7.6.16 Flashcards
(161 cards)
1
Q
radial N: motor fx
A
- extend: arm, wrist, fingers
- supination
- thumb abduct
2
Q
radial N: sensory fx
A
post arm, forearm, hand
3
Q
what passes thru the supinator canal?
A
radial N
4
Q
radial N injury at supinator canal: cause?
A
- repetitive pronation/supination
- direct trauma
- subluxation of radius
5
Q
radial N injury at supinator canal: ssx
A
- weak finger/thumb extend (finger drop)
- no wrist drop
- no sensory deficits
6
Q
renal papillary necrosis: commonly seen in?
A
- sickle cell dz/trait
- analgesic nephropathy (NSAID)
- DM
- severe obstructive pyelonephritis
7
Q
renal papillary necrosis: classic presentation
A
- gross hematuria
- acute flank pain
- passage of tissue fragments in urine
8
Q
McArdle dz: pathophys? ssx?
A
glycogen storage dz: deficient myophosphorylase –> isoenzyme of glycogen phosphorylase present in muscle tissue
decreased brkdown of glycogen during exercise:
- poor exercise tolerance
- muscle cramp
- rhabdomyolysis –> myoglobinuria
- no rise in blood lactate after exercise
9
Q
Pompe dz: def? main features?
A
acid a-glucosidase –> lysosome can’t brkdown glucose
- normal glucose
- severe cardiomegaly
- glycogen accum in lysosomes
10
Q
Cori dz: def? main features?
A
debranching enzyme
- hepatomegaly
- ketotic hypoglycemia
- hypotonia, weak
- abnormal glycogen w very short outer chains
11
Q
von Gierke dz: def? main features?
A
glucose 6-phosphatase
- hepatomegaly
- steatosis
- fasting hypoglycemia
- lactic acidosis
- hyperuricemia
- hyperlipid
12
Q
what is the purpose of blinding in clinical trials?
A
prevent observer bias: prevent pt/researcher expectancy from interfering w outcome
13
Q
what gives elastin its rubber-like properties?
A
lysyl oxidase –> extensive crosslinking bw elastin monomers (desmosine crosslinks)
14
Q
how does a1 antitrypsin def lead to early onset emphysema?
A
excessive alveolar elastin degradation
15
Q
bronchial tree –> particle clearance?
A
mucociliary clearance: proximal transport of mucus by ciliated epithelial cells
16
Q
distal to terminal bronchioles –> particle clearance?
A
alveolar macrophage
17
Q
what is: HbF
A
a2gamma2
18
Q
what is: HbA2
A
a2delta2
19
Q
thalassemia: what does B-null indicate?
A
absent B-globin
20
Q
thalassemia: what does B+ indicate?
A
diminished B-globin
21
Q
B-thalassemia: who?
A
- african
- mediterranean
22
Q
B-thalassemia minor: genotype
A
B/B+
23
Q
B-thalassemia minor: ssx
A
usu asymptomatic w increased RBC count
24
Q
B-thalassemia minor: histology? Hb electrophoresis?
A
- microcytic, hypochromic RBC
- target cells
Hb electrophoresis:
- slight decrease HbA
- increase HbA2
- increase HbF
25
B-thalassemia major: genotype
Bnull/Bnull
26
B-thalassemia major: onset
few months after birth --> severe anemia
27
vancomycin: MOA
direct bind D-ala-D-ala in cell wall --> prevent peptidoglycan formation
28
hepatitis E: what kind of virus? transmission?
unenveloped ssRNA --> fecal-oral
29
hepatitis E: #1 concerning feature
high mortality rate in infected preg F
30
dystrophic calcifcation --> indicatess?
hallmark of cell injury & death --> occurs in damaged, necrotic tissue
31
what is: metastatic calcification
hyperCa --> calcification of normal tissue
32
why would you see dystrophic calcifcation on the aortic valve? how does it manifest?
chronic hemodynamic stress --> endothelial, fibroblast death
aortic sclerosis --> usu benign --> over time --> calcific aortic stenosis
33
isoproterenol: what is? effect?
