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Last Set Flashcards

1
Q

ADPKD associated with (4)

A

Berry aneurysms
MVP
Benign hepatic
Diverticulosis

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2
Q

Anaerobes

A

Anaerobes Cant Breath Fresh Air

Clostridium
Bacteroides
Fusobacterium
Actinomyces

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3
Q

Facultative intracellular

A

Some Nasty Bugs May Live FacultativeLY

Salmonella
Neisseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia pestis
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4
Q

Urease positive

A

Pee CHUNKSS

Proteus
Cryptococcus 
H pylori
Ureaplasma
Nocardia
Klebsiella
S epidermidis
S saprophyticus
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5
Q

Catalase positive organisms

A

Cats Need PLACESS to Belch their Hairballs

Catalase

Nocrrdia
Pseudomonas
Listeria
Aspergillus
Candida
E coli
Staphylococci
Serratia
B cepacia
H pylori
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6
Q

Live attenuated vaccine

A

“Attention Teachers” Please Vaccinate Small Beautiful Young Infants with MMR Regularly

Adenovirus
Typhoid
Polio (Oral)
Varicella
Small pox
BCG
Yellow fever
Influena (intranasal)
MMR
Rotavirus
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7
Q

Killed vaccine

A

RIP Always

Rabies
Influenza (injection)
Polio (injectable)
Hepatitis A

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8
Q

Gardner
Dimorphic fungus

Pustule on puncture site

Nodules follow draining lymphatics

Tx

A

Sporothrix schenckii

Tx: Itraconazole (first line)
potassium iodine

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9
Q

Bloody diarrhea
Flask shaped ulcers
RUQ pain

  • type organism
  • transmittered
  • diagnosis
  • tx
A

Entamoeba histolytica

Liver abscesses

Fecal-oral route
- eating food or water contaminated with feces that contain cysts

Trophozoites or cysts in stool

Treatment

  • trophozoites= metronidazole or tinidazole
  • cysts= iodoquinol or paromomycin
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10
Q

Ingest helminths

A

“EAT”

Enterobius vermicularis
Ascaris lumbricoides
Trichinella spiralis

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11
Q

Penetrating helminths

A

“Sand”

Stronglyoides
Ancylostoma
Necator
D

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12
Q

Giant limbs

  • type
  • transmitted
  • tx
A

Wuchereria bancrofti

Helminth, neomatoid
Round worm in GI

Mosquitoes

Migrate to lymphatics

Elephantiasis of limbs
Hydrocele of scrotum

Tx
Diethylcarbamazine

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13
Q

Hydatid cyst lesion in liver
RUQ pain
Well circumscribed circular lesion

  • transmitted
  • can find where in body
  • symptom
  • tx
A

Echinococcus granulosus

dog feces

Egg shell calcifications

Form mature larval cysts in liver and lungs

Anaphylaxis

Surgical removal of cysts

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14
Q

Ixodes deer tick

A

Borrelia burgdorferi
Anaplasma
Babesia

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15
Q

Giemsa Stain

A 
Rickettsia
Chlamydia
Trypanosomes
Plasmodium
Borrelia
Helicobacter pylori (Histoplasma)

Ricky got Chlamydia as he Tried to Please the Bored Hot Geisha

Chinese Painted wHores Bow To Rich

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16
Q

Silver stain

A

Fungi

  • Coccidioides
  • Pneumocytstis jirovecii
  • Legionella
  • H. pylori
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17
Q

Drug binds to cell wall glycoproteins

Drug interferes with DNA replication proteins

Drug binds to ribosomal proteins

Drug binds to transpeptidases

A

Vancomycin

Fluoroquinolones, binds DNA gyrase

Macrolides, tetracyclines

Pencillin, cephalosporins

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18
Q

1st generation cephalosporins

A

Cefazolin
Cephalexin

Gram + cocci

PEcK
Proteus mirabilis
E. coli
Klebsiella

UTIs
URIs

Prophylaxis viridans strep endocarditis

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19
Q

2nd generation cephalosporins

A

Cefoxitin
Cefaclor
Cefuroxime
Cefprozil

HENS PEcK
H. influenza
Enterobacter
Neisseria
Serratia marcescens
Proteus mirabilis
Ecoli
Klebsiella

Not used for gonorrhea

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20
Q

3rd generation cephalosporins

A

Ceftriaxone
Cefotaxime
Ceftazidime
Cefdinir

Serious gram - infections

HENS PEcK
E.coli
Proteus mirabilis
Klebsiella
Enterobacter
Serratia
Citrobacter
Neisseria
H. influenza
Strep pneumoniae **
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21
Q

4th generation cephalosporin

  • use
  • coverage
A

cefepime
broad spectrum
Pseudomonas

Gram + coverage

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22
Q

5th generation cephalosporin

A

Ceftaroline
Broad spectrum

MRSA

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23
Q

Protein synthesis inhibitors

mneumonic

A

Buy AT 30, CCELL at 50

30S inhibitors

  • Aminoglycosides
  • Tetracyclines

50S

  • Chloramphenicol
  • Clindamycin
  • Erythromycin, macrolides
  • Lincomycin
  • Linezolid
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24
Q

TCA

  • MOA
  • coverage
  • avoid with
  • toxicity
A

Binds 30S
Prevents attachment of aminoacyl tRNA

VACUUM THe BedRoom
Vibrio cholerae
Acne
Chlamydia
Ureapolasma urelyticum
Mycoplasma pneumoniae
Tularemia
Helicobacter pylori
Borrelia burgdorferi
Rickettsia

Avoid with
- milk antiacids
Iron, calcium, magnesium
(inhibit absorption in gut)

Discoloration teeth
Inhibit bone growth kids
Photosensitivity
Blue skin (minocycline)

