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

vertical transmission of hepatitis occurs via..

A

passage through birth canal, or transplacental infxn

2
Q

increased risk of vertical transmission marked by..

A

HBeAg (marks viral replication & infectivity)

3
Q

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

A

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

4
Q

window period of hep B detected w/

A

HbcAb

5
Q

histology of macula (3)

A

densely packed cone, few overlying cells, no blood vessels

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

all = greater visual acuity

6
Q

scotoma

A

visual defect surrounded by relatively unimpaired field of vision

7
Q

causes of scotoma

A

pathology in retina / optic nerve

  1. demyelinating disease (MS)
  2. diabetic retinopathy
  3. retinitis pigmentosa
  4. macular degeneration = CENTRAL scotoma
8
Q

dry vs wet macular degeneration

A

dry: deposition of fatty tissue (drusen) behind retina
wet: neovascularization of retina

9
Q

arcuate scotoma

A

due to damage to a particular region of optic nerve head

resulting defect follows arcuate shape of nerve fiber pattern

10
Q

deep intramuscular injections to the buttock should be

A

superlateral quadrant

11
Q

superomedial injection to the buttock can..

A

injure superior gluteal n.

12
Q

path of superior gluteal n.

A

L4-S1

leaves pelvis via greater sciatic foramen above level of piriformis

13
Q

inferomedial quadrant to the buttock injection can..

A

injure sciatic n.

14
Q

mucinous cystadenocarcinoma

A

malignant neoplasm arising from ovarian surface epithelium

produce mucin –> pseudomyxoma peritonei

15
Q

pseudomyxoma peritonei

A

associated w/ mucinous cystadenocarcinoma & appendiceal tumor

peritoneal cavity fills w/ mucin due to widespread intraperitoneal metastases

16
Q

demographic for dysgerminoma in females

A

YOUNGER, 10-30y/o

17
Q

benign cystic teratoma in females

A

dermoid cysts

18
Q

most common germ cell tumors in females

A

benign cystic teratoma

dermoid cysts

19
Q

struma ovarii

A

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

20
Q

ovarian tumor & hyperthyroidism

A

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

21
Q

presentation of granulosa cell tumor

A

secrete estrogen –>

young: precocious puberty
older: abnormal endometrial bleeding, endometrial carcinoma

22
Q

alpha 1-antitrypsin on diffusing capacity

A

decreased diffusing capacity bc destruction of alveoli and adjoining capillary beds

23
Q

Curschmann spirals

A

shed epithelium forming mucus plug in asthma

24
Q

Charcot-Leyden crystals

A

breakdown of eosinophils in sputum

25
Q

asthma characterized by what:

FEV/FVC, TLV, DC

A

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

26
Q

selective proteinuria

A

suggests foot process effacesment

loss of ALBUMIN mostly

(less bulky proteins like IgG and macroglobulin)

27
Q

components of glomeruliar filtration barrier (3)

A
  1. fenestrated endothelium
  2. glomerular basement membrane
  3. epithelial cell foot processes
28
Q

size selectivity in glomerulus conferred by.. most selective?

A

dimension of pores

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

selective: GBM & slit diaphragm

29
Q

charge selectivity in glomerulus conferred by?

A

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

–> repel albumin

30
Q

how is albumin lost into urine

A

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

in MCD: loose some neg charge in basement membrane

31
Q

tubular proteinuria

A

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

due to PCT disruption

(normally filtered & completely reabsorbed in PCT)

32
Q

overload proteinuria

A

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

33
Q

functional proteinuria

A

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
Q

orthostatic proteinuria

A

older, tall, thin, adolescents

increased when upright, decreased when supine

<1g.day

35
Q

isolated proteinuria

A

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

36
Q

secretin stimulates

A

bicarb secretion from pancreas

response to acidity in intestine; S cells

37
Q

composition of pancreatic fluid

A

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

high flow: higher bicarb, low Cl-

38
Q

what stimulates pancreatic enzyme secretion?

