Midterm Exam Flashcards
(223 cards)
1
Q
True or false:
problems with the “firing” (depolarization) of the cochlear hair cells and “electrical” conduction of these neural impulses through the auditory nerve (CN VIII) result in sensorineural hearing loss
A
True
2
Q
How and when can HSV be spread/when does the viral shedding occur?
A
It can occur during and between reactivations and breakouts
3
Q
True or false:
Vestibular neuritis needs meds to go away
A
FALSE
it goes away on its own, but meds can decrease symptoms
4
Q
- Bacteria that takes root in the blood is called what?
- What is this caused if bacteria was introduced to the bloodstream via a medical catheter?
A
- bacteremia or bloodstream infection
- catheter-related bloodstream infection
5
Q
- What condition is defined as infection of the epithelium (mucosa or lining) of the bladdder?
- Usually, this is localized to the bladder, but occasionally spreads up a ureter to involve one kidney. What is this called?
A
- Acute cystitis
- Pyelonephritis
6
Q
- 90% of those in the US have been infected with which type of HSV by age 40?
- 20% of those in the US have been infected with which type of HSV, although infection rarely occurs before puberty?
A
- HSV1
- HSV2
7
Q
What is the most malignant-like dysplasia (but still pre-malignant) called?
A
carcinoma in situ
8
Q
What condition is a unique STI that can rarely cause sepsis, septic arthritis, or infectious dermatitis?
A
Gonorrhea
In men/women, it can “spread widely via blood” → disseminiated gonococcal infection (DGI)
9
Q
OM or OE:
usually relates to some trauma or moisture of the ear canal, TM normal
A
OE
10
Q
Which individuals can you find iron deficiency anemia that is mild?
A
healthy young women who lose a bit more iron in red cells of menstrual flow than the iron they are eating (and absorbing)
11
Q
What condition has an acute onset with systemic manifestations at onset such as fever and chills and appears on the skin as bright red, sharply demarcated borders with normal skin?
A
Erysipelas
12
Q
Where do microbes especially like to form protective biofilms on?
A
- heart valves
- catheters
- prosthetic joints
13
Q
- Anaphylaxis is a (…) hypersensitivity reaction that involves a total body allergic response
- How quick does this occur?
- What are some manifestations of anaphylaxis?
A
- type I
- seconds to minutes
- swelling of the larynx → rapid asphyxiation; bronchospasm in the lungs, dilation of blood vessels → anaphylactic shock (distibutive shock); N/V/D, abdominal pain, urticaria, angioedema
14
Q
What condition in males is due to the STI microbes that cause urethritis?
A
Epididymitis
15
Q
(…) genes halt cell division if there are mutations. Once this happens, the cell is triggered to die by (…) or there is time for DNA to be repaired
A
- tumor suppressor genes
- apoptosis
16
Q
What are the clinical manifestations of strep throat?
A
- sudden onset of sore throat, tonsillar exudate, tender cervical lymphadenopathy, fever
- absent cough and significant nasal symptoms
17
Q
What ways can NHL be classified?
A
- indolent (35-40%)
- aggressive (about 50%)
- highly aggressive (only 5%)
18
Q
What are some clinical manifestations of UTI’s in older men and women?
A
- fever
- acute dysuria, new onset urgency and frequency
- new/worsening incontinence
- hematuria, suprapubic/flank pain, costovertebral tenderness
- change in mental status due to sepis
19
Q
What are some complications of the common cold?
A
- otitis media
- sinusitis (rhinosinusitis)
- bronchitis/pneumonia
- flare up/exacerbation of asthma
20
Q
What is the treatment for bullous pemphigoid and other blistering diseases?
A
immunosuppression; some end up getting care in burn units
21
Q
What is the change in the lens of the eye causing you to need bifocals due to age?
A
presbyopia
22
Q
- What part of the dermis does erysipelas affect?
- Where is erysipelas more frequently affecting on the body?
A
- top of the dermis (epidermis/upper dermis)
- most frequent on the legs
23
Q
What is the most common form of anemia?
A
iron deficiency anemia
but many of these cases are not diagnosed
24
Q
- Sudden sensorineural hearing loss is almost always unilateral or bilateral?
- This is described by sudden decrease in hearing over hours (less than 72 hours) and about half of these patients notice the hearing loss when?
A
- unilateral
- when they wake up
this may be due to a viral infection or an autoimmune attack
25
What is not a UTI but almost always a sexually transmitted infection (STI)?
Urethritis
26
What are the two types of hearing loss and are there fixes for these types?
1. conductive hearing loss → fixes!
2. sensorineural hearing loss → no fix :( but can override with cochlear implants
27
(...) can cause severe stomatitis with the first infection with many ulcers in the oral cavity and gums, or no symptoms at all
HSV1
28
The majority of individuals infected with TB contain the microbe wherever it has traveled to in the blood and lymph (this always includes the lungs but can include other organs), this is called what?
latent TB
29
What is the reaction type is psoriasis and psoriatic arthritis?
autoimmune type IV
30
A subset of MSM with syphilis are bisexual and can infect women, which if become pregnant, can pass the infection to whom?
developing embryo or newborn (without prophylactic treatment)
31
Epididymitis is an infection within what area of the scrotum?
posterior
32
What is caused by an autoimmune attach that destroys the ADAMTS13 enzymes or proteins, and as a result, VWFs are too long and trigger needless clotting that uses up platelets and causes other problems?