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25
Sulfa drug allergies
"Sulfa Pills Frequently Cause Terrible Allergy Symptoms" ``` Sulfasalazine Probenecid Furosemide Celecoxib Thaizide (TMP-SMX) Acetazolamide Sulfonyureas ```
26
Vaccines 1) 1st Given 2) Who gets flu shot 3) 2 months 4) 4 months 5) 6 months
1) Hep B- 1st given 2) Yearly from 6 months 2,4,6 (8) who do we appreciate STRIPPERS "Damn BaBy, ROTate that ass on the POLe" 3) Dtap, HepB, Hib, Rotavirus, Polio (IPV), PCV (pneumococcal) 4) DTaP, Hib, Polio, PCV, Rotavirus 5) DTAP, Hib, PCV, RV
27
CCR-5 antagonist
Maraviroc CCR-5 on macrophages and CD4 T cells Inhibits gp120 conformational change Only in patients with all R5 virus
28
HIV drug causes 1. Bone marrow suppression 2. Pancreatitis 3. Hepatic steatosis 4. Hypersensitivity rxn 5. Rash 6. Nightmares, vivid dreams, depression 7. False-positive to drug test for cannabinoids 8. Teratogenic 9. Nephrolithiasis 10. Increases bilirubin 11. peripheral neuropathy
1. Zidovudine (NRTI) 2. Didanosine (NRTI) Ritonavir (PI) 3. Didanosine (NRTI) 4. Abacovir (NRTI) 5. NNRTIs 6. Efavirenz (NNRTI) 7. Efavirenz (NNRTI) 8. Efavirenz (NNRTI) 9. Indinavir, Atazanavir (protease inhibitor) 10. Atazanavir (protease inhibitor) 11. Didanosine
29
Antifungal that 1. Disrupts membrane 2. Disrupts microtubules 3. Blocks precursors to pyrimidines 4. Blocks Squalene to lanosterol 5. Blocks lanosterol to ergosterol
1. Nystatin, Amphotericin B 2. Griseofulvin 3. Flucytosine 4. Terbinafine 5. -azoles
30
Terbinafine - use - side effects
Inhibits enzyme squalene epoxidase uses superficial fungal infections Hepatotoxicity GI symptoms Headache TASTE disturbance
31
Haemophilus influenzae can be grown tx
Chocoalte agar w/ factor V and X or w/ S. aureus which provides factor V (NAD) through hemolysis of RBCs Tx: Amoxicillin +/- clavulanate (mucosal infxn) Ceftriaxone (meningitis) Rifampin prophylaxis
32
S or comma shaped
Campylobacter jejuni - bloody diarrhea Vibrio cholerae - water diarrhea
33
``` Constipation Red spots of abdomen Abdominal pain Fever Followed by diarrhea ``` Tx
Salmonella typhi Ceftriaxone Fluroquinolone
34
Myalgia of calves Jaundice Photophobia Flu like Tx
Leptospira interrogans Water contaminated with animal urine Pencillin Ceftriaxone Doxycycline
35
Tongue ulcers | Splenomegaly
Histoplasmosis
36
Severe diarrhea in AIDS
Cryptosporidium Oocytes in water Oocytes on acid fast Nitazoxaninde in IC hosts
37
What viruses uses this receptor 1) Integrins 2) CD21 3) CD4, CXCR4, CCR5 4) P antigen on RBCs 5) Nicotinic AChR 6) ICAM-1
1) Integrins= CMV 2) CD21= EBV 3) CD4, CXCR4, CCR5= HIV 4) P antigen on RBCs= ParvoB19 5) Nicotinic AChR= Rabies 6) ICAM-1= Rhinovirus
38
Rotavirus - causes - type of virus - MOA
infantile gastroenteritis Segmented ds RNA virus (reovirus) Diarrhea - day care center Villous destruction with atrophy leads to decreased absorption of Na and loss K
39
Paramyxovirus Prophylaxis
Palivizumab paramyxovirus causes RSV, croup, mumps, measles
40
Strawberry cervix
Trichomoniasis Trichomonas vaginalis
41
Daptomycin - MOA - uses - adverse effects
Lipopeptide that disrupts the cell membrane of gram + cocci by creating transmembrane channels S aureus skin infections (MRSA), bacteremia, endocarditis, VRE Adverse - myopathy - rhabdomyolysis
42
S. aureus tissue destruction with MRSA uses what toxin ____ affects what two cell types
Panton-Valentine Leukocidin Neutrophils Macrophages
43
Gram positive rods
Clostridum (anaerobes) Corynebacterium Listeria Bacillus
44
Gram negative oxidase positive diplococci 1) sputum from COPD 2) Urethral discharge 3) CSF
1) sputum from COPD= Moraxella catarrhalis 2) Urethral discharge= N. gonorrhoeae 3) CSF= N. meningitis
45
Gram negative cocci Gram negative coccobacill
Cocci - N. meningitidis - N. gonorrhea - Moraxella catarrhalis Coccobacilli - H. influenza - Bordatella pertussis - Pasteurella - Brucella
46
Gram negative Lactose fermenting rods Gram negative non lactose fermenting rods
Lactose (Fast) - Klebsiella - E.coli - Enterobacter Lactose (slow) - Citrobacter - Settaria Non lactose fermenter - Shigella - Salmonella - Proteus - Yersinia - Pseudomonas (oxidase +)
47
Painful enlarged swollen LN in groin | Came into contact with animal
Yersinia pestis Safety pin on staining Prarie dog New mexico
48
[Linezolid, Tetracycline, Aminoglycoside, Macrolides, Chloramphenicol, clindamycin] 1) Ototoxicity 2) Pseudomembranous colitis 3) Prolonged QT 4) Gray baby syndrome 5) PHotosensitivity 6) MRSA/ VRE coverage 7) Anaerobic coverage 8) Discolored teeth 9) Atypical pneumonia coverage
1) Aminoglycosides 2) Clindamycin 3) Macrolide 4) Chloramphenicol 5) Tetracycline 6) Linezolid 7) Clindamycin 8) Tetracycline 9) Macrolide
49
MOA of each drug 1) Sulfamethoxazole 2) Trimethoprim 3) Levofloxacin 4) Nitrofurantoin 5) Metronidazole 6) Polymyxin B
1) Sulfamethoxazole - Inhibit dihydropteroate synthetase 2) Trimethoprim - inhibit dihydrofolate reductase 3) Levofloxacin - Inhibit DNA gyrase (topoisomerase II) 4) Nitrofurantoin - Inhibit bacterial ribosomes 5) Metronidazole - Forms toxic free radicals that damages DNA 6) Polymyxin B - Acts like cationic detergent
50
1) Vomiting and watery diarrhea on cruise | 2) Watery diarrhea 12 hrs after eating meat or poultry from cafeteria
1) Norovirus | 2) Clostridium perfringens
51
Which RNA virus 1) Hand, foot, and mouth 2) Break bone fever 3) Common COld 4) Fever, jaundice, black vomit 5) Meningitis in summer months 6) Tourniquet test helps diagnose hemorrhagic disease 7) Infects motor neurons of anterior horn
1) Hand, foot, and mouth= coxsackievirus 2) Break bone fever= dengue 3) Common COld= rhinovirus, coronavirus 4) Fever, jaundice, black vomit= yellow fever 5) Meningitis in summer months= Echovirus, coxsackievirus, other enteroviruses 6) Tourniquet test helps diagnose hemorrhagic disease= dengue 7) Infects motor neurons of anterior horn= poliovirus, west nile virus
52
Which antiviral 1) Prophylaxis for influenza A 2) used to tx for chronic hep C 3) First line for herpes simplex virus or VZV
