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Flashcards in Quiz 4 Deck (169):
1

What is Wilms tumor?

It is a nephroblastoma, a renal tumor found in children, and most common in first 3 years. It is the most common congenital tumor.

2

Disulfiram

Used to treat Alcoholism. Inhibits ALDH (aldehyde dehydrogenase) with resulting ↑ acetaldehyde after drinking. Abstinence is reinforced to avoid the resulting adverse reaction.

3

A fetus has severe oligohydramnios and bilateral enlarged kidneys by ultrasound. At birth, there is severe pulmonary hypoplasia, resulting in nearly immediate death. The kidneys are large, but have the normal renal shape. This baby is likely to have: A. Autosomal dominant polycystic renal disease. B. Autosomal recessive polycystic renal disease. C. Renal dysplasia.

B

4

What are the requirements for chronic bronchitis?

Persistent productive cough for 3 months in 2 consecutive years, and it is caused by smoking, air pollution and has hypersecretion of mucus by airways and infections are often secondarily present. If the mucus glands get expanded and reach greater than 40$ to the epithelium, than it suggests chronic bronchitis - Reid index.

5

What is primary and secondary hemostasis?

Primary involves platelets, • Typically initiated by injury • Adherence to subendothelium by interacting with von Willebrand factor - Secrete contents of granules • Aggregate with other platelets and form surface for coagulation cascade - Provide a procoagulant surface for the coagulation cascade Secondary involves the coagulation cascade-fibrin formation • Coagulation cascade (factors mostly made from liver) • Cascade of activating enzymatic conversions • Fibrin and platelet aggregates form stable clot a. Factors II, VII, IX and X are vitamin K-dependent-necessary for calcium binding sites activating coagulation cascade b. For final step thrombin catalyzes fibrinogen (soluble) to fibrin (insoluble) [note: thrombin acts at other levels of the cascade]. Fibrin cross-links form under the influence of Factor XIII

6

What are the pharmacokinetics behind alcohol?

It exhibits passive diffusion, gets everywhere, food slows its absorption, it is distributed everywhere, even through placental barrier and breast milk. it exhibits zero order kinetics, meaning constant rate, and independent of original concentration.

7

What is COPD?

Chronic Obstructive Pulmonary Disease. Includes emphysema, chronic bronchitis, asthma, bronchiectasis, and the main cause is cigarette smoke.

8

What can cause thrombocytopenia?

• Decreased bone marrow production • Hemodilution due to multiple transfusions • Immune reaction due to platelet autoantibodies directed at platelet surface proteins

9

What are the common organisms that cause pulmonary fungal infections?

Histoplasma (Ohio River Valley), Coccidiodes (Valley fever, Utah), Blastomycoses

10

What are some of the inherited coagulable states?

• Some aspect of cascade abnormal • Factor V Leiden-single nucleotide point mutation in coagulation factor V. Interferes with an anticoagulant factor, thus increasing formation of fibrin and becoming “prothrombic.” The mutation makes factor V resistant to cleavage and inactivation by activated protein C.

11

What are the basic tests used to evaluate hemostasis?

• Platelet count (part of CBC-complete blood count) Coagulation cascade: • Prothrombin time-PT (12-15 seconds). Extrinsic and common pathways through factor VII • Partial thromboplastin time-PTT. Measures intrinsic and common pathways and includes factors XII, XI, X, VIII • Fibrinolysis • Prolonged coagulation tests may be due to deficiency or inhibitor of a coagulation factor

12

What are some differences between inherited and acquired abnormalities in coagulation factors?

Inherited usually affect a single coagulation factor, Von-Willebrand disease (associated with factor VIII-get increased bleeding, hemophilia A and B. ), Hemophilia A (factor VIII) and B (factor IX - Christmas Disease): Have prolonged PTT and normal PT and platelet count: severe hemorrhaging internally/organs and soft tissue or into joints Acquired usually affect multiple coagulation factors, liver disease, vitamin K deficiency, DIC

13

How are influenza viruses classified and what are the main treatments?

They are classified by their core proteins, A, B, or C, species of origin, and geographic site of isolation. Most antiviral drugs for influenza have activity for influenza A. • Oseltamivir (Tamiflu)-prevents separation of virus particle from cell receptors, stopping viral spread—earlier treatment essential (can decrease the duration of flu 1-2 days)-works against type A and B flus.

14

A 31-year-old otherwise-healthy man presents with severe renal colic, with intermittent mild gross hematuria. He takes megadose vitamin C supplements. Abdominal films show a ureteral calculus. The stone is passed in the urine, and is analyzed chemically. What is the most likely composition? A. Urate. B. Cystine. C. Calcium oxalate. D. Struvite.

C

15

What does smoking do to alpha-1-antitrypsin?

It inhibits it, so trypsin goes uncontrolled and destroys particles in lungs and good tissue in lungs.