B1 & B2 agonist:
- increase myocardial contractility
- decrease SVR
34
hepatocell damage: indicators
increased: ALT, AST
35
biliary injury: indicators
increased: alk phos, gamma-glutamyl transpeptidase
36
liver fx: indicators
impaired biosyn capacity:
- elevated prothrombin time
- hypoalbumin
impaired transport, metab capacity:
- elevated bilirubin
37
aromatase: rxn
testosterone --> estradiol
38
aromatase inh: drugs
- anastrozole
- letrozole
- exemestane
39
aromatase inh: MOA
decrease estrogen syn from androgen --> suppress estrogen level --> slow progression of ER+ breast cancer
40
what are the parts of an advance directive?
1) living will: end of life wishes, other specific directives
2) health care proxy
41
when should you do advance care planning?
- ideally in outpt w PCP
| - essential when admitted to hosp
42
humerus --> midshaft fracture --> may injure?
- deep brachial A
| - radial N
43
what A runs with radial N at post aspect of humerus?
deep brachial A
44
what is: diffuse esophageal spasm
esophageal myenteric plexus --> impaired inh innervation --> periodic, simult, non-peristaltic contractions
45
diffuse esophageal spasm: ssx
- liq/solid dysphagia
| - chest pain
46
what is: reverse T3
inactive form of T3 generated from peripheral conversion of T4
47
how do you dx celiac dz?
- screening test: elevated tissue transglutaminase IgA
| - confirmatory test: duodenal bx --> villous flattening, intraepi lymphocyte infiltration
48
hereditary nonpolyposis colon cancer (HNPCC): aka
Lynch synd
49
what is: HNPCC
AD genetic predisposition to colon CA
50
HNPCC: mutation
DNA mismatch repair genes --> MSH2, MLH1, MSH6, PMS2
51
HNPCC: presentation
colonic adenoCA at young age (
52
Lynch synd: assoc neoplasms
- colorectal
- endom
- ovarian
53
APC mutation --> leads to
familial adenomatous polyposis
54
familial adenomatous polyposis: mutation? assoc neoplasm?
APC
- colorectal
- desmoid & osteoma
- brain tumor
55
von Hippel-Lindau synd: mutation? assoc neoplasm?
VHL
- hemangioblastoma
- clear cell renal CA
- pheochromocytoma
56
Li-Fraumeni synd: mutation? assoc neoplasm?
TP53
- sarcoma
- breast cancer
- brain tumor
- adrenocortical CA
- leukemia
57
what hereditary cancer synd is caused by an activating mutation?
MEN2 --> RET
58
lab test --> lower cutoff point --> what happens to:
- TP
- FP
- FN
- sensitivity
- PPV
- TP: increase
- FP: increase increase
- FN: decrease
- sensitivity: increase
- PPV: decrease
59
enteric bact produce what vit?
- vitK
| - folate
60
small intestinal bact overgrowth (SIBO): charact
- overproduction of vitK, folate
- nausea
- bloat
- abd discomfort
- malabsorption: deficiency of most vit (B12, A, D, E, iron)
61
small intestinal bact overgrowth (SIBO) is seen in?
gastric bypass surg: excessive bact prolif in blind-ended gastroduodenal segment
62
transketolase: fx
pentose phosphate pathway --> nonoxidative (reversible) br --> ribose-5-phosphate for nucleotide syn
interconversion of ribose-5-phosphate (nucleotide precursor) & fructose 6 phosphate (glycolytic interm)
63
what is the NADPH generated from the pentose phosphate pathway used for?
- chol & fa syn
| - glutathione antioxidant mechanism
64
succinylcholine --> who is at high risk for hyperK?
