Boards - Bbc Session 10

Front 1

What level does bili usually have to be higher than to cause jaundice?

Back 1

5mg/dL

Front 2

Pt has scleral icterus and sublingual icterus. What do they have?

Back 2

Jaundice

Front 3

How does billi form?

Back 3

RBCs lyse or die --> release hemoglobin --> heme (+ globin) --> biliverdin --> bilirubin (unconjugated = indirect bili) --> binds albumin --> delivered by albumin via serum to liver --> conjugated in liver by uridine diphosphate glucuronosyl transferase (to become direct ie conjugated bili) --> released to intrahepatic bile ducts

Front 4

What are the different causes of jaundice?

Back 4

Hemolysis, Deficiency of Glucuronosyl transferase, Defects in transport of bili from hepatocyte to bile duct, Obstruction of biliary system

Front 5

Describe Crigler-Najjar syndrome, one of the causes of jaundice?

Back 5

Autosomal dominant - dec expression of uridine diphosphate glucuronosyl transferase - chronic elevation of indirect bili

Autosomal recessive - Absent UGT expression - no conjugation occurs, lethal

Front 6

What is Gilbert syndrome, one of the causes of jaundice?

Back 6

Mildly decreased expression of uridine diphosphate glucuronosyl transferase

= elevated indirect bili at time of physical stress

Front 7

Define Rotor, one of the causes of jaundice

Back 7

Impaired hepatocellular secretion secondary to a carrier defect = elevated bili

Front 8

Define Dubin-Johnson syndrome?

Back 8

Impaired hepatocellular secretion secondary to a carrier defect = darkly pigmented liver + elevated direct bili

Front 9

T/F: Hepatitis A is only acute, never chronic

Back 9

TRUE

Front 10

How s HEP A transmitted?

Back 10

fecal-oral

Front 11

How do we tell if a pt with Hep A is in the acute phase or chronic phase?

Back 11

Acute = IgM
Chronic = IgG

Front 12

Whats the incubation period for Hep A?

Back 12

2-6 weeks

Front 13

Earliest marker for Hep B?

Back 13

HBs-Ag = indicates current or chronic infection

Front 14

What does Hbe-Ag indicate?

Back 14

An especially infective state

Front 15

How is Hep B transmitted?

Back 15

parenterally, sexually and vertically

Front 16

Whats the incubation time for Hep B?

Back 16

2-6 months (vs Hep A = 2-6 weeks)

Front 17

Define Dane Particle

Back 17

A capsid of Hep B = envelope and glubular proteins = the "serum" hepatitis

Front 18

How is Hep B transmitted?

Back 18

Parenterally, sexually and vertically

Front 19

Whats the leading cause of infectious liver in the Western world?

Back 19

Hep C (an RNA virus)

Front 20

90% of transfusion hepatitis is due to what?

Back 20

Hep C

Front 21

How is Hep C transmitted?

Back 21

parenterally

Front 22

Whats the incubation for Hep C? What percent of cases become chronic?

Back 22

1-2 months

50-70% of cases become chronic

Front 23

What two enzymes will we see elevated with Hep C?

Back 23

ALT and AST

note: these don't have to be elevated

Front 24

What are the two types of infections Hep D can cause?

Back 24

Coinfection and Superinfection

Front 25

How is Hep D transmitted?

Back 25

parenterally or sexually

Front 26

How is Hep S spread?

Back 26

fecal-oral. Often fulminant in pregnant women = preggos can die from it, where normally it never becomes a chronic disease

Front 27

Pneumonic for remembering Hep A and E are transmitted via fecal-oral?

Back 27

"Vowels = in the Bowels"

Front 28

T/F: HIV+ pts with Hep G have been shown to survive longer than those without Hep G

Back 28

TRUE

Front 29

How is Hep G transmitted?

Back 29

Sexually, parenterally, vertically

Front 30

A pts serology has HBsAg in it one week after symptom onset. What type of Hep do they have?

