test #11 3.28 Flashcards Preview

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Flashcards in test #11 3.28 Deck (140)
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1
Q
compare distal and proximal radial n. lesion (i.e. motor & sensory involvement)
A
proximal lesion (i.e. midshaft of humerus) will injure radian n. & posterior cutaneous branch (which comes off above spiral groove). distal lesion near radial head / lateral epicondyle will not impair arm sensation, ONLY wrist extension (deep branch). no sensory defects
2
Q
lateral and medial branches of median n innervates
A
sensory innervatino of palmar & dorsral surfaces of distal 3 1/2 digits
3
Q
when an adult attempts to pull a child upward by the arm...
A
radial head subluxation "nurse-maid elbow", can damage the deep branch of the radial n (paralysis of forearm extensor w/o affecting any sensory)
4
Q
boundaries of guyon's canal? what n. passes through here?
A
between hook of hamate and pisiform bone (fibroosseus tunnel)
5
Q
fracture of the surgical neck of the humerus damages.. what will be lost (3)
A
axillary n. paralyzed (1) deltoid (2) teres minor (2) sensation on lateral upper arm
6
Q
immune response to Tb..
A
macrophage phagocytosis & antigen presentation --> CD4+ T cell stimulate macrophages --> activated macrophages form Langerhans giant cells (multiple nuclei organized peripherally in the shape of a horseshoe)
7
Q
what cell type is primary responsible for Giant cell formation?
A
CD4+ Th1 cells --> IFN-gamma
8
Q
Th2 cells activate..
A
mast cells, basophils, eosinophils
9
Q
heavy smoker w/ exertional dyspnea and airspace enlargement on CT likely has...
A
centriacinar emphysema
10
Q
descirbe pathophhysiology of centriacinar emphysema
A
oxidative injury to respiratory bronchioles --> activation & recruitment of resident macrophages --> neutrophil release of elastase, proteinase 3, cathepsin G, matrix metalloproteases, proteases, oxygen free-radicals (inhibit a1-antityrpsin). net protease-antiprotease & oxidant-antioxidant imbalance destroy's acinar walls.
11
Q
clara cells histologically are.. located.. secrete..
A
non-ciliated, secretory constituents of terminal respiratory epithelium. secrete clara cell secretory protein (CCSP), which inhibits neutrophil recruitment and activation, as well as neutrophil-dependent mucin production.
12
Q
what 3 things can reduce pulmonary compliance?
A
(1) pulmonary fibrosis (2) insufficient surfactant (3) pulmonary edema
13
Q
coenzymes needed for pyruvate dehydrogenase
A
thiamine pyrophosphate (TPP), lipoic acid, CoA, FAD, NAD (mnemonic: tender love and care for nancy)
14
Q
lipoic acid needed for.. (2)
A
needed for the (1) decarboxylation of alpha ketoacids and (2) transfer of alkyl groups
15
Q
PDH is needed to.. absence leads to..
A
converte pyruvate acid to acetyl-CoA in the TCA cycle. w/o PDH or its 5 coenzymes, pyruvate --> lactic acid (lactate dehydrogenase)
16
Q
lipoic acid is an important coenzyme for..
A
alpha ketoglutarate dehydrogenase and branched-chain ketoacid dehydrogenase
17
Q
citrullinemia
A
urea cycle disorder that results from deficiency of arginosuccinate synthetase. ATP is cofactor required.
18
Q
homocysteinuria
A
deficiency in cystathione synthase. characterized by premature atherosclerosis. disposed by 2 pathways: (1) conversion to cysteine by the combined actions of two vitamin B6-requiring enzymes, cystathione synthase and cystathionase and (2) conversion to methionine by a folate & vitamin B12-dependent process.
19
Q
orotic aciduria
A
results from a defective pyrimidine synthesis resulting from a deficiency of the enzyme orotate phosphoribosyl transferase (requires glutathione as a coenzyme)
20
Q
lipoic acid is a cofactor for which mitochondrial enzymes
A
(1) PDH (deficiency --> lactic acidosis) (2) alpha-ketoglutarate DH (3) branched-chain ketoacid DH (deficiency results in maple syrup urine disease)
21
Q
karyotype difference between complete vs. partial moles
A
complete mole: 46XX or XY (of paternal origin).
partial mole: 69XXX or XXY.
22
Q
evacuated uterine contents of complete vs. partial mole
A
complete: trophoblasts only, "bunch of grapes".
partial: fetus, cord, amniotic membrane, some grossly enlarged villi
23
Q
microscopic appearance of complete vs. partial mole
A
complete: enlarged edematous villi and trophoblastic proliferation. no fetal tissue.