16

What are the main organisms that cause Community Acquired Pneumonia?

S. pneumoniae, H, influenzae, S. aureus.

17

Acamprosate

Used to treat Alcoholism. Weak antagonist of NMDA receptors, activator of GABAA receptors; may ↓ mild protracted abstinence syndromes with ↓ feelings of a "need" for alcohol.

18

What are the symptoms of urinary stones?

Renal Colic, hematuria, pyelonephritis, or asymptomatic

19

Dabigatran

Is an alternative drug for warfarin, has fewer side effects and is more popular than heparin or warfarin, it affects PTT sensitive pathway, but has unique mechanisms that makes it distinct from heparin and warfarin, used on out patient basis.

20

What do antimuscarinics do for Asthma?

During an asthma attack, ACh is released from the vagus nerve. Antimuscarinics like ipatroprium bromide reverses the contraction of airway smooth muscles and production of mucus caused in response to this vagal activity.

21

What are the main features of Benign Prostatic Hyperplasia?

• Very common in older men; 95% > 75 years old • Serious sequelae less common • Cause not well known; perhaps has to do with androgens or even estrogens • Urinary obstruction is common-bladder can’t empty completely • 10% require surgery to relieve

22

What does a prostatic massage reveal?

leukocytes

23

Albuterol

Fast acting reliever, the only true "rescue" reliever, acts within 15 minutes and is effective for 4-6 hours. directly relax airway smooth muscle and bronchodilate.

24

What is the difference between centrilobular emphysema and panacinar emphysema?

Cintrolobular is smoking-related, and panacinar is alpha-1-antitrypsin related.

25

When does urinary obstruction cause severe, irreversible renal damage if it is a complete obstruction? Partial?

3 weeks, 3 months

26

Newborn with large renal mass composed of benign- appearing spindled cells. What is it?

Mesoblastic nephroma

27

What is disulfiram?

-Disulfiram acts as a deterrant and when people drink it they feel awful so it tries to keep individuals from consuming large amounts. -Asians can turn red when they drink, they don’t have as much aldehyde dehydrogenase

28

Allopurinol

Reduces the amount of uric acid produced in patients with uric acid stones, also used for gout.

29

What does MCV stand for?

Mean Corpuscular Volume = size of RBC

30

What is pyonephritis?

Severe pyelonephritis of entire kidney, uncommon, seen with obstruction

31

How do you treat larger kidney stones (>cm)?

• Lithotripsy (shock wave treatment)-break up stones • Surgical removal • Opioid analgesics for pain

32

An adult who died of unrelated causes is found to have one small kidney (the other kidney, while slightly enlarged, is essentially normal). The small kidney has several cysts in it, some loose mesenchymal tissue, and cartilage. This patient has: A. Autosomal dominant polycystic renal disease. B. Autosomal recessive polycystic renal disease. C. Renal dysplasia.

C

33

Where is iron primarily absorbed?

In the duodenum

34

What is the basic pharmacology of alcohol?

Ethanol, small molecule, gets everywhere in the body, depressant, barbiturate-like.

35

What are the normal percentages and numbers for a WBC?

Normal WBC (3500-10,000 cells/microliter) differential: Neutrophils- 1800-6700 (55%) Eosinophils-0-570 (3%) Lymphocytes- 1400-3900 (35%) Monocytes 6% Basophils 0.5% •Note: pay attention to both total and percent

36

What is the leading cause of cancer deaths in the world for both men and women?

Lung tumors. 95% of primary lung cancers are carcinomas.

37

What are the main adverse effects from alcohol consumption?

Cancer -Increased risk in mouth, esophagus, increase GI cancer, increase liver cancer Malnourishment - Worse if you smoke, Vitamin deficiencies Fetal Alcohol Syndrome - facial abnormalities, impaired cognition, joints/bone problems Hang-Over --Headache, Nausea, Vomiting, Dehydrated

38

What is macrocytic anemia and what causes it?

Macrocytic (too many cells) • Liver disease • Drugs • Vitamin B12 or folate deficiency-often includes neurological findings (paresthesia, weakness,dementia) (These two are megaloblastic anemia)

39

A 62 year old female presented with anemia and fever. Peripheral blood examination identified 35% myeloid blasts. This patient is diagnosed with A) chronic lymphoid leukemia B) acute lymphoblastic leukemia C) acute myeloid leukemia D) chronic myeloid leukemia

C

40

What are the characteristics behind prophylactic antibiotics for dental procedures?

• Use for procedures associated with bleeding • Typically administer 30-60 min prior to procedure • Recommended: -amoxicillin or cefazolin preferred -clindamycin

41

34-year-old renal transplant patient with large left kidney. It is yellow and has no areas of necrosis. Histologically, it is composed of foamy macrophages containing abundant bacteria. No Michaelis-Guttman bodies are seen. What is it?

Xanthogranulomatous pyelonephritis

42

What greater risk number do smokers have of developing lung cancer?

