Random Flashcards
(176 cards)
1
Q
Pathogenesis of centiacinar emph
A
release of proteinases (esp elastase) from infiltrating neutrophils and alveolar macrophages
2
Q
paranoid personality vs delusional disorder
A
paranoid= pervasive pattern of suspicions or odd beliefs (no delusions)
delusional = delusion(s) for at least 1 month; subtypes: erotomanic, grandiose, jealous, persecutory, & somatic
3
Q
caudal regression (sacral agenesis –> LE paralysis and and urinary incont)
A
poorly controlled maternal diabetes
4
Q
cocaine + fetus
A
vasocontriction –> insufficient blood flow –> spontaneous abortion, intrauterine growth retardaion, placental abruption, and/or prematurity
5
Q
rubella (maternal URI) + fetus
A
mental retardation, heart defects
6
Q
vit A + fetus
A
craniofacial abn, posterior fossa CNS defects, auditory defects, abn of great vessesl (similar to DiGeorge)
7
Q
Fe def anemia + fetus
A
growth restriction
8
Q
Fe most important during which part of preg
A
2nd half - blood volume expands considerably
9
Q
dorsal panc bud
A
body, tail, most of head, accessory duct (Santorini)
10
Q
ventral panc bud
A
uncinate, inf/post head, major panc duct (of Wirsung)
11
Q
Disseminated mycobacterial disease in infancy or early childhood
A
INF-gamma
12
Q
Lower resp infx + Giardia
A
X-linked aggammaglobinemia; B-cell immunodeficiency - issue in maturation of B cells
13
Q
Infx with encapsulated org; reccurent N. meningitidis/N. gonorrhoeae
A
C3 deficiency
14
Q
Delayed separation of umbilical cord
A
Leukocyte adhesion deficiency - defect in CD18 (integrin component - adherence/transmigration)
15
Q
Reccurrant cutaneous infx withoug pus formation, poor wound healing
A
Leukocyte adhesion deficiency (CD18 - intgrin)
16
Q
Gram negative kindey-shaped cocci
A
N. Men
17
Q
Virulence factor correlated to morbidity/mortality of N. Men
A
Meningococccal lipooligosaccharide
differs from LPS b/c lacks repading O antigen
18
Q
Cheyne stokes description
A
cyclic - gradually increasing tidal volume then gradually decreasing tidal volume then apnea… repeat
19
Q
Cheyne stokes a/w
A
- Cadiac disease (advanced CHF)
- Neurologic (stroke, brain tumor, trauma)
20
Q
Cheyne stokes etiology
A
slow resp feedback loop w/ enhanced response to CO2;
slow to respond –> max CO2 –> hyperventilate -> drop CO2 –> stop breathing
21
Q
Prox tubule curve…
A
(Pic)
22
Q
Fragile X - etio
A
increased CGG repeats on long arm of X –> hypermethylation of cytosine bases –> gene inactivation (FMR-1)
23
Q
mental retardation, facial dysmorphism, macroorchidsm
A
Fragile X
24
Q
CF Chloride channel -( ___ gated)
A
ATP- gated
25
thrush, otitis media, bronchilitis, chronic loose stools, absence of thymic shadow, no other structural anomalies
SCID
26
ataxia - telangiectasia symp
sinopulmonary infx
| + ataxia, telangiectasias
27
oculocutaneous albanism, pyogenic infx, progressive neuro dysfx
chediak-higashi
28
severe bacterial and fungal infx
chronic granulomatous dis
29
congenital heart dis, dysmorphic facies, hypocalciemia
Di George
30
Sever bacterial/viral, chronic diarrhea, mucocutaneous candidiasis
SCID
31
recurrent neisseria infx
CD5, CD6, CD7, CD8, or CD9 def
32
reccurant infx that worsen with age, easy bleeding, eczema
Wiskott-Aldrich
33
Pure sensory stroke
Thalmus
34
Lesion to internal capsule
motor def
35
Lesion to caudate nucleus
transient hemiparesis + frontla lobe symptoms (forgetfullness, abulia, inattentivess) +/- agitation, psychosis, choreoathetosis, dyskinesias
36
Lesion to the thalamus
total sensory loss to contralateral side, proprioception loss can lead to difficulty walking/falls; NO motor deficits
37
Lacunar infarctions
small vessel liphyalinosis and atherosclerosis of deep brain structures
risks - uncontrolled htn and DM
38
P/V loop mneumonic (starting at lower right)
MAAM
| COCO
39
"opening snap"
mitral stenosis
40
glucocortocoid-induced mypopathy
- progressive prox muscle WEAKNESS AND ATROPHY W/O PAIN
- LE more
- CK norm
41
polymyalgia rhumatica
- prox muscle PAIN & STIFFNESS
- worse in morning and w/activity
- CK norm
42
Inflam myopathies (polymyo/dermatomyo)
- prox muscle weakness
- SKIN RASH & INFLAMMATORY ARTHRITIS may be present
