test #20 4.10 Flashcards Preview

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Flashcards in test #20 4.10 Deck (124):
1

describe alcoholic cirrhosis

form of micronodular cirrhosis, associated w/ hepatocyte death followed by fine fibrosis of liver.

will result in increased portal HTN.

2

pathogenesis of ascites in patients w/ cirrhosis. rx (2)?

1. mechanical compromise of portal vein (fibrotic tissue)
2. vasoactive agents cause dilation of splanchnic arterial vasculature & further intrahepatic vasoconstriction.

ascitic fluid formation --> overall, decreases systemic fluid pressure --> kidney's RAA --> Na+ and H20 retention.

rx: furosemide and spironolactone

3

male mesonephric ducts form (3)

internal genitalia: epididymis, ductus deferens, seminal vesicles.

4

urogenital folds form? in male & female?

male: ventral aspect of penis.
female: labia minora

5

genital swellings form? in male & female?

male: scrotum
female: labia majora

6

urogenital sinus in males? females?

male: bladder, urethra, prostate, bulbourethral glands.
female: bladder, urethra, lower vagina, bartholin glands.

7

female paramesonephric ducts form?

internal genitalia: uterine tubes, uterus, cervix, upper vagina

8

DHT role in embryonic life? adult life?

embryonic life: formation of external male genitalia.

adult: secondary sex characteristics.

9

why are inferior MI associated w/ bradycardia? rx?

usu result from right coronary artery occlusion, which also feeds sinoatrial node.

rx: atropine. recall side effects though (i.e. myadriasis: acute-angle glaucoma)

10

risk for closed angle glaucoma?

asian's and inuits

11

iridovyclitis

aka uveitis. anticholinergics can help reduce pain & prevent adhesion formation

12

rx for bradycardia?

atropine!

13

PTSD criteria

repeatedly reliving traumatic, life-threatening event in form of nightmare / flashbacks. avoid reminders. social detachment. poor sleep/concentration. hypervigilance. LONGER THAN 4 wks.

14

acute stress disorder

identical symptoms to PTSD, but symptoms from 2 days - 4 weeks.

15

adjustment disorder

behavioral or emotional symptoms in response to a psychosocial stressed that arose within 3 months. marked distress in EXCESS of that EXPECTED from exposure to stressor. functional expected.

16

differentiate PTSD from acute stress disorder? from adjustment disorder?

PTSD > 4 wks. acute stress 2 days - 4wks.

adjustment: distress in excess of what you'd expect for a given exposure.

17

repeated & prolonged kneeling causes..

PREPATELLAR bursitis. "housemaid's knee". see in roofers, carpenters, plumbers. pain erythema, swelling, inability to kneel on affected side.

located between patella & the overlying skin & prepatellar tendon. lined by synovium, contains little fluid.

18

popliteal and gastrocnemius bursitis associated w/

formation of Baker's cyst

19

anserine bursitis (pes anserinus bursitis)

pain along medial aspect of knee. overuse in athletes, or chronic trauma in patients w/ heavy body habitus. tenderness to palpation 4xm distal to anteromedial joint margin of knee.

20

diabetic ketoacidosis

low total K+: low intracellular stores w/ normal-HIGH extracellular levels.

acidosis, lack of insulin = pulls into extracellular environment.
osmotic diuresis = pulls K+ out of body

MUST REPLACE K+ during ketoacidosis.

21

what drug reduces morbidity and mortality in class III and IV heart failure patients?

spironolactone / epleperone (more selective)

(in addition to standard therapy of ACEIs, digoxin, diuretic)

less about its diuretic effect. more about blockade of aldosterone on heart remodeling.

22

elastase can be found..

in macrophage lysosomes & large, azurophil (primary) granules of neutrophils.

23

what does clara cell CCSP do?

inhibit neutrophil recruitment and activation.

24

where do goblet cells stop

are not in bronchioles downwards.

25

urge incontinence / overactive bladder syndrome caused by...

uninhibited bladder contractions (detrusor instability) rx: oxybutynin: antagonist muscarinic receptors, esp M3 on smooth muscle of bladder.