partial: some enlarged villi w/ trophoblastic proliferation. normal villi and fetal tissue also present.
24
Q
risk of complications w/ complete vs. partial mole
A
complete: 15-20% risk of malignant trophoblastic disease.

partial: low risk of malignancy (>5%)
25
Q
clinical presentation of complete mole
A
vaginal bleeding, uterus enlarged out of proportion to gestational age, pre-eclampsia, hyperthyroidism, theca-lutein cysts (hCG driven)
26
Q
clinical presentation of choriocarcinoma
A
after molar pregnancy, abortion, or normal pregnancy. presents w/ vaginal bleeding & symptoms of metastatic disease (eg cough w/ lung metastases). inappropriately elevated hCG levels
27
Q
missed abortion is...
A
embryonic death in utero. signs: vaginal bleeding w/ closed cervical os, small uterus, absence of fetal heart tones, & low hCG levels
28
Q
presentation of abruptio placentae
A
premature placental separation. can occur in 3rd trimester of pregnancy. manifests w/ vaginal bleeding, hypertonic uterus, intense painful contractions
29
Q
ruptured tubal pregnancy presents w/? curretage will reveal?
A
vaginal bleeding, abdominal pain, signs of hemorrhagic shock. curretage reveals endometrial lining w/ gestational changes. fetus and trophoblast are absent.
30
Q
phencyclidine (1) mode of action (2) symptoms (3) examination findings
A
(1) hallucinogen (2) agitation, dissociation, hallucinations, VIOLENT BEHAVIOR, memory loss (3) NYSTAGMUS, ataxia
31
Q
cocaine (1) mode of action (2) symptoms (3) examination findings
A
(1) stimulant (2) euphoria, increased arousal, agitation, CHEST PAIN, headaches, SEIZURES (3) tachycardia, hypertension, MYDRIASIS
32
Q
methamphetamine (1) mode of action (2) symptoms (3) examination findings
A
(1) stimulant (2) agitation, PSYCHOSIS, diaphoresis, violent behavior (3) tooth decay, HTN, tachycardia, choreiform movt
33
Q
LSD (1) mode of action (2) symptoms (3) examination findings
A
(1) hallucinogen (2) VISUAL HALLUCINATIONS, depersonalization, euphoria, occasional dysphoria, panic (3) mild tachycardia, mild HTN, ALERT & ORIENTED
34
Q
marijuana (1) mode of action (2) symptoms (3) examination findings
A
(1) psychoactive drug (2) increased appetite, euphoria, slowed reflexes, impaired time perception (3) dry mouth, CONJUNCTIVAL INJECTION, mild tachycardia
35
Q
heroin (1) mode of action (2) symptoms (3) examination findings
A
(1) opioid analgesic (2) mild euphoria or lethargy to coma (3) MIOSIS, DECREASED respiratory rate, DECREASED bowel sounds
36
Q
PCP mechanism
A
NMDA receptor antagonist. moderate -- dissociative symptoms (detachment & withdrawal). higher -- agitation, hallucinations, violent behavior. ataxia, nystagmus (both horizontal and vertical) and memory loss
37
Q
cocaine mechanism
A
blocks reuptake of dopamine, NE, and 5-HT at CNS synapses. tachycardia, HTN, blurry vision, euphoria, and agitation. ischemic side effects: i.e. MI and stroke can occur due to severe vasoconstriction. acute intoxication lasts for less than an hour.
38
Q
differentiate methampetamine and PCP intoxication.
