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Flashcards in General Knowledge 3 Deck (254):
1

Staph. epidermidis

- Novobiocin sensitive - coagulase negative - part of normal skin flora - infects prosthetic devices, IV catheters by producing adherent biofilms ((think--> bacterial endocarditis on a prosthetic valve)) "At the Staph retreat there was NO StRES" (Saprophyticus novobiocin resistant, epidermidis sensitive)

2

Staph. Saprophyticus

- Novobiocin resistant - Coagulase negative - 2nd leading cause of UTI in sexually active women * leukocyte esterase test positive = bacterial cause of UTI

3

Staph. aureus

- gram + cocci in clusters Manifestations: - recurrent URIs in cystic fibrosis - toxic shock syndrome - scalded skin syndrome - food poisoning (preformed enterotoxin-- rapid onset & resolve) - abscesses ( think pus, empyema, surgical wounds) - bronchopneumonia or lung abscess - bacterial endocarditis - osteomyelitis (w/ elevated CRP and ESR) - infectious arthritis - impetigo - breast abscess (during breastfeeding) - catalase positive - coagulase positive - has protein A (prevents phagocytosis) - treat w/ penicillinase resistant penicillins (methicillin, naficillin or VANC for MRSA

4

Strep. pyogenes

- gram positive cocci in chains - group A strep - beta hemolytic (complete clearance) - pharyngitis - Rheumatic fever (cross reactive antibodies to the M protein) - glomerulonephritis - cellulitis, impetigo - scarlet fever - bronchopneumonia - toxic shock syndrome (exotoxin A) - has streptolysin O (lyses RBC membranes) - sensitive to bacitracin Treat: penicillin

5

Pathogens most often responsible for secondary bacterial pneumonia (after viral illness , like influenza)?

Strep. pneumonia Staph. aureus Haemophilus influenza

6

This bacterial structure mediates adherence to surfaces, especially foreign surfaces (catheters)

GLYCOCALYX

7

Unique to gram positive bacteria

Lipoteichoic acid , thick peptidoglycan cell wall

8

Unique to gram negative bacteria

Endotoxin (LPS)

9

The gram negative coccus bacteria

Neisseria

10

Gram positive bacteria with no cell wall

Mycoplasma

11

These bugs do not stain well with gram stain... "These Rascals May Microscopically Lack Color"

Treponema (too thin) Rickettsia (intracellular) Mycobacteria ( high lipid content, needs acid fast stain) Mycoplasma (no cell wall) Legionella (intracellular- needs silver stain) Chlamydia (intracellular, lacks muramic acid)

12

Stain Used to diagnose Whipple's dz

PAS

13

Stain used to diagnose Cryptococcus neoformans

India Ink

14

------- Is a TLR (toll like receptor) that recognizes LPS ( a PAMP) on gram neg bacteria

CD14

15

Arachidonic acid is released from the lipid membrane by -----?

Phospholipase A2

16

TLR activation results in upregulation of _____, a nuclear transcription factor that leads to production of more immune mediators

NF- kappa B

17

This prostaglandin mediates pain and fever

PGE2

18

Things that attract and activate neutrophils: (4)

LTB4, C5a, IL-8, and bacterial products

19

What 3 things activate mast cells?

Tissue trauma, C3a and C5a, and cross linking of surface IgE by antigen

20

gingivostomatitis, fever, lymphadenopathy in a young child

primary type 1 herpesvirus infection (HSV 1)

21

Herpesvirus --> enveloped?, DNA or RNA? double or single stranded?

enveloped, double- stranded DNA virus

22

serologic test for detecting EBV infection (mono)

monospot test --> tests for heterophile antibodies (IgM)

23

male with hemarthrosis, prolonged bleeding after tooth extraction or surgery

suspect Hemophilia (prolonged PTT)

24

deficiency of factors II, V, VII , X & fibrinogen cause the _____ time to be prolonged

PT (warfarin will also prolong this)

25

bilateral renal angiomyolipomas is associated with ______

Tuberous sclerosis (also look for >2 ash leaf macules!)

26

Why doesn't chlamydia respond to Ceftriaxone?

NO cell wall peptidoglycan

27

What makes up "Hesselbach's triangle" , the location of a direct inguinal hernia...

the inferior epigastric vessels, the lateral border of the rectus abdominus m. and the inguinal ligament

28

gingivostomatitis, fever, lymphadenopathy in a young child

primary type 1 herpesvirus infection (HSV 1)

29

Herpesvirus --> enveloped?, DNA or RNA? double or single stranded?

enveloped, double- stranded DNA virus

30

serologic test for detecting EBV infection (mono)

monospot test --> tests for heterophile antibodies (IgM)

31

male with hemarthrosis, prolonged bleeding after tooth extraction or surgery

suspect Hemophilia (prolonged PTT)

32

deficiency of factors II, V, VII , X & fibrinogen cause the _____ time to be prolonged

PT (warfarin will also prolong this)

33

bilateral renal angiomyolipomas is associated with ______

Tuberous sclerosis (also look for >2 ash leaf macules!)

34

Why doesn't chlamydia respond to Ceftriaxone?