- burn
- myopathy
- crush injury
- denervating injury, dz
65
succinylcholine: MOA
depolarizing NM-blocking agent: attach to nAChR --> depolarize end plate:
- phase 1 block: end plate depolarized --> flaccid paralysis
- phase II block: nAChR become desensitized to succinylcholine --> gradual repolarization --> non-depolarizing blockade
66
succinylcholine: AE
- malig hyperthermia
- severe hyperK
- bradycardia/tachycardia
67
hyperK --> leads to?
life threatening arrhythmia
68
what is: placenta accreta
placenta adhered to myometrium
69
what is the most common cause of postpartum hemorrhage?
uterine atony: fail of uterus to contract adeq after delivery
70
how can placenta accreta occur?
prior surg (C-section) --> scar tissue --> malformed or absent decidual layer bw placenta & myometrium --> villous tissue direct attach to myometrium
71
which has higher distending pressure: small or lrg sphere? why?
small
Laplace's law: distending pressure (pressure required to keep sphere distended):
- directly proportional to surface tension
- inversely proportional to radius
72
which will collapse first: small or lrg sphere? why?
what would counteract this?
small --> higher distending pressure
surfactant: decrease surface tension as alveolar radius decrease --> counteract alveolar collapse
73
cyclosporine: MOA
inh nuclear factor of activated T cells (NFAT) from enter nucleus --> modulate transcription activity --> impair IL2 production & release --> inh IL2-induced activation of resting T cells
74
what is: etanercept
recombinant form of TNF receptor --> bind TNFa
75
topical vitD analog: drugs
- calcipotriene
- calcitriol
- tacalcitol
76
topical vitD analog: MOA? use?
bind vitD receptor:
- inh keratinocyte prolif
- stim keratinocyte differentiation
psoriasis
77
subthalamic nucleus: fx
modulation of basal ganglia output
78
damage to subthalamic nucleus --> leads to?
decrease excitation to globus pallidus internus --> reduce inh of thalamus --> contralat hemiballism --> wild, involuntary, lrg amplitude, flinging mvmts of proximal limbs (arm and/or leg)
79
damage to subthalamic nucleus: #1 cause
lacunar stroke (conseq of longstanding HTN, DM)
80
what makes up most of the heart's ant surface?
RV
81
penetrating injury to L sternal border at 4th intercostal space would puncture?
RV
82
CSF: viral pattern
- elevated protein
- normal glucose
- lymphocytic predominance
83
CSF: bact pattern
- elevated protein
- low glucose
- neutrophilic predominance
84
what is a L shift on Hb-O2 dissociation curve? cause?
increased Hb-O2 affinity --> O2 less avail to tissues
- increased pH
- decrease 2,3 bisphosphoglycerate
- decrease temp
85
neurofibromatosis type 1: cause? ssx?
AD --> NF1 gene
- cafe au lait spots
- mult neurofibroma
- Lisch nodules
- pseudoarthrosis
86
what is: Lisch nodules
pigmented asymptomatic hamartoma of iris
87
severe combined immune def (SCID): pathophys? ssx?
combined T & B cell dysfx --> present in infancy:
- severe bact & viral infect
- mucocut candidiasis
- persistent diarrhea
- fail to thrive
88
SCID: lab findings
- absent T cells
- hypoIg
- no thymic shadow (d/t severe T cell def)
89
what is: CFRT protein
transmembrane ATP-gated Cl- channel
90
leukemoid rxn: cause
- severe infect
- severe hemorrhage
- malig (ie leukemia)
- acute hemolysis
91
leukemoid rxn: histology
- increased bands
- early mature neutrophil precursors (myelocytes)
- basophilic granules (Dohle bodies) in neutrophils
92
lung abscess: tx? why?
clindamycin --> covers anaerobic oral flora + aerobic bact
93
what is depersonalization/derealization disorder? how is it diff from psychotic disorders?
dissociative disorder involving recurrent episodes of feeling detached from one's body and/or feelings of unreality
intact reality testing
94
what is: depersonalitzation
sense of being outside observer of self
95
what is: derealization
sense of detachment or unreality regarding surroundings
96
vesicoureteral reflux: what is most susceptible to reflux-induced damage? how does this present?
compound papilla in upper & lower poles of kidney --> dilated calyces w overlying renal cortical scarring
97
vesicoureteral reflux --> can lead to?
loss of nephrons --> 2ndary HTN
98
nasal mucosal ulceration + glomerulonephritis --> indicates?
granulomatosis w polyangiitis (Wegener's)
99
granulomatosis w polyangiitis (Wegener's): what Ab will you find? where?
