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175 Cards in this Set
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12 yo falls from tree and catches himself and jumps over, next few hrs comes to ER with right handed clumsiness what structure did he injure?
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brachial plexus (lower trunk) C8-T1...makes the median and ulnar nerve which innervate the hand
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A shoulder dislocation would most likely damage which nerve?
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Axillary nerve
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Midshaft fracture of the humerus would damage what nerve
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Radial nerve
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Rhogam given to mothers is what type of immunoglobulin?
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igG
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A baby with bilateral cleft lip, microcephaly, microopthalmose viscera, umbilical outside the abdomen is presenting with what?
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trisomy 13 (patau's) also see cyclops, absent nose, CNS mental retardation, rocker-bottom, omphalocele, polydactyl, hopoprosencephaly...nondisjunction meiosis I
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Clenching hands with overriding fingers, rocker-bottom feet is what?
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Trisomy 18
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47XYY presents with what characteristics?
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tall, severe acne, mild delay but mostly normal
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What WBC disorder are DS at 10-20x risk for
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acute lymphocytic leukemia
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Chronic myeloid leukemia has what kind of chromosome deformity?
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t (9;22) philadelphia; fuses BCR-ABL
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Paramesonephric ducts fuse to form what in females?
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uterine tubes, uterus, cervix, superior 1/3 of the vagina...if doesn't fuse see female parts malformed
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What does the mesonephric form in females?
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Gartner's ducts
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What does the mesonephric form in males?
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epididymis, ductus, Seminiferous tubuls, and ejaculatory duct
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Mesonephric differentiation does what in males?
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takes sperm from testis to epididymis
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Urethral fold in female and males forms?
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urethra!
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What happens with aldolase B deficiency?
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Get fructose intolerance, breaks down Fructose 1,phosphate decreasing phosphate & inhibiting gluconeogenesis & glycogenolysis, see hypoglycemia, jaundince, cirrhosis, vomiting
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How do you treat fructose intolerance?
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decrease intake of fructose & sucrose (glucose & fructose)
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person comes in with ataxia, pes cavus, hammer tose, hyphoscoliosis, loss of joint and sensory what do they have?
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Friederich ataxia- trinucleotide repeat of GAA encodes fratoxin impair mitochondrial function, posterior column and spinocerebellar tracts of spinal cord are degraded
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What is someone with Friederich ataxia most likely to die from?
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Cardiomyopathy 50%, cardiac arrythmia or CHF, bulbar dysfunction is common to (protects the airway) , DM in 10%
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5yo w persisten food-seeking behavior, obesity mom says aggressive behavior/bizarre what area does he have a lesion in
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ventromedial hypothalamus
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If there is a lesion in the lateral hypothalamus what kind of things would you see
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lose hunger
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what does the suprachiasmatic do in the hypothalamus?
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above the optic chiasm/receive visual input form retina via optic tract- regulate cricadian rhythms by relaying light
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what does the supraoptic/paraventricular do
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it produces ADH & oxytocin to the posterior pituitary
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What does the anterior hypothalamus control
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cool/stimulation PSNS, vasodilation & sweating
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Posterior hypothalamus does?
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heat conservation
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if someone has ingested rat poison what should you do and why?
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makes brodifacam which inhibits vit K so need to give frozen plasma and vit K
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impaired tetrahydrobiopetin synthase will disrupt which neurotransmitters?
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dopa, sertonine, tyrosine, NO
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22yo fm has a infant w ambiguous genitalia but no uterus present what caused this to be absent?
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Mullerian inhibitin factor (regress paramesonephric internal female structures)
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Collagen is made of what kind of helix and what is found every 3?
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triple/glycine
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Glucose is converted to sorbitol by aldolase reductase (NADPH) what does sorbitol get converted to and by what?
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Sorbitol dehydrogenase (NAD+) makes fructose
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Which cells do not have sorbitol dehydrogenase?
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schwann, retina, and kidney (causes built up of sorbitol) cataracts :(
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Female 16yo no period, cramps for 28 days, serum B0hcG is negative and she has normal seondary sexual characteristics what is wrong with her?
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anatomical problem so probably imperforate hymen or mullerian duct defect
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Female patient comes in with hyperthyroidism that is controlled by medication and now presents with a fever, what test would you order?
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WBC
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What is are the 2 hyperthryoid drugs and what is a rare but serious SE?
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Methimazole & PTU (preggo) a serious but rare= argnulocytosis
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what additional enzyme does PTU block?