Back 30

Hep B

Front 31

What antigen, if found in blood, indicates an extreme state of infectiousness?

Back 31

HBeAg

Front 32

What antigens are present during the window period of Hepatitis infection?

Back 32

Anti-HBc

HBV DNA

Front 33

Which antigen during Hepatitis infection is protective?

Back 33

Anti-HBs

= Ab to the hep B surface antigen that appears after symptoms disappear indicating immunity = its protective

Front 34

Define the window period of Hep B infection

Back 34

A period of time in which a person WITH Hep B will have a window of time in which the 2 primary screening and diagnostic tests (HBsAg and anti-HBs) will be negative (after HBsAg is no longer measurable and before anti-HBs is measurable)

Anti-ABc and HBV DNA, which are not used typically as initial tests, will be positive during that period of time

Front 35

Describe the curves of antigen present with Hepatitis infections?

Back 35

Hbs Ag - Hbe Ag - Anti-HBc Ag - Anti-Hbs AG

Front 36

What will we see in vaccinated individuals with Hepatitis?

Back 36

Anti-Hbs Ag, won't have Anti-Hbc

Front 37

Pt has HBs Ag and is negative on all other tests. Dx?

Back 37

Hep B

Front 38

Pt has HBe Ag. Dx?

Back 38

Very infectious acute Hep B

Front 39

Pt has HBs Ag on initil presentation, and comes back 7 months later with still + HBs Ag. Dx?

Back 39

Chronic Hep B

Front 40

Pt has + anti-HBs and (-) anti-HBc. Dx?

Back 40

Immune to Hep B due to vaccination

Front 41

Pt has + anti-HBs and + anti-HBc. Dx?

Back 41

Immune to Hep B due to resolved Hep B infection

Front 42

Pt has symptoms of Hep B, but demonstrates - HBs Ag, and - anti-HBs. Dx?

Back 42

Either Hep B neg or has Hep B but is in window period. So you run anti-HBc and its +. Dx is acute Hep B (but in window period)

Front 43

Define Toxic hepatitis

Back 43

Hepatitis ie inflamm of liver due to a toxin which can be a poison or a drug

Front 44

What are some major causes of toxic hepatitis?

Back 44

Methotrexate, chloramphenicol, halothane, isoniazid

Front 45

Define Cirrhosis

Back 45

Diffuse organization of normal hepatic structure by regenerative nodules that are surrounded by fibrotic tissue

Front 46

Whats the end stage of many liver diseases?

Back 46

Cirrhosis

Front 47

What are the signs and symptoms of cirrhosis?

Back 47

weakness, anorexia, ascites, fat-soluble vitamin deficiencies, hepatic encephalopathy, portal HTN with varices, malaise, fat malabsorption, caput medusa, weight loss, bleeding probs, infection

Front 48

What are the types of alcoholic cirrhosis?

Back 48

Alcoholic, Cirrhosis due to Viruses or toxins, Primary Biliary Cirrhosis

Front 49

How long will a pt have Alcoholic cirrhosis?

Back 49

Irreversible

First we'll see fatty change

Front 50

Mallory Bodies and Alcoholic hyaline mean what?

Back 50

Alcoholic Cirrhosis

Front 51

What other damages will we see due to alcoholic cirrhosis?

Back 51

Toxicity to testes --> testicular atrophy

Further cirrhosis --> high E2 --> Spider Angiomata --> Gynecomastia and Palmar Erythema

Further cirrhosis --> Hepatocyte death --> Hepatic Encephalopathy

Alcoholic cirrhosis --> impaired blood flow through liver due to fibrotic bands --> portal HTN --> Ascites varices

Front 52

We see micronodular liver pathology from an alcoholic pt. Is this early or late stage alcoholic cirrhosis?

Back 52

EARLY

Macronodular = late

Front 53

Whats the first sign of Primary Biliary Cirrhosis?

