test #32 4.22 Flashcards Preview

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Flashcards in test #32 4.22 Deck (150):
1

when is hCG detectable

secreted by syncitiotrophoblasts.

zygote implants as blastocoele ~8 days

2

when does zygote enter uterus

zygote enters uterus as 2-8 celled embryo / morula on day 3-4

3

hCG production by embryo/zygote begins? in maternal serum

free-floating blastocyst in uterine secretes hCG ~6 days, but won't enter maternal serum until implanatation.

no early than 6-11 days post ovulation in maternal serum (usu day 8)

4

CMV retinitis

inflammatory vascular sheathing & hemorrhage

full thickness retinal necrosis & edema. eventually replaced w/ atrophic scar

can result in retinal detachment -- tearing of thin atrophic scar that forms in areas of prior inflammation

5

when does CMV infect HIV+ patients?

CD4 < 50 cells/uL

6

flucytosine mechanism

converted to 5-FU by fungal cytosine deaminase.

causes RNA miscoding and inhibtion of DNA synthesis

7

IFN-alpha used to treat (4)

(1) hep B and C
(2) hairy cell leukemia
(3) condyloma acuminatum
(4) Kaposi sarcoma

8

pentamadine rx for?

pneumocystis pneumonia

9

friedrich ataxia inheritence

autosomal recessive

10

pathogenesis in friedrich ataxia? presentation

(1) posterior column and spinocerebellar tract degeneration
(2) loss of larger sensory cells of dorsal root ganglion

children 5-15 y/o w/ gait ataxia (wide-based gait w/ difficulty maintaining balance, progressively slow and clumsy

11

5 symptoms associated w/ friedrich's ataxia

1. progressive ataxia of all 4 limbs, cerebellar dyfxn, early. degeneration of dorsal column -- loss of position and vibration

2. hypertrophic cardiomyopathy in more than 50% of patients --> cardiac arrhythmia and CHF

3. skeletal abnormalities: kyphoscoliosis, pes cavus, hamemrtoes

4. diabetes mellitus in about 10%

12

most common cause of death in friedrich's ataxia? (2)

cardiomyopathy

bulbar dysfxn (unable to protect airway)

13

trinucleotide repeat of friedrich's ataxia. chromosome? codes for?

autosomal recessive
chr. 9
GAA
codes for frataxin = iron binding protein

mitochondrial dysfunction

14

eroded teeth enamel and enlarged, firm parotid glands, irregular menses (not amenorrhea though)

bullimia nervosa

amenorrhea = almost always in anorexia nervosa

15

glucagon's action in DKA

(1) stimulate ketoacid synthesis in adipose tissue
(2) increases glyocogenolysis
(2) gluconeongeisis
(4) lipolysis
(5) urea production

16

JVP waves

peak: A
peak : C
dip: x
peak: V
dip: y

a: atrial contraction
c: bulging of tricuspid valve into atrium (isovol contraction)
x: opening of pulmonic valve / relaxation of atrial muscle
v: continuous flow of venous blood into atria
y: opening of tricuspid valve (passing emptying)

17

sign of contrictive pericarditis on JVP wave

y descent is deeper and steeper on inspiration

18

causes of (chronic) constrictive pericarditis

go from 1-3mm to 4-20mm thick. looks like thick line surrounded heart

caused by radiation therapy to chest, cardiac surgery, and TB

19

evidence of ischemic heart disease on CT?

calcified vessels

20

clinical signs of constrictive pericarditis

slowed progressive dyspnea, peripheral edema, ascites

21

what provides nerves, arteries, veins, and lymphatics to ovaries

suspensory ligament

22

broad ligament

mesoovarium that covers ovaries, uterine tube, ovarian ligament, round ligament of uterus, portion of suspensory ligament.

23

blood supply and drainage of ovaries

gonads!
blood supply from aorta.
right drains to IVC
left to renal vein

24

nervous supply to ovaries

from vagus n.