A

CCK

39
Q

fractional excretion of Na+ into urine

A

<1%

99% of filtered = reabsorbed

40
Q

reabsorption of urea

A

40-50% inPCT

more in CD depending on ADH expression

41
Q

eye presentation of MS

A
  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
Q

cerebellar dysfunction in MS

A

tremor, ataxia, nystagmus

43
Q

sensory & motor dysfxn in MS

A

bowel & bladder dysfxn

44
Q

presentation of MS

A

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
Q

what exacerbates MS symptoms

A

HEAT or STRENUOUS ACTIVITY

(decreased axonal transmission w. heat)

heat also exacerbates neuro symptoms -> heat insensitivity

46
Q

TIA

A

transient focal neurolgoic symptoms, last less than 24 hours

47
Q

amaurosis fugax

A

transient monocular blindness

associated w/ TIA

48
Q

why does polycythemia present w/ puritus post shower

A

release of histamine from basophils

49
Q

xanthelasma associated w/

A

primary biliary cirrhosis

secondary hypercholesterolemia

50
Q

Wermer syndrome

A

MEN I (menin gene, not ret)

51
Q

what’s in the pseudomembrane of diptheria infxn

A

c. diptheria bacteria
leukocyte
fibrin
necrotic mucosal epithelial cells

52
Q

systemic diptheria infxn (TOXIN absorbed in blood stream)

A

cardiac & neural toxicity

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

note: bacteria is not absorbed, only toxin

53
Q

role of IgA

A

PREVENT infxn by inhibiting bacterial itxn w/ epithelial cells

54
Q

diptheria toxin subunits

A

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

ADP ribosylation of EF-2

55
Q

which cells make EPO

A

interstitial cells in renal cortex

56
Q

familial dysbetalipoproteinemia (type III)

A

defective ApoE3 & E4

on chylomicrons & VLDL
bind hepatic apolipoprotein receptors “recycle”

elevated cholesterol & triglycerides

xanthona, premature coronary & peripheral vascular disease

57
Q

what do chylomicrons get from HDL?

A

apoC-II and apo-E

58
Q

ApoA-1

A

LCAT activation (cholesterol esterification in HDL)

59
Q

ApoB-48

A

chylomicron assembly & secretion by intestine

60
Q

ApoB-100

A

LDL particle uptake by extrahepatic cells

VLDL marker

61
Q

which Apo protein binds to LDL?

A

ApoB100

62
Q

intermittent claudication

A

muscle pain w/ exercise that remits w/ rest

often: peripheral vascular disease due to atherosclerosis of larger arteries

63
Q

onion-like thickening of arteriolar walls

A

due to laminated CMV and reduplicated basement membrane

hyperplastic arteriolosclerosis

arterioles

64
Q

hyaline arteriolosclersosis

A

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

intima thickened, lumen narrowed

65
Q

3 major presentation of sickle-cell

A
  1. hemolysis (intra & extra vascular)
  2. vasooclusive: bone infarct, dactylitis (hand & foot syndrome), acute chest
  3. infxn (splenic infarct -> fxnl asplenia)
66
Q

sickle dactylitis

A

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
Q

vaso-occlusion in children vs. adult

A

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
Q

alendronate

A

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
Q

specific MAO-B inhibitor?

A

selegiline

70
Q

phenelzine

A

MAOi

71
Q

tranylcypromine

A

MAOi

72
Q

isocarboxazid

A

MAOi

73
Q

pergolide

A

dopamine agonist D2.

modest improvement of parkinsons symptoms

74
Q

amantadine (3)

A

antiviral (prevent uncoating

& anti-cholinergic
& promote dopamine release

75
Q

rx for parkinsons

A

BALSA

bromocriptine
amantidine
levadopa/carbidopa
segeline (+ COMT inhibitors)
anticholinergics (benztropine etc)
76
Q

nausea / vomiting w/ levadopa

A

due to peripheral conversion to dopamine

limited w/ carbidopa addition

77
Q

galactose processing

A

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
Q

galactosemia deficiency

A

deficiency in..