NO cell wall peptidoglycan

35

What makes up "Hesselbach's triangle" , the location of a direct inguinal hernia...

the inferior epigastric vessels, the lateral border of the rectus abdominus m. and the inguinal ligament

36

Name all the Retroperitoneal structures

Suprarenal (adrenal) glands Aorta and IVC Duodenum (parts 2,3,4) Pancreas (head and body) Ureters Colon (descending & ascending) Kidneys Esophagus (lower 2/3) Rectum (upper 2/3)

37

What connects the liver to the anterior abd wall? And what structure does it contain?

Falciform ligament - contains the ligamentum teres (remnant of umbilical vein)

38

Which ligament contains the portal triad and what does that ligament connect?

Hepatoduodenal ligament (connects liver to duodenum) **portal triad= common bile duct, hepatic artery & portal vein

39

Which ligament contains the splenic artery and vein?

Splenorenal ligament (connects spleen to post abd wall)

40

Which part of the small intestine has largest number of goblet cells?

Jejunum

41

structures of the foregut are supplied by the ______ artery and the _________ nerve

Celiac trunk and vagus nerve ((Foregut structures are ----> stomach , duodenum, liver, GB, pancreas and spleen ))

42

Midgut structures are supplied by the __________ artery and the _________ nerve

SMA and Vagus nerve ((Midgut structures -----> distal duodenum to proximal 2/3 of transverse colon (to splenic flexure))

43

Hindgut structures are supplied by ____ artery and _____ nerve

IMA and pelvic nerve ((Hindgut structures ---> distal 1/3 transverse colon (splenic flexure) to upper rectum))

44

What is SMA syndrome?

The transverse part of the duodenum can become trapped btw the aorta and the SMA if the angle of the SMA decreases---> leading to a partial small bowel obstruction

45

Branches of the celiac trunk?

-Left gastric a. -splenic a. -common hepatic a.

46

Above the pectinate line ----> drains to portal vein and receives visceral innervation. Kind of hemmorhoids ? Kind of cancer?

Internal hemorrhoids (NOT painful) -- sign of portal HTN Above line= Adenocarcinoma

47

Below pectinate line--> venous drainage is to inferior rectal vein-----> IVC and innervation is somatic (pudendal nerve) Type of hemmorhoids? Type of cancer?

External hemorrhoids (painful) and Squamous Cell Carcinoma

48

Which zone of a hepatocyte is the outermost and is affected first by viruses??`

Zone 1 -- the periportal zone

49

Which zone of the hepatocyte is affected 1st by ischemia and is most sensitive to toxins and alcohol?

Zone 3 - pericentral zone

50

Acute pancreatitis causes:

- Something obstructing the duct (tumor at head of pancreas, gallstones) - Alcohol - (causes sphincter of Oddi to contract) - Scorpion sting - Trauma (MVA) - Hypercalcemia , hyperlipidemia - Mumps - Rupture of a posterior duodenal ulcer

51

hormone secreted by cells in the antrum of the stomach, cause trophic growth of the gastric mucose, incrs acid secretion and incrs motility

GASTRIN (from G cells in the antrum)

52

hormone secreted from cells in the small intestine that incrs pancreatic secretions, GB motility & decrs gastric emptying

CCK (from I cells in the duodenum & jejunum)

53

hormone secreted by cells in the duodenum that incrs pancreatic HCO3- secretion, incrs bile secretion and decreases gastric acid (wants to neutralize acid in the duodenum)

Secretin (from S cells in duodenum)

54

why is an oral glucose load used more rapidly by the body than an IV dose?

b/c the hormone GIP (from K cells in the small intestine) causes increased INSULIN RELEASE

55

hormone that increases water & electrolyte secretions and relaxes sphincters throughout the GI Tract

VIP --> a VIPoma causes copious diarrhea - VIP is inhibited by somatostatin

56

Loss of this hormone is implicated in the tight LES tone of Achalasia

loss of Nitric Oxide

57

B12 is taken up in the ____________ with the help of _____ secreted by parietal cells in the stomach

terminal Ileum w/ Intrinsic factor ((B12 and bile acids are absorbed in the ileum ))

58

3 things that act on parietal cells to increase gastric acid secretion

-Ach -Gastrin -Histamine --> (Histamine from ECL cells most potent activator of acid)

59

things that decrease acid secretion from parietal cells

-Prostaglandins / Misoprostol - Somatostatin

60

Iron (Fe++) is absorbed mainly in the ____

duodenum

61

Folate is absorbed mainly in the ____

jejunum

62

peyer's patches in the Ileum have B cell germinal centers which make _______

IgA secreting plasma cells (secretory IgA)

63

function of bile?

cholesterol excretion, help absorb fats and fat soluble vitamins, antimicrobial properties

64

bilirubin gets conjugated with ______ in the liver to become "direct bilirubin" which is water soluble

conjugated with glucaronic acid

65

Types of Salivary gland tumors

-Pleomorphic adenoma -- benign, most common tumor of the parotid, high rate of recurrance -Warthin's tumor -- benign, glands + lymph tissue, in parotid - Mucoepidermoid carcinoma -- malignant , usually in parotid , involves Facial nerve

