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Caleb's Step 1 > March 27 > Flashcards

March 27 Flashcards

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1
Q

cytokines attributing to elevated ESR

A

IL-1, IL-6, TNF-alpha

elevate acute phase reactant in the liver –> fibrinogen –> erythrocyte stacks (rouleaux) –> increased ESR

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2
Q

lung particle clearance in respiratory bronchioles and alveolar ducts

A

phagocytosis via alveolar macs

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3
Q

lung particle clearance in bronchi and proximal bronchioles

A

mucociliary clearance

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4
Q

Succinylcholine

A

depolarizing blocker @ NMJ (neuromuscular junction)

prevent depolarization of the motor endplate

@ phase I blockade: show content but diminished signal

persistent exposure –> Phase II Blockade: ACh receptors become desensitized and inactivated –> Fade response

Phase II looks like non depolarizing NMJ blockers like vecuronium and pancuronium

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5
Q

Nondepolarizing Neuromuscular junction blockers

A

vecuronium, pancuronium, tubocurarine

competitive inhibitors of postsynaptic ACh receptor

stimulation demonstrates Fade = progressive reduction of signal strength

due to less ACh release with each subsequent impulse

reversal with Neostigmine!

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6
Q

Dantrolene

A

relaxes skeletal muscle by blocking Ca++ release from SR

tx for malignant hyperthermia

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7
Q

Mesothelioma

A

dyspnea and chest pain (Asbestos Exposure) also hemorrhagic pleural effusions

nodular or smooth pleural thickening

histopath: epithelia-type cells joined by desmosomes, abundant monofilaments, long slender microvilli, psammoma bodies

IHC shows +pancytokeratin / cytokeratin
+ calretinin

remember that bronchogenic carcinoma is more common outcome of asbestos exposure than mesothelioma

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8
Q

Pancoast Tumor

A

Tumor at the lung apex, often in the Superior Sulcus (groove @ subclavian vessels)

shoulder pain radiating toward axilla and scapula

horner syndrome due to involvement with cervical sympathetic ganglia (ptosis, mitosis, anhyrosis)

upper extremity edema due to compression of subclavian vessels

spinal cord compression and paraplegia due to tumor extension into intervertebral foramina

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9
Q

Mechanism of cavitary lesion in TB

A

macrophages grab bugs -> present on MHCII to CD4+ T-cells –> TNF and IFN-gamma

macrophages release proteases NO and ROS to try and destroy TB –> tissue damage!

macrophages (and neutrophils) also release their lysosomal content (!) in an attempt to digest pathogens but also damage parenchyma

granuloma of macrophages and T-cells –> caseous necrosis and cavitary lung lesion.

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10
Q

Mycoplasma

A

Lack peptidoglycan cell walls

they are resistant to penicillins, cephalosporins, carbapenems, vancomycin

treat with anti ribosomal agents: tetracyclines, macrolides)

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11
Q

Pulmonary Edema

A

causes increased alveolar surface tension (opposite of surfactant which decreases the tension and makes inflation easier)

causes decreased lung compliance due to fluid in the interstitial –> swelling.

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12
Q

Reduced pulmonary compliance (causes)

A

pulmonary edema
surfactant insufficiency
pulmonary fibrosis

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13
Q

Non-maligant results of Asbestos exposure

A

pleural thickening with calcification of there posterolateral middling zones and diaphragm

calcified lesions = pleural plaques esp @ parietal pleura, esp @ ribs 6-9

generally asymptomatic

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14
Q

oxygen induced hypercapnia

A

COPD patients have main respiratory drive based on hypoxemia instead of hypercapnia

when you give them a bunch of oxygen their respiratory drive goes down

decreased RR causes hypercapnia (increased CO2)

causes confusion and lethargy - increased dead space ventilation

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15
Q

Cold agglutinins

A

mycoplasma pneumonias infection

also EBV and hematologic malignancy

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16
Q

Small cell carcinoma

A

most aggressive

produce ACTH, ADH, and can cause myasthenia syndrome (Lambert-Eaton syndrome)

express neural cell adhesion molecule (NCAM aka CD56) enolase, chromogranin, synaptophysin

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17
Q

metyrapone stimulation test

A

investigates HPA axis

blocks cortisol synthesis by inhibiting 11-beta-hydroxylase –> reduced cortisol –> ACTH spike

ACTH –> increased production of 11-deoxycortisol –> 12-hydroxycorticosteroids in the urine

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18
Q

DNA viruses

A

DNA viruses are HHAPPPy

Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
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19
Q

Herpesviruses

A

Nuclear Membrane (bud through and acquire the lipid bilayer envelope of the host cell nuclear membrane)

