mixed deck 04/14 and 15 Flashcards Preview

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Flashcards in mixed deck 04/14 and 15 Deck (23):
1

vasecotmy

-after vasecotmy viable sperm remain in the portion of the vas deferense proximal to the ligation
-20% of patients still have some viable sperm in their ejaculate after 3 months and at least 20 ejaculations

2

corynebacterium diphtheriae

-non motile, unencapsulated, gram positive rod
-found in clumps resembling chinese letters or joined in V- or Y-shaped chains on microscopic examination.
-their cytoplasm contains metachromatic granules that statin with aniline dyes like methylene blue

3

Corynebacterium diptheriase produces a classic two subunit AB exotoxin

-B subunit binds to the heparin binding epidermal growth factor receptor found on cardiac and neural cells and it is responsible for the toxins affinity for heart and nervous tissue.
-A the active subunit inhibits host cell protein synthesis by catalyzing the ADP ibosylation of protein EF-2
EF-3 is necessary for tRNA to insert new amino acids into the growing protein chain during translation

4

ERB-B2 (Her2/neu) positivity in breast cancer is

consistent with more aggressive tumor that should respond to therapy with the monoclonal antibody trastuzumab

5

Symptoms indicative of both nicotinic blockade (diplopia, dysphagia) and muscarinic blockade (dry mouth)
strongly suffest food poisoning with botulinium toxin a preformed neurotoxin

-descending paralysis
-diplopia, dysphagia and difficulty speaking
-nausea, vomiting and abdominal pain may also occur in food-born botulisms
-12-36 hour incubation period
-the toxin prevents binding and fusion of the AcH SYNAPTIC VESICLES WITH THE PLASMA MEMBRANE EFFECTIVELY BLOCKING RELEASE OF ACH FROM THE NEUROMUSCULAR SYNAPSE!

6

Distal vagina, vulva and scrotum drain to what lymph nodes?

superficial inguinal nodes

7

Follicular lymphoma

-most common indolent non-hodkin lymphoma in adults
-it is of b cell origin and present with painless waxing and waning lymphadenopathy
-t(14:18) is characteristic and results in over expression of the bcl-2 oncogene

8

de quervains thyroiditis

also known as subacute granulomatous thyroiditis
-features thyroxixosis, tenderness over the thyroid gland, increased ESR and a markedly-reduced radioactive iodine uptake are diagnostic
-mixed cellular infiltration with occasional multinucleate giant cells are characteristic histologic findings.

9

c-Myc

burkitt
-nuclear phosphoprotein that functions as a transcription activator

10

Congenital torticollis

-caused by birth trauma (breech) or malposition of head in utero (due to fetal macrosomia or oligohydramnios)
-2-4 weeks of age seen
-both result in SCM injury and fibrosis
Features:
-chin will point away from the contracted muscle
-bulge in contracted muscle (inferior 1/3 of the affected SCM)
-head tilted toward affected muscle

Most cases resolve with conservative therapy and stretching exercises

11

Malignant hyperthermia occurs after the administration of inhaled anesthetics and or succinylcholine to genetically susceptible individuals

-autosomal dominant trait, defect is related to ryanodine receptors of SR.

presentation:
-fever, muscle rigidity soon after surgery under general anesthesia, tach, HTN, hyperkalemia and myoglobinemia are characteristic.

treat: Dantrolene - acts on the ryanodine receptor and prevents further release of C into the cytoplasm of muscle fibers

12

Treatment of choice for early < 6 weeks ectopic pregnancies?

Methotrexate
-irreversibly inhibits DHF recutase
recall folic acid --> DHF--> THF
-MTX inhibits DHF --> THF
-thus we have a build up of DHF polyglutamate

13

Watch out for bblockers and non-dihydropyridine-type Ca channel blockers (verapamil, dilitiazem) when used concomitantly can cause

additive negative effects on HR, AV node conduction and myocadrial contractility.
-sinus brady and hypotension may occur

14

Daptomycin is a lipopeptide antibiotic

-disrupts the bacterial membrane through the creation of transmembrane channels. These channels cause leakage of intracellular ions leading to depolarization of the cellular membrane and inhibition of macromolecular (DNA, RNA and protein) synthesis which ultimately leads to cell death.

Treat:
-limited to gram-postive including MRSA!

tox:
-associated with increased creatine phosphokinase (CPK) levels and an increased incidence of myopathy

15

coronary sinus is where the coronary veins drain to before entering the RA. They have less O2 than systemic blood returning

-myocardial oxygen extraction exceeds that of any tissue or organ the body.
-resting myocardium extracts 75-80% of the oxygen present in the blood, while myocardium at work extracts up to 90% of oxygen from the blood.

16

What bone cancer is the most commonly assoc with retinoblastoma?

osteosarcoma
-metaohysis of long bones, most often around knee
-codman triangle
-sunburst pattern on xray
-now better seen on MRI as a heterogenous mass with periosteal elevation

17

What are the key growth factors that promote angiogenesis?

-VEGF and FGF
-proinflammatory cytokines IL-1 and INF-gamma can indirectly promote angiogenesis though increased VEGF expression

18

TNF-alpha was shown to induce a wasting syndrome (cachexia) in experimental animals

-it is thought to mediate paraneoplastic cachhexia in humans by suppressing appetite, inhibiting lipoprotein lipase and increasing insulin resistance of peripheral tissues

19

cluster headache

-severe, episodic, unilateral periorbital and temporal pain associated with lacrimation, nasal congestion and ptosis.
-classically occur at the same time each day and are more common in males

20

PCOS hormonal dysregulation

-progesterone deficiency, acyclic estrogen production, and elevated LH level). The effects of abnormally high levels of unopposed estrogen on the endometrium increase the long-term risk of endometrial hyperplaisia and endometrial adenocarcinoma

21

Enterobiasis is the most common helmithic infection in the US, occuring most frequently in school children age 5-10 years

pinworm: Enterobius vermicularis

-scotch tape test
-pruitis perianal area

treat:
albendazole and mebendazole

22

recurrent lobar (cerebral hemispheres) hemorrhages in an elderly patient most likely results from cerebral amyloid angiopathy

-this condition occurs when B-amyloid is deposited into the arterial wall, resulting in weakening of the wall and predisposition to rupture.
-asoc with advanced age

23

lithium side effects

-hypothyroidism
-nephrogenic diabetes insipidus