BOARDVITALS part 2 Flashcards
(249 cards)
1
Q
specific tests for hepatitis C
A
PCR testing, transciprtion mediated amplification (TMA), EIAs (enzyme immunoassays)
2
Q
which is false about HCV (hepatitis C)?
a. initial sx of HCV infection are commonly extrahepatic and often involve MSK system
b. palmar erythema is a late sign
c. alanine aminotransferase levels are generally decreased
d. patients should be screen for alcohol and drug abuse
A
c. alanine aminotransferase levels are generally decreased
–> usually increased
3
Q
nonalcoholic fatty liver (NAFLD) and non-alcoholic steatohepatitis (NASH) true statement
a. NAFLD is a spectrum of conditions which encompasses NASH
b. NAFLD is an acute condition that progresses to NASH
c. NASh is a an acute condition that NAFLD
d. they are NOT commonly associated with obesity and metabolic syndrome
A
a. NAFLD is a spectrum of conditions which encompasses NASH
4
Q
varices are commonly seen as sequelae of
A
portal hypertension
–> generally in distal esophagus or proximal stomach; from elevated pressure in portal venous system
Varices are abnormally dilated veins that form due to increased venous pressure, often from obstruction or backflow in the venous system.
5
Q
which hepatitis are usually not chronic
A
hepatitis A and E
6
Q
heart valves that close during S2 “dub”
A
aortic and pulmonic
S1= tricuspid and mitral
7
Q
hypertension guidelines: 3 or more in office blood pressure readings above what value indicate hypertension diagnosis
A
130/80 mmHg
normal <120/80
stage 1: 130-139 over 80-89
stage 2_ >140 over >90
8
Q
direct branches of arch of aorta
A
brachiocephalic trunk, common carotid and subclavian
9
Q
bence jones proteins in urine
A
multiple myelomma
10
Q
reed Sternberg cells
A
Hodgkins lymphoma
11
Q
cardiac output formula
A
CO = HR x SV
12
Q
multiple sclerosis
A
most common demyelinating disease of the brain and spinal cord
13
Q
myelin
A
myelin is supplied by oligodendrocytes cells in the brain; not all axons are covered by myelin. myelin can greatly increase the speed of electrical impulses in neurons
14
Q
which cranial nerve is impacted if someone has visual blurring that resolves with either eye being covered. double vision from cranial nerve palsy (DIPLOPIA)
A
CN VI; lateral rectus muscle (abduction of eye)
15
Q
order of flow of CSF from origin to where it enters the blood stresm
A
choroid plexus, lateral ventricle, third ventricle, fourth ventricle, subarachnoid space
returns blood via dural sinuses
16
Q
where is CSF made
A
choroid plexus
17
Q
motor weakness in multiple sclerosis and motor neuron deficits
A
upper; spastic weakness; hyperreflexia; no significant muscle atrophy; babinski’s reflex may be present
18
Q
HSV1 vs HSV2 latent wher
A
1: trigeminal ganglion
2: lumbar or sacral ganglia
19
Q
viral adsorption is
A
viral attachment to cell (via specific receptors or lectin interactions)
once attaches can disassemble then replicate
20
Q
______ involves the loss or gain of heat by transfer of thermal energy during collision between adjacent molecules
A
conduction
21
Q
radiation
A
process by which surfaces of all objects constantly emit heat
22
Q
convection
A
conductive heat loss or gain is aided by movement of air or water next to the body
23
Q
evaporation
A
occurs when water molecules absorb enough heat and escape as gas, i.e. sweating
24
Q
convection vs conduction
A
conduction: Transfer of heat through direct contact (solids)
convection: Transfer of heat by the movement of fluids (liquid or gas)
25
head of phospholipid id hydrophilic or hydrophobic? oriented toward?
hydrophilic; surface of membrane
head of phospholipid is polar, charged and hydrophilic and faces towards the surface of the membrane due to its attraction to water molecules in the cytosol and extracellular fluid
the tail of the phospholipid is non polar, uncharged, and hydrophobic and is composed of fatty acid chains that face towards the inside of the bilayer
26
which amino acid can increase herpes simplex viral outbreaks
arginine
"ARG" not again!
27
urease effect on stomach in pathogenesis of ulcerated tissue
increased gastric pH
h. pylori
- chronic gastrisitis, peptic ulcers, gastric adenocarcinoma
- gram negative spiral
- survive in acid envos like stomach
- makes urease that is made in response to acid; its breaks down gastric luminal urea forming ammonia that then neutralizes the gastric pH allowing bacteria to survive and carry out functions
- h pylori also makes proteases and phospholipase that break down the glycoproteins of the protective mucus layer and expresses adhesins that allow bacteria to adhere to the epithelial cells
- makes surface factors that attract neutrophils and macrophages
28
h pylori makes
- urease ( to increase gastric pH)
- proteases and phospholipase to break down glycoproteins
-adhesins
29
achlorhydria from chronic gastritis leads to which type of anemia
pernicious anemia
-cobalamin (b12) absorbed in ileum and need to be bound to gastric-produced intrinsic factor.
