Dit Cram Session

Front 1

What is the relationship between the notochord, neural plate and neural crest cells?

Back 1

-Notochord induces overlying ectoderm to form Neural Plate

-Neural plate then folds to form the neural tube and and neural crest cells

Front 2

What is the embryologic origin of:

olfactory epithelium

Back 2

Surface ectoderm

Front 3

What is the embryologic origin of:

Cornea of the eye

Back 3

Neural crest

Front 4

What is the embryologic origin of:

lens of the eye

Back 4

surface ectoderm

Front 5

What is the embryologic origin of:

retina of the eye

Back 5

neuroectoderm

Front 6

What is the embryologic origin of:

salivary, sweat, mammary glands

Back 6

surface ectoderm

Front 7

What is the embryologic origin of:

tissue just above the pectinate line

Back 7

endoderm

Front 8

What is the embryologic origin of:

tissue just below the pectinate line

Back 8

ectoderm

Front 9

What is the embryologic origin of:

lower 2/3 vagina

Back 9

endoderm

Front 10

What is the embryologic origin of:

upper 1/3 vagina

Back 10

mesoderm

Front 11

What is the embryologic origin of:

Adrenal Medulla?

Adrenal cortex?

Back 11

Medulla = neural crest

Cortex = mesoderm

Front 12

What is the embryologic origin of:

testes, ovaries

Back 12

endoderm

Front 13

The following are defects of which embryologic origin:

Vertebral Defects

Anal Atresia

Cardiac Defects

Tracheo-Esophageal Fistula

Renal Defects

Limb Defects (bone and muscle)

Back 13

Mesoderm

Front 14

What is the embryologic origin of:

Adenohypohysis

Back 14

Surface Ectoderm

Front 15

What is the embryologic origin of:

Neurohypophysis

Back 15

Neuroectoderm

Front 16

What is the embryologic origin of:

Autonomic Nervous system

Back 16

Neural Crest

Front 17

What is the embryologic origin of:

CNS

Back 17

Neuroectoderm

Front 18

What is the embryologic origin of:

-Aorticopulmonary Septum?

-Heart Structures?

Back 18

Aorticopulmonary Septum= Neural Crest

Heart Structures = Mesoderm

Front 19

What is the embryologic origin of:

Eustachian tube

Back 19

Endoderm

Front 20

What is the embryologic origin of:

Bones of inner ear

Back 20

Neural Crest

Front 21

What is the embryologic origin of:

Melanocytes

Back 21

Neural Crest

Front 22

What is the embryologic origin of:

Cranial Nerves

Back 22

Neural Crest

Front 23

What vitamin overdose during pregnancy can alter HOX-gene expression and cause synpolydactyly (fused 3rd-4th digit)

Back 23

Vitamin A

(retinoic acid)

Front 24

What precursor cell type invaginates to form the primitive streak?

Back 24

Epiblast

Front 25

What is the embryologic origin of:

bones of the skull

Back 25

Neural Crest

Front 26

What is the embryologic origin of:

Bladder, urethra

Back 26

Endoderm

Front 27

What drives the cell cycle?

Back 27

Cyclins activate CDK forming Cyclin-CDK complexes

Complexes phosphorylate target proteins to drive the cycle

Front 28

What tumor suppressor blocks the G2 --> M phase?

Back 28

p53

Front 29

Which tumor suppressors inhibit G1-->S ?

Back 29

p53

Rb

Front 30

Cyclin

CDK

Tumor Suppressors

These regulate what?

Back 30

Cell Cycle progression

Front 31

When Rb is phosporylated, it is released from ____.

Back 31

EF-2

Whith EF-2 unbound, it carries out the synthesis needed to progress to the S-phase

Front 32

A mother gives birth to monozygotic twins.

The placenta is sent to the lab and shows that the twins were diaminonic and dichorionic.

When did cleavage take place?

Back 32

Before day 3

(@ Day 3 the chorion develops)

Front 33

A mother gives birth to monozygotic twins.

The placenta is sent to the lab and shows that the twins were monochorionic and diamniotic.

When did cleavage take place?

Back 33

After day 3, before day 8

(after day 3 means they have one placenta that they share, after day 8 means they both have their own amniotic sac)

Front 34

Failure of the decidua basalis to form can result in a placenta _____ where the placenta invades the myometrium

Back 34

placenta accreta

Front 35

A child presents with increased orotic acid in the urine, megaloblastic anemia and failure to thrive.

Vit. B12 and folate supplementation do not correct the anemia.

What is going on?

Back 35

Orotic aciduria

----------------------------------------------
↓Orotic Acid PRPP
or
↓ ortodine 5'-phosphate decarboxylase

Front 36

What drug blocks ribonucleotide reductase and inhibits pyrimidine/purine synthesis?

Back 36

Hydroxyurea

Front 37

What drug blocks thymidylate synthase (↓dTMP) which inhibits pyrimidine/purine synthesis?

Back 37

5-FU

Front 38

Orotic Acid is needed for ____ synthesis

Back 38

pyrimidine

Front 39

This disease is marked by adenosine deaminase deficiency which creates excess ATP and dATP.

Imbalances in ATP and dATP inhibit ribonucleotide reductase which PREVENTS DNA synthesis and ↓ lymphocyte count.

Back 39

SCID

Front 40

This syndrome is caused by defective purine salvage due to absence of HGPRT, which converts hypoxanthine to IMP and Gaunine into GMP.

Ultimately, the result is increased uric acid production and increased de-novo purine synthesis

Sx: mental retardation, self-mutilation, agression, hyperuricemia and gout

Back 40

Lesch-Nyhan Syndrome

Front 41

What form of DNA repair is mutates in xeroderma pigmentosum?

Mutation prevents repair of thymine-thymine dimers caused by UV-light exposure..

Back 41

Nucleotide Excision repair

Front 42

Which tpye of DNA repair is mutated in Hereditary Nonpolyposis Colon CA?

Back 42

mis-match repair

Front 43

What is the mRNA start codon?

Back 43

AUG

(codes for methionine in euks)

(codes for formyl-methionine in proks)

Front 44

What are the 3 mRNA stop codons?

Back 44

UGA (you go away)

UAG (you are gone

UAA (you are away)

Front 45

____ is a stretch of DNA that alters gene expression by binding to transcription factors

Back 45

Enhancer region

Front 46

_____ is the site on DNA where RNA polymerase and multiple other transcription factors bind to DNA upstream from gene loci (AT-rich, upstream sequence with TATA and CAAT boxes)

Back 46

Promoter

Front 47

Where do negative regulators (repressors) bind toon DNA?

Back 47

Silencer region

Front 48

rRNA synthesis occurs in the cell's ____

Back 48

nucleolus

Front 49

mRNA and tRNA synthesis occur in the cell's ______

Back 49

cytoplasm

Front 50

What 3 steps are required for RNA processing?

Back 50

1) 5' capping (7-methylgaunosine)

2) 3' Poly-A tail (about 200 adenines)

3) Splicing out of introns

------------------------------------------
Capped, spliced and tailed transcript is called mRNA!!!!

3)

Front 51

Patients with SLE make antibodies to what proteins needed for splicing of pre-RNA?

Back 51

anti-sNRPs antibodies

Front 52

Patients with SLE have anti-sNRP antibodies that ultimately inhibits _____ of pre-RNA...

Back 52

splicing of introns

Front 53

What enzyme matches AA's to tRNA?

What antibiotic blocks this enzyme on the 30s ribosome?

Back 53

Aminoacyl-tRNA synthetase

(-) by Tetracyclines

Front 54

Protein Synthesis inhibitors:

- bind to 30S and (-) formation of initiation complex and cause mis-reading of mRNA

Back 54

Aminoglycosides

Front 55

Protein Synthesis inhibitors:

-inhibits 50S peptidyltransferase

Back 55

Chloramphenicol

Front 56

Protein Synthesis inhibitors:

-block translocation (moving from A to P site)

Back 56

Macrolides (erythromycin)

Front 57

Protein Synthesis inhibitors:

-blocl peptide bond formation (2)

Back 57

Clindamycin and Chloramphenicol

Front 58

This cell organelle catabolizes very long-chain fatty acids and amino acids via beta-oxidation

Helps to generate PLASMALOGEN for neural tissue which aid in getting rid of reactive O2 species

Back 58

Peroxisome

Front 59

In this disease, ↓ mannose-6-phosphate means that lysosomal enzymes cannot be targeted to lysosomes for trafficking.

Enzymes leak outside of cell instead of sent to lysosomes.

Sx:
-coarse facial features
- ↓ joint movement
- ↑ levels of lysosomal enzymes in serum

Back 59

I-cell Disease

Front 60

Name 5 drugs that act on microtubules:

Back 60

1) Mebendazole (anti-helminthic)

2) Vincristine (anti-cancer

3) Paclitaxel (anti-breast cancer)

4) Griseofulvin (antifungal)

5) Colchicine (anti-gout)

Front 61

Which disease is characterized by a microtubule polymerization defect resulting in ↓ fusion of of phagosomes and phagolysosomes?

Sx:
recurrent pyogenic infections
partial albinism
peripheral neuropathy

Back 61

Chediak Higashi Syndrome

Front 62

What is the powerhouse behind cilia movement?

Back 62

Dynein ATPase

(absent in Kartagener's)

Front 63

What is alcohol's effect on a cell?

Back 63

degrades the plasma membrane

Front 64

What intermediate filament stain could you use for:

-osteosarcoma

Back 64

Vimentin

(Connective tissue)

Front 65

What intermediate filament stain could you use for:

-Squamous cell carcinoma

Back 65

Cytokeratin

(Epithelial cells)

Front 66

What intermediate filament stain could you use for:

-Astrocytoma, GBM, Schwannoma

Back 66

GFAP

Front 67

What intermediate filament stain could you use for:

-Leiomyoma (uterine fibroid)

Back 67

Desmin

(smooth m, skeletal m., cardiac m.)

Front 68

What intermediate filament stain could you use for:

-Neuroblastoma (Adrenal)

Back 68

Neurofilaments

(Axons within neurons)

Front 69

Na+/K+ ATPase

For every 3 Na+ that come into the cell, how many K+ molecules are pumped out?