25

common complication in pelvic surgery when ligating ovarian vessels

ligating ureter (traveling underneath)

26

round ligament of uterus

courses through inguinal canal. links uterus to external genitalia. contains artery of sampson, which is rarely a source of blood.

also round ligament in liver

27

ovarian ligament

contains no vessels. courses form uterine pole of ovary to body of uterus, just below uterus

28

transverse cervical ligament, or cardinal ligament

extends from cervix and lateral fornix of vagina to lateral pelvic walls.

contains uterine artery!

29

gingival bleeding, echymoses & petechiae, impaired wound healing. perifollicular hemorrhages w/ coiled (corkscrew hairs)

collagen problem.
scurvy: lysyl hydroxylase and proyl hydroxylase deficiency

requires vitamin C
occurs in rough ER

mutation:
1. decreases amount of collagen secreted
2. impairs triple helix stability
3. impairs covalent cross link formation

30

collagen mutation in ehlers-danlos (type I & II)

mutation in type V collagen

31

defining characterestics of ehlers-danlos type I & II

joint hypermobility
hyperextensible, fragile, skin

32

osteogenesis imperfecta mutation

type I collagen.
spontaneous fracture, bone & tooth malformation, blue sclerae

33

how does dopamine come to inhibit prolactin secretion in pituitary

via tuberoinfundibular dopaminergic pathway -- connect hypothalamus to pituitary gland

34

mucicarmine stain

cryptococcus neoformans. detects polysaccharide capsule
(only one w/ capsule)

round yeast cells w/ narrow-based buds

(can cause pulmonary infxn first)

35

blastomyces dermatididis on culture

lung & disseminated.

round yeast
broad-based budding
thick, doubly-reflective wall

36

histoplasma on culture

TB pulmonary & disseminated

intracellularly within macrophages -- small, ovoid, budding yeast cells

37

coccidioides immitis

lung in competent.
disseminated in compromised.

large, irregularly sized, thick walled spherules w/ small, round endospores

38

only pathogenic fungus w/ polysacch capsule?

cryptococcus neoformans!

red on mucicarmine stain.
clear in india ink.

39

cystic degeneration of the putamen

many can cause. usmle = think wilson's disease

40

sudden cardiac death in youth? in adults?

youth: Vfib from hypertrophic cardiomyopathy

adult: 80% due to acute plaque change superimposed on coronaryatherosclerosis

41

90% of cardiomyopathies are..

dilated cardiomyopathy! but only account for 10-15% of sudden cardiac death

42

why do babies need brown fat (5% of their body mass)

susceptible to hypothermia:
1. immature nervous system
2. high body surface are to volume ratio
3. decreased ability to shiver for heat production

43

white vs brown fat.

white: one intracytoplasmic fat droplet

brown:
- several fat vacuoles,
- considerably more MITO (colour)
- higher oxygen requirement
- contains more capillaries

44

how does brown fat make heat

uncouple electron transport and phosphorylation.

protons pumped out why electron transport chain return to matrix via mitochondrial matrix protein THERMOGENIN (uncoupler).

no ATP synthesizes, energy = heat

45

ascending paralysis post febrile illness

guillian barre

46

guillan barre is associated w/

young adults.
preceeded by upper respiratory or GI infection. could be after vaccine or allergic reaction.

strongly associated w/ campylobacter jejuni infection

47

pathogenesis of guillan barre

ACUTE DEMYELINATING DISEASE. immune-mediated.

antibodies to infection cross-react w/ myelin of spinal roots & peripheral nerves.

