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Flashcards in test #47 5.6 Deck (108):
1

POMC is a polypeptide cleaved to make..

ACTH
MSH
enkephalins

2

enkephalins, endorphins, dynorphins all bind to

endogenous opoids

bind to mu, delta, fatta receptors

3

somatomedin C

= IGF-1

released in response to growth hormone

4

middle meningeal artery is a brach of..

maxillary artery, which is a branch of the external carotid artery

epidural hematoma

5

occipital artery

branch of external carotid
supply posterior scalp & SCM

6

opthalmic artery

branch of internal carotid:
serves eye & orbit contents

also eyelid, forehead, nose, nasal mucosa

(internal carotid has no branch in neck)

7

artery responsible for nosebleeds

kiesselbach's plexus,

sphenopalatine artery (branch of maxillary artery) anastamoses w/ opthalmic & facial

8

facial artery

branch of external carotid
couses over mandible anterior to insertion of masseter

supply oral region & nose & buccal

9

how does middle mengingeal artery enter skull

foramen spinosum

10

touch to anterior 2/3 of tongue

trigeminal V3
(lingual n)

11

touch to posterior 1/3 of tongue

glossopharyngeal CN IX

12

intrinsic muscles of tongue innervated by (2)

most: CN XII hypoglossal

palatoglossus -> CN X vagus

13

taste in pharynx & epiglottis

vagus CN X

14

ESR increased due to

acute phase reactants released by IL-6

fibrinogen, ferritin, CRP, serum amyloid A, serum amyloid P, complement

15

why does erythroyte sedimentation increase w/ inflammation

fibrinogen causes RBC to rouleaux --> sediment faster

16

cytokines impt for systemic inflammation (3)

IL-1, IL-6, TNF-alpha

17

bradykinin effects (4)

vasodilation
vascular permeability
smooth muscle contraction
pain

18

PAF effects

vasoconstriction
bronchoconstriction
platelet stimulation

also enhances leukocyte adhesion to endothelium, chemotaxis, phagocytosis, degranulation

19

epinephrine for anaphylactic shock

counteracts the..
1. vasodilation
by alpha-1 agonist vasoconstrction

2. increased vascular permeability
by increases CO, B1 agonist

3. bronchoconstriction
by bronchodilating, B2 agonist

20

morphology of crytococcos neoformans

yeast only
round/oval encapsulated w/ narrow based buds

virulence: thick polysacch capsule

21

flutamide, cyproterone

blocks androgen receptor

testosterone/DHT

22

leuprolide, goserelin, nafarelin, histrelin

GnRH agonists

23

anorexia induced amenorrhea due to..

hypothalamic dysfunction

nonpulsatile GnRH

(NOT problem in pituitary/gonad)

24

most important mediator of sepsis

TNF-alpha

also IL-1, IL-6

25

liver cyst in person from endemic region (middle easy, south america, iceland, australia, new zealand, africa) or sheep/dog exposure

echinococcus granulosus

encapsulated calcified cyst

rupture: eosinophilia --> ANAPHYLAXIS

rx: bendazole

26

mitral stenosis can cause hoarseness bc..

compression of left recurrent laryngeal

via really enlarged left atrium

27

recurrent laryngeal innervates

all intrinsic muscles of larynx except cricothyroid

28

p-ANCA suggests..

microscopic polyangiitis

or churg-strauss (eosinophilia)

29

characterize churg strauss

adult onset asthma
eosinophilia
history of allergy
mono or poly-neuropathy
migratory/transient pulmonary infiltrate
paranasal sinus abnormalities

30

mechanism of glucose-induced inhibition of lac operon

glucose decreases adenylyl cyclase, depleting cAMP

REDUCTION of cAMP, low CAP-DNA binding

(not related to repressor binding to operon)

31

operon

DNA sequence that has at least 2 regulatory sites: promoter & regulator (operon) in addition to gene coding for protein

32

lac operon

proteins required for metabolism of lactose

regulatory gene,
- repressor for lac operon

promoter gene,
- binding site for RNA pol

operator gene
- binding site for repressor

3 structural gene
- b-gal
- permease

low cAMP, (caused by glucose) shuts it off

33

culturing e. coli in lactose. what happens in lac operon

lactose (inducer) binds to repressor protein, which can no longer bind to operon.

increases transcription of lac operon.

34

anti-reticulin, anti-endomysial antibodies

along w/ anti-gliadin

in celiac sprue

35

urticaria (hives) histologically

DERMIS: mild, superficial infiltrate of mononuclear cells & eosinophils around dermal venules.

collagen bundles are parted by DERMAL EDEMA and lymphatic channels dilated w/ excess transudate

no epidermal changes

antigen induced degranulation of focal mast cells due to IgE antibody sentization

or, direct activatio nof mast cells

microvasculature hyperpermeability

36

urticaria vs. eczematous dermatitis

urticaria (wheel): DERMAL edema

eczematous dermatitis: spongiosis (epidermal edema) w/ acantholysis

37

staph aureus food posioning due to

exotoxin formed prior to ingestion

highly heat stable enterotoxin

rapid onset: less than 6 hrs

usu mayo containing (potato, macaroni salad)