C-ANCA (cytoplasmic-staining antineutrophil cytoplasmic Ab)
neutrophil
100
cardiac tissue conduction velocity: fastest-->slowest
"Park At Venture Ave":
- Purkinje
- Atrial muscle
- Ventricular muscle
- AV node
101
Zollinger-Ellison synd --> leads to?
- peptic ulcer dz
| - parietal cell hyperplasia --> gastric fold enlargement
102
sulfonylurea: MOA
increase insulin secretion by pancreatic B cells indep of blood glucose []
103
sulfonylurea: drug
- glyburide
| - glimepiride
104
sulfonylurea: AE
hypoglyemia --> esp elderly
105
chloramphenicol: AE
- dose-dep (reversible) cytopenia: anemia, leukopenia, and/or thrombocytopenia
- dose-indep (irrev) aplastic anemia
106
septic abortion: presentation
after preg termination:
- fever
- abd pain
- uterine tenderness
- foul smelling discharge
107
septic abortion: cause
bact seeding of uterine cavity during instrumentation --> usu Staph aureus, E.coli
108
septic abortion: tx
- broad spectrum abx
| - prompt surgical evacuation --> remv nidus of infection
109
what is: septic abortion
any type of abortion resulting in infected retained products of conception
110
septic abortion: comp
adhesions in uterine cavity --> Asherman synd (2ndary amenorrhea, infertile)
111
what cytokines induce the systemic inflamm response?
- IL1
- IL6
- TNFa
112
TNFa --> high concentration --> can lead to?
ssx of septic shock & cachexia
113
IFNgamma: fx? produced by?
activated T cell
- recruit leukocytes
- activate phagocytosis
114
IL3: fx? produced by?
activated T cell
stimulate growth & differentiation of stem cells in BM
115
IL4: fx? produced by?
TH2
- stim growth of B cells
- increase # of TH2 cells at site of inflamm
116
IL10: fx? produced by?
macrophage, TH2
anti-inflamm --> limit production of pro-inflamm cytokines (IFNgamma, IL2, IL3, TNFa)
117
glomangioma: what is? origin?
benign glomus tumor --> very tender, small, red-blue lesion under nailbed
originates from modified smooth muscle cells that ctrl thermoreg fx of dermal glomus bodies
118
what is: bursa
fluid-filled synovial sac that serves to alleviate pressure from bony prominences and reduce friction bw muscles & tendons
119
repetitive, prolonged kneeling --> leads to?
prepatellar bursitis --> ant knee pain
120
CD18 def --> indicates?
leukocyte adhesion def
121
leukocyte adhesion def: pathophys
absence of CD18 antigens necess for formation of integrins --> fail of leukocyte chemotaxis
122
leukocyte adhesion def: ssx
- recurrent skin, mucosal infect --> no purulence
- delayed sep of umbilical cord
- persistent leukocytosis
123
delirium: tx
low dose antipsych (haloperidol) --> acute tx of agitation & psychosis assoc w delirium
124
what is: delirium
acute onset "confusional state" charact primarily by waxing/waning mental status change and impaired attention
125
what is the most common hemolytic anemia?
hereditary spherocytosis
126
chronic hemolysis --> can lead to what in gallbladder?
pigmented gallstones
RBC lyse --> high bilirubin
127
hereditary spherocytosis: comp
- pigmented gallstone
| - aplastic crisis from parvovirus B19
128
primaquine: use
eradicate hypnozoites in P vivax & ovale infections
129
hospital discharge --> what is the most effective strategy for decreasing adverse outcomes and preventing avoidable readmissions?
hospital discharge checklist
130
spinal stenosis: location
lumbar
131
spinal stenosis: ssx
- posture-dep LE pain: worse w lumbar extension, better w flexion
- numb, paresthesia
- weak
132
spinal stenosis: #1 cause
degen arthritis of spine:
- intervertebral disc herniation
- ligamentum flavum hypertrophy
- osteophyte formation affecting facet jts
==> narrow spinal canal
133
aedes aegypti mosquito transmits?