Thrombotic Thrombycytopenic Purpura (TTP)
33
What interleukin goes up in in psoriasis/psoriatic arthritis that stimulates proliferation of keratinocytes into thick plaques?
IL 33
34
What is the main microbe that causes hemolytic uremia syndrome?
E. coli O157H7
35
- About 10-20% of all cases of acute encephalitis are caused by (...)
- 95% are caused by (...) versus (...)
- What symptoms do patients present with?
- HSV
- HSV1 vs HSV2
- acute onset fever and focal neurological deficits
36
Which individuals don't lose iron normally except in a tiny amount in dead cells that are lost in the skin for example?
men
37
What condition is almost always a STI that can ascend further to cause endometritis, salpingitis, and pelvic inflammatory disease (however some of these infections except PID can be **asymptomatic**?
Cervicitis
38
What are some examples of atypical pneumonia microbes?
- Legionella pneumophilia (standing water → showers, whirl pools, decorative fountains)
- Mycoplasma pneumoniae (common in children, young adults, college students, military recruits)
- Chlamydia pneumoniae (nursing homes)
- Chlamydia psittacii (birds, pet stores)
39
True or False:
spider bites are a common cause of painful red raised skin leions
False
40
What are the 3 different clinical forms of acute sinusitis?
## Footnote
Acute rhinosinusitis is more common in women and most common between 45-64 y/o
1. acute **viral** rhinosinusitis
2. uncomplicated acute **bacterial** rhinosinusitis → **without** spread outside of the sinuses
3. complicated acute **bacterial** rhinosinusitis → **with** spread outside of the sinuses, causing neurologic, ophthalmologic, soft tissue involvement
41
- If a women has **any one** symptom of a UTI, she has a (...)% change of having a UTI or urethritis
- If a women has both **dysuria and frequency PLUS absence of vaginal symptoms**, she has a (...)% chance of having a UTI or urethritis
- 50%
- 90%
42
What is the difference between labyrinthitis and vestibular neuritis?
Hearing loss is present in labyrinthitis but absent in vestibular neuritis
43
- What organ quickly filters out bacteremia from out systems during activities like brushing our teeth and dental procedures?
spleen
## Footnote
However, some rotten teeth get bigger boluses of microbes that may overwhelm the spleen
44
Metastases of cancer can occur anywhere, but what are the big 4?
- bone
- brain
- liver
- lung
45
True or false:
Only select individuals need vaccinated against pertussis
FALSE:
everyone (both adults and children) need this vaccine
## Footnote
occasionally, very young children can die from pertussis
46
- (...) is a big stimulator of erythropoietin, but (...) from lung or heart disease also stimulates erythropoietin
- The (...) only "looks for O2 passing by in the blood"
- If it doesn't see enough, it assumes it is because of what?
- anemia, hypoxemia
- juxtaglomerular apparatus
- anemia, but low O2 in the blood will also do it
47
What is the second-most commonly reported bacterial cause of sexually transmitted infections?
Gonorrhea
48
Blistering diseases are what type of hypersensitivity reaction?
autoimmune type II hypersensitivity
49
True or false:
Skin abscesses form in the lower dermis, upper subcutaneous
true
50
- What microbe(s) typically cause erysipelas?
- What microbe(s) typically cause cellulitis?
- strep pyogenes
- staph, sometimes strep
51
- What parts of the skin does cellulitis typically affect?
- What part of the body?
- lower dermis/upper subcutaneous tissue
52
What describes age-related hearing loss characterized by bilateral progressive hearing loss over many years caused by age-related degeneration of the cochlea, including loss of hair cells?
presbycusis
53
True or false:
Hepatitis B is not sexually transmitted so individuals do not have to worry about safe sex but should be vaccinated against hep B to prevent infections
FALSE:
Hepatits B IS sexually transmitted, safe sex is important; vaccination against Hep B is important to prevent these infections
54
What is the ugly duckling sign in regards to melanoma?
if a person has many many moles, typically they will took similar to each other → look for the one that is unlike the rest
55
True or false:
only a small percentage of the elderly have hearing loss, called presbycusis
false → almost half of the elderly have presbycusis
56
What is described as inflammation in the nasal cavity AND paranasal sinuses and the acute version resolves before 4 weeks but often less than 2 weeks?
rhinosinusitis
57
What areas of the body is atopic dermatitis commonly found?
antecubital fossae and popliteal fossae
58
What can help alleviate the symptoms of psoriasis and psoriatic arthritis? What is the negative effect of this?
blocking tumor necrosis factor alpha helps both, but it suppresses the immune system
59
What are the causes of vertigo?