- CK up
43
statin-induced myopathy
- prox muscle pain/weakness usually within weeks to months after starting a statin
- CK up
44
hypothyroid myopathy
- prox muscle pain/cramps/weakness
- delayed reflexes
- myodema
- CK up
45
facial dysmorphia, cleft palate, ch22 deletion on long arm
DiGeorge
46
MC route of HepB infx in developed countries
unprotected sex (>70%)
47
Hep C risk of infx via sex (high or low)
low
48
Lipid-lowering drug that raises TGs
Bile acid-binding resins:
- cholestyramine
- colestipol
- colesevelam
49
ragged red skeletal muscle fibers + lactic acidosis + neuormusc lesions (familial);
name + genetics
mitochondrial encephalomyopthy
heteroplasmy - coexisitance of both mutated and nml versions of mitochondrial genomes inan individual cell
50
CMV immunocompetent
subclinical or mono
*monospot negative
51
CMV immunocompromised
severe retinitis, pneumonia, esophagitis, colitis, and/or hepatitis
52
check to prevent mammilary body destruction
erythrocyte transketolase activity
53
X linked PRPP def (what organs affected)
joints
54
Acute gout tx targets what cells
neutrophils
- NSAIDs inhibit
- colchicine inhibits neutrophil chemotaxis and phagocytosis via preventing microtubule formation
55
Blocking CD19 on B lyphocytes would prevent inx with what virus
EBV
56
attach to erythroid cells via blood group P antigen
Parvo B19
57
requires contact with glycosaminoglycan chains on host cell surface proteoglycans to enter cell
herpesviruses
58
rodlike fibers project from base are responsible for mediating adsorption into host
adenovirus
59
CD21 mediated entry into host cell
EBV
60
Hemorrhage post temporal bone fracture - b/w which layers
Bone and Dura
| Epidural hematoma
61
LOC, lucid state, LOC
EPIdural hematoma
62
Biconvex pattern of blood
EPIdural hematoma
63
Epidural hematoma
- middle meningeal ARTERY
- b/w skull and dura
- lucid interval--> LOC
- biconvex hematoma
64
Subdural hematoma
- bridging VEINS
- b/w dura and arachnoid
- gradual onset of h/a and confusion
- cresent shaped
65
Subarachnoid hem
- aneurysm or AV malform of ant and post communicating ARTERIES
- b/w arachnoid and pia
- severe h/a, fever, nuchal regididty
- blood in basal cisterns
66
PE blood gases
hypoxemia --> hypervent--> low CO2-->resp alkalosis
(pH high, O2 low, CO2 low, bicarb low)
* O2 impared by V/Q mismatch
* CO2 more dependent on total lung ventilation
67
MCC of death in DM
Coronary Artery Disease (MI)
68
Highest risk factors for Coronary Heart Disease
- Noncoronary athersclerotic disease
- DM
- Chronic kidney disease
69
psychotropic drug that can cause hypothyroidsm
Lithium
70
Salmonella virulence factor in sickle cell osteomyelitis
Resistance to opsonization
| - sickle cell pts have functional asplenia
71
Leukomoid reaction vs Chronic myelogenous leukemia
Neutrophil alkaline phosphatase:
leukomoid rx: nml or up
CML - decreased
72
Increased metalloproteinase activity
contracture
| functions to degrate collagen and other proteins; encourages myofibrolast accumulation
73
selective for ischemic myocardial tissue
Lidocaine (type 1B antiarrhyth)
| specifically binds to rapidly depolarizing and deparized cells
74
Med management of V tach
amioderode
75
Sucrose
Lactose
Maltose
sucrose: fructose + glucose
lactose: galactose + glucose
maltose: 2glucose
76
cell body rounding, peripheral displacement of nuclei, dispersion of Nissl substance to periphery of cell
axonal reaction
| vs wallerian degeneration - axon that lost connection
77
- apoptosis of hepatocytes
- acinar necrosis
- mononuclear inflammatory inflitration
viral hepatitis
78
cetrilobular congestion (liver)
RHF
79
- bile duct destruction
- periductal granulomatous inflm
- bile duct proliferation
Primary biliary cirrhosis
80
Location of hernias relative to inferior epigastric vessles
Order lateral to medial:
- indirect inguinal hernia
- inferior epigastric vessels
- direct inguinal hernia
81
ganglionic receptors
nicotinic
| Ach
82
Sympathetic receptors in renal vasculature
D1
| according to uworld chart
83
sympathetic receptors on sweat glands
M
| Ach
84
skeletal muscle somatic nerve receptors
nicotinic
| Ach
85
increased ADH will decrease excretion of...