- dengue fever
| - chikungunya
134
dengue fever: presentation
acute febrile illness w HA, retro-orbital pain, jt & muscle pain
135
chikungunya: presentation
febrile illness w flu-like ssx, prominent polyarthralgias, diffuse macular rash
136
bony pain in an older man w osteoblastic lesions --> indicates?
prostate cancer
137
what cancers that metastasis to bone make osteoblastic lesions?
- prostate cancer
- small cell lung CA
- Hodgkin lymphoma
138
elevated PTH-related peptide --> indicates?
non-small cell lung cancer
139
sickle cell dz --> what happens to spleen?
vasoocclusive events --> repeated splenic infarcts --> fibrosis & atrophy --> asplenia
140
chronic hemolytic anemia --> can lead to what vit def?
folic acid def d/t increased RBC turnover
141
C1 inh (C1INH) def: pathophys
low C1 inh:
- increase cleavage of C2 & C4 --> inapprop activation of complement cascade
- can't block kallikrein-induced conversion of kininogen to bradykinin --> increased bradykinin
142
what is: Jervell and Lange-Nielsen synd
congenital long-QT synd --> AR:
- QT prolong: syncope, sudden cardiac death from torsades
- neurosensory deaf
143
what is: Pringle maneuver
occlude portal triad to disting source of RUQ bleed --> if bleed not stop --> injury to IVC, hepatic V
144
portal triad --> runs thru?
hepatoduodenal lig
145
portal triad: composed of?
- hepatic A
- portal V
- common bile duct
146
secretory phase of menstrual cycle: when?
day 15-28
147
prolif phase of menstrual cycle: when?
day 1-14
148
secretory phase of menstrual cycle: histology
- coiled uterine glands --> secrete glycogen-rich mucus
- edematous stroma
- tortuous spiral A --> extend from deeper layers to uterine lumen
149
prolif phase of menstrual cycle: histology
- straight narrow glands --> no secretions
- compact, non-edematous stroma
- spiral A only at deeper layers
150
humoral hyperCa of malig: cause
malig --> secrete PTHrP
151
fibrate: MOA
activate peroxisome prolif-activated receptor alpha:
- increase LPL activity
- decrease hepatic VLDL production
==> lower TG levels
152
omega 3 fa: MOA
decrease production of VLDL, apoB --> lower TG
153
what is most similar bw systemic & pulm circ?
blood flow per min
154
accessory nipple: pathophy
failed regression of mammary ridge in utero
155
what is: progestin
synthetic equivalent to progresterone --> responsible for preg prevention in all hormonal contraceptives
156
combined hormonal contraceptive: MOA
suppress GnRH in hypo --> decrease FSH, LH syn --> no LH spike --> inh ovulation
157
how do you differentiate precursor B-ALL vs T-ALL?
immunophenotyping:
- precursor B-ALL: TdT+, CD10+, CD19+
- precursor T-ALL: TdT, CD1, CD2, CD5
158
Down synd: assoc w what quadruple screen results?
- maternal serum a-fetoprotein: low
- estriol: low
- B-hCG: high
- inhibin A: high
159
low maternal serum a-fetoprotein (MSAFP) --> indicates?
aneuploidy --> trisomy 18, 21
160
high maternal serum a-fetoprotein (MSAFP) --> indicates?
- open neural tube defect
- mult gestation
- abd wall defect
161
chronic lymphocytic (Hashimoto) thyroiditis: histology
- intense lymphocytic infiltrate
- germinal center
- Hurthle cells: lrg oxyphilic cells filled w granular cyto