- parietal cells of stomach makes both gastric acid and intrinsic factor
- cobalamin and folate are required in DNA synthesis and deficiency can cause megaloblastic erythropoeisus due to DNA defects leading to macrocytosis seen in pernicious anemia
30
in a parietal cell, bicarbonate ions exit the basolateral membrane into the interstitial fluid in exhange for what ion
chloride
pariterla cells for HCL secretion controlled by acetylcholine, histamine and gastrin
hydrogen ions formed from dissociation of water leaving hydroxyl ions to combine with carbon dioxide via carbonic anhydrase to form bicarbonate. bicarbonate then exhacneg from chloride ions on basloateral side. H+/K+ ATPs and can bind chloride to form HCl
31
acid secretion in the stomach is influenced by lots including _____ which stimulates release of histamine from enterochromaffin like cells
gastrin
32
parietal cells
have receptors for gastrin, acetylcholine, and histamine --> HCl secretion
33
G cells (gastrin) are locates? stimulated by?
antrum of stomach; stimulated by proteins and increased pH to release gastrin
34
chronic NSAID use can cause gastritis and peptic ulcers. non-selective NSAIDs block the activity of cyclooxyrgenase that converts arachidonic acid into
prostaglandins
35
which of the following may predispose to aortic stenosis
a. hypocalcemia
b. infective endocarditis
c. congenital bicuspid aortic valve
d. aortic valve regurgitation
c. congenital bicuspid aortic valve
36
physical finding that could be a direct sequela of aortic stenosis?
a. increased left ventricular ejection fraction
b. mitral regurgitation
c. cor pulmonale
d. left ventricular hypertrophy
d. left ventricular hypertrophy
37
aortic valve opens during which phase of the cardiac cycle
isovolumic contraction/ ejection
38
the aortic valve is derived from what embryonic structure
truncus arteriosus
39
the opening of the left coronary artery is found in what portion of the aortic valve?
a. posterior sinus
b. left lunule
c. left sinus
d. posteior lunule
c. left sinus
40
layers of epidermis
"Come Let’s Get Sun Burned" (top → bottom)
Stratum Corneum – dead, keratinized cells (protective barrier)
Stratum Lucidum – only in thick skin (palms, soles)
Stratum Granulosum – keratohyalin granules; waterproofing
Stratum Spinosum – "spiny" desmosomes; Langerhans cells here
Stratum Basale (Germinativum) – mitotic stem cells, melanocytes, Merkel cells
41
peanut and milk --> swollen lip, wheezing, hives, low BP, high RR and high HR
what type of hypersensitivity rxn? what enzymes are involved?
type I, histamine and tryptase, prostaglandin D2, cytokines released by pre-sensitized mast cells and basophils
42
mechanism of immune activation in systemic hypersensitivity rxn
antigen cross-links IgE molecules on presensitized mast cells and basophils resulting in the release of mediators that act on post capillary venules
43
mast cells vs basophils
-both made in bone marrow
- both important for hypersensitivity rxn
- subsequent exposure to same allergen stimulates the sensitized mast cells and basophils to degranulate
- mature mast cells reside in tissue
-basophils found in blood circulation
44
in the presence of IL_ secereted by mast cells, the activated T cells differentiate to Th_ cells
IL4; Th2
45
physiologic changes in hypersensitivity rxn
increased vascular permeability, increased mucus production, vasodilation, respiratory smooth muscle contractions
46
tryptase and histamine
most abundant mediators of hypersensitivity rxn via basophils and mast cells
tryptase in intestinal mucosa, lung alveolar walls, nasal mucosa
histamine in skin, smooth muscle, lungs, stomach, brain
47
Ig_ in both atopic eczema and type I hypersensitivity
IgE
48
sarcoidosis finding
noncaseating granulomatous
49
birfurcation of trachea at which spinal level
T4-T7
50
cardiac notch is located at
anteroinferior edge of left superior lobe
51
which muscle is not involved in raising ribs in forced inspiration?
