Study Journal Flashcards
(90 cards)
1
Q
- Complete digestion and removal of necrotic tissue
- Caused by release of lysosomal enzymes from ischemic tissue
- Phagocytic cells migrate, formation of a cystic cavity
- Hypoxic CNS injury often precedes this
A
Liquefactive necrosis
2
Q
- Implies relative preservation of the architecture of the necrotic tissue
- Hypoxia leads to buildup of lactic acid and denatured proteins
- Denatured proteins look coagulated
A
Coagulative necrosis
3
Q
- Blood entry into a necrotic area
- Occurs in organs with a dual blood supply (lung)
- Occurs in reperfusion injury of the CNS
A
Hemorrhagic infarcts (871)
4
Q
Lithium toxicity
A
- Narrow therapeutic index
- Acute toxicity: GI upset, and neurologic findings (NMJ excite, delirium)
- Chronic toxicity preceded by volume depletion
- Chronic tox: involuntary mvmt, tremor, and ataxia
- Excreted exclusively by kidneys, filtered by PCT
- Thiazides limit Na+ reabs in DCT→+reabs in PCT
- ACEi’s and NSAIDs also impair clearance
5
Q
- Risk factors present for airborne antigen exposure
- CD8+ cells predominate in BAL
A
Hypersensitivity pneumonitis (796)
6
Q
- Sxs of wheezing, fever, and BAL eosinophilia
- Pt from Indian subcontinent
- Clinical manifestation of lymphatic filariasis (roundworms)
A
Tropical pulmonary eosinophilia (TPE)
7
Q
Tyramine hypertensive crisis (572)
- Which MAO?
- Which transporter:
- What causes sxs?
A
- Cheese, draft beer, sausage contain this
- MAO-A inhibition increases concentration
- Gets taken up via NE transporter and vesicular monoamine transporter
- NE is displaced and increases sympathetic activity and HTN
8
Q
- Increased V and P of endolymph, defective resorption
- Dmg to vestibule and cochlea
- Episodic triad: tinnitus, with feeling of ear fullness; vertigo without motion and n/v; sensorineural hearing loss with variable severity
A
Meniere disease (308)
9
Q
- Otoliths in semicircular canals
- Brief episodes brought on by head mvmd
- No auditory sxs
A
BPPV
10
Q
- Inflammation of vestibular nerve (viral, post viral)
- Single episode lasting days
- Severe vertigo, no hearing loss
A
Vestibular neuritis (labyrinthitis)
11
Q
- Overuse of diuretics leading to volume loss
- Compensatory increase in aldosterone production
- Na+ and water retention, K+ and H+ wasting
- High pH, high HCO3-, and high pCO2
A
Contraction alkalosis
12
Q
- From C1-C3, innervates sternohyoid, sternothyroid, and omohyoid mm
- Penetrating injury to the neck above cricoid cartilage can injure
A
Ansa cervicalis
13
Q
- May be injured during surgery of posterior triangle
- SCM, traps, and clavicle
A
Accessory nerve
14
Q
- Thyrocervical trunk goes posterior to carotid and jugular
- Serves inferior pole of thyroid
- Injury common with hoarseness due to proximity to recurrent laryngeal
A
Inferior thyroid artery
15
Q
- Acid labile: pts with achlorhydia or taking PPI’s (omeprazole) are sensitive to IFX
- Grows on highly alkaline selective media
A
Vibrio cholera (977)
16
Q
- Increased risk with chronic liver disease
- Occurs in setting of open wound infected by contaminated water
- Also in raw seafood like oysters
- GI illness, shock after raw seafood ingestion or seawater
- Culture wound/stool–>fastidious, salt loving bacteria
- Sp?
- Tx?