26

b1 receptors are located..

in heart & renal juxtaglomerular cells

27

a2-agonists? rx?

methyldopa and clonidine. decrease sympathetic outflow and BP.

28

B2 stimulation causes..

bronchodilation, vasodilation, and tocolysis (baby extrusion)

29

5-HT, serotonergic neurons are located in brain...

raphe nucleus of brainstrem (midbrain, pons, medulla)

sleep-wake cycle, arousal.

30

NE-secreting neurons found in brain...

nucleus ceruleus. DORSAL PONS

31

acetylcholine neuron cell bodies located in..

nucleus basalis of Meynert

32

red nucleus of midbrain?

motor coordination of upper extremeities.

33

for blood flow to be continuous..

systemic blood flow / minute = pulmonary blood flow / minute (in both exercise and rest)

continuous circuit!

in all scenarios, arterial resistance is higher in systemic circulation.

34

normal systemic & pulmonary blood pressure

systemic: 120/80.
pulmonary: 14mmHg

35

rx for tinea (pityriasis) versicolor

(1) topical antifungals or (2) selenium-containing shampoo.

present as hypopigmented spots on sun-tanned skin. only really a cosmetic problem.

36

most important factors locally regulating coronary blood flow?

adenosine and NO

37

formation of NO in coronary endothelial cells? downstream signalling?

arginine + oxygen ---> nitric oxide (with eNOS, endothelial nitric oxide synthase).

works on cytosolic guanylate cyclase

38

a2 receptors are..

CENTRALLY located!

39

Courvoisier sign

palpable but not tender gallbladder

40

(5) risk for pancreatic adenocarcinoma (at head)

1. age: 65-75
2. SMOKING (most impt environment risk factor; DOUBLE risk)
3. diabetes mellitus: increases w/ duration of disease
4. chronic pancreatitis
5. genetic predisposition: hereditary pancreatitis, MEN, HNPCC, FAP

41

low-fiber diet increases risk of...

colon adenocarcinoma

42

alcohol consumption increases risk for which malignant tumors?

head, neck, esophagus, liver

43

strawberry hemangioma

unencapsulated aggregates of closely packed, thin-walled capillaries. benign, common. found in skin, subcut tissue, oral mucous membranes, lips. can occur in liver, spleen, kidney.

initially, grow in proportion to child. 'regress spontaneously before/at puberty.

44

cortisol receptor and downstream signal cascade

cytoplasmic, binding causes homodimerization. translocate to nucleus, control gene expression by binding to DNA at hormone-response elements in promoter region of genes.

increase transcription of genes needed for gluconeogenesis (formation of glucose from fat and protein)

45

growth hormone signal transduction

membrane bound receptor --> dimierzation, conformational chain in JAK, stimulates tyrosine kinase, activates STAT transcription activity.

increases gluconeogenesis by increasing lipoylysis, gluconeogenesis in liver.

46

catecholamines & glucagon signal transduction

GPCRs coupled to adenylyl cyclase.

epinephrine and glucagon increase glycogenolysis. stimulate glycogen phosphorylase kinase, which activates glycogen phosphorylates & liberates glucose.

47

abnormal transformation of mullerian ducts can result in

wide range of defects: hypoplasia or agenesis of vagina / uterus, duplication of vagina, cervix, uterus; and unicornate, bicornuate, septate uterus.

48

2 most common causes of eugonadotropic amenorrhea

imperforate hymen and mullerian duct abnormalities.

49

distinguish presentation of HUS and TTP

different points on spectrum of disease. both: fever, thrombocytopenia, microangiopathic hemolytic anemia.

TTP: often adult w/ neurological symptom
HUS: often children w/ renal involvement

BOTH life threatening

50

HUS

endothelial damage, isolated activation of platelets, shearing on RBCs (hemolysis)

51

autoimmune hemolytic anemia can occur w/ (2)

mycoplasma pneumonia and EBV

52

leukoerythroblastosis peripheral smear?

nucleated red cells, immature white cells. seen when bone marrow replaced w/ fibrosis or metastatic cancer. dacrocytes on smear

53

schistocytes suggests..

microangiopathic hemolytic anemia (TTP, HUS, DIC) or mechanical damage (i.e. mechanical valve)

54

most common inherited blood disorder in US

sickle cell anemia

55

sicking in sickle cell anemia promoted by..

low oxygen, increased acidity, low blood volume (dehydration)

56

how does 2,3 DPG increase oxygen delivery?

binds 2 beta chains (ionic), stabilize taut deoxyhemoglobin.