a. scalenes
b. SCM
c. pec minor
d. pec major
d. pec major
52
surfactant is a phospholipoprotien complex made by _____ cells
type II alveolar
53
type I alveolar cells
simple squamous epithelial cells that are involved in exchange of carbon dioxide and oxygen
54
what is secretes by mast cells and creates allergy symptoms
histamine
-released in response to allergy or parasites
-bronchiole smooth muscle contraction, capillary dilation and increased capillary permeability
also has;
-heparin as anti-coagulant
-serotonin for vasoconstriction
55
hyoid bone at spinal level of
C2-C3
56
sinus that drains directly into nasal cavity
maxillary
57
sinus drainage flow
sphenoid --> ethmoid --> maxillary --> nasal cavity
frontal --> maxillary --> nasal cavity
58
type of epithelium lining the conducting portion of the nasopharynx
respiratory stratified squamous epithelium
59
epithelium in terminal bronchioles
cuboidal epithelium
60
epithelium in trachea and bronchi
ciliated columnar epithelium
61
epithelium in alveolar sacs and avleoli
simple squamous
62
malaria; which part of the lifecycle is injected by the mosquito and asymptomatically infects hepatocytes
sporozoites
these sporozoites asexually divide to form merozoites and then invade RBCs.... can become male and female gametocytes....
63
what is the stage when malaria asexually divide from sporozoites to form ____ and invade RBCs
merozoites
64
what species causes the most deadly form of malaria
plasmodium (p.) falciparum
via female anopheles mosquito
65
immature RBC is called _____ in which a nucleus is _____
reticulocyte; absent
66
key regulatory enzyme in heme synthesis that is found in the mitochondria
ALA synthase
combined succinyl coa with glycine to form ALA
67
what disease is protective against malaria
sickle cell trait
68
hemophilia A is blood coagulation disorder with defieicny in factor
factor VIII
69
hepatitis A, B, C transmission
A: fecal oral
B: sexual or parenteral
C: parenteral or transfusion (blood)
D: blood or sex (need HBV)
E: fecal oral
70
bare area of the liver on posterior aspect. what ligament separates it from rest of liver?
coronary ligament
71
falciform ligament of liver
attaches liver to abdominal wall and separates the tow lobes on the diaphragmatic surface
72
right triangular ligament of lvier
formed by left most layers of coronary ligament and lesser omentum
73
round ligament of liver
remnant of fetal umbilical cord
74
which vessels deliver blood to liver? and leave liver via?
portal vein and hepatic artery
leave: via hepatic vein which drain into IVC
75
what type of jaundice could be in hepatitis
impaired conjugation
resulting in unconjugated hyperbilirubinemia
76
obstructive jaundice
i.e. from gallstone and pancreatic carcinoma where ducts are blocked thereby preventing bile flow
77
HAV (hepatitis A) true statement
a. infection will likely result in chronic hepatits
b. at risk for developing hepatocellualr carcinoma
c. infection will likely resolve without complication
d. damage done to liver increases risk of developing cirrhosis
c. infection will likely resolve without complication
78
which hepatitis usually becomes chronic and you can become a carrier? these can also cause cirrhosis and hepatocellular carcinoma
hep B and C
79
Dermatomyositis
Dermatomyositis is an idiopathic inflammatory myopathy characterized by:
Symmetric proximal muscle weakness
Distinctive skin rash
It is a systemic autoimmune disorder that affects skin, muscles, and occasionally lungs and vessels.
80
type of rash seen in dermatomyositis
heliotrope ; a purplish rash found around the eyes and extremities
81
lymes disease rash
erythema migraines; annular rash that expands from initial erythematous macule or papule and leaves a partial central clearing as rash expands
82
tinea infection causes what type of rash
red raised ring with central clearing
83
tinea
Tinea refers to a group of superficial fungal infections caused by dermatophytes (keratin‐loving fungi)
84
what is elevated in cases of dermatomuositis
creatine- kinase MM
--> muscle damage
85
creatine kinase MB raised when
cardiac muscle damage
86
which cells are in dermatomyositis
CD4+
87
key for dermatomyosisits
CK-MM high
CD4+ cells
heliotrope rash
88
complement involved in immune complex removal
C3b
C3b activates macrophages and results in removal of immune complexes and opsonization
89
C3a and C5a
peptide inflammation mediators that recruit phagocytes
90
C5b and C6-9
form a membrane attack complex that causes cell lysis
91
type _____ muscle fibers are pink in color, intermediate in size, contain fast acting myosin ATPases and are moderately fatigue resistnace
type IIA
92
type I muscle fibers
slow oxidative fibers, contain slow actin myosin ATPase and contract slowly. have high concentration of myoglobin and are resistant to fatigue
93
type IIB muscle fibers
fast glycolytic fibers; large and contain fast acting myosin ATPases. contain little myoglobin and therefore fatigue quickly
94
common causes of congestive heart failure
atherosclerosis (and the resulting hypertension)
-----
diabetes increases risk of heart failure
-----
renal failure as result of CHF
------
lung diseases like COPD can cause cor pulmonale or right sided CHF
95
he is prescribed angiotensin converting enzyme inhibitor (ACEI) drug. where can you find the highest concentration of the enzyme that this drug acts on.