A
Vibrio vulnificus
-Doxycycline and 3rd get cephalosporin
17
Q
- Tremors, agitation, anxiety, delirium, psychosis
- Seizures, tachycardia, palpitations
A
Alcohol Withdrawal
18
Q
- Tremors, anxiety, perceptual disturbances, psychosis, insomnia
- Seizures, tachycardia, palpitations
A
BDZ withdrawal
19
Q
- N/V, cramping, mm aches
- Dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds
A
Heroin withdrawal
20
Q
-Increased appetite, hypersomnia, intense psychomotor retardation, severe depression “crash”
A
Stimulants (cocaine, amphetamines) withdrawal
21
Q
-Dysphoria, irritability, anxiety, increased appetite
A
Nicotine withdrawal
22
Q
Pt sxs:
- At least 2 weeks
- At least 5/9 SIGECAPS
- Fx impairment
- No history of mania
- Not due to other condition or drugs
A
MDD
23
Q
Pt sxs:
- Identifiable stressor
- Onset within 3 months of stressor
- Marked distress
- Fx impairment
A
Adjustment disorder with depressed mood
24
Q
- Clinical triad: acute onset neurologic abn, hypoxemia, petechial rash
- Pt. with long bone/pelvic fx
- Fat globules occlude pulmonary microvessels→shunting
- Some escape, get to CNS and skin
A
Fat embolism syndrome
25
Five phases of inflammatory leukocyte accumulation
- Margination
- Rolling: Sialyl Lewis X or PSGL-1 to L-Selectin on N or E/P selectin on endothelial cells (cytokines increase)
- Activation: slow rolling activates integrins
- Tight adhesion and crawling: N binds with CD18 beta 2 integrins (mac-1 and LFA-1) to ICAM-1 on endothelial cells
- Transmigration: squeeze out via integrins and PECAM-1
26
-Delayed detachment of the umbilical cord
-Recurrent skin IFX without pus formation
-Poor wound healing
Which CD marker is deficient?
Inheritance pattern?
Leukocyte adhesion deficiency (LAD) type 1
- Absence of CD18 part of beta 2 interns--> low Mac-1 and LFA-1
- AR
27
DX? Name 2 sequelae
- Relaxation of pharyngeal mm→closure
- Loud snoring/apnea
- Daytime somnolence
- Non-restorative sleep, frequent awakenings
- Morning HAs
- Affective, cognintive sxs
Obstructive sleep apnea
HTN
pHTN and RHF
28
- Restricted expansion of thorax due to severe obesity
- DX?
- pCO and pO2?
Obesity hypoventilation syndrome (Pickwickian syndrome)
| -Chronically elevated pCO2, low pO2
29
3 vaccines with protein carriers
| 3 proteins
- S pneumo, N meningitides, H flu
| - Diphtheria toxin, N meningitides outer membrane complex, tetanus toxoid
30
Etanercept, Infliximab, Adalimub
- MOA
- Use
- ADRs
- Decoy receptor for TNF-alpha
- Tx moderate to severe RA, esp in pts who fail MTX
- Increase susceptibility to TB, fungi, and atypical mycobacteria
31
MTX
| -Tests at baseline and why
-Lung and lvier toxicity: CXR and LFTs recommended at baseline
32
Hydroxychloroquine
- Use
- MOA
- ADRs*
- antimalarial, also for SLE and rheumatic dz (RA, sjogrens)
- Decreases TLRs, reducing dendritic signaling
- Irreversible retinal dmg
33
Murmur
- Wide fixed split S2
- Mid systolic murmur over P, mid diastolic murmur over T
- Risk for what?
ASD
| -Paradoxical embolism occurs with transient reversal due to straining in coughing or defecation
34
Murmur
- Early diastolic decrescendo over upper left sternal border
- Effect of amyl nitrite?
Aortic regurgitation
| -amyl nitrite-->vasodilation-->low TPR-->less regard-->softer murmur
35
Murmur
- Systolic ejection murmur heard simultaneously over A and M
- Diamond shaped
- Increases with standing
HOCM
36
Murmur
- Systolic ejection murmur
- Decreases in intensity upon standing
Valvular aortic stenosis
37
Murmur
- Wide splitting of S1 accentuated by inspiration
- MCC?