66

triad of dysphagia (esophageal webs), glossitis, iron deficiency anemia

Plummer - Vinson syndrome

67

Jaundice -- 4 main causes:

1- Direct injury to hepatocyte (incr total bili) 2- Obstruction of bile flow (incr direct bilirubin) 3- Hemolysis (incr indirect bilirubin) 4- **Physiologic neonatal jaundice --- due to immature UDP-glucuronyl transferase -> high indirect bilirubin --> risk of kernicterus**

68

Treatment for physio neonatal jaundice

Phototherapy -- makes the UCB water soluble (does not actually conjugate it)

69

Mild decrs in UDP-glucuronyl transferase --> generally asymptomatic until fasting or stress causes mild jaundice

Gilbert's syndrome

70

completely absent UDP-glucuronyl transferase, jaundice, kernicterus, death

Crigler- Najjar syndrome

71

defective liver excretion of of bilirubin, BENIGN, just elevated conjugated bili, liver is dark color, lysosome are filled with Epinephrine

Dubin- Johnson Syndrome (Rotor's syndrome is even milder and liver is not black)

72

Treatment for Wilson's disease

Penicillamine (copper chelating agent )

73

air in the biliary tree

think --> fistula has formed btw GB and duodenum due to gallstones

74

tumor marker CA 19-9

Pancreatic cancer

75

Cimetidine, Ranitidine, Famotidine & Nizatidine

histamine (H2) receptor blockers ---> (take H2 blockers before you --"dine") - for ulcers, reflux, gastritis

76

Omeprazole, Lansoprazole

Proton pump inhibitors (irreversible inhibitors of Na/K/ATPase in parietal cells ) --- no acid gets secreted

77

these bind directly to the base of the ulcer , providing physical protection

Bismuth, Sucralfate

78

a PGE1 analog, incrs mucous, decrs acid in stomach (can also be used to maintain a PDA or as an abortifacent)

Misoprostol

79

long acting Somatostatin analog -used for Acromegaly, VIPoma, Carcinoid tumors...

Octreotide

80

Infliximab

-MAB to TNF -used for Chron's dz , RA - side effect is infection risk

81

Sulfasalazine

antibacterial + anti-inflammatory - used for U.C. & Chron's

82

powerful, central acting antiemetic, 5-HT antagonist -used in chemo patients

Ondansetron (Zofran)

83

a prokinetic, D2 antagonist -incrs tone of sphincters, contractility, motility -used post surgery or in diabetics to get the bowel moving again!

Metoclopramide -has extra pyramidal side effects b/c it block's dopamine!

84

painful ulcer in oral mucosa, gray base of granulomatous tissue surrounded by erythema

Aphthous Ulcer -related to stress - cause unknown (prob immune complexes) -"Behcet Syndrome" --> recurring ap. ulcers

85

most common location for SCC of the oral cavity

Floor of mouth -alcohol & smoking risk factors

86

Erythroplakia & Leukoplakia are precursor lesions to _____

Oral SCC -represent squamous cell dysplasia

87

rough, white patch on the lateral tongue of a man with AIDS or EBV

Hairy Leukoplakia - NOT PRECANCEROUS - represents squamous cell hyperplasia

88

elevated serum Amylase = rule out:

-Mumps / Salivary gland problem -Pancreatitis

89

Halitosis, dysphagia, obstruction

Zenker diverticulum

90

cause of subcutaneous emphysema (air bubbles trapped under skin, around neck)

Boerhaave syndrome (esophageal rupture-> air makes it's way through mediastinum into subcutaneous tissues)

91

Most common cause of death from Cirrhosis

bleeding Esophageal varices

92

adult onset Asthma, chest pain after eating...

GERD -acid can irritate lungs -can also get up to mouth and damage enamel

93

olive like mass, projectile vomiting, 2 weeks after birth of baby boy

Pyloric Stenosis - hypertrophy of pyloric muscle

94

Risk factors for acute gastritis

-Severe burns ("Curling Ulcer") - hypovolemia, less perfusion to stomach -NSAIDS - Alcoholism - Chemotherapy -Incrs ICP ("Cushing Ulcer") --> vagus (Ach) stimulation, more acid is made - Shock (hypoperfusion)

95

Erosion = loss of ________ Ulcer = loss of _______

epithelium , mucosal layer

96

Chronic gastritis two types / causes

1- H. pylori (90%) -- treat with 'triple therapy' 2- Autoimmune (10%)-- T cell mediated (type IV hypersensitivity)

97

duodenal ulcer is almost always due to

H. pylori --improves with meals b/c the duodenum is starting to secrete neutralizing liquid

98

epigastric pain, worse with food

gastric ulcer

99

Risk factors for Intestinal type gastric carcinoma (most common gastric cancer)

- Japanese - Smoked food - Blood type A - H. pylori *Note: Intestinal type can have 'Sister Mary Joseph nodes"

100

signet ring cells, linitis plastica (from desmoplasia of stomach)

Diffuse type gastric carcinoma -NOT assoc with H. pylori

101

bilateral mucinous ovarian tumors are mets from _______ cancer

Diffuse type gastric cancer "Krukenberg Tumor"

102

failure of the vitelline duct to involute

Meckel's Diverticulum ( a true diverticulum -- outpouching of all 3 layers)

103

twisting of the bowel along it's mesentery

Volvulus (most common at sigmoid, cecum)

104

Lactose intolerance is usually congenital or acquired???