1) Prophylaxis for influenza A= zonamivir, oseltamivir 2) used to tx for chronic hep C= ribavirin + IFN-alpha 3) First line for herpes simplex virus or VZV = acyclovir, valacyclovir, famiciclovir
53
Bilateral interstitial infiltrates Silver stain Tx
Pneumocystis jirovecii circular ring with clear center TMP-SMX
54
Flu vaccine against what part
Humoral response to hemaglutinin
55
Organisms that cause granulomatous disease - Bacteria - Fungal - Parasitic
Bacteria - Mycobacteria (tuberculosis, leprosy) - Bartonella henselae (cat scratch) - Listeria monocytogenes - Treponema pallidum (tertiary syphilis) Fungal - Histoplasmosis Parasitic - Schistosomiasis
56
Zoonotic bacteria 1) Cat scratch 2) Rodents to Tick 3) Cattle fluids 4) Birds and pigs 5) Birds 6) Infected placenta or contaminated fluid of newborn farm animals 7) Lone star tick 8) Rabbit or squirrel 9) Infected animal urine 10) Nine-banded armadillo 11) dog bit 12) Lice 13) Fleas 14) Tick, rash on palms 15) Fleas, prairie dogs
1) Cat scratch= Bartonella henselae 2) Rodent to tick= Borrelia burgdorferi 3) Cattle fluids= Brucellosis 4) Birds and pigs= Campylobacter 5) Birds= Chlamydophila psittaci 6) Infected placenta or contaminated fluid of newborn farm animal= Coxiella burneii 7) Lone star tick= Ehrlichia chaffeensis 8) Rabbit or squirrel= Francisella tularensis 9) Infected animal urine= Leptospira 10) Nine-banded armadillo= Mycobacterium leprae 11) Dog bite= Pasteurella multocida 12) Lice= Rickettsia prowazekii 13) Fleas= Rickettsia typhi 14) Tick, rash on palm= Rickettsia rickettsii (rocky mountain spotted fever) 15) Fleas, prairie dogs= Yersinia pestis
57
Obligate anaerobes (3) Tx
Clostridium species Actinomyces (Gram +) Bacteroides (Gram -) Tx metronidazole Clindamycin
58
Headache Fever Rash on wrist and ankles moves to palms soles and trunk
Ricketta ricksttsii Rocky mountain spotted fever
59
Pseudoappendicitis
Yersinia enterocolitica Heat stable toxin Increase cGMP
60
Common infectious organism of tonsils and adenoids Common infectious organism of salivary gland
S. pyogenes S. aureus, viridans group streptococci
61
Bacteria vaccine - toxin - capsular polysaccharides - killed bacteria - live attenuated bacteria
Toxin - Tetanus toxoid Capsular polysaccharides - S. pneumoniae - H. influenzae Killed bacteria - Vibrio cholerae Live attenuated bacteria - Typhoid vaccine - BCG vaccine
62
Lactose non-fermenters Urease producing -Creates what
Proteus spp ``` Alkaline urine Struvite stones (Staghorn calculi) ```
63
What is the unique features of gram negative bacteria cell wall
Outer membrane - endotoxin (LPS) - induce IL-1, TNF alpha ``` Periplasmic space (between membranes) - beta lactamase ```
64
Spore forming bacteria
Bacillus anthracis Bacillus cereus Clostridum spp (perfringens, tetani, botulinum, difficle) Coxiella burnetti
65
``` Weight loss Lymphadenopathy Hyperpigmentation Cardiac symptoms Arthralgias Neurlogic symptoms PAS+ Foamy macrophages in lamina propria ```
``` Whippe disease Tropheryma whipplei (Gram +) ``` Penicillin Ampicillin Tetracycline
66
Nef | tat
HIV regulatory genes Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells tat: is a transcriptional activator that promotes viral gene expression
67
5 y.o difficulty breathing dysphagia drooling fever Swollen and cherry red epiglottis sign
H. influenzae type B thumb sign
68
``` Headache Fever Malaise Cough Nodular infiltrates Clumping once room temp ```
Mycoplasma pneumoniae Walking pneumoniae Cross reactive IgM Activate complement --> erythrocyte lysis Cold agglutinins
69
1) Parasite eggs in stool 2) Perianal egg deposition 3) Proglottids in the stool 4) Rhabdoitiform larvae in the stool 5) Trophozoites and cysts in the stool
1) Schistosoma mansoni or S. japonicum 2) Enterobius vermicularis (pinworms) 3) Intestinal tape worms (Taenia solium, T saginata, Diphyllobothrium latum) 4) Strongyloides stercoralis 5) Protozoal infections (Giardia lamblia, entamoeba histolyticsa)
70
Four obligate aerobic bacteria
Nagging Pest Must Breathe Nocardia Pseudomonas aeruginosa Mycobacterium tuberculosis Bacillus
71
``` Fever Headache Nuchal rigidity Normal glucose elevated protein ```
Aseptic meningitis Enteroviruses - coxsackievirus - echovirus - poliovirus
72
Pig farmer
Loeffler syndrome Ascaris infection Eosinophilic invasion due to parasitic infection
73
Goes with? Lecithinase M protein Protein A Trehalose dimycolate Polyribosylribitol phosphate (PRP)
Lecithinase: toxin A, clostridium perfringens - results in cell lysis and gas gangrene M protein: strep. pyogenes -Binds factor H to prevent opsonization and destruction by alternative complement pathway Protein A: staph aureus - prevent opsonization by binding Fc region of immunoglobulins Trehalose dimycolate: cellw all component , mycobacterium tuberculosis - protects from being killed by macrophages and stimulates granuloma formation Polyribosylribitol phosphate: Haemophilus influenzae type b - capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells
74
1) Budding yeast with thick capsule 2) Macropahges with intracellular small yeast 3) Round spherules iwth multiple endospores 4) Septate hyphae with dichotomous branching 5) Yeasts with pseudohyphae and blastoconidia
1) Cryptococcus neoformans - bird droppings - immunocompromised - meningoencephalitis 2) Histoplasma capsulatum - Missouri caves - fever nonproductive cough 3) Coccidioides immitis - pulmonary disease 4) Aspergilus fumigatus - V shaped branching - AIDS
75
Multiple ulcers Mucosal erosions Large cells iwth basophili cintranuclear and intracytoplasmic inclusions`
CMV | herpesvirus
76
Rash followed by desquamation of hands and feet (sloughing of skin) Snuffles (blood tinged nasal secretions) Skeletal abnromalities Hepatomegaly
Early manifestations Congenital syphilis (during first 2 years)
77
Identify 1) Multiple painful ulcers 2) Painful single ulcer 3) Painless ulcer, raised indurated edges 4) School of fish 5) Granulomatous lesions on skin ( large areas of dying flesh)
