test #42 4.30 Flashcards Preview

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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
  4. 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

  1. inflammatory: regenerating intestinal mucosa (ulcerative colitis or crohn’s)
  2. 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!)

  1. 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