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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