Heme/onc and micro + review Flashcards Preview

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Flashcards in Heme/onc and micro + review Deck (85):
1

Hematuria, flank pain, low-grade fever after upper respiratory infection

IgA nephropathy

2

Tay-Sachs vs. Niemann-Pick

Niemann-Pick: Hepatosplenomegaly
Lipid laden foamy macrophages

Tay-Sachs: NO hepatosplenomegaly

3

Nonsense vs. Frameshift

Nonsense: adding a stop codon leading to truncated proteins. Only affects protein translation (NOT RNA transcription)

Frameshift: adding or removing a number of bases not divisible by 3
alter the reading frame and thus the mRNA produced

4

PRPP synthetase mutation

Leads to increased production and breakdown of purines thus more uric acid--> GOUT

5

Pyruvate dehydrogenase deficiency

build up of lactate and alanine (via ALT)

tx: lysine and leucine (ketogenic nutrients)

6

Possible products from pyruvate

Alanine
lactate (using NADH)
Oxaloacetate
Acetyl-CoA

7

Transamination leads to and requires?

rxn between aa and alpha kept acid
Leads to transfer of N from alanine to Glutamate
moving NH3 from muscle to liver for urea cycle

Requires Pyridoxine (B6)

8

Biotin rxns

pyruvate carboxylase (pyruvate to oxaloacetate)
Acetyl-CoA carboxylase (acetyl-CoA to malonyl-CoA)
Propionyl-CoA carboxylase (propinyl-CoA to methylmalonyl CoA)

9

Consequence of high-oxygen affinity Hb

trouble releasing O2 in the peripheral tissues--> renal hypoxia--> increased epo synthesis--> erythrocytosis

10

DNA polymerase I

5 to 3 exonuclease activity
removes RNA primer
repair damage

11

DNA polymerase III exonuclease

3 to 5 activity
5 to 3 polymerase

12

Where does the herpes virus hang out?

In the nucleus of cells

thus envelope is made up of nuclear membrane

13

Desmopressin MOA

For hemophilia A and vWbrand dz: increases circulating factor VIII and endothelial secretion of vWF to stop bleeding

For CDI and Nocturnal enuresis: binds V2 receptors--> increase aquaporin channels

14

Von Recklinghausen

NF1

neurofibromas, optic nerve gliomas, lisch nodules (eye), cafe au lait spots

15

Osler-Weber-Rendu

hereditary hemorrhagic telangiectasis

epistaxis, GI bleed or hematuria

16

Sturge-Weber

STURGE
Sporadic
port wine Stain
Tram track calcifications
Unilateral
Retardation
Glaucoma
GNAQ
Epilepsy

17

Cause of extramedullary hematopoiesis

Chronic hemolytic anemia (Beta thalassemia)

see erythroid precursors in liver and spleen

18

skin and subcutaneous tissue necrosis after warfarin

protein C deficiency

19

carcinoid histology

neatly arranged cells in trabecular pattern surrounded by a fibrovascular storm

dense core membrane bound neurosecretory granules

+ chromogranin, synaptophysin, CD57

20

tx for methanol poisoning

folic acid

21

Treatment for thyroid storm

Propranolol
PTU
Prednisolone

22

Relative risk

Cohort study
RR= [a/(a+b)]/[c/(c+d)]

23

Attributable risk

difference in risk between exposed and not exposed

AR= [a/a+b] - [c/c+d]


ARP=100*(RR-1/RR)

24

Relative risk reduction

RRR=1-RR

(proportion of risk reduction attributable to intervention)

25

Absolute risk reduction (ARR)

ARR=[c/c+d] - [a/a+b]

26

Number needed to treat

NNT=1/ARR

27

Hormone levels in Klinefelter syndrome

primary issue: Dysfunctional leydig cells

Decreased T
increased LH and FSH
increased estrogen

small testes and dysgenesis of seminiferous tubules

28

Nausea and vomiting, headaches, vertical gaze palsy. paplledemia

Pineal mass
increased ICP

29

Signaling pathway of steroid hormones

1. enters cell (lipophilic)
2. binds to intracellular receptor
3. hormone-receptor complex then undergoes a conformational change (reveal DNA-binding site)
4. binds to DNA enhancer elements

30

Normal sized head and trunk but short limbs

Achondroplasia

defect in FGFR3 (AD)

associated with advanced paternal age

31

woman with bitemporal hemianopsia and amenorrhea

Prolactinoma

from lactotroph cells

32

Glucagon target

The liver!!
increases glucose production via glycogenolysis and gluconeogenesis

33

Glucagonoma

Dermatitis (necrolytic migratory erythema), Diabetes, Diarrhea, anemia

34

excess Vit. D

hypercalcemia
muscle weakness, constipation, mental status changes
impaired concentration of urine

bone pain

35

Where is Urea reabsorbed

Mostly in proximal tubule

with ADH also reabsorbed in medullary collecting duct

36

Desmopressin effect on renal clearance of urea

decreases clearance

increases reabsorption in medullary collecting duct increasing medullary osmotic gradient and leading to more concentrated urine

37

Pathophys of PAH

BMPR2

dysfunctional endothelial and smooth muscle cell proliferation

THEN vascular remodeling, elevated pulmonary vascular resistance--> progressive pulmonary HTN

38

Cardiac drug that lengthens QRS duration in a rate-dependent manner

Use-dependent Flecanide (class 1C anti arrhythmic)

39

Why are reticulocytes blue on wright-giemsa stain?

residual ribosomal RNA

40

Histology of follicular lymphoma

B cells predominantly centrocytes

packed follicles that obscure normal LN architecture

41

Causes of folate deficiency

Poor diet (alcoholics and elderly)