Acquired -- after a GI illness/ infection

105

Cecliac dz is associated with HLA _____

HLA-DQ2 & DQ8 -gliadin is presented via MHC class II -helper T cells mediate damage -mostly affects duodenum

106

autosomal recessive deficiency of APO B-48 & APO B-100

Abetalipoproteinemia no B-48 --> no chylomicrons no B-100 --> no plasma VLDL & LDL

107

tumor cells + for chromogranin

Carcinoid tumor

108

what is secreted into the urine when someone has a Carcinoid tumor

5-hydroxy indoacetic acid (5-HIAA)

109

Hirschsprungs and duodenal atresia are associated with what chromosomal defect?

Down's syndrome

110

____________ impairs the progression of the adenoma-carcinoma sequence

ASPIRIN -b/c COX is needed for the progression to carcinoma

111

autosomal dominant, hamartomatous polyps all along GI tract , freckle like spots on lips, increases risk for colon, breast cancer

Peutz - Jeghers syndrome

112

autosomal dominant inherited mutation in APC gene -- if rectum & colon not removed, 100% chance of cancer

FAP

113

decreased stool caliber, tumor wraps around lumen

Left sided colon cancer

114

iron-deficiency anemia, occult bleeding, vague pain

Right sided colon cancer *an older adult with Fe deficiency anemia has colon cancer until disproven

115

tumor marker for Colorectal cancer -- only good for assessing response & recurrance 

CEA  (( Carcinoembryogenic antigen)) 

116

complication of pancreatitis, fibrous tissue surrounding liquefactive necrosis

Pancreatic Psuedocyst

117

risk factors for pancreatic cancer

SMOKING, & chronic pancreatitis

118

What is the Whipple procedure?

removal of head & neck of pancreas, proximal duodenum and GB **need to supplement IRON after this procedure

119

these gallstones are radiolucent (can't see them)

Cholesterol stones

120

pain radiating to right scapula, fever, WBC incrs, incrs alk phos

Acute cholecystitis

121

cholecystitis in a thin, elderly women

think of GALBLADDER CARCINOMA

122

fecal oral hepatitis viruses, NO chronic states

Hep A & E ("fEcAl -oral")

123

Hepatitis ______ is assoc with high mortality in pregnant women (from fulminant hapatitis)

Hep E

124

most people infected with Hep ____ go into chronic carrier states

Hep C

125

______ indicates a resolved Hep B infection (or vaccination)

IgG to HBaAB

126

______ indicates that the Hep B virus is infective / transmissible

HBeAG (envelope)

127

cirrhosis damage is mediated by

TGF-beta from stellate cells

128

decreased synthesis of clotting factors in cirrhosis leads to prolongation of the ____ time

PT time

129

obstructive jaundice & antimitochondrial antibodies in a 40 y.o woman

Primary Biliary Cirrhosis

130

hydatid cysts from Echinococcus tapeworm infections look like "eggshell calcifications"  in the liver and if disrupted during surgery can cause

Anaphylaxis

131

Most common benign liver tumor

Q image thumb

Cavernous Hemangioma -- blood vascular spaces with single layer of epithelium 

132

this type of tumor can regress upon stopping oral contraceptives 

Q image thumb

Hepatic Adenoma 

133

serum marker for Hepatocellular Carcinoma risk 

Alpha fetoprotein (AFP)

134

Most common outcome of Hepatitis B infection 

complete resolution (no chronic infection) 

135

air in biliary tree  ("pneumobilia") 

Gallstone ileus 

--large gallstone passes into intestine via a fistula

-- eventually obstructs (usuallyat ileocecal valve) 

136

a patient with visible Kayser-Fleischer rings probbaly also has what other manifestations of Wilson's dz?

neuropsych symptoms, especially basal ganglia atrophy 

137

characteristic histo finding of a child with hepatoc failure due to Reye's syndrome

microvesicular steatosis of hepatocytes 

138

liver biopsy showing ballooning hepatocytes, lymphocytic infiltrates, necrosis, apoptosis (and subsequent pink/acidophilic "Councilman bodies" on H&E)

Viral Hepatitis 

139

pt w/ fever, fatigue, joint pain, skin rash.... then later his LFT's are elevated

HEPATITIS B 

- has a "serum sickness like" prodrome period

 

140

D-xylose absorption testing tests the function of what??

the intestinal brush border absorption independent of pancreatic enzymes

- used to distinguish malabsorption caused by panc or intestine 

141

-rectum always involved

-inflammation of mucosa & submucoas only

- continuous mucosal damage

 - bloody diarrhea is hallmark of this dz

Ulcerative Colitis 

142

confirmatory test for Celiac disease 

small intestine biopsy 

- atrophy & villi blunting

- chronic inflammatory infiltrate in lamina propria

143

porcelain gallbladder puts the pt at high risk for ______

gallbladder cancer 

- develops in pts with chronic cholecystitis

- cholecystecomy is reccommended 

144

Where are most Zollinger Ellison (gastrinomas) tumors found? 

