test #42 4.30 Flashcards Preview

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Flashcards in test #42 4.30 Deck (141)
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1
Q
gross cirrhotic liver
A
diffuse hepatic fibrosis w/ regenerative nodules
2
Q
granulomatous destruction of bile ducts w/ lymphocytic infiltrate
A
primary biliary cirrhosis
3
Q
onion-skin bile duct fibrosis
A
primary sclerosing cholangitis
4
Q
glossopharyngeal n fxn
A
1. somatic motor: stylopharngeus only
2. parasympathetic: otic ganglion: parotid gland
3. general sensation:
-inner surface of tympanic membrane
- eustachian tube
- posterior 1/3 of tongue
- tonsilar region
- upper pharynx (afferent gag)
- carotid body
- carotid sinus
3. visceral sensation:
taste posterior 1/3 of tongue
5
Q
describe path of parotid gland innervation
A
inferior salivatory nucleus
CN IX
otic ganglion
travel along auriculotemporal n (CN V)
parotid gland
6
Q
salivation from submandibular & sublingual gland from? parotid?
A
submandibular & sublingual
FACIAL
- superior salivatory nucleus, CN VII (facial) via chorda tympani n (lingual n) across submandibular ganglion

parotid:
GLOSSOPHARYNGEAL
- inferior salivaatory nucleus, CN IX (glossopharyngeal), otic ganglion, travel w/ auricotemporal n CN V

think: facial n travels THOUGH parotid, but doesn't innervate it!
7
Q
M3 AML chromosomal translocation
A
t(15,17)
peroxidase +
8
Q
M2 AML chromosomal translocation
A
AML w/ maturation
Aur rods present, peroxidase +

t (8,21)
9
Q
molecular defect in CLL
A
deletion of 13q
10
Q
FSH, LH, estradiol in pt w/ severe anorexia
A
ALL down. inadequate hypothalamic-pituitary gonadotropic secretion
11
Q
distal ileum winding around a thin vascular stalk
A
think appel peel atresia
12
Q
causes of jejunal, ileal, colonic atresia
A
NOT abnormal fetal development / malformations.

result from VASCULAR ACCIDENTS in utero
13
Q
describe jejunal, ileas, colonic atresia process
A
vascular occlusion, diminished intestinal perfusion leads to ischemia of a segment of bowel.

subsequent narrowing / obliteration of lumen.

ileum most often affected

if SMA affect --> intestinal wall necrosis forms blind-ending proximal jejunum. terminal ileum distal to atresia forms a spiral configuration around an ileocolic vessel -- "apple peel' or 'christmas tree' deformity
14
Q
mechanism of duodenal atresia
A
failure of recanalization

(for jejunal, ileal, colon --> vascular accident)
15
Q
what favors non-renal clearance (hepatic metabolism / clearance)
A
high lipophilicity & high volume of distribution

lipophilic -- lets it enter hepatocyte

-- poorly eliminated in kidney as they rapidly cross tubular cell membranes after filtration
16
Q
primary site of drug excretion
A
kidney
17
Q
primary site of drug biotransformation / metabolism
A
liver (also does some excretion in bile)
18
Q
calcium chelator that prevents stone formation
A
citrate
19
Q
ulcer on lesser curvature of stomach can penetrate what artery
A
left gastric
20
Q
ulcer on duodenum can penetrate what artery
A
gastroduodenal
21
Q
where do gastric ulcers most commonly form
A
lesser curvature of stomach

transitional zone between acid-secreting epitheium of corpus & gastrin-producing epithlium of antrum
22
Q
measure of fetal lung maturity
A
lecithin/sphingomyelin ratio
(L/S ratio)

phosphatidylcholine / sphingomyelin ratio

1/1 until 3rd trimeter.
week 25 ~ 2:1 ratio
23
Q
phosphatidylcholine is also know as
A
lecithin
24
Q
how do tyramine foods trigger hypertensive crisis w/ MAOi?
A
tyramine is a sympathomimetic, usu metabolized in GI tract.

