test #46 5.6 Flashcards Preview

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Flashcards in test #46 5.6 Deck (121):
1

vertical transmission of hepatitis occurs via..

passage through birth canal, or transplacental infxn

2

increased risk of vertical transmission marked by..

HBeAg (marks viral replication & infectivity)

3

rx for all newborns of all mothers w/ active hepatitis B?

-passively via HBIG (hep B Ig)
&
-active immunization w/ recombinant HBV vaccine

4

window period of hep B detected w/

HbcAb

5

histology of macula (3)

densely packed cone, few overlying cells, no blood vessels

1 cone -> 1 bipolar cell -> 1 ganglion cell

all = greater visual acuity

6

scotoma

visual defect surrounded by relatively unimpaired field of vision

7

causes of scotoma

pathology in retina / optic nerve

1. demyelinating disease (MS)
2. diabetic retinopathy
3. retinitis pigmentosa
4. macular degeneration = CENTRAL scotoma

8

dry vs wet macular degeneration

dry: deposition of fatty tissue (drusen) behind retina

wet: neovascularization of retina

9

arcuate scotoma

due to damage to a particular region of optic nerve head

resulting defect follows arcuate shape of nerve fiber pattern

10

deep intramuscular injections to the buttock should be

superlateral quadrant

11

superomedial injection to the buttock can..

injure superior gluteal n.

12

path of superior gluteal n.

L4-S1
leaves pelvis via greater sciatic foramen above level of piriformis

13

inferomedial quadrant to the buttock injection can..

injure sciatic n.

14

mucinous cystadenocarcinoma

malignant neoplasm arising from ovarian surface epithelium

produce mucin --> pseudomyxoma peritonei

15

pseudomyxoma peritonei

associated w/ mucinous cystadenocarcinoma & appendiceal tumor

peritoneal cavity fills w/ mucin due to widespread intraperitoneal metastases

16

demographic for dysgerminoma in females

YOUNGER, 10-30y/o

17

benign cystic teratoma in females

dermoid cysts

18

most common germ cell tumors in females

benign cystic teratoma
(dermoid cysts)

19

struma ovarii

dermoid cysts / cystic teratoma in ovary -- can secrete excessive thyroid hormone

20

ovarian tumor & hyperthyroidism

struma ovari --> dermoid cysts // benign cystic teratoma of ovaries

21

presentation of granulosa cell tumor

secrete estrogen -->
young: precocious puberty
older: abnormal endometrial bleeding, endometrial carcinoma

22

alpha 1-antitrypsin on diffusing capacity

decreased diffusing capacity bc destruction of alveoli and adjoining capillary beds

23

Curschmann spirals

shed epithelium forming mucus plug in asthma

24

Charcot-Leyden crystals

breakdown of eosinophils in sputum

25

asthma characterized by what:
FEV/FVC, TLV, DC

decreased FEV/FVC
increased TLV
increased DC (increased pulmonary blood volume)

26

selective proteinuria

suggests foot process effacesment

loss of ALBUMIN mostly

(less bulky proteins like IgG and macroglobulin)

27

components of glomeruliar filtration barrier (3)

1. fenestrated endothelium
2. glomerular basement membrane
3. epithelial cell foot processes

28

size selectivity in glomerulus conferred by.. most selective?

dimension of pores

-endothelial cell fenestration (40nm)
-GBM pore (4nm)
- slit process between foot processes (also 4nm)

selective: GBM & slit diaphragm

29

charge selectivity in glomerulus conferred by?

by negatively charged anions (heparan sulfate & proteoglycans) on endothelial cells and GBM

--> repel albumin

30

how is albumin lost into urine

small enough to fit through GBM pores. normally kept out via charge

in MCD: loose some neg charge in basement membrane

31

tubular proteinuria

low molecular weight proteins
(Ig light chains, B2 microglobulin, amino acid)

due to PCT disruption

(normally filtered & completely reabsorbed in PCT)

32

overload proteinuria

when low molecular weight proteins are made in excess (Ig light chain in MM), overloading PCT ability to reabsorb