  1. GALT (galactose 1-P uridyltransferase)
  2. galactokinase
  3. UDP-glucose 4-epimerase
79
Q

what converts galactose to galactitol?

A

aldose reductase

80
Q
  • glanzman thrombasthenia
  • abciximab, eptifibitide, tirofiban
  • ITP

alll….

A

block GbIIbIIIa!

81
Q

Abciximab, eptifibatide, tirofiban

A

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

82
Q

cilostazol, dipyridamole

A

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
Q

peripheral smear with no platelet clumping

A

think glanzman thombasthenia
inhibited defect in GbIIbIIIa

present: mucocutaneous bleeding

84
Q

ouabain

A

blocks Na/K+ pump at K+ binding site

85
Q

digoxin toxicity is exacerbated w…

A

hypokalemia! bc Na/K+ pump already less functional

86
Q

digoxin toxicity causes..

A

hyperkalemia!

block Na/K+ pump

87
Q

digoxin toxicity presents as..

A

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

88
Q

immune complex mediated RPGN caused by..

A

post-strep glomerulonephritis
SLE
IgA nephropathy

89
Q

anti-neutrophil cytoplasmic antibody

A

ANCA

90
Q

decreased serum C4 levels seen in..

A

hereditary angioedema
lack C1 esterase inhibitor

C1 esterase breaks C4 down.

91
Q

pathogenesis of wilson’s disease

A

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
Q

skin hyperpigmentation w/ ACTH?

A

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

even w/ small cell carcinoma producing ACTH

93
Q

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

A

gastric supplied by short gastric artieries

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

94
Q

arteries coming off of splenic

A
splenic
short gastric
left gastroepiploic (greater curvature
95
Q

right gastric artery

A

comes off of proper hepatic artery

96
Q

what part of kidney tubules is most susceptible to ischemic injury

A

PCT & TAL

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

also affect DT and CD, but not as sensitive

97
Q

Papillary necrosis associated w/

A

DM
analgesic nephropathy
sickle cell

not related to ischemia:

(so sAAD)
sickle cell
obstruction
analgesic
acute pyelo
diabetes
98
Q

vitelligo caused by..

A

autoimmune destruction of melanocytes

usu kicks in 20-30s

99
Q

albinism

A

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

100
Q

myasthenia gravis associated w/

A

thymoma

101
Q

tensilon test

A

edrophonium. brief acetycholinesterase inhbitir

improves myasthenia gravis

102
Q

onset of dermatitis herpetiformis?

etiology?

A

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
Q

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

A

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
Q

blood supply to macula

A

choroidal artery

NOT central retinal artery

105
Q

antibody to alpha3-chain of collagen type IV

A

goodpastures

anti-GBM

106
Q

type 4 collagen

A

basement membrane

107
Q

measles presentation

A

paramyxovirus

CCCK

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

then maculopapular rash

108
Q

major proliferative stimuli for cellular components of atherosclerotic plaques

A

platelets: PDGF and TGF-B

stimulate SMC prolif & migration & interstitial collagen production

secreted by platelets, endothelial cells, infiltrating macrophages

109
Q

dimercaperol & EDTA for..

A

lead poisioning

all rest: penicillamine

110
Q

deferoxamine

A

iron chelator: hemochromatosis

111
Q

rx for wilson’s

A

pencillinamine

112
Q

energy for myocardial cellular fxn from (3) sources

A
  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
Q

reduction in fatty acid oxidation in heart will..

A

reduce oxygen demand!

potential rx for angina due to atherosclersosis

114
Q

how do oral contraceptives reduce risk of ovarian cancer?

A

reduce number of ovulations

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

115
Q

what gynecologic cancer has highest mortality rate

A

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

116
Q

2nd most common cause of mental retardation

1st most common inherited form

A

fragile X

appears broken when cultured in folate-deficient medium

117
Q

highly mitotic tumor suggests

A

high grade (low differentiating)

118
Q

staging system

A

measures spread:

often via TNM synstem

119
Q

TNM system

A

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

120
Q

grading system

A

differentiation aka malignant potential

121
Q

radiosensitivity correlation w/ grade

A

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