(similar to b. cereus, but diff food)

38

b. cereus food poisioning

similar to staph aureus!
exotoxin formed prior to ingestion

heat stable

but, diff food: here, reheated rice

39

exotoxin staph aureus diseases (3)

1. toxic shock
2. scalded skin
3. gastroenteritis

40

pulsatile notching vessels under ribs

coarctation of aorta

could also have headache & epistaxis from HTN in blood to head -- post-ductal in adults

41

3 major risk factor for squamous cell carcinoma of esophagus

alcohol
smoking
n-nitroso-containing foods (smoked fish, etc)

(asia: chewing betel nut & n-nitroso compounds)

42

3 major risk factors for adenocarcinoma

barrett's esophagus
GERD
obesity
tobacco use

43

anytime you see a squamous cell carcinoma

expect keratin pearls

44

mu opiod receptor responsible for

respiratory & cardiac depression
reduce GI motility

also: dependence, euphoria, sedation

45

kappa opiod receptor responsible for..

miosis

also: dysphoria, sedation

46

delta opiod receptor responsible for..

antidepressant effects

47

naloxone

opiod receptor antagonist, especially mu

good for overdose / intoxication rx

48

terbinafine antifungals act on..

block squalene expoidase

prevent conversion of langosterol to ergosterol

49

rx for dermatophytosis (i.e. tinea corporis)

terbinafines

50

MRI of MS

periventricular plaques of demyelination (axons in tact)

51

MLF damage

impaired adduction of eye during lateral gaze

BUT

intact adduction w/ ocular convergence

i.e. not a problem w/ nerve or muscle

52

what's inside an acute MS plaque?

1. demyelination w/ preservation of axon
2. accumulation of lipid-laden macrophages
3. astrocytosis (response to injury)
4. infiltration by lymphocytes / mononucear cells

overtime: damage of axons, neurons, oligodendrocytes

53

hypertensive heart results in what type of dysfxn

DIASTOLIC

concentric hypertrophy; net decrease in LV chamber size

filling and diastolic fxn is normal though

54

what causes hepatic injury w/ hepatitis B infxn

NOT direct cytopathic effect if virus

instead, MHC I expression of HbsAg & HbcAg activates CD8+ T cells to attack

damage tapers when HBV is incorportated into host genome & antiviral antibodies appear

risk of hepatocellular carcinoma remains elevated

55

autoimmune hepatitis

due to antigen mimicry w/ generation of self-antigen recognizing CD4+ T lymphocytes that damage hepatocytes

56

location of broca

inferior frontal gyrus

57

MCA covers what impt territories

all lateral hemispheres

-frontal eye fields
-broca (inferior frontal gyrus)
-wernicke (posterior superior temporal gyrus)
- primary motor cortex esp face/hands
-some perforating branches to internal capsule & basal ganglia

58

left hemipshere is dominant (side of language) in what people

most left & right handed people

59

ACA infarct can present w/

hemiplegia of lower extremities
urinary incontinence
primitive reflexes

60

1. contralateral loss of pain & temp
2. ipsilateral deficits of CN V,
3. ipsilateral facial CN VII
4. ispilateral vestibulococh CN VIII
4. horner's
5. cerebellar symptoms

AICA occlusion causeslateral inferior pontine syndrome

61

contralateral loss of pain & temp
w/
ipsilateral defecits in CN V, VIII, IX, X, & XI
w/
Horner

notably: dysphagia & hoarseness

PICA, lateral medullary

62

abdominal pain, distension
w/
fever, diarrhea, shock
in ulcerative colitis patient..

think: toxic megacolon

63

toxic megacolon is more common in..

ulcerative colitis

64

pathogenesis of toxic megacolon

complete cessation of neuromuscular activity in intestinal wall.

rapid colonic distension -> prone to rupture

segmental necrosis

perforation risk!

65

diagnosis of toxic megacolon

sufficient w/ plain abdominal x-ray: colonic dilatation, maybe fluid levels

66

1. chora
2. aggression/apathy/depression
3. dementia

hungtington

67

w/ hungtingtons, when does expansion of CAG repeats occur?

in spermatogenesis!

when receive abnormal gene from father, tend to have ANTICIPATION

no expansion from mama

68

emotional lability
insatiable hunger & thirst
in child

prader-willi
mutation in chr. 15 of papa

(same gene as angelman)

69

happy puppet
jerky movement (like marionette)
pathological happy disposition

angelman
mutation in chr. 15 of mama

(same gene as prader-willi)

70

multiple myeloma

neoplastic B-lymphocytes mature into plasma cells that synthesize abnormally large amounts of monogclonal Ig or Ig fragments (light chains)

-impaired hematopoesis (bc bone marrow filled w/ plasma cells)
-lytic bone lesions
-hypercalcemia
-AL amyloidosis
-renal dysfxn