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conversion of T4--> T3
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Decribe the steps of collagen synthesis
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takes place in fibroblast, osteoblasts, chondroblasts and the procollagen is hydroxylized & glycosylated --> pro alpha chaines secrete to golgi cleave N & C peptide cross-link collage= lysyl oxidase
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Woman with breast cancer takes Tamoxifen what should she be worried about?
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Endometrial hyperplase (partial agonist) incr risk for endometrail cancer
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What does Tamoxifen prevent?
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Breast Cancer (Estrogen antagonist) osteoperosis (estrogen agonist)
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what's diff with Raloxifene compare to tamoxifen?
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no endmetrial cancer risk ( estro antagonist there)
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Alcoholic comes in with fever, wt loss, productive cough and claims to drink 12-18 beers a day, and CT shows a lung abscess what is this tx?
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Clindamycin, Step pneumonia, bacterioids, provetlla, fusobacterium can all be treated with tihs (anaerobic) more likley in alcoholic
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19yo with history of otitis media, gets in an accident and receives blood transfusion of type O-, suddenly turns red, itchy, bronchospasms and dies... what did she have?
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Selective Immunoglobulin Deficiency (IgA) MC immunodeficiency!
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Describe what happens in selective igA deficiency?
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Anaphylaxis reaction to any blood product with igA, thought that B cells are unable to switch from igM to igA; their also predisposed to Gi/sinupolmonary infections
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A patient has compresses of the nerve through the obturator foramen, what will they be limited in?
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adduction of thigh! (only nerve through foramen)
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What surgery commonly can hit the Obturator nerve?
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lymph node dissection/pelvic surgeries
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A drug your taking disrupts lamellar bodies of type II pneumocytes.. what will youl likely see on xray?
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patchy atelectasis
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What's the pathology of emphysema
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too much protease released from neutrophils & macrophages in the alveoli
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What do smokers always have increased in their lungs?
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neutrophils!
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16yo with fever, sore throat, PE hows cervical & axillary lymphadenopathy and cells show atypical lymphocytes what is he at risk for?
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Hodgkin and non-hodgkin lymphomase & nasopharyngeal carcinoma
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What does this 16yo w cervical lymphadenopathy and atypical lymphocytes Have/
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EBV mononucleosis
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pt comes in with pain/swellingon R knee you take synovial fluid and WBC is 25,000 with mostly neutrophils its a + bifirenegence polarized light what crystal is this and whats the situation called?
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Calcium pyrophsophate- pseudo gout
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Describe characteristics of pseudogout
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calcium pyrophosphate crystals within the joint space, forms basophilic rhomboid shaped cyrstald weakly positive birefringent!, pseudogout crystals= blue when parallel to the light
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stillborn fetus on biopsy shows aortic coarctation, edematous neck, broad chest, fused kidney, bicuspid aortic valve what did they have?
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45 XO, turner's sydnrome key* lymphedema, coarctation oartia, & horshoe kidneys
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Where is sertonin released from?
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raphe nucleus plays with sleep-awake cycle!
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Buspirone is used for?
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GAD, stim 5HT no sedation, addiction, or hypnotic- takes 1-2 weeks to work, no alcohol problems
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Bupropion is used for?
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atypical antidepressant: incr NE, used for smoking cessation, stimulant effect, seizure in bulimics, non sexual SE
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26yo med student - PPD, 2 yrs later has lesion what is the immuno mechanism for this?
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tuberculosis= CD4 + T lymphocytes and macrophage (noncaseating granulomas)
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describe the epithelium of the respiratory tract
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begins as pseudostratified ciliated columnar cells and then at the terminal bronchioles becomes ciliaeted simple cuboidal
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What all stops at terminal bronchioles?
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cartilage, goblet cells, & serous cells
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What continues to the end of the respitory tract?
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cilia except not to the alveoli/alvolar ducts but it continues through the respiratory bronchioles
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Most common mutation for cystic fibrosis?
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3 base removal of phenylalanin at amino acid 508
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What does the mutation for cystic fibrosis cause?
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abnormal protein degradation, impairs post-translational process of CFTR gene= degradation before transport so no CFTTR at apical membrance of exocrine epithelial cells
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Autopsy of a baby that died in respiratory disrtress reveals pulmonary hypoplasia, no kidneys, & facial deformities what did he die of?