A
BOTH can have violent behavior, but PCP will produce nystagmus and ataxia. methamphetamine intox typically lasts for up to 20 hours (much longer than PCP)
39
Q
narcolepsy clinical presentation (3).
A
excessive daytime sleepiness, episodic loss of motor tone triggered by emotion (cataplexy) and inability to move on awakening (sleep paralysis).
40
Q
narcolepsy is commonly caused by lack of which neuropeptides? where are these produced?
A
LACK of hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B). promote wakefulness & inhibit REM sleep-related phenomena. produced only in neurons located in the lateral hypothalamus
41
Q
clinical diagnosis for narcolepsy (definition and inclusion)
A
recurrent lapsing into sleep or napping mult times within same day, occurring at least 3x/wk for 3 months. w/ at least one of the following: (1) cataplexy: conscious, brief episodes of sudden, bilateral muscle tone loss precipitated by emotions such as laughing or joking. or spontaneous abnormal facial movements w/o emotional triggers (2) hypocretin-1 deficiency by CSF analysis (3) rapid eye movement sleep latency <15min
42
Q
low CSF HIAA associated w/ what behaviour?
A
impulsive, destructive behaviors, particularly -- aggression, suicide, and violence
43
Q
elevated amounts of 14-3-3 protein in CSF helps w/ diagnosis of..
A
Creutzfeldt-Jakob disease
44
Q
decreases of melatonin in CSF associated w/
A
progression to alzheimer's disease
45
Q
two most frequent causes of eugonadotropic amenorrhea?
A
(1) incomplete canalization of the vaginal plate (agenesis or imperforate hymen) or (2) mullerian duct anomalies
46
Q
primary amenorrhea in a pt w/ fully developed secondary sexual characterestics?
A
anatomic defect in genital tract. most commonly imperforate hymen or mullerian duct anomaly. former presents w/ cyclic abdominal/pelvic pain w/ hematocolpos
47
Q
hematocolpos:
A
accumulation of blood in vaginal canal -- distend vaginal, vaginal bulge or mass palpated anterior to rectum
48
Q
filtration fraction formula?
A
GFR/RPF
49
Q
mucosal neuromas
A
unencapsulated, thickened proliferations of neural tissue
50
Q
NF1 vs NF2
A
NF2 -- the more 'central' form w/ bilateral acoustic neuromas, brain meningiomas, schwanommas of dorsal roots in spinal cord. NF1 -- cafe au lait spots, cutaneous neurofibromas, axillary or inguinal freckling, optic glioma, iris hamartomas, ossessous lesions
51
Q
role of dynein
A
(1) retrograde transport in cells (2) cillary & flagellar movement
52
Q
ethambutol side effect
A
optic neuritis (decreased visual acuity, central scotoma, or colour-blindness). may be reversible w/ discontinuiation
53
Q
mesoderm derived organ that originates from the dorsal mesentary but receives blood supply by an artery of foregut
A
spleen (from splenic artery, branch of celiac artery). spleen = NOT a foregut derivative
54
Q
foregut includes?
A
esophagus through the 2nd part of duodenum (includes liver, gallbladder, and portion of pancreas)
55
Q
embryology of liver
A
