test #42 4.30 Flashcards Preview

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Flashcards in test #42 4.30 Deck (141):
1

gross cirrhotic liver

diffuse hepatic fibrosis w/ regenerative nodules

2

granulomatous destruction of bile ducts w/ lymphocytic infiltrate

primary biliary cirrhosis

3

onion-skin bile duct fibrosis

primary sclerosing cholangitis

4

glossopharyngeal n fxn

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

describe path of parotid gland innervation

inferior salivatory nucleus
CN IX
otic ganglion
travel along auriculotemporal n (CN V)
parotid gland

6

salivation from submandibular & sublingual gland from? parotid?

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

M3 AML chromosomal translocation

t(15,17)
peroxidase +

8

M2 AML chromosomal translocation

AML w/ maturation
Aur rods present, peroxidase +

t (8,21)

9

molecular defect in CLL

deletion of 13q

10

FSH, LH, estradiol in pt w/ severe anorexia

ALL down. inadequate hypothalamic-pituitary gonadotropic secretion

11

distal ileum winding around a thin vascular stalk

think appel peel atresia

12

causes of jejunal, ileal, colonic atresia

NOT abnormal fetal development / malformations.

result from VASCULAR ACCIDENTS in utero

13

describe jejunal, ileas, colonic atresia process

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

mechanism of duodenal atresia

failure of recanalization

(for jejunal, ileal, colon --> vascular accident)

15

what favors non-renal clearance (hepatic metabolism / clearance)

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

primary site of drug excretion

kidney

17

primary site of drug biotransformation / metabolism

liver (also does some excretion in bile)

18

calcium chelator that prevents stone formation

citrate

19

ulcer on lesser curvature of stomach can penetrate what artery

left gastric

20

ulcer on duodenum can penetrate what artery

gastroduodenal

21

where do gastric ulcers most commonly form

lesser curvature of stomach

transitional zone between acid-secreting epitheium of corpus & gastrin-producing epithlium of antrum

22

measure of fetal lung maturity

lecithin/sphingomyelin ratio
(L/S ratio)

phosphatidylcholine / sphingomyelin ratio

1/1 until 3rd trimeter.
week 25 ~ 2:1 ratio

23

phosphatidylcholine is also know as

lecithin

24

how do tyramine foods trigger hypertensive crisis w/ MAOi?

tyramine is a sympathomimetic, usu metabolized in GI tract.

MAO inhibitors block degradation, allow it to flow in circulation

25

phenelzine

MAOi

26

tyramine containing foods

cheese, sausage, wine

27

trancypromine

MAOi

28

isocarboxazid

MAOi

29

paroxetine

SSRI

30

chlomipramine

TCA

31

depressed patient who has hypertensive crisis after cheese or wine

MAOi

32

agent in pneumonia in HIV+ w/ T-cell >800

still s. pneumonia; he is immunocompetent

33

when are HIV+ patients at risk for TB

anytime, regardless of CD4+ count

34

streptokinase

converts plasminogen --> plasmin. dissolves thrombi

also destroy: fibrinogen, factor V and VII

major side effect: hemorrhage

35

where is streptokinase derived from

beta-hemolytic bacteria! can cause HSR

36

diarrhea caught from a pet puppy?

campylobacter

domestic animal --> human

37

characterestic motility of campylobacter. growth?

"corkscrew" fashion

grows at 42 degress!

38

most common cause of acute gastroenteritis in children & adults in industrialized country?

camplyobacter jejuni

1. domestic animals
2. contaminated food (undercooked chicken, unpasteurized milk)

39

diarrhea w/ campylobacter?

inflammatory: initially watery, then bloody

40

infectious agent most associated w/ guillan-barre?

camplyobacter jejuni

41

shock w/ hyponatremia, hyperkalemia, and hypoglycemia suggests..

adrenal crisis

42

fever, vomiting, nuchal rigidity, and petechial rash suggests

meningococcal menigitis

43

Neisseria meningitis septicemia can result in..

Waterhouse-Fridrichsen syndrome; adrenal hemorrhage --> acute adrenal crisis

44

waterhouse-friedrichsen

adrenal hemorrhage w/ neisseria septicemia

45

PKA is stimulated by what upstream agent

G protein coupled receptor!

46

4 types of nonneoplastic polyps

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

juvenille polyps are often..

hamartomas

48

most common nonneoplastic polyp

hyperplastic.
(>50% in rectosigmoid)
serrated "saw tooth"

well differentiated musocal cells, form glands & crypts

49

determinants of adenomatous polyp malignant potential

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

human mitochondrial DNA codes for..

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

genetic code in mitochondria vs. nucleus

slightly different.