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Oligohydroamniosis (no kidneys can't pee and drink it) Potter's syndrome also associated with limb deficiencies , ARPKD
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Define lead-time bias
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artificial increase in survival of tested patient with unchanged increase of prognosis (some tests are more sensitive and detected early on) it was probably just detected earlier- think of this for bad prognosis dz (pancreas)
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A left shift on the hemoglobin curve shows what status?
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O2 has an increase affinity so less likely to give to tissues= hypoxia, & you get a reflex of polycythemia
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A cell with low or missing MHC I is going to get killed by which cell?
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Natural Killers- kill cells with absent MHCI class
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What do Nk cells pocess to assist in the killin?
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perforin (holes in membrances) & granzymes causes apoptosiis
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Which CD's may be seen on NK cells?
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CD16 & CD58
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what activates NK cells?
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interferon gamma & IL-12
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Do Nk cells need an antigen or memory?
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NO
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what do dendritic cells do?
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they constantly sample for antigens if they find any the present MHCII to T & B cells
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how do B cells become plasma cells what other cell do they need?
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T helper cells
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Decribe how entacaptone & telcapone work?
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Used for parkinson's pts. COMT inihibitors, so block the break down of L-dopa in the periphery and sent i all to the brain since it crosses BBB, must give L-dopa with these drugs or their useless
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Does dopamine cross BBB?
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NO! or we couldve cured parkinsons!
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What is unique about the O2 content and resistance in lungs?
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As O2 content decreases, the arteriolar resistance increases- shunting away blood from those underventilated areas
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An african baby is exclusively breast fed what vitamins may you need to supplement?
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Bc he african he needs extra sun exposure for Vitamin D, so give him some of that and probably some vit K bc babies dont have enough to clot!
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Diabetic pt comes in with low glucose level what drug are you going to give to treat them?
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B1 blocker, don't want to use non-selective because that will inhibit B2 which is doing gluconeogensis, and this will just work on the tremors/adrenergic symptoms
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What do you see early on in a hypoglycemic patient?
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tremor, palpations, hunger, extra release of NE/Epi
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What do you see later on in a hypoglycemic pt?
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confusion, dizziness, behavior
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A male presents to you he can speak well but does not seem to understand you, follow directions, or repeat after you...which artery is occluded?
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MCA- Wernicke's area (thought processing) Word SALAS, broca's speaking. These are located on the temporal lobes
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Chediak-Higashi syndrome has a triad of 3 things what are they?
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recurrent pyogenic infections, partial albinism, and peripheral neuropathy
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What is deficient in Chediak-Higashi syndrome? and how is it geneticlaly inherited
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autosomal recessive, mutation in lyososmal trafficking gene LYST, needed for microtubule-dependent sorting of endosomal protiens into late multivesicular endosomes...no phagosomes/lysosomes and abnormal neutrophils
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A man comes in with albinims, nystagmus, and recurrent skin and respiratory infections..what are you thinking?
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chediak-higashi
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What is the triad for wiskott-aldrich syndrome/
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immunodefcieinzy, ezcema, and thrombocytopenia (B/T cell disorder) (TIE)
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What is the genetic deficieny in wiskott-aldrich and how is this inherity?
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X-linked, WAS gene on X chromosome is defected T cells can not reorganze actin cytoskeleton, see incr igE/igA and decr in igM
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Exposure to UV radiation causes
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thymide-thymidine dimers
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Exposure to radiation causes?
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1. DNA double strand breaks 2. free radicals release to damage the DNA and cellular damage
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characteristics of SCID
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severe recurrent infection (VSV/HZV), chronic diarrhea, failure to thrive (-) thymus
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What cancer is associated with Hasmito's Thyroiditis?
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non-hodgkin's lymphoma
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Leukemia Vs lymphoma whats the difference?
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leukemia= BM
lymphoma= lymph node |
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4yo with pancreas acinar cells in the pouch that was connected to the ileum what is this called?
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ectopy (tissue found somewhere abnormal)
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Inflammation shows high 72 kd only with lots of inflammatory cells not normally what binds directly to this?
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aspiring- COX2 is only present with lots of inflammation and the weight is 72kd
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how is cox1 expressed?
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consituitely
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What kind of inhibitor is aspirin
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irrversible so you need to make new enzymes
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Allopurinol does what
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inhibits XO for gout
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infliximab does what
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it's a monoclonal antibody, irrversible inihbitor of TNF alpha inflammatory
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Prednisone does what?
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binds to cytoplasmic receptors goes to nucleus and upregulates expression of anti-inflammatories
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Strep pmeun meningitis given with low dose cefrtriazone shows 5 bands what is this binding to?
