test #41 4.30 Flashcards Preview

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Flashcards in test #41 4.30 Deck (127):
1

immunoglobulins made by Salk polio vaccine?

killed -- only IgG

injected intramuscularly, unable to stimulate mucosal secretory IgA

2

immunoglobulins made by Sabin polio vaccine?

live -- both IgG and IgA on (mucosal surfaces)

will colonize natural site of viral entry, producing a greater & more prolonged immune response there.

3

difference between Salk & Sabin's polio vaccine

Salk - killed. less effective in generating prolonged oropharyngeal & intestinal IgA
(not serum)

Sabin - live, will be able to colonize mucosal surface and secrete IgA

4

two primary sites of poliovirus replication

oropharynx & intestine

5

common sites of psoriasis

elbow, knees, gluteal cleft, lumbosacral area, glans penis, scalp

6

nail changes associated w/ psoriasis

yellow-brown discoloration w/ pitting, thickening, or crumbling

7

type of arthritis w/ psoriasis

often deforming, upper extremity, small joint

dactylitis (sausage fingers), pencil-in-cup defomity on x-ray

8

HLA subtype associated w/ psoriasis

HLA C

HLAB27 too bc of psoriatic arthritis

9

who makes angiotensin converting enzyme?

pulmonary vascular endothelial cells

10

three direct effects of antgiotensin II

1. sodium retention (direct)
2. aldosterone production
3. vasconstriction

11

negative predictive value.
"what's the probability that negative test results truly mean absence of disease"

of the people who tested negative, how many don't have the disease

12

relationship of NPV and prevalence

NPV decreases as prevalence increases

13

Gardos channel blockers for Sickle-cell anemia

Ca2+ dependent K+ channel blockers, reduces K+ & H2O efflux from erythrocytes

prevents dehydration & sickling in Sickle-cell anemia

14

which substances increase gastric acid production from parietal cells? block

increase: histamine, Ach, gastrin

block: PGE2

15

predominant source of TGF-alpha

CARCIMONAS

also, mac

16

cachexia cytokines

TNF-alpha, IFN-gamma, IL-6

17

what can severely impair cardiac output in patients w/ aortic stenosis

sudden drop in preload w/ loss of atrial contraction (i.e. atrial fibrillation)

bc left heart needs to generate lots of pressure to get blood out in aortic stenosis, now relies on atrial contraction for maximal preload (max LV filling)

18

in which pts is atrial contraction importrant

patients w/ poorly compliant left ventricles. needed to maintain adequate LV filling.

19

definition of preload

end-diastolic volume in ventricle

20

definition of afterload

arterial resistance

21

where does CN I olfactory bundles enter skull?

cribiform plate

22

what goes through optic canal

1. CN II
2. central retinal vein
3. opthalmic artery

23

what goes through superior orbital fissure?

1. CN III
2. CN IV
3. CN VII
4. CN V1
5. opthalmic vein
6. sympathetic fibers

24

foramen rotundum

CN V2

25

foramen ovale

CN V3

26

foramen spinosum

middle meningeal artery & vein

27

internal acoustic meatus

CN VII
CN VIII

28

jugular foramen

CN IX,
CNX,
CN XI,
jugular vein

29

foramen magnum

spinal root of CN XI
brain stem
vertebral artery

30

hypoglossal canal

CN XII

31

jugular foramen (vernet) syndrome

loss of CN IX, X, XI

- loss of taste from posterior 1/3 tongue (CN IX)
- reduce parotid gland secretion (CN IX)
- loss of gag reflex (CN IX, X)
- dysphagia (CN IX, X)
- dysphonia/hoarseness (CN X)
- soft palate drop w/ deviation of uvula to normal side (CN X)
- SCN and trapezius paralysis (CN XI)

32

air in the gallbladder biliary tree suggests

gallstone ileus

33

where does gallstone lodge in gallstone ileus

trapped behind the ileocecal valve.

see it in ileum

34

choledocolithiasis

obstruction of cystic or common bile duct by gallstone

35

mechanism of genomic imprinting

DNA methylation by DNA methytransferases

transfer methy from donors, like S-adenosyl-methionine (SAM) to CYSTEINE residues

36

describe airway resistance

upper respiratory tract: nasal passage, mouth, pharynx, larynx = 1/2

trachea & mainstem bronchus: HIGH

increases in MEDIUM-sized bronchi bc of highly turbulent flow (generation 2-5)

falls in smaller airways bc high cross-sectional area is combined high.