10-55X, squamous cell and small cell most closely tied to smoking.

43

What are the characteristics of the serum PSA testing?

PSA (prostate specific antigen)-only associated with prostate tissue • >4-6 mg/ml is abnormal (usually higher with age) • Rapidly increasing PSA means high risk for cancer • The more PSA bound to alpha-1-antichymotrypsin, the greater the risk of cancer (should be free in plasma) - PSA is also elevated in BPH and cancer

44

What causes 80-90% of all renal malignancies?

Renal cell carcinoma

45

What are the characteristics associated with the extrinsic pathway dealing with clotting through fibrin mechanisms?

• Extrinsic factors pathway (i.e. from damaged tissue)-works through factor VIIa and leads to Xa and is measured by PT (Prothrombin time)/INR (international normalized ratio) • Normal PT is 11-13.5 seconds • Normal INR is 0.8-1.1 • Sensitive to warfarin (Coumadin) or -side effects: hemorrhage, numbness, pain, headache, dizziness -oral warfarin is prescribed for out patient

46

Penicillamine

Chelating agent that binds to cystine and improves its solubility in patients with cystine stones.

47

What is bacterial cystitis and what does it cause?

It is pyuria, dysuria, positive culture, and you get edema and neutrophils in mucosa.

48

What percentage of chronic renal failure does pyelonephritis cause?

10-20%

49

What does Hemodialysis do?

It removes waste and excess water from blood through diffusion (waste removal) and ultrafiltration (fluid removal) and restores proper electrolyte balance, but does not correct kidney's endocrine functions like producing EPO.

50

Although rare, what are some of the side effects associated with statins?

rare: elevate blood sugar, cognitive problems, muscle weakness, G.I irritation

51

Cellular polypoid bladder tumor in 6-year-old girl. What is it?

Rhabdomyosarcoma

52

Montelukast

Selective leukotriene receptor antagonist (leukotrienes are associated with the pathophysiology of asthma (airway edema, smooth muscle contraction)). Used for prophylaxis and chronic treatment of asthma. So this blocks the synthesis of leukotrienes, this would be good for patients who comply poorly to inhaled therapies.

53

What is sarcoidosis?

It is also a restrictive lung disease, believed to be driven by anormally stimulated CD4+ helper T cells. Abnormal connective tissue and reduced elastic properties; multi-organ involvement.

54

Acetohydroxamic Acid (AHA)

Used for kidney stones, is an irreversible inhibitor of bacterial urease, which will prevent formation and slow growth of struvite crystals, but has many side effects like increasing risk of phlebitis, deep venous thrombosis, and hemolytic anemia.

55

In terms of pulmonary pharmacology, what are relievers?

They are rapid bronchodilators (Beta-2 agonists), used at minimum dose and frequency. They are short-acting, for less severe cases. Drugs include albuterol and salmaterol.

56

What is Virchow's triad?

1. Endothelial injury 2. Abnormal blood flow (stasis, turbulence) 3. Hypercoagulability of blood (acquired or inherited factors) -These are things that can cause pathological clotting

57

What is bronchiectasis?

Results from obstruction of the bronchi and persistent necrotizing infections. You get destruction of elastin and muscles in bronchial walls-congenital expression often caused by cystic fibrosis. You get persistent productive cough, and the infection which causes the suppurative pneumonia is usually caused by TB, Staph, Klebsiella (Alcoholics).

58

Bupropion

Is a tetracyclic antidepressant that also helps people quit smoking. Smoking cessation name is Zyban.

59

How do you treat small kidney stones (

• Drink considerable water • Dietary changes • OTC analgesics (ibuprofen, Naprosyn) • Tamsusolin (Flomax)—relaxes ureter muscle (often have spasm due to irritation of the stone)

60

What do leukotriene modifiers do for Asthma?

Use is for prophylaxis and chronic treatment-for patients who have trouble with inhaled therapies (e.g., nasal bleeding)-can take orally-especially good for aspirin-induced asthma. Montelukast is an example drug. Mechanism: block leukotriene-binding to receptor.

61

What is microcytic anemia and what causes it?

Microcytic (too few cells) • Iron deficiency (most often caused by hemorrhaging)-often has glossitis • Lead poisoning

62

What are the natural anticoagulants and what do they do?

Protein C, protein S, and antithrombin. They inactivate activated coagulation factors and prevent growth of existing clot.

63

What are the four main types of kidney stones?