MAO inhibitors block degradation, allow it to flow in circulation
25
Q
phenelzine
A
MAOi
26
Q
tyramine containing foods
A
cheese, sausage, wine
27
Q
trancypromine
A
MAOi
28
Q
isocarboxazid
A
MAOi
29
Q
paroxetine
A
SSRI
30
Q
chlomipramine
A
TCA
31
Q
depressed patient who has hypertensive crisis after cheese or wine
A
MAOi
32
Q
agent in pneumonia in HIV+ w/ T-cell >800
A
still s. pneumonia; he is immunocompetent
33
Q
when are HIV+ patients at risk for TB
A
anytime, regardless of CD4+ count
34
Q
streptokinase
A
converts plasminogen --> plasmin. dissolves thrombi

also destroy: fibrinogen, factor V and VII

major side effect: hemorrhage
35
Q
where is streptokinase derived from
A
beta-hemolytic bacteria! can cause HSR
36
Q
diarrhea caught from a pet puppy?
A
campylobacter

domestic animal --> human
37
Q
characterestic motility of campylobacter. growth?
A
"corkscrew" fashion

grows at 42 degress!
38
Q
most common cause of acute gastroenteritis in children & adults in industrialized country?
A
camplyobacter jejuni

1. domestic animals
2. contaminated food (undercooked chicken, unpasteurized milk)
39
Q
diarrhea w/ campylobacter?
A
inflammatory: initially watery, then bloody
40
Q
infectious agent most associated w/ guillan-barre?
A
camplyobacter jejuni
41
Q
shock w/ hyponatremia, hyperkalemia, and hypoglycemia suggests..
A
adrenal crisis
42
Q
fever, vomiting, nuchal rigidity, and petechial rash suggests
A
meningococcal menigitis
43
Q
Neisseria meningitis septicemia can result in..
A
Waterhouse-Fridrichsen syndrome; adrenal hemorrhage --> acute adrenal crisis
44
Q
waterhouse-friedrichsen
A
adrenal hemorrhage w/ neisseria septicemia
45
Q
PKA is stimulated by what upstream agent
A
G protein coupled receptor!
46
Q
4 types of nonneoplastic polyps
A
1. hyperplastic: well-differentiated mucosal cells, form glands & crypts

2. hamartomatous: mucosal glands, smooth muscle, connective tissue.

can occur sporadically via Peutz-Jeghers or juvenile polyposis

3. inflammatory: regenerating intestinal mucosa (ulcerative colitis or crohn's)

4. lymphoid: in children. instestinal mucosa infiltrate w/ lymphocytes
47
Q
juvenille polyps are often..
A
hamartomas
48
Q
most common nonneoplastic polyp
A
hyperplastic.
(>50% in rectosigmoid)
serrated "saw tooth"

well differentiated musocal cells, form glands & crypts
49
Q
determinants of adenomatous polyp malignant potential
A
1. degree of dysplasia
2. histologic pattern: VILLOUS more likely than tubular to transform
3. size of adenoma >4cm have 40% chance of malignancy
50
Q
human mitochondrial DNA codes for..
A
37 genes for 13 proteins, 2 rRNA, 22 tRNA

produce some proteins needed for oxidative metabolic pathways

(nuclear DNA encodes for MOST proteins in mitochondria)
51
Q
genetic code in mitochondria vs. nucleus
A
slightly different.
52
Q
vitamin precursor to NAD+
A
tryptophan
53
Q
what type of diet predisposes to pellagra?
A
corn-based!

niacin in corn is unabsorbable
54
Q
pellagra can present in what type pt
A
corn-based diet
hartnup disease
carcinoid
alcoholic
55
Q
carotene is the precursor to..
A
vitamin A
56
Q
arginine is precursor to..
A
nitric oxide, urea, ornithine, agmatine, creatinine
57
Q
nonsense, missense all result from
A
single base SUBSTITUTION

insertion/deletion --> FRAMESHIFT
58
Q
optic neuritis, intention tremor, pain w/ ocular movements suggest

waxing & waning neuro deficits in 20-30 y/o
A
multiple sclerosis

SIIIN
- scanning speech
- intention tremor
- incontinence
- internuclear opthalmoplegia
- nystagmus

usu present w/ optic neuritis
59
Q
CSF in multiple sclerosis
A
elevated IgG
- oligoclonal band on electrophoresis

suggests activation of B cells
60
Q
in what population is multiple sclerosis more common
A
temperate latitudes, USA, Canada, Northern Europe
61
Q
periventricular plaques on MRI
A
think multiple sclerosis
62
Q
rx: for MS
A
1. beta-interferon
2. natalizumab (ab against alpha 4 integrin, blocks migration of inflammatory cells across BBB)
3. baclofen - GABAb antagonist for spasticity
63
Q
metyrapone testing
A
inhibits 11-b-hydroxylase. can't convert 11-beta-deoxycortisol into cortisol

