UW Deck 1 Flashcards
(200 cards)
1
Q
hepatic abscess
A
staph aureus through hematogenous spread, enteric bacteria by ascending biliary tract infection or direct invasion
2
Q
entamoeba histolytica
A
food borne illness, areas of poor sanitation
3
Q
penetrating injuries
A
mixed aerobic and anaerobic
4
Q
lead poisonining
A
hypochromic anemia, lead inhibits mitochondrial iron transport, important for heme synthesis
5
Q
T / B cell relation
A
T cells needed to active B cell maturation and class switching
6
Q
temporal arteritis
A
giant cell arteritis (multinucleated giant cells), polymyalgia rheumatica (neck, torso, shoulder, pelvic girdle pain, morning stiffness), fatigue, fever, weight loss, monocular vision loss, jaw pain and tongue claudication, ESR uniformaly elevated, temporal artery bx to confirm dx, corticosteroids started ASAP to prevent vision loss
7
Q
constrictive pericarditis
A
thick fibrosis between parietal and visceral pericardium in pericardial space, kussmaul’s sign (inspiration –> paradoxical increased JVP instead of decreased JVP), pulsus paradoxus
8
Q
holosystolic murmur
A
apex: MR, LLSB: VSD
9
Q
loud p2
A
pulmonary htn
10
Q
S3
A
volume overload, reduced ventricular compliance (diastolic dysfunction)
11
Q
pericardial knock
A
constrictive pericarditis (reduced ventricular compliance), right after S2, earlier than S3
12
Q
Alzheimer
A
word-finding difficulties, visuospatial, later on: executive, behavioral; atrophy in temporoparietal and hippocampus, strong genetic component
13
Q
brain tumors in children
A
MC: pilocytic astrocytoma, 2nd MC: medulloblastoma = both in posterior fossa/cerebellum, differentiate with histology
14
Q
primitive neuroectodermal tumor
A
sheets of primitive cells, many mitotic figures, poorly differentiated, poor prognosis
15
Q
cerebellar tumor
A
gait instability, limb ataxia, increased intracranial pressure (headache, lethargy, vomiting)
16
Q
medulloblastoma
A
undifferentiated/aggressive tumor, small blue cells = scant cytoplasm, basophilic nuclei, often in vermis of cerebellum
17
Q
mental status exam (MMSE)
A
orientation to time/space, attention & concentration (spell world backwards), comprehension (3-step command) memory, visuospatial (draw clockface), language (write a sentence)
18
Q
TOF
A
asymmetric division of embryonic truncus arteriosus
19
Q
acyanotic heart diseases
A
ASD, VSD, PDA –> eisenmenger syndrome –> maybe cyanotic
20
Q
coarctation of aorta
A
preductal in infant, ductal dependent systemic perfusion
21
Q
lung recoil
A
elastic fibers, surface tension, not affected by PANS
22
Q
PANS on lungs
A
increased smooth muscle contraction, increased bronchial mucous secretion –> greater airway resistance, decreased ventilation; muscarinic acetylchoine antagonists block vagally-mediated bronchoconstriction
23
Q
polyhydramnios
A
inability to swallow, increased production of fetal urine
24
Q
APP
A
amyloid precursor protein –> cleavage –> A beta amyloid (accumulated in AD), more APP in down syndrome (trisomy 21)
25
myotonia
slow relaxation of muscles
26
myotonic muscular dystrophy
autosomal dominant, trinucleotide repeat expansion (anticipation) for myotonia protein kinase gene, myotonia, weakness, muscle atrophy, cataracts, gonadal atrophy, frontal balding
27
peripheral vascular disease
diminished pulses in affected areas (most commonly in legs)
28
acute aortic dissection
tearing chest pain, radiates to back, unequal pulse strength in upper and lower extremities
29
pulsus paradoxus
korotkoff sounds intermittently heard during expration --\> drop in greater than 10 mmHg --\> sounds heard inspiration and expiration; systolic pressure drops more than 10 mm Hg with inspiration
30
asthma attack: sx
prolonged expiration, pulsus paradoxus (severe obstructive pulmonary disease), wheezing, tachypnea, SOB
31
albuterol
acute asthmatic control: b2 adrenergic agonist --\> increase cAMP --\> relax bronchial smooth muscle
32
cromolyn
mast cell stabilization, helps asthma (but not in acute setting)
33
asthma pathology