33

functional proteinuria

due to change in blood flow through glomerulus

not a big deal, goes away on repeat testing

due to exercise, high fever, emotional stress, cold exposure

34

orthostatic proteinuria

older, tall, thin, adolescents

increased when upright, decreased when supine

<1g.day

35

isolated proteinuria

incidental finding in asymptomatic person w/ normal renal fxn and urine sediment

36

secretin stimulates

bicarb secretion from pancreas

response to acidity in intestine; S cells

37

composition of pancreatic fluid

isotonic
normally Na+, K+ like plasma
high HCO3
low Cl-

high flow: higher bicarb, low Cl-

38

what stimulates pancreatic enzyme secretion?

CCK

39

fractional excretion of Na+ into urine

<1%

(99% of filtered = reabsorbed)

40

reabsorption of urea

40-50% inPCT

more in CD depending on ADH expression

41

eye presentation of MS

1. optic neuritis
-visual disturbances (central scotoma)
-painful eye movements

2. internuclear opthalmoplegia: impaired eye adduction during lateral gaze (MLF)

(nystagmus, but thats cerebellar)

42

cerebellar dysfunction in MS

tremor, ataxia, nystagmus

43

sensory & motor dysfxn in MS

bowel & bladder dysfxn

44

presentation of MS

chronic demyelinating disease
white matter of CNS

highly variable, exacerbation & remission

most common nonspecific: FATIGUE

SIIIN

scanning speech,
intention tremor,
incontienence,
internuclear opthalmoplegia,
nystagmus

45

what exacerbates MS symptoms

HEAT or STRENUOUS ACTIVITY

(decreased axonal transmission w. heat)

heat also exacerbates neuro symptoms -> heat insensitivity

46

TIA

transient focal neurolgoic symptoms, last less than 24 hours

47

amaurosis fugax

transient monocular blindness

associated w/ TIA

48

why does polycythemia present w/ puritus post shower

release of histamine from basophils

49

xanthelasma associated w/

primary biliary cirrhosis

secondary hypercholesterolemia

50

Wermer syndrome

MEN I (menin gene, not ret)

51

what's in the pseudomembrane of diptheria infxn

c. diptheria bacteria
leukocyte
fibrin
necrotic mucosal epithelial cells

52

systemic diptheria infxn (TOXIN absorbed in blood stream)

cardiac & neural toxicity

myocarditis, arrhythmia, heart failure, neuropathy, paralysis, coma

note: bacteria is not absorbed, only toxin

53

role of IgA

PREVENT infxn by inhibiting bacterial itxn w/ epithelial cells

54

diptheria toxin subunits

AB
B: (binding) allows penetration of A:active subunit into thecell to inhibit ribosome fxn

ADP ribosylation of EF-2

55

which cells make EPO

interstitial cells in renal cortex

56

familial dysbetalipoproteinemia (type III)

defective ApoE3 & E4

on chylomicrons & VLDL
bind hepatic apolipoprotein receptors "recycle"

elevated cholesterol & triglycerides

xanthona, premature coronary & peripheral vascular disease

57

what do chylomicrons get from HDL?

apoC-II and apo-E

58

ApoA-1

LCAT activation (cholesterol esterification in HDL)

59

ApoB-48

chylomicron assembly & secretion by intestine

60

ApoB-100

LDL particle uptake by extrahepatic cells

VLDL marker

61

which Apo protein binds to LDL?