52

vitamin precursor to NAD+

tryptophan

53

what type of diet predisposes to pellagra?

corn-based!

niacin in corn is unabsorbable

54

pellagra can present in what type pt

corn-based diet
hartnup disease
carcinoid
alcoholic

55

carotene is the precursor to..

vitamin A

56

arginine is precursor to..

nitric oxide, urea, ornithine, agmatine, creatinine

57

nonsense, missense all result from

single base SUBSTITUTION

insertion/deletion --> FRAMESHIFT

58

optic neuritis, intention tremor, pain w/ ocular movements suggest

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

multiple sclerosis

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

usu present w/ optic neuritis

59

CSF in multiple sclerosis

elevated IgG
- oligoclonal band on electrophoresis

suggests activation of B cells

60

in what population is multiple sclerosis more common

temperate latitudes, USA, Canada, Northern Europe

61

periventricular plaques on MRI

think multiple sclerosis

62

rx: for MS

1. beta-interferon
2. natalizumab (ab against alpha 4 integrin, blocks migration of inflammatory cells across BBB)
3. baclofen - GABAb antagonist for spasticity

63

metyrapone testing

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

test for normal ACTH secrection (HPA-adrenal axis)

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

before prescribing isotretinoin (accutane) for acne, what must be checked

pregnancy test!
serum b-HCG

66

how does isotretinoin reduce acne

inhibits follicular epidermal keratinization, loosening keratin plugs of comedones, facilitating their expulsion.

reduces size of sebaceous glands and inhibits sebum production.

TERATOGEN & HYPERTRIGLYCERIDEMIA

67

fate of duodenal ulcer on anterior wall? posterior wall?

anterior wall: perforate

posterior wall: hemorrhage (gastroduodenal artery)

68

what is the duodenal bulb

begins at pylorus, ends at neck of gallbladder, and rests posterior to gallbladder & liver.

head of pancreas located inferiorly

69

major toxicity of thiazolidinediones

hepatoxoticity, must monitor LFTs

70

thazolidinediones can be used for..

metabolic syndrome, nonalcoholic fatty liver disease (NASH), PCOS

(insulin resistance)

71

for what drugs must thyroid function tests be monitored

amiodarone and lithium

72

what diabetes drugs cannot be used w/ renal problems?

metformin! the risk of lactic acidosis increases w/ renal failure

73

side effects of thiazolidinediones (2)

hepatotoxicity

fluid retention, which can exacerbate CHF if have underlying cardiac problems.

74

niacin side effects

- hyperuricemia
- hyperglycemia (insulin resistance --> acanthosis nigricans)
- flushing (vasodilation)

75

rx for essential tremor

propanolol

76

inheritance of essential tremor

autosomal dominant

77

tremor when holding posture

essential tremor

78

resting tremor

parkinsons

79

charcoal yeast extract agar supplemented w/ cysteine

Legionella

80

subthalamic nucleus

major excitatory input to GPi, when then strongly inhibits thalamus

81

direct path in basal ganglia

putamen -> GPi -> thalamus

82

indirect path in basal ganglia

putamen -> GPe -> subthalamic nuclei -> Gpi -> thalamus

83

damage to subthalamic nucleus results in..

contralateral hemiballiusmus

(no longer stimulating GPi to inhibit thalamocortical circuit. now: thalamocortical circuit too active)

84

clinical presentation of wilson'd disease basal ganglia degeneration

wing-beating tremor, psychosis, cirrhosis

85

dejerine-roussy syndrome

central post-stroke pain syndrome, after thalamic stroke

have numbness, tingling, burning, stabbing pain on one half of body, contralateral to thalamic stroke

86

Meniere's disease

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

distinguishing vertigo from meniere's disease vs. schwanoma in cerebellopontine angle

same triad:
1. tinnitus
2. vertigo
3. hearing loss

meniere: wax & wane. episodic

schwanomma of CN VIII: progressive and constant

88

vertigo vs. diziness

vertigo: sensation of motion in absence of actual motion

dizziness: sensation of lightheadedness

89

central vs. peripheral vertigo

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

airway flow rate is directly related to? inversely related to?

directly related to pressure difference in alveoli & mouth

inversely related to airway resistance

91

describe airway resistance

like vessels, airway resistance inversely related to cross-sectional area of conductive vessel.

92

describe why pulmonary fibrosis has increased FEV1 (expiratory flow rate)

decreased lung compliance (increased elastic recoil & increased radial traction (interstitial fibrosis) --> less airway resistance, increased expiratory flow rate

93

describe why emphysema/COPD has reduced FEV1 (expiratory flow rate)

airways narrowed / loss of radial traction on airways--> increased airway resistance, so reduced expiratory flow rate.

94

CEA is produced by..

70% of colorectal & pancreatic cancer

95

CA 19-9 is produced by

pancreatic cancer

96

AFP is related to which cancer

hepatocellular cacinoma

nonseminomatous testicular germ cell cancer (i.e. yolk sac)

97

CA-125

secreted by malignant ovarian epithelial tumors

90% with advanced ovarian carcinoma have it. 50% w/ early stage.