71

lab abnormalities in multiple myeloma

rouleaxu erytheocytes in blood

bence jones protein in urine

M peak on serum protein electrophoresis -- monoclonal proliferation

72

prognosis for esophageal cancer

generally poor, present w/ incurable locally advanced or metastatic disease

73

histology of reflux esophagitis (3)

elongation of papillae
basal cell hypertrophy
intraepithlieal EOSINOPHILS

usu leads to barett esophagus

74

benign tumor of esophagus

super rare, but could be leiomyoma

75

why do colonic diverticula form? describe mechanism & fate

mechanism: pulsion
structure: false

mucosa & submucosa herneat through weak spots in colonic muscular layer; due to increased intraluminal pressure (i.e. constipation)

76

false diverticula (2)

colonic & zenker in upper esophagus

77

presentation of colonic diverticula

lower GI bleed

78

traction diverticula

inflammation & scarring.
true: contains 3 layers

example: midesophageal diverticula, which occur w/ mediastinal lymphadenitis and periesophageal scarring

79

location & predisposition for colonic diverticula

usu sigmoid colon

constipation : risk factor

80

lack of peroxisomes prevents

special form of beta oxidation for
very long chain fatty acids

or alpha oxidation for branched chain fatty acids (phytanic acid)

accumulate fatty acids in tissue

81

Zellweger syndrome

absence of peroxisomes

infant unable to make myelin in CNS

present: hypotonia, seizures, hepatomegaly, metal retardation, early death

82

Refsum disease

defective alpha oxidation in peroxisomes

leads to neuro disturbances bc accumulate phytanic acid

rx; avoid chlorophyll in diet

83

what types of fatty acids does the mitochondria NOT oxidize

very long chain fatty acids

or

fatty acids w/ branch points at odd number carbons

(peroxisome does)

84

rx for NARDs

supplemental oxygen at high concentration

nasal continuous positive airway pressure

mechanical ventilation w/ intratracheal surfactant

85

concern w/ oxygen therapy in neonate

retinal damage

local hyperoxia --> upregulate VEGF --> retinal detachment/blindness

retinopathy or prematurity
or
retrolental fibroplasia

86

causes of acute MR

spontaneous rupture of chordae tendinae, infective endocarditis w/ destruction of valve leaflets, chordal rupture, ischemia /rupture of papillary muscles

87

compliance =

V/P

88

left atrial compliance in acute MR? chronic?

acute: normal compliance, so will lead to pulmonary edema

chronic: increased compliance, less prone to pulmonary edema, but more protein to Afib & thromboemboli

89

thiamine deficiency on TCA cycle

most severely impairs alpha-ketoglutarate dehydrogenase --> succinylCoA

dehydrogenases require thiamine, lipoate, CoA, FAD, NAD+

90

thiamine, lipoate, CoA, FAD, NAD+ are important for..

alpha ketoglutarate dehydrogenase

pyruvate dehydrogenase

acyl-CoA dehydrogenase

91

thiamine needed for

transketolase (specific)

alpha ketoglutarate dehydrogenase

pyruvate dehydrogenase

acyl-CoA dehydrogenase

92

rate limting step in TCA

isocitrate dehydrogenase

isocitrate -> alpha-ketoglutarate

first NADH produced

93

what step of TCA makes GTP

succinyl CoA -> succinate

succinylCoA synthetase

substrate level phosphorylation

94

what step of TCA makes FADH

succinate dehydrogenase

succinate -> fumarate

95

order things are made in TCA

starting w/ isocitrate -> alphaketo

NADH (isocitrate -> alpha-keto)
NADH (alphaketo -> succinylcoa)
GTP (succinylcoA -> succinate)
FADH (succinate -> fumarate)
skip (fumarate -> malate)
NADH (malate -> oxaloacetate)

96

alcohol dehydrogenase & acetaldehyde dehydrogenase both

increase NADH/NAD+ ratio

though all of TCA is inhibited w/ alcohol, thiamine dependent ones are especially inhibited

97

mifepristone RU-486

anti-progestin
abortifacient

decidual necrosis and expulsion of products of conception

98

misoprostol

prostaglandin analogue, also abortifacent

also increases gastric mucosal barrier

99

methotrexate on pregnancy

inhibits trophoblast division

used for ectopic pregnancy

100

common complication after subarachnoid hemorrhage

secondary arterial vasospasm

can lead to cerebral ischemia

present: new onset confusion / focal neuro defect 4-12 days after initial insult

can also have rebleed: see on CT

101

rx to prevent vasospasm after a subarachnoid hemorrhage

nimodipine, selective Ca2+ channel blocker

102

linear velocity V =

Q/A

or total flow = velocity x cross sectional area; where flow = constant

103

addition of what in a pt w/ hemophilia will induce clotting

thrombin! will then activate fibrinogen -> fibrin

104

fatal toxicity w/ digoxin

arrthythmia due to hyperkalemia

105

associated NF-1 findings

meningioma, astrocytoma, glioma, pheochromocytoma

106

inheritance of NF-1

single gene autosomal dominant

107

how is INH neurotoxic?

chemically similar to vitamin B6, can compete with it in synthesis of ntx (GABA) resulting in defective end products

also increases urinary excretion of pyridoxine

neurotoxic bc causes VITAMIN DEFICIENCY

drug is not directly toxic!

108

counteract isoniazid toxicity

supplement w/ B6

neurotoxicity due to vitamin deficiency!