57

pseudomonas cepacia =

Burkholderia cepacia

58

heart failure

broadly defined term meaning heart either cannot pump enough blood to meet tissue metabolic requirements or can do so only from an elevated ventricular filling pressure.

59

systolic vs. diastolic heart failure

diastolic: NORMAL ejection fraction, NORMAL contractility. POOR compliance.

systolic: POOR EF, POOR contractility

long-standing HTN leads to both impaired relaxation & stiffness of heart (diastolic heart problems)

60

isolated diastolic heart failure on pressure-volume curve

upward and to the left (bc of compliance problems)

increased LVEDP. normal ejection fraction, normal LVEDV.

decompensation when LVEDP is so high we get pulmonary edema, dyspnea. etc

61

isolated systolic heart failure on pressure-volume curve

poor stroke volume. to counter this and maintain CO --> increase LVEDP and LVEDV (to improve stroke volume)

62

differentiate rubella (german measles) and measles (rubeola)

both maculopapular rash that begins on face and spreads to trunk & extremities.

rubella spreads faster.
measles darkens / coalesces.

rubella: postauricular & occipital lymphadenopathy (togavirus)

63

describe appearance of varicella zoster rash

maculopapular rash, begins on trunk and spreads centrifugally to face & extremities.

64

describe rash of roseola (HHV-6)

exanthem subitum (roseola infantum)

transient maculopapular rash that appears for a few days on chest & trunk, disappears when fever subsides.

65

differentiate carboxyhemoglobin & methemoglobin.

carboxyhemoglobin: CO bound to hemoglobin at heme binding sites (normally occupied by oxygen)

methemoglobin: when Fe2+ in heme is oxidized to Fe3+. results from drug exposures (dapsone, nitrites) as well as enzyme deficiencies and hemoglobinopathies.

66

carbon monoxide poisoning causes..

(1) binds to hemoglobin w/ 250x affinity more than O2. reduce number of heme binding sites available for oxygen.

(2) CO causes leftward shift of hemoglobin-oxygen dissociation curve (decrease tendency to unload)

(3) interruption of oxidative phosphorylation

CO + hemoglobin = carboxyhemoglobin

67

hypoxia seen w/ CO poisoning is similar to that in..

anemia! decreases in oxygen carrying capacity of blood [CO is worse, bc of leftward shift]

68

most dangerous side effect of amphotericin B

nephrotoxicity.

decrease GFR and direct toxic effects on tubular epithelium.

can lead to anemia & electrolyte abnormalities --> hypokalemia (weakness and arrhythmia) due to increased distal tubular membrane permeability.

69

ECG findings of hypokalemia

T-wave flattening, ST-degment depression, prominent U waves, premature atrial and ventricular contractions. even ventricular tachycardia / fibrillation.

70

acetaminophine and halothane toxic effect..

liver necrosis.

71

chronic rejection of lungs

affects small bronchioli -- obstructive lung diesase: BRONCHIOLITIS OBLITERANS

72

acute rejection of lungs

perivascular mononuclear infiltrates on histology. dry cough, dyspnea, fever

73

leading cause of death in lung transplant recipients?

infection. CMV, most significant opportunitistic infection.

74

primadone

antiepileptic that is metabolized to phenobarbital and PEMA (phenylethylmalonamide). all 3 are active anticonvulsants.

75

acylclovir toxicity. prevent?

crystalline nephropathy. prevent w/ aggressive hydration

76

1st most common brain tumor in adult? 2nd?

1st: glioblastoma multiforme.
2nd: meningioma.

77

describe meningioma

benign slow growing tumor arising from arachnoid villi. concentrically-arranged meningothelial cells. psammoma bodies.

commonly parasagital or adjacent to lateral convexity of hemisphere (sphenoid wing & olfactory groove)

78

dihydrofolate reductase important for..

reducing folic acid --> tetrahydrofolate. needed for transfer of carbon groups.