Urea
86
Flow in relation to radius
Flow directly proportional to the vessel radius raised to the FOURTH power
i.e. a decrease in flow by a factor of 16 (1/16th)= decrease in radius of 50% (1/2)
87
Immunocomp
Brain Mass
EBV+ cells
Primary CNS lymphoma
- MC cns tumor in immunosuppresed
- ususally B-cells
- diffues large B MC subtype
- CD20+ CD79a+
88
MAP Kinase pathway
```
growth factor ligand binding to receptor tyrosine kinases -->
auto-phos of receptor -->
SH2 domain protiens/SOS proteins --->
Ras activation -->
[Ras/GDP = inactive;
Ras/GTP = active]
Ras begins phosphorylation cascade -->
activates Raf kinase -->
activates MAP kinase -->
MAP kinase enters nucleus (infl gene transcription)
```
89
Increased elastic resistance (pulmonary fibrosis, pulm edema, ARDS) -- effect on breaths per minute
rapid shallow breaths minimize work due to elastic resistance
90
Increased air flow resisitance (asthma, COPD) -- effect on breaths per minute
slow deep breaths minimize work due to air resistance
91
decreased GFR, hyperkalemia in pt with hyperchol, diabetes, htn... what drug
ACE inhib (e.g. lisinopril)
```
SE:
decreased GFR
hyperkalemia
cough
angioedema
```
92
glucagon actions
- increase urea production
- increase ketoacid production by adipocytes
(increases gycogenolysis, gluconeogen, lipolysis)
93
lewey bodies composed of...
alpha-synuclein
| CYTOPLASMIC inclusions in parkinsons and lewey body dementia
94
Negri bodies
rabies
round eiosinophilic CYTOPLASMIC inclusions
- pyramidal neurons in hippocampus
- perkinge cells in cerebellum
95
Pick bodies
cytoplasimic
cortical neurons
FTD (Pick's disease)
96
- Abd pain
- Abd distention
- Fever
- Diarrhea
- Decreasing BP/Increasing HR (signs of shock)
Toxic Megacolon
(possible)
- common complication of IBD (UC >> crohns)
- dx: Xray
97
work via increasing cGMP (endog)
NO (primarily responsible for erection)
| ANP
98
Poststrep glomerulonephritis
| IF
granular
IgG
IgM
C3
(in mesangium and basement memrane - "starry sky")
99
```
child
periorbital edema
cola-colored urine
oliguria
high BP
```
PSGN
will also show red cell casts in urine and mild proteinuria
ASO+
decreased C3
100
hypercellular glomeruli
dx and mech
PSGN
leukocyte (neutrophils an monocytes) infiltration and mesangial/endothelial cell proliferation
101
subepithelial humps
PSGN
102
C1q deposits (kidney)
MPGN type 1
103
subendothelial deposits
MPGN type 1
104
lupus nephritis - where are the IgE deposits
confined to capillary wall - a/w poor prognosis
105
first sign of uncal herniation
| + other signs
fixed and dilated pupil on same side as lesion
"down and out" +ptosis
ipsilateral paralysis of both oculomotor muscles, contra or ipsi hemiparesis, and contra hom/hemi w/ macular sparing may occur
106
uncal hernia compresses what cranial nerve
CN III
| oculomotor
107
only HIV gene product that is gycosylated
env gene polyprotein product:
glycosylated to pg160 --> cleaved w/in ER and golgi to form envelope proteins gp120 and gp41
108
where is gp160 cleaved into gp120 and gp41
ER and golgi
109
where are the pol gene protein products cleaved
in virion during maturation
110
infliximab started -->
- joint pain
- pruritic skin rash
- scattered fibrinoid necrosis and neutrophil infiltration involving small blood vessels
```
Serum sickness
(type III hypersens)
```
- reaction to nonhuman proteins --> vasculitis from tissue depo of immune complexes