REDUCE serum cortisol, which should stimulate ACTH release, which builds up deoxycortisol (metabolite in urine -> 17-hydroxycorticosteroid)

unlike cortisol, deoxycortisol does not inhibit ACTH release.

normal HPA axis: increase 11-deoxycortisol in serum. increase 17-hydroxycorticosteroid in urine.
64
Q
test for normal ACTH secrection (HPA-adrenal axis)
A
metyrapone testing

reduce serum cortisol,
expect elevated ACTH,

will generate elevated 11-deoxycortisol in serum & 17-hydroxycortisol in urine

bc metyapone blocks 11-b-hydroxylase
65
Q
before prescribing isotretinoin (accutane) for acne, what must be checked
A
pregnancy test!
serum b-HCG
66
Q
how does isotretinoin reduce acne
A
inhibits follicular epidermal keratinization, loosening keratin plugs of comedones, facilitating their expulsion.

reduces size of sebaceous glands and inhibits sebum production.

TERATOGEN & HYPERTRIGLYCERIDEMIA
67
Q
fate of duodenal ulcer on anterior wall? posterior wall?
A
anterior wall: perforate

posterior wall: hemorrhage (gastroduodenal artery)
68
Q
what is the duodenal bulb
A
begins at pylorus, ends at neck of gallbladder, and rests posterior to gallbladder & liver.

head of pancreas located inferiorly
69
Q
major toxicity of thiazolidinediones
A
hepatoxoticity, must monitor LFTs
70
Q
thazolidinediones can be used for..
A
metabolic syndrome, nonalcoholic fatty liver disease (NASH), PCOS

(insulin resistance)
71
Q
for what drugs must thyroid function tests be monitored
A
amiodarone and lithium
72
Q
what diabetes drugs cannot be used w/ renal problems?
A
metformin! the risk of lactic acidosis increases w/ renal failure
73
Q
side effects of thiazolidinediones (2)
A
hepatotoxicity

fluid retention, which can exacerbate CHF if have underlying cardiac problems.
74
Q
niacin side effects
A
- hyperuricemia
- hyperglycemia (insulin resistance --> acanthosis nigricans)
- flushing (vasodilation)
75
Q
rx for essential tremor
A
propanolol
76
Q
inheritance of essential tremor
A
autosomal dominant
77
Q
tremor when holding posture
A
essential tremor
78
Q
resting tremor
A
parkinsons
79
Q
charcoal yeast extract agar supplemented w/ cysteine
A
Legionella
80
Q
subthalamic nucleus
A
major excitatory input to GPi, when then strongly inhibits thalamus
81
Q
direct path in basal ganglia
A
putamen -> GPi -> thalamus
82
Q
indirect path in basal ganglia
A
putamen -> GPe -> subthalamic nuclei -> Gpi -> thalamus
83
Q
damage to subthalamic nucleus results in..
A
contralateral hemiballiusmus

(no longer stimulating GPi to inhibit thalamocortical circuit. now: thalamocortical circuit too active)
84
Q
clinical presentation of wilson'd disease basal ganglia degeneration
A
wing-beating tremor, psychosis, cirrhosis
85
Q
dejerine-roussy syndrome
A
central post-stroke pain syndrome, after thalamic stroke

have numbness, tingling, burning, stabbing pain on one half of body, contralateral to thalamic stroke
86
Q
Meniere's disease
A
increased volume of endolymph in inner ear (due to decreased resoption)

distention damages both vestibular and cochlear components of inner ear

triad:
1. tinnitus
2. vertigo
3. hearing loss
87
Q
distinguishing vertigo from meniere's disease vs. schwanoma in cerebellopontine angle
A
same triad:
1. tinnitus
2. vertigo
3. hearing loss