Back 69

2

Front 70

Name the type of collagen that produces:

-Skin, Tendon, Bone

Back 70

Type I

Front 71

Name the type of collagen that produces:

-cartilage, vitreous body, nucleus pulposis

Back 71

Type II

Front 72

Name the type of collagen that produces:

-Cornea

Back 72

Type I

Front 73

Name the type of collagen that produces:

-skin, blood vessels, uterus, fetal tissue, granulation tissue

Back 73

Type III

Front 74

Name the type of collagen that produces:

-Basement membrane or basal lamina

Back 74

Type IV

Front 75

What type of collagen is missing/defective in:

-Osteogenesis imperfecta

Back 75

Type I

Front 76

What type of collagen is missing/defective in:

-Ehrler's Danlos

Back 76

Type III

Front 77

What type of collagen is missing/defective in:

-Alport Syndrome

Back 77

Type IV

Front 78

What's the best Tx for a keloid scar?

Back 78

glucocorticoids

Front 79

Collagen is made inside ____blasts

Back 79

fibroblasts

Front 80

During collagen synthesis, hydroxylation of proline and lysine residues in the RER of the fibroblasts requires ______

Back 80

Vit. C

Front 81

During collagen synthesis, tropocollagen molecules are reinforced by COVALENT lysine-hydroxylysine cross linkage to make collagen fibrils.


Does this take place inside or outside of the fibroblast?

Back 81

outside of fibroblast

Front 82

Type ___ osteogenesis imperfecta is fatal in the utero or neonatal perioid

Back 82

Type II osteogenesis imperfecta

Front 83

elastase is normally inhibited by _____

Back 83

alpha-1-antitrypsin

Front 84

What is the inheritance of Alport syndrome?

Back 84

XR

Front 85

This blotting test identifies DNA-binding proteins (transcription factors) using labeled oligonucleotide probes

Back 85

Southwestern Blot

(longest name, longest probe)

Front 86

What antibiotic can be used to treat SIADH?

Back 86

demeclocycline

Front 87

What is it causes when 1 gene has more than 1 effect on a person's phenotype?

Back 87

Pleiotrophy

Front 88

What is genetic imprinting? Give an example..

Back 88

At some loci, only one gene is active while the other is Inactive.

With 1 allele inactivated, deletion of the active allele results in disease.

In Prader Willi syndrome, the maternal allele is inactivated, while the PATERNAL allele is deleted.

(Chromosome 15)

Front 89

What heart-valve deformity is associated with ADPKD?

Back 89

mitral valve prolapse

Front 90

In patients with Familial adenomatous polyposis, the mutation of the APC gene occurs on chromosome ____

Back 90

chromosome 5

Front 91

This autosomal dominant disease affects the blood vessels and features:

-telangiectasia
-recurrent epistaxis
-skin discoloration
-arteriorvenous malformations (AVM)

Back 91

Hereditary hemorrhagic telangiectasia

(Osler-Weber-Rendu Syndrome)

Front 92

What type of aortic necrosis occurs in patients with Marfan Syndrome?

Back 92

cystic medial necrosis of the aorta

Front 93

This AD disease features:

-cafe-au-lait spots

-neuronal tumors

-Lisch nodules (pigmented iris hamartomas)

-skeletal deformities

-optic gliomas

-mutation on chromosome 17

Back 93

Neurofibromatosis type I

(von Recklinghausen)

Front 94

This AD disease features:

-Bilateral acoustic schwannomas

-juvenile cataracts

-mutation on chromosome 22

Back 94

Neurofibromatosis type II

Front 95

A sweat chloride test greater than 60 mg/L is diagnostic of ____

Back 95

cystic fibrosis

(CTFR gene chromosome 7)

Front 96

In this autosomal recessive disease, a mutation causes ABNORMAL PROTEIN FOLDING resulting in the degredation of the Cl- channel

Back 96

Cystic fibrosis

Front 97

patients with cystic fibrosis can have deficiencies in what vitamins?

Back 97

Fat Soluble
(ADEK)

Front 98

What drug can you give to loosen mucus plugs in patients with CF?

Back 98

N-acetylcisteine

Front 99

What is the inheritance pattern for:

-Wiskott-Aldrich
-Fabry Disease
-Hunter Disease
-G6PD deficiency
-Ocular albinsim
-Lesch-Nyhan Syndrome
-Duchenne + Becker MD
-Hemophilia A + B

Back 99

x-linked recessive

Front 100

What is the inheritance pattern for:

-Albinism
-Infant Polycystic Kidney Dz
-cystic fibrosis
-glycogen storage diseases
-mucoploysaccharidoses
-PKU
-Sickle Cell Anemia
-Sphingolipidoses
-Thalassemias

Back 100

Autosomal recessive

Front 101

-CGG repeat

-macro-orchidism

-long face w/ large jaw

- large everted ears

-autism

-Mitral valve prolapse

Back 101

Fragile X

(X-linked)

Front 102

What is the trinucleotide repeat for:

-Fragile X Syndrome:

-Friedrich's Ataxia:

-Huntington's:

-Myotonic dystrophy:

Back 102

-Fragile X Syndrome: CGC

-Friedrich's Ataxia: GAA

-Huntington's: CAG

-Myotonic dystrophy: CTG

Front 103

Fetal Quad Screen Shows:

↓ α-fetoprotein

↑ β-hCG

↓ estriol

↑ inhibin A

Back 103

Downs Syndrome

Front 104

Fetal Quad Screen Shows:

↓ α-fetoprotein

↓ β-hCG

↓ estriol

normal inhibin A

Back 104

Trisomy 18 (Edwards)

Front 105

Quad Screen Shows:

normal α-fetoprotein

normal β-hCG

normal estriol

normal inhibin A

*Baby is born with severe MR, cleft palate/lip holoproscenephaly, polydactyly

Back 105

Trimsomy 13 (Patau)

Front 106

95% of cases of Down Syndrome are associated with _____ in women over the age of 35

Back 106

↑ meiotic non-dishunction

Front 107

-Child is born with:

rocker bottom feet

severe MR

micrognathia

low-set ears

clenched hands**

Back 107

Trisomy 18 (Edwards)

Front 108

Robertsonian translocation commonly occurs on which (5) chromosomes?

Back 108

13, 14, 15

21, 22

------------------------------------------

Long arms of two chromosomes fuse and the short arms are lost

Front 109

This vitamin is essential for normal differentiation of epithelial cells into specialized tissue

Back 109

Vit. A

Front 110

This vitamin is used to treat measles and AML type M3

Back 110

Vit A

Front 111

Deficiency of this vitamin causes night-blindness and dry skin

Back 111

Vit. A

Front 112

Defieciencies of this vitamin can cause beriberi

Back 112

Vit. B1 (thiamine)

----------------------------------------------

**Dry Beriberi**
-polyneuritis, symetrical muscle wasting

**Wet Beriberi**
-high-output cardio failure (dilated cardiomyopathy), edema

Front 113

This vitamin is derived from tryptophan and requires B6

Back 113

B3 (niacin)

Front 114

This vitamin is a cofactor in oxidation and reduction (FADH2)

-Deficiency causes Cheilosis and Corneal vascularization

Back 114

Vitamin B2 (riboflavin)

Front 115

This Vitamin is used as a constituent of NAD+, NADP+ (used in redox rxns)

Deficiency may result in Pellagra.

Back 115

Vitamin B3 (niacin)

(excess=flushing)

Front 116

This B vitamin is an essential component of CoA and fatty acid synthesis

Deficiencies result in Dermatitis, enteritis, alopecia and adrenal insufficiency

Back 116

B5 (pantothenate)

Front 117

This vitamin is needed for synthesis of cystathionine, heme, niacin and GABA

Back 117

Vit. B6

Front 118

Deficiency of this vitamin is inducible from drugs such as INH and OCPs

Back 118

Vit. B6

Front 119

This vitamin is an antioxidant for erythrocytes.

Deficiency of this vitamin leads to ↑ RBC fragility (hemolytic anemia)

Back 119

Vit. E

Front 120

This Vitamin is an antioxidant that also:

1) Facilitates iron absorption by keeping iron in reduced Fe++ state

2) Necessary for hydroxylation of proline and lysine in collagen synthesis

3) necessary for dopamine β-hydroxylase which converts dopamine to NE

Back 120

Vit. C

Front 121

This product in raw egg whites binds up biotin and can cause a biotin deficiency

Back 121

Avidin

Front 122

Vit. K catalyzes the ___-carboxylation of glutamic acid residues on various proteins concerned with blood clotting

Back 122

γ-carboxylation of glutamic acid

Front 123

Aerobic Metabolsim produces ___ ATP via the malate-aspartate shuttle (Heart and Liver)

___ ATP are produced via the glycerol-3-phosphate shuttle (muscle)

Back 123

32

30

Front 124

What AA is the precursor to:

-Dopamine, NE, Epi

Back 124

Phenylalanine

Front 125

What AA is the precursor to:

-GABA, Glutathione

Back 125

Glutamate

Front 126

What AA is the precursor to:

-Heme

Back 126

Glycine

Front 127

What AA is the precursor to:

Serotonin, melatonin, Vit. B3 (niacin)

Back 127

Tryptophan

Front 128

What metabolic scenario favors Ketone production?

Back 128

When Acetyl CoA exceeds oxidative capacity of TCA cycle

Front 129

What controls our blood glucose during times of fasting between meals?

Back 129

Hepatic Glycogenolysis is major contributor

Gluconeogenisis and FFA are minor contributors

Front 130

This vitamin is also called α-tocopherol

Back 130

Vit. E

Front 131

What amniotic fluid abnormality might you find in a fetus with anencephaly?

Back 131

↑ α-fetoprotein

↑ AChE

Front 132

Which amino acids are modified in the golgi apparatus?

Back 132

Serine
Asparagine
Threonine

"SAT"

Front 133

What sense is preserved in the upper extremities in a patient with syringomyelia?

Back 133

sense of touch is preserved

**Bilateral loss of pain and temperature**

Front 134

What are the phagocytes of the CNS?

What is their embryonic origin?

Back 134

Microglia

**Derived from MESODERM**

Front 135

What are Lewy Bodies found in Parkinson's composed of?

Back 135

α-synnuclein

Front 136

A patient sustains a lesion to the right cortical motor face region..

What will the face look like?

Back 136

Left Lower Face will Droop

-----------------------------------------------
NOTES:

The facial motor nucleus receives motor fibers for the lower face from the opposite motor cortex.

Motor fibers for the upper face are sent by both the left and right motor cortex

Front 137

A patient receives a lesion to the right facial nerve (CN VII).