excessive cytokines from Th2; small airway obstruction; mast cells release histamine and leukotrienes --\> bronchospasm, increase mucous secretion
34
corticosteroids
impairs eosinophil degranulation, helps asthma in acute setting (but takes longer than albuterol, hours to days)
35
histamine
released in hypersensitivity reaction, can lead to bronchial smooth muscle contraction
36
atopic/extrinsic allergic asthma
high serum IgE
37
non-immune-mediated asthma
normal levels of serum IgE, "intrinsic" asthma, precipitated by pulmonary infections (espeically viral), aspirin ingestion, cold air, inhaled irritants, stress, exercise
38
immune mediated and non-immune mediated asthma
bronchial hyperreactivity
39
tuberculosis histology
in granulomas: th1-activated macrophages form langhans giant cells = characteristic of caseating granulomas in m tb, multiple nuclei in periphery/horseshoe shape
40
tuberculosis
inhalation --\> ghon complex in middle or lower lobes --\> apical lungs + hilar lymph nodes: caseating granulomas + cavitary pulmonary lesions
41
tuberculosis pathogenesis
macrophage phagocytosis --\> t cell activation --\> macrophage activation: kill intracellular bugs, form epithelioid cells and langhans giant cells
42
tuberculosis IFN-g
responsible for granuloma formation and caseous necrosis
43
afib
no p waves, tachycardia, irregular rate set by AV node refractory period (can't conduct all atrial electrical activity), without AV node, afib and vfib can be \>300 bpm
44
cardiac hyperpolarization
K channels remain open a little longer after repolarization
45
K permeability of the heart
highest during repolarization (higher than resting)
46
spleen, embryology
mesoderm derived (not foregut), but supplied by foregut artery (celiac --\> splenic artery), everything else supplied by celiac is from foregut
47
liver and pancreas, embryology
outpouching of endoderm foregut
48
transverse colon blood supply
middle colic (SMA) + left colic (IMA)
49
pancreatic blood supply
superior and inferior pancreaticoduodenal arteries
50
cholesterol source
intake, production by liver
51
cholesterol --\> bile
cholesterol (insoluble) --\> bile acids --\> bile salts (soluble) --\> secreted into bile
52
gallstone formation
increased cholesterol (insoluble), decreased bile salts (detergent activity = helps make cholesterol soluble), decreased phosphatidylcholine (phospholipid, helps make cholesterol soluble)
53
efferent arteriolar constriction
increases GFR up to a point, decreased RPF = always increased FF; GFR starts decreasing because of flow-mediated increase in oncotic pressure in glomerular capillaries
54
afferent arteriolar constrictoin
decreased GFR, decreased RPF = same FF
55
Huntington's disease
abnormal protein huntingtin (gene HD), hypermethylates certain histones --\> gene silencing; NMDA receptors depleted in striatum
56
gene transcription regulation: histones
methylation silences, acetylation increases txn
57
thymidine dimerization
UV damage to DNA
58
adenosine deaminase
adenosine --\> inosine (first step in elimination of excess adenosine)
59
adenosine deaminase deficiency
second MC SCID, autosomal recessive, current tx research: retroviral vectors to infect pt stem cells with deficient gene
60
myeloperoxidase
neutrophil enzyme, helps kill phagocytized bugs, makes hypochlorite (bleach) from H2O2 and chloride
61
reverse transcriptase
rna-dependent DNA polymerase + dna-dependent DNA polymerase
62
NADPH oxidase
allows neutrophils to form ROS for oxidative burst, deficient in chronic granulomatous disease
63
chronic granulomatous disease (CGD)
recurrent infections with catalase-producing bugs (staphylococcus), neutrophils don't turn blue (need ROS to turn blue) in nitroblue tetrazolium testing, bugs that don't produce catalyse die of H2O2 accumulation
64
chronic granulomatous disease (CGD)
decreased NADPH oxidase activity --\> defective neutrophil oxidative burse (can't make H2O2 or ROS), x-linked, failure of myeloperoxidase system
65
contralateral homonymous hemianopia