-Pancreas

- some in duodenum, stomach.. 

145

Shigella exhibits specificty for what kind of cell in the intestine??

M- cells in the Peyer's patches of the Ileum 

146

Pruritis in a woman w/ a history of Sjogren's syndrome 

suspect Primary Biliary Cirrhosis 

- pruritis is 1st symptom, worse at night

- fatigue

-hepatosplenomegaly

-xanthelasmas 

147

most common location of an anal fissure 

posterior midline of anus distal to the dentate line 

- associated w/ low fiber diet, constipation 

148

conditions that cause hyperosmotic volume contraction 

-Diabetes insipidus

- Excessive sweating w/out electrolyte & fluid replenishing 

149

Functions of Thyroid Peroxidase 

-Iodide oxidation

- Formation of MIT & DIT 

- Coupling of MITs & DITs that forms T3 & T4 

150

function of Glyburide 

an oral hypoglycemic (sulfonylurea) that stimulates the release of Insulin from any remaining functioning beta cells in Type 2 diabetics 

151

function of Metformin 

-a biguanide

-- increases the SENSITIVITY of target tissues to Insulin 

--decrs gluconeogenesis

-- incrs glycolysis 

(have little effect on actual Insulin secretion) 

152

mechanisn of Acarbose 

inhibits alpha-glucosidase in the intestinal brush border

- inhibits the absoroption of ingested sugar

153

an injection of hCG in a woman on fertility treatment will mimic what hormone??

hCG mimics LH 

- ovulation can be induced in a woman by a shot of hCG which mimics the LH surge 

154

hypocalcemia and a overactive 'jaw-jerk' reflex when you tap on the angle of the jaw

Hypoparathyroidism 

- possibly removed in thyroid surgery 

- causes low calcium 

- "Chvostek's Sign" -- twitching or reflex when tap of facial nerve 

155

Neurophysins are secreted into systemic circulation from ____________

- from nerve terminals of the posterior pituitary 

- they are secreted along with ADH and Oxytocin 

156

term meaning decreased response to a drug with repeated administration 

Tachyphylaxis 

157

two tissue types that use INSULIN DEPENDENT Glucose uptake (Glut 4)

-Adipose

- Skeletal muscle 

158

Glut transporter in the placenta, brain & kidneys 

GLUT 3 

159

Glut transporter in the spermatocytes & GI tract 

 

*hint : uptake of Fructose 

GLUT-5 

160

LH stimulates the release of _________ from the Leydig cells and FSH stimulates the release of _________ from the Sertoli cells 

LH ---> testosterone

FSH --> Inhibin B 

161

which hormone level can be used to confirm that a woman is in menopause 

FSH

- will be high due to loss of inhibition by estrogen feedback 

162

NF-kappa B stimulates ____________ production 

more cytokines 

163

an elevated alk phos should be followed up with what other test to pinpoint the problem to the liver??

gamma-glutamyl transpeptidase (ggt)

164

first test used in screening for Malabsorption 

Fecal fat test 

-"Sudan III stool stain"

165

What causes appendicitis?

Obstruction of the appendix --> usually by a Fecalith (adults) or hyperplastic lymphoid tissue (in kids after an illness) 

 

*general principle = inflammation & infection will set in behind an obstructed lumen **

166

to diagnosie Hirschsprung's disease you want to do a ____________ from the narrow or distended part of the intestine?

-Suction Biopsy (must get down to submucosa at least to sample Meissners plexus)

-take it of the narrow part (the affcted section cannot relax and the normal part above wil be distended)

167

most common liver neoplasm 

metastases!

- multiple , well demarcated nodules 

168

TH___ cells involved in Chron's 

TH___ cells involved in Ulcerative Colitis 

TH1 -- Chron's

TH2 -- Ulcerative Colitis 

169

-thyrotoxicosis (fetures of hyperthyroid), elevated ESR, reduced radioactive Iodine uptake and tenderness over thyroid

 

-histologically: mixed infiltrate with occasional multinucleated giant cells 

Subacute (granulomatous) thyroiditis 

170

extensive fibrosis of the thyroid gland that can extend into other nearby structures 

Riedel thyroiditis 

171

Must check a patient's ____ levels before starting Amiodarone therapy because it is 40% Iodine!

TSH 

-excessive iodine can cause hypothyroidism 

172

Pituitary tumors

Parathyroid tumors

Pancreatic endocrine tumors (ZE syndrome/VIPomas...) 

 

Presents as: **kidney stones, stomach ulcers, prolactin or GH incrs...))