lungs
(which is why these meds have dry cough side effect)
96
which creatine phosphokinase isoenzyme elevated when cardiac muscle death occurs
CK-MB
97
low density lipoprotein transports cholesterol to periphery via which apoprotein
B-100
98
VLDL, IDL and LDL use which apoprotein for trasnport
B-100
HDL uses apoprotein A
99
chylomicrons and chylomicron remnants use which apoprotein
B-48
100
HDL uses which apoprotein for trasnport of cholesterol to level
apoprotein A
101
lipoprotein A uses which apoprotein for transport
apoprotein (a)
102
which type of pericardial effusion in congestive heart failure
transudative or exudative
transudative (in CHF, hypothryoid, nephrotic)
exudative in infections like TB
103
which IL_ secreted by macrophages and monocytes causes fever
IL1
104
IL2
secreted by TH1 for growth and proliferation
105
IL4
secreted by Th2 and is for proliferation
106
IL6
via monocytes and macrophages and triggers differentiation and antibody secretion
107
parasite in this case
colorado rockies- diarrhea, cramps, weight loss, fever from unfiltered water
giardia lamblia
108
oropharynx lies the only muscle innervated by cranial nerve IX; whats the muscle
stylopharyngeus
levator and tensor palate: CN 5 and 10
palatopharyngeus and salpingopharyngeus: CN 10
109
the enteric nervous system; which intrinsic plexus controlling motility is overactive due to infectious parasite?
myenteric (Auerbach's) plexus
110
2 enteric nervous system plexi and roles
submucosal (meissner's plexus): blood flow and secretion
myenteric (auerbach's plexus): for motility
111
G cells of stomach secete what substance that stimulates H+ and gastric mucosa
gastrin
112
Wilsons disease is what type (i.e. autosomal, x linked, and recessive or dominant)
autosomal recessive
113
Wilsons disease impacts the metabolism of
copper
114
which protein is deficient in Wilsons disease
ceruloplasmin (causing copper to accumulate)
115
finding in Wilson diseases that cause golden-brown discolouration of outer cornea
kayser-fleishcer rings
116
Wilsons disease can lead to brain damage and result in extrapyramidal toro symptoms. when these symptoms occur which part of the brain is damaged
basal ganglia
117
primary motor cortex
planning and execution of movement
118
cerebellum
coordination of movement and motor learning
119
damage to ventral horn causes
atrophy of muscles that it innervates
120
which gyrus is located in the posterior parietal lobe
angular
121
Broca's aphasia and wernicke's aphasia
broca's: Non‑fluent, good comprehension
wernicke's: Fluent, poor comprehension
------ --
brocas area is for speech production and syntax
wernicke is for language comprehension and semantics
122
cingulate gyrus
medial aspect of cerebral cortex and lies immediately superior to corpus callosum
123
pre and post central gyrus
anterior and posterior to central sulcus
124
a patent ductus ateriosus represents a persistent communication between which 2 things
pulmonary artery and descending thoracic aorta
(its a functional L-R shunt)
impacted by prostalgandin E2
125
ductus arteriosus closes at birth due to
a decrease in prostaglandin E2 levels after removal of placenta
126
ductus arteriosus should close with how much time after birth
10-18 hours
127
a patent ductus arteriosus results in what % of congenital heart defects
5-10%
128
a patent ductus arteriosus can result in what
left heart enlargement, increased pulmonary vascular resistance and pulmonary artery hypertension
129
appendicitis has tenderness where on physical exam
right lower quadrant
mcburneys point
130
lymphatics from the appendix drain directly into what lymph nodes
ileocolic
131
what is not a rate limiting enzyme in Krebs cycle?
a. citrate synthase
b. isocitrate dehydrogenase
c. alpha-ketoglutarate dehydrogenase
d. succinate dehydrogenase
d. succinate dehydrogenase
citrate synthase is controlled by availability of substrates acetyl coa and oxaloacetate as well as succinyl coa, NADH, and ATP
isocitrate dehydrogenase is stimulated by isocitrate, ADP, and NAD and is inhibited by ATP and NADH.
alphaketoglutarate dehydrogenase is inhibited by succinyl coa, NADH, ATP and GTP
132
3 muscles that make up the levator ani muscle (for the pelvic floor)
puborectalis
pubococcygeus
iliococcygeus
133
which organ is not retroperitoneal?