1. Calcium oxalate (75%) 2. Magnesium ammonium phosphate (struvite, triple phosphate, 15% stones, alkaline urine) 3. Uric acid stones (5%), half are gout associated 4. Cystine stones (5%), defective tubular transport of cystine

64

Ipatroprium Bromide

Is an antimuscarinic used to treat Asthma and specifically bronchospasms, related to Tiotropium Bromide-(Spriva)-which is not approved for asthma, but is approved to treat COPD) –reverses contraction of smooth muscle from vagal activity-usually backup for beta 2 agonists-sometimes combine antimuscarinics with β2 agonists (eg, albuterol). Reversible blockade of acetylcholine by antimuscarinics prevents the release of IP3 and prevents the inhibition of ACh at postganglionic muscarinic receptors. • Side effect of dry mouth • Used as an inhalant for bronchospasms

65

73-year-old male smoker with intermittent hematuria and a small tan papillary bladder mass. Histologically, there are small papillary structures but the papillae are coated by benign-appearing urothelial cells. Urine cytology is negative. What is it?

Transitional Cell Papilloma

66

What are the features of platelets?

• Anucleated • Lifespan ~10 days • Circulating platelets do not adhere-during stasis, adhesion occurs

67

What is platelet-type bleeding and what causes it?

Mucocutaneous bleeding pattern from like skin and mucous membranes, petechiae, ecchymoses, epistaxis, GI bleeding are examples. Causes include vascular abnormalities, thrombocytopenia, qualitative platelet dysfunction, von Willebrand disease (interferes with von Willebrand factor preventing clot from adhering to endothelium and clot formation).

68

What is the definition of acute myeloid or lymphoid leukemia?

• No evidence of maturation in blood or marrow • >20% blast (immature) cells • Can have skin and gum infiltration

69

What are the main causes of COPD?

• Long smoking hx, or exposure to environmental irritants • Airflow limitations-due to progressive, irreversible airway remodeling • Not fully reversible in contrast to asthma which can be at least partially reversible

70

68-year-old male smoker with 9 cm diameter renal mass. He presented with dull flank pain, low grade fever, and polycythemia. What is it?

D - Renal Cell Carcinoma

71

Which two organisms that cause pneumonia in the immunocompromised often demonstrate blood vessel invasions?

Aspergillus and Mucormycosis. Aspergillus histo has acute angled branching/septa.

72

What are the types and what can cause occupational lung diseases?

They are restrictive, and are mineral dust induced lung injury and fibrosis (restrictive), e.g., mineral dust-induced, silicosis [inhalation of crysalline silica by sandlblasters and miners], asbestosis [mesothelioma].

73

What are the main causes of chronic renal disease?

Diabetes, Hypertension (-aterionephrosclerosis caused by hypertension or diabetes -hyaline thickening of arterioles), Chronic Glomerulonephritis (can be acute or chronic

74

What are some symptoms that Alcoholics get when they try and withdraw?

Anxiety, insomnia, temor, nausea, palpitations, anorexia, seizures and hallucinations within first 1-4 days, delirium tremens (tachycardia, hypertension, fever, diaphoresis, delirium, agitation).

75

What are the different types of leukemia?

Acute vs. Chronic, and Lymphoblastic vs. Myeloid. Acute means blastic phase, early on, if you have 20% blast, then you can call it lymphoblastic acute leukemia.

76

What are symptoms of a urinary obstruction?

Anuria, polyuria, bladder distention, sometimes asymptomatic.

77

Omalizumab

Drug used to treat asthma, considered a monoclonal antibody. Inhibits IgE binding to mast cells-very expensive, only for severe non-responsive asthma. This is reserved for patients with chronic severe asthma inadequately controlled by high dose corticosteroid plus long-acting beta-2 agonist combination treatment who have been shown to have IgE mediated sensitivity.

78

A 56-yearold man has hypertension and has developed slowly progressive renal failure, and his kidneys are 25 cm long (twice normal) and are deformed by innumerable large round cysts. Intermittently, he has had renal pain and hematuria. He is likely to have: A. Autosomal dominant polycystic renal disease. B. Autosomal recessive polycystic renal disease. C. Renal dysplasia.A

A

79

What are the main reasons why individuals use, abuse, or become alcoholics?

Self medication, anxiety, depression, altered mental state, increased dopamine reward, genetics (50%, the other 50% is environment)

80

Amoxicillin + Clavulonic Acid

Used for UTI's, is a beta-lactam, but resistant bacteria can be a problem.

81

Cromolyn

This drug is considered a mast cell stabilizer, is used to treat asthma, inhibits release of inflammatory mediators such as histamine (mast cell stabilizer). Prophylactic use often before exercise and allergen exposure—no rescue action (i.e., not a replacement for albuterol).

82

What causes pulmonary hypertension and what are the consequences?

Causes: heart disease, recurrent thromboemboli, and it can cause cor pulmonale- right ventricular failure.

83

What are the lab values for LDL's?

189 very high

84

What are two antifungal treatments that help with candidiasis associated with using steroids for asthma?

1. Fluconazole 2. Clotrimazole

85

What is thrombosis?

The pathologic counterpart of hemostasis and also involves vessels, platelets, and the coagulation cascade.