1) Herpes simplex 2) Haemophilus ducreyi 3) Syphilis 4) Haemophilus ducreyi 5) Tertiary syphilis - Gummatous syphilis
78
Severe fetal anemia Ascites Pleural effusions
Hydrops fetalis Parvovirus B19
79
Clostridium perfringens toxins
Alpha toxin (phospholipase) - Gas gangrene - Myonecrosis Enterotoxin - Food poisoning - Food left out too long once cooked
80
Bacteria w/ capsule pneumonic
Even Some Pretty Nasty Killers have Shiny Bodies ``` E coli Strep pneumonia Pseudomonas Neisseria meningitidis Klebsiella Haemophilius influenza type B Salmonella Group B strep ``` Cryptococcus neoformans - encapsulated yeast
81
Bilateral facial nerve palsy Tx
Borrelia burgdorferi Ixodes tick Tx Doxycycline (early stage) Amoxicilin (children <8) Doxycycline or Ceftriaxone (late)
82
Rash involving palms and soles | Maculopapular
Kawasaki disease Coxsackie A virus Rocky mountain spotted fever Syphillis Meningococcemia You drive Kawaski CARS with your hands and feet
83
What three bacteria are obligate intracellular bacteria
Rickettsia Coxiella Chlamydia
84
Replicative process 1) DS dna --> DS dna template --> ds DNA progeny 2) DS dna -> +RNA template -> partially ds-DNA 3) ssDNA --> ds DNA template --> ss DNA progeny 4) ss +RNA --> ds DNA template --> ss +RNA progeny 5) ss +RNA --> - RNA template --> ss + RNA progeny 6) ss -RNA --> +RNA template --> ss -RNA progeny
1) Adenovius, herpesvirus, poxvirus 2) Hepatitis virus 3) Parvovirus B19 4) Retroviruses (HIV) 5) poliovirus 6) Influenza virua, measles virus, rabies virus
85
Facial infection of jaw/mandible | Sinus tracts draining pus
Actinomyces israelii
86
Shiga toxin
Cleaves host rRNA at adenine base in 60S ribosomal subunit Inhibition of protein synthesis Shigella
87
Repetitive unilateral shooting/ shock like pain in face. Triggered by chewing, talking touching certain parts of face. Lasts seconds to minutes. Increase in intensity and frequency over time Tx
Trigeminal neuralgia Carbamazepine - Blocks Na channels
88
Appendectomy, Anesthesia by mask to quickly anesthetize would have what characteristic ``` A. High blood solubility B. High cerebrospinal fluid solubility C. High lipid solubility D. Low blood solubility E. Low lipid solubility ```
D. Low Blood solubility CNS drugs must be lipid soluble (cross the bbb) Drugs with low solubility in blood= rapidly induction and recovery time Increase solubility in lipids= increased potency
89
A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex c) Decreased concentration of the GpIb/IX complex D) Decreased concentration of the GpIIb/IIIa complex F) Deficient binding of von Willebrand factor to the GpIb/IX complex
A) ITP C) Bernard-Soulier D) Glanzman thromboasthenia F) Von Willebrand def
90
Blistering lesions in sun exposed areas. Recurrent hx of these lesions. Increased Total porphyrin Increase Urine uroporphyrin III Precursor to uroporphyrin?
Dx: Porphyria Precursor= Succinyl-CoA Defective uroporphyrinogen decarboxylase= porphyria cutanea tardia. Succinyl-CoA combines with glycine to form ALA start of heme synthesis
91
``` Enlarged tongue Progressive weakness Hypotonia Cardiomegaly Increased glycogen ``` Impairment of what enzyme? ``` A. Branching enzyme B. Glucose-6-phosphatase C. alpha-1,4-glucosidase D. Glycogen synthase E. Phosphoglucomutase ```
C. Alpha-1,4- glucosidase Pompe disease
92
Heart transplant One year later, increase BP and creatinine. Which immunosuppressive drug would cause this? ``` A) Azathioprine B) Corticosteroid C) Cyclophosphamide D) Cyclosporine E) Muromonab CD3 ```
D) Cyclosporine - Nephrotoxicity - HTN - Gingival hyperplasia - Hirsutism Azathioprine - Pancytopenia Cyclophosphamade - Hemorrhagic ycstitis - SIADH
93
Bulimia values K HCO3 Anion Gap pH
Increase pH Increase HCO3 Decrease K Normal Anion gap
94
Blood dots on tongue and lips Progressive SOB Nosebleeds CLubbing nails Disease? What is causing SOB
Hereditary hemorrhagic telangiectasia (osler-weber-rondu) ``` Arteriovenous malformations (AVMS) - atrial septal defect ```
95
Hematocrit
Volume of RBC compared to total volume
96
Major manifestations Familial chylomicronemia assoc with Familial hypercholesterolemia assoc with Familial dysbetalipoproteinemia assoc with Familial hypertriglyceridemia
``` Familial chylomicronemia - Acute pancreatitis - Hepatomegaly - Eruptive skin xanthomas (Tendon xanthomas) ``` Familial hypercholesterolemia - Premature MI - Tendon xanthomas - Corneal arcus Familial dysbetalipoproteinemia - Premature MI - Palmar xanthomas Familial hypertriglyceridemia - Pancreatitis risk - Obesity - Insulin resistance
97
Nest of polygonal cells with congo red positive deposits
Medullary thyroid cancer Polygonal shaped cells with extramedullary amyloid deposits Polygonal or spindle shaped cells with extrameduallary amyloid deposits
98
Branching structures with interspersed calcified bodies
Papillary thyroid cancer | Psammoma bodies
99
Pleomorphic giant cell nests with occasional multinucleated cells
Anaplastic thyroid cancer, aggressive Often irregular giant cells and biphasic spindle cells
100
Fabry disease most at risk for developing
Renal failure ``` Neuropathic pain Angiokeratomas Telangiectasias glomerular disease (proteinuria) Cerebrovascular disease (stroke) Cardiac disease (left ventricular hypertrophy) ```
101
13 yo girl. Blood pressure 152/91. Lack of secondary sexual characteristics and pelvic examination shows a blind vagina. Lab studies show hypokalemia and low testosterone and estradiol levels. Cytogenetic analysis shows 46, XY karyotype. What is deficient ``` A. 21-hydroxylase B. 17a- hydroxylase C. 11b-hydroxylase D. Side chain cleavage enzyme E. 5a-reductase ```
B. 17a- hydroxylase
102
Spliceosomes remove introns at
GU at 5' splice site AG at 3' splice site
103
Progressive back pain Intermittent fever Vertebral boen destruction with fluid collection
Mycobacterium tuberculosis spondylitis (potts disease)
104
Pruritic skin rash Pink papules symmetrically over anterior surface of shins and ankles Hyperkeratosis with a thickened granular layer Rete ridges with sawtooth appearance Scattered colloid bodies