79

5-fluorouracil

pyrimidine analog, inhibits thymidylate synthetase (after conversion to floxuridine monophosphate)

binds THF and thymidylate synthetase in a stable rxn intermediate form (decreases amount of thymidylate synthetase available for thymidine synthesis)

requires THF

80

leucovorin (N5-formyl-tetrahydrofolate) w/ methotrexate? w/ fluoropyrimidines (5-FU)?

THF derivative that does not require reduction by dihydrofolate reductase to act as cofactor for thymidylate synthase. can RESCUE normal cells from toxicity of methotrextate

leucovorin can POTENTIATE toxicity of 5-FU by strengthening the association of drug w/ thymidylate synthase (more THF available)

81

cytarabine

pyrimidine analogue antimetabolite. incorporate into DNA, strand termination.

82

gemcitabine

pyrmidine analogue, not S-phase specific. also can inhibit ribonucleotide reductase.

83

fludarabine

deamination-resistant purine analogue. many mechanisms of action: inhibit DNA pol, DNA primase, DNA ligase, ribonucleotide reductase. rx for CLL.

84

rx for CLL

fludarabine and alemtuxumab

85

how long can glycogen stores keep us going

depleted after 12-18 hours

86

energy source when fasting (between meals)

mostly hepatic glycogenolysis

87

energy source 1-3 days of starvation

glycogen delete after day 1. hepatic gluconeogenesis.

88

energy source after 3 days of starvation

adipose stores. then protein degradation.

89

from what can glucose be generated from in gluconeogenesis. describe pyruvate conversion to glucose (initial steps)

glucose formed from pyruvate, from lactate, glycerol, glucogenic amino acids.

pyruvate cannot be converted to phosphoenolpyruvate directly (pyruvate kinase is unidirectional).

1. pyruvate --> oxaloacetate (pyruvate carboxylase, increased activity w/ acetyl-CoA).
2. oxaloacetate --> malate (malate dehydrogenase) and shuttled out of mitochondria
3. malate ---> oxaloacetate (malate dehydrogenase)
4. oxaloacetate ---> PEP (phosphoenolpyruvate (PEP carboxykinase)

90

why does acetyl-CoA stimulate gluconeogenesis

pyruvate builds up when converted from lactate, glycerol, glucogenic amino acids. stimulate pyruvate ---> oxaloacetate (pyruvate carboxylase)

91

pyruvate & alanine relationship

(1) muscle converts pyruvate --> alanine (alanine aminotransferase) via transamination.
(2) alanine transported to liver
(3) alanine used in gluconeogenesis

alanine inhibits pyruvate kinase (inhibits glycolysis, but does not promote gluconeogenesis)

92

fructose 2,6-bisphosphate role in gluconeogenesis / glycolysis

LOW fructose 2,6-bisphosphate promotes GLUCONEOGENESIS (via fructose-2,6-bisphosphatase)

HIGH F2,6BP promotes GLYCOLYSIS. (via phosphofructokinase-2)

93

how does shiga-like toxin cause pathology?

transmitted to e.coli via bacteriophage. B-subunit allows for internalization.

A-subunit removes a single specific adenine residue in rRNA, preventing binding of tRNA to 60S subunit (inhibit protein synthesis) --> intestinal mucosal death

94

salmonella infectious path

enters orally, penetrates intestinal mucosa, travels to mesenteric lymph nodes, multiples & phagocytosed by macrophages, where it lives.

95

oxalate crystals suggest..

ethylene glycol ingestion (automobile antifreeze, engine coolants, hydraulic breaks).

rapidly metabolized into glycolic acid (toxic to renal tubules) and oxalic acid (ppts calcium oxalate crystals)

96

folded envelope / dumbell crystal in urine

calcium oxalate

97

coffin-shaped crystal in urine

AMP

98

rhomboid or rosette crystal in urine

uric acid

99

hexagonal crystal in urine

cysteine

100

early death in rheumatic fever due to..

myocarditis (pancarditis) --> cardiac dilation --> DEATH

101

early valvular disease w/ acute rheumatic fever

mitral valve regurgitation

102

late valvular disease w/ acute rheumatic fever

mitral valve stenosis

103

valvular damage in rheumatic fever

vegetation & fibrosis

104

tubular adenoma vs. villous adenoma in colon

TUBULAR adenoma: tubular-shaped glands, often smaller & pedunculated.

