test #20 4.10 Flashcards Preview

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

describe alcoholic cirrhosis

A

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

will result in increased portal HTN.

2
Q

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

A
  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
Q

male mesonephric ducts form (3)

A

internal genitalia: epididymis, ductus deferens, seminal vesicles.

4
Q

urogenital folds form? in male & female?

A

male: ventral aspect of penis.
female: labia minora

5
Q

genital swellings form? in male & female?

A

male: scrotum
female: labia majora

6
Q

urogenital sinus in males? females?

A

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

7
Q

female paramesonephric ducts form?

A

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

8
Q

DHT role in embryonic life? adult life?

A

embryonic life: formation of external male genitalia.

adult: secondary sex characteristics.

9
Q

why are inferior MI associated w/ bradycardia? rx?

A

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
Q

risk for closed angle glaucoma?

A

asian’s and inuits

11
Q

iridovyclitis

A

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

12
Q

rx for bradycardia?

A

atropine!

13
Q

PTSD criteria

A

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

14
Q

acute stress disorder

A

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

15
Q

adjustment disorder

A

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
Q

differentiate PTSD from acute stress disorder? from adjustment disorder?

A

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

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

17
Q

repeated & prolonged kneeling causes..

A

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
Q

popliteal and gastrocnemius bursitis associated w/

A

formation of Baker’s cyst

19
Q

anserine bursitis (pes anserinus bursitis)

A

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
Q

diabetic ketoacidosis

A

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
Q

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

A

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
Q

elastase can be found..

A

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

23
Q

what does clara cell CCSP do?

A

inhibit neutrophil recruitment and activation.

24
Q

where do goblet cells stop

A

are not in bronchioles downwards.

25
Q

urge incontinence / overactive bladder syndrome caused by…

A

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

26
Q

b1 receptors are located..

A

in heart & renal juxtaglomerular cells

27
Q

a2-agonists? rx?

A

methyldopa and clonidine. decrease sympathetic outflow and BP.

28
Q

B2 stimulation causes..

A

bronchodilation, vasodilation, and tocolysis (baby extrusion)

29
Q

5-HT, serotonergic neurons are located in brain…

A

raphe nucleus of brainstrem (midbrain, pons, medulla)

sleep-wake cycle, arousal.

30
Q

NE-secreting neurons found in brain…

A

nucleus ceruleus. DORSAL PONS

31
Q

acetylcholine neuron cell bodies located in..

A

nucleus basalis of Meynert

32
Q

red nucleus of midbrain?

A

motor coordination of upper extremeities.

33
Q

for blood flow to be continuous..

A

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
Q

normal systemic & pulmonary blood pressure

A

systemic: 120/80.
pulmonary: 14mmHg

35
Q

rx for tinea (pityriasis) versicolor

A

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

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

36
Q

most important factors locally regulating coronary blood flow?

A

adenosine and NO

37
Q

formation of NO in coronary endothelial cells? downstream signalling?

A

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

works on cytosolic guanylate cyclase

38
Q

a2 receptors are..

A

CENTRALLY located!

39
Q

Courvoisier sign

A

palpable but not tender gallbladder

40
Q

(5) risk for pancreatic adenocarcinoma (at head)

A
  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
Q

low-fiber diet increases risk of…

A

colon adenocarcinoma

42
Q

alcohol consumption increases risk for which malignant tumors?

A

head, neck, esophagus, liver

43
Q

strawberry hemangioma

A

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
Q

cortisol receptor and downstream signal cascade

A

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
Q

growth hormone signal transduction

A

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

increases gluconeogenesis by increasing lipoylysis, gluconeogenesis in liver.

46
Q

catecholamines & glucagon signal transduction

A

GPCRs coupled to adenylyl cyclase.

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

47
Q

abnormal transformation of mullerian ducts can result in

A

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

48
Q

2 most common causes of eugonadotropic amenorrhea

A

imperforate hymen and mullerian duct abnormalities.

49
Q

distinguish presentation of HUS and TTP

A

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
Q

HUS

A

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

51
Q

autoimmune hemolytic anemia can occur w/ (2)

A

mycoplasma pneumonia and EBV

52
Q

leukoerythroblastosis peripheral smear?

A

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

53
Q

schistocytes suggests..

A

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

54
Q

most common inherited blood disorder in US

A

sickle cell anemia

55
Q

sicking in sickle cell anemia promoted by..

A

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

56
Q

how does 2,3 DPG increase oxygen delivery?

A

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

57
Q

pseudomonas cepacia =

A

Burkholderia cepacia

58
Q

heart failure

A

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
Q

systolic vs. diastolic heart failure

A

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
Q

isolated diastolic heart failure on pressure-volume curve

A

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
Q

isolated systolic heart failure on pressure-volume curve

A

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

62
Q

differentiate rubella (german measles) and measles (rubeola)

A

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

rubella spreads faster.
measles darkens / coalesces.

rubella: postauricular & occipital lymphadenopathy (togavirus)

63
Q

describe appearance of varicella zoster rash

A

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

64
Q

describe rash of roseola (HHV-6)

A

exanthem subitum (roseola infantum)

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

65
Q

differentiate carboxyhemoglobin & methemoglobin.