Back 53

Inc. Alkaline Phosphatase
1st symptom is Pruritis, esp at night

Micronodular

Autoimmune disease with anti-mitochondrial Abs

Front 54

Inc. Fe absorption leads to Fe deposits in liver, heart, pancreas, and skin in form of hemosiderin. Pt presents with new onset DM, skin pigmentation = "Bronze diabetes", and possibly cardiomyopathy. DX?

Back 54

Hemochromatosis

Front 55

Define Wilson's disease

Back 55

Autosomal recessive. AKA Hepatolenticular Degeneration

Accumulation of Copper which may lead to fulminant Hep and later cirrhosis

Dec serum ceruloplasmin so Cu deposits inappropriately in brain, kidney, cornea, liver

Front 56

What do the Copper deposits in all the dif tissues seen with Wilson's disease lead to?

Back 56

Cu in brain --> Psychosis, atehtosis, incoordination
Kidney --> High urinary Cu
Cornea --> Kayser-Fleischer rings (orange rings on cornea)
Liver --> Cirrhosis

Front 57

Define Amyloidosis

Back 57

A disease marked by accumulation of amyloid = affects liver 50% of time

Front 58

Whats the most common liver cancer? Primary sites of metastatic liver cancer?

Back 58

Metastatic is the most common liver cancer

Primary sites = breast, lung, colon

Front 59

Whats the greatest risk factor for Cholangiocarcinoma?

Back 59

Infection with Clonorchis sinensis (liver fluke)

Front 60

What are the major causes of Pancreatitis?

Back 60

Alcoholism, Gallstones (obstruct pancreatic duct system), Hypertriglyceridemia

Front 61

Pt presents with severe pain radiating to back and elevated amylase and lipase on labs. Dx?

Back 61

Pancreatitis

Front 62

Define Intussusception

Back 62

Bowel telescopes in

Front 63

Where does Intussusception usually occur?

Back 63

terminal ileum into ascending colon

Front 64

Whats the most significant risk for Intussusception?

Back 64

Adenovirus infection

Front 65

Pt has vomiting, palpable right upper quadrant sausage-shaped mass with vacant lower right quadrant, currant jelly stool

Back 65

Intussusception

Front 66

Define Midgut volvulus

Back 66

During fetal development, Duodenum and colon malrotate around mesentery, causing constriction of bowel and vasculature

Front 67

Define Necrotizing Enterocolitis

Back 67

Neonates

Risk factors = maternal NSAID use, prematurity, comorbid disease at birth

Bowel mucosa necroses

Front 68

this disease is due to lack of development o fAuerbach's and Meissner's plexuses at focal regions of colon

Back 68

Hirschprung's disease

Front 69

Whats the #1 cause of GI obstruction in infants?

Back 69

Pyloric stenosis

Due to hypertrophy and hyperplasia of muscular layers of pylorus

Front 70

Pt has firm non-tender "olive" at pylorus. Dx?

Back 70

Pyloric stenosis

Front 71

Osteoarthritis vs. Rheumatoid Arthritis?

Back 71

OA = Disorder of hyaline cartilage and subchondral bone but surrounding tissues are hypertrophied. Slow, Progressive. SITFFNESS LESS THAN 1 HR. Heberden's nodes and Bouchard's nodes

Rheumatoid Arthritis = autoimmune destruction of joint. ABRUPT and multiple joints involved. Rheumatoid nodules, STIFFNESS LASTS > 1 HR in MORNING

Front 72

Stiffness in multiple joints that lasts greater than 1 hr in pt. DX?

Back 72

Rheumatoid arthritis. (if less than 1 hr, its osteoarthritis)

Front 73

What are the Criteria for rheumatoid arthritis that we must have 4 our of 7 of in order to make the Dx?