86

Fluticasone

Inhaled steroid for controlled asthma, prevents transcription of inflammatory mediators in the nucleus, resulting in a decrease in inflammation. Side effects: nose bleeds, sores in nose, mouth, tongue that don’t heal, oropharyngeal candidiasis (thrush), interfere with growth in children.

87

What kind of drugs are considered asthma controllers?

]Take regularly for long-term stable control-often more side effects Inhaled: corticosteroids/drug of choice for moderate to severe asthma -often combine with β 2 agonists, e.g., fluticasone + salmeterol (Advair Diskus) -chronic management, not for rescue

88

What are signs of restrictive lung diseases?

Reduced lung compliance, more effort required to expand lungs, leading to dyspnea, "ground-glass" infiltrates, fibrosis is common.

89

In what population is renal cell carcinoma most popular?

Male, >40, smoker, analgesic users, obesity

90

In which population is asthma the greatest?

In children, especially women.

91

What three things are associated with bleeding disorders?

1. Abnormal vessels 2. Decreased platelets or platelet dysfunction 3. Abnormal coagulation factors

92

What are the organisms typically involved with UTIs?

E. coli, then Staph and Klebsiella.

93

What usually causes prostatitis?

Often caused by bacteria, like cystitis, often seen with BPH and recurrent UTI's. And prostatitis causes enlarged and tender prostate, which can cause obstruction.

94

What is the definition of alcohol use disorder (AUD)?

AUDs are medical conditions that doctors diagnose when a patient􏰹s drinking causes distress or harm.

95

21⁄2-year-old boy with large renal mass. It is composed of small cells with scanty cytoplasm. Focally, primitive glomeruli and tubules are formed by the tumor cells. What is it?

Wilms tumor

96

What are the symptoms of renal cell carcinoma?

Often clinically silent until large, painless hematuria, dull flank pain, fever, fatigue. Most likely metastasized to lungs or bones.

97

What are the other less popular drugs used to treat hypercholesterolemia?

a. Niacin—side effects include annoying vasodilation and flushing of face b. Fibrates: e.g., gemfibrozil c. Bile acid binding resins such as cholestyramine d. Ezetimibe-inhibits intestinal absorption of cholesterol

98

What is emphysema?

It is destruction of alveolar walls leading to permanent enlargement of airspaces. Caused by smoking, alpha-1 antitrypsin deficiency (imbalance of proteases and antiproteases), air pollution. You get a barrel chest with hyperinflation, low Forced Extrctory Volume.

99

Salmeterol

Pulmonary reliever, slower onset, longer-acting reliever than albuterol, effective 12 or more hours. directly relax airway smooth muscle and bronchodilate.

100

A 43-year-old woman with recurrent cystitis (Proteus has been cultured) has developed a panful renal stone. It is large, and involved an entire renal pelvis. What is the most likely composition? A. Urate. B. Cystine. C. Calcium oxalate. D. Struvite.

D

101

What is schistosomiasis?

-infection from snails -leading cause of squamous cell carcinoma in bladder, found in urinary tract -primarily from Middle East -shitosomoiasis eggs deposited in bladder -causes obstruction, hydronephrosis, and malignant tumors

102

What are the characteristics associated with the intrinsic pathway dealing with clotting through fibrin mechanisms?

1. Intrinsic pathway • Contact factors through factor XIa to Xa-this is measured by PTT (partial thromboplastin time) • Normal PTT is 25-35 seconds • Sensitive to heparin as an anticlotting agent • Side effects: hemorrhage, allergic reactions, osteoporosis and bone fractures • Heparin typically used in hospital setting

103

What is the order in which alcohol affects the following various brain structures? Cerebellum Cerebral Cortex Hypothalamus and pituitary gland Limbic system Medulla

Cerebral Cortex Limbic system Cerebellum Hypothalamus and pituitary gland Medulla

104

What are the main treatments for COPD?

• Longer acting bronchodilators such as Tiotropium Bromide (Spireva) • Longer acting beta 2 agonists such as Salmeterol • Theophylline with glucocorticoids (glucocorticoids alone not very effective) • Typically responses not as good as with asthma

105

Amantadine

An antiviral and a weak anti-Parkinson drug, effective against influenza A but not influenza B.

106

What are the three main types of lung diseases and a summary of each?

1. Restrictive: caused by fibrosis or chest wall abnormalities; gas exchange impaired; difficulty inhaling and expanding lungs 2. Vascular: gas exchange impaired by obstruction or hemorrhage; may be abrupt or insidious 3. Obstruction: blocked airways; gas exchange through septal walls not impaired; unable to exhale

107

What are the drugs commonly administered to patients on dialysis?

1. Atenolol (beta-1 selective antagonist) reduces hypertension and lowers heart rate. 2. Captopril (ACE inhibitor) reduces hypertension. 3. Heparin - anticoagulant which prevents the formation of clots in blood passing through the dialysis machine. 4. Furosemide - A loop diuretic used before to reduce fluid retention and amount of fluid that has to be removed during treatment. 5. Prophylactic antibiotics - prevent infection. Kidney disease patients or on dialysis have higher incidence of periodontal disease and are at greater risk of infections because of weakened immune systems.

