test #49 5.6 Flashcards Preview

UWorld mixed > test #49 5.6 > Flashcards

Flashcards in test #49 5.6 Deck (78):
1

phagocyte dysfxn immunodeficiency present with..

recurrent abscesses

(can't kill what they phagocytose)

2

candida skin test

tests for cell-mediated immunity, since we have all been exposed to candida, we should mount a response to it

via macrophages, CD4+, CD8+, NK cells

absence of response suggests SCID

type 4 HSR

3

most common causes of spontaneous intracerebral hemorrhage (3)

1. arteriovenous malformations
2. ruptured cerebral aneursyms
3. abuse of sympthatomimetic drugs (cocaine)

4

cause of death in adult-type coarctation of aorta

HTN-related complications

left ventricle failure, ruptured dissecting aortic aneursym, intracranial hemorrhage (bc increased blood flow tere)

5

typical site of pathology w/ crohn's disease

terminal ileum

6

why may crohn's have increased gallstones?

bc loss of bile acid reabsorption in terminal ileum

7

sharp pull on outstretched hand while forearm is pronated and elbow is extended

radial head subluxation (nursemaid elbow)

most common elbow injury in children

tear annular ligament that holds radius to ulna at elbow

will hold in that position

8

which antipsychotics help treat negative symptoms of schizophrenia

atypicals!

emotional range, poverty of speech, loss of interest, loss of drive

9

rx for prevention of GBS meningitis in neonate

intrapartum ampicillin

(rx earlier still leaves mom susceptible at time of birth)

10

V2 vasopressin increases CD permeability to (2)

1. water (aquaporins)
2. urea

11

two ways of regulating lac operon expression

negatively: bind repressor protein to operon locus

positive: cAMP-CAP binding upstream promoter

12

receptors w/ Gq activation

a1, m1, m3
oxytocin
V1 ADH (vascular)
angiotensin II
GHRH
TRH
GnRH

think:
'vasoconstrictors'
adh V2, ang II, histamine
&
hypothalamic reproductive
GnRH, oxytocin
& TRH

13

calcipotriene, calcitriol, tacalcitol

topical vitamin D analog
used to treat psoriasis

activate vitamin D receptor nuclear transcription factor, inhibits keratinocyte proliferation & stimulates differentiation

14

utekinumab

human monoclonal antibody used in psoriasis, targets IL-12 and IL-23.

inhibits differentation and activation of CD4+ Th1 and Th17 cells

15

aortic regurg murmur

VERY EARLY diastole.
listen carefully, might sound like systole

16

hypertrophic cardiomyopathy murmur

definitely LVOT
can ALSO have mitral regurg bc of impaired valve closure

both systolic murmurs

17

alcoholic w/ megaloblastic anemia

likely folate deficiency
1. poor intake
2. poor absorption, utilization, enterohepatic recycling

(not B12)

18

rx for acute coronary syndrome, angina

aspirin
clopidogrel (irreversible ADP block)
ticlopidine

19

considerations before giving metformin

kidney fxn!

worry about lactic acidosis

contraindicate in any condition that might raise lactic acid levels: liver dysfunction, heart failure, alcoholism, sepsis

20

where does inferior mesenteric vein drain?

into SPLENIC vein, which joins SMA --> portal vein

note: different from arterial supply

21

what component of meningococcus correlates w/ patient morbidity & mortality

LPS equivalent: outer membrane lipooligosaccharide

in serum


leads to sepsis, petechiae, waterhouse-friederichson

[note: not the capsule]

22

how do nitrates cause vasodilation

NO, stimulate guanylate cyclase, convert GTP -> cGMP

-decreases intracellcular Ca2+
-decreases myosin lightchain kinase

--> myosin light chain dephosphorylation & smooth muscle relaxation

23

histology of schwanomma

spindle cells

biphasic:
antoni A pattern: highly cellular
antoni B pattern: myxoid areas of low cellularity

antoni A areas may form "palisading" patterns like a picket fence

S-100 positive

24

impt S100 tumors

melanoma
schwanoma

both neural crest derivatives

25

what is the only CN that cannot develop a schwanoma

CN II optic nerve!
covered by oligodendrocytes

26

what are CN myelinated by? exception

normally schwann cells (PNS)

except CN II optic: oligodendrocytes

27

histology of psoriasis

hyperparakeratosis
acanthosis (increased spinosum)
elongation of rete ridges
mitotic activity above epidermal basal cell layer
reduced/absent stratum granulosum

epidermal layer above dermal papillae = thinned & contained dilated vessels --> pinpoint bleeding-- AUSPITZ sign

neutrophils may form clusters in superficial dermis & parakeratotic stratum corneum --> MUNRO MICROABSCESSES