lesion in optic tract, lateral geniculate nucleus, optic radiation
66
pupillary light reflex
retina --\> optic nerve --\> optic chiasm --\> optic tract --\> some fibers go to pretectal nucleus in midbrain --\> EW nucleus
67
Marcuss Gunn pupil
nasal retina fibers \> temporal retina fibers go to pretectal nucleus; damage to left optic tract = right nasal fibers damaged = right pupillary constricts less with light
68
frontal eye fields
region in prefrontal cortex, generates conjugate gaze movements to contralateral side; lesion: eye looks to side of lesion
69
contralateral homonymous hemianopia + intact pupillary response
lesion in lateral geniculate nucleus, optic radiation
70
contralateral homonymous hemianopia + macular sparing
lesion in visual cortex, pupillary reflexes intact
71
neural tube defects related to drugs
valproate: inhibits intestinal folic acid absorption
72
ebstein's anomly
atrialized right ventricle, downward displacement of tricuspid valve, lithium during early pregnancy
73
Ach in alzheimer's
decreased Ach in hippocampus and nucleus basalis of Meynert (deficiency in choline acetyltransferase)
74
locus ceruleus
panic disorders, area contains a lot of NE
75
raphe nucleus
contains a lot of serotonin, part of brainstem's reticular formation, serotonin implicated in anorexia, depression, sleep disorders
76
rabies
bats, restlessness, agitation, dysphagia (painful spasms with swallowing) then coma, killed virus vaccine, rapid spread and replication through/in nerves/CNS
77
delusional disorder
non-bizarre delusions (vs. bizarre delusions in schizophrenia), function not impaired (impaired in schizophrenia)
78
familial hypercholesterolemia
LDL receptor defect --\> decreased LDL uptake by liver --\> increased LDL and total cholesterol
79
strep pneumo vaccine
capsule polysaccharide of many strains (but not all), recommended for \>65, COPD, immunosuppressed, asplenic pts, unconjugated vaccine (no Th response, only IgM)
80
live attenuated bacterial vaccine
live vaccines more common for viruses, for bacteria: BCG vaccine (TB), typhoid (salmonella typhi), francisella tularensis
81
live attenuted viral vaccines
measles, mumps, rotavirus, Sabin polio
82
killed bacterial vaccines
pertussis, yersinia pestis (plague), cholera, bacillus anthracis
83
killed viral vaccines
rabies, influenza, Hep A, salk polio
84
hep b vaccine
recombinant surface protein
85
inactivated toxin vaccines
diphtheria toxoid, tetanus toxoid
86
polysaccharide capsule vaccines
strep pneumo, h flu, neisseria meningitidis
87
cephalic, gastric, intestinal phases
cephalic and gastric phases increase gastric acid secretion, intestinal phase decreases it
88
tetrodotoxin
puffer fish, blocks vg-Na channels in cardiac and neural tissues, sx: weakness, paresthesias, loss of reflexes, n/v
89
apex
left mid clavicular line, 5th ICS, LV (covered by lung)
90
azygous vein
posterior mediastinum, immediately to the right of midline, drains posterior intercostal veins --\> SVC
91
lung position relative to heart
lungs overlie majority of anterior heart, cardiac impression in both lungs
92
right ventricle, position in thorax
majority of inferior border of heart
93
just below the diaphragm
liver, stomach, spleen
94
MAP kinase signal transduction pathway
autophosphorylation of tyrosine residues --\> activation of Ras = G protein, GDP (inactive state), needs GTP to be active (mutated/always active Ras: cancer) --\> activate MAP kinase --\> MAP kinase enters nucleus and modifies transcription
95
cAMP signal transduction pathway
cAMP activates protein kinase A
96
inositol-lipid pathway
IP3 messenger --\> release Ca from ER
97
lung problems that involve hilar LN
TB granulomas (perihilar lymph node involvement), SLE (hilar adenopathy), sarcoidosis (bilateral hilar lymphadenopathy), silicosis (eggshell calcification of hilar LNs), squamous cell carcinoma (hilar mass arising from bronchus)
98
mycoplasma pneumonia