a. pancreas
b. ascending colon
c. descending colon
d. transverse colon
d. transverse colon
retroperitoneal: adrenal, majority of duodenum, head, neck and body of pancreas, ascending and descending colon, rectum
134
positive nikolsky's sign
skin blisters with gentle mechanical pressure
135
pemphigus vulgaris is an autoimmune attack on
desmoglein 1 and 3
--> thereby it interferes with keratinocyte adhesion
136
pemphigigoid
autoimmune disease where immungolobulin is directed against hemidesmosomes
137
pemphigus vulgaris
An autoimmune blistering disease characterized by flaccid (intraepidermal) bullae and mucosal involvement.
2. Pathogenesis
Autoantibodies (IgG) directed against desmoglein‑3 (and sometimes desmoglein‑1) in desmosomes
Loss of keratinocyte cell–cell adhesion → acantholysis (suprabasal split)
3. Clinical Features
Flaccid, easily ruptured bullae → painful erosions
Mucosal involvement (oral mucosa in ~90%) often precedes skin lesions
Nikolsky’s sign: gentle lateral pressure on skin → new blister formation
138
_____ create a very small intercellular space consisting of tubular channels that allow for communication between cells
gap junctions
139
tight junctions
encircle cells at their apical surfaces, close the intercellular space and prevent free diffusion of substances between epithelial cells and endothelial cells in areas where a strong barrier is needed
140
desmosomes/ adherens junctions
allow small intercellular space and are generally found in epithelial that experience strong mehcanical forces
141
______ is produced by undamaged endothelial cells. its a vasodilator and inhibits platelet aggregation
prostacyclins
142
which layer of the stratified squamous epithelium lies above stratum spinous and contains dying cells that secrete lamellar bodies as they are pushed towards the skin surface
stratum granulosum
pneumonic:
Come
Let’s
Get
Sun
Burned
Layers: (outer to inner)
Corneum (stratum corneum)
Lucidum (stratum lucidum) – only in thick skin: palms, soles
Granulosum (stratum granulosum)
Spinosum (stratum spinosum)
Basale (stratum basale)
143
varicella zoster virus is ss or ds and RNA or DNA
dsDNA
144
varicella zoster virus becomes latent in
dorsal root ganglia
HSV1 in trigminal
HSV2 in sacral
145
what is a complication of VZV infection in kids given aspirin
Reye's sydnrome
swelling of liver and brain
146
impetigo cause
staph aureus or strep pyogenes
Impetigo is a highly contagious superficial skin infection, most common in children, caused by Staphylococcus aureus or Streptococcus pyogenes. It presents with honey-colored crusted lesions (non-bullous type) or flaccid bullae (bullous type) and is treated with topical or oral antibiotics depending on severity.
147
which interleukin is endogenous pyrogen
IL1 also IL6 and TNFa
pyrogen= fever
148
____ is produced by T cells to inhibit viral replication
interferon
149
IL4 and IL5
important role in allergies because promote growth and activation of eosinophils and mast cells
150
which fissure seperates middle lobe from lower lobe on right lung
oblique fissure
151
the phrenic nerve innervates the diaphragm and is made up of motor nerve fibers originating from which spinal levels
C3, C4, C5
152
main physiologic mechanism of bronchoconstriction
parasympathetic innervation
153
which vessels supply the lung tissue with oxygenated blood
bronchial arteries
154
which microorganism is repsonsible for highest % of community acquired pneumonia cases in adults
streptococcus pneumonia
155
order of carpal bones
proximal row (thumb side ro pinky)
Scaphoid
Lunate
Triquetrum
Pisiform (sits on top of triquetrum)
distal row:
Trapezium (thumb side)
Trapezoid
Capitate (largest carpal)
Hamate (has hook)
156
the palmar carpal branch of the radial artery enters the ____ pole of the scaphoid
distal
157
_____ are derived from osteoprogenitor cells and ____ are derived from hematopoietic progenitor cells
osteoblasts from osteoprogenitor
osteoclasts from hematopoietic
158
osteobaslts
from osteoprogenitors
found in growing portions of bones, secrete collagen matrix and calcium salts to promote matrix mineralization
159
osteoclasts
from hematorpoetic progenitor cells
large multinucleate cells; in bone marrow
resorb bone
160
risk factors for avascular necrosis
excessive alcohol use
161
avascular necrosis
Avascular necrosis (AVN)—also called osteonecrosis—is the death of bone tissue due to a lack of blood supply, leading to bone collapse and joint dysfunction.