What will the face look like?

Back 137

Both Upper + Lower Face will droop

Front 138

A CN XII lesion will cause the tongue to deviated to the ____ of the lesion

Back 138

same side

Front 139

In a patient with a CN X lesion, the uvula deviates ___ the side of the lesion

Back 139

away

(Weak palate collapses and uvula moves away)

Front 140

A patient with a CN XI lesion will have weakness turning the head to the ___ side and ____ side shoulder droop.

Back 140

turning head to contralateral side

same side should droop

Front 141

What structures travel through the cavernous sinus?

Back 141

Internal carotid a.

CN III

CN IV

CN V1

CN V2

CN VI (6)

Front 142

What should you immediately think of if a patient presents with Bilateral Bell's Palsy?

Back 142

Guillan Barre

Front 143

This disease is associated with both LMN + UMN signs. It can be caused to a defect in superoxide dismutase 1

There are NO sensory, occulomotor or cognitive defects

Back 143

ALS

Front 144

Tabes dorsalis is caused by tertiary syphillis and causes degeneration of the ____ columns and roots

Back 144

dorsal columns + dorsal roots

Front 145

What CNs exit the internal auditory meatus?

Back 145

CN VII

CN VIII

Front 146

What artery supplies the retinal artery?

Back 146

choroid artery

Front 147

Which nerve carries the post-ganglionic sympathetic signal to dilate the eye?

Back 147

long ciliary n.

Front 148

β-amyloid plaques

Neurofibrillary tangles

Back 148

Alzheimers

Front 149

APOE4 = late onset of disease

APOE2= protective

Back 149

Alzheimers

Front 150

See intracellular inclusions of tau protein in frontal lobe

Back 150

Pick's Dz
(frontotemporal dementia)

**Pick bodies**

Front 151

Dementia + hallucinations + α-synuclein defect

Back 151

Lewy Body Dementia

Front 152

APP gene in chromosome 21 makes patients with Down Syndrome more susceptible to what?

Back 152

Alzheimer's

Front 153

Rapid onset dementia

Spongiform cortex

Back 153

Creutzfield-Jacob

(prion disease)

Front 154

Dementia and ↓ACh

Back 154

Alzheimers

Front 155

Ascending muscle weakness following a Campylobacter jejuni or Herpes Virus infection

↑ CSF protein with a normal cell count (no increase in WBCs)

Back 155

Guillan Barre


"Albuminocytologic Dissociation"

Front 156

What anti-seizure drug can be used to increase liver enzyme synthesis in a patient with Crigger Najar?

Back 156

phenobarbitol

Front 157

skip lesions + transmural inflammation

Back 157

crohn's dz

Front 158

skip lesions

granulomas

spares rectum

Back 158

crohn's dz

Front 159

G+ vs. G-

-Peptidoglycan for support.

-Lipoteichoic Acid induces TNF, IL-1, IL-6

Back 159

G+ cell wall/cell membrane

Front 160

G+ vs. G-

-Site of major endotoxin (lipopolysaccharide)

-Lipid A induces TNF and IL-1, polysaccharide is the antigen

Back 160

G- outer membrane

Front 161

Mediates adherence of bacteria to foreign surfaces such as catheters or tubes

Back 161

glycocalyx

Front 162

Protects bacteria against phagocytosis

Back 162

capsule

Front 163

Bacterial capsules are made of polysaccharide

Except for Bacillus anthracis which has a capsule made of ____

Back 163

D-glutamate

Front 164

This provides rigid support for the bacterial cell and proctects against osmotic pressure differences

Back 164

peptidoglycan

(sugar backbone w/ crosslinked side chains)

Front 165

What is the space between the inner and outer cell membranes in G (-) bacteria?

Back 165

periplasm

Front 166

This bacterial structure mediates adherence of bacteria to cells

Back 166

fimbrea/pilus

Front 167

This is a keratin-like coat made of dipicolinic acid and is produced by bacteria in the end of the stationary phase of their life cycle

Back 167

spore

Front 168

What is a bacterial spore made of?

Back 168

dipicolinic acid

Front 169

What type of stain would you use to visualize Cryptococcus neoformans?

Back 169

india ink

Front 170

What stain would you use for Pneumocystis jirovecii?

Back 170

silver stain

Front 171

What type of stain would you use for amyloid?

Back 171

congo red

Front 172

what type of stain would you use for Chlamydia?

Back 172

Giemsa

Front 173

Lipoteichoic acid is unique to Gram ___ bacteria

Back 173

Gram +

(induces TNF, IL-1, IL-6)

Front 174

Which has a bigger peptidoglycan membrane? G(+) or G(-) organisms?

Back 174

G +

Front 175

Which has a endotoxin/LPS outer membrane? G(+) or G(-) organisms?

Back 175

G(-)

Front 176

What 2 bugs are "branching filamentous"?

Back 176

Actinomyces

Nocardia

Front 177

Use a ____ stain for Legionella

What type of agar?

Back 177

silver stain

charcoal auger

Front 178

These bacteria have no cell wall, only cell membranes containing sterols

Back 178

Mycoplasma

Front 179

These bugs have cell walls that contain mycolic acid and a high lipid content

Back 179

Mycobacterium (TB, leprae)

Front 180

What bugs do not gram stain well? (6)

"These Bugs May Microscopically Lack Color"

Back 180

Treponema

Boriella

Mycobacterium

Mycoplasma

Legionella

Chlamydia

Front 181

What type of stain is used to diagnose Tropheryma whippelii infection in the distal small intestine?

Back 181

PAS stain

(Periodic acid-Schiff)

Front 182

One bug and one fungus that are stained with silver stain

Back 182

Pneumocystis jirovecii

Legionella pneumophilia

Front 183

What type of stain do you use for:

Borrelia, Plasmodium, trypanosomes, Chlamydia

Back 183

Giemsa

Front 184

What type of stain do you use for Mycoplasma?

Back 184

Ziehl-Neelson

(Acid Fast Stain)

Front 185

This bug is grown on a Chocolate Agar with factors V (NAD+) and X (hematin)

Back 185

Haemophilus influenzae

Front 186

This bug is grown on a Lowenstein-Jensen agar

Back 186

Mycobacterium tuberculosis

Front 187

This bug is grown on Eaton's agar

Back 187

Mycoplasma pneumoniae

Front 188

This bug is grown on a charcoal yest extract agar

(buffered with cysteine and iron)

Back 188

Legionella pneumophilia

Front 189

An infection with this bug may reactivate after using TNF-α inhibitors (Inflixumab, Etanercept)

It has a predilection for the apices of the lung where the O2 content is high

Back 189

Mycobacterium tuberculosis

Front 190

What are the obligate aerobe bacteria? (4)

"Nagging Pests Must Breathe"

Back 190

Nocardia

Pseudomonas

Mycobacterium tuberculosis

Bacillus

Front 191

What are the obligate anaerobic bacteria? (3)

"Can't Breathe Air"

Back 191

**All lack catalase/Super oxide dismutase**

Clostridium

Bacteroides

Actinomyces

Front 192

What are the two obligate intracellular bacteria?

Back 192

Chlamydia

Rickettsia

Front 193

Which bugs are encapsulated? (6)

"Some Killers Have Nice Shiny Bodies"

Back 193

Strep pneumo

Klebsiella

Haemophilus

Neisseria

Salmonella

group B Strep (agalactiae)

Front 194

What test is (+) for encapsulated bacteria?

Back 194

Quellung

Front 195

People with Chronic Granulomatous disease have recurrent infections with ____ (+) bacteria

Back 195

catalase (+)

Front 196

What are the catalase (+) bacteria? (6)

"SSPACE"

Back 196

Staph aureus

Serriata

Pseudomonas

Actinomyces

Candida

E. coli

Front 197

If a vaccine containing polysaccharide capsule chains was NOT conjugated protein, what type of immune response would occur?

Back 197

No T-cell response because a polysaccharide capsule alone would not be presented to T-cells

***Only IgM antibodies would be produced***

Front 198

____ is a polysaccharide vaccine with no conjugated protein

Back 198

Pneumovax

(Strep pneumo)

Front 199

_____ is a conjugated capsular polysacharride vaccine

Back 199

HiB (H. influenzae type B)

Front 200

A positive Urea breath test indicates ____ colonization

Back 200

H. pylori

Front 201

this bug produces yellow "sulfur granules"

Back 201

Actinomyces israelii

Front 202

This bug produces a blue-green pigment that smells fruity (grapes)

Back 202

Pseudomonas

Front 203

***HY***

What is the virulence factor for Staph. aureus that binds Fc region of Ig and prevents opsonization and phagocytosis?

Back 203

Protein A

Front 204

**HY***

What bugs produce IgA protease?

Enzyme that cleaves IgA in order to colonize the respiratory mucosa?

(3) "SHiN"

Back 204

Strep pneumo

Haemophilus influenza

Neisseria

Front 205

**HY**

What is Strep pyogenes' (Group A) virulence factor?

Helps it to evade phagocytosis

Back 205

M protein

Front 206

Exotoxins are _______

Endotoxins are _______


A) Lipopolysaccharides

B) Polypeptides

Back 206

Exotoxins are Polypeptides

Endotoxins are Lipopolysaccharides


(Endotoxins are mostly found in G (-) )

Front 207

This bacteria has Endotoxin A which inactivates EF-2 and causes host cell death

Back 207

Pseudomonas

Front 208

This toxin inactivates EF-2 and causes Pharyngitis and Pseudomembranes in the throat

Back 208

diptheria toxin

(Cornybacterium diptheriae)

Front 209

This toxin inactivates the 60s ribosome by cleaving rRNA.

Leads to GI mucosal damage, bloody diarrhea and release of cytokines causing HUS

Back 209

Shiga toxin

(Shigella)

Front 210

This toxin inactivates the 60s ribosome by cleaving rRNA.

DOES NOT INVADE HOST

Causes cytokine release leading to HUS

Back 210

Shiga-Like Toxin

(E. coli 0157:H7)

Front 211

Enterotoxigenic E. coli (ETEC) has **heat labile toxin** which over-activates ______ leading to watery diarrhea.