Increased demand (hemolytic anemia, pregnancy, cancer)

folate antagonists (methotrexate)

42

Mutation in polycythemia vera

JAK2
cytoplasmic tyrosine kinase

43

Li-Fraumeni

mut in p53
Sarcomas
breast
brain
adrenal

44

MOA Enoxaparin

Binds ATIII

a LMWH

45

Consequences of Multiple Myeloma

CRAAB
hyperCalcemia
Renal failure
Anemia (normocytic)
AL amyloid
Bone lytic lesions
Back pain

46

Trastuzumab

inhibits tyrosine kinase
Antibody dependent cytotoxicity

treat HER2+ breast cancer

47

JAK2 mutation

Polycythemia vera
makes hematopoietic cells more sensitive to growth factors

48

Microsomal monooxygenase role

cytochrome P450 monooxygenase

found in hepatic microsomes
metabolizes steroids, alcohol and toxins making them easier to excrete

can make pro-carcinogens into carcinogens

49

HBV life cycle

DNA VIRUS!!

Incorporates into host DNA

can continue to produce HBx protein--> inactivates p53 tumor suppressor gene

50

effect of carbon tetrachloride

free radical injury

lipid peroxidation

51

tumor stage

extent of expansion

most important for PROGNOSIS

52

Tumor grade

degree of tumor differentiation

(mitotic figures, aneuploidy and cell differentiation)

53

anaplastic tumors

loss of structural differentiation and function of cells--primative cells of the same tissue

GIANT CELLS

54

Function of BRCA1 and 2

Tumor supressor gene

DNA repair of dsDNA breaks

55

Qualitative plt disorders

Uremic plt dysfunction
Bernard-soulier syndrome (GpIb)
Glanzmann thrombasthenia (GpIIb/IIIa)

56

localized loss of sensation and positive rhomberg

Medial leminscus (goes to VPL from contralateral dorsal column)

57

Treatment for supra ventricular tachyarrhythmia

Adenosine
carotid massage
Valsalva maneuver

58

Type IV Renal tubular acidosis

Caused by hypoaldo
HYPERkalemia (other types of RTA are hypokalemic)

low urine pH because hyperkalemia inhibits ammonia excretion

59

Painful vesicle on external genitalia with bilateral inguinal adenopathy

Chancroid

Haemophilus ducreyi

tx: Ceftriaxone

60

Differential for genital ulcers

Primary syphilis (painless)
Herpes (painful)
Chancroid (painful)

61

Baby with abnormal skull and facial features, growth deficiency, underdeveloped nails, and mild developmental delay

Fetal hydantoin syndrome

due to phenytoin

62

SE of Phenytoin

Nystagmus
diplopia
ataxia
gingival hyperplasia
megaloblastic anemia
Fetal hydantoin syndrome
steven-johnson
osteopenia

63

Bacitracin MOA

Inhibits peptidoglycan synthesis
prevents transfer of mucopeptides into the growing bacterial cell wall

SE:Nephrotoxicity

64

Organs effected by ADPKD

LIVER--but usually asymptomatic

Also: cerebral vessels (berry aneurysms)
mitral valve prolapse
cysts in seminal vesicles

65

what artery runs with the recurrent laryngeal nerve?

R subclavian a.

66

Matinance dose

MD=Cp x CL/F

67

Loading dose

LD= Cp x Vd/F

68

Half life

t=0.7 x Vd/ CL

69

Tx for metastatic renal cell carcinoma

Recombinant IL-2
(aldesleukin)

70

SE of protease inhibitors

Metabolic (lipodystrophy, dyslipidemia, insulin resistance)

71

Painful abdomen, Port-wine colored urine, polyneuropathy, psychological disturbances

Acute intermittent porphyria

Enzyme: porphobilinogen deaminase

build up of prophobilinogen, delta-ALA, coporphobilinogen

tx: glucose and heme (inhibits ALA synthesis)

72

TNF alpha

mediates septic shock
activates endothelium
causes WBC recruitment
vascular leak

73

what innervates the uvula

Vagus nerve! if damage the uvula deviates away from the side of the lesion

also soft palate elevation, swallowing, coughing, talking, aortic arch chemo and baroreceptors

74

Hereditary sphereocytosis treatment

splenectomy

75

Isotretinoin

Acne treatment

pregnancy category X

other preg X: Warfarin, Methotrexate, danazol (tx for endometriosis), synthetic progestins

76

Risks associated with H. pylori infection

Increased risk of duodenal ulcers, gastric carcinoma, B-cell non-Hodgkin gastric lymphoma

MALT

77

Hyperventilation, tinnitus, abdominal pain, n/v, sweating, dizziness after OD

Aspirin

tx: Bicarb

78

Function of protein C

cleavage of factor Va and VIIIa

requires vitamin K

79

Aschoff bodies

Noncaseating granuloma with multinucleate gian cells

80

Amatoxin target

RNA polymerase II

stops mRNA synthesis

81

GVH in the liver

T cells infiltrate and destroy small intrahepatic bile ducts

increased Alk phos

Looks like Primary biliary cholangitis

82

Myocardial thinning and fibrosis

Infiltrative cardiomypoathy (sacroid, amyloid), chagas, myocarditis, prior MI

83

Differential for ring enhancing lesions with mass effect in HIV pts

Toxo--most common

Primary central nervous system lymphoma (B-cell origin associated with EBV)

84

Replication of Hep B

partially dsDNA-->dsDNA-->+ssRNA-->makes viral proteins and ssDNA-->dsDNA

85

Acid fast staining takes advantage of what?

mycolic acid in the cell wall