108

What are the most common drug interactions involving alcohol?

-The most common pharmacokinetic alcohol-drug interactions stem from alcohol-induced increases of drug- metabolizing enzymes. -Prolonged intake without damage to the liver can enhance the metabolic biotransformation of other drugs (i.e., induction of hepatic cytochrome P450 enzymes is particularly important with regard to acetaminophen, as it increases risk of hepatotoxicity as a result of conversion of acetaminophen to reactive hepatotoxic metabolites.) -Acute alcohol use can inhibit metabolism of other drugs because of decreased enzyme activity or decreased liver blood flow (i.e., phenothiazines, tricyclic antidepressants, and sedative-hypnotic drugs). -Additive/synergistic CNS depression if combined with other CNS depressants, particularly sedative-hypnotics -Potentiation of vasodilators and oral hypoglycemic agents (can also cause flushing)

109

What are some of the main acquired hypercoagulable states?

• Surgery/trauma • Limb immobilization • Bedridden • Long-distance air travel • Pregnancy • Advancing age • Oral contraceptives

110

A 68-year-old man with urinary hesitancy and slow urinary stream, often has to get up twice a night to urinate. He presents to a urologist, and is found to have a moderately enlarged but not hard prostate. PSA is 4.2. Free PSA is 9%. The urologist decides to do a transrectal biopsy. What in this history is most concerning for a prostatic adenocarcinoma, which prompted the urologist to do the biopsy? A. His high PSA. B. His low free PSA. C. His large but not hard prostate. D. His urinary obstructive symptoms.

B

111

What is ARDS?

Acute Respiratory Distress Syndrome - and it is progression of acute injury and damage from activated neutrophils.

112

What are the characteristics of Tuberculosis?

D. Tuberculosis-caused by mycobacterium tuberculosis 1. Usually lungs but can affect other organs 2. Flourishes in crowded, impoverished areas 3. Non-contagious during long periods of dormancy 4. Problems with multidrug antibiotic resistance 5. Forms necrotizing granulomas

113

What is pyelonephritis?

Due to retrograde spread from cystitis or hematogenous spread, commonly seen with urinary obstruction, stenosis, can cause flank pain, fever, or asymptomatic, it is more severe in diabetics and with obstruction, can cause scarring.

114

What is the most common bladder malignancy in children?

Rhabdomyosarcoma

115

What are the two main types of lymphoma?

• Non-Hodgkin lymphoma (indolent to very aggressive: survival is years to weeks depending on type). Two examples are follicular lymphoma and diffuse large B cell lymphoma • Hodgkin lymphoma (all types-curable in most)

116

What is a WBC?

The total white blood cell count (WBC, leukocyte count) includes all circulating nucleated hematopoietic cells with the exception of nucleated red blood cells (NRBCs). The WBC is of great importance in the diagnosis and management of patients with hematologic and infectious diseases.

117

NRTs

Nictoine Replacement Therapies. Gum or transdermal patch, action of NRTs derive from the slow absorption of nicotine which delays and limits binding at alpha-4-beta-2 receptors in the CNS to reduce cravings and the pleasurable feelings of smoking.

118

What is fibrinolysis?

It is mediated by plasmin and it breaks down fibrin clot and creates fibrin degradation products such as d-dimer.

119

What are the lab values for triglycerides?

Triglicerides: 200 high

120

Ciprofloxacin

Used for UTI's, is a 3rd generation fluoroquinolone, side effects include seizures.

121

What lobe is usually involved with aspiration pneumonia?

Right lower lobe - caustic gastric contents

122

What are the two main cell types of renal cell carcinoma?

1. Papillary (If you see a bunch of macrophages, think papillary RCC) 2. Clear cell (abundant glycogen or lipid), and you see a lot of vascular background with RBC's in clear cell RCC.

123

What is a pulmonary embolus?

Can cause sudden death if in pulmonary artery. Origin from deep veins in legs. Cause: prolonged bed rest, surgery, congestive heart failure. Small emboli can cause pulmonary hypertension.

124

Why do diabetics get nephritic syndrome because of worsening proteinuria?

They get nephrotic syndrome because they run out of the plasma proteins that they should have in their blood because of the proteinuria, and they start getting edema because of this.

125

What are the dental relevant points regarding asthma?

• Asthmatics tend to be mouth breathers—dry mouth • Asthma inhalers irritate muscosa of mouth, especially back of roof of mouth • Remember stress (such as being in a dentist office), can precipitate an asthma attack-be prepared to address • Make sure asthmatics bring inhalers to appoint: avoid asthma attacks • Steroid use can cause oral sores and candida infections (thrush)

126

What does alcohol do to the heart? Liver? Kidneys? GI?