It also has a **heat-stabile** toxin that causes watery diarrhea by over-activating ______

Back 211

Heat-Labile: adenylate cyclase, ↑ cAMP

Heat-Stabile: gaunylate cyclase, ↑cGMP

Front 212

Y. enterolitica has ___ toxin which activates adenylate cyclase (↑ cAMP) and and causes BLOODY diarrhea by invading and destroying cells

Back 212

Heat-Stabile toxin

Front 213

What is the name of the exotoxin of Bacillus anthracis that **mimics adenylate cyclase enzyme** ( ↑ cAMP)

Causes erythematous borders around black eschar

Back 213

Edema Factor

Front 214

What is the mechanism of Edema Factor released by B. anthracis?

Back 214

**mimics adenylate cyclase enzyme**

(↑ cAMP)

Front 215

What is the mechanism of Cholera toxin?

Back 215

Over-activates adenylate cyclase (↑ cAMP) by PERMANENTLY ACTIVATING Gs --> "rice water" diarhhea

(Vibrio cholerae)

Front 216

This toxin Over-activates adenylate cyclase by (↑ cAMP) by PERMANENTLY INHIBITING Gi

-Impairs phagocytosis to permit survival of microbe

Back 216

Pertussis toxin

**WHOOPING COUGH**
(Bordatellu pertussis)

Front 217

Which bug releases a toxin that prevents the release of inhibitory GABA and glycine neurotransmitters in the spinal cord?

Leads to muscle rigidity

Back 217

C. tetani

tetanospasmin

Front 218

What is the mechanism by which Botulism toxin and Tetanospasmin prevent neurotransmitter release?

Back 218

cleave SNARE protein

Front 219

This bug produces a toxin that inhibits the RELEASE of ACh into the neuromuscular junction.

Leads to flaccid paralysis

Back 219

C. botulinum

Botulism toxin

Front 220

What is the exotoxin of Clostridium perfringes responsible for degrading phospholipids and causing **Gas Gangrene**?

Back 220

Alpha toxin

(see **double zone** of hemolysis on blood agar)

Front 221

What is the exotoxin produced by Strep pyogenes (GBHS) that lyses RBCs and contributes to β-hemolysis?

Back 221

Streptolysin O

(body makes ASO ab)

Front 222

Bacteria release exotoxins that bring MHC II and T-cell receptors into close proximity to each other to cause an overwhelming release of IFN-γ and IL-2 -->SHOCK

Back 222

Superantigens

-Strep pyogenes --> Exotoxin A

-Staph aureus --> TSST-1

Front 223

Are ENDOtoxins (G-) heat stabile?

Back 223

Yes

Front 224

Which Staph. aureus toxin causes scalded-skin syndrome?

Back 224

efoliative toxin

Front 225

Which toxin secreted by Strep. pyogenes causes Scarlet Fever?

Back 225

erythrotoxin/pyrotoxin

Front 226

Toxin released by Staph aureus that causes Leukocytosis

Back 226

Leukocidin

Front 227

By what method are plasmids exchanged by bacteria?

Back 227

Sex pilus --> conjugation

Front 228

Which ENDOtoxin (G-) activates Hageman factor?

Back 228

Lipid A

Front 229

These bacteria (4) produce toxins that are ADP-ribosylating A +B toxins.

B component binds to host cell, while the A component attaches ADP-ribosyl to disrupt cell proteins

Back 229

Pseudomonas --> Exotoxin A

EHEC --> Heat Labile toxin

V. cholerae --> cholera toxin

B. pertussis --> pertussis toxin

Front 230

Penicillins and Cepahlosporins act on bacteria in the ______ phase as peptidoglycan is being made

Back 230

Exponential Growth Phase

Front 231

What is it called when a bacterium takes up DNA from the environment?

Back 231

**Transformation**

(SHiN bacteria with IgA protease are really good at this)

Front 232

What is it called when a bacterium is infected by a viral phage and parts of the bacterial DNA are packed into the virus when it goes off to infect another bacterial cell?

Back 232

**Tranduction**

Front 233

What is it called when a bacterial segment of DNA "jumps" (excision and reincorporation) from one location to the other?

Back 233

**Transposition**

Front 234

Causes dental carries

Back 234

Strep mutans

(Strep viridans group- alpha hemolytic)

Front 235

Strep viridans is ____ to optichinin

Back 235

Resistant

Front 236

Strep pyogenes is ___ to optichinin

Back 236

Susceptible

Front 237

This bug is the most common cause of:

Meningitis
Otitis Media
Pneumonia
Sinusitus

Back 237

Strep pneumoniae

Front 238

Which type of streptococcus coloonizes the vagina, causes pneumonia, meningitis and sepsis in neonates?

Back 238

Group B Beta-Hemolytic Strep

-Strep agalactiae

Front 239

Lancefield group D Steptococci =?

Back 239

Enterococci spp.

Front 240

This bug can cause sub-acute endocarditis in colon cancer patients

Back 240

Strep. bovis

Front 241

Club-shaped gram (+) rods with metachromic (blue+red) granules.

-Use Elek test for toxin

Back 241

Cornybacterium diptheriae

(remember, ADP-ribosylation, and a Beta-prophage codes for the exotoxin)

Front 242

Where do the GABA and Glycine inhibitory neurotransmiters blocked by tetanus in the spinal cord come from?

Back 242

Renshaw cells

Front 243

Describe the 2 toxins of C. diffiile

Back 243

Toxin A:
binds to brush border

Toxin B:
destroys cytoskeletal structure of enterocytes

Front 244

Faculative intracellular anaerobe acquired by eating unpasteurized milk/cheese and deli meats.

Back 244

Listeria monocytogenes

Front 245

Caseous cavitary lesion in the lung

Back 245

Tuberculosis

**CASEATING GRANULOMA**

Front 246

Perihilar lymphadenopathy + caseating granuloma in lung

Back 246

Gohn Complex

**PRIMARY TB INFECTION**

Front 247

Prophylactic treatment for Mycobacterium avian-intracellulare (MAC) in an AIDS patient?

Back 247

Azithromycin

Front 248

resevoir in the U.S. is an armidillo

Back 248

Mycobacterium leprae

Front 249

Treatment for M. leprae?

Back 249

Dapsone

Front 250

T cell response Lepromatous M. leprae infection?

Back 250

Th1

Front 251

T cell response for Tuberculoid M. lepreae infection (hypoesthetic skin plaques)

Back 251

Th2

Front 252

Do Neisseria ferment glucose?

Back 252

yes

Front 253

Which Neisseria ferments Maltose

Back 253

N. meningitidis

Front 254

Does N. gonorrhea have a capsule?

How about N. meningitidis?

Back 254

N. gonorrhea = no

N. meningitidis = yes

Front 255

Superior colliculi lesion

Back 255

paralysis of upward gaze

Front 256

Inferior colliculi lesion

Back 256

hearing issues

Front 257

What causes Epiglottitis

(+) thumb sign

Back 257

Haemophilus Influenzae type B

Front 258

Tx. for Legionella pneumophilia?

Back 258

erythromycin

Front 259

DOC for Haemophilus influenzae

Back 259

ceftriaxone

Front 260

Aerobic, G (-) rod, non-lactose fermenter, oxidase positive

Back 260

Pseudomonas

Front 261

E. coli virulence factor for cystitis and pyelonephritis

Back 261

fimbriae

Front 262

E.coli virulence factor for pneumonia and meningitis

Back 262

k capsule

Front 263

Salmonella Vs. Shigella

-Produces H2S4

Back 263

Salmonella

Front 264

Bloody Diarrhea

-poultry, meat, unpasteurized milk

-Comma or S-shaped, grows at 42*C

Back 264

Campylobacter jejuni

Front 265

-Pet feces, contaminated milk, pork

-G (-)

-outbreaks of diarrhea common at day-care centers

Back 265

Yersinia enteroliticus

Front 266

-Question mark shaped G (-)

-found in water contaminated with animal urine

Flulike symptoms, jaundice, photophobia with conjunctivitis.

-Surfers in the Tropics

Back 266

Leptospira interrogans

Front 267

"bullseye" rash with central clearing (erythema chronicum migrans)

Joint pain, headache

Back 267

-Lyme Dz

Borrelloa burgdorferi

Front 268

DOC for Lyme Dz

Back 268

doxycycline or ceftriaxone

Front 269

Darkfield microscopy

Back 269

Treponema pallidum

Front 270

DOC for Treponema pallidum

Back 270

Penicillin G

Front 271

Rash on the palm and soles is seen with what? (3)

Back 271

Coxsackie A

Rickettsia rickettsi

Syphillis (Treponema)

Front 272

Oncogenes:

abl

Back 272

CML

------------------------------------
Gene product?

Hint 272

tyrosine kinase

Front 273

Oncogenes:

c-myc

Back 273

Burkitt Lymphoma

---------------------------------

Gene product?

Hint 273

transcription factor

Front 274

Oncogenes:

bcl2

Back 274

Follicular and undifferentiated lymphomas

(inhibits apoptosis)

---------------------------
Gene product?

Hint 274

Anti-apoptotic molecule

Front 275

Oncogenes:

-erb-B2

Back 275

Breast, ovarian, gastric carcinoma


--------------------------------

Gene product?

Hint 275

tyrosine kinase

Front 276

Oncogenes:

ras

Back 276

Colon cancer

-----------------------------

Gene product?

Hint 276

GTPase

Front 277

Oncogenes:

L-myc

Back 277

Lung tumor


-------------------------------

Gene product?

Hint 277

Transcription factor

Front 278

Oncogenes:

ret

Back 278

MEN types 2A, 2B, Medullary Thyroid CA

-------------------------
Gene Product?

Hint 278

tyrosine kinase

Front 279

Oncogenes:

c-kit

Back 279

Gastrointestinal stromal tumor

-----------------------------------
Gene product?

Hint 279

cytokine receptor

Front 280

Oncogenes:

N-myc

Back 280

Neuroblastoma (Adrenal)


-----------------------------

Gene product?

Hint 280

transcription factor

Front 281

Which tumor marker would you use to follow the progression of Colon Cancer?

Back 281

CEA

Front 282

What tumor marker would you use to monitor treatment of a Neuroblastoma (Adrenal) ?

Back 282

Bombesin

Front 283

Anti-presynaptic Ca++ antibodies

Back 283

Lambert Eaton Syndrome

-Small cell lung CA
-Also thymomas

Front 284

How can tumor cells induce apoptosis of T-cells?

Back 284

FasL

Front 285

What types of receptors relax renal vascular smooth m.?