48

light microscopy of guillan barre

segmental demyelination of peripheral nerves. accompanied by endoneural inflammatory infiltrate -- lymphocyte & macriohages

49

endoneural inflammatory infiltrate =

guillan barre

50

CSF in guillan barre:

increase protein, with normal/slightly elevated cell count
= ALBUMINOCYTOLOGIC DISSOCIATION

51

polymyositis vs. guillan barre?

nerves are fine in polymyositis, despite weakness.

guillan barre -- NO DTRs

52

flat yellow spots on inner surface of aorta

fatty streaks

53

fate of fatty streaks

earliest lesions in progression to atherosclerosis, BUT do NOT predict occurance or location of atheromatous plaques later in live.

in all individuals after age 10

often occur in regions not particularly prone to atheroma. frequently affect people/regions w/ low lifetime incidence of atheromatous plaques

54

what are fatty streaks

intimal lipid-filled foam cells.
derivived from macrophage and smooth muscle cells that have engulfed LDL, entered intima through injured, leaky endothelium.

usu begin as multiple yellow spots (1mm in diameter) which form streaks.

NOT raised, so do NOT disturb blood flow.

NOT ALL PROGRESS to atheromas! common age 10 onwards. mostly consist of macrophages.

55

nitric oxide originates from

amino acid arginine

56

urea originates from..

arginine + aspartate

57

heme originates from

succinyl-CoA and glycine

58

creatine originates from

glycine + arginine + SAM

59

GABA originates from

glutamate

60

glutathione originates from

glutamate

61

pyrimidines originate from..

glutamate + aspartate

62

purines originate from..

glutamate + aspartate + glycine

63

histidine originates from...

histamine

64

dopamine pathway origination

phenylalanine -> tyrosine -> DOPA -> dopamine

65

tryptophan makes.. (2)

tryptophan -> serotonin -> melatonin

&

tryptophan -> niacin

66

tyrosine makes (2)

thryoxine & melanin

67

which factors stimulate vasodilation of epicardial vessels?

acetylcholine, bradykinin, shear stress, serotonin, substance P.

all stimulates influx of Ca2+ in endothelium. turns on eNOS

eNOS:

arginine+ O2 -> nitric oxide + citrulline

NO from endothlium goes to smooth muscle cells in vasculature --> turns on guanylate cyclase to make cGMP -- vasodilates

cGMP causes vasodilatoin bc protein kinase G reduces cytosolic calcium levels

68

amino acid w/ adjunctive role in rx of conditions that improve w/ vasodilation

arginine! precursor to nitric oxide

69

location of enhancers? promoters?

enhancers: increase rate of transcription intiation through protein binding & intxn w/ transcription factors bound to promoter sequences.

enhancer/repressors: anywhere: upstream. downstream, in gene, thousands bp away, sep chromosomes

promoter: binding site for transcription factor and RNA pol II.

two types of promoter:
1. TATA (hogness) box: 25 nucleotides upstream from gene
2. CAAT box, 70-80 bases upstream from gene

70

tetanus route

clostridium tetani spores germinate in wound (low oxygen, high nutrients). u

pon bacterial cell autolysis, TOXIN is released and enters motor neuron (axon terminal).

TOXIN travels via retrograde transport to spinal cord, medulla.

ORGANISM stays at site of wound

71

route of rabies virus

wound -> neuron axons -> salivary glands.

specifically: motor neuron -> retrograde into nerves of spinal cord -> into cerebellum, brainstem -> hippocampus.

from there -> within nerve axons --> tissue of salivary glands

72

route of diptheria toxin

fibrinous exudate (pseudomembranous exudate) -> blood stream systemic circulation -> cortical neurons & cardiac cells

73

pressure volume curve of lung & chest wall compliance.

alveolar transmural pressure
chest wall transmural pressure

intrapleural pressure?

lung transmural pressure: ALWAYS + (wants to collapse)

chest wall:
usually - (wants to expand,
except at maximal inspiration, will be +

when positive alveolar transmural pressure = negative chest wall transmural pressure --> airway pressure = 0 (functional residual capacity)

intrapleural pressure: always negative. at FRC (-5cmH20). in inspiration (-7.5cmH20) --> helps draw air into lungs

74

explain why intrapleural pressure is always negative (even at 0 airway pressure)

recall: pneumothorax, make intrapleural pressure = 0 (atmospheric pressure)

this causes lung to collapse and chest wall to expand.