meniere: wax & wane. episodic

schwanomma of CN VIII: progressive and constant
88
Q
vertigo vs. diziness
A
vertigo: sensation of motion in absence of actual motion

dizziness: sensation of lightheadedness
89
Q
central vs. peripheral vertigo
A
peripheral: meniere, semicircular canal debris, etc
->positional testing, delayed horizontal nystagmus

central: i.e. stroke of vestibular nuclei, posterior fossa
->positional testing, immediate nystagmus in any direction, may change directions.
90
Q
airway flow rate is directly related to? inversely related to?
A
directly related to pressure difference in alveoli & mouth

inversely related to airway resistance
91
Q
describe airway resistance
A
like vessels, airway resistance inversely related to cross-sectional area of conductive vessel.
92
Q
describe why pulmonary fibrosis has increased FEV1 (expiratory flow rate)
A
decreased lung compliance (increased elastic recoil & increased radial traction (interstitial fibrosis) --> less airway resistance, increased expiratory flow rate
93
Q
describe why emphysema/COPD has reduced FEV1 (expiratory flow rate)
A
airways narrowed / loss of radial traction on airways--> increased airway resistance, so reduced expiratory flow rate.
94
Q
CEA is produced by..
A
70% of colorectal & pancreatic cancer
95
Q
CA 19-9 is produced by
A
pancreatic cancer
96
Q
AFP is related to which cancer
A
hepatocellular cacinoma

nonseminomatous testicular germ cell cancer (i.e. yolk sac)
97
Q
CA-125
A
secreted by malignant ovarian epithelial tumors

90% with advanced ovarian carcinoma have it. 50% w/ early stage.
98
Q
b-HCG is produced with which pathology
A
hydatidiform mole
choriocarcinoma
gestational trophoblastic tumor
99
Q
Ca-15-3 / CA-27-29
A
breast cancer
100
Q
RET gene
A
membrane bound tyrosine kinase receptor

mutated in 95% of familial medullary thyroid cancer & many sporadic too

activating mutation in proto-oncogene
101
Q
RAS mutations are common in..
A
AMP kinase pathway -- cell prolif

follicular thyroid cancer, follicular adenoma
102
Q
anaplastic thyroid carcinoma often have..
A
inactivating p53 mutations
103
Q
Curling ulcers
A
ulcers in proximal duodenum in associated w/ severe trauma or burn
104
Q
Cushing ulcer
A
ulcer in esophagus, stomach, or duodenum in patients w/ high intracranial pressure

direct stimulation of vagus nerve, hypersecretion of acid
105
Q
chronic gastritis w/ antral sparing
A
autoimmune, type A
106
Q
chronic antral predominant gastritis
A
h. pylori
107
Q
intestinal subtype of gastric adenocarcinoma
A
intestinal: arises from precursor lesion

intestinal glands similar in appearance to those of colonic adenocarcinoma
108
Q
diffuse subtype of gastric adenocarcinoma
A
characterized by signet ring cells

109
Q
epiphyseal cartilage is also known as..
A
growth plate

diaphysis, metaphysis, epiphyseal cartilage, epiphysis
110
Q
short stature in growth hormone / IGF-1 deficiency
A
will be proportional, in both axial and appendicular skeleton

unlike achondroplasia, where normal axial length, short appendicular limbs
111
Q
most common location for anal fissure
A
posterior midline (poorly perfused), distal to dentate line.

severe tearing pain w/ passage of bowel movement.

may see skin tag.

associate w/ low fiber diet
112
Q
mannitol primary affects (2) of renal tubules
A
1. PCT
2. descending loop of henle
113
Q
spironolactone good for heart failure?
A
diuretic, and also prevents aldosterone induced cardiac remodeling
114
Q
ethacrynic acid
A
loop diuretic
115
Q
bumetanide
A
loop diuretic
116
Q
how much cardiac output does the brain receive?
A
15%

consumes 20% of all O2 in body
117
Q
when does PCO2 cause cerebral dilation? when does PO2?
A
PCO2 -- linear change!

PO2 -- only kicks in <50mmHg (very low)
118
Q
why must supplemental oxygen be used carefully in COPD patients?
A
chronic hypercapnia causes oxygen to be primary mediator of respiratory drive.

