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Flashcards in pathophysiology Deck (95):
1

diet supplement to improve homocysteinuria

B6 (homocysteinuria is often a deficiency of cystathionine synthetase, which requires pyridoxine as a cofactor)

2

viral phenotypic mixing

co-infection of a host cell by two viral strains resulting in progeny virions that contain nucleocapsid proteins from one strain and the genome of the other. No change in genome so progeny will revert to original, unmixed phenotypes

3

urethritis, conjunctivitis, arthritis

triad of reactive arthritis (type of spondyloarthropathy)
-symptoms manifest following a primary infection

4

2 sequelae of subarachnoid hemorrhage

rebleeding
secondary vasospasm (prevent with nimodipine)

5

why do kids squat when they have tetralogy of fallot

squatting cuts off some of the circulation to legs which increases resistance in left heart. The increasing pressure then limits the right to left flow through the VSD.

6

Eisenmenger syndrome

reversal of shunt to right-left (occurs with increasing pulmonary hypertension that increases right-sided heart pressures that overcome left)

7

how to tell the difference between myasthenic and cholinergic crisis in pts with myasthenia gravis

administer edrophonium (Tensilon test)
- clinical improvement indicates the pt is undertreated (myasthenic crisis) and meds should be increased
- no improvement indicates cholinergic crisis (too much meds)

8

coronary steal

phenomenon in which blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas
- can lead to hypo perfusion and worsening of ischemia
- drugs like adenosine and dipyramidole
- used in myocardial perfusion imaging to simulate coronary vasodilation induced by exercise

9

erythema infectosum

fifth disease (parvoviridae)

10

only non-enveloped, single stranded DNA virus

parvoviridae (fifth disease)

11

complication of ulcerative colitis presenting with signs of shock

toxic megacolon
- diagnose with X-ray
- risk of perforation
- usually along transverse colon

12

pulsus paradoxus

decrease in systolic BP greater than 10 with inspiration
- acute cardiac tamponade, restrictive cardiomyopathy
- constrictive pericarditis, severe obstructive lung disease

13

pro-carcinogens are metabolized into carcinogens by...

cytochrome p450 system (microsomal monooxygenase)

14

pathogenesis of centriacinar emphysema

chronic, heavy smoking causes release of proteinases, especially elastase, from infiltrating neutrophils and alveolar macrophage

15

true vs. false diverticuli

true contain all parts of intestinal wall but false don't have muscle component
- true: meckel's, appendix
- false: colon diverticuli, Zenker's

16

hypoglycemia following prolonged fasting (>24 hrs) with low ketones

think beta-oxidation enzyme deficiency (vs. glycogen storage disorder)

17

which non-essential amino acid becomes essential in phenylketonuria?

tyrosine (need to supplement)

18

atypical/malignant phenylketonuria

deficiency of dihydriopterin reductase
- responsible for reduction of BH2 to BH4
- BH4 is a cofactor for many enzymes in tyrosine pathway

19

silicosis impairs what cell type?

macrophage due to internalized silicon particles

20

cause of low calcium following blood transfusion

calcium chelation by citrate coagulation in whole blood/packed RBC blood transfusions

21

cysteinuria defect and only clinical manifestation

- defect of transporter of cysteine, ornithine, lysine and arginine
- chronic nephrolithiasis

22

3 causes of HIV-associated esophagitis

candida, HSV-1, CMV

23

pelvic fracture and inability to void in male suggests....

urethral injury, usually at membranous urethra (weakest point)
Foley catheter contraindicated

24

glomangioma

- benign bluish lesion under the nail bed
- originates from smooth mm. cells that control the thermoregulatory function of dermal glomus bodies

25

reperfusion injury

paradoxical death of cells via apoptosis or necrosis after blood flow restored
- can cause oxidative damage, cell membrane damage, mitochondrial damage, complement and inflammation

26

chronic diseases associated with amyloidosis

AL - multiple myeloma. nephrotic syndrome
AA - RA, IBD, spondyloarthropathy

27

ligating the inferior thyroid artery can damage which nerve?

recurrent laryngeal nerve

28

most common cardiac defect in Down's

endocardial cushion defects

29

special types of necrosis

liquefactive = CNS
fat = acute pancreatitis
caseous = TB

30

most common tumor of pineal gland

germinoma
- kids/adolescents, males more
- precocious puberty, impaired upward gaze, possible obstructive hydrocephalus all due to mass effect

31

test for hereditary spherocytosis

osmotic fragility test (do RBCs lyse in hypotonic soln?)