Lichen Planus
105
Acute dystonic reaction - is what - due to
Spasmodic torticollis Antipsychotic medication D2 antagonism of nigrostriatal pathway
106
Name 1) Bile soluble 2) Bacitracin sensitive 3) Complete hemolysis 4) Optochin sensitive 5) Growth in hypertonic saline 6) Optochin resistance 7) Bile insoluble
1) Bile soluble= S. pneu 2) Bacitracin sensitive= Streptococcus pyogenes 3) Complete hemolysis= Group A Strep (s. pyogenes) Group B Strep ( S. agalactiae) 4) Optochin sensitive= S. pneu 5) Growth in hypertonic saline= gamma- hemolytic ( No hemolysis ) Enterococci S. bovis 6) Optochin resistance= Viridans group streptococci 7) Bile insoluble= VIridans group streptococci
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More chloride in RBC Enzyme responsible
Excess HCO3 transferred out of RBC in exchange for Cl Carbonic anhydrase
108
Thickening of pleural membranes around whole lung Disease Due to Histology
Mesothelioma - Asbestos exposure Spindle cell positive for cytokeratin
109
Central areas of whorled collagen fibers in lungs
SIlicosis - inhaled silica Nodules of whorled collagen fibers and dust-laden macrophages
110
Riboflavin deficiency ``` WHat enzyme impaired? A. Fumarase B. G6PD C. HMG-COA reductase D. Isocitrate dehydrogenase E. Malate dehydrogenase F. Succinate dehydrogenase G. Succinate thiokinase ```
F. Succinate dehydrogenase
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Cytotoxic exotoxin organisms
Clostridium botulinum Clostridium tetani Corynebacterium diphtheriae Promote host cell death
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``` Dysphagia Dry mouth Blurred vision Mydriasis Poorly reactive pupils ``` Suggests
Clostridium botulinum toxin - neurotoxin Inhibit ACh release Canned foods
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Nephrotic syndromes - proteinuria - albumin - feature Does not have Examples
Heavy proteinuria Low albumin Edema No hematuria or red blood cell casts Diabetic nephropathy Membranous nephropathy Minimal change disease
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Nephritic syndrome - proteinuria - albumin - features
<3.5 proteinuria Hematuria Red blood cell casts Azotemia HTN PSGN Membranoproliferative Lupus nephritis IgA nephropathy
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Nephritic syndrome associated iwth normal complement levels
IgA neprhopathy
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Oliguria High serum creatinine level Intranasal ulcer that wont heal Ab against? ``` A. Glomerular basement membrane B. Smooth m. cells C. Neutrophils D. Erythrocytes E. Platelets F. Mitochondria ```
C. Neutrophils Granulomatosis with polyangiitis (wegners) Nasal mucosal ulcerations and glomerulonephritis + c-ANCA ( cytoplasmic staining anti-neutrophil cytoplasmic antibodies)
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Excessive bleeding in patient with renal dysfunction due to
Accumulation of uremic toxins Impair platelet aggregation and adhesion Prolonged bleeding Normal platelet count Normal PT and PTT
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Sore throat and fever Mild tonsillar erythema and exudates Clumped gram positive bacteria with polar granules that stain deeply with analine dyes Pathogenesis?
Diphtheria AB Exotoxin - B binds heparin-binding epidermal growth factor - A inhibits host cell protein synthesis by catalyzing the ADP-ribosylation of protein elongation factor EF-2 Impairment of protein synthesis
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Jejunum removal requires what supplementation after
Decrease in gastric acidity as diminishes iron absorption Iron absorption duodenum and proximal jejunum
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Ascorbic acid absorbed where Pyridoxine absorbed where Biotin absorbed where Panthothenic acid absorbed where
Vit C: distal small bowel Pyridoxine (B6) jejunum and ileum Biotin (B7) small and large intestine Panthothenic aicd (B5) small and large intestine
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Large cells iwth intranuclear eosinophilic inclusions, intracytoplasmic basophilic inclusions - Presentation - Tx
CMV Fever, fatigue, abdominal pain, diarrhea Ganciclovir - interferes with viral replication by competitvely inhibiting the incorporation of guanosine triphosphate into CMV stands by CMV DNA polymerase
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Right gaze - right eye: right - left eye: forward Neutral normal Left gaze - both look left Convergence: normal
Left internuclear ophthalmoplegia Damage to medial longitudinal fasciculus Lesion at left dorsal pons
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``` Fever Body aches Generalized weakness Rash on legs Abdominal pain and weight loss Decreased sensation in leftfoot Edema Biopsy: necrotizing vasculitis without IgA deposition c-ANCA and p-ANCA negative Image: red dots all over legs ``` What is most likely associated with the vasculitis? ``` A. Hepatitis B seropositivity B. History of heavy smoking C. Jaw claudication D. Recent upper respiratory infection E. Weak pulses in upper extremities ```
A. Hepatitis B seropositivity Patient has polyarteritis nodosa (PAN) ``` Vasculitis of medium vessels Spares lungs Palpable purpura Assoc w/ Hep B Necrotizing inflammatory lesions HTN Asymmetric polyneuropathy Skin lesions GI ```
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+ p-ANCA Lungs Kidneys Nasophagyngeal
Microscopic polyangitis
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5 y.o low grade fever and rash Bright red erythemaous rash on face prominent on cheeks Blanching reticulated rash on arms and trunk. Up to date on vaccinations. Facial rash erupted 3 days ago and body rash this morning. Reticulocytopenia ``` A. Coxsackievirus A B. Human herpesvirus 6 C. Measles D. Parvovirus B19 E. Streptococcus pyogenes ```
D. Parvovirus B19 Fifth's disease Erythema infectiosum Slapped cheek - respiratory droplets - bone marrow suppression