162
papulopustular acne rosacea is most common in what demogrpahic
caucasian women of middle age
163
other systems or organs that can be involved in acne rosacea
eyes can be involved with blepharitis, conjunctivitis and inflammation of eyelids and meiobomian glands
164
pathogenesis of acne rosacea
over expression of vascular endothelial growth factor (VEGF) and anti microbial peptide (AMPs)
165
IL1 and TNFa
are proinflammaotry cytokines
166
phymatous rosacea is characterized by
skin thickening with irregular nodules of the chin, nose, forehead, ears and eyelids
167
papulopustular and erythematotelangiectacic rosacea
history of flushing and telangiectasis hidden by extensive erythematous regions
erythematotelangiectacic rosacea also commonly exhibits central flushing, burning and stinging and patients frequently report dietary and environmental triggers
168
ocular rosacea
blepharitis, conjunctivitis, and conjunctival telangiectasis
169
Duchenne muscular dystrophy is caused by defective gene in
dystrophin
dystrophin is for muscle fiber strength; protect fibers from injury as they contract and relax
169
duchenne muscular dystrophy- what inheritnace
x linked
170
what is elevated in duchenne muscular dystrophy?
a. CRP
b. CK
c. LDH
d. ESR
b. CK
171
_____ receptors are located on most post synaptic neurons in smooth muscle cells whereas ____ receptors are found in the neuromuscular junctions
muscarinic; nicotinic
172
which posterior crural muscles connects to the posterior head of the fibula and calcaneus
coleus
gastrocnemius origin is lateral and medial condyles of femur and also inserts on calcaneus via calcaneal tendon
173
skeletal muscle
long, cylindrical, multinucleated, striated
174
smooth muscle
fusiform fibers, elongated cells, tapered ends, not striated
175
cardiac muscl
branching cells arranged in layers and have intercalated disc
176
muscle weakness, absent DTR, neuropathy - what dx
Guillian barre syndrome
Guillain-Barré Syndrome (GBS) is a rapid-onset autoimmune polyneuropathy in which the immune system attacks peripheral nerves, leading to ascending weakness and areflexia.
177
Hansens disease
cause? vectror?
AKA leprosy
caused by mycobacterium leprae
spread via humans and armadillos
Hansen's Disease (commonly known as Leprosy) is a chronic infectious disease caused by the bacterium Mycobacterium leprae, which primarily affects the skin, peripheral nerves, mucosa, and upper respiratory tract.
1. Tuberculoid leprosy presents with a strong immune response, causing a few well-defined, hypopigmented anesthetic skin lesions and localized nerve damage.
2. Lepromatous leprosy involves a weak immune response, leading to widespread skin nodules, diffuse lesions, and extensive peripheral nerve involvement.
3. Borderline leprosy falls between the two extremes, showing mixed features that can shift toward either form depending on immune status.
178
hansens diseases is caused by
mycobacterium leprae (AKA LEPROSY)
179
what can trigger Gillian barre sydnrome
viruses like influenza
180
Weils disease cause
spirochete leptospira
181
histopathological findings in Hansens disease
granulomas and multinucleate giant cells found in the skin
182
diagnosis of bacteria for leprosy/ hansens disease can be made by
skin biopsy with PCR
to detect the M. leprae DNA
183
which MHC class in type 1 diabetes
MHC II
beta cell destruction via CD4+ and MHC II
184
in normal functioning beta cell, insulin secretion is stimulated by membrane depolarization and resultant influx of what ion
Ca2+
blood glucose increases causing GLUT2 transporter
Ca stimulates the release of stored insulin from secretory granules within beta cells
185
blood supply to body and tail or pancreas from what artery
body and tail: splenic artery
head: GDA and SMA (gastroduodenal and superior mesenteric arteries)
186
what type of transport to reabsorb glucose in proximal convolute tubules of kidney
secondary active
sodium/glucose cotrasnporter
187
previously diagnosed type 1 diabetic presents to your office complaining of lethargy and nausea. on physical exam you note hyperventilation and kussmaul respiration. whats the problem?
diabetic ketoacidosis
from insulin deficiency or glucagon excess leading to extreme hyperglycemia; causing lipolysis and FFA and glycerol to be released into circulation. FFA are taken up by hepatocytes where beta oxidation converts them into acetyl coa which is oxidized to form ATP or enters ketogenic pathway and becomes a ketone body, acetoacetic acid..... etc
188
common cause of primary form of Conns syndrome
adrenocortical adenoma
also could be from hyperplasia of zona glomerulosa of adrenal cortex
189
Conns syndrome
Conn’s Syndrome (also called Primary Hyperaldosteronism) is a condition where the adrenal glands produce too much aldosterone, leading to hypertension and hypokalemia.