endoderm-derivived foregut structure, forms from diverticulum of primitive gut tube within ventral mesentary
56
Q
loss to follow-up (disproportionately in exposed / unexposed groups) results in
A
attrition bias -- type of SELECTION BIAS. results in over/underestimation of association between exposure and outcome
57
Q
sampling bias results from..
A
type of SELECTION BIAS; results from nonrandom sampling of target population. characteristics of study population differ from target population: results are not generalizable.
58
Q
nondisjunction in meiosis I or II can cause...
A
monosomy or trisomy
59
Q
differentiating bet meiosis I or II nondisjunction events
A
nondisjunction in meiosis I: 2 diff alleles inherited from one parent (homologous chromosomes -- child has 3 diff bands). nondisjunction in meiosis II: 2 same alleles inherited from one parent (sister chromatid) -- child: 2 0bands, 2x normal amt of one
60
Q
majority of nondisjunction trisomy 21 occurs during
A
meiosis I (inherit mom's homologous chromosomes)
61
Q
classic triad of congenital rubella
A
(1) sensorineural hearing loss (2) cataracts (3) PDA
62
Q
IFN-alpha approved for rx of..
A
hepatitis B and C, hairy cell leukemia, condyloma acuminatum, kaposi sarcoma
63
Q
naturally competent bacteria that can undergo transformation (3)
A
(1) streptococcus pneumoniae (2) haemophilus influenza (3) neisseria gonorrhoeae & meningitidis
64
Q
generalized transduction vs. specialized transduction
A
Generalized: during lytic infxn, RANDOM bacterial genes accidentally packaged into viral capsid. Specialized: lysogenic ifxn, SELECT bacterial genes near viral insertion site are excised & packaged into viron
65
Q
normal relationship between LAEDP (left atrium end diastolic pressure) and LVEDP (left ventricle end diastolic pressure)
A
equivalent! mitral senosis elevates LAEDP and PCWP relative to LVEDP
66
Q
kartagener's is related to..
A
microtubular dynein arm defect (also have sinusitis, bronchiectasis, and situs inversus)
67
Q
tuberous sclerosis
A
AD, angiofibromas (adenoma sebaceum) seizures, and mental retardation
68
Q
main cardiovascular pathology / developmental defect in down's?
A
endocardial cushion defect (ostium primum ASD, regurgitant AV valves)
69
Q
main cardiovascular pathology / developmental defect in di george?
A
1.Conotruncal - truncus arteriosus
2. tetrology of fallot
3. interrupted aortic arch (atretic or segment is absent)
70
Q
main cardiovascular pathology / defect in friedrich's ataxia?
A
hypertrophic cardiomyopathy
71
Q
main cardiovascular pathology / defect in Marfan's?
A
cystic medial necrosis of aorta -->
1. dissection
2. Thoracic aneursym
3. aortic valve incompetence
72
Q
main cardiovascular pathology / defect in tuberous scerlosis?
A
valvular obstruction due to cardiac rhabdomyomas
73
Q
GI loss of K+ leading to hypokalemia results from..
A
prolonged diarrhea
74
Q
early serum marker of thiamine deficiency
A
erythrocyte transketolase activity (solely uses thiamine as cofactor).
75
Q
transketolase fxns to..
A
in hexose monophosphate pathway (HMP).
w/ phosphopentose isomerase