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Sand paper rash
Strep pyogenes Scarlet fever Delayed type skin reactivity to pyrogenic exotoxins
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Bone tumor 1) Anaplastic stromal cells make a tumor osteoid bone matrix 2) Epitheloid clusters with vesicular nuclei and abundant vacuolated soap bubble like cytoplasm 3) Sheets of oval/spindle cell with interspersed large multinuclearted ostoclast like giant cells 4) Small round cells some of which are binucleated with abundant cartilage like matrix
1) Osteosarcoma 2) Chordomas 3) Giant cell tumor 4) Chondrosarcoma
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Cardiogenic shock ``` A. High cardiac output B. Hyperkalemic hyponatremic metabolic acidosis C. Inadequate ventricular function D. Low cardiac filling pressures E. Low pulmonary wedge pressure ```
C. Inadequate ventricular function Shock - Low blood pressure - Hypoperfusion - Adequate blood volume Inability of heart to generate flow thorughout the body due to myocardial infarction Unable to maintain oxygenation of its tissues A. High cardiac output - Septic shock early presentation B. Hyperkalemic hyponatremic metabolic acidosis - adrenal shock secondary to addisonian crisis D. Low cardiac filling pressure - opposite in shock, have high cardiac filling pressures due to failure of cardiac output to match venous return E. Wedge pressure= left atrial pressure is elevated in shock
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Describes what 1) 2 micron spherical micro-organism in the brush border 2) 4-6 micron single cell organisms in the lumen near teh absorptive surface 3) Macrophages in the lamina propria bearing PAS positive bacteria 4) Superficial penertrating ulcers with a mixed inflammatory infiltrate perhaps containing non-caseating granulomas
1) Cryptosporidia - malabsorption in immunocompromised 2) Giardiasis - prevent absorption of nutrients - nausea - purple burps - belching sulfurous taste Ghost face on stain (ghost balloon) 3) whipple disease 4) crohns disease
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CTG trinucleotide in a serine-threonine kinase - caused by Instability during both maternal and paternal meiosis Instability during paternal meiosis
Myotonic dystrophy type I (DM1) -Instability during maternal meiosis Friedreich ataxia - AR - GAA repeat - Limb and gait ataxia - Cardiomyopathy - DM Huntington disease CAG repeat
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Uncontrollable facial and chest flushing Diarrhea Wheezing Elevated 5-HIAA Tx Can led to Additonal finding
Carcinoid syndrome - secretion of serotonin Octreotide Niacin deficiency Tricuspid regurgitation
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H2S enterobacteriaceae
Salmonella
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1) Microcytic hypochromic RBC with coarse basophilic stippling 2) Microcytic hypochromic RBC with elongation
1) Beta-thalassemia | 2) Iron deficiency anemia
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Hypertensive crisis
``` Severe HTN End organ symptoms Tachycardia Cardia arrthymias Stroke ``` Too much monoamine oxidase inhibitors or taken with drugs that potentiate catecholamine activity or tyramine (wine cheese)
135
Neuroleptic malignant syndrome
Adverse drug rxn to antipsychotic Increased dopamine blockade throughout body Autonomic instability Muscle rigidity high fever Decreased reflexes ``` "FEVER" Fever Encephalopathy Vital signs unstable Elevated creatine phosphokinase Rigidity of muscle ```
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What would increase MVP murmur
Valsalva maneuver Decrease volume of left ventricle, causes the prolapse to occur sooner
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Increase preload maneuver
Squatting Isometric handgrip Aortic regurg louder
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Inspiration on heart murmur
increase right heart sounds
139
Hand grip
Increase afterload Increase intensity MR, AR, VSD Decrease hypertrophic cardiomyopathy and AS murmurs
140
Valsalva
Decrease preload Decrease intensity of most murmurs Increase hypertrophic cardiomyopathy MVP earlier onset
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Rapid squatting
Increase venous return Increase preload Incerase afterload Decrease intensity of hypertrophy cardiomyopathy Increase MR, AR, and VSD murmur MVP later onset
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VHL syndrome - inheritence - 3 features
AD Multiple tumors including hemangioblastomas, RCC, pheochromocytomas
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Enlarged bilateral cystic ovaries in obese infertile female due to lab values associated with
Polycystic ovarian syndrome Increased LH production and slightly decreased FSH Abnormal fxn of HPO axis Deranged steroid synthesis by theca cells ``` Increased LH Decreased FSH Increased testosterone Increased androgens Increased estrogen ``` Insulin resistance type 2 DM
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Slowest and highest amplitude waves on EEG
Delta brain waves non-REM stage 3
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Used to tx? STI 1) 5-flurouracil 2) Acyclovir 3) Metronidazole 4) Penicillin
1) HPV 2) HSV 3) Gardnerella vaginalis 4) Syphilis (trepponema pallidum)
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``` Turkish Mediterranean descent Mouth and genital ulcers No sexual history Uveitis Erythema nodosum ``` What is it Associated with
Behcet syndrome Immune complex vasculitis Associated iwth HLA-B51
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Alcoholic with swelling in extremities. Shifting dullness to percussion. Periumbilical vessels. Tender nodules at 5th intercostal space. Mechanism of edema? A. Decreased plasma colloid oncotic pressure B. Increased capillary hydrostatic pressure C. Increased interstitial colloid oncotic pressure D. Increased interstitial glycosaminoglycans accumulation E. Increased permeability of the capillary walls