🧠 Pathophysiology
Caused by an aldosterone-secreting adrenal adenoma (Conn's syndrome) or bilateral adrenal hyperplasia
Aldosterone → ↑ Na⁺ and water retention, ↓ K⁺ → hypertension + low potassium
190
which syndrome has high aldosterone, high Na+. hyerptwension and low potassium
Conns syndrome (adrenals make too much aldosterone)
191
why is edema present in conns syndrome
excess aldosterone causes excessive potassium loss and sodium retention thereby water retention
192
where are aldosterone receptors found in the kidneys
🔹 Late distal convoluted tubule
🔹 Collecting duct (especially the cortical collecting duct)
193
mineralocorticoids are made where in adrenal gland
mineralocorticoids= aldosterone
zona glomerulosa
194
adrenal cortex is derived from _____ whereas adrenal medulla is derived from _____
mesoderm; neural crest cells
195
no medical history, gets pelvic pain with mistral flow, symptoms since menarche
what is it
primary dysmenorrhea
196
endometriosis and just started getting pain with period
what is dx
secondary dysmenorrhea
197
uterine tissue layers in outer to inner
perimetric, myometrium, endometrium
198
hormones secretion order in follicular phase
GnRH, LH and FSH, estradiol and progesterone
199
primary dysmenorrhea pathophysiology
excessive release of prostaglandins from secretory epithelium
200
gut bacteria strongly associated with ankylosing spondylitis due to cross reaction against sacroiliac joints
klebsiella spp.
201
strep pyogenes cross reacts in what diseases
glomerulonephritis and rheumatic fever
202
complication of anklyosing spondylitis
uveitis or iritis, ascending aortitis, aortic valve insufficiency, osteoporosis, causa equina syndrome
203
what type of joint is sacroiliac joint
diarticular joint
does slight gliding and rotatory movements
204
pubic symphysis is what type of joint
secondary cartilaginous joint
no movements
205
spine changes in ankylosing spondylitis
rigidity along entire spine
fibrous ring of intervertebral discs ossify --> marginal syndesmophwytes between adjoining vertebrae
206
spine curvature
cervical- lordosis (curve inward- anterior)
thoracic- kyphosis (curve outward- posterior)
lumbar- lordosis
sacral- kyphosis
207
pituitary gland is seated in the fossa of the sella turcica of the
sphenoid bone
208
excess ACTH binds to melanocyte stimulating hormone receptrors in Cushing's disease and results in
hyperpigmentation
209
anterior pituitary comes from ______ which is an invagination of roof of oral cavity
rathke pouch
posterior pituitary= infundibulum (which is an invagination of diencephalon)
both lobes of pituitary are derived from ectoderm
210
____ is made by hypothalamus which eventually causes an increase in cortisol production by adrenal glands
CRH
211
most gallstones contain ____- as their major compoennt
**cholesterol**
but can include bilirubin (unconjugated) and calcium
212
major components of bile
bile salts, bile pigments, cholesterol, lecithin, bicarbonate
213
____ stones are radiolucent whereas _____ stones are radiopaque (visible on radiographs)
cholesterol; black pigment
stones containing calcium and black pigment (bilirubin) are visible
stones containing cholesterol and uric acid are not visible
214
what enzyme is the rate limiting and committing step in bile acid synthesis
7 alpha hydroxylase
--> which is responsible for hydroxylation of cholesterol
215
bile acids made why?
Bile acids are synthesized in the liver from cholesterol and help with fat digestion and absorption in the intestine.
216
bile acid synthesis
🔬 Steps of Bile Acid Synthesis
1. Cholesterol
↓ (via CYP7A1, the rate-limiting enzyme)
2. 7α-hydroxycholesterol
↓
3. Primary bile acids:
Cholic acid
Chenodeoxycholic acid
4. In the intestine, gut bacteria convert primary bile acids into:
Secondary bile acids:
Deoxycholic acid (from cholic acid)
Lithocholic acid (from chenodeoxycholic acid)
5. These bile acids are then conjugated with glycine or taurine in the liver to form bile salts → stored in the gallbladder
217
how do primary bile acids get made into secondary bile acids
in intestine by gut bacteria
218
what are the primary and secondary bile acids
cholic acid --> deoxycholic acid
chenodeoxycholic acid --> lithocholic acid
219
what happens to secondary bile acids
liver conjugates them with glycine or taurine in the liver to form bile salts --> stored in gall bladder
220
where are bile salts stored
where are they made
gall bladder
liver
221
the common bile duct is formed by the union of what 2 ducts
cystic and hepatic ducts
cystic duct from the gallbladder and common hepatic duct from the liver
common bile duct joins the main pancreatic duct to form the hepatopancreatic ampulla which empties into the duodenum
222
where do bile acids act on
Bile acids act primarily in the small intestine, especially the duodenum and jejunum, to aid in fat digestion and absorption.