Back 285

D1--->Gs--> ↑cAMP --> ↑ protein kinase A --> (-) myosin light chain kinase

Front 286

What receptors are found in the neuromuscular junction and autonomic ganglia?

Back 286

Nicotonic receptors

ACh binds---> (+) Na+/K+ ligand gated channel

Front 287

Are nicotinic receptors G-coupled receptors?

Back 287

No

The (+) Na+/K+ ligand gated channel

Front 288

How do H2 receptors increase gastric acid secretion?

Back 288

Facilitate K+ resorption, which means for every K+ absorbed, a H+ is released into the lumen


Bind to Gs --> (+) adenylate cyclase --> ↑cAMP --> ↑ protein kinase A

Front 289

What are the Gq coupled receptors?

Back 289

H1
α1
V1
M1
M3

"HAVe 1 M&M"

Front 290

What are the Gi coupled receptors?

Back 290

M2
α2
D2

"MAD 2's"

Front 291

What are the Gs coupled receptors?

Back 291

β1
β2
H2
V2
D1

Front 292

What type of drugs are these?

-Bethanechol
-Carbachol
-Pilocarpine
-Methacholine

Back 292

Direct Muscarinic Agonists

(↑ PNS activity)

Front 293

What types of drugs are these?

-Neostigmine
-Pyridostigmine
-Edrophonium
-Physostigmine
-Echothiphate
-Donepezil

Back 293

AChE inhibitors

(↑ PNS activity)

Front 294

Antidote for organophosphate poisoning?

Back 294

Atropine + Pralidoxime

Front 295

What are the side effects of Atropine overdose?

Back 295

Hot as a hare (↓ sweat)
Dry as a bone (dry mouth, urine retention)
Blind as a bat (mydriasis)
Red as a beet (flushing)
Mad as a hatter (delirium)

Front 296

What types of drugs are clonidine and α-methyldopa?

Back 296

α2 central agonists

(decrease central SNS flow)

Front 297

What drug would you give to someone who is depressed and refuses to eat?

Back 297

Mirtazapine

α2-blocker that increases appetite

Front 298

How do Beta-blockers affect renin release from JG cells?

Back 298

↓ renin release

Front 299

If you were to increase the radius of a blood vessel 2x, how would that effect resistance of flow?

Back 299

↓ resistance 16x

Front 300

If you were to decrease the size of a blood vessel to 1/2 it's radius, how would that effect resistance of flow?

Back 300

↑ resistance 16x

Front 301

What are the waveforms of the Jugular venous pulse?

Back 301

a = RA contracts

c = RV contracts

x = RA relaxes (during RV contraction)

v = RA fills

y = RA empties to RV

"At Carter's X (crossing), Vehicles Yield"

Front 302

When does Isovolumetric Contraction occur in the cardiac cycle?

Back 302

After mitral valve closes and before aortic valve opens...

So, LV is contracting, but the aortic valve is closed so you're not affecting the volume in the LV

Front 303

When does isovolumetric relaxation occur in the cardiac cycle?

Back 303

After aortic valve closes, before mitral valve opens...

You've pushed everything out, there's nothing left in the LV

After the Mitral valve opens back up, rapid ventricular filling can occur

Front 304

Why does normal S2 splitting occur during inspiration?

Back 304

When you inhale, you ↓ intrathoracic pressure.

This drop in pressure causes an ↑ in preload, and in ↑ in the amount of blood in the RV.

As a result, the RV takes longer to push out all the blood and the PULMONIC VALVE CLOSES LATER THAN THE AORTIC VALVE

Front 305

Crescendo-decrescendo systolic murmur heard in the 2nd-3rd right IC space, close to sternum

Back 305

Aortic Stenosis

Front 306

Early diastolic decrescendo murmur best heard along the left side of the apex.

Back 306

Pulmonic Regurge

Front 307

Late diastolic decrescendo murmur best heard along the left side of the apex.

Back 307

Tricuspid Stenosis

Front 308

Pancystolic (Holosystolic) murmur best heard at the apex and radiates to the axilla

Back 308

Mitral Regurge

Front 309

Late systolic murmur preceded by a mid-systolic click

Back 309

MVP

Front 310

Crescendo-decrescendo systolic murmur heard in the 2nd-3rd left IC spaces close to the sternum

Back 310

Pulmonic Stenosis

Front 311

Pansystolic (holosystolic) murmur heard best along the left lower sternal border and radiates to right sternal border

Back 311

Tricuspid Regurge or VSD

Front 312

Pansystolic (holosystolic) murmur heard best along the left 4th-6th intercostal spaces

Back 312

Tricuspid Regurge or VSD

Front 313

Rumbling late diastolic murmur with an opening "snap"

Back 313

Mitral Stenosis

Front 314

High-pitched diastolic murmur associated with widened pulse pressure and "head bobbing"

Back 314

Aortic Regurge

(Syphilis, Marfans)

Front 315

Ventricular tachycardia with *sinusoidal waveforms** =

Back 315

Torsades de Pointes

d/t prolonged QT
(Na+ & K+ channel conductance)

Front 316

Why would you give a pt. in A-fib warfarin?

Back 316

Prophylaxis against thromboembolism

Front 317

What is Atrial natriuetic peptide's action on the efferent and afferent renal arterioles?

Back 317

Afferent: DILATES

Efferent: CONSTRICTS

Diuresis occurs as a result.

Helps to curb effects of ↑↑ aldosterone in Conn Syndrome

Front 318

A pulmonary capillary wedge pressure (PCWP) > than LV diastolic pressure indicates what valve problem?

Back 318

Mitral Stenosis

Front 319

In the lungs, hypoxia causes ____ so only the will ventilated areas are prefused

Back 319

vasoconstriction

Front 320

If there are ↓ plasma proteins, that means there is ↓ ____ pressure pulling fluid into the vascular system..

The result is edema in the form of nephrotic syndrome or renal failure

Back 320

↓ plasma oncotic pressure (↓πc)

Front 321

What change in pressure causes edema in CHF?

Back 321

↑ capillary pressure

↑ pressure causes fluid to leak from the capillaries into the interstitium

Front 322

Edema caused by toxins or burns is due to ↑ ______

Back 322

↑ capillary permeability (↑Kf)

Front 323

Lymphatic blockage causes a ↑ in _____ pressure causing fluid to be pulled from systemic circulation and into the interstitium

Back 323

↑ interstitial osmotic pressure


↑ interstitial osmotic pressure (more proteins) draws fluid from vasculature into the interstitium

Front 324

What are the 5 T's that cause early cyanosis in newborns?

Back 324

Truncus arteriosus

Tetralogy of Fallot

Transposition of great vessels

Tricuspid Atresia

Total Anomalous Pulmonary Venous return (TAPVR)

Front 325

Kid comes in with late cyanosis.

You hear a loud S1 and a fixed, split S2

Back 325

ASD

Front 326

What heart anomaly can occur to babies born to diabetic mothers?

Back 326

Transposition of the great vessels

Front 327

This heart anomaly is due to failure of the aorticopulmonary septum to spiral (Neural crest)

Back 327

Transposition of the great vessels

Front 328

This heart anomaly is connected with Turner's Syndrome?

Back 328

Coarctation of the Aorta

Front 329

Infantile Coarctation of the Aorta occurs PROXIMAL (before) the _________

Back 329

ligamentum arteriosum

Front 330

Coarctation of the Aorta is most commonly associated with what valve problem?

Back 330

Bicuspid aortic valve

Front 331

Which congenital cardiac anomaly is related to:

-22q1 deletions

Back 331

Truncus arteriosus

Tetralogy of fallot

Front 332

Which congenital cardiac anomaly is related to:

-Down Syndrome

Back 332

endocardial cushion defects

(VSD, ASD, AV septal defect)

Front 333

Which congenital cardiac anomaly is related to:

-Congenital Rubella

Back 333

PDA
Pulmonary a. stenosis

Front 334

Which congenital cardiac anomaly is related to:

Marafan's

Back 334

Aortic Insufficiency

(dilation of aortic root)

Front 335

Why are Turner Syndrome patients at an increased risk for subacute bacterial endocarditis?

Back 335

bicuspid aortic valve

Front 336

Foam cells are macrophages seen in ____

Back 336

atherosclerosis

Front 337

Hyaline arteriolosclerosis is seen in patients with long-standing ____ or ____ and causes hyaline thickening of small arteries and hyperplastic "onion skinning" in episodes of malignant hypertension

Back 337

longstanding HTN

diabetes

Front 338

Longstanding hypertension may result in hyaline arteriosclerosis of the ________ and weaken the media of the aorta.

This can lead to an aortic aneurysm..

Back 338

vasa vasorum

(supply the media of the aorta with blood)

Front 339

_____ angina shows ST depression on EKG

Back 339

Stable angina

(secondary to atherosclerosis)

Front 340

_____ angina shows ST elevation on EKG

Back 340

Prinzmetal's Angina

(secondary to CORONARY VASOSPASM)

Front 341

What is the most common cause of death one hour after an MI?

Back 341

Lethal arrythmia

Front 342

The heart undergoes _____ necrosis if damaged

Back 342

coagulative necrosis

Front 343

What presents as chest pain with a friction rub following an MI?

Back 343

Fibrinous pericarditis

Front 344

If an MI causes subendocardial necrosis in less than 50% of the myocardial wall, what will be seen on EKG?

Back 344

ST-depression

Front 345

If an MI causes transmural necrosis of the entire mycoardial wall, the EKG will show ______

Back 345

ST-elevation

Front 346

What appears at the margins of an MI 5-10 days after?

Back 346

Granulation tissue

(Macrophages have removed dead tissue making it weak and more susceptible to papillary free wall rupture)

Front 347

ST-elevation and Abnormal Q waves signifies a ____ MI

Back 347

Transmural MI

Front 348

Dilated cardiomyopathy causes a ____ heart sound and systolic dysfunction

Back 348

S3

(causes: chronic alcohol, Coxsackie B, Cocaine, Chagas, Doxorubicin toxixity)

Front 349

Hypertrophic cardiomyopathy causes a ____ hear sound and diastolic dysfunction

Back 349

S4

Front 350

Disordered, tangled, hypertrophied myocardial fibers

Back 350

hypertrophic cardiomyopathy

Front 351

What should you think if you see a low-voltage EKG with a diminished QRS amplitude

Back 351

Restrictive Cardiomyopathy

decreased compliance leads to shitty filling of the heart during diastole

(Causes: sarcoidosis, amyloidosis, post-radiation, endocardial fibreolastosis)

Front 352

What is the cause of orthopnea in a patient with Left CHF?