- will also sho low serum C3 and C4
111
increases marginalization
increased vascular leakage --> hemoconcentration and decreased wall shear stress --> improves contact of neutrophils with endothelial lining
112
sialylated carb groups: Sialy Lewis X or PSGL-1
+
L-selectin (neutrophils) or
E-selectin/P selectin on endothelial cells
Rolling
113
```
CD18 integrins (Mac-1 and LFA-1)
+ ICAM-1 (intercellular adhesion molecule) on endothelial cells
```
Tight adhesion and crawling
114
platelet endothelial cell adhesion molecule (PECAM) at peripheral intercellular junctions of endothelial cells
Transmigration
115
between what two stages does activation of leukocytes occur
rolling and tight adhesion/crawling
116
ethnicities at increased risk of osteoporosis
white
hispanic
asian
117
elderly patient with gross hematuria (2)
renal or urothelial neoplasm
118
all staph are catalase ____
| all strep are catalase ___
staph = cat +
strep = cat (-)
119
mannitol fermentation
staph aureus
120
novobiocin resistant
staph saprophyticus
121
s. epidermidis = "_____ straph"
coagulase negative
122
drugs that inhibit dihydrofolate reductase
| 3
trimethoprim
methotrexate
pyrimethamine
123
How is DKA usually compensated
Respiratory compensation (hyperventilation)
124
DKA + norm-ish CO2
```
respiratory failure
(superimposed respiratory acidosis)
```
125
Substances that play a role in allergic asthma AND have pharm receptor ANTagonists
(that offer clear therapeutic benefit)
```
Ach
Leukotries
- LTC4
- LTD4
- LTE 4
```
126
thickened brochial walls
neutrophil infiltration
mucous gland enlargement
squamous metaplasia
chronic bronchitis
127
sulfhydryl group donor = antitode for what
why?
acetaminophen
- most metabolized by liver by sulfation and glucuronide conjugation (becomes saturated in overdose)
- remainder P450--> toxic NAPQI (n-acetyl-p-benzoquinoneimine)
128
two mechanisms of N-acetyl cysteine in tx of tylenol tox
- acts as glutathione substitue and binds to toxic metabolite (NAPQI_
- provides sulfhydryl groups to enhance non-toxic sulfation elimination
129
Fluctyosine target
(anti-fungal)
| DNA/RNA synth
130
Caspogungin target
(anti-fungal)
cell wall
*active against candida and aspergillus
131
Amph B target
(anti-fungal)
cell membrane
binds to ergosterol
132
Nystatin target
(anti-fungal)
cell membrane
binds to ergosterol
133
Azoles target
(anti-fungal)
cell membrane
inhibit synth of ergosterol
134
Griseofulfin target
(anti-fungal)
interferes with microtubules
*accumulates in keratin-containing tissues
135
ethambutol
| SEs
optic neuritis --> color blindness
central scotoma
decreased visual acuity
(may be reversible)
136
CBC should be monitored with what drugs
- chloramphicol
(aplastic anemia)
- dapsone
(agranulocytosis)
- TMP-SMX
(megoloblastic anemia)
137
apocrine vs eccrine (merocrine) sweat glands
vs holocrine
apocrine: secrete membrane bound vesicles into hair follicles
eccrine: secrete fluid directly to the skin serface
holocrine: sebaceous glands, secretory cells breakdown to release entire contents of cell
138
anastrozone
selective aromatase inhibitor
| also letrozole, exemestane
139
ketoconazole - anti androgen effect mech
inhibits production
140
tastuzumab mech
inhib epidermal growth factor and HER2/neu pathways --> apoptosis of breast cancer cells
141
activation of HER2/neu receptor leads to activation of...