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penicillin binding proteins like transpeptidase which prevent cross-link peptide backbone
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Azoles do what to P450?
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inhibit
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Someone with atherosclerotic plaques comes in what would predispose them to an MI?
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the clots depend on the strength, metalloprotease would break them which could increase change of MI
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metalloproteinase is
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collagenase
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obstructive sleep apnea can cause
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pulmonary HTN, by obstructed the airway- you shunt the blood around vasoconstrict certain areas.
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trochlear nerve problems are characterized by
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vertical diplopia
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28yo had a baby who is crying, dilated pupils, rhinitis, & diarrhea- the mom lives on the street- what are you going to give the baby to help?
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opium- seems to be going through opiod withdrawal, eventually taper them off
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naloxene is used for?
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opiod receptor antagonists- acute needs
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baby has swollen hands & posterior neck mass with lymphoid aggregates what is this mass?
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cystic hygroma- likely to be turner syndrome (can't spread lymph around builds up here)
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round face, cat cry, & micrcephaly and characteristics of
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cri-du chat syndrome
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Blind ended vaginal pouch without a uterus is
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testiculare feminization syndrome- appears as a male outside
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clara cells do
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in termpinal respiratory epihtleium- secrete protein, surfactant, and detox by p450
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Th2 exposed to inhaled produces and produce B cells that switch to igE what interluekin?
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IL-4
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what are the IL released by Th2?
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Il-3, Il-4, Il-5 (eosinophils/igA), B cells
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Th1 released which interluekin/
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Il-2, interferon gamma, cell mediated and type IV HS
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RNa polyermase II is used for eukaryotic gene transcription where are the enhancers?
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anywhere
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Where it the TATA box? (promoter)
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25 bases upstream
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where is the CAAT? (promoter)
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70-80 bases upstream
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what is conjuctival injection?
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short-last unilateral neuraligiofrm headaches (rare) trigeminal cephalgia
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What are 2 most common immedaite SE from marijuana?
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incr heart rate & conjuctival injection
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What is seen with MArijuana and how does it work?
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has THC and binds cannabinoids (Cb1 & Cb2) changes mood, memory, euphoria, laugh, slow reflexes, dizzy, impair
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PCP abuse causes
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nystamus & ataxia
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Fast shallow breathes are seen with what lung disorders?
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restrictive, increase elastic tissue
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Deep slow breathes are seen with what lung disorders?
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obstructive, decreased elastic tissue
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Babay with microcephaly, low set ears, prominent occiput, small mandible, fingers overlapping is?
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trisomy 18
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when does genitalie differentiate
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8-15 weeks
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urethral folds don't fused in a male and you get?
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hypospodia
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abnormal position of genital tubercle can cause
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epispadia
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what is cryptorchidism
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failed to descend testis
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DNa methyltransferase S-adenosyl-methionine transfers methyl group to cytosine, what is this process called genetically?
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imprinting
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What is imprinting
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one gene maternal/paternal is silences or deleted by methylation- only one is active, seen in prader-will/angelman syndromes
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what is pleiotropy?
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one single gene effecting multiple phenotype characteristics
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What is SAM?
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Main methyl transferer
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What makes SAM?
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ATP+Methionine
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Regeneration of methionin for SAM is dependent on what 2 things?
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vitamin B12 & folate
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What does SAM do to NE
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converts to epinephrine
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Describe the Weber test and the abnormal findings.
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Weber test places tuning fork on the forehead...sound should be even... if it's conductive hearing loss, the sound lateralizes to affected ear making it hear better, if it's sensorineural loss the sound lateralizes to the unaffected ear making that ear hear better.
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Describe the Rinne test and abnormal findings.
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Place fork on external auditory meatus and the mastoid process... Sensorineural hear better on meatus than bone (normal) conductive hear better on bone than meatus
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decrease in expiratory, decrease in tidal volume, and increase in residual volume described what type of lung disease?
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obstructive
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Decrease in tidal volume, residual volume, and normal expiratory describes what lung diseases?
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restrictive
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Alveolar hyaline membrane would cause what in a lung?
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decr compliance...and work as a restrictive disease, decr LV, compliance, tidal vol, residual vol decr expiration is normal
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intralveolar hemorrhage would cause?
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restrictive type disease bc would dilute surfactant and cause atelectasis
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What happen to lungs in obstructive disease?
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hyperinflate lungs, decr tidal volume, decr lung elasticity & increase bronchial resistance
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Taxi driver has a fear that a group of people will kill him, his wife denies any sort of threat or any mental problems with her husband what is he going through?