MEN 1 

-autosomal dominant 

 

173

Parathyroid tumors

Pheochromocytomas

Medullary Thyroid carcinoma (calcitonin secreting) 

MEN 2A

-autosomal dominant

-associated with RET gene 

174

Oral/intestinal neuromas & Marfan habitus

Pheochromocytomas

Medullary Thyroid Carcinoma (celcitonin secreting) 

MEN 2B

-autosomal dominant

- assoc w/ ret gene 

175

A man in DKA needs Insulin, after an initial Insulin bolus & fluids, continuous IV _________ Insulin is the preferred tx for DKA 

Regular insulin --given IV

-tales effect very rapidly 

176

pancreatic islet amyloid deposition is characteristic of Type ____ DM 

TYPE 2 

177

diarrhea, abdominal pain, duodenal & jejunal ulcers 

Gastrinoma 

178

increased AFP leves in a pregnant woman.....

-Dating error

- multiples

- Neural tube defects

-ompahlocele/gastroschisis 

179

child with fever, vomiting, altered mental status, hypotension, tachycardia, nuchal rigidity, petichial rash

meningicoccal meningitis 

-Neisseria septicemia 

-beware of adrenal hemorrhage in these kids (Waterhouse Friderichsen syndrome)

180

How do Methimazole & Propylthiouricil work to treat hyperthyroidism?

they block the Peroxidase enzyme --blocking organification & coupling of iodotyrosines

((Propylthiouricil also decreases the Peripheral conversion of T4 to T3 ))

181

a patient in DKA will have what kind of potassium values in the cell and outside the cell??

Intracellular K+ --decreased

Extracellular K+ -- normal or increased 

((and Total K+ is low))

 

*They lose K+ as part of the osmotic diuresis with glucose loss in the urine (also remember, Insulin normally puts K+ in the cells, if you have no Insulin, K+ comes out)

182

What structures are neural crest cell derived?

  • All sensory ganglion and autonomic ganglion 
  • Melanocytes
  • Chromaffin cells (adrenal medulla) 
  • Schwann cells & Satellite cells
  • Meninges (Pia and arachnoid mater)
  • Pharyngeal arch cartilage
  • Odontoblasts
  • Parafollicular (C) cells
  • Aorticopulmonary septum
  • Endocardial cushions

183

How does increased Estrogen affect thyroid hormone levels?

-Estrogen decreases the catabolism of Thyroid Binding Globulin (TBG) --> therfore increases the TBG

- incrs TBG = incrs total T4 and total T3

-increase is in the BOUND to TBG forms so the Free thyroid hormone remains normal and they are 'euthyroid'

184

what is the mechanism of injury in diabetics who develop neuropathy and cataracts?

-Osmotic injury!

- the excess plasma glucose is converted to Sorbitol & Fructose by aldose reductase 

- Sorbitol accumulates within some cells and draws water in, causing osmotic injury 

(( this occurs in the lens, nerves, blood vessels & kidneys ))

185

most common type of pituitary tumor

Prolactinoma 

-bitemporal henianopsia

-galactorrhea in females

- hypogonadism 

186

Treatment of Congenital Adrenal Hyperplasia involves directly suppressing what hormone??

ACTH

-give low (physiologic) doses of exogenous corticosteroids to suppress the overproduction of ACTH

187

Dexamethasone suppression test will suppress ACTH levels if  the tumor is from ___________

a pituitary adenoma 

-- it will NOT suppress exogenous ACTH from a small cell lung cancer for example 

188

a person with diabetes is most likley to die from _________

a Myocardial Infarction 

189

Glucocorticoids will cause an increase in protein production in which organ/tissue?

-the LIVER

- steroids cause an increase in gluconeogenesis and glycogenolysis 

- they contribute to hyperglycemia 

190

mechanism of action of Sulonylureas (ie: Glyburide, Glipizide...)

trigger more Insulin release via Ca++ influx 

191

what hormones are decreased in a woman with anorexia nervosa causing amenorrhea?

-low LH, FSH, Estradiol and Estrone

-"hypogonadotropic amenorrhea"

192

excessive Growth Hormone increases linear bone growth by stimulating ____________

IGF-1 from the LIVER 

(Gigantism -- if before growth plates fuse, Acromegay -- if after) 

193

Which symptom of thyrotoxicosis (ie: Graves dz) will not be helped with a beta blocker?

-Exophthalmos 

-b/c this is due to incrs soft tissue mass within the orbit behind the eye 

194

pt with a "cold" thyroid nodule, Calcitonin producing tumor with splindle shaped cells 

Medullary Thyroid Cancer 

-assoc with MEN 2 syndromes

- RET proto oncogene 

195

drugs used to treat the proptosis and prevent exophthalmos of Grave's dz

-Prednisone

- you have to prevent the inflammation and edema behind the eye

196

why do antipsychotics cause Hyperprolactinemia?

they inhibit Dopamine (which normally inhibits Prolactin) 

197

how can ADH (desmopressin) be used to treat the bleeding of von Willebrand's disease?