tyrosine kinase
142
child under 2
| currant jelly stool
intussusception
143
hemophilia lab
prolonged PTT
| normal PT, TT, and bleeding time
144
ST elevation in leads I and V3-V6
location
anterolateral left ventricle
often a/w prolonged, burning substernal pain
145
Indwelling catheters --> UTI
opportunistic
psuedomonas
enterococcus
other staph
fungal
146
non-lactose fermenting
gram negative rod
oxidase positive
psuedomonas
147
lactose fermenting
gram negative rod
extensive abx resistance
enterobacter
148
activity increases risk of plaque rupture
metalloproteinases (from inflamatory macrophages)
| -->degrades collagen and reduces strength of fibrous cap
149
Lipid (TGs, cholesterol, phospholipids):
digestion
absorption
digested: duodenum
absorbed: jejunum
150
```
medically treated hyperthyroidsm (e.g. graves)
+
fever
+
sore throat
```
thionamide-induced agranulocytosis!!
thionamides:
methimazole
propylthiouracil
stop drug and get white blood cell count with differnential to confirm dx
151
elderly woman with osteoporosis -
| what are her PTH, calcium, and phosphate levels
normal
152
Low renin hypertension
(with normal creatinine)
Na, K, HCO3 levels
primary hyperaldo -->
- normal Na
- hypokalemia
- met alk (high bicarb)
153
intracranial calcified cystic mass filled with think brownish fluid rich in cholesterol
craniopharyngioma
derived from remnants of rathke's pouch
154
IgG4 ab against the phospholipase A2 receptor (PLA2R)- a transmembrane protein on podocyes is a/w
idopathic membranous nephropathy
155
streptokinase
thrombolytic that converts plasminogen into plasmin
foreign protein dervived from streptococci and can induce hypersensitivity rx
156
musculocutaneous sensory innervation
lateral forearm
157
isoniazid is structurally similar to...
pyridoxine (B6)
competes for binding sites --> defective sythesis of neurotransmitters like GABA
158
chlorpheniramine
1st gen antihistamine
can be be very sedating b/c block central and periph H1
other 1st gen: diphenhydramine, promethanzine, hydroxyzine
159
cyanide tox antidote stategies (3)
1) direct binding of cyanide ions (hydroxocobalamin)
2) induction of methemoglobinemia (sodium nitrite)
3) use of detoxifying sulfer donors (sodium thiosulfate)
160
corneal reflex (af/ef)
af: CN V
ef: CN VII
161
Rhumatoid factor
IgM against Fc component of self IgG
162
HSP mech
leukocytoclastic vasculitis
deposition of IgA-containing immune complexes
163
polymyositis mech
overexpression of MCH I on sarcolemma --> infiltration with CD8+ T lymphocytes and myoctye damage
164
pertussis toxin mech
AB exotoxin
stimulates intracellular G-proteins to increase cAMP -->
- increased insulin production
- lymphocyte and neutrophil dysfunction
- increased sensitivity to histamine
165
acquire their envelope from host NUCLEAR membrane (not plasma membrane)
herpes viruses
| e.g. cytomegalovirus
166
G6PD def:
| G6P ----X---->?
6-phosphogluconate
167
thyrotoxicosis histo
mixed cellular infiltration with occasional multinucleate giant cells
(often after viral infx)
aka: granulomatous thyroiditis or Quervain's thyroiditis
168
Hep B damage etio
CD8+ T cells destroy infected hepatocytes (respond to HBsAg and HBcAg on cell surface)
Note: antibodies bind to free HBsAb and neutralize by preventing Ag from interacting with hepatocyte
NO direct cytotoxic effect
169
Two phases of Hep B
proliferative: active infection
integrative: incorporated in host genone; liver damage tapers off, but risk of cancer remains elevated
170
toxic component of LPS
lipid A
171
Lipid A mech
activation of macrophages --> widespread realease of IL-1 and TNF-alpha --> shock
(fever, hypotn, diarrhea, oliguria, vasc compromise, DIC)
172
sharp pain in neck/shoulder
worse on inspiration
pain mediated by?
phrenic nerve
| irritation of mediastinal or diaphragmatic parietal pleura---> referred pain in the C3-C5 dist
173
type of nerve that innrvates parietal pleura
somatic sensory (allows for sharp/localized pain)
174
Torsades de pointes precipitated by what meds
(drugs that prolong the QT interval)
antiarrhythmics:
- sotalol
- quinidine
- procainamide
- disopyramide
- ibutilide
- dofetilide
TCAs
Phenolthiazines
175
strongest and most predictible effects on the inflammatory component of asthma
corticosteroids
| e.g. Fluticasone
176
line the wall of old cerebral infarct
astrocytes