37

what constitutes "upper" respiratory tract

nasal passage, mouth, pharynx, larynx

38

what constitutes "lower" respiratory tract

trachea & 23 generation of airways

39

where is lower respiratory airway resistance highest

MEDIUM-sized bronchi (generation 2-5) bc of turbulent flow

moderately high in trachea too. falls after medium sized bronchi (bc summation of cross-sectional area = low)

40

antipseudomonal penicillins

ticarcillin, piperacillin

41

antipseudomonal cephalosporins

ceftazidime (3rd gen)
cefepime (4th gen)

42

antipseudomonal aminoglycosides

amikan, gentamycin, tobramycin

43

antipseudomonal fluroquinolones

ciprofloxacin
levofloxacin

44

antipseudomonal monobactam

aztreonam

45

antipseudomonal carbapenem

imipenem
meropenem

46

azetreonam works on

aerobic gram negatives

(bad against gram positive and anerobes)

47

what type of haemophilus produces ear infxn

noncapsular, nontypable

h. flu vaccine won't prevent it

48

what kind of illness can nontypable h. flu cause?

part of upper respiratory normal flora

otitis media
sinusitis
bronchitis

49

type of immunity conferred by conjugated vaccine

humoral.
adding protein helps it be presented on MHC II.

doesn't stimulate a cell-mediated response (not on MHC I)

50

time frame for ischemic-related brain injury

hypoxia > 1 min = cessation of neuronal fxn

permanent damage to brain tissue in 4-5min

51

gingival hyperplasia

phenytoin, nifedipine, verapamil,

52

adverse effects of phenytoin

CNS: cerebeullum & vestibular, ataxia & nystagmus

gingival hyperplasia, coarsening facial features, hirsitism

interfere w/ folic acid absorption

induces P450

teratogen: fetal hydantoin syndrome

53

mechanism of gingival hyperplasia w/ phenytoin

increases expression of PDGF, stimulating prolif of gingival cells & alveolar bone.

54

how are the 3 genes in lac operon coordinated to be made in equal amounts

prokaryotic mRNA can be polycistronic (on mRNA codes for several proteins)

3 genes regulated by SINGLE promoter, operator & regulatory elements

55

duodenal atresia occurs due to..

failure of duodenum to recanalizein early embryonic life

56

malrotation in gut

failure of midgut to rotate counterclockwise as it returns to abdominal cavity

57

when does vitelline duct normally obliterate

7th week

58

aminoglycoside resistance (i.e. via enterococci)

aminoglycoside-modifying agents that transfer diff chemical groups -- acetyl, adenyl, phosphate

outside of bacteria, so it can no longer bind to ribosomes.

aqcuired by plasmid / transposons

59

penicillin resistance

(1) b-lactamase
(2) penicillin-binding proteins

60

vancomycin resistance

mutation in cell wall precursor turning D-ala-D-ala to D-ala-D-lactate

(altered target)

61

tetracycline resistance

1. mutation in ribosome
2. increased efflux, influx

62

fluoroquinolone resistance

mutations in gyrase / topoisomerase gene

63

what is hepatic encephalopathy acutely triggered by

often GI bleed, increasing ammonia & nitrogen in gut for absorption

64

relationship between alpha-ketoglutarate, glutamate, and glutamine

alpha-ketoglutarate + NH3 --> glutamate
(via glutamate dehydrogenase, both ways)

glutamate + NH3 --> glutamine
(via glutamine synthase)

glutamine ---> glutamate + NH3
glutaminase

65

describe glutamate-glutamine cycle

in neuron:

glutamate made 2 ways
1. glutamine -> glutamate + NH3
(via glutaminase)
2. alpha-ketoglutarate + NH3 --> glutamate
(via glutamate dehydrogenase)

in synaptic cleft, glutamate is taken up by astrocytes
1. glutamate + NH3 --> glutamine
(via glutamine synthase)

glutamine is shuttled back into neurons

66

how does hyperammonia affect glutamate-glutamine cycle

1. in astrocyte, excess NH3 creates toxic accumulation of glutamine

2. in neuron, excess NH3 promotes excess consumption of alpha-ketoglutarate --> glutamate

this leaves less alpha-ketoglutarate for TCA in neurons!