A. Decreased plasma colloid oncotic pressure Cirrhosis of liver Decreased production of albumin
148
``` Alcoholic in ER Weakness, dizzinuess Numbness in both lower extremities Malnourished Homeless Bilateral rotatry nystagmus Angular cheilitis ``` Microcytic hypochromic red cells with coarse basophilic granules
Vitamin B6 deficiency Sideroblastic anemia Numbness of extremities Glossitis Cheilosis
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Organism? 1) Cleaving SNARE protein required for neurotransmitter release 2) Inactivation of the 60S ribosome by cleaving rRNA 3) Inactivation of mitogen-activated protein kinase kinases
1) Clostridium tetani 2) Shigella species - dysentery due to shiga toxin - shiga toxin works by inactivating 60S ribosome through cleaving rRNA 3) Bacillus anthracis - black eschar - Protective factor and lethal factor combine on surface they form lethal toxin - Lethal toxin is a Zn-dependent endoprotease that clips off the N-terminus of mitogen-activated protein kinase kinases (MAPKK)
150
Diarrhea 1) Motile trophozoites on microscopy 2) Genome identified by reverse transcriptase PCR 3) growth at 42 C (107.6 F) 4) Growth on thiosulphase citrate bile salt sucrose agar 5) Lactose fermentation on MacConkey agar
1) Giardia lamblia 2) Norovirus 3) Campylobacter jejuni 4) Vibrio cholerae 5) E. Coli
151
Patient with MS and spasticity tx
Baclofen (Agonist at the GABA-B receptor) Tizanidine (alpha 2 agonist)
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Tumor penetration of basement membrane uses which substances
Collagenases and hydrolases (Metalloproteinase)
153
Myelofibrosis - type of malignancy - clonal expansion of - secretion of
Hematopoietic stem cell malignancy Megakaryocytes TGF-beta secretion - stimualtes fibroblasts to fill medullary space with collagen.
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Solid left adnexal mass Ovarian mass is yellow and firm Small cuboidal cells in sheet with glandular structures containing acidophilic material Cells are arranged in microfollicular pattern around a pink eosinophilic center
Granulosa cell tumor - secreting estrogen Call-Exner bodies
155
Duchenne muscular dystrophy mRNA change
Nonsense mutation UCA --> [ UAA, UAG, UGA]
156
Rituximab Infliximab Imatinib Abciximab
Rituximab= Monoclonal Ab for CD20 Infliximab= TNF-alpha monoclonal Ab BCR/ ABL (CML) Monoclonal Ab againts platelet GP IIb/IIIa receptor
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Neurologic regression Hepatosplenomegaly Diminished reflexes Cherry red spot
Niemann Pick | - Spingomyelin
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Total gastrectomy need to supplement
A water soluble vitamin B12
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Lysing of blood cells when incubated in hypotonic saline with glycerol
Hereditary spherocytosis (HS)
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Progressive weakness and fatigue over last year. Loss of expression of mutation that codes for a protein found on basolateral surface of hepatocytes and enterocytes. Protein is known to interact with transferrin receptor Greatest risk of developing?
Primary hemochromatosis - mutation of HFE protein Detects falsely low iron levels Get iron accumulation Enterocytes: increase apical expression of DMT1, increasing iron absorption Hepatocytes: decreasing hepcidin synthsis, increased feroportin expression --> increased iron secretion Iron excess --> bronze diabetes At risk for hepatocellular carcinoma
161
Type 2 DM Confusion lethargy Hypoglycemia Elevated C-protein What drug was used
Medication that stimulates pancreatic insulin secretion independent of blood glucose levels Sulfonylureas (glyburide) - glyburide - glimepiride - glipizide
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Painless Testicular tumor Elevated lactate dehydrogenase Elevated alpha fetoprotein
Nonseminomatous germ cell tumor - embryonal carcinoma - yolk sac tumor - choriocarcinoma hCG AFP
163
Flutamide MOA Leuprolide MOA Anastrozole MOA Finasteride MOA
Flutamide: Impaired androgen receptor interaction Competitive testosterone receptor inhibitor Leuprolide: Long acting GnRH agonist - decrease testicular leydig cell stimualtion Anastrozole: Aromatase inhibitors -Decrease peripheral conversion of androgens to estrogen Finasteride: Decreases peripheral conversion of testosterone to DHT by binding 5alpha reductase
164
Shigella infects via what cell
microfold (M) cells at base of mucosal villi within a Peyers patch
165
Intranuclear inclusions in oligodendrocytes
Progressive multifocal leukocencephalopathy due to JC virus
166
Bone pain Hearing impairment Multinucleated cells with over 100 nuclei -Factor essential for differentiation of cells
Paget's disease of bone | RANK-L Receptor activator of nuclear factor kappa-B ligand
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Mitral regurgitation - Afterload - Preload - Ejection fraction
Afterload: decrease (regurg so low resistance) Preload: increase (LV end-diastolic volume) EF: Increase (decreased afterload --> increase EF)
168
Polyp formation mutation steps
1) Normal mucosa --> small adenomatous polyp (adenoma) = APC mutation 2) Increase size of adenoma = KRAS mutation 3) Malignant transformation, adenoma to carcinoma = TP53 mutation
169
5 y.o, bites on inbetween toes. Stool shows smooth thin walled eggs. Infection? Complication
Hookworm - Necator americanus - Ancylostoma duodenale Egg-containing human feces in soil - skin direct contact with soil Larvae to lungs, rupture, coughed up and swallowed. In small intestine, mature into adults and attach to GI mucosa and feed on uman blood by lacerating capillaries Iron- deficiency anemia Microcytic anemia
170
Fever HA confusion Allergic to penicillin Antibiotic started Low Erythrocytes Low Platelets Low Leukocytes which antibiotic? ``` A. Chloramphenicol B. Clindamycin C. Gentamicin D. Metronidazole E. Vancomycin ```
A. Chloramphenicol Aplastic anemia - Carbamazepine - Chloramphenicol - Sulfonamides