Back 352

↑ Venous Return in supine position exacerbates pulmonary congestion

Front 353

A patient with SLE has sterile vegetations on BOTH sides of the mitral valve... What's up?

Back 353

Libman Sacks endocarditis

Front 354

Staph aureus most commonly effects which heart valve?

Back 354

tricuspid

Front 355

Which bug causes bacterial endocarditis on prosthetic heart valves?

Back 355

Staph. epidermitis

Front 356

Which bug infects previously damaged heart valves?

Back 356

Strep. viridans

Front 357

What bug causes endocarditis in people with colon cancer?

Back 357

Strep. bovis

Front 358

You suspect endocarditis but the blood culture is negative, what organisms could be causing it?

Back 358

HACEK Bugs

-Haemophilus
-Actinobaccilus
-Cardiobacterium
-Eikenella
-Kingella

Front 359

IV drug use endocarditis caused by S. aureus, Pseudomonas or Candida spp.most commonly infects which valve?

Back 359

tricuspid

Front 360

Which valve is most likely to be infected in bacterial endocarditis?

Back 360

Mitral valve

Front 361

What antibodies are seen in rheumatic fever?

Back 361

anti-M protein

M protein mimics myocytes so body attacks its own myocytes

Front 362

What are the major Jones criteria for rheumatic fever?

Back 362

J-joints
♡-Pancarditis
N- Nodules (SubQ)
E- Erythema marginatum
S- St. Vitus' Dance (chorea)

Front 363

A patient presents with sharp chest pain aggrevated by inspiration.

He leans forward to decrease the pain.

Auscultation reveals a friction rub and EKG shows ST-elevation in all 12 leads.

Back 363

Acute pericarditis

Front 364

Temporal arteritis causes granulomatous inflammation of the branches of the ____ artery

Biopsy shows an inflamed vessel wall with giant cells in the INTIMA.

Back 364

carotid arteries

**may involve joint pain and stiffness in proximal joints = polymyalgia rheumatica**

Front 365

Takayasu's arteritis causes granulomatous thickening of the ________.

Classically presents as the "pulseless disease" (weak UE pulses)

Back 365

aortic arch

Front 366

This medium vessel vasculitis is associated with Hepatitis B.

Causes FIBRINOID necrosis of vessels leading to multiple organs (spares the lungs)

It is immune complex mediated.

"String of pearls" sign on angiogram due to fibrosis and subsequent dilation of vessels.

Presents with Fever, weight loss, malaise, abdominal pain, melana, neurologic dysfunction and cutaneous eruptions

Back 366

Polyarteritis Nodosa

****(-) p-ANCA ****

Front 367

Granulomatous

URI symptoms, sinusitis


Hemoptysis, cough

Renal = hematuria and red cell casts

(+) c-ANCA

Back 367

Wegener's Granulomatosis

(+) c-ANCA

Front 368

Non-granulomatous inflammation of small vessels

-no Nasal/URI involvement

-may involve lungs and kidneys

(+) p-ANCA

Back 368

Microscopic polyangitis

Front 369

Asthma, sinusitis palpable purpura and peripheral neuropathy (wrist/foot drop)****

-Granulomatous vaculitis with EOSINOPHILIA

(+) p-ANCA

Back 369

Churg-Strauss syndrome

Front 370

This is a highly lethal liver malignancy.

Associated with vinyl chloride, arsenic and ThO2 (Thorotrast) exposure

Back 370

Angiosarcoma

Front 371

What are benign skin papules found in AIDS patients due to Bartonella henselae infections called?

Back 371

Bacillary angiomatosis

(confused for Kaposi's)

Front 372

Explain whats going on in Phase 0-4

Back 372

Phase 0
voltage gated Na+ channels open

Phase 1
Na+ channels close. K+ channels open

Phase 2
Ca++ channels open and balance K+ efflux

Phase 3
massive efflux of K+ due to opening of slow K+ channels. Ca++ channels close

Phase 4
high permeability through K+ channels

Front 373

Pancreas:

-What do pancreatic α cells, β cells, and δ cells secrete?

Back 373

α cells = Glucagon

β cells = Insulin

δ cells = Somatostatin

Front 374

What types of receptors are utilized by insulin and IGF-1?

Back 374

Intrinsic Tyrosine Kinase Receptors

Front 375

What types of signaling pathways are used by FSH, LH, ACTH, hCG, PTH and ADH and glucagon?

Back 375

cAMP

Front 376

What type of steroid receptor is used for Vit. D, Estrogen, Testosterone, Cortisol, Aldosterone and Progesterone

Back 376

Cytosolic Steroid receptor

Front 377

What type of steroid receptor is used for T3/T4?

Back 377

Nuclear Receptor

Front 378

What is the result of ↑ SHBG in men?

Back 378

↑ SHBG --> binds free Testosterone --> Gynecomastia

Front 379

What is the result of ↓ SHBG in women?

Back 379

↓ SHBG --> more free testosterone unbound

leads to hirsutism

Front 380

What will ACTH levels be like in a patient with Cushing Disease (pituitary adenoma)?

Back 380

↑ ACTH being pumped out by tumor

Front 381

What will ACTH levels be like in a patient with Cushing's Syndrome due to a cortisol-producing adrenal adenoma?

Back 381

↓ ACTH

Front 382

What is the rule of 10's for pheochromocytoma?

Back 382

10% malignant

10% bilateral

10% extra-adrenal

10% calcify

10% kids

10% familial

Front 383

What marker do you find in the urine that would suggest a Neuroblastoma (adrenal) in a kid?

Back 383

HVA

(breakdown marker of dopamine)

Front 384

Pretibial myxedema is seen in _______

Back 384

Grave's Dz

(hyperthyroid)

Front 385

What is the most common Thyroid CA?

Back 385

Papillary Thyroid CA

-----------------------------------

-"Ground-glass" nuclei (Orphan Annie)

-PSAMMOMA BODIES

-Nuclear grooves

Front 386

Which thyroid CA is associated with amyloid sheets composed of calcitonin?

Back 386

Medullary Thyroid CA


-----------------------------------

-Parafollicular C cells

- assoc w/ MEN 2A + MEN 2B

Front 387

The ret gene mutation is associated with which two forms of thryoid CA?

Back 387

Medullary Thyroid CA

Papillary Thyroid CA

Front 388

What is the mechanism of hyperpigmentation in Addison's Disease?

Back 388

Addison's = Primary Adrenal Insufficiency

-Adrenal atrophy = no corisol or aldosterone

- ↑ ACTH production from Ant. Pituitary

- POMC needed to make ACTH also stimulates MSH to increase melanocyte producton

Front 389

Patient presents one week after a recent flu-like illness.

They complain of jaw pain and have a tender thyroid to palpation

Back 389

Subacute Thyroiditis
(de Quervain's)

Front 390

What is the name given to a thyroid-secreting teratoma?

Back 390

Struma Ovari

-contains thyroid tissue, presents as hyperthryroidism

Front 391

Are you hyper- or hypo- natreminc when you have SIADH

Back 391

hyponatremic

You are reabsorbing too much water and diluting your serum sodium

Front 392

Urine osmolarity > Serum osmolarity

Back 392

SIADH

Front 393

In which type of Diabetes Mellitus would you see:

-Islet amyloid deposit

Back 393

Type II DM

Front 394

In which type of Diabetes Mellitus would you see

-Islet lymphocytic infiltrate

Back 394

Type I DM

Front 395

What is the most common tumor of the appendix?

-Derived from neuroendocrine cells

Back 395

Carcinoid Tumor

Front 396

Increased 5-HIAA in urine

Back 396

Carcinoid Syndrome

Front 397

Which MEN syndrome is associated with Zollinger-Ellison syndrome?

Back 397

MEN 1

Front 398

What does a Zollinger-Ellison tumor secrete?

Back 398

Gastrin --> hyperacidity of the stomach and RUGAL THICKENING

Front 399

What tumors are associated with MEN type I?

**Commonly presents with kidney stones and stomach ulcers**

Back 399

Pituitary Adenomas

Parathyroid tumors

Pancreatic Tumors (Zollinger-Ellison)

Front 400

What tumors are associated with MEN 2A?

Back 400

Parathyroid tumors

Pheochromocytoma

Medullary Thyroid CA

Front 401

What tumors are associated with MEN 2B?

Back 401

Oral/intestinal ganglioneuromatosis

Pheochromocytoma

Medullary Thyroid CA

Front 402

Name the retroperitoneal organs

"SAD PUCKER"

Back 402

Suprarenal (Adrenal) Glands

Aorta

Duodenum

Pancreas (except tail***)

Ureter

Colon (Descending + Ascending)

Kidneys

Esophagus (lower 2/3)

Rectum (upper 2/3)

Front 403

What is the portal triad?

What ligament holds the portal triad?

Back 403

**Triad**
1) Common Bile duct
2) portal vein
3) proper hepatic a.

**Hepatoduodenal Ligament**

Front 404

What ligament connects the liver to the abdominal wall?

What is it a remnant of?

Back 404

Falciform ligament

**Derived from Umbilical Vein**

Front 405

The submucosa of the gut wall contains the _____ plexus

Back 405

Meissner's Plexus

Front 406

The muscularis of the gut wall contains the _____ plexus

Back 406

Auerbach's plexus

Front 407

Brunner's glands are located in the _____ and serve to secrete an alkaline rich secretion to protect the rest of the GI tract from stomach acid

Back 407

Duodenum

Front 408

Peyer's patches are normally found in which portion of the small intestine?

They are located in the submucosa and lamina propria

Back 408

Ileum

Front 409

Which portion of the small intestine has neither Brunner's glands or Peyer's patches?

Back 409

Jejunum

Front 410

The ____ artery supplies the Stomach to proximal duodenum, liver, gallbladder, pancreas, spleen

Back 410

celiac artery

**Foregut**

Front 411

The ____ artery supplies the distal duodenum to proximal 2/3 of the transverse colon

Back 411

SMA

**Midgut**

Front 412

The ____ artery supplies the Distal 1/3 of the transverse colon to upper portion of rectum

(splenic flexure is watershed area)

Back 412

IMA

Front 413

Name the 3 main branches of the celiac trunk

Back 413

Common Hepatic a.