ADH increases vWF release from endothelial cells 

198

a man with a testicular tumor starts to develop hyperthyroidism ... which hormone could be causing the thyroid symptoms?

hCG from the testicular mass

- hCG is structurally similar to TSH (and also LH in women) and could cause the hyperthyroidism 

199

name the diabetes drugs that inhibit intestinal brush border enzyme (alpha glucosidase) to decrs glucose absorption 

-Acarbose

- Miglitol 

200

treatment for SIADH

- has toxicities of Nephrogenic DI, photosensitiivy, bone & teeth abnormalities

Demeclocycline 

- an ADH antagonist

- from the tetrocycline family (hence the SE's)

201

hormone responsible for fetal lung maturity and surfactant production , only secreted late in gestation 

Cortisol 

-only secreted late in gestation

- premature --> low surfactant --> IRDS

202

2 places in the body with their own portal circulation 

-Pituitary

-Liver 

203

this hormone:

-incrs glucose transport into skeletal m

- incrs glycogen synthesis

- incrs trig synthesis / storage

- incrs Na+ retention, protein synthesis

- incrs cellular uptake of K+ and amino acids 

INSULIN 

204

Insulin is secreted in exchange for ______________ into the cell 

Ca++ 

205

GLUT receptor for the brain and RBC's

GLUT 1

206

Why do women who are breastfeeding stop ovulating?

Prolactin inhibits GnRH

207

which is the more active form of Thyroid hormone?

T3

-but T4 is made more and just converted as needed by 5-deiodinase

 

208

hormones that use the cAMP second messenger system 

"FLAT CHAMP"

  • FSH
  • LH
  • ACTH
  • TSH
  • CRH
  • hCG
  • ADH
  • MSH
  • PTH
  • also Caclitonin, GnRH and Glucagon 

209

how do you tell a Follicular thyroid Adenoma (benign) from a Follicular Carcinoma (malig)?

the Follicular Carcinoma INVADES THE CAPSULE 

210

-pathological activation of coagulation (blood clotting) mechanisms that happens in response to a variety of diseases

-leads to the formation of small blood clots inside the blood vessels throughout the body.

-As the small clots consume coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding occurs from the skin.

DIC

211

cytokine that stimulates NK cells to destroy target cells and makes T helper cells secrete IFN-gamma

IL-12 

212

impairement of the ____________ process can lead to neurodegenerative disorders like Parkinson's & Alzheimer's

Ubiquitin- proteosome system 

-failure of this system to degrade abnormal proteins leads to accumulation of misfolded proteins 

213

test you use to determine if the means of 2 populations are equal 

2 Sample T Test 

214

MOST COMMON primary brain tumor in adults 

Glioblastoma Multiforme

- in frontal or temporal lobe or basal ganglia

-can cross hemispheres (but not always)

- foci of necrosis and hemorrhage 

215

RNA Pol 1 --- functions?

RNA Pol 2---

RNA Pol 3--- 

RNA Pol 1 -- makes rRNA in the nucleolus

RNA Pol 2-- make mRNA

RNA Pol 3-- DNA to tRNA some rRNA and snRNPS

216

When doing a Cricothyrotomy, what structures do you pass through to get to the airway?

1- Skin

2- Superficial cervical fascia (including fat & Platysma m)

3- Investing & Pretracheal layers of the deep cervical fascia 

4- Cricothyroid membrane 

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217

Molecule with the amino acid sequence of (Gly -x-y)333 ((Glycine every 3rd amino acid) 

COLLAGEN 

-folds into a triple helix

- glycine is the smallest aa, so needed to fold into a triple helix!

218

Medical treatment for aldosterone secreting adenoma (Conns syndrome)

Spironolactone, Eplerenone 

219

a segmenting vasculitis that can extend into the veins and nerves (eventually encasing all 3 infibrous tissue)

Buerger's disease (aka "thromboangiitis obliterans")

- male heavy smokers < age 35 

-pt w/ "hypersensitivity to injection of tobacco extract" 

220

child with BP of 160/98, hypokalemia, lack of secondary sexual characteristics 

17-a-hydroxylase deficiency 

221

some non-polar, hydrophobic amino acids that span lipid membranes in transmembrane proteins:

Valine, Alanine, Isoleucine, Metionine, Phenyalanine 

222

Which ligement contains the ovarian artery and vein and must be carefully ligated when removing an overy to prevent hemorrhage?

the Suspensory Ligament 

 

223

Which  ligament contains the uterine artery and must be carefully ligated before a radical hysterectomy?

Cardinal ligament (aka 'transverse cervial lig") 

224

Most common cause of Meconium Ileus in a child?

(child most likely also has what dz?)

CYSTIC FIBROSIS 

- meconium Ileus is a distal, small bowel obstruction in a neonate due to abnormally dehydrated meconium 

- it is quite specific for CF 

225

Some children who have gotten the Hib vaccine can still get infections with H.flu..... how?

-there are several 'non-typable' strains of H. flu that do not have a capsule 

-the vaccine only confers immunity to the type B strain 

226

-connects the lateral femoral condyle to the anterio-medial tibial head 

-prevents anterior motion of the tibia w/ respect to the femur

ACL 

227

Which type of Heparin binds to antithrombin and thrombin to allow antithrombin to inactivate thrombin 

Unfractionated Heparin 

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228

girl with heavy periods and history of frequent nosebleeds as a child-- what is the most likley bleeding disorder?

von Willebrand factor deficiency 

- easy bleeding from mucosal sites (gingiva, nasal mucosa, GI tract, and heavy periods) 

-autosomal dominant 

229

function of vWF in the blood

-what does it bind to?