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Brain natriuretic effect on kidney
Increases sodium excretion Increase GFR
172
Unilateral painless testicular enlargement. Bilateral gynecomastia. Elevated serum beta human chorionic gonadotropin level. ``` A. Choriocarcinoma B. Diffuse large B cell lymphoma C. Leydig cell tumor D. Sertoli cell tumor E. Yolk sac tumor ```
A. Choriocarcinoma hCG has an analogue similar to LH --> precocious puberty, gynecomastia, impotence or loss of libido Leydig - increased testosterone - Virulization and gynecomastia Sertoli - androgens or estrogens - not enough to cause endocrinologic changes Yolk Sac tumor - infants and children - painless bulky testicular mass - Alpha-fetoprotein
173
Leydig cell tumor - secretion - causes - description - feature associated with - Marker - histology Sertoli cell tumor - secretion - causes - description - histology - feature associated with - marker Yolk Sac tumor - affects who - description - pattern - histology - feature associated with and description of - marker
Leydig - increased testosterone - Virulization and gynecomastia - yellow tan color - solid lobulated - Reinke crystals - Inhibin A - round nuclei, single prominent nucleoli and abundant eosinophilic cytoplasm or clear cytoplasm Sertoli - androgens or estrogens - not enough to cause endocrinologic changes - well circumscribed, pale yellow to whitish gray - tall polyhedral cells arranged in nests, sheets and cords resembling spermatic tubules - perinuclear aggregates of intermediate filaments - Inhibin A marker ``` Yolk Sac tumor - infants and children - painless bulky testicular mass -honey comb pattern - reticular network is formed by vacuolated cytoplasm of tumor cells -Schiller-Duvall bodies (Central vessel rimmed by fibrous tissue and surrounded by malignant epithelial cells in a cystic space - Alpha-fetoprotein ```
174
First line A-fib First line tx SVT
1) Afib - Dofetilide (Class III antiarrhythmic) - Blocks K channels 2) SVT - Adenosine
175
Spiking fevers hepatosplenomegaly Pancrytopenia - Disease - organism - transmitted - tx
Kala-azar aka visceral leishmaniasis Caused by parasite Leishmania donovani Sand fly India Sodium stibogluconate
176
MRI of child's brain reveals enamel-like calcifications and tumor that is located supratentorially A. Containing foamy cells that are highly vascular B. A remnant of Rathke's pouch C. Containing solid rosettes of small blue cells D. Composed of Rosenthal fibers E. Having a "Fried egg" appearance on histology
B. A remnant of Rathke's pouch Craniopharyngioma Ectoderm Supra cellar calcifications
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Brain tumor 1) Highly vascular foamy cells 2) Containing solid rosettes of small blue cells 3) Composed of Rosenthal fibers 4) Having a "fried egg" appearance on histology
1) Von Hippel-Lindau disease 2) Neuroblastoma 3) Rosenthal fibers are corkscrew-shaped intracytoplasmic inclusions that are seen in optic gliomas of neurofibromatosis 1 and pilocystic astrocytomas - AD - Cafe au lait - visual disturbances 4) Oligodendrogliomas
178
Tumor in proximal colon Signet ring cells Father and grandfather same presentation ``` A. Alternative splicing B. Base excision repair C. Mismatch repair D. Nucleotide excision repair E. Purine salvage ```
Lynch syndrome - Hereditary nonpolyposis colorectal cancer C. Mismatch repair
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``` 21 month old Sick all the time Oral thrush RSV and influenza Impetigo and exudative tonsillitis ```
Severe combined immunodeficiency
180
50 y.o man. Fatigue, fevers, joint and muscle pain and weight loss. Cough and dyspnea and occasional hemoptysis. Denies upper respiratory involvement. Peripheral sensory loss. Palpable purpura on skin and elevated erythrocyte sedimentary rate. Hematuria and mild proteinuira. Biopsy: vasculitis with an absence of granuloma formation. Diagnosis Marker Tx
Microscopic polyangiitis (MPA) Males 50 y.o [Dont have chronic sinusitis seen in granulomatosis w/ polyangiitis] Necrotizing vasculitis involving kidneys, lungs and skin with pauci-immune glomerulonephritis and palpable purpura p-ANCA + (anti-myeloperoxidase) Tx Cyclophosphamide
181
``` Nausea, vomiting Vertigo Numbness on right side of face Dysarthria and dysphagia Uvula deviation to left Hemianalgesia on right side of face and left side of body Ataxia ``` Artery involved
Lateral medullary syndrome RIght PICA
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Loss of pain and temp on face and body Ipsl facial hemiparesis Ipsilateral deafness C/L body analgesia
Lateral pontine syndrome AICA
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``` Fever that rises and falls through day Night sweats Joint pain Heart murmur Mexico Goat cheese and unpasteurized milk ```
Brucellosis
184
Recurrent pyogenic infections Oculocutaneous albinism Progressive neurologic abnormalities Coagulation defects
Chediak-Higashi syndrome - AR Abnormal lysosomal trafficking protein that results in defective phagolysosome formation
185
Nephritic vs Nephrotic types
``` Nephritic [ HTN, Inc BUN/CR, Oliguria, RBC casts] 1) Post streptococcal glomerul 2) Rapidly progressive glomer 3) IgA nephropathy (berger) 4) Alport 5) Membranoproliferative glome ``` ``` Nephrotic [Proteinuria, edema] 1) Focal segmental glomeruloscl 2) Minimal change 3) Membranous nephropathy 4) Amyloidosis 5) Diabetic glomerulonephri ``` Nephritic/Nephrotic - Diffuse proliferative glomerulonephrtis - Membranoproliferative glomerulonephritis
186
Temporal vs parietal radiation visual defect
Temporal -upper right quadrant Parietal - Lower left quadrant
187
``` Fever Rash Dysuria Urinary urgency Hematuria, mild proteinuria WBC (eosinophils) in urine Azotemia Costovertebral angle tenderness ``` Diagnosis Caused by
Acute interstitial nephritis Drug induced ``` 5 P's Pee (diuretics) Pain-free (NSAIDs) Penicillins and cephalosporins Proton pump inhibitors RifamPin ```

AM- STEP1 (20 decks)

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