- inner ear problems → common (imbalance between the inputs from the two inner ears)
- brainstem/cerebrellar problems → rare (abnormality in the CNS pathways or central processing areas)
60
True or false:
Some strains of HPV cause regular warts that commonly develop in adolescense/young adulthood, others cause plantar warts, warts of the larynx, genital warts, and some may lead to cervical or anal cancer, along with other types of cancer
True
61
True or false:
acute bronchitis is less common than the common cold and is usually self-limited, lasting 1-3 weeks
True
## Footnote
However, this is not the same as acute bronchitis occurring in a person with underlying chronic lung disease
62
What is defined as fluid in the middle ear accompanied by pain, fever, ear fullness, and/or decreased hearing?
acute OM
63
Both old age and noise damage cause the most loss of what pitched tones? What do these tones allow us to hear?
- higher pitched tones
- allow us to hear the difference b/w "came" and cane"
## Footnote
we don't notice we hear these overtones because we focus on lower pitches of people's voices; when high pitches are lost due to age/noise, they are never deaf!
64
Which individuals is AML most common in?
middle age and the elderly
## Footnote
this is very hard to treat
65
What are the B symptoms of lymphomas?
- fevers
- involuntary weight loss
- night sweats (occur when a night-time fever resolves → cancer fevers come and go)
66
What is the clinical presentation of necrotizing fasciitis?
deep pain but the leg looks completely normal early on while the infection spreads up and does the leg
67
What conditions/circumstances can lead to a folate deficiency?
- severe small bowel disease
- alcoholics who are not eating that much
## Footnote
folate deficiency is not that common
68
Which individuals are at risk of developing pressure ulcers?
- bedridden patients
- paplegic patients
- those in comas
- patients with severe dimentia
## Footnote
patients that are at high risk and have difficulty turning to relieve pressure
69
At least 75% of sexually active men and women acquire (...) at some point in their lives in which there are over 200 strains but **only some may result in genital warts**?
HPV
70
What are the ABCDEs of looking at moles/nevi?
A → asymmetry
B → border
C → color
D → diameter 6 mm or greater
E → evolution/enlargement
71
- What is the usual cause of mono-microbial necrotizing fasciitis?
- Water exposure can sometimes result in cellulitis and/or NSTI with either (...) or (...)
- strep pyogenes
- auromonas or vibrio
## Footnote
aeromonas → fresh water; vibrio → salt water
72
What have we found that blocks the protein/growth factor in CML from stimulating WBC prescurs from replicating wildly?
biological agents
73
What are we referring to nowadays when discussing "bird flu"?
- we are not referring to bird flu genes mixing in pigs
- we are talking about humans getting bird flu directly from birds; luckily most bird flue doesn't spread from bird to humans very well (possibly droplets don't go far, bird flu may now have tropism to infect humans much at this time)
- these characteristics can change with spontaneous mutations
74
(...) causes 80% of adult leukemia
AML
75
What bacteria causes syphilis?
Treponema pallidum
76
- What describes swelling in the upper dermis that is not a common drug allergic response?
- What type of hypersensitivity reaction is this?
- urticaria
- type I
## Footnote
urticaria is classified as acute if less than 6 weeks; chronic if 6+ weeks
77
- What can see early necrotizing infections?
- What needs to be done when it is determined someone has necrotizing fasciitis?
- imaging like MRI
- infections need completely cut open and dead tissue removed; sometimes amputations are needed; sometimes, sepsis cannot be stopped no matter what
78
Influenza evolves usually with small changes every year called (...), but can occasionally evolve with major changes called (...)
- antigenic drift
- antigenic shift
79
What are the intermediate steps in between called where abnormal cells are present in the body but is still considered pre-malignant?
dysplasia
80
What are common offenders leading to anaphylaxis?
- peanuts and tree nuts
- shell fish
- hymenoptera venom (bees, yellow jackets)
81
True or false:
We only absorb a small amount of the iron we eat
TRUE
82
What is caused by just a virus and has more "trophism" for URTI and usually resolves in a week, but the cough may linger?
acute bronchitis
83
- Before reacivation of HSV1, the virus can happily exist in a latent state where?
- Where can this travel to and what can it cause?
- the tigeminal ganglion
- can travel to the temporal lobes and cause severe encephalitis
84
What is the most common form of psoriasis? Where are classic lesions found on the body?
chronic plaque psoriasis; opposite sides of the knees and elbows as atopic dermatitis
85
Genetic causes of SNHL account for (...)% of all cases of SNHL
50%
86
What is the cause of vestibular neuritis?
viral or post-viral inflammatory disorders affecting the vestibular branch of the 8th cranial nerve and/or cochlea
## Footnote
vestibular part of inner ear infected by a virus or an autoimmune attack of it
87
- What is the biggest cause of having a high WBC?
- What else can cause a high WBC?
- the patient is "fighting" a bacterial infection
- severe inflammation without infection and tissue necrosis; leukemia
88
- Certain dental infections with some (weaker) (...) microbes do not cause sepsis, but **stick** to heart valves and start destroying them; what is this called?
- More virulent microbes such as (...) can infect the heart valves which is called (...)
- strep microbes
- subacute bacterial endocarditis
- staph aureus
- acute endocarditis
89
What are common bugs causing UTIs?
- E. coli → **most common**
- Staphylococcus saprophyticus → big killer!