ApoB100

62

intermittent claudication

muscle pain w/ exercise that remits w/ rest

often: peripheral vascular disease due to atherosclerosis of larger arteries

63

onion-like thickening of arteriolar walls

due to laminated CMV and reduplicated basement membrane

hyperplastic arteriolosclerosis

arterioles

64

hyaline arteriolosclersosis

deposition of hyaline in intima and media of small arteries / arterioles

intima thickened, lumen narrowed

65

3 major presentation of sickle-cell

1. hemolysis (intra & extra vascular)
2. vasooclusive: bone infarct, dactylitis (hand & foot syndrome), acute chest
3. infxn (splenic infarct -> fxnl asplenia)

66

sickle dactylitis

hand & foot syndrome
- small infarctions within marrow, trabeculae, inner cortical layers of bone in hand, wrist, feet, ankle

leads to swelling, tenderness, & warmth

common in first years of life --> bc affected bones still contain hematopoetic marrow

67

vaso-occlusion in children vs. adult

generally: bone / marrow infarcts

young: sickle-cell dactylitis in hand, wrist, feet, ankle, bc still have marrow there!

older kids & adult: pain crises, acute chest syndrome, leg ulceration, priapism, autosplenectomy, stroke

68

alendronate

rx for osteoporosis

pyrophosphate analogue (impt component of hydroxyapatite)

1. makes hydroxyapatitie more insoluble
2. interfere w/ osteoclasts

[absorption is really bad, must be taken in fasting state w/ plenty of fluids, and must stay upright for 30min bc caustic to esophagus]

69

specific MAO-B inhibitor?

selegiline

70

phenelzine

MAOi

71

tranylcypromine

MAOi

72

isocarboxazid

MAOi

73

pergolide

dopamine agonist D2.
modest improvement of parkinsons symptoms

74

amantadine (3)

antiviral (prevent uncoating

& anti-cholinergic
& promote dopamine release

75

rx for parkinsons

BALSA

bromocriptine
amantidine
levadopa/carbidopa
segeline (+ COMT inhibitors)
anticholinergics (benztropine etc)

76

nausea / vomiting w/ levadopa

due to peripheral conversion to dopamine

limited w/ carbidopa addition

77

galactose processing

galactose -> galactose 1-phosphate
-via galactokinase

galactose 1-phosphate -> UDP-galactose
w/ UDP-glucose -> glucose 1-phosphate
- via galactose 1-P uridyl transferase

2 fates:
1. UDP galactose epimerized to UDP glucose
-via UDP-galactose-4-epimerase
(then act as glucose)

OR

in mammary glands:
1. UDP-galactose + glucose -> lactose
-via lactose synthase

lactose -> galactose
- via b-galactosidase

note lactose = galactosyl b-1,4 glucose

78

galactosemia deficiency

deficiency in..
1. GALT (galactose 1-P uridyltransferase)
2. galactokinase
3. UDP-glucose 4-epimerase

79

what converts galactose to galactitol?

aldose reductase

80

-glanzman thrombasthenia
-abciximab, eptifibitide, tirofiban
-ITP

alll....

block GbIIbIIIa!

81

Abciximab, eptifibatide, tirofiban

unstable angina
acute coronary syndrome
(esp undergoing percutaneous coronary intervention)

82

cilostazol, dipyridamole

PDE III inhibitors
-increase cAMP in platelets,
--> inhibiting aggregation.

also vasodilation

rx: intermittent claudiation, coronary vasodilation, preventing stroke or TIA w/ aspirin, angina prophylaxis

83

peripheral smear with no platelet clumping

think glanzman thombasthenia
inhibited defect in GbIIbIIIa

present: mucocutaneous bleeding

84

ouabain

blocks Na/K+ pump at K+ binding site

85

digoxin toxicity is exacerbated w...

hypokalemia! bc Na/K+ pump already less functional

86

digoxin toxicity causes..

hyperkalemia!
block Na/K+ pump

87

digoxin toxicity presents as..

nausea, vomiting, anorexia, confusion, CHANGED VISUAL PERCEPTION, bradycardia, etc etc

88

immune complex mediated RPGN caused by..

post-strep glomerulonephritis
SLE
IgA nephropathy

89

anti-neutrophil cytoplasmic antibody

ANCA

90

decreased serum C4 levels seen in..

hereditary angioedema
lack C1 esterase inhibitor

C1 esterase breaks C4 down.