VILLOUS adenoma: long-fingerlike projections. large & more commonly sessile. can have velvety / cauliflower like projections. more likely to progress to adenocarcinoma. can also secrete fluid -- SECRETORY DIARRHEA.

105

peutz-jegher syndrome

(1) multiple hamartomatous polyps in GI tract.
(2) black spots on skin & mucosa.

AUTOSOMAL DOMINANT, but RARE.

106

intestinal carcinoid location

usu appendeix, ileum, rectum. RARE

107

signet cell carcinoma locations

stomach, breast, ovary, colorectal area, etc.

108

symptoms of villous adenoma

bleeding, secretory diarrhea (mucous), partial intestinal obstruction. typically sessile w/ cauliflower / velvety appearance. more likely to progress to adenocarcinoma

109

appearance of uterus w/ ectopic pregnancy

will see pregnancy-related endometrial changes: decidualization of stroma

(w/o embryonic tissue or chorionic villi)

110

main risk factor for ectopic pregnancy

PID

111

capacity-limited (saturable) enzyme kinetics

from first-order (constant proportion metabolized over time) to zero-order (constant-AMOUNT) metabolized over time.

112

arteries affected in thrombangitis obliterans (buerger's). caused by? can present w/

radial and tibial. thought to related to direct toxic injury from tobacco or hypersensitivity. often presents w/ raynaud's

113

which vasculitis can extend into contiguous veins and nerves?

thrombangitis obliterans

114

craniopharyngioma on MRI? presentation?

usu 3 components:
1. solid: actual tumor cell
2. cystic: filled w/ 'machinery oil' liquid
3. tooth-enamel califications

most common supratentorial tumor in children. present w/ headache, visual field fects, hypopituitarism (but potentially hyperprolactinemia bc of compression of pituitary stalk --> loss of dopaminergic inhibition

115

which amino acid becomes ESSENTIAL in PKU?

tyrosine, can no longer synthesize from phenylalanine.

116

clinical presentation of PKU

mutation in phenylalanine hydroxylase. can no longer make tyrosine. autosomal recessive.

fair pigmentation w/ MOUSY odor, mental impairment by 1 year, seizure, hyperactivity, gait abnormalities, problems w/ postural control, eczema.

117

3 major distinguishing factors between pemphigus vulgaris & bullous pemphigoid

1. oral mucosa involvement
PV: affects oral mucosa most commonly.
BP: does not affect oral

2. rupture
PV: rupture easily
BP: does not rupture easily

3. immune problem
PV: desmosomes
BP: hemidemosomes

118

Nikolsky & Asboe-Hansen sign w/ pemphigus vulgaris

Nikolsy: new bullae form w/ gentle traction

Asboe-Hansen sign: bullar spread laterally w/ pressure

119

autoantibodies to cutaneous basement membrane proteins seen in

epidermylosis bullosa acquista and cicatrical pemphigoid

120

palmoplantar keratoderma & deafness ichthyosis

related to connexin defects

121

NAD+ regeneration on glycolysis.

needed for glycolysis, must be regenerated from NADH for glycolysis to continue.

aerobic conditions: NAD+ --> NADH in TCA, and NADH --> NAD+ in oxidative phosphorylation.

anaerobic glycolysis: NADH --> NAD+ in formation of lactate.

when strenuously exercising, can be limited by degree of NAD+ regeneration

122

when is FADH2 produced

TCA, conversion of sucinate to fumarate (succinate dehydrogenase)

123

carnitine

amino acid responsible for transport of fatty acids into mitochondria for beta-oxidation. synthesized from lysine and methionine, requires vitamin C

124

citrate is formed by.. powerfully inhibits..

formed by acetyl-CoA + oxaloacetate. powerfully inhibits phosphofructokinase-1 (rate limiting step in glycolysis)