O2 supplementation can lead to respiratory suppression & coma
119
Q
team physician's responsibility
A
overriding duty of all physicians is to protect health & safety of patient.

preferences expressed by patient cannot influence decision

student athletes sign authorization form permitting physician to SHARE health info w/ coaches (family educational rights & privacy act)

employed by university, not the personal physician. exception to HIPAA.
120
Q
acute onset heart failure after recent viral infxn..
A
think dilated cardiomyopathy caused by viral myocarditis
121
Q
dilated cardiomyopathy excludes what causes
A
dilation due to..

coronary artery disease, valvular pathology, congenital disorders

typically a diagnosis of exclusion
122
Q
progressive pathophysiology of dilated cardiomyopathy
A
1. initial ventricle dilation and dysfunction w/ progressive biventricular myocardial failure

2. reduced stroke volume --> increased ventricular end-systolic and end-diastolic volumes

3. ventricular dilation --> regurgitation across AV valves
123
Q
progression of primary biliary cirrhosis
A
1. precirrhotic:
intralobular bile ducts destroyed by granulomatous inflammation "florid duct lesions"
&
heavy portal tract infiltrate of macrophages, lymphocytes, plasma cells, eosinophils

(like graft vs. host disease!)

2. eventually progressive hepatic damage due to obstructed intrahepatic bile flow.

liver -> green and micronodular
124
Q
graft vs. host disease histologically mirrors what liver pathology
A
primary billiary cirrhosis

granulomatous lesions of intralobular bile ducts.

heavy portal tract infiltration of macrophage, lymphocyte, plasma cells, and eosinophils.
125
Q
liver in budd-chiari
A
thrombosis of hepatic vein

hepatomegaly, abdominal pain, ascites

liver: swollen, reddish purple, tense capsule
126
Q
liver in acetominophen toxicit
A
centrilobular necrosis, that can extend to include entire lobule
127
Q
deficiency in crigler-Najjar
A
autosomal recessive

absent UGT
uridine diphosphate glucuronyltransferase in endoplasmic reticulum

present as baby w/ persistent jaundice, muscle rigidity, lethargy, seizure
128
Q
fate of excess conjugated bilirubin
A
water soluble, bound to albumin, can be excreted in urine
129
Q
fate of excess unconjugated bilirubin
A
insoluble in water! deposits in tissue, including brain

leads to kernicterus--> bilirubin encephalopathy
130
Q
dubin johnson deficiency
A
autosomal recessive

absence of biliary transport protein MRP2 -- hepatocellular excretion of bilirubin glucoronides into bile canaliculu

dark liver
131
Q
rotor syndrome deficiency
A
rare autosomal

asymptomatic conjugated hyperbilirubinemia.

numerous defects in hepatic uptake & excretion of bilirubin pigments

no black liver
132
Q
bile acid deconjugation
A
removal of glycine and taurine, rendering less soluble, impairing reabsorption of bile acid and fat absorption

done by anareobes
133
Q
CD19+ CD20+
A
precursor B cell
134
Q
CD1+ CD2+ CD5+
A
precursor T cell
135
Q
describe lymphoblast
A
immature, high nuclear-to-cytoplasmic ratio, variably condensed nuclear chromatin, prominent nucleoli
136
Q
B-ALL presentation
A
Tdt+, CD19+, CD20+

bone marrow failure; thrombocytopenia and/or anemia and/or neutropenia

usu young child
137
Q
presentation of T-ALL
A
usu teen, adolescent

high leukocyte count, large mediastinal mass.

TdT+, CD1a, CD3, CD4, CD5, CD8
138
Q
cell markers of CLL/SLL
mature B cell lymphoma
A
CD19+ B cell marker
CD5+ T cell marker

neoplasm of small, round, monomorphic B-lymphocytes in peripheral blood, bone marrow, and lymph nodes.
139
Q
CD19+ CD5+
A
B cell, T cell marker respectively

CLL/SLL, mature B cell leukemia
140
Q
how to distinguish precursor B-ALL and precursor T-ALL
A
only w/ immunophenotyping for CD status
141
Q
TdT+
A
marker for pre-B cell and pre-Tcell