Delayed closure of tricuspid valve
| -Right bundle branch block
38
SIGECAPS
| at least 5 for at least 2 weeks
```
Sleep changes
Interest
Guilt
Energy decrease
Cognition/concentration
Appetite changes
Psychomotor retardation
Suicide
```
39
- Dz due to lack of phenylalanine hydroxylase
- Important molecules in pathway: phenylalanine, tyrosine, DOPA, dopamine, NE, and epinephrine
- What cofactor/coenzyme do phenylalanine hydroxylase and tyrosine hydroxylase require?
- Phenylketonuria
| - DHF/dihydropterin reductase
40
Pes anserinus (3 mm)
- Semitendinosus
- Gracillis
- Sartorius
41
Most medial leg flexor
| -Insertion
Semimembranosus
| -medial condyle of tibia
42
Most lateral leg flexor
| -Insertion
Biceps femoris
| -head of the fibula
43
Gabapentin
- MOA
- Effect
- blocks VG Ca+ channels
| - attenuates excitatory NT release
44
Phenytoin
- MOA
- Use
- blocks presynaptic VG-Na+ channels
| - prevents recurrence of status epilepticus
45
```
Pt presentation:
Thin, off white vaginal discharge with fishy odor
No inflammation
Clue cells on LM
-Sp?
-Tx?
-pH > or
```
- Gardnarella
- Metronidazole/clindamycin
- pH > 4.5
46
```
Pt presentation:
Thin, yellow-green, malodorous, frothy
Vaginal inflammation
-Sp?
-Tx?
-pH > or
```
Trichomonas
Metronidole + PPx sexual partner
pH > 4.5
47
```
Pt presentation:
Thick, cottage cheeses discharge
Vaginal inflammation
-Sp?
-Tx?
-pH > or
```
Candida albicans
fluconazole
pH
48
Abacavir, tenofovir, emtricitabine, didanosine, stavudine, lamivudine, zidovudine
- Class?
- General ADR's
- Which causes: HS rxn? Pancreatitis? BM suppression?
```
-Nucleoside Reverse Transcriptase I
inhibitors
-lactic acidosis, lipodystrophy
-abacavir
-didanosine
-zidovudine
```
49
Efavirenz and nevirapine
- Class?
- General ADR's
* Unique ADR: efavirenz
NNRTIs
Rash, SJS
Hepatotoxicity
*Neuropsych sxs
50
Atazanavir, Darunavir, Indinavir, ritonavir
- Class?
- General ADR's
Protease inhibitors
| Metabolic complications lipodystrophy, dyslipidemia, insulin resistance
51
Dolutegravir, raltegravir
- Class?
- General ADR's
- Integrase inhibitors
| - myopathy
52
CD4 Th1 cells
- Cell or humoral
- cytokines released
- cell
- IL-2
- IFN-gamma
53
CD4 Th2 cells
- Cell or humoral
- cytokines released
- humoral
- IL-4
- IL-5
- IL-12
54
Which artery has been occluded?
- L Tongue hemiparesis (WHY)
- R Loss of proprioception on half of body
- R hemiparesis
Medial medullary syndrome
- L Anterior spinal artery or paramedian branches
- hypoglossal nucleus
55
Which artery is involved?
- Vertigo, n/v
- hoarseness, dysphagia (WHY)
- decreased pain and temp on L face and R body
- L Horner syndrome
Lateral medullary syndrome (Wallenberg)
- L PICA
- nucleus ambiguous
56
Which artery is involved?
- vertigo, n/v
- decreased pain and temp on L face and R body
- paralysis of entire L face (what else should be missing?)
- L Horner syndrom
Lateral pontine syndrome
L AICA
-L/O taste to anterior 2/3 of L tongue, lacrimation to L eye, salivation to submandibular and sublingual glands,
-L/O function of L stapedius mm (hyperacusis)
57
Which artery is involved?
| -L hemianopsia with macular sparing
R posterior cerebral artery
58
Which chromosome?