28

signs of portal HTN w/ normal liver biopsy suggests

presinusoidal process (aka not budd chiari)

must be portal vein thrombosis

unlikely to see ascites bc obstruction is presinusoidal

29

differentiating portal HTN due to budd chiari vs portal vein thrombosis

liver biopsy.

if it was budd-chiari (occlusion of hepatic vein, which drains hepatic & portal circulation into systemic circulation), would see centrilogular congestion & fibrosis in liver.

see nothing w/ portal vein thrombosis

30

acetaminophen overdoses causes what type of liver histology

centrilobular hepatic necrosis and failure in 24-48 hrs after ingestion

31

kussmaul sign

paradoxical increase in JVP with insipiration

suggests constrictive pericarditis

32

causes of constrictive pericarditis

usu chronic
-idiopathic/viral
-cardiac surgery/radiation therapy
-tuberculosis (in endemic areas)

33

hemodynamic signs of constrictive pericarditis

-increased JVP
-kussmaul sign
-pulsus paraoxous
-pericardial knock

34

pericardial knock vs. S3

S3: sudden deceleration of incoming blood as it reaches an elastic limit (reduced INSTRINSIC) ventricular compliance

pericardial knock: reduced ventricular compliance via an EXTERNAL force. sharper, more accentuate sound heard earlier in diastole

35

most common liver neoplasm

metastasis

36

if see multiple hypodense masses in liver

think mets

37

causes of hepatic adenoma

uncommon, benign epithelial tumors

associated w/ oral contraceptives, or anabolic steroid use

presentation: upper abdominal pain, or incidental

can rupture and cause intraabdominal hemorrhage

38

hepatic angiosarcoma associated w.

exposure to vinyl chloride, thorotrast, or arsenic

aggressive and associated w/ poor prognosis. most die within 1 year.

39

hepatoblastoma

most common liver neoplasm in kids.

associated with FAP and beckwith-Wiedemann syndrome

fatal within a few years if not surgically resected.

40

cholangiocarcinoma

rare, from intra / extrahepatic bile ducts.

intrahepatic: grossly like tree-like mass along biliary system. typically resulting in extensive intrahepatic metastasis.

risk: primary sclerosing cholangiitis, fibropolycystic liver disease, infxn w/ liver flukes in endemic areas.

poor prognosis

41

superior sulcus

lung groove formed by subclavian vessels

location of pancoast tumors

42

another location name for pancoast tumors

superior sulcus tumors

43

local invasion of pancoast tumor can cause..

1. pain in shoulder that radiates to axilla / scapula: most common, brachial plexus. also paraesthesia, etc

2. horner's

3. upper extremity edema: compression of subclavian

4. spinal cord compression/paraplegia if extend into intervertebral foramina

44

mediastinal mass can cause..

superior sulcus mass can cause..

mediastinal: SVC syndrome: headache, face plethora

superior sulcus: compression of subclavians: arm edema

45

2 centrally located lung cancers

squamous cell
small cell

46

warty brown plaques that look like can be peeled off

seborrheic keratosis

47

discoid lupud erythematous

thick scaly discoid plaques that erupt on unexposed skin, may result in scarring.

no systemic disease is present in 90%

48

when are macroscopic changes first seen post ischemic infarct to brain

12 hours

49

red neurons

sign of irreversible damage

during first 48 hours

50

demyelination of peripheral nerves

Guillan-Barre

acute demylelinating disease after infxn, immunization, allergic rxn

51

pathogenesis of guillan-barre

some infectious agents contain ganglioside-like substance in LPS.

antibodies form, cross-react w/ ganglioside in myelin. segmental demyelination & endoneural inflammation on light microscope.