- Proteus mirabilis
- Klebsiella pneumoniae
90
What is one of the few microbes that forms tiny respiratory droplets that can be carried across the room on air currents, making it easy to infect others nearby if the person has active pulmonary TB and especially if they are coughing?
## Footnote
(breathing can still send this tiny "droplet nuclei" across a room)
Tuberculosis
91
Bacteria in the blood can "stick to" and "seed" other tissues and organs other than heart valves such as?
- kidneys
- bones
- joints
- outside the spinal cord (epidural abscesses)
92
True or false:
sudden hearing loss is not an emergent/immediate issue and will get better over time without treatment
FALSE:
These patients need to be seen by ENT immediately and get steroids and antivirals (in case its a viral cause like HSV1)
## Footnote
it usually improves with treatment and occasionally goes back to normal
93
About 10-15% of people with **unexplained** iron deficiency anemia have what?
GI lesions like ulcers, gastric cancer, esophagus cancer, small bowel cancer (rare), or **colon cancer (common)**
94
How can you clinically differentiate between viral and bacterial rhinosinusitis?
- **viral:** resolves by 7-10 days, no fever, initial d/c is clear, then becomes purulent, then clear again
- **bacterial:** persists > 10 days, facial pain/pressure/fullness is prominent, purulent d/c occurs early, usually severe, high fever > 39 (102)
95
What does tumor necrosis factor alpha do?
activates macrophages which creates more macrophages from monocytes which attacts neutrophils and macrophages and other immune system cells to the area
96
- What type of hypersensitivity reaction is atopic dermatitis?
- What symptoms manifest from this?
- Type I hypersensitivity
- allergic rhinitis and childhood asthma
## Footnote
There is also a hereditary component about faulty (leaky) protein in the skin
97
True or false:
Pressure ulcers affect the deeper layers first, so a lot of tissue necrosis occurs before anything can be seen
true
98
What syndrome is more common in kids and is due to a bacterial toxin that damages the endothelium and causes needless clotting that uses up platelets?
Hemolytic uremia syndrome
99
Which HSV causes mostly orofacial/orolabial infections?
HSV1
100
In NHL, once the indolent lymphoma cancers begin to progress, they can often be kept in check for a while or slowed, but they cannot be (...)
cured
101
True or false:
it takes only a few mutations to cause enough crazy properties and abilities to produce cancer
false:
it takes many mutations to cause cancer
102
What condition can be compared to (but is not the same) as severe unilateral scrotal pain that is sometimes due to acute ischemia by the twisting of the spermatic cord above the scrotum (testicular torsion)?
Epididymitis
## Footnote
This is the **most common** cuase of scrotal pain in adult men in the outpatient setting
103
True or false:
Some years, influenza is more aggressive become of less pre-exisiting immunity
True
104
What condition is described as an infection/inflammation of the vagina?
Vaginitis
105
What group of people does urethritis often affect?
Adolescent girls and women
106
- What can mono appear as?
- What can CMV and acute HIV appear as?
- strep throat
- mono
107
What should be on your radar in any patient with manifestations of skin infection and/or any red, tender, or painful skin lesions?
Skin abscesses
108
A high WBC count almost always means high what?
high neutrophils
109
The symptoms of urethritis often overlap with symptoms of what other condition?
Cystitis
110
What types of microbes does polymicrobial necrotizing fasciitis include?
- anaerobes
- non-group A strep
- gram-negative bacteria
111
(...) in a suppressor gene that elephants have 13 copies of → they do not get cancer
p53
112
(...) infections are deeper than cellulitis involving deep fascia and involve muscle and subcutaneous tissue, can be polymicrobial or mono-microbial (strep pyogenes for example)?
necrotizing soft tissue infections
113
Certain HPV strains can "turn off" **two** important (...) which can lead to cancer
Tumor suppressor genes
## Footnote
p53 and pRB
114
Besides pernicious anemia, what else can cause B12 deficiencies?
- gastric resection
- severe small bowel disease
115
True or false:
you should always check the nailbeds for brown and black hyperpigmented streaks or bands that are parallel to the direction of the fingers, but these are rarely melanomas
FALSE
you should always check these areas because these are almost always melanomas
## Footnote
you can get melanoma anywhere, such as in the retina and bowel linings, but these are rare
116
What are the similarities/differences between symptoms in adults and children who have a cold?
- **similarities**: both have nasal discharge/obstruction and a cough
- **differences**: the cough is more common in children, adults may have a sore throat, a fever is present in children by typically absent in adults, and symptoms resolve in 5-7 days in adults vs 10+ days in 70% of children
117
Audiogram clue of noise damage is worst loss at (...) cycles per second (or hertz)
4000
118
In vaginitis, vaginal discharge often changes in (...) and (...)
appearance and quantity
119
What are some clinical manifestations of cystitis?
- dysuria
- frequency to use the bathroom
- urgency to use the bathroom
- suprapubic pain
- hematuria
120
- What is B12 needed for?
- Without B12, what can happen?
- myelination of nerves
- peripheral neuropathy
121
True or false:
you can have sepsis and then get endocarditis or get endocarditis and then get sepsis, or you can have them both at once
TRUE
122
What does EBV often presents with?