- cafe au-lait spots
- neurofibromas on or under the skin
- Lisch nodules
- mental retardation
- brain tumors
Neurofibromatosis 1
| -chromosome 17
59
- tumors of both auditory nerves
- gliomas
- multiple tumors in the brain and spinal cord
Neurofibromatosis 2
| -chromosome 22
60
-sxs
Hemochromatosis
| -deposition of iron salts
61
-sxs
Glycogen storage diseases
62
-sxs
Sphingolipidoses
63
-sxs
Wilson dz
64
-sxs
Albinism
65
-sxs
Phenylketonuria
66
```
DX?
Tx?
-Neurologic symptoms
-low BUN
-hyperammonemia
```
Ornithine transcarbamylase deficiency
- XR deficiency in ornithine transcarbamoylase
- Normally adds carbamoyl phosphate to ornithine to make citrulline for the urea cycle
- This causes a buildup of orotic acid
- Blocked urea cycle-->hyperammonemia
67
-sxs
Fabry dz
68
-sxs
Wiskott-Aldrich syndrome
69
-sxs
G6PD deficiency
70
-sxs
Hunter syndrome
71
-sxs
Hemophilia A
72
-sxs
Hemophilia B
73
```
What metabolite is built up in this pt?
Which enzyme is deficient?
Tx?
-Looks like cerebral palsy
-self-mutilation
```
Lesch-Nyan syndrome-->uric acidemia
HGPRT
allopurinol to block xanthine oxidase
74
-sxs
Duchenne MD
75
-sxs
Becker MD
76
```
DX?
Tx?
-Baby presents with failure to thrive and MR
-Crystals in the diaper
-Megaloblastic anemia (why?)
```
Orotic acuduria
Give uridine (UMP) to bypass UMP synthase
-UMP synthase deficiency
-Can't produce pyrimidines
77
3 week old boy brought due to lethargy. Does not interact very much. Has lost weight.
- megaloblastic anemia
- yellow crystals found in his diaper
- What is the most likely tx?
- What is the deficiency?
- UMP
| - orotic acid phosphribosyltransferase or oritidine 5' phosphate decarboxylase
78
Deficient pro collagen peptidase
Ehlers-Danlos
79
ADR's of SSRIs
- Sexual: decreased libido, anorgasmia in women, ejaculatory delay
- QT prolongation, low risk of arrhythmia when used properly
80
TCA ADRs
- Seizures
| - Anticholinergic: urinary hesitancy and orthostatic hypotension
81
dermatitis, diarrhea, dementia
| -Source
Pellagra (low niacin)
| -Obtained from diet or synthesized from tryptophan
82
Attributable risk
event rate (treatment)-event rate (placebo)
83
Number needed to harm
1/attributable risk
84
Sub epithelial deposits of IgG, IgM, C3
PSGN
85
- mTOR signaling pathway
| - Binds FK-506 binding protein (FKBP) and inhibits mTOR→interrupts IL-2 signal transduction
Sirolimus
86
bind cyclophilin or FKBP→inhibit calcineurine→decrease NFAT activitiy→no IL-2 gene txn
-Cyclosporine, tacrolimus
87
- L1 nerve root→upper psoas major→behind kidney to quadratus lumborum
- Fx to anterolateral ab wall mm
Iliohypogastric nerve
88
- L1-L2 roots
- Sensation to upper anterior thigh
- Motor to parts of genitalia
Genitofemoral nerve
89
- L1 root
- Goes through sup ring with spermatic cord
- Sensation to upper and medial thigh, parts of genital s
- Inward part of cremasteric reflex
Ilioinguinal nerve
90
This drug is a nucleoside analog used to inhibit HIV reverse transcriptase.
-ADR: associated with HLA-B*57:01
Abacavir
| -AHR: fever, malaise, GI, and delayed rash