converts ribulose 5-p (derivived from glucose) to

Ribose 5-phosphate
glyceraldehyde 3P (intermediary of glycolysis)
fructose-6 phosphate
76
Q
if give glucose to alcoholic / malnourished patient, must also..
A
give thiamine! needed for glucose utilization. w/o thiamine, may cause acute cerebral damage
77
Q
glucose-6-6 phosphate dehydrogenase is important for..? low levels suggest..?
A
rate limiting step in pentose phosphate pathway, needed for (1) NADPH production (2) fxn of the erythrocyte antioxidant system. decrease G6PD suggests hemolytic anemia
78
Q
methylmalonyl CoA mutase
A
uses B12 as cofactor. converts methylmalonic acid --> succinyl coA. methylmalonic acid is a product of fatty acid oxidation
79
Q
why is hypernatremia rarely observed w/ mineralcorticoid excess?
A
aldosterone escape -- increase in Na+, increased volume, increase RBF and GFR --> increase Na+ excretion. also increased volume --> increased ANP --> naturesis
80
Q
snRNPs are needed for
A
small nuclear ribonucleoproteins --> splicesosome
81
Q
transcription factor II D
A
transcription factor that binds to TATA promoter region.
82
Q
elongation factors
A
facilitate tRNA binding and translocation step of protein synthesis
83
Q
releasing factors
A
recognize stop codon (UGA, UAA, UAG) to terminate protein synthesis.
84
Q
severe intellectual disability, history of seizures, and abnormal pallor of catecholaminergic brain nuclei, hair, eye, skin. also classic musty / mousy body odor
A
phenylketonuria -- inability to convert phenylalanine to tyrosine (phenylalanine hydroxylase, requires BH4 (tetrahydrobiopterin; tetrahydropteridine reductase)
85
Q
hypopigmentation of skin, hair, eyes, catecholaminergic brain nuclei in PKU results from..
A
inhibitory effect of excess phenylalanine on melanin synthesis.
86
Q
absence of dopamine hydroxylase
A
results in rare form of dysautonomia, characterized by ptosis, orthostatic hypotension, hypoglycemia, and hypothermia. can't convert dopamine to NE
87
Q
alkaptonuria
A
autosomal recessive disorder of tyrosine degradation -- deficiency of homogentisic acid oxidase. accumulation of homogentisic -- hyperpigmentation and degenerative joint disease
88
Q
albinism
A
autosomal recessive, defects in biosynth/distribution of melanin. most commonly due to depressed/absent TYROSINASE activity. [melanin synth = tyrosine --> DOPA --> dopaquinone by tyrosinase in melanocytes]
89
Q
deficiency in which two proteins can lead to phenylketonuria?
A
phenylalanine hydroxylase or cofactor tetrahydrobiopterin (or enzyme dihydropteridine reductase)
90
Q
first line treatment for isolated systolic hypertension (common in elderly)
A
thiazide diuretics and dihydropyridine calcium antagonists, like amlodipine and nifedipine (in non-diabetics. diabetics: ACE-I or ARB)
91
Q
side effect profile of nifedipine
A
bilateral ankle swelling and flushing
92
Q
gynecomastic caused by which 2 diuretic?
A
spironolactone (9%), epeleperone (1%)
93
Q
adverse effects from verapamil
A
constipation and gingival hyperplasia
94
Q
mechanism of thiazolidinediones
A
decrease insulin resistance. bind to PPAR-gamma (perioxisome proliferator activated receptor gammA) transcriptional regulator of genes involved in glucose and lipid metabolism. CRUCIAL GENE regulated by PPAR-gamma: adiponectin (cytokine released by fat tissue). adiponectin low in type II diabetics. thiazolidinediones increase adiponectin
95
Q
genes altered by PPAR-gamma (upregulated by thiazolidinediones)
A
(1) crucial: adiponectin (2) fatty acid transport protein (3) insulin receptor substrate (4) glucose transporter-4 (glut-4)
96
Q
main side effects of thiazolidinediones?
A
fluid retention, weight gain, precipitation of CHF
97
Q
blood/gas partition coefficient
A
anesthetics w/ higher blood solubility have larger blood/gas partition coefficients. high solubility --> dissolve easily in blood --> larger amounts must be absorbed before blood is saturated --> delayed rise in partial pressure
98
Q
if partial pressure rises rapidly in blood..
A
gas is not very soluble in blood --> rapid onset in brain
99
Q
speed of anesthetic induction determined by...
A
rate of uptake in brain --> dependent on solubility of anesthetic in blood. very soluble (high blood/gas partition) --> slower onset
100
Q
example of poorly soluble gas? highly soluble has?
A
poor solubility --> nitrous oxide N20 (small amt needed to saturate blood, rapid rise in blood partial pressure, rapid equilibration in brain, rapid onset of action.