Prodrom: malaise, HA, low-grade fever; THEN:
- sore throat
- tonsillitis/pharyngitis
- tender cervical lymphadenopathy
- high fever
- prominent, long-lasting fatigue
- splenomegaly
- rash (esp. if given pcn)
123
In which individuals where iron deficiency anemia is found does it mean they must be **bleeding** somewhere?
## Footnote
Where does almost all of the bleeding in these cases come from?
- boys and men
- girls before menarche
- postmenopausal women
## Footnote
the stool where blood can be mixed with stool and become invisible
124
- In anemia of chronic disease/inflammation, inflammatory cytokines stimulate the liver to secrete more of another chemical messenger called (...)
- High amounts of this make the GI tract incapable of absorbing (...)
- Also, the macrophages in the liver and spleen that have digested red cells cannot secrete their own (...) which is normally transferred to the (...)
- hepcidin
- iron
- iron; bone marrow
125
What is this describing:
stem cells, in most cases, are destroyed by autoimmune attacks → thus, platelets, red cells, and neutrophils are low
Aplastic anemia
## Footnote
however, aplastic anemia is a misnomer
126
HSV can become (...) where it exists in the body but no symptoms/signs are present?
## Footnote
What other viruses can this happen with?
latent
## Footnote
Can happen with EBV, VZV, CMV as well
127
What is the highest sexual risk of HIV transmission?
receptive anal sex
128
What are the common killer cancers?
- lung CA
- colon CA
- breast CA
- pancreatic CA
129
Which individuals are more likely to spread hepatitis B?
- IV drug users
- unvaccinated individuals
130
True or false:
Sinusitis is almost always caused by a bacterial infection
FALSE
sinusitis is usually viral, but **rarely** can be bacterial
## Footnote
patients with bacterial sinusitis can be very sick and sometimes have it spread to the brain or sepsis
131
What is a relatively common cause of atypical pneumonia, especially in younger people (under 35-40)? What are other common causes of atypical pneumonia?
- Mycoplasma pneumoniae
- Viruses, covid
## Footnote
Covid can also lead to acute respiratory distress syndrome, respiratory failure, and death
132
What are causes of excessive bleeding?
1. **low platelets** → ITP, aplastic anemia, leukemia "taking up all the space" in the bone marrow
2. **abnormal platelet function** → d/t aspirin or other medications that block platelet function (to prevent future strokes)
3. **genetic deficiencies of clotting factors** → Factor VIII Hemophilia A, Factor IX Hemophilia B (can be easily treated now)
4. **acquired problems with making CF** → liver disease and cirrhosis bc they made the CF
5. **using up platelets** → sepsis-caused disseminated intravascular coagulation (DIC), rare thrombotic microhemangiopathic anemias such as TTP and hemolytic uremia syndrome
133
- What do aggressive lymphomas present with?
- What can these be cured with?
- lymphadenopathy peripherally or within an organ/chest/abdomen
- intensive chemo
134
CML occurs because a (...) mutation occured
driver mutation
135
What type of pneumonia does this describe:
patient may have fever, chills, a high WBC, can't eat, cough up yellow/green sputum, maybe a little blood, pleuritic CP, often lobar pneumonia, and is often due to bacterial causes
typical pneumonia
136
About 60% of melanomas arise from what?
normal skin as new lesions, but they are colored/pigmented
## Footnote
tans, blacks, browns, blues, sometimes red → these keep getting bigger/changing
137
Whenever there is hearing loss of any cause, there may be abnormal sounds heard, called (...), which can sound like buzzing, ringing, crickets, or other weird sounds
tinnitus
138
True or false:
the rash from allergic contact dermatitis appears immediately after individuals are exposed
FALSE:
it takes time to produce cell-mediated immune system weapons (ex: cytotoxic T cells CD8) so the rash doesn't appear until 48-72 hours after exposure
139
What is a bacterial respiratory tract infection that can damage the upper airway for months which can cause paroxysms of cough, with a noisy inspiration (whoop)?
## Footnote
The bacteria releases a toxin
bordatella pertussis
140
What is a huge problem that can occur in patients often years after having DVTs in the leg veins?
chronic venous insufficiency
141
Which individuals are among the highest risk of acquiring syphilis?
## Footnote
What other condition may these individuals also have?
MSM
## Footnote
May also have HIV
142
What cancerous condition can arise from moles or nevi?
melanoma
143
- What type of reaction is this describing → swelling in the deeper dermis and subcutaneous tissues
- What type of hypersensitivity reaction is this?
- angioedema
- type I
144
In what condition do antibodies (auto-reactive IgGs) attack hemidesmosomes that are deeper and conenct cells to basement membrane where edema fluid pushes upward into vesicles and bullae?
bullous pemphigoid
## Footnote
this is often a disease of the elderly
145
What is the big fear with bird flu?
- that it will mutate so a person walking into a pet store may get a fatal pneumonia from the bird flu
- at least half die who get bird flu (only few contract this, mostly in Asia) → no way to prevent this now
- if mutation does develop, it will take at least a year to get a vaccine → many will die before this → although, masks will work better to block influenza than they did COVID
146
What are some complications of pneumonia (what it can lead to)?
