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)