high solubility --> halothane. large amount needed to saturate blood, slow rise in PP in blood, slow equilibration in brain, slow onset of action.
101
Q
potency of gas determined by...
A
minimal alveolar concentration. potent --> lower partial pressure needed to be effective.
102
Q
nitrates cause reflex..
A
tachycardia. block w/ beta-blockers
103
Q
hydralazine
A
direct-acting arteriolar dilator
104
Q
phenylephrine
A
alpha-agonist -- vasopressor
105
Q
2 uses of N-acetylcysteine
A
(1) antidote in acetaminophen/tylenol overdose (2) renal protective agent prior to IV iodine contrast for radiologicalstudies
106
Q
in parkinson's, prescribe L-dopa with...
A
(1) carbidopa -- peripheral dopa decarboxylase inhibitors (2) entacapone -- COMT inhibitor. COMT -- catechol-O-methyl-transferase impt in methylation of levodopa. entacapone inhibits peripheral COMT. tolcapone inhibits central and peripheral COMT, but is hepatotoxic.
107
Q
how does amantadine enhance the effect of endogenous dopamine
A
increase synthesis, release, and reuptake of dopamine
108
Q
name some dopamine agonists (4)
A
bromocriptine, pergolide, pramipexole, ropinerole
109
Q
selegiline
A
inhibitor of MAO-B. decreases central dopamine degradation.
110
Q
anticholinergics used for parkinsons (2)
A
trihexyphenidyl and benztropine
111
Q
2 causes of peptic ulcer disease
A
(1) helicobacter pylori infxn (80-90%) (2) NSAID use.
112
Q
rx for h. pylori
A
2 antibiotics (metronidazole, tetracycline, amoxicillin, clarithromycin) and PPI and/or bismuth for 14 days
113
Q
PPI vs. H2 blockers for peptic ulcer disease?
A
PPI superior
114
Q
sucralfate
A
binds to base of mucosal ulcers, protecting against gastric acid. can help duodenal ulcers heal.
115
Q
metoclopramide? rx?
A
dopamine antagonist w/ central & peripheral effects. prokinetic & antiemetic. rx: GI motility disorders, gastroparesis. prevent nausea and vomiting.
116
Q
misoprostol GI rx?
A
prostaglandin E1 analog. prevent NSAID induced peptic ulcer disease
117
Q
three main causes of acute urethritis in healthy young?
A
N. gonorrhea, C. trachomatis, HSV. if engage in anal sex: e. coli
118
Q
rx for gonococcal urethritis?
A
ceftriaxone or fluoroquinolone.
119
Q
rx for chlamydia urethritis?
A
single dose of azithromycin or multi-day doxycycline.
120
Q
pentamidine (3 rx)
A
prophylaxis and treatment of (1) PCP pneumonia. rx: (2) leishmaniasis and (3) African sleeping sickness.
121
Q
nifurtimox rx:
A
trypanosoma cruzi Chagas' disease
122
Q
mebenzaole rx (4)
A
ascariasis, truchuriasis, hookworm, pinworm
123
Q
nitroprusside use? toxicity? sign? antidote?
A
use: emergent setting where quick onset of action needed to control BP and prevent target organ damage; mixed arterial and venous vasodilation. could cause cyanide toxicity. metabolized into cyanide and nitric oxide -->

cyanide metabolized in liver (by liver rhodanase to thiocynate (excreted in urine).

sign: altered mental status and lactic acidosis. rx: Na2S2O4 (sodium thiosulfate) --> donates sulfur to lier rhodanase --> enhance metabolism and detox of cyanide to thiocyanide.