at FRC --> tendency of chest wall to expand and lung to collapse creates a negative intrapleural pressure of -5cm H20 (more negative when inspire)

75

rx for amiodarone-induced hypothyroidism?

levothyroxine. typically continue.

always monitor TSH before giving amiodarone

76

HIV associated esophagitis (3). distinguish?

cannot distinguish clinically. endoscopic & microscopic

(1) candida albicans
- patches of adherent, grey/white pseudomembranes on erythematous mucosa

yeast cells and pseudohyphae invade mucosal cells

(2) Herpes simplex
- small vesicles that evolve into typical "PUNCHED out" ulcers

eosinophilic intranuclear inclusions (cowdry type A) in multinuclear squamous cells at margins of ulcer

(3) CMV
- LINEAR ulceration

both intranuclear and cytoplasmic inclusions

77

babesia infection

tick bite. endemic in northeast US.

influenza-like symptoms, hepatosplenomegaly, anemia.

often in asplenic patients

78

isospora belli

profuse, watery diarrhea in HIV patients.

also cryptosporidium spp.

79

chronic trypanosoma cruzi infection

Chagas disease.

dilated cardiomyopathy, achalasia & megaesophagus, megaolon, megaureter

80

esophageal involvement of scleroderma (2)

1. abnormal peristalsis (dysphagia)
2. lower LES tone (GERD)

81

janeway lesions: painful or not?
osler nodes: painful or not?

janeway: NOT PAINFUL

osler: PAINFUL. osler = ouch!

82

janeway lesions

small erythematous, possibly hemorrhagic macules that appear on soles of feet and palms in pt w. bacterial endocarditis.

caused by septic microemboli to cutaneous vasculature.

emboli = infected intracardiac vegetations (bacteria, neutrophil, necrotic materia)

83

osler nodes

painful papulopustules on pulps of fingers and toes.

84

cycloserine

inhibits incorporation of D-alanine into UDP-MUrNAc-oligopeptide during bacterial cell wall synthesis.

HIGH level of ototoxicity, rarely used

85

polymixin

binds to, disrupts, and interferes w/ permeability of cytoplasmic membrane

86

cysteinuria

autosomal recessive. only issue is stones

defective PCT and intestinal (jejunal) reabsorption of dibasic amino acid.

cysteine, ornithine, lysine, and arginine.

risk for cysteine stones --> hexagonal.

87

diphenhydramine on sleep

H1 receptor inhibitor.

reduce time to sleep onset & increase depth of sleep.

88

benzodiazepine 3 effects

1. anxiolytic
2. muscle relaxant
3. anticonvulsant

89

dystonia

neurological movt disorder

sustained involuntary muscle contractions. force certain parts of body into abnormal, painful movements or postures.

may affect single muscle or group.

(i.e. writer's cramp, spasmodic torticollis, blepharospasm)

90

spasmodic torticollis

cervical dystonia. most common focal dystonia

91

blepharospasm

second most common focal dystonia.

involuntary, forcible closure of eyelids.

initial symptom is uncontrollable blinding.
later -> complete closure of eyelids

92

myoclonus

sudden, brief, severe muscle contraction

93

physiologic myoclonus

hiccups and hypnic jerks (occurs when falling asleep)

94

chorea

involuntary muscle activity that flows from one muscle group to another. may appear fragmented or jerky. may display dancing gait.

95

hemiballism

flinging of limbs on one side of body. due to contralateral injury of STN.