67

which 2 substances are depleted in the brain during hyperammonia? accumulated?

deplete:
1. glutamate
(too much glutamine formation in astrocytes

2. alpha-ketoglutarate
(used to make more glutamate)

accumulate: glutamine in astrocytes! swell

68

oxindole

tryptophan derivative

formed by bacteria in gut & normally cleaved by liver. elevated in hepatic encephalopathy.

69

milrinone

strong ionotropic agent
inhibit phosphodiesterase

increase cardiac cAMP, increased contractility

70

rx: during angioplasty in patients w/ acute coronary syndrome

abciximab

71

deciding between uricosuric (probenicid) agents vs. allopurinol/febuxostat?

if has uric stones, don't want to add more uric acid in urine. give febuxostat / allopurinol.

72

sudden liver failure after surgery?

consider hepatic necrosis caused by halothane!

73

halothane side effects

type 1: aminotransferase elevation, mild syptoms

type 2: fulminant hepatitis. extensive hepatocellular damage.

RAPID ATROPHY - widespread centrilobular hepatocellular necrosis & inflammation of portal tracts & parenchyma

74

decreased albumin levels is a sign of..

chronic liver injury. NOT aute.

half-life of 20 days.

75

presentation of fulminant hepatitis caused by halothane

elevated aminotransferases
prolonged prothrombin
eosinophilia

(albumin takes 20 days to rise)

76

anti-topoisomerase I specific for..

scleroderma (anti Scl-70)

77

characterestics of esophageal motility

fibrosis of distal esophagus

1. esophageal hypomotlity
2. loss of tone in LES

manifests as GERD

78

drug induced lupus

procainamide, hydralazine, isoniazid, d-penicillamine

79

presentation of sjogren

keratoconjunctivitis sicca (dry eye)

xerostomia (dry mouth

may be parotid enlargement

increased risk of non-hodgkin lymphoma

80

anomaly in antiphospholipid syndrome

thombophilia w/ paradoxical increased PTT

81

hydronephrosis vs. autosomal dominant polycystic kidney disease

hydronephrosis: smooth surface

ADPKD: cyst bumps visualized on surface

82

cysts in ADPKD and ARPKD

ADPKD: large cysts, from anywhere.
-lumpy bumpy cysts seen on gross exam of surface

ARPKD: small cysts in collecting duct.
- generally smooth surface

83

shrunken kidney on ultrasound can suggest?

medullary cystic disease -- inherited

tubulointerstitial fibrosis, progressive renal insufficiency. medullary cysts usu NOT visualized.

(shrunken, as opposed to polycystic kidney --> large)

84

mucosa in lactase deficiency

normal

85

pancreatic pseudocyst

potential complication of pancreatitis.

leakage of pancreatic secretions -- induce inflammatory response --> granulation tissue & fibrosis forms to trap fluid

86

cyst vs. pseudocyst

cyst: lined w/ epithelial cells

pseudocyst: granulation tissue

87

most common location for pancreatic pseudocyst:

lesser peritoneal sac, bordered by stomach, duodenum, transverse colon

88

the only radiolucent stone

uric acid stones

89

colorless octahedron crystals

calcium oxalate or calcium phosphate

90

rectangular prism "coffin-lid" crystal

struvite (AMP or triple phosphate

proteus mirabilis / vulgaris, klebsiella, staphlococcus

91

yellow, red-brown, diamond or rhombus

uric acid

92

flat, yellow, hexagonal crystals

cysteine

93

which 2 stones ppt in basic environment

calcium phosphate (or neutral)

AMP

94

inheritance of alpha-1 antitrypsin

co-dominant, affects lung and liver

95

genotype in alpha-1-antitrypsin deficiency

homozygous for Z allele - decrease secretion of A1AT secondary to abnormal protein folding.