Back 73

Morning stiffness > 1 hr
Arthritis in 3 or more joints simultaneously
Arthritis in hand joints
Symetrical arthritis
Rheumatoid nodules
Serum Rheumatoid factor
Erosions or bony calcifications identifiable on x-ray

Front 74

Define Still's disease

Back 74

Systemic juvenile arthritis or juvenile rheumatoid arthritis

Acutely febrile, polyarthritis, - rheumatoid factor

Occurs before age 16

Front 75

Define Psoriatic arthritis

Back 75

Psoriais of skin/nails seen
No rheumatoid factor
Affects DIPs
Causes sausage digits
HLA-B27+

Front 76

Define Felty's syndrome

Back 76

Polyarticular RA, spenomegaly, leukopenia, leg ulcers, inc. infection

Front 77

Define Osteogenesis imperfecta

Back 77

Abnormal fragility of bone due to disorder of collagen synthesis

Blue sclera

Front 78

Define Osteopetrosis

Back 78

"Marble bones or Albers-Schonberg"

Sclerosis of vertebral end plate --> "rugger's jersey" look

leads to brittle bones

Front 79

Define Achondroplasia

Back 79

A type of chondrodystrophy = defective cartilage synth

= a type of dwarfism

Auto. Dominant --> short limbs with normal sized head and trunk

Front 80

Define Aspetic necrosis

Back 80

due to cut in blood supply

Can be secondary to trauma of the head of the femur, tibial tuberosity, or scaphoid bone

Includes Osgood-Schlatter disease + Legg-Calve perthes disease

Front 81

T/F: NO serum markers or abnormalities occur with Osteoporsis

Back 81

TRUE

test with bone density or DEXA scan

Front 82

Define osteoporosis

Back 82

Thinned cortical bone and enlarged medullary cavity

pts easily fracture bones with falls

esp at risk are small-boned, petit women

Front 83

What are the various causes of Osteoporosis

Back 83

Estrogen-deficient state
Physical inactivity/ bed ridden
Hypercorticolism
Hyperthyroidism
Subclinical Ca2+ deficiency

Front 84

What are the dif types of primary osteoporosis?

Back 84

Idiopathic
Type 1 = post-menopausal
Type 2 = Involutional osteoporosis = affects pple 70 or older

Front 85

Define Osteomalacia

Back 85

Due to inadequate bone mineralization

AKA Rickets in kids caused by vit. D deficinecy

Radiographically you'll see "Looser's zones" = radiolucent bands that run perpendicular to the periosteal surface = due to pseudofractures

Front 86

What are the causes of Osteomalacia?

Back 86

Vit D deficiency, Severe liver dis of any type, anticonvulsant drugs (Phenobabitol and Phenytoin), Renal Osteodystrophy, Fanconi's syndrome, Malnutrition/Malabsorption

Front 87

Define Osteitis Fibrosa Cystica

Back 87

AKA von Recklinghausen disease of bone

Its the focal bone damage caused by severe hyperthyroidism

Results in micro-fractures and secondary hemorrhages

Front 88

Define Paget's disease

Back 88

"Osteitis deformans"

Inc., uncontrolled bone turnover, with bone formation outpacing bone resorption and that formation is disorganized bone

Symptoms = frontal bossing, deafness, bony pain and pain secondary to compression of the spinal and cranial nerve roots, vertebral compression fractures

Radiologically = enlarged thick bones

Front 89

Primary innervation of Hamstring? Quadriceps?

Back 89

Hamstrings = Sciatic n.
Quadriceps = Femoral n.

Front 90

What 3 muscles comprise the "hamstrings"?

Back 90

Semi-membraneous, semi-tendinous, biceps femoris

Front 91

A peroneal n. injury affects the foot how?

Back 91

Loss of Dorsiflexion

Front 92

Major contents of superior mediastinum? middle mediastinum? posterior mediastinum? anterior mediastinum?

Back 92

superior mediastinum = Thymus, great vessels, esophagus, trachea
middle mediastinum = Heart
posterior mediastinum = Descending aorta and esophagus
anterior mediastinum = Thymus

Front 93

What are the 3 signs of portal hypertension in terms of the portocaval shunts involved?