223
which hormone causes the sphincter of oddi to relax and the gallbladder to contract and release concentrated bile into the duodenum
cholecystokinin
224
creutzfeld Jacob disease (mad cow diseased) is caused by
prions
which are protein that fold abnormally
"proteinaceous infectious particle"
225
infectious agent causing Creutzfeldt Jacob disease
nerve tissue of cows (via prions)
226
incubation period for Creutzfeldt Jacob disease
years
takes at least a couple years to damage nerve system then can be there for 5-20yrs
227
prognosis of Creutzfeldt Jacob disease
poor- develop progressive dementia, myoclonus and die
congnitive decline, convulsions, loss of coordination, dementia, visual impairment
228
transmission of Creutzfeldt Jacob disease
blood/ plasma derived products
229
most common congenital gastrointestinal anomaly and where its found in the intestine
meckel's diverticulum, in small intestine (distal ileum)
esp in males < 2yoa
230
what embryologic structure remnants are still present in meckel's diverticulum
the remnants of the proximal end of the vitelline blood vessel within 2 feet (85 cm) of the ileocecal valve
normally the vitelline duct is obliterated
231
what type of ectopic tissue is commonly associated with meckel's diverticulum
gastric
may cause ab pain and painless rectal bleeding
232
the innermost layer of the intestinal wall, known as the mucosa, consists of 3 layers. Which layer moves the mucosa into contact with food?
muscularis mucosa (smooth muscle layer)
233
meckel's diverticulum is associated with bowel obstruction, and it is one of the risk factors for intussusception. what is the mechanism of intussusception
the structure of this condition acts as a lead point for the proximal bowerl to involute into the distal bowel
234
intussusception
proximal segment of bowel telescopes into the immediately distal segment of the bowel, and can compromise blood supply
common in meckel's diverticulum
235
which parts of intestinal system does celiac disease effect
duodenum and jejunum
celiac has cell attacking antibody-coated gliadin antigens in mucosal villi of D and J
236
steatorrhea commonly occurs in celiac disease as a result of villi damage. which cells can be found in the villi?
goblet cells
-secrete mucus and protect GI tract
237
chylomicrons eventually pass the lymph into what structure before emptying into the bloodstream?
thoracic duct
chylomicrons enter lacteals and eventually pass with lymph into thoracic duct. the thoracic duct is the largest lymphatic vessel and empties into systemic circulation at the left subclavian vein
238
sinusoids
Sinusoids are wide, leaky capillaries with fenestrations and discontinuous basement membranes, allowing passage of proteins, blood cells, and other large molecules.
i..e liver, spleen, bone marroe
239
celiac lymph nodes
located along celiac trunk and drain lymph from stomach, duodenum, pancreas, spleen and biliary tract
240
what is a complication of celiac disease
dermatitis herpetiformis, osteoporosis, intestinal lymphoma, autoimmune thyroiditis
241
which vitamin deficiency in celiac
folate
242
SOB, blood in urine, back pain, ate ethnic food, tachycardia, splenomegaly, scleral icterus (aka acute hemolytic crisis) - whats the possible dx and from what?
glucose- 6-phosphate dehydrogenase deficiency, fava bean ingestion
243
glucose- 6-phosphate dehydrogenase deficiency,
G6PD deficiency is an X-linked disorder where red blood cells lack the enzyme glucose-6-phosphate dehydrogenase, making them vulnerable to oxidative stress. Triggers like certain drugs, infections, or fava beans can cause acute hemolytic anemia, leading to fatigue, jaundice, and dark urine. Diagnosis is made with a G6PD enzyme assay, and management focuses on avoiding triggers and supportive care during episodes.
244
in a hemolytic crisis what does the peripheral blood smear look like
normochromic, normocytic, anisocytosis, poikilocytosis, "bite cells"
245
bite cells in what condition
G6PD deficiency; hemolytic crisis
246
G6PD deficiency is what type of inheritance
X linked recessive; therefore characteristic of inheritance is that fathers cannot pass x linked traits to their sons
247
which metabolic pathway for G6PD enzyme
1st step of pentose phosphate pathway; which provides NADPH
248
role of NADPH for glutathione
NADPH keeps glutathione reduced in order to protect against oxidizing free radicals and hydrogen peroxide, a strong oxidizing agent
LEO GER