walking PNA, nonproductive cough, only mycoplasma genus requires cholesterol to grow (bc cell membrane has a single cholesterol-rich phospholipid bilayer), bug lacks peptidoglycan cell wall, envelope, or capsule
99
streptococcus pneumoniae
lobar consolidation, MCC CAP
100
klebsiella pneumoniae
debilitated, hospitalized, alcoholics; current jelly
101
h influenzae
chocolate agar, factor X, factor V
102
legionella pneumophila
requires L-cysteine in agar
103
coxiella burnetii
q fever, mild PNA, spores inhaled from animal hides, obligate intracellular
104
coccidioides immitis
southwest US, northern mexico, san joaquin valley fever, frequently asx, can also cause severe disseminated dz in immunocompromised
105
histoplasma capsulatum
similar dz as cocci, mississippi and ohio
106
pneumocystis jiroveci
fungus, severe PNA in HIV+ CD4\<200, ground glass, silver stain fluid collected with bronchoscopy
107
aspiration PNA in alcoholics
alcohol intoxication impairs gag and cough reflexes, infection with anerobes (bacteroides, prevotella, fusobacterium, peptostreptococcus) and aerobes. Lung abscesses. Tx: clindamycin: most activity against oral anaerobes + gram positive bugs (strep pneumo)
108
metronidazole
anerobes but not GP bugs
109
vancomycin, ciprofloxacin, cefazolin
no anaerobes
110
acute otitis media
h influenzae, strep pneumo
111
h influenza epidemiology
different types based on polysaccharide capsule, nontypable strains = ones that don't have a capsule, part of normal flora in upper respiratory tract, but can cause otitis media, sinusitis, bronchitis; vaccine is for type b (Hib)
112
cold agglutinins
mycoplasma pneumonia, EBV infection, hematologic malignancy, antibodies against RBCs (antigenic mimicry) that only agglutinate at low temperatues, can cause transient anemia
113
PPV/NPV vs. sensitivity/specificity
PPV/NPV depend on disease prevalence in population, sensitivity/specificity only depend on the test
114
alveolar hyaline membranes
decreased lung compliance
115
asthma triggers
viral URI, allergens, smoke, cold weather
116
HOCM etiology
autosomal dominant disease of cardiac sarcomere (mutation in cardiac sarcomere protein, most common: beta myosin heavy chain)
117
laryngeal carcinoma associated with
associated with cigarettes, alcohol
118
acquired bronchiectasis associated with
infection, impaired drainage, airway obstruction, inadequate host defense
119
asthma: allergic triad
allergic rhinitis, atopic dermatitis
120
type 1 pneumocytes cell type
squamous cells
121
PKU mutation
mutation in hepatocyte intracellular enzyme phenylalanine hydroxylase --\> protein misfolding
122
sickle cell mutation
mutation in b-globin gene (Hb S)
123
avoid sunlight in
photodermatosis (cutaneous porphyria or lupus photosensitivity)
124
minute ventilation vs. alveolar ventilation
minute: TV (L/breath) RR (b/minute), alveolar: (TV-dead space)RR
125
Kartagener syndrome
autosomal recessive, microtubular defect --\> immotile cilia --\> male infertility, recurrent sinusitis, bronchiectasis; associated with situs inversus
126
Marfan's genetic defect
autosomal dominant, defect in connective tissue glycoprotein (fibrillin-1) --\> abnormal monomers --\> can't polymerize --\> no normal microfibrils in connective tissue
127
Marfan's associated with
(aortic) cystic medial necrosis --\> risk for aortic root dilation, aortic valve incompetence, dissecting aortic aneurysm, MVP, high arched palate, crowded teeth, narrow face, lens displacement
128
pyruvate kinase deficiency
common cause of hemolytic anemia
129
stool guaiac test
trace bleeding in GI
130
pulmonary embolism
pleuritic (associated with deep breathing) chest pain; associated with dyspnea, cough, hemoptysis
131
IVDU right heart endocarditis --\> pulmonary septic emboli
IVDU endocarditis: S aureus, then P aeruginosa --\> hemorrhagic pulmonary infarcts (pulmonary infarcts are almost always hemorrhagic due to dual blood supply -- pulmonary and bronchial arteries)
132
staph endocarditis
penicillin (nafcillin) + aminoglycoside (gentamycin). If MRSA: vancomycin + rifampin/aminoglycoside.