-Their faces get flushed because it is a vasodilator -Low doses of alcohol can have some benefit, it can increase your HDL cholesterol -High doses can make you more likely to have high hypertension, more arrythmias, more coronary artery disease -Can cause liver cirrhosis -Can serve as a diuretic, decreasing ADH -Can increase GI acid secretion

127

Which adult renal tumors have a good prognosis?

Adenomas (histologically identical to papillary renal cell carcinoma, but less than 0.5 cm). Oncocytomas (generally have bland round nuclei with abundant eosinophilic cytoplasm). If you see mitochondria, think oncocytoma.

128

What are the factors that may affect CBC parameters?

• Iron deficiency • Medications • Alcohol • Infections • Gender • Pregnancy

129

71-year-old former chemical plant worker who presents with painless intermittent hematuria. Cystoscopy shows a flat red lesion in the bladder, but no papillary structures or invasive mass. Urine cytology is compatible with carcinoma. What is it?

Transitional cell carcinoma in situ

130

What is alpha-1-antitrypsin?

-it is rare, but their liver doesn’t produce antitrypsin, which helps control trypsin, which destroys particles in lungs that would do bad, but we need to be able to control trypsin.

131

What are the lab values for total cholesterol?

>200 mg/dL desirable 200-239 mg/dL borderline high >240 mg/dL high

132

What do lymphomas and leukemias have in common?

They are both clonal expansions of white blood cells at certain developmental stages.

133

What is leukocytosis and what can cause it?

Leukocytosis- WBC> 10,000 (a) Causes: • Chronic infection or inflammation • Exercise (can cause decreased margination • Some leukemias

134

Naltrexone

Used to treat Alcoholism. μ opioid receptor antagonist; felt to ↓ drinking through ↓ feelings of reward with alcohol and/or ↓ craving.

135

What are the main drugs used to treat hypercholesterolemia?

Statins -inhibitors of HMG-CoA reductase-rate controlling step for synthesis of LDL-typically the most effective at lowering LDL up to 50-60% a. Drugs: -Lovastatin (been around a long time) -Rosuvastatin (Crestor >$5 billion/yr sales) -Atorvastatin (Lipitor)

136

What are the main organisms that cause Community Acquired Atypical Pneumonia ("walking pneumonia")?

Mycoplasma pneumoniae, viruses like influenza

137

What is the dental relevance of high LDL?

Won’t directly affect most dental procedures, but is suggestive that there may be cardiovascular disease present that will have an impact such as hypertension, potential MI or stroke, and artherosclerosis. Check for these other issues carefully.

138

What is alcohol's MOA?

It alters several receptors and cellular functions, including GABA-A receptors, Kir3/GIRK channels, adenosine reuptake (through the equilibrative nucleoside transporter, ENT1), glycine receptor, NMDA receptor, and 5-HT3 receptor. It also disrupts lipid membranes.

139

TMP-SMX

Used with patients with struvite (infection) stones, preventing or controlling UTI with antibiotics to prevent the recurrence of struvite stones. Also used for UTI's, -side effects include: photosensitivity, Stevens-Johnson syndrome- but usually the preferred treatment

140

What is leukemia?

Systemically distributed neoplasms of white cells.

141

What are contributing factors of bacterial cystitis?

Stones, cather, other foreign objects, reflux, short female urethra, obstructing lesions, diverticula.

142

What is the pathology of a urinary obstruction?

Hydronephrosis and dilated ureter. If distal to bladder can get dilated bladder with a thickening of the bladder wall. Can be caused by or create stones.

143

What are the main organisms that cause Hospital Acquired Pneumonia?

Enterbocteriaceae, Pseudomonas, S. aureus

144

What is DIC and what is the test used to diagnose it?

Disseminated Intravascular Coagulation, activation of clotting should be limited to site of an injury, and this is a massive systemic intrasvascular activation of coagulation. You get elevated D-Dimer with this, which is a type of fibrin degradation product.

145

What are the main causes of chronic renal disease?

Diabetes, hypertension, chronic glomerulonephritis

146

What are lymphomas?

They are solid tumors of the hematopoietic system, neoplasms of lymphoid origin, typically causing lymphadenopathy.

147

What is the treatment for prostatic adenocarcinoma?

• Prostatectomy (affects bladder function) • Radiation • Hormonal: block androgen receptors-affects male functions • Chemotherapy or bisphosphonate

148

What is thrombocytopenia?

Decreased platelet count. Normal platelet count is 150,000 to 450,000 per microliter. It is quantitative. • Platelet counts

149

What are the characteristics of urothelial carcinoma?

• Most often in males >50 years old • Associated with smoking, carcinogens (e.g., dyes, paint etc.) • Most common urothelial malignancy - Associated with Lynch Syndrome (HNPCC), they get colon cancer, urinary cancer, and upper tract infections.