98

b-HCG is produced with which pathology

hydatidiform mole
choriocarcinoma
gestational trophoblastic tumor

99

Ca-15-3 / CA-27-29

breast cancer

100

RET gene

membrane bound tyrosine kinase receptor

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

activating mutation in proto-oncogene

101

RAS mutations are common in..

AMP kinase pathway -- cell prolif

follicular thyroid cancer, follicular adenoma

102

anaplastic thyroid carcinoma often have..

inactivating p53 mutations

103

Curling ulcers

ulcers in proximal duodenum in associated w/ severe trauma or burn

104

Cushing ulcer

ulcer in esophagus, stomach, or duodenum in patients w/ high intracranial pressure

direct stimulation of vagus nerve, hypersecretion of acid

105

chronic gastritis w/ antral sparing

autoimmune, type A

106

chronic antral predominant gastritis

h. pylori

107

intestinal subtype of gastric adenocarcinoma

intestinal: arises from precursor lesion

intestinal glands similar in appearance to those of colonic adenocarcinoma

108

diffuse subtype of gastric adenocarcinoma

characterized by signet ring cells

109

epiphyseal cartilage is also known as..

growth plate

diaphysis, metaphysis, epiphyseal cartilage, epiphysis

110

short stature in growth hormone / IGF-1 deficiency

will be proportional, in both axial and appendicular skeleton

unlike achondroplasia, where normal axial length, short appendicular limbs

111

most common location for anal fissure

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

mannitol primary affects (2) of renal tubules

1. PCT
2. descending loop of henle

113

spironolactone good for heart failure?

diuretic, and also prevents aldosterone induced cardiac remodeling

114

ethacrynic acid

loop diuretic

115

bumetanide

loop diuretic

116

how much cardiac output does the brain receive?

15%

consumes 20% of all O2 in body

117

when does PCO2 cause cerebral dilation? when does PO2?

PCO2 -- linear change!

PO2 -- only kicks in <50mmHg (very low)

118

why must supplemental oxygen be used carefully in COPD patients?

chronic hypercapnia causes oxygen to be primary mediator of respiratory drive.

O2 supplementation can lead to respiratory suppression & coma

119

team physician's responsibility

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

acute onset heart failure after recent viral infxn..

think dilated cardiomyopathy caused by viral myocarditis

121

dilated cardiomyopathy excludes what causes

dilation due to..

coronary artery disease, valvular pathology, congenital disorders

typically a diagnosis of exclusion

122

progressive pathophysiology of dilated cardiomyopathy

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

progression of primary biliary cirrhosis

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

graft vs. host disease histologically mirrors what liver pathology

primary billiary cirrhosis

granulomatous lesions of intralobular bile ducts.

heavy portal tract infiltration of macrophage, lymphocyte, plasma cells, and eosinophils.

125

liver in budd-chiari

thrombosis of hepatic vein

hepatomegaly, abdominal pain, ascites

liver: swollen, reddish purple, tense capsule

126

liver in acetominophen toxicit

centrilobular necrosis, that can extend to include entire lobule

127

deficiency in crigler-Najjar

autosomal recessive

absent UGT
uridine diphosphate glucuronyltransferase in endoplasmic reticulum

present as baby w/ persistent jaundice, muscle rigidity, lethargy, seizure

128

fate of excess conjugated bilirubin

water soluble, bound to albumin, can be excreted in urine

129

fate of excess unconjugated bilirubin

insoluble in water! deposits in tissue, including brain

leads to kernicterus--> bilirubin encephalopathy

130

dubin johnson deficiency

autosomal recessive

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

dark liver

131

rotor syndrome deficiency

rare autosomal

asymptomatic conjugated hyperbilirubinemia.

numerous defects in hepatic uptake & excretion of bilirubin pigments

no black liver

132

bile acid deconjugation

removal of glycine and taurine, rendering less soluble, impairing reabsorption of bile acid and fat absorption

done by anareobes

133

CD19+ CD20+

precursor B cell

134

CD1+ CD2+ CD5+

precursor T cell

135

describe lymphoblast

immature, high nuclear-to-cytoplasmic ratio, variably condensed nuclear chromatin, prominent nucleoli

136

B-ALL presentation

Tdt+, CD19+, CD20+

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

usu young child

137

presentation of T-ALL

usu teen, adolescent

high leukocyte count, large mediastinal mass.

TdT+, CD1a, CD3, CD4, CD5, CD8

138

cell markers of CLL/SLL
mature B cell lymphoma

CD19+ B cell marker
CD5+ T cell marker

neoplasm of small, round, monomorphic B-lymphocytes in peripheral blood, bone marrow, and lymph nodes.

139

CD19+ CD5+

B cell, T cell marker respectively

CLL/SLL, mature B cell leukemia

140

how to distinguish precursor B-ALL and precursor T-ALL

only w/ immunophenotyping for CD status

141

TdT+

marker for pre-B cell and pre-Tcell