91

pathogenesis of wilson's disease

autosomal recessive
mutation in ATP7B chr. 13

-reduces formation & secretion of ceruloplasmin.
-decreased secretion of Cu2+ into bile

Cu2+ = pro-oxidant, injures hepatic tissue & deposits in cornea & basal ganglia

92

skin hyperpigmentation w/ ACTH?

ACTH directly stimulates melanotropin receptors due to sequence homology w/ a-MSH

even w/ small cell carcinoma producing ACTH

93

splenic artery compression would most severely affect what gastric artery / tissue

gastric supplied by short gastric artieries

bc even though splenic gives left gastroepiploic, we have collateral circulation from right gastricepiploic (from gastroduodenal)

94

arteries coming off of splenic

splenic
short gastric
left gastroepiploic (greater curvature

95

right gastric artery

comes off of proper hepatic artery

96

what part of kidney tubules is most susceptible to ischemic injury

PCT & TAL

-in outer medulla, less blood flow
-ATP consuming transport of ions

also affect DT and CD, but not as sensitive

97

Papillary necrosis associated w/

DM
analgesic nephropathy
sickle cell


not related to ischemia:

(so sAAD)
sickle cell
obstruction
analgesic
acute pyelo
diabetes

98

vitelligo caused by..

autoimmune destruction of melanocytes

usu kicks in 20-30s

99

albinism

have melanocytes, but don't make melanin bc lack of tyrosinase

100

myasthenia gravis associated w/

thymoma

101

tensilon test

edrophonium. brief acetycholinesterase inhbitir

improves myasthenia gravis

102

onset of dermatitis herpetiformis?

etiology?

3rd-4th decade of life
vesicular

cross-reaction between IgA and IgG against gliadin --> RETICULIN in basement membrane

microabscesses containing fibrin and neutrophils at dermal papillae tips. overlying basal cells become vacuolated and blisters form at tips.

103

pale retina w/ cherry red spot in macula of older man

think: retinal artery occlusion

macula blood supply: choroid artery
rest of retina: central retinal artery (branch of opthalmic artery or internal carotid)

occlusion of retinal artery: makes macula look red

104

blood supply to macula

choroidal artery

(NOT central retinal artery)

105

antibody to alpha3-chain of collagen type IV

goodpastures
anti-GBM

106

type 4 collagen

basement membrane

107

measles presentation

paramyxovirus

CCCK
-cough
-coryza (rhinitis, infl of muccosal membranes)
-conjunctivitis
-koplik spots - small white/blue/gray specks on buccal mucosa

then maculopapular rash

108

major proliferative stimuli for cellular components of atherosclerotic plaques

platelets: PDGF and TGF-B

stimulate SMC prolif & migration & interstitial collagen production

secreted by platelets, endothelial cells, infiltrating macrophages

109

dimercaperol & EDTA for..

lead poisioning

(all rest: penicillamine)

110

deferoxamine

iron chelator: hemochromatosis

111

rx for wilson's

pencillinamine

112

energy for myocardial cellular fxn from (3) sources

1. glycolysis (5%)
2. glucose oxidation (30%)
3. fatty acid oxidation (60%)
% source of energy

fatty acid oxidation: makes more ATP, but costs more oxygen.

still, is main source

113

reduction in fatty acid oxidation in heart will..

reduce oxygen demand!

potential rx for angina due to atherosclersosis

114

how do oral contraceptives reduce risk of ovarian cancer?

reduce number of ovulations

fewer ovulatory cycles: less need to repair ovarian surface, less chance for abberrant repair -> cancer

115

what gynecologic cancer has highest mortality rate

ovarian cancer! bc no effective screening, present w/ advanced disease

116

2nd most common cause of mental retardation
(1st most common inherited form)

fragile X

appears broken when cultured in folate-deficient medium

117

highly mitotic tumor suggests

high grade (low differentiating)

118

staging system

measures spread:
often via TNM synstem

119

TNM system

measure of spread
T: size of primary tumor
N: nodal involvement
M: metastasis

120

grading system

differentiation aka malignant potential

121

radiosensitivity correlation w/ grade

high grade - usually radiosenstivity, bc rapidly dividing --> target of radiation