32

fundoscopy for diabetic retinopathy

"cotton wool" exudates, retinal hemorrhages, new vessel formation

33

2 tumors of cerebellum

medulloblastoma and pilocytic astrocytoma

34

superior vena cava syndrome

MOA: obstruction of SVC that impairs blood drainage from head
S/S: swelling of face/neck, dilated collateral vv., elevated ICP possible
- medical emergency

35

heteroplasmy

coexistence of both mutated and wild type versions of mitochondrial genomes in an individual cell

36

holosystolic murmur that increases with inspiration

tricuspid regurgitation (more venous return causes increase with inspiration)

37

CREST syndrdome

type of scleroderma
Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia

38

toe gangrene, renal failure following invasive procedure

artheroembolic renal disease (cholesterol crystals in arteriole lumen)

39

myxomatous degeneration

pathological weakening of connective tissue
- associated with Marfan's, aortic aneurysms, mitral prolapse

40

alpha-1 antitrypsin deficiency associated with

panacinar emphysema DON'T SMOKE

41

MOA alpha-1 antitrypsin deficiency

A1AT main role is to protect lungs from neutrophil elastase (breaks down elastase, also found in alveolar macrophage)

42

pathophysiology of tertiary syphilis aneurysm

obliterative endarteritis of the vasa vasorum

43

CD55/59 deficiency on RBC
venous thrombosis (ie: hepatic vein)
pancytopenia

paroxysmal nocturnal hemoglubinuria
MOA: complement-mediated RBC lysis due to impaired GPI anchor for decay-accelerating factor that protects RBC membrane from compliment)
tx: eculizumab

44

porcelain gallbladder

diffuse gallbladder calcification
- usually an incidental finding
- 11-33% will develop gallbladder carcinoma
- recommend cholecystectomy

45

thalamic syndrome

total sensory loss (not motor) on contralateral side of body

46

hydrocele MOA

MOA: incomplete obliteration of processus vaginalis forming a connection between scrotum and abdominal cavity that allows for fluid leakage

47

mechanism of panic attacks

hyperventilation causes decreased PCO2, hypercapnia causes vasoconstriction and decreased cerebral blood flow (dizziness, weakness, blurred vision)

48

how to tell in an elevated alk phos is of bony or liver origin

follow up with gamma-glutamyl transpeptidase (GGTP)
- will be elevated if biliary/liver origin

49

hemiballism occurs due to a lesion where?

contralateral subthalamic nucleus (often due to lacunar strokes)

50

origin of small cell lung tumors

neuroendocrine (will stain for neuroendocrine markers)

51

murmur heard with intracardiac shunt

splitting of S2 (no change with respiration)

52

solvent that can inactivate enveloped viruses

ether

53

pathophys of Janeway lesions

emboli of fragments of infected intracardiac vegetations

54

enzyme to screen for carcinoid tumors

5-hydroxyindoleacetic acid (breakdown product of serotonin)

55

scotoma

area in visual field that is diminished
central or arcuate (arc shape)
due to lesions on macula

56

ectopy definition

microscopically and functionally normal tissue found in an abnormal location due to embryonic maldevelopment (i.e.: Meckel's)

57

recurrent pulm/sinus infections
ataxia
telangectasias

ataxia-telangiectasia (defect in ATM gene responsible for repairing double strand DNA breaks)

58

MOA stable vs unstable angina vs prinzmental

stable: fixed plaque occluding >75% of coronary a. lumen
prinzmetal: vasospasm
unstable: ulcerated plaque with partially obstructive thrombus

59

increased activity of what enzyme may contribute to colon adenocarcinoma

COX-2 (over expression)

60

hemoglobin S aggregates in which conformation

deoxygenated/taut form (curve shifted to right)