oxygen also given to prevent cyanide inhibition of cytochrome oxidase (needed for respiration)
124
Q
bicornuate uterus
A
partially septate uterus attached to a single cervix and vagina. results from failure of paramesonephric ducts to fuse. total nonfusion: uterus didelphys -- two sep vaginas, cervices, and uterine horns
125
Q
mesonephric ducts in female and male
A
female: from Gartner duct. male: epididymis, ductus deferens, seminal vesicles, and ejaculatory duct
126
Q
paramesonephric ducts in female and male
A
female: uterine tubes, uterus, cervix, and superior 1/3 of vagina.

male: involute, leaving only vestige appendices of the testes
127
Q
concentric vs. eccentric left ventricular hypertrophy
A
concentric: pressure overload: aortic stenosis, chronic HTN. thickens wall uniformly, outer dimension of ventricle remaining unchanged (narrowed cavity).

eccentric: volume overload: aortic or mitral regurgitation, myocardial infarction, dilated cardiomyopathy.
128
Q
structural heart changes w/ aging (after 65)
A
decreased LV size, predominately through shortening of the apex-to-base dimension, accompanied by leftward bowing or lower interventricular (sigmoid) septum.
129
Q
ventricular remodeling post-MI
A
often results in volume overload, poor contractile fxn -- eccentric cardiac hypertrophy
130
Q
lynch syndrome (HNPCC)
A
autosomal dominant. microsatellite instability --> DNA mismatch repair defect. inherit one allele, acquire one later.
131
Q
HNPCC-associated colon adenocarcinoma vs. sporadic
A
HNPCC: younger than 50, usu right sided, mult cancers are common: synchronous (same time w/ primary) and metachronous (occur after resection). arises from macroscopically-normal areas of dysplastic mucosa. mutation: DNA mismatch repair: MLH-1, MSH-2, MSH-6, PMS-2)

sporadic: older than 50, predominantly left, uncommon to have mult cancer, adenomatous polyp is source. "adenoma-to-carcinoma" sequence (mutation in APC, k-ras, p53 and DCC)
132
Q
Lynch I and II
A
Lynch I: familial predisposition to colon adenocarcinoma.

Lynch II: predisposition to colon cancer AND increased incidence of extraintestinal cancers (i.e. endometrial, ovarian, stomach, pancreas, urothelial tract
133
Q
APC gene
A
intracellular attachment. mutation: formation of adenomatoius polyp from normal mucosa. mutation detected in MOST sporadic colon cancers and ALL familial polyposis
134
Q
MEN 2b
A
medullary carinoma of thyroid (calcitonin), pheochromocytoma, mucosal neuromas & marfinoid habitus
135
Q
pancreatic tumor in Men 1
A
often gastrinoma --> zollinger-ellison. rarely: insulinoma --> hypoglycemia. vasoactive intestinal polypeptide: massive diarrhea
136
Q
pathogenesis of typhoid fever
A
fecal-oral. penetrate gut mucosa via transporters on enterocytes & phagocytosis by M cells in peyer's patches. phagocytosed by macrophages (specially designed to live there. macrophages carry to liver, spleen, bone marrow , gallbladder --> hepatosplenomegaly.

in gut lumen --> inflammation of peyer's patches, intestinal hemmorhage, gut performation -- polymicrobial peritonitis & sepsis --> death.

can be carrier in gallbladder: typhoid mary (bile --> stool).

presentation: rose spots on abdomen.
137
Q
hodgkin's disease age presentation?
A
usu bimodal, peak in 20-30s and 50's. B symptoms, reed-sternberg cell surrounded by normal lymphocytes in node.
138
Q
histology of follicular lymphoma. 2 major cell types.
A
aggregates of closely packed lymph follicles. 2 major cell types (1) centrocytes: small cleaved cells. centroblasts: large noncleaved cells.
139
Q
histology of large B-cell lymphoma
A
diffuse sheets of large lymphocytes w/ nuclei at least 5x size of small lymphocytes.
140
Q
describe Reed-Sternberg cells
A
abdundant cytoplasm, bilobed/double nuclei, inclusion-like eosinophilic nucleoli.