HSV, EBV, CMV, KSV

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20
Q

Cholestasis

A

dilated bile canaliculi and green-brown plugs and yellow-green accumulation of pigment in the hepatic parenchyma

+striking increase in serum all pos, elevated bili, elevated hepatic transaminases

intrahepatic due to: PBC, PSC, cholestasis due to pregnancy/contraceptives (estrogen), also erythromycin

extra hepatic: choledocholithiasis or malignancy (gallbladder or pancreas)

can cause malabsorption of fats and fat soluble vitamins

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21
Q

Competitive inhibitors

A

bind at active site
increase Km
Vmax is unchanged, just requires more substrate to get there

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22
Q

GLUT4

A

glucose transporter on adipose cells

carrier-mediated transport of D-glucose - form of facilitated diffusion

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23
Q

Bacterial Toxin Matching

Inactivates EF-2

A

C. diphtheria - Diphtheria toxin

Pseudomonas aeruginosa - Exotoxin A

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24
Q

Bacterial Toxin Matching

Inactivates 60S

A

Shigella - Shiga toxin

EHEC - Shiga-like toxin

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25
Bacterial Toxin Matching cleave SNAREs
Clostridium tetani - tetanospasmin Clostridium botulinum - botulinum toxin
26
Bacterial Toxin Matching increases cAMP
ETEC - heat labile toxin Bacillus anthracis - edema toxin Vibrio cholerae - cholera toxin Bordetella pertussis - pertussis toxin (microbial survival) --> whooping cough
27
Bacterial Toxin Matching massive T-cell activation
Staph aureus - Toxic Shock Syndrome Toxin Strep pyogenes - Exotoxin A
28
inter scalene nerve block
gets brachial plexus + phrenic nerve --> ipsilateral diaphragmatic paralysis
29
S3
filling against stiff ventricle normal in kids, abnormal in adults provoked by left lateral decubitus @ end expiration
30
Side Effects of systemic Glucocorticoids
``` muscle weakness skin thinning impaired wound healing osteoporosis immunosuppresion ``` increased hepatic gluconeogenesis and glycogenesis + peripheral insulin antagonism --> hyperglycemia
31
Primary carnitine deficiency
mild motor delay, hypoglycemia with fasting, muscle weakness, cardiomyopathy, elevated muscle TGs no carnitine, no fatty acid shuffle from cytoplasm --> mitochondria (via carnitine shuttle) --> no beta oxidation of fact acids --> liver is unable to synthesize ketones (acetoacetate is a ketone)
32
extra medullary hematopoiesis (cause)
chronic hemolytic anemia (beta-thalassemia)
33
Flutamide
competitive testosterone receptor inhibitor (glutamine, cyproterone, spironolactone) used in the treatment of prostate cancer tumor size reduction and reduction in symptoms (bony pain and urinary obstruction)
34
Proximal Convoluted Tubule
resorption of Glucose, Amino Acids, Bicarb secretion of PAH, Cr, Inulin > urea > Cl-
35
Osteoprotegerin
blocks interaction of RANK and RANK-L by binding RANK-L --> decreased differentiation and survival of osteoclasts --> decreased bone resorption and increased bone density (blocks activation of osteoclasts by osteoblasts) estrogen increases osteoprotegerin - protects the bones Denosumab does the same thing, binds RANK-L and blocks interaction with RANK
36
Deficit in N-terminal propertied removal @ collagen processing
Ehler-Danlos variant - deficient in procollagen peptidase fragile, hyper extensible skin, easy bruising, umbilical herniation prevents proper collagen cross linking
37
Collagen Synthesis
Starts in RER 1. hydroxylation @ proline and lysine - VitC dependent 2. Glycosylation of hydroxylysine 3. assembly into pro collagen triple helix Triple helix pro collagen is then processed in the golgi and secreted into extracellular matrix 4. N and C terminal pro peptides are cleaved off by pro collagen peptidases (pro collagen --> tropocollagen) 5. Tropocollagen fibrils are covalently corsslinked by lysol oxidase increased cross linking, decreased production, increased breakdown without clearance produce less and what is there is broken down and left
38
Ecthyma gangrenosum
Pseudomonas aeruginosa bacteremia cutaneous necrotic lesions from perivascular invasion and release of tissue destroying exotoxins --> decreased blood flow and patches of necrosis seen in neutropenia, burns, indwelling catheters