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delusional disorder
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What differentiates paranoid schizophrenia from delusional disorder?
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paranoid schizo has bizarre delusions, delusional are non-bizarre have the possability of happening
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tom has been feeling very deprssed but then has at least 2 weeks of a good mood but with psychotic symptoms it's been happening for less than a month what is this?
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schizoaffective disorder
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what is the point of giving live-killed virus vaccines?
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prevent cases increase the host antibodies to hemoagglutin, prevent virus entry to cells by receptor-mediated endocytosis
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what kind of immunity is built with vaccines
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humoral
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what do thalassemias come from?
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mutated mRNA processing
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Someone comes in with 6500 RBC, asymptomatic, iron pills are not helping improve his low Hb, on histo: hypochromic RBC & target cells what is happening to him?
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Beta-thalassemia minor, hardly any symptoms & only one gene is affects, Iron pills will not improve this, commonly seen in mediterranena descent
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Patient who smokes a lot comes in w sudden onsent of dyspnea and upon PE you see swelling of the calf, what happened to him?
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Pulmonary Embolism
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How does a pulmonary embolism affect the lungs?
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the emboli goes to the blood supply of a lung, causing dyspnea...causeing V/Q inbalance--> hypoxemia which causes hypventilation producing respiratory alkalosis--> decrease PaO2 and PaCO2
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5 month old brought to you with right scrotal mass what is this often presented like?
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indirect inguinal hernia, it's a hydrocele
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Describe the processus vaginalis?
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testes are in the peritoneal cavity they go to scrotum and invaginate below forming the processus vaginalis which follow sthe testes--> oblierates after testes descend...if they don't descend you can build up fluid or get abdominal stuff
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Describe indirect inguinal hernia
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the processus vaginalis did not obliterate- you get abdominal stuff through this connection
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Describe the mechanisms of Leuprolide
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it's a GnRH agonist, pulsatile fashion of GnRH intially will cause an increase in hormones, and then eventually they negatively feedback and turn of GnRH- good for prostate cancer
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Lady with joint pain comes in what are you going to give her and warn her about?
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Methotrexate- 1st line for RA/joint pain
SE: stomatitis (mouth ulcers) hepatoxicity , myelosupression |
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Can you give methotrexate to pregnant woman, why or why not?
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NO neural tube defects
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How does methotrexate work?
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dihydrofolate reductase (folic acid i)
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Is there a rescue drug for methotrexate?
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yes, leucovorin
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phosphatidylcholien is the same thing as
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lecthin (surfactant producer)
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How do you know lung is ready to mature at 35 weeks gestation
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lecthin: sphingomyelin is 2:1
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ARP is
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atrributable risk, you can say a certain risk is why the disease happens
RR-1/RR |
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what is the CD for monocyte-macrophages that you would see in noncaseating granulomas
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CD14
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Alcoholic cirrhosis causes a build up in portal blood, portal HTN on the CT where would the pressure build up?
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portal vein
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what are P bodies
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after transcription of mRNA leaves to go to ribosome to translate but some go to P bodies for regulation, degradation, and storage
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which cells release a basic protein capable of attacking helminths?
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eosinophils
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Which cell has a bilobed nucleus packed with granules?
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eosinophils
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major immune for influenze are antibodies to immungluttins which 2 and where
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igG in the circulation and igA in the mucous and nasopharynx
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The main side effect of ziodovudine is
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Bone marrow suppression
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Side effects of ganciclovir
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Neutropenia,anemia,thrombocytopenia,impair renal function
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Didanosine main side effect
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Pancreatitis
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Forscarnet side effects
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Electrolyte imbalance nephrotoxicity hypocalcemia,hypokalemia,hypomagnesia,hypophosphate
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high plasma porphryin levels most likely indicates?
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porphyria cutanea tarda
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What enzyme is missing in porphyria cutanea tarda?
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Urophyrinogen decarboxylase
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What is the rate limiting step in heme synthesis
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ALA synthase
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What inhibits ALA synthase and what stimulates it?
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inhibited by glucose, heme, stimulated by alcohol, barbiturates, and hypoxia
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What enzyme missing in heme pathway to cause lead poisoning?
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ALA dehydratase
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What enzyme missing in heme pathway to cause acute intermittent porphyria?
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porphobillinogen deaminase
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What enzyme at end of heme pathway effects lead poisoning?
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ferrochelatase
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