52

ascending muscle weakness after a respiratory or GI illness.

no DTR

esp camplyobacter jejuni

guillan barre

can ascend to cranial n.

worry: paralysis of respiratory muscles -> fatal

53

werdnig-hoffman

anterior horn cell damage

lower motor neuron signs "floppy child"

54

b12 deficiency neuro presentation

subacute combined degeneration

degeneration of DORSAL COLUMN and LATERAL corticospinal (can also be spinocerebellar) tracts

55

neuro beri beri

can cause demylelination too, but NO perineural inflammation.

usu: weakness, areflexia, pain & parathesia. usu distal lower limb

56

most common cause of spontaneous nipple discharge

intraductal papilloma

bloody or serosanguinious

57

breast cancer associated w/ peau de orange?

inflammatory breast cancer

lymphatic obstruction and tissue swelling --> collections of neoplastic cells plugging dermal lymphatic channels

58

presentation of inflammatory breast cancer

-breast tenderness
-skin discoloration
(pale pink to deep red brown to purple)
-rapidly progressive underlying mass

peau d;orange: putting edema in subcutaneous break tissue w/ skin thickening around exaggerated follicles.

plugging of lymphatic channels

59

3 phases of wound healing

1. inflammatory:
-within 1 day: neutrophils
-2-3day: macrophages

2. proliferative:
-3-5days: fibroblasts and endothelial vascular cells -> vascular granulation tissue

3. maturation phase:
-after 1 wk: active fibroblasts make collagen, elastin, etc. replace type III w/ type I collagen.

6-8 wks: scar complete, 30-40% of tensile strength. mature for several months, increasing tensile

70-80% in 3 months

60

keloid vs. hypertrophic scar

excessive collagen formation during tissue repair.

keloid:
-extend beyond borders,
-don't regress,
-recur after resection
- collagen fibers DISORGANIZED

hypertrophic:
-limited to area of wound,
-can regress.
-collagen fibers PARALELL

61

what vessels are affected by atherosclerosis

large elastic: aorta, carotid iliac

large/medium muscular:coronary, popliteal

rank:
-ABDOMINAL AORTA, near renal ostia
-coronary
-popliteal
-internal carotid
-circle of willis

62

hypoxemia defined as

drop in PaO2 below 80mmHg

63

normal A-a gradient

< 20mmHg
(10-15) normal

64

causes of hypoxemia with normal A-a gradient (2)

1. hypoventillation
2. low pO2 (high altitude)

hypoventilation: suppressed respiratory drive, i.e. sedative overdose, sleep apnea, or decreased inspiratory capacity: myasthenia, obesity

65

how does decreased alveolar ventillation affect PaO2

will have LOWER alveolar gas
normal A-a gradient
hypoxemia

66

how does a right-to-left shunt affected PaO2

will have increased A-a gradient (>15-20)

alveolar gas = normal
but hypoxemia

67

how does V/Q mismatch affect PaO2?

poor ventilation of perfused alveoli -> physiologic right-left shunt.

increased A-a gradient

pneumonia, obstructive pulmonary disease, PE

68

what part of gI tract is affected in Crohn's

anything from mouth to anus!

classically: ileocecal region

69

sarcoidosis produces elevated

vitamin D --> HYPERCALCEMIA

&

ACE

70

what types of patients frequently develop hypercalcemia / hypercalciuria

granulomatous disorders!

sarcodosis, TB, hodgkin's disease, non-hodgkins

granuloma giant cells have 1-alpha-hydroxase, activating vitamin D

71

carcinoid syndrome is associated w/ decreased

niacin!

tryptophan all consumed to make sertotonin, less for niacin production

72

TB tissue damaged caused by

T-cell delayed HSR
Th1 stimulation of both CD8+ T cells and macrophages

bacteria itself does not cause tissue damage

73

histology of s. pneumoniae pneumonia

1. congestion: fluid extravasation into alveolar space

2. red hepatization: extravasated PMN and RBC in alveolar space

3. grey hepatization: deposition of fibrinous material in alveolar space

4. elimination, histologic resolution

74

intracellular fungus in macrophage

histoplasma

75

features of disseminated histoplasmosis (3)

1. hepatosplenomegaly
- loves mononuclear phagocyte system

2. ulcerated lesions of tongue

3. usu pulmonary disease

76

chest x-ray of disseminated histoplasma

hilar adenopathy

can resemble pulmonary TB (cavitary lesions in upper lobe, calcified nodes)

77

histology of coccidiodes immitis

thick walled spherules containing endospores

(don't confuse w/ histo: macrophage filled w/ yeast)

78

vitamin E deficiency presentation

neuromuscular disease
DORSAL COLUMN, SPINOCEREBELLAR

-skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy

hemolytic anemia