-carrier of factor VIII (protects it from degredation) 

- binds to exposed collagen and platelet glycoproteins and promotes more platelet binding 

230

child with eczema, recurrent infections (combined B & T cell deficiency) and thrombocytopenia

Wiskott - Aldrich syndrome 

- X linked (only in males)

- increased risk of pyogenic infections do to humoral (B cell) deficit -(Neisseria, H.flu, S. pneumo)

-risk of opportunistic pathogens due to T cell deficit  (P. jiroveci , Herpes)

231

-dz in which platelets contain defective or low levels of GpIIb/IIIa, which is a receptor for fibrinogen

-As a result, no fibrinogen bridging of platelets to other platelets can occur, and the bleeding time is significantly prolonged.

Glanzmann's thrombasthenia

232

drug that blocks gpIIbIIIa on platelets to prevent platelet plug formation 

Abciximab 

233

-child w/ abdominal pain, joint pain, proteinuria, blood in stool

-the most common kind of systemic vasculitis in kids

Henoch- Schonlein Purpura

-expect the child to develop palpable purpura esp on legs, buttocks

- occurs due to deposition of IgA immune complexes 

-males 3-10 years old usually 

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234

lacunar stroke affecting the subthalamic nucleus will cause

contra Hemiballismus 

235

severe hypoplasia of erythroid precursors in the marrow, but normal granulopoesis and thrombopoesis 

Pure Red Cell Aplasia (PRCA)

- form of marrow failure assoc. with Thymic tumors and leukemias

- can also result from Parvovirus infection (pref attacks proerythroblasts)

236

in a male, non-fusion of the urethral folds would cause:

Hypospadias 

237

type of renal cell cast most specific for pyelonephritis 

WBC casts 

-esp in conjunction with burning, urgency, fever

238

Radiation therapy for cancer treatment -- how does it kill/ affect the cancer cells?

-Double stranded DNA breaks or 

- Formation of free radicals 

239

dry, nagging cough, low grade fever, malaise, CXR that looks much worse than the pt feels 

"Walking Pneumonia"

- caused by Mycoplasma pneumonia

- requires cholesterol agar to grow in lab 

240

baby born with Hydrocephalus, intracranial calcifications and chorioretinitis (inflammation that leaves "cotton like" white/yellow lesions on the chorio/retinas)

--classic presentation of a baby with Congenital Toxoplasmosis 

- fetus gets the dz only if mom is infected in 1st 6 months of pregnancy 

241

cyclophosphamide (& other mustard chemo agents) get metabolized to Acrolein (toxic to urothelium) & cause hemorrhagic cystitis --- what agent can prevent this?

MESNA (aka 2-mercaptoethanesulfonate)

242

baby with fever, pharyngitis, diffuse rash that blanches w/ pressure, strawberry tongue

Scarlett fever (group A strep) 

243

transplant patient with onset of rash, jaundice, hepatosplenomegaly, diarrhea 1 week after surgery ---what kind of rxn?

Graft vs Host disease 

- Graft T cells attack the "foreign" host cells (that's why so many organ systems are affected)

244

anaphylactic rxn to blood transfusion 

IgA deficiency 

-these pts must recieve blood products with no IgA in it (they have no IgA so any in their blood is foreign)

-they form IgG against the IgA

245

Pt with recurrent pyogenic infections, his neutrophils fail to turn blue upon nitroblue tetrazolium exposure---- he is deficient in what enzyme?

-NADPH Oxidase 

- the pt has Chronic Granulomatous dz (manifest by recurring infections w/ catalase producing organisms like Staph aureus)

 

246

lack of complement C5b -C9 results in recurring ___________ infections

NEISSERIA 

247

woman with Lupus and antiphospholipid antibodies is predisposed to ____________

-Recurrent Miscarriages 

- they will have the 'lupus anticoagulant'-- which actually causes clotting

- they will have a false + VDRL test and a prolonged PTT 

248

In type A & B mothers, Erythroblastosis fetalis does not occur b/c the antibodies are _____

IgM

-With type O mothers, the antibodies in the serum are usually IgG so they can cross the placenta and cause EF

 

249

T cells undergo positive selection in the thymic ______ & negative selection in the thymic ______

positive selection --> cortex

negative selection --> medulla

250

Isotype switching of B cells in the lymph node happens in the _________

germinal center 

- it is the heavy chain Fc region that determines the isotype 

251

Muscle biopsy in a pt w/ polymyostitis would show _________

CD8+ T cells, and overexpression of MHC I 

252

Erythroblastosis Fetalis (maternal IgG crossing the placenta and lysing baby's A or B blood) is an example of a Type ______ hypersensitivity 

TYPE 2 (antibody mediated) 

253

Drugs that increase IL-2 (Aldesleukin) can be used to reduce tumor burdens in renal cell cancer b/c _______

IL-2 activates more NK cells and monocytes to kill the tumor cells 

254