Splenic a.

L. gastric a.

Front 414

Why are internal hemorrhoids NOT painful?

Back 414

They are above the pectinate line and receive visceral innervation.

Front 415

Why are external hemorrhoids PAINFUL?

Back 415

They are below the pectinate line and receive innervation from the inferior rectal branch of the pudendal nerve.

Front 416

Internal vs. External Hemorrhoids:

-sign of portal HTN

Back 416

Internal Hemorrhoids

-----------------------------------------

Internal hemorrhoids drain to the superior rectal vein which drains to the portal system

External hemorrhoids drain to the inferior rectal vein --> internal pudendal v. --> internal ilac v. --> IVC

Front 417

Failure of the ________ to close may result in an indirect inguinal hernia.

**LATERAL to inferior epigastric a.***

Back 417

Processus Vaginalis

Front 418

A direct inguinal hernia will go through the _____ ring

Back 418

Superficial inguinal ring

------------------------------------

An indirect hernia will enter the internal inguinal ring and travel with the spermatic cord down into the scrotum

Front 419

What 2 amino acids are potent stimulators of Gastrin release from G cells in the antrum of the stomach?

Back 419

Phenylalanine and tryptophan

Front 420

Explain why an oral glucose load is used more rapidly than an IV glucose load.

Back 420

K cells in the duodenum/jejunum sense glucose and secrete **Gastric Inhibitory Peptide** which ↑ insulin release

↑ insulin utilizes the glucose more quickly

Front 421

What is the purpose of Pepsin produced by chief cells in the stomach?

Back 421

protein digestion

Front 422

What is the most common tumor of the salivary glands?

-Composed of stromal (cartilage) and epithelial tissue

Back 422

Plepmorphic Adenoma (benign)

-Arises in **parotid gland** but DOES NOT affect CN 7

-HIGH RATE OF RECURRENCE
(Surgeon misses some of the tumor)

Front 423

What type of salivary gland tumor has:

-Abundant lymphocytes with germinal centers (lymph-node like stroma)?

-Almost always arises from parotid gland

Back 423

Warthin Tumor (benign)

Front 424

What is the most common malignant tumor of the salivary gland?

-Contains squamous + mucinous cells

-Commonly involves the facial n. (CN 7)

Back 424

Mucoepidermoid Carcinoma

Front 425

-Failure of LES to relax as a result of the loss of Auerbach's (myenteric) Plexus.

-High LES opening pressure

--Trouble swallowing liquids + solids

Back 425

Achalasia

"Bird Beak" seen on barium swallow

Front 426

What type of things would a person with esophageal webs have trouble swallowing?

Back 426

Solids (food) only..

(obstruction)

Front 427

Which type of CA occurs in the upper 2/3 of the esophagus?

Back 427

Squamous Cell

Front 428

Which type of CA occurs in the lower 1/3 of the esophagus?

Back 428

Barret's Esophagus --> Adenocarcinoma

Front 429

Malabsorption Syndrome:


-PAS(+) foamy macrophages in intestinal LAMINA PROPRIA

- (+) mesenteric nodes

-Steatorrhea b/c chylomicrons can't be offloaded from enterocytes to lymphatics

- Arthralgias, cardiac symptoms are common

Back 429

Whipple's Dz

T. whippelii (GRAM +++)

Front 430

What skin rash is common with Celiac Sprue?

Back 430

dermatitis herpetiformis

(IgA deposition at tips of dermal papillae)

Front 431

Which part of the small bowel is tropical sprue most likely to infect?

Back 431

Jejunum + Ileum
(distal small bowel)

Front 432

What may be a consequence of tropical sprue due to destruction of the ileum and jejunum?

Back 432

Vit. B12 and Folate deficiency

Front 433

Which type of gastritis would you expect to find in a patient with RA taking heavy doses of NSAIDs?

Back 433

Acute Gastritis

(NSAIDs decrease PGs which help to protect the mucous linings!)

Front 434

What is a Curling Ulcer in the stomach?

Back 434

Patient suffers a BURN --> hypovolemia

Hypovolemia --> ↓ Blood supply to stomach

Front 435

What is a Cushing's ulcer in the stomach?

Back 435

↑ ICP --> (+) vagus nerve --> ↑ stomach acid production

Front 436

Type __ chronic gastritis is autoimmune and affects the body/fundus***

-Anti-parietal cell Ab, and Anti-IF Ab

-Achlorydia with ↑ Gastrin levels from G-cell Hyperplasia***

-May ↑ Goblet cells --> Gastric adenocarcinoma **

Back 436

Type A Chronic Gastritis
(Autoimmune)

Front 437

What type of hypersensitivity is seen in Type A (autoimmune) Chronic Gastritis ?

Back 437

Type IV

(T-cell mediated)

Front 438

Type B Chronic gastritis is caused by H. pylori colonization in the ____ of the stomach

Back 438

antrum

Front 439

(+) urea breath test = ?

Back 439

H. pylori infection

Front 440

If a peptic ulcer in the duodenum eats through the entire posterior intestinal wall, it may damage the _____ artery

Back 440

gastroduodenal a.

(branch of common hepatic a. from Celiac trunk)

**Can also cause acute pancreatitis**

Front 441

-Gastric hypertrophy with protein loss

-Parietal cell atrophy and ↑ mucous cells

-Rugae of stomach are so hypertrophied they resemble brain gyri***

Back 441

Menetrier's Disease

Front 442

Epigastric pain that improves with meals

Back 442

Duodenal ulcer

Front 443

Epigastric pain that increases with meals

Back 443

Gastric ulcer

Front 444

Ruptures of gastric ulcers carry risk of bleeding from damage to the ___ artery

Back 444

L. gastric artery

Front 445

Which form of GI cancer is a/w dietary nitrosamines** (smoked foods)?

(Japan)**

Back 445

Intestinal Gastric Carcinoma

Front 446

Involvement of left supraclavicular node d/t mets from the stomach

Back 446

Virchow Node

Front 447

Bilateral mets to the ovaries from stomach, abundant mucous and **signet ring cells**

Back 447

Krukenberg's Tumor

Front 448

Stomach mets to subcutaneous periumbilical lymphnodes

Back 448

Sister Mary Joseph's Nodule

Front 449

What skin sign do gastric carcinomas often create at the base of the neck?

Back 449

Acanthosis nigricans

Front 450

What are two primary forms of cancer that you see **Signet ring** cells?

Back 450

Stomach CA (Diffuse)

Lobular Breast CA

Front 451

Gastric vs. Duodenal ulcers

-No risk of cancer

Back 451

Duodenal ulcer

Front 452

what blood type is associated with stomach CA?

Back 452

Type A

Front 453

What is the "triple therapy" for H. pylori?

Back 453

-PPI (-prazole)

-clarithromycin

-amoxicillin

(use metronidazole if pt. allergic to penicillins)

Front 454

Granulomas seen in Crohn's Dz are mediated by which type of T-helper cells?

Back 454

Th1

(Th1 + Macrophages = granuloma)

Front 455

Crohn's Dz Vs. Ulcerative Colitis

-may see calcium oxolate nephrolithiasis

Back 455

Crohn's

Front 456

Crohn's Dz Vs. Ulcerative Colitis

- associated with HLA-B27 and Jewish descent

Back 456

Crohn's

Front 457

Crohn's Dz Vs. Ulcerative Colitis

-associated with (+) p-ANCA and primary sclerosing cholangitis

Back 457

UC

Front 458

Crohn's Dz Vs. Ulcerative Colitis

-Crypt abscesses

Back 458

UC

Front 459

Crohn's Dz Vs. Ulcerative Colitis

-loss of haufstra

Back 459

UC

"lead pipe"

Front 460

Crohn's Dz Vs. Ulcerative Colitis

-associated with bladder infections

Back 460

Crohn's

**fistulas**

Front 461

Common cause of appendicitis in kids?

Back 461

lymphoid hyperplasia

Front 462

Meckel's diverticulum is an outpouching of ______

Back 462

**all three gut layers**

-Mucosa
-Submucosa
-Muscularis propria


** failure of vitelline duct to involute**

Front 463

-Colon pathology related to ↑ intraluminal pressure (constipation, straining)

-Many outpouchings

-Most often in sigmoid colon

Back 463

Diverticulosis

Front 464

What is a Zenker's Diverticulum?

Back 464

Herniation of mucosal tissue*** at junction of pharynx and esophagus.

-hallotosis, obstruction, dysphagia

(FALSE DIVERTICULUM)

Front 465

What two types of tissue might be found in a Meckel's diverticulum?

Back 465

Pancreatic or Gastric tissue

Front 466

Buzzword:

**currant jelly stools**

Back 466

intussusception

Front 467

-Failure of Neural crest cells to migrate

-see dilated megacolon with failure to pass stool

-↑ risk in Down Syndrome

Back 467

Hirschsprung's Dz

(absent Auerbach + Meissner's Plexus)

Front 468

What is the most common cause of ischemic colitis?

Back 468

Atherosclerosis of the SMA

-Splenic Flexure is most common area (watershed)

Front 469

A patient has Familial Adenomatous Polyposis + osseous +soft tissue tumors and retinal hyperplasia

Back 469

Gardner's Syndrome

Front 470

A patient has Familial Adenomatous Polyposis + a malignant CNS tumor (medulloblastoma)

Back 470

Turcot Syndrome

Front 471

This form of colon cancer features micro-satellite instability due to a defect in DNA mismatch repair

Back 471

Hereditary non-polyposis colorectal cancer

** increased risk for breast, ovarian and endometrial cancer**

Front 472

What is the APC/β-catenin pathway that leads to colorectal cancer?