1. acute respiratory distress syndrome (ARDS) and respiratory failure
2. microbes may spread to the bloodstream → bacteremia
3. bacteria infecting the lungs may diffuse into the blood stream
4. immune system battle in the lung raises inflammatory cytokines to very high levels, which enter the blood stream
## Footnote
These can damage endothelial lining and make it leaky, increasing nitric oxide (NO) produced by blood vessel walls, which dilate the blood vessels → too much space in the circulatory system (PVR is low) → bp drops d/t septic shock
147
Some with dysuria have (...), which is usually an STI; some have (...), and a few may even have (...)
- urethritis
- cystitis
- vaginitis
148
How is HIV transmitted?
- sexually transmitted
- IV drug use
- vertically
- bloody sputum, etc
149
What type of cancer spreads to bones, weakening them, causing spontaneous (pathogenic) fractures?
myeloma
150
What is the common finding in secondary syphilis?
A diffuse maculopapular rash that involves the soles and palms
## Footnote
It is rare for body-wide rashes to involve the soles and palms but it does so in secondary syphilis
151
What are some causes of cancer?
- tobacco (all forms)
- alcohol
- obesity
- certain viruses → hep C, hep B, HIV, HPV (certain strains), EBV occasionally
- toxic chemicals → benzene
- radiation
- chemotherapy → can cause new cancers later on in small number of patients
- immunosuppression
- **spontaneous** mutations
- inherited mutations
- homorones → sometimes assist in causing cancers
152
- In myeloma, the dissolving bones cause (...)
- Patients may also have (...)
- The antibodies get stuck in (...) and cause (...)
- Because the marrow is getting filled with replicating plasma cells, (...) and (...) can be low, and (...) function is impaired so infections are **common**
- hypercalcemia
- anemia
- kidney tubules; renal failure
- neuthrophils and platelets; immune function is impaired
153
- What is the value of TIBC and ferritin in anemia of chronic disease?
- What is the value of TIBC and ferritin in iron deficiency anemia?
- ACD → TIBC: not high, low; Ferritin: normal or high
- IDA → TIBC: high; Ferritin: low or zero
154
What HSV is commonly associated with genital herpes?
HSV2
## Footnote
However, some causes **are due to HSV1**
155
What is the name of the cancer of plasma cells?
myeloma
156
What type of anemia is defined by an autoimmune attack on gastric parietal cells that make the B12 carrier, **intrinsic factor**?
pernicious anemia
157
What are some clinical manifestations of pyelonephritis?
- +/- symptoms of cystitis
- fever (>38)
- chills
- flank pain
- costovertebral angle tenderness
- nausea
- vomiting
- **+/- severe sepsis/septic shock**
158
What are examples of typical pneumonia microbes?
- Strep pneumoniae (5-15%)
- Haemophilus influenzae (elderly, COPD)
- Staphylococcus aureus (often after flu)
- Klebsiella pneumoniae (COPD, alcoholism, diabetes)
159
Primary lesions of (...) are erythematous macules, papules, and vesicles which "coalesce" into red patches or plaques
## Footnote
This condition is very itchy but can lead to secondary bacterial infections from scratching
atopic dermatitis
## Footnote
raised lesions are d/t edema between keratinocytes of the epidermis → "spongiosis"
160
- In a cold, what symptoms are predominant?
- In the flu, what symptoms are predominant?
- nasal symptoms (rhinorrhea, rhinitis, scratchy throat, cough)
- severe sore throat, HA, muscle aches, joint aches, dry cough, fever, extreme fatigue
161
On biopsies of most common cancers, which occurs in (...) cells, once the cells invade down through the (...), that proves it is cancer → this is invasion, and from there they will invade lymph channels and blood
- epithelial cells
- basement membrane
162
What is the most common cause of vertigo that is due to crystals containing calcium that come loose in the semicircular canals and drand endolymph fluid with it after you move your head?
benign paroxysmal positional vertigo (BPPV)
163
What condition was called the "hundred day cough" or whooping cough?
pertussis
164
Why do we treat strep throat?
To prevent possibility of autoimmune diseases that attack the heart valves (rheumatic fever)
165
What is the patho behind how a person gets a pressure ulcer?
the pressure squeezes closed the capillaries that deliver O2 to muscle, fascia, subcutaneous tissue, and dermis → ischemia develops, tissues get inflamed and necrotic → ulcer develops from the bottom up and get infected and very hard to hear
166
True or false:
in blistering diseases, antibodies attack desmosones so cells pull apart and edema fluid appears between cells and pushes epidermis upward into vesicles and bullae (pemphigus)?
true
167
True or false:
Non-hodgkins lymphoma is common and consists of many subtypes and some just smolder for years (indolent lymphomas) and there is no treat to treat these until they pick up speed and progress
True
168
- What are collections of pus within the dermis and deeper skin tissues?
- What is an infection of the hair follicle in which purulent material extends through the dermis into the subcutaneous tissue?
- What is a coalescense of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles?
- skin abscesses
- furuncle
- carbuncle
169
"Hair-follicle-invading" skin infections and skin abscesses are usually do to which microbe?
staphylococcus aureus
## Footnote
Folliculitis is almost always caused by S. aureus → can occur anywhere on the skin
170
A larger subset of individuals infected with TB develop acute pneumonia with pleural effusion (these individuals get really sick), and this is called (...)
Primary active TB
## Footnote
some may have a miliary pattern on CXR
171
What type of treatment works on a lot of patients with aplastic anemia?
immunosuppression
172
What do some bloodstream infections depend on?
the virulence of the microbe
## Footnote
Something aggressive like Staph aureus can cause sepsis/septic shock
173
What are the associated symptoms with vestibular neuritis?
- rapid onset of severe, persistent vertigo
- nausea and vomiting
- gait instability
- **no hearing loss**
174
In primary syphilis, what is the common finding?
chancre that goes away even without treatment
175
What protein in atopical dermatitis patients is abnormal?
filaggrin protein
176
True or False:
In chronic myeloid leukemia (CML), the neutrophils look normal and in acute myeloid leukemia (AML), the malignant cells are immature cells, blasts, **not mature neutrophils**
TRUE
177
What will always be visible on imaging for acute pneumonia?
infiltrate
## Footnote
sometimes CXRs can be negative for a day or so before showing it
178
What are some complications of influenza?
- some may develop influenza pneumonia (can be severe)
- after influenza, the upper airway and lung defenses may be temporarily impaired → severe secondary bacterial pneumonia
179
What type of hypersensitivity reaction is allergic contact dermatitis?
type IV hypersensitivity
180
oncogenes were once normal cell-proliferation genes called what?
protooncogenes
181
True or False:
Skin abscesses are often worse "down deep" than they are superficially
true
182
Which individuals is acute lymphoid leukemia (ALL) most common in?
young children
## Footnote
this is fairly easy to cure, but takes at least a year and a half of hard times
183
Any changes or expansions of nevi warrant what?
a derm consult or removal for biopsy
## Footnote
if diameter > 6 mm → possibly melanoma
184
True or false:
pressure sores are easy to prevent because we know how often we are adjusting out bodies to relieve pressure
FALSE
they are **hard to prevent** because we do not realize how often we adjust our body to relieve pressure
185
What animal can "cook up" flu viruses that have components of human, pig, and bird flu which can be transmitted to farmers and other people easily?
pigs
## Footnote
antigenic shift occurs d/t missing together of genes from bird, human, and pig/swine influenza
186
Urethritis in men is due to which infections(organisms?)?
- Gonorrhea and Chlamydia more commonly
- Less commonly → Chlamydia mimics (Mycoplasma genitalium) or Trichomonas
## Footnote
In men, **anterior** urethritis is more common
187
True or false:
Musch of hereditary loss is at birth an complete or severe, but some lose some hearing in middle-age
true
188
In patients with **chronic kidney disease**, they cannot make (...) to stimulate bone marrow, these patients are anemic
erythropoietin (EPO)
## Footnote
this is a classic form of an individual with ACD
189
Herpes primary infection or reactivations can involve the cornea, called (...), which can cause blindness without treatment
Herpes keratitis
190
OM or OE:
blocked eustachian tube, TM red and bulging or immobile with puff of air
OM
191
What often follows a cold during which the orifiice of the eustachian tube is swollen shut?
otitis media
192
What are 2 uncommon causes of vertigo that are important to mention?
1. brainstem ischemia d/t stroke or TIA → s/s other than vertigo/nystagmus are seen
2. cerebellar infarct or hemorrhage → can cause sudden, intense vertigo w/ N/V
## Footnote
These are usually in older patients and have other brainstem or cerebellar deficits
193
Most active TB cases in the US come from which individuals?
individuals who came to the US with latent TB and reactivate here due to them being older and having weaker immune systems
## Footnote
(often in the apices of the lungs)
194
What is this describing:
an oncogene formed because 2 chromosomes broke during replication, there was a switcheroo that put 2 genes side by side that should never be near each other (9 and 22) → the philadelphia chromosome → this oncogene proteins a protein/growth factor that stimultes WBC precursors in the bone marrow to replicate wildly
CML
195
In psoriasis and psoriatic arthritis, there is a chronic attack that involves high levels of (...) that drives up both the rask, and in the subset with psoriatic athritis, the arthritis in the finger joints (mostly)
tumor necrosis factor alpha
196
What is the most common childhood disorder associated with conductive hearing loss?
Otitis media (OM)
197
True or false:
Some individuals who come into contact with TB have great immune systems and kill the microbe immediately
true
198
What are some causes of sensorineural hearing loss?
- hereditary
- congenital infections
- meningitis
- noise exposure
- ototoxic drugs
- traumatic brain injury
- Meniere's disease
- acoustic neuroma (tumor)
- presbycusis (old age)
- sudden hearing loss
199
What is this describing:
- uncommon
- characteristic **reed sternberg cells**
- cured pretty easily
- most patients present with **enlarged palpable nodes**
hodgkins lymphoma
200
What type of pneumonia does this describe:
usually begins slowly, sometimes as if a cold or sore throat that morphs into a dry cough that worsens and persists; fever may or may not be present, CXR does not reveal any whited-out areas as in lobar pneumonia; and imaging may reveal tiny areas of infiltrate along bronchi → called bronchopneumonia
atypical pneumonia
201
Out of all the genetic cases of SNHL, about what fraction are in those with multisystem syndromes and what fraction only have hearing loss inherited in an autosomal recessive manner?
- 1/3 syndromes
- 2/3 autosomal recessive
202
Like Chlamydia, what else is a common cause of cervicitis in women, as well as urethritis in both men and women, and epididymitis in men?
| (and can lead to pelvic inflammatory disease in women)
Gonorrhea
203
In individuals who lose hearing of higher pitches, when is it worst (in what situations)?
when environments are loud and everyone is talking → cannot figure out what people are saying to them
204
- What must be absorbed to activate folate?
- What is folate needed for to do?
- B12
- folate is needed to duplicate DNA to make new cells (especially cells that are made in a hurry, such as blood cells)
205
True or false:
Individuals infected with latent TB never reactivate and will never spread the infection to others
FALSE:
individuals may reactivate later in life and can spread it to others when they reactivate
206
What is the most common offending antigen of allergic contact dermatitis?
urushiol produced from plants in poison ivy, poison oak, and poison sumac
207
What percentage of those with psoriasis have a first degree relative with it?
40%
208
True or false:
Strep throat infections becomes less common as we get older
True
209
What condition may manifest with:
- purulent/mucopurulent vaginal discharge
- intermentrual or postcoital bleeding
- vaginal pain or pelvic heaviness
- pain on intercourse (dyspareunia)
- dysuria?
Cervicitis
210
- What do plasma cells produce?
- In myelomas, because plasma cells are affects, what occurs?
- Where do these show up on (tests?)?
- antibodies
- overproduction of antibodies, either one or a few types (forming clones)
- protein electrophoresis or urine electrophoresis, or both
211
(...) lead to proteins within the cell that actually do proofreading and correction
DNA repair genes
212
- In (...), as the cusps are eaten away, you get valvular insufficiency (mitral insufficiency or regurgitation) or aortic insufficiency/regurgitation
- IV drug users inject so many microbes into venous blood, it often sticks to the (...), which will destroy it
- Microbes + clots form together on heart valves, called (...), and can break off and embolize to the (...) or (...) and elsewhere from the aortic or mitral valve
- endocarditis
- tricuspid valve
- vegetations; lung (from tricuspid) or brain
213
True or False:
ALL in adults is the same as ALL in children
FALSE:
ALL in adults is bad and different than ALL in children
214
True or false:
E. coli is one of the main bugs causing vaginitis?
FALSE
E. coli is a causative organism of cystitis; other microbes such as candida can cause vaginitis
215
- What act as portals for bacterial infections?
- What is a classic example of this?
- rashes
- dermatophytosis of feet (athlete's foot)
216
What can cause conductive hearing loss?
- cerumen impaction
- TM perforation
- fluid in middle ear
- OE/OM
- cholesteatoma
- arthritis and bone spurs that limit ossicle movements (osteosclerosis)
217
What diseases are caused by auto-antibodies that attack cohesion molecules in the skin; loss of intercellular cohesion is called "acantholysis"?
blistering diseases
218
- When a DVT occurs, the length of the vein is not only clotted but inflamed; this inflammation destroyes the (...)
- Some people have multiple DVTs in both legs, others have idiopathic dilation of the deep and superficial veins called (...)
- Dilated veins pull apart the valve cusps so that they (...)
- Either way, the pressure from the blood from the (...) pushes down so pressure is really high near the (...) and it forces out fluid, red cells, and proteins
- This inflames the dermis and subcutaneous tissue and develops into a firm, thick edema that feels like soft wood, which can be called (...) or (...)
- This tissue is so abnormal that it can spontaneously "break open" and form ulcers that become infected and very hard to heal → in some patients, fluid "weeps" out of the involved parts of their legs
- If fluid can weep out, (...) can enter the deeper tissues → these patients have frequent (...) infections and there is no cure of this
- The mildest form of this is a brownish discoloration about the medial malleolus called (...) where the brown comes from digested red cells
- one-way valves
- varicose veins
- leak
- IVC; ankles
- woody edema or brawny edema
- staph aureus; cellulitis
- stasis dermatitis
219
What condition has a gradual onset without systemic manifestations at onset that appears frequently on the legs with no fever/acute illness at first but can lead to sepsis/septic shock and has no sharp demarcation with normal skin?
cellulitis
220
True or false:
People with HIV on ART have little replicating virus in their blood and cells making them less likely to spread HIV, but safe sex should always be done alone with testing for all STIs before sex in future monogamous relationships
True
221
What is the name for one secondary syphilis lesion?
## Footnote
These may look like lesions of HPV (condyloma acuminatum)
Condyloma lata
222
A patient complains of a brief episode of vertigo when turning in bed, or moving head suddenly that only lasts a few seconds that is accomanied with nausea. They deny ear pain/fullness, hearing loss, and tinnitus. What is the possible cause?
BPPV
223
Most medication rashes are what type of reactions?
morbilliform or "measles" like