96

essential tremor (postural) vs. resting tremor vs. intention tremor

essential: action, exacerbated by holding position (genetic predisposition)

resting: uncontrolled movement, alleviated by intentional movement (parkinsons)

intention: zig-zag motion when pointing/extending to target (cerebellar dysfunction)

97

rx for essential tremor

b-blocker and primadone (anticonvulsant that becomes phenobarb and PEMA)

98

progressive EKG findings of acute MI

1. peaked T waves --> local hyperkalemia
2. ST-segment elevation (min-hrs)
3. Q waves (hr-days)

99

transmural infarct usu caused by..

acute plaque change (rupture) w/ superimposed thrombus that completely occludes involved coronary artery

100

stable angina begins w/ how much occlusion

75% occlusion

101

ulcerated atherosclerotic plaque w/ partially obstructive thrombus

unstable angina, subendocardial MI, sudden cardiac death

102

rx for early ectopic pregnancy (<6 wks)

methotrexate, will accumulate in rapidly dividing trophoblasts

103

THF is important for what 3 general processes

1. thymidine synthesis (DNA)
2. amino acid synth
3. purine synthesis

104

folinic acid is..

N5-formyl-THF
N5-N10 methyelene THF

105

DHF is important for which 2 rxns?

folic acid -> DHF
DHF -> THF

106

mechanism of methotrexate

structually similar to folic acid. enters cell, converted to polyglutamate form.

polyglutamate form prevents movt of MTX out of cell.

(folate & DHF are stored in cells this way too)

107

how is folate and DHF stored in cells?

polyglutamation

108

PABA

folic acid precursor in prokaryotes. sulfonamide antibiotics are chemical analogues.

humans can't convert PABA into folic acid. so we gotta eat folate

109

folinic acid (leucovorin)

pre-reduced form of folic acid that can be used for synthesis of purine & thymidylate without first being converted by DHF reductase.

rescue therapy w/ MTX

110

hep B mediated HCC?
hep C mediated HCC?

hep B:
integration into host genome:
-inflammation
-HBx protein disrupts hepatic cell growth &
-blocks p53

hep C:
does NOT integrate
- chronic inflammation etc.

111

familial hypercholesterolemia

autosomal DOMINANT mutation in LDL receptor
- can't take up LDL into liver.

112

serotonin syndrome drugs

sinners ONLY sell LACED drugs that truly make me trip &&..

TRAMADOL, ONDANSETRON (5-HT3 antagonist), LINEZOLID

st. john's wort
ondasetron
selective 5-HT reuptake (inhibitors (SSRI & SNRI)
linezolid
dextromethorphan
TCA
tramadol
MAOi
meperidine
triptans

113

serotonin syndrome presentation (3)

(1) neuromuscular excitation: hyperreflexia, clonus, myoclonus, rigidity

(2) autonomic stimulation: hyperthermia, tachycardia, diaphoresis, tremor

(3) altered mental status: agitation & confusion

114

rx for serotonin syndrome

cryptoheptadine 5-HT2 receptor antagonist

115

linezolid

serious gram positive infections (VRE and MRSA). weak monoamine oxidase inhibitor. can ppt serotonin syndrome

116

doxycycline toxicity

photosensitivty, pill induced esophagitis.

enamel hypoplasia or permanent tooth discoloration

117

which commonly used drugs can ppt serotonin syndrome in a patient using SSRIs etc?

tramadol, ondansterone, and linezolid

118

propanonol helps hyperthyroidism by.. (2)

(1) reduce symptoms (thyroid hormone upregulate b-adrenergic expression)

(2) reduce peripheral conversion of T4 to T3

119

3 drugs that block peripheral conversion of T4 -> T3?

(1) PTU
(2) ipodate
(3) b-blockers

120

which hormone upregulates beta-receptor expression? alpha-receptor?

beta-receptor: thyroid hormone (increase HR, anxiety)

alpha-receptor: cortisol (increase BP)

121

which hyperthyroid symptoms are NOT improved by beta-blockers?

- increased tissue oxygen consumption
- circulating thyroxine levels
- weight loss
- exopthalmosis (graves)

helps w/ HR and anxiety!

122

crystals in gout?

monosodium uraate

123

where can monosodium urate crystals deposit?

(1) joint
(2) tissue -> tophi nodules

124

describe gouty arthritis

monosodium urate ppts in joint, eaten by neutrophils --> inflammatory response

125

typical gout patient and presentation

- 40-60 y/o obese patient.
- MONOarticular (podagra, usu MTP)
- acute onset joint pain, warmth, erythema, swelling

will resolve w/o treatment

126

definitive diagnosis of gout?

synovial fluid analysis: increased WBC, mostly NEUTROPHILS.

micropscoy: monosodium urate crystals: parallel -> yellow, negatively birefrigent under polarized light.

127

negative birefringence means..

aligned parallel to ray -> yellow
aligned perpendicular -> blue

128

uric acid into joint?

does NOT cause gout. need monosodium urate crystals, not just uric acid.

129

pseudogout?

clinically just like gout.

joint: see rhomboid blue crystals of calcium pyrrophosphate.

affects both genders. larger joints.

130

calcific tendonitis

deposits of calcium hydroxyapatite crystals in periarticular soft tissue (esp tendon)

usu rotator cuff

131

what deposits in joints during gout?

monosodium urate.

NOT uric acid.

132

organs primarily affected in hemochromatosis (4)

liver, heart, and pancreas
(& skin)

133

hemachromatosis inheritance

autosomal recessive

134

budd-chiari

syndrome secondary to thrombotic occlusion of hepatic vein OR intra/suprahepatic IVC

increased sinusoidal pressure --> portal HTN, ascites, hepatomegaly, splenomegaly

135

patient younger than 30 y/o with unexplained chronic hepatitis?

consider WILSON's disease.

low ceruloplasmin, increase urinary Cu2+ excretion, Kayser-Fleischer rings

136

rapid correction of hyponatremia can cause..

low to high, pons will die
osmotic demyelination.
central pontine myelinolysis

locked-in syndrome:
1. spastic quadriplegia: demyelination of corticospinal tracts
2. pseudobulbar palsy: demyelination of corticobulbar tracts of CN IX, X and XI

137

pseudobulbar palsy is..

bulbar palsy?

head & neck muscle weakness, dysphagia, dysarthria.

pseudobulbar = NUCLEI of corresponding cranial n. IN TACT.

bulbar palsy = pathologic process in nuclei of these tracts

138

rapid correction of hypernatremia can cause

cerebral edema

139

magnesium citrate & polyethylene glycol are..

osmotic laxatives -- distend intestinal wall and increase peristalisis

140

rectal prolapse

protrustion of rectal mucosa through anus

(associated w/ pregnancy & constipation & severe diarrhea & cystic fibrosis)

141

composition of keratin (3)

(1) alanine & (2) glycine
small, tightly coil, many H bonds

& (3) cysteine
disulfide allows for rigidity

142

vimentin is a marker for

mesenchymal cells -- intermediate filament

143

RNA pol I makes

18S, 5.8S, 28S rRNA
(from single: 45S pre-RNA gene that is then cleaved)

only in nucleolus

144

RNA pol II makes (3)

1. mRNA
2. snRNA (small nuclear: mRNA splicing and transcription regulatoin
3. miRNA (micro: silencing via translation arrest / mRNA degradation

145

RNA pol III makes (2)

1. tRNA
2. 5S rRNA (essential component of 60s ribosomal subunit)

146

production of rRNA

45s pre-rRNA genes divided among multiple chromosomes.

arranged into clusters called "nucleolar organizing regions" --> such that all copies are located in nucleolus

147

role of nucleolus

- transcribe rRNA
- maturation & assembly of ribosomal subunits

(ribosomal protein componenets are made in cytoplasm and brought into nucleolus).

complete ribosome is shuttled out of nucleus.

148

5s rRNA is special bc

only rRNA located outside of nucleolus (made by RNA Pol III)

149

classic signs of mononucleosis

sore throat
moderate - high fever
cervical lymphadenopathy
splenomegaly

150

h. pylori associated w/ what malignancies

gastric adenocarcinoma
MALToma