Back 472

loss of APC gene
↓
k-ras mutation
↓
loss of p53

-----------------------------------------

Start seeing polyps after k-ras mutation

***p53 loss is mediated by ↑COX (asprin will hault this***

Front 473

Reye's syndrome causes _____ damage of hepatocytes

Back 473

mitochondrial damage

**Seen when Aspirin is given to kids***

-Aspirin metabolites ↓ β-oxidation by mitochondrial enzymes

Front 474

This is a benign tumor of hepatocytes

-Associated with OCP use and regresses when OCPs are stopped

Back 474

Hepatic Adenoma

(Tumors are subcapsular and grow with exposure to estrogen**

Front 475

-Jaundice, tender hepatomegaly

-ascites

-polycythemia + hypoglycemia

- ↑ α-fetoprotein

Back 475

hepatocellular carcinoma

Front 476

-Occlusion of IVC or hepatic veins with centrilobular necrosis

-leads to congestive liver disease

-May develop varices and be able to see abdominal and back veins

Back 476

Budd-Chiari Syndrome

Front 477

(+) PAS globules in liver --> cirrhosis

- Emphysema in lungs

Back 477

α-1 antitrypsin deficiency

Front 478

Hereditary CONJUGATED Bilirubinemia

Back 478

-Dubin-Johnson

-can't excrete conjugated bilirubin from liver

Front 479

-Mutation of HFE gene

-Triad: cirrhosis, secondary diabetes, hyperpigmentation

Back 479

Hemochromatosis

Front 480

What will ferritin, TIBC, Serum Iron, and % Iron saturation look likein a patient with Hemochromatosis?

Back 480

↑ Ferritin

↓ TIBC

↑ Serum iron

↑ % Saturation

Front 481

"Onion Skin" bile duct fibrosis

Alternating strictures with dilation causing a "Beading" of bile ducts

(+) p-ANCA

Associated with Ulcerative Colitis

Back 481

Primary Sclerosing Cholangitis

Front 482

-Pruritus, jaundice, dark urine (tea colored), light stool

-hepatosplenomegaly

-Anti-mitochondrial Ab, including IgM

Back 482

Primary Biliary Cirrhosis

Front 483

Is alcohol a risk factor for pancreatic carcinoma?

Back 483

No, but tobacco is...

Front 484

This drug is a long-acting somatostatin analog used for acromegaly, variceal bleeds, carcinoid tumors and VIPomas

Back 484

Ocreotide

Front 485

What does anisocytosis mean?

Back 485

varying sizes of RBCs

Front 486

What does poikilocytosis mean?

Back 486

varying shapes of RBCs

Front 487

What is the lifespan of an RBC?

Back 487

120 days

Front 488

Platelets are derived from _____

Back 488

megakaryocytes

(fragment off)

Front 489

Platelet glycoprotein that binds to vWF?

Back 489

Gp1b

Front 490

Platelet glycoprotein that binds to fibrinogen?

Back 490

G2b/3a

Front 491

What is the WBC differential from highest to lowest?

Back 491

Neutrophils (57-67%)

Lymphocytes (23-33%)

Monocytes (3-7%)

Eosinophils (1-3%)

Basophils (0-1%)


"Neutrophils Like Making Everything Better"

Front 492

Where do you see hyper-segmented PMNs?

Back 492

Megaloblastic anemia

(↓ B12 + Folate)

Front 493

These WBCs are marked with CD40 + CD14

Back 493

Macrophages

Front 494

These blood cells can bind to the Fc portion of IgE

Back 494

Mast Cells

Front 495

Multiple myeloma is a ____ cell neoplasm

Back 495

plasma cell neoplasm

-----------------------------------

-abundant RER

-chromatin = "clock-face"

Front 496

"A" antigen on RBCs and "B" antibodies in plasma

Back 496

Type A

Front 497

"B" antigen on RBCs and "A" antibody in the blood

Back 497

Type B

Front 498

Both "A+B" antigens on RBCs and NO antibodies in plasma.

"Universal recipient"

Back 498

Type AB

Front 499

Neither "A" or "B" antigens on RBCs, but "A+B" antibodies in the plasma.

"Universal donor"

Back 499

Type O

Front 500

Why is it that a mom can carry a baby with a different bloodtype than her own?

Say, a type A blood mom is having a Type AB baby and this wouldn't cause a reaction.

Back 500

anti-AB antigbodies are IgM

DO NOT CROSS PLACENTA

Front 501

What clotting factors does Antithrombin inactivate?

Back 501

II, VII, IX, X + XI & XII

(1972 +11+12)

Front 502

Warfarin inhibits what enzyme?

Back 502

epoxide reductase

(enzyme that activates Vit. K)

Front 503

How does Clopidogrel block thrombus formation?

Back 503

Blocks ADP

-By blocking ADP the platelet cannot express GpIIb/IIIa needed for fibrinogen cross-linking to other platelets

Front 504

This is a monoclonal antibody to GIIb/IIIa that inhibits fibrinogen binding and crosslinking between platelets

Back 504

Abciximab

Front 505

What is the deficiency in Glanzmann's thrombasthenia?

Back 505

GpIb/IIIa deficiency

**↓ Aggregation**

Front 506

What is the deficiency in Bernard-Soulier Syndrome that impairs platelet adhesion?

Back 506

GpIb deficiency

**Platelets can't bind to vWF on damaged endothelial surface**

Front 507

How does Asprin inhibit thrombus formation

Back 507

Asprin irreversibly inhibits COX
↓
↓ Thromboxane A2

**↓ Aggregation)

Front 508

What is Thromboxane A2's job in platelet aggregation?

Back 508

↓ blood flow , allows more platelets to bind

Front 509

How do prostaglandins (PG I2) and NO stop platelet aggregation?

Back 509

Increase bloodflow through the area

Front 510

What do you call RBCs with nuclear remnants?

Back 510

Howell Jolly Bodies

Front 511

What is the job of Proteins C + S regarding anti-coagulation?

Back 511

Cleave factors Va and VIIIa

(In Factor V Leiden, factor V is resistant to cleaving)

Front 512

Thalassemia:

4 α-gene mutations

Back 512

Hb Barts (γ4) --> hydrops fetalis

Front 513

Thalassemia:

3 α-gene mutations

Back 513

HbH disease (β4)

Front 514

-Marrow expansion --> "crewcut" on XR

-Chipmunk facies

-Mediterranean descent

- See ↑ HBF (α2γ2)

Back 514

β-thalassemia major

Front 515

Lead poisoning inhibits what two enzymes?

Back 515

δ-ALA-dehydratase

ferrochelatase

Front 516

Burton's Lines on Gingiva + Epiphyses of long bones

-RBC basophilic stippling

-Abdominal Colic

-Wrist/foot drop

Back 516

Lead Poisoning

Front 517

Sideroblastic anemia is a hereditary defect in which enzyme needed for Heme Synthesis?

**ringed sideroblasts**--> Fe++ in mitochondria

-Can also be caused by alcohol + lead

Back 517

δ-ALA synthase

Front 518

In megaloblastic anemia caused by folate deficiency, what are the levels of homocysteine and methylmalonic acid like?

Back 518

↑ homocysteine

normal methylmalonic acid

Front 519

In megaloblastic anemia caused by Vit. B12 deficiency, what are the levels of homocysteine and methylmalonic acid like?

Back 519

↑ homocysteine

↑ methylmalonic acid

Front 520

Which tapeworm can cause megaloblastic anemia?

Back 520

Diphyllobothrium latum

Front 521

What type of anemia occurs in patients on chemotherapy (5-FU, AZT, Hydroxyurea)?

Back 521

Nonmegaloblastic Macrocytic Anemia

Front 522

In a patient using Heparin, you monitor the ____

Back 522

PTT

Front 523

In a patient using warfarin, you monitor the _____

Back 523

PT/INR

Front 524

Anemia of chronic disease is innitiated when long-standing inflammation causes the liver to release _______

Back 524

hepcidin

(binds to ferroportin on intestinal cells and inhibits iron transport, decreases iron relased from MΦ

Front 525

What are the lab findings for total iron, TIBC and ferritin in Anemia of Chronic Dz?

Back 525

↓ Iron

↓ TIBC

↑ Ferritin

Front 526

What will bone marrow look like in a patient with aplastic anemia?

Back 526

Hypocellular bone marrow with fatty infiltration (full of adipocytes)

Front 527

What is aplastic anemia?

Back 527

**Failure or destruction of myeloid stem cells**

1) Radiation and drugs

2) Viral (parvo B19, EBV, HIV, HCV)

3) Fanconi's Anemia (DNA repair defect)

4) Idiopathic (may follow hepatitis)

Front 528

(+) osmotic fragility test

Back 528

Hereditary Spherocytosis

Front 529

↓ Ankyrin, Spectrin, band 3, protein 4.2

Back 529

Hereditary Spherocytosis

Front 530

What does the MCHC and RDW look like in Hereditary Spherocytosis?

Back 530

↑ MCHC (measures [Hb] in RBCs)

↑ RDW (measures variation in RBC size)


---------------------------------------

With MCHC, larger cells (Macrocytic) still have the same concentration of hemoglobin as normal cells, but their increased size decreases the MCHC

Front 531

Where do you see Heinz bodies + Bite Cells

Back 531

G6PD deficiency

-back pain, with hemoglobinuria a few days later

Front 532

Hemolytic anemia of the newborn

- ↓ ATP production due to an enzyme deficiency --> rigid RBCs

Back 532

Pyruvate Kinase Deficiency/Defect

Front 533

What is the mutation seen in patients with Hemoglobin C?

**See HbC Crystals in RBCs**

Back 533

Glu --> Lys

(at position 6)

Front 534

What is the mutation seen in in patients with Sickle Cell Anemia?

Back 534

Glu --> Val

Front 535

What test can you use to cause RBC sickling to diagnose sickle cell anemia?

Back 535

Metabisulfide test

(causes any cell with HbS to sickle)

Front 536

In a patient with Sickle Cell Anemia, HbS _____ when deoxygenated and the cell forms a sickled shape

Back 536

polymerizes when deoxygenated

Front 537

Reticulocyte Count is often falsely elevated in anemia.

How do you correct reticulocyte count?

Back 537

(Ret. count )x (Hct/45)


If corrected count > 3%, marrow has a good response --> peripheral RBC destruction

Corrected count < 3% = poor bone marrow response --> bone marrow destruction (underproduction)

Front 538

(+) Ham's Test

↓ CD 55

↓ CD 59

Back 538

Paroxysmal Nocturnal Hemoglobinuria

↑ complement-mediated lysis of RBCs d/t:

-impaired synthesis of GPI and ↓DAF

Front 539

Which virus can cause aplastic crisis in a patient with Sickle Cell?

(Seen in spherocytosis too)

Back 539

Parvo B19

(ss DNA)

Front 540

Heterozygotes with Sickle Cell Trait have resistance to _____

Back 540

Malaria

Front 541

Why does Paroxysmal Nocturnal Hemoglobinuria occur at night?

Back 541

Shallow breathing during sleep causes Resp. Acidosis which (+) complement

Front 542

(+) Direct Coