distinguishes heart circ from systemic circ?
- heart muscle is perfused during diastole
- myocardial O2 extraction is very high
- myocardial O2 demand & coronary blood flow are tightly coupled
115
what is: Dandy Walker malformation
dev analomy --> cerebellar vermis --> hypoplasia/absence --> cystic dilation of 4th ventricle w post fossa enlrgmt
116
what can lead to a cavernous sinus thrombosis?
medial face, sinus (ethmoidal, sphenoidal), teeth --> infect --> spread to valveless facial venous system --> cavernous sinus --> thrombosis
117
follicular lymphoma: what is the cell of origin?
B cell
118
Lyme dz --> 2nd stage: ssx
- AV block
| - facial palsy
119
renal cell CA: ssx
asympt til relatively advanced:
- hematuria
- abd mass
- flank pain
- wt loss
- polycythemia
120
lobar pneumonia --> gray hepatization: key features
day 4-6
microscopic:
- RBC disintegrate
- alveolar exudate --> neutrophil, fibrin
gross: gray-brown firm lobe
121
increased pulm A pressure --> on auscultation?
accentuation of pulm compt of S2 (P2)
122
what are the stop codons?
- UAG
- UAA
- UGA
123
CN V --> ophthalmic & maxillary br --> injury --> ssx?
lose:
- upper facial sensation
- aff limb of corneal reflex
124
how is phosphorylase kinase (PK) activated in muscle?
- Epi
- intracell Ca
no glucagon receptors on skeletal muscle
125
follicular lymphoma: cytogenetic change
t(14; 18) --> bcl-2 overexpression
126
Dx: central obesity, resp ssx
obesity-related restrictive lung dz
127
mutated BMPR2 --> leads to?
1ary pulm art HTN
128
hereditary pulm art HTN: pathophys
2-hit hypothesis:
1) inactivating mutation in BMPR2 --> predispose to excessive endothelial & SM cell prolif
2) 2nd insult --> activate dz process --> vasc remodeling, elevated pulm vasc resistance, progressive pulm HTN
129
what is: coronary sinus
large vessel that collects blood from the heart muscle --> drain most coronary venous blood --> RA
130
hypoglycemia: neuroglycopenic ssx
- beh change
- confuse
- visual disturb
- stupor
- sz
131
follicular lymphoma: histology
mixture of cleaved & noncleaved follicle center cells in a nodular pattern
132
what is responsible for synchronization of glycogen degradation w skeletal muscle contraction?
release of sarcoplasmic Ca following NM stim