39
Chronic allograft rejection
obliterative fibrous intimal thickening with scattered mononuclear infiltrate for kidney: tubular atrophy and interstitial fibrosis
40
Haptoglobin
serum protein, brings free hemoglobin and promotes clearance decreases with hemolysis
41
Protein A
in cell wall of Staph aureus, binds Fc portion of IgG to prevent complement activation, opsonization, phagocytosis
42
Vessel posterior to duodenal bulb (prox 1/4)
gastroduodenal artery
43
CYP Inhibitors
``` Cimetidine Ciprofloxacin Erythromycin Azole antifungals grapefruit juice Isoniazid Ritonavir / Protease Inhibitors ```
44
CYP inducers
``` carbamazepine phenobarbital phenytoin rifampin griseofulvin ```
45
Porphyria cutanea tarda
deficiency in Uroporphyrinogen decarboxylase vesicles and erosions on the dorsum of the hands
46
Acute intermittent porphyria
deficiency in Porphobilinogen deaminase accumulated porphobilinogen, ALA ``` Painful abdomen Port-wine colored urine Polyneuropathy Psychological disturbances Precipitated by drugs ```
47
Proteasome inhibitors
bortezomib - moronic acid dipeptide tx for multiple myeloma cause accumulation of toxic intracellular proteins that can no longer be degraded by the proteasome inhibition of proteasome --> induced apoptosis (of malignant plasma cells)
48
Huntington's Disease
trinucleotide repeat disease at CAG atrophy of caudate nucleus > putamen and frontal lobes striatum = caudate + putamen
49
atrophy of caudate and putamen
Huntingtons
50
atrophy of substantia nigra
Parkinsons
51
Polymyositis
symmetrical proximal muscle weakness increased expression of MHC-I on the sarcolemma --> CD8+ infiltrate biopsy shows: inflammation, patchy necrosis and areas of fibrosis + infiltration with macrophages and CD8+ T-cells +ANA and anti-Jo-1
52
Arachnoid granulations
site of CSF reabsorption subarachnoid space --> arachnoid granulations --> venous sinuses
53
Flow of CSF
``` lateral ventricles inter ventricular foramen of monro third ventricle cerebral aqueduct fourth ventricle foramina of Luschka and Magendie Subarachnoid space arachnoid granulations venous sinuses ```
54
CYP oxygenase (aka)
microsomal monooxygenase responsible for metabolism of steroids, alcohol, toxins, foreign substances
55
Associated condition with Downs
duodenal atresia, hirschprung, imperforate anus, tracheoesophageal fistula, celiac disease AV septal defect (endocardial cushion) VSD and ASD ALL, AML (15:17) Alzheimers
56
Rosenthal fibers
Pilocytic Astrocytoma well circumscribed, posterior fossa tumors with solid+cystic components GFAP+ "spindle cells with hair-like glial processes associated with micro cysts"
57
Homer-Wright rosettes
Medulloblastoma highly malignant cerebellar tumor from neuroectoderm compresses 4th ventricle and causes obstructive hydrocephalus
58
Stress incontinence
urethral sphincter dysfunction
59
Primary Biliary Cirrhosis
Middle-aged women - associated with other autoimmune conditions (Sjögren, CREST, RA, celiac) autoimmune reaction --> lymphocytic infiltrate + granuloma --> destruction of interlobular bile ducts pruritus, fatigue, HSM, xanthomatous lesions @ eyelids/skin/tendons --> jaundice, steatorrhea, portal HTN
60
Clozapine
second gen antipsychotic for treatment-resistant schizophrenia +/- suicidality ARD: agranulocytosis - Monitor WBC! seizures, myocarditis, metabolic syndrome
61
Analgesic Nephropathy
NSAID induced Chronic interstitial nephritis: patchy interstitial inflammation, fibrosis, tubular atrophy, papillary necrosis, calcium deposition bilateral shrunken and irregular kidneys with papillary calcifications
62
Argatroban
Direct thrombin inhibitor
63
Ticlopidine and Clopidogrel and Prasugrel
inhibit ADP mediated platelet aggregation ADP induces expression of GpIIb/IIIa (binds fibrinogen)
64
Dipyridamole and Cilostazol
inhibit PDE activity and increase cAMP - decreased platelet aggregation
65
Abciximab, eptifibatide, tirofiban
inhibit GpIIb/IIIa directly
66
alpha-helix --> beta-pleated sheet
hydrogen bonding
67
HSV1 cencephalitis
edema and hemorrhagic necrosis of the temporal lobe headache, fever, mental status changes, seizures, aphasia, *personality changes: hyper sexuality, aggression bilateral hemorrhagic necrosis of temporal lobes
68
Rituximab
anti-CD20
69
Infliximab
anti-TNF-alpha
70
Abciximab
anti-GPIIb/IIIa
71
Ulcer in the distal duodenum