A

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
Q

carbon monoxide poisoning causes..

A

(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
Q

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

A

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

68
Q

most dangerous side effect of amphotericin B

A

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
Q

ECG findings of hypokalemia

A

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

70
Q

acetaminophine and halothane toxic effect..

A

liver necrosis.

71
Q

chronic rejection of lungs

A

affects small bronchioli – obstructive lung diesase: BRONCHIOLITIS OBLITERANS

72
Q

acute rejection of lungs

A

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

73
Q

leading cause of death in lung transplant recipients?

A

infection. CMV, most significant opportunitistic infection.

74
Q

primadone

A

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

75
Q

acylclovir toxicity. prevent?

A

crystalline nephropathy. prevent w/ aggressive hydration

76
Q

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

A

1st: glioblastoma multiforme.
2nd: meningioma.

77
Q

describe meningioma

A

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
Q

dihydrofolate reductase important for..

A

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

79
Q

5-fluorouracil

A

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
Q

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

A

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
Q

cytarabine

A

pyrimidine analogue antimetabolite. incorporate into DNA, strand termination.

82
Q

gemcitabine

A

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

83
Q

fludarabine

A

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

84
Q

rx for CLL

A

fludarabine and alemtuxumab

85
Q

how long can glycogen stores keep us going

A

depleted after 12-18 hours

86
Q

energy source when fasting (between meals)

A

mostly hepatic glycogenolysis

87
Q

energy source 1-3 days of starvation

A

glycogen delete after day 1. hepatic gluconeogenesis.

88
Q

energy source after 3 days of starvation

A

adipose stores. then protein degradation.

89
Q

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

A

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
Q

why does acetyl-CoA stimulate gluconeogenesis

A

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

91
Q

pyruvate & alanine relationship

A

(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
Q

fructose 2,6-bisphosphate role in gluconeogenesis / glycolysis

A

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

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

93
Q

how does shiga-like toxin cause pathology?

A

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
Q

salmonella infectious path

A

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

95
Q

oxalate crystals suggest..

A

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
Q

folded envelope / dumbell crystal in urine

A

calcium oxalate

97
Q

coffin-shaped crystal in urine

A

AMP

98
Q

rhomboid or rosette crystal in urine

A

uric acid

99
Q

hexagonal crystal in urine

A

cysteine

100
Q

early death in rheumatic fever due to..

A

myocarditis (pancarditis) –> cardiac dilation –> DEATH

101
Q

early valvular disease w/ acute rheumatic fever

A

mitral valve regurgitation

102
Q

late valvular disease w/ acute rheumatic fever

A

mitral valve stenosis

103
Q

valvular damage in rheumatic fever

A

vegetation & fibrosis

104
Q

tubular adenoma vs. villous adenoma in colon

A

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
Q

peutz-jegher syndrome

A

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

AUTOSOMAL DOMINANT, but RARE.

106
Q

intestinal carcinoid location

A

usu appendeix, ileum, rectum. RARE

107
Q

signet cell carcinoma locations

A

stomach, breast, ovary, colorectal area, etc.

108
Q

symptoms of villous adenoma

A

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

109
Q

appearance of uterus w/ ectopic pregnancy

A

will see pregnancy-related endometrial changes: decidualization of stroma

(w/o embryonic tissue or chorionic villi)

110
Q

main risk factor for ectopic pregnancy

A

PID

111
Q

capacity-limited (saturable) enzyme kinetics

A

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

112
Q

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

A

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

113
Q

which vasculitis can extend into contiguous veins and nerves?

A

thrombangitis obliterans

114
Q

craniopharyngioma on MRI? presentation?

A

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
Q

which amino acid becomes ESSENTIAL in PKU?

A

tyrosine, can no longer synthesize from phenylalanine.

116
Q

clinical presentation of PKU

A

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
Q

3 major distinguishing factors between pemphigus vulgaris & bullous pemphigoid

A
  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
Q

Nikolsky & Asboe-Hansen sign w/ pemphigus vulgaris

A

Nikolsy: new bullae form w/ gentle traction

Asboe-Hansen sign: bullar spread laterally w/ pressure

119
Q

autoantibodies to cutaneous basement membrane proteins seen in

A

epidermylosis bullosa acquista and cicatrical pemphigoid

120
Q

palmoplantar keratoderma & deafness ichthyosis

A

related to connexin defects

121
Q

NAD+ regeneration on glycolysis.

A

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
Q

when is FADH2 produced

A

TCA, conversion of sucinate to fumarate (succinate dehydrogenase)

123
Q

carnitine

A

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

124
Q

citrate is formed by.. powerfully inhibits..

A

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