150

Hydrochlorothiazide

A thiazide diuretic, very effetive in the DCT of nephron at reducing calcium in the urine and preventing calcium kidney stones.

151

At what Blood-Alcohol Concentration can alcohol be lethal?

0.4% is lethal, or greater than 400 mg/dL

152

What are the three main congenital kidney diseases or disorders, and their characteristics?

1. Single or fused kidneys (horseshoe) 2. Renal dysplasia (multiple cysts, cartilage, urinary tract dysfunction) 3. Adult polycystic kidneys (genetic (dominant), renal insuffiency, linked to intracranial aneurysms, other organs also have cysts, enlarged kidneys)

153

Besides skin cancer, what is the most common malignancy in older men?

Prostatic adenocarcinoma, present in 60% of men greater than 80 years old. • Most often detected by rectal exams • Many are small and not clinically significant • Most metastasize to bone and occasionally to regional lymph nodes • However, can be deadly in some patients, especially in younger men - Serum PSA test (prostate specific antigen)

154

What are the subtypes of lung carcinoma?

- Non-small cell carcinomas include adenocarcinoma and squamous cell carcinoma. (adeno and squamous cell [contains keratin] types most common) - Large cell neuroendocrine carcinoma - Small cell carcinoma

155

What are the details surrounding the four most common types of kidney stones and how are they usually treated?

a. Calcium/oxylate: excess calcium and oxalate in urine (~80% of stones) -men more likely than women Alkalinize urine (stop drinking carbonated soft drinks) b. Struvite (~10% of stones)-magnesium ammonium phosphate crystals-often associated with urinary infections- only type where treatment is to acidify urine. -more common in females (the only type) c. Uric acid- excess waste, uric acid, in urine mineralizes into stones when urine is too acidic-often associated with gout -more common in men, must decrease uric acid production and alkanize urine pH d. Cysteine - excess cystine production causes hypercystinuria and deposition when urine is too acidic. Must dissolve cystine, thus alkanize urine and increase water consumption to flush kidneys.

156

What is the definition of Atelectasis? What can cause it?

Collapse, caused by inadequate expansion of airspaces. Gives rise to hypoxia, can be caused by airway obstruction, compression, pleural effusion, pneumothorax, aspiration, pleural fibrosis.

157

What are fibrosing lung diseases?

Associated with collagen vascular diseases such as rheumatoid arthritis-restrictive lung disease: stiff lung and hard to expand lungs. Usual Interstitial Pneumonitis is UIP and is idiopathic pulmonary fibrosis and this type has the worst prognosis. RB-ILD and DIP is common in smokers, but good prognosis if they quit.

158

Theophylline

Is a type of methylxanthine drug used as an add-on controller for asthma, it is a phosphodiesterase inhibitor and increases cAMP and relaxes airway smooth muscle. Available as tablet or inhaler through tea. Monotherapy for mild asthma. Combine with corticosteroids to reduce steroid doses and side effects. Also helps relax diaphragmatic fatigue in COPD. Toxicity: nausea, headache and anxiety. Requires plasma level monitoring.

159

What is a CBC?

A. CBC (complete blood count)—automated hematological evaluation—includes red and white blood cells and platelets

160

What causes pneumonia in the immunocompromised?

Pneumonia in immunocompromised (e.g., AIDS) -Can be caused by micro-organisms including from normal flora -CMV (cytomegalo virus-common infection) causes ‘owl’s eye’ histology -Pneumocystis jiroveci is also an opportunistic fungus

161

Sodium Bicarbonate

Alkanizes urine, which decreases the amount of uric acid and cystine deposition from the urine. Recommended for uric acid and cystine stones, may also benefit calcium stones, but contraindicated for struvite stones, so don't give this to women with struvite crystals.

162

What are the lab values for HDL's (scavenger receptors)?

Scavenger receptors—HDL

163

What is the definition of binge drinking?

NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This usually occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.

164

What class does methylxanthine drugs fall into?

Add-on controllers for Asthma.

165

What does hydronephrosis cause?

Inability to concentrate urine (first defect), reflux and or lack of effective peristalsis cause pyelonephritis, complete loss of function - late complication.

166

What does alcohol due to our immune systems?

Suppresses both innate (white blood cells, cytokines that trigger inflammatory response) and adaptive (T- lymphocytes, B-cells) immune system

167

What is asthma?

It is a reactive airway disease and narrowing of airways-hyperreactivity: hyperinflated lungs, thick mucus plugs in airways, smooth muscle hypertrophy • Types: • Atopic- childhood onset often with allergic rhinitis, type I hypersensitiviy response. • Non-atopic- non-immune, occupational exposures, like aspirin or viral infections.

168

What is the most common nutritional deficiency in the world?

Iron Deficiency Anemia, usually due to bleeding too much.

169

What is dyspnea?

Acute shortness of breathe, difficulty breathing.