133
ethylene glycol
antifreeze, forms toxins to renal tubules, forms calcium oxalate crystals (folded envelopes) --\> ARF (ballooning and vacuolar degeneration), anion-gap acidosis
134
ATN
oliguria, muddy brown casts
135
laplace's law
distending pressure (to keep sphere distended) = 2T (surface tension) / r
136
surfactant
surfactant reduces variation in distending pressure among alveoli of different sizes (greater concentration in smaller alveoli = less surface tension in smaller alveoli = prevent smaller alveoli from collapsing)
137
acute (calculous) cholecystitis pathogenesis
stone + GB contraction --\> inflammation, irritation --\> ischemic/injured/necrotic tissue --\> bacterial invasion/infection --\> complications: peritonitis, abscess
138
acute cholecystitis clinical
RUQ pain, radiates to back or neck, triggered by large meal, fever, n/v, female, fat, forty
139
biliary colic
when inflammed or obstructed gallbladder contracts; stimulated by fatty meal (fatty acids --\> cholecystokinin stimulates GB contraction)
140
causes of cholestasis
intrahepatic (PSC, PBS, cholestasis of pregnancy, drug-induced: erythromycin, contraceptives), extrahepatic (choledocholithiasis, malignancy - pancreatic, gallbladder), hepatocellular dysfunction
141
cholestasis histology
green-brown plugs in dilated bile canaliculi
142
cholestasis clinical
malabsorption, nutritional deficiencies (ADEK) --\> osteomalacia
143
nuclear medicine hepatobiliary scan (HIDA)
definitive dx acute calculous cholecystitis by showing cystic duct obstruction (failed gallbladder visualization on radionuclide biliary scan = no radionuclide is filling the gallbladder because it's obstructed); nonobstructing biliary stones on US are suggestive but not diagnostic; many gallstones are asx
144
labs for cholecystitis
increased serum AST, ALT (not diagnostic)
145
left-sided colon cancer
obstruction: cramping, change in stool caliber, constipation, distention, n/v
146
right-sided colon cancer
iron deficiency anemia, systemic sx
147
pre-eclampsia
maternal HTN + proteinuria, can progress to eclampsia (seizures) or HELLP syndrome
148
placental previa
placenta implanted over cervical os, common cause of vaginal bleeding during pregnancy
149
maternal hyperglycemia
sign of gestational diabetes, associated with increased rates of stillbirth, macrosomia, postnatal hypoglycemia in infant
150
megaloblastic anemia
vitamin B12 or folate
151
partial moles
dispermy or duplication of paternal chromosomes --\> triploid genome
152
antibiotic use causes disease
c diff colitis, vaginal candidiasis
153
prevent neonatal tetanus
vaccinate mom with tetanus toxoid --\> mom transfers protective IgG antitoxin across placenta --\> no risk for infxn of umbilical cord stump
154
tetanus
skeletal muscle spasms and rigidity
155
prevent neonatal disease
immunize mom, not baby, give baby passive immunity, neonate immune system can't mount proper response to vaccine
156
peripartal antibiotics
only for GBS, HIV
157
passive immunity to infants
IgA mucosal antibodies from breast feeding
158
meniere's disease
disorder of inner ear, defective endolymph resorption --\> increased endolymph volume and pressure in vestibular apartus --\> distention of endolymphatic system --\> damage to vestibular and cochlear components of inner ear --\> tinnitus, vertigo, sensorineural hearing loss, NL Rinne test, Weber test: healthy side
159
rinne test
nl = air conduction superior to bone conduction
160
weber test
reveals lateralization to healthy side
161
passive aggressive behavior
express aggression by passively refusing to meet their needs, act out hostility in non-confrontational manner
162
friedreich's ataxia