Back 93

Gastric or Esophageal shunt can lead to esophageal varices

Peri-umbilical shunt allows for caput medusa

Anorectal vein --> Hemorrhoids

Front 94

Where is McBurney's point located?

Back 94

Between ASIS and belly button 1/3rd of the way away from ASIS

Front 95

What is the triad for peritonitis?

Back 95

Rebound tenderness, Abd. muscle rigidity, Severe pain

Front 96

Name the layers of the spermatic cord, from most superficial to deepest layer

Back 96

Superficial fascia --> External Spermatic fascia --> Cremasteric m. + fascia --> Internal spermatic fascia --> Loose connective tissue

Front 97

From what artery does the ovarian artery directly originate?

Back 97

Aorta

Front 98

Compare Broca's aphasia with Wernicke's aphasia in terms of fluency of speech and comprehension of language

Back 98

Broca's aphasia = non-fluent speech but good comprehension

Wernicke's aphasia = fluid speech but no workd recognition = word salad (poor comprehension)

Front 99

What cerebral artery supplies the lateral cortex? Medial cortex?

Back 99

Lateral cortex = middle cerebral a.
Medial cortex = Ant. cerebral a.

Front 100

Name all 5 of the signs/symptoms assoc. with transient ischemia involving vertebrobasilar artery insufficiency

Back 100

Vertigo, Diplopia, Ataxia = loss of balance, Facial m. weakness or numbness, Nausea

Front 101

What CNs do taste? Hearing? Mastication? Movement of trapezius? facial expression? sensory transmission from viscera?

Back 101

taste = 7 + 9
Hearing = 8
Mastication = 5
Movement of trapezius = 11
facial expression = 7
sensory transmission from viscera = 10

Front 102

What CN is served by the Edinger-Westphal nucleus? Inferior Salivary nucleus? Dorsal motor nucleus?

Back 102

Edinger-Westphal nuc = 3
Inferior salivary nuc = 9
Dorsal motor nuc = 10

Front 103

What part of the striatum atrophies in Huntington's disease?

Back 103

Caudate and Putamen

Front 104

What brainstem area is lost in Parkinson's?

Back 104

Substantia nigra

Front 105

What part of the basal ganglion is the site of copper accumulation in Wilson's dis?

Back 105

Lentiform nuc

Front 106

What two structures comprise part of the basal ganglion?

Back 106

Putamen and Globus pallidus

Front 107

The thalamus receives ALL Sensory input except for this one type

Back 107

Olefactory

Front 108

What part of the brainstem is destroyed in Wallenberg syndrome, and what artery infarcts to bring this about?

Back 108

The Lateral Medulla is destroyed and the posterior inferior cerebellar artery brings this about

Front 109

IF contralateral body pain and temp. sensation is lost, what spinal tract has been injured?

Back 109

Spinothalamic tract

Front 110

What occurs to the body if the corticospinal tract is damaged?

Back 110

Allows us to have motor function, so with damage we'll get spastic paralysis (b/c its an upper motor neuron lesion)

Front 111

What lesion tops your list of differential Diagnoses if there is a muscle weakness and loss of sensation in the right arm? left leg?

Back 111

Right arm = CVA of left cerebral artery
Left leg = think stroke - R. side of brain, R. anterior cerebral a.

Front 112

In what dermatomes do the following structures lie:

Anus, umbilicus, great toe

Back 112

Anus = S5
Umbilicus = T10
Great toe = Top is L5, Medial is L4, Bottom is S1

Front 113

What disorder exists if an L5 transverse process articulates or is fused with the sacrum?

Back 113

Sacrilization

Front 114

What gene is responsible for producing: gp41 and gp120 in HIV? p24? reverse transcriptase in HIV?

Back 114

gp41 and gp120 = ENV gene
p24 = GAG gene
Reverse transcriptase = Pol gene