61

pathophysiology of nondestructive fibrinous vegetations on cardiac valve cusps

nonbacterial thrombotic endocarditis (NBTE)
-hypercoagulability caused by procoagulant effects of circulating products of cancers

62

red neurons

first microscopic change following ischemic brain injury
- 12-24 hours
- will be phagocytized by macrophage

63

pathophysiology of diabetic mononeuropathy

ischemic nerve damage
- in CNIII damage, peripheral nerve is spared, core damaged so motor function impaired but not pupillary size and reactivity

64

heart problems associated with carcinoid syndrome

right-sided valvular heart disease (tricuspid, pulmonary)

65

free air in the biliary tree

fistula forms between gallbladder and small intestine
- can lead to obstruction of ileoceccal valve

66

serum autoantibodies highly specific for RA

anti-cyclic citrullinated peptides (rheumatoid factor is not specific)

67

vitamin deficiency that mimics Friederich ataxia

vitamin E

68

pulsus paradoxus

seen with cardiac tamponade
- drop of > 10 mmHg on inspiration
- radial pulse disappears with inspiration

69

structure commonly injured in anterior or posterior dislocations of knee

popliteal artery (tibial nerve more likely injured with tibial fracture)

70

skin condition associated with celiac disease

dermatitis herpatiformis

71

heart problems in DiGeorge

great vessel defects: persistent truncus arteriosus, Fallot, interrupted aortic arch

72

most common cause of death from MI before hospitalization

ventricular fibrillation precipitated from ischemia

73

most common cause of death from MI in hospital

ventricular failure/contractile dysfunction

74

most common cardiac manifestation of SLE

pericarditis (sharp pleuritic pain relieved by leaning forward)

75

medulloblastoma vs pilocytic astrocytoma on imaging

medulloblastoma is solid but pilocytic astrocytoma is solid and also cystic

76

S. bovis endocarditis is associated with....

colon cancer

77

kidney stones that are radiolucent

uric acid stones (all others radioopaque), use ultrasound to visualize

78

where do clear cell carcinomas originate?

epithelial cells of proximal renal tubule

79

ezcema
thrombocytopenia
recurrent infections

Wiskott-Aldrich syndrome
- X-linked
- tx: bone marrow transplant

80

order of cardiac AP velocity (fastest to slowest)

"Park AT VENTura Avenue"
Purkinji system, atrial mm., ventricular mm., AV node

81

cell type that prevents hematologic spread of candida

neutrophils (T cells responsible for fighting local infection only)

82

myotonia (abnormally slow relaxation)
frontal baldness
cataracts
testicular atrophy

myotonic dystrophy
- CTG repeat expansion
- abnormal expression of myotonin protein kinase

83

AML vs ALL (stains)

AML: auer rods stain positive for myeloperoxidase
ALL: TdT

84

psammoma bodies

papillary CA of thyroid
meningioma
mesothelioma
serous endometrial CA

85

nerve commonly injured during thyroidectomy

superior laryngeal (innervates cricothyroid mm.)

86

renal papillary necrosis diseases

"SAAD papa"
- Sickle cell disease/trait, Analgesics, Acute pyelo, DM
- from ischemia, causes hematuria

87

S-100 positivity

tumors of neural crest origin (melanoma, schwanomma, etc.)

88

proto-oncogene examples

ras, ERB, N-myc, abl (anti-oncogenes: Rb, WF-1, p53, APC, BRCA)

89

3 ways to get Down's

1. meiotic nondisjunction
2. unbalanced Robertsonian translocation
3. mosaicism

90

BRAF mutation

melanoma (signaling pathway for melanocytes)

91

dysthymic disorder

less severe than major depressive disorder
- only 4 or fewer symptoms present (> 5 for MDD)
- must be present at least 2 years

92

uptake of promodeoxyuridine indicates...

high grade in brain tumor (reflects number of cells in S phase - preparing to divide)

93

first area damaged by global cerebral ischemia

hippocampus (pyramidal cells) followed by purkinje cells of cerebellum

94

chronic diarrhea
bacterial and viral infections
mucocutaneous candidiasis

SCID

95

parinaud syndrome

paralysis of conjugate vertical gaze due to lesion in superior colliculi (ie: pinealoma), upward gaze palsy