spinocerebellar degeneration (predominantly spinal ataxia), loss of dorsal column (position, vibration, sensation), associated with diabetes, HOCM leads to arrhythmias, CHF
163
parkinson's
extrapyramidal hypokinetic movement disorder: tremor, rigidity, akinesia, postural instability
164
ingestion + intestinal attachment
salmonella, shigella, EIEC, entamoeba histolytica
165
posterior pituitary
oxytocin (stimulates uterine contractions in late pregnancy, facilitates breast milk ejection postpartum), vasopressin/ADH
166
duodenal mucosal cells
gastrin, secretin, cck
167
silicosis
birefringement silica particles surrounded by fibrous tissue
168
pulmonary asbestosis
ferruginous bodies (fusiform or beaded rods, translucent asbestos center, coated with iron-containing proteinaceous material), calcified pleural plaques
169
coal worker's
perilymphatic accumulation of coal dust-laden macrophages = coal macules
170
hypersensitivity pneumonitis
inhalation of organic dusts, noncaseating granulomas (berylliosis and hypersensitivity pneumonitis)
171
Dx ZES
serum gastrin
172
Dx UC/Crohn's, screen CRC
colonoscopy
173
schilling test
detect cause of abnormal B12 absorption (see improvement of B12 absorption after intrinsic factor administration = pernicious anemia)
174
chronic pancreatitis, CT
abdominal CT = calcificaiton
175
evaluate chronic hepatitis and cirrhosis
liver bx
176
spectrin
structural component of RBC membrane, abnormalities --\> hereditary spherocytosis (susceptible to hemolysis)
177
DM1
T cell infiltration and fibrosis of islets of langerhans
178
ulcerative colitis
bloody diarrhea +/- abdominal pain = hallmark; most dangerous complication = megacolon (can lead to performation); low grade fever
179
crohn's
if bloody diarrhea, abdominal pain always present
180
whipple dz
rod-shaped bacilli
181
malar rash + pleural effusion in yount pt
SLE, circulating immune complex nephritis, most are ANA positive (sensitive test)
182
pauci immune
no anti-GBM antibodies or IC deposition
183
rheumatic fever
antibodies against streptococci M proteins, in situ immune complexes on the heart (vs. circulating immune complexes for the kidney), affects heart, brain, and joints; occurs after pharyngitis
184
poststreptococcal glomerulonephritis
circulating immune complexes (deposit and fix complement), high ASO titers, low C3, anti-DNAase B, 2-3 weeks after upper respiratory or skin infection, occurs even if you treat pharyngitis/skin infxn
185
duodenal ulcers
most in duodenal bulb, if unusual (ulcer in distal duodenum or other atypical location, multiple ulcers, ulcers refractory to therapy) = ZES
186
zollinger-ellison syndrome
acid inactivates pancreatic and intestinal enzymes --\> diarrhea
187
erosive gastritis
erosions = do not penetrate muscularis mucosa
188
antral sparing
autoimmun egastritis
189
antral predominant
h pylori
190
PUD
ulcers in duodenal bulb, lesser curvature of stomach
191
trinucleotide repeats/expansion
Friedreich's ataxia, myotonic dystrophy, Huntington's, fragile X
192
pleiotropy
one gene mutation --\> affects many organs (ex: Huntington's)
193
mosaicism occurs in
turner's, klinefelters, down syndrome
194
down syndrome dx
karyotyping of fetal cells (screen: AFP)
195
MHC I
heavy chain + b microglobulin; combines with antigen in ER; antigen processing in cytoplasm
196
MHC II
alpha and beta polypeptide chain
197
TH cells
CD4 T cells
198
area postrema
contains chemoreceptor trigger zone, dorsal medulla, caudal end of 4th ventricle, fenestrated capillaries allow it to sample chemicals in blood, causes n/v after systemic chemotherapy
199
thalamus
sensory and motor
200
dorsal to midbrain
3rd ventricle (dorsal to superior and inferior colliculi)