STUCK IN ER

96

liver consequences in alpha-1-antitrypsin deficiency

accumulation of anti 1-antitrypsin.

liver issues before lung issues usually

leads to..
1. cirrhosis (2nd most common cause of death) and
2. hepatocellular carcinoma

97

histology of liver w/ alpha 1-antitrypsin deficiency

intracellular granules of unsecreted A1AT.

stain reddish pink w/ PAS

resist digestion by diastase

98

symptoms of scurvy

impaired collagen formation

hemorrhage
SUBPERIOSTEAL HEMATOMA
bleeding into JOINT SPACE
GINGIVAL swelling
secondary peridontal infection
anemia
hyperkeratotic papular rash
impaired wound healing
weakened immune response

99

vitamin K deficiency vs. vitamin C deficiency

both have bleeding diathesis, but vitamin K usu doesn't present w/ PAINFUL GUMS

100

acrodermatitis enteropathica, growth retardation, infertility

zinc deficiency

101

b-blocker overdose?

glucagon

increase cAMP, increase Ca2+ release during contraction. increases HR & contractility (independent of adrenergic receptors)

102

histological diagnosis of celiac

small intestine: MOST: duodenum and proximal jejuneum

flattening of mucosa w/ loss of villi and chronic inflammatory infiltration of lamina propria

103

antibodies seen in celiac (3)

anti-endomysial
anti-reticulin
anti-transglutaminase

104

common finding in GI malabsorption?

steatorrhea: foul, smelling, bulky, floating, greasy stoof

105

dfiferential of steatorrhea (3)

1. pancreatic insufficiency
- chronic pancreatitis, cystic fibrosis

2. intestinal mucosal defect
- celiac, tropical spru, whipple, chron.

3. bacterial proliferation
small bowel diverticulosis, diabetic neuropathy. bacteria eat nutrients

106

differentiate cause of steatorrhea?

stool sample
1. sudan III stool stain: identidy fat
2. quantitative analysis of amt of fat

then bariums studies to see what caused it.

107

what do you need for diagnosis of malabsorption

STOOL SAMPLE

108

major pathophysiology w/ prolonged NSAID use

chronic interstitial nephritis

clinically: see modest elevation in serum creatinine, evidence of tubular dysfxn, fanconi syndrome (aminoaciduria, glycosuria, hypophosphatemia, hypouricemia)

109

fibromyalgia

key: multiple symmetrically distributed tender spots over patients' muscles, joints, tendons (spine of scapula, lateral epicondyle, medial fat pad of knee)

demo: 20-50y/o. mostly women

widespread musculoskeletal pain w. stiffness, paresthesia, poor sleep, emotional disturbance.

muscle pain & stiffness severe in morning. exacerbated w/ exercise.

110

polymyalgia rheumatica

>50 y/o.

morning stiffness of neck, shoulder, pelvic girdle.

weight loss, fever, increased ESR

111

presentation of ankylosing spondylitis

low back stiffness, resolves w/ exercise.

usu affects males

PE: decrease anterior flexion of spine.

112

formula for clearance

urine concentration x urine flow rate

over

plasma concentration

113

normal filtration rate

~20%

114

common side effects of first-generation anti-histamine

anti-muscarinic
anti-5HT
anti-alpha-adrenergic

and lipophilic --> sedation / cognitive dysfxn

115

second generation antihistamine

NO anti-muscarininc, anti-5HT, anti-alpha-adrenergic.

not lipohilic --> no sedation / cognitive dysfxn

116

hydroxyzine, promethazine, chlorpheniramine, diphenhydramine

1st gen anti-histamine

side effects!

117

fexofenadine

2nd gen anti-histamine

minimal sedation & anti-muscarinic

118

wax & waning lymphadenopathy

follicular lymphoma!

119

follicular lymphoma

most common indolent non-hodgkin lymphoma in adults

indolent course, marked by remission & recurrence

wax & wane

t(14,18) bcl-2 overexpression

120

diffuse large cell lymphoma often involves..

waldeyer ring (oropharyngeal lymphoid tissue)

GI tract

most common aggressive non-hodgkin's lymphoma in adult

121

mycosis fungoides

cutaneous T-cell lymphoma

proliferating CD4+ T cell infiltrate dermis & epidermis --> PAUTRIER MICROABSCESSES.

manifest w/ plaques that may be confused w/ psoriasis or eczema

generalized erythema, scaling, thickening of skin

122

clinical presentation of hairy cell leukemia

splenomegaly & pancytopenia in older men

123

BRAF mutation w/ glutamic acid for valine at position 600 (V600E)

melanoma

124

antibody rx for mutant BRAF in melanoma?

vemurafenib

125

vemurafenib

inhibitor of mutant BRAF in melanoma

126

most common AGGRESSIVE non-hodgkin lymphoma

diffuse large B cell lymphoma

rapidly enlarging mass

127

most common INDOLENT non-hodgkin lymphoma?

follicular lymphoma, wax & wane