Neoplasm! Zollinger-Ellison syndrome = Gastrinoma secretin paradoxically stimulates gastrin release from gastrinomas
72
Complications of Wilson's Disease
neuro disease (atrophy of basal ganglia, dysarthria, dystonia, premier, parkinsonism) liver disease (hepatitis, acute liver failure, cirrhosis, hepatocellular carcinoma) hemolytic anemia renal disease (Fanconi syndrome = defect in resorption at PCT, lose amino acids, glucose, HCO3- which are normally resorbed) low serum ceruloplasmin
73
Neuron Markers
Synaptophysin: found in presynaptic vesicles of neurons neurons are GFAP NEGATIVE (glial cells are GFAP +, glioblastoma, oligodendroma, ependymoma) GFAP = glial fibrillary acidic protein
74
Esophageal Varicies and normal liver biopsy
Portal vein thrombosis
75
Elevated PT
Factor VII - Extrinsic pathway issue
76
Elevated PTT
Factor VIII and IX, XI | Hemophilia A, B, C
77
Li-Fraumeni Syndrome
TP53 dysfunction Sarcoma Breast Cancer Brain Tumor Leukemia Autosomal Dominant LOH disease
78
Acute Neuronal Injury
Red Neuron shrinkage of cell body Pyknosis of the nucleus Loss of Nissl substance Eosinophilic cytoplasm results in cell death due to trauma
79
Axonal Reaction
Enlargement of cell body eccentric nucleus enlargement of nucleolus dispersion of Nissle substance loss of axon
80
Neuronal Atrophy
loss of neurons and functional groups of neurons reactive gliosis degenerative disease
81
extensive lymphocytic infiltration and granulomatous destruction of interlobular bile ducts
Primary Biliary Cirrhosis long history of pruritus and fatigue with pale stools and xanthelasma
82
Lesion to cerebellar vermis
truncal ataxia
83
deep inguinal ring
transversals fascia
84
superficial inguinal ring
external oblique muscle aponeurosis
85
Jugular Foramen
CN IX CN X CN XI Jugular vein
86
Hemolytic Uremic Syndrome
elevated serum indirect bilirubin
87
Ankylosing spondylitis
HLA-B27 low back/hip/buttock pain anterior uveitis --> pain, blurred vision, photophobia monitor disease with degree of chest expansion (disease limits chest expansion and spinal mobility)
88
How to calculate bioavailability (F)
``` F = Bioavailability AUC = area under curve ``` F = (AUC oral x dose IV) / (AUC IV x dose oral)
89
E. coli Virulence Factors LPS K1 capsular polysaccaride Verotoxin = Shiga-like toxin P Fimbriae
LPS --> IL-1, IL-6, TNF-alpha - bacteriemia & septic shock Capsule --> prevents phagocytosis and complement lysis - neonatal meningitis shiga-like toxin --> inactivates the 60S rRNA - bloody gastro fimbriae --> adhesion to uroepithelium - UTI
90
Why do alcoholics get fatty livers?
increased NADH decreased free fatty acid oxidation
91
Effects of inhalation anesthetics
``` decrease hepatic blood flow decrease GFR, decrease RPF increase cerebral blood flow respiratory depression mucociliary clearance decrease decreased CO and increased atrial and ventricular pressures ``` cause hypotension
92
Wiskott Aldrich
WATER ``` Wiskott Aldrich Thrombocytopenia Eczema Recurrent infections ```
93
ANP and BNP
cause vasodilation by binding ANP receptors --> guanylyl cyclase --> increased cGMP
94
Main mechanism of combined OCPs
reduce serum gonadotropins suppress GnRH --> inhibition of ovulation
95
poor platelet aggregation in the presence of ristocetin
decreased vWF (like in vWD)
96
MOA pulmonary HTN due to LV hypertrophy?
vasoconstriction due to pulmonary venous congestion high pressure --> endothelial damage and capillary leakage --> decreased NO --> increased endothelin --> vasoconstriction and increased vascular tone --> remodeling and smooth muscle proliferation
97
IL-10
anti-inflammatory inhibits TH1 reduces MHC-II suppression of activated macrophages and dendritic cells
98
CREST
``` Calcinosis Raynaud Esophageal dysmotility - fibrous replacement of muscular in the LES --> heart burn Sclerodactyly Telangiectasia ```
99
Charcot-Bouchard aneurysm
due to HTN at basal ganglia, cerebellum thalamus, pons intracerebral neuro deficits --> headache
100
Saccular (berry) aneurysms
due to ADPKD, Ehlers-Danlos, HTN at circle of willis subarachnoid sudden severe headache; focal deficits UNCOMMON
101
Sign of Leser-Trélat
sudden onset multiple subhorrheic keratoses --> GI/Visceral malignancy
102
Manifestations of Thymoma
Myasthenia gravis pure RBC aplasia - anemia with low retics good syndrome= hypogammaglobunlinemia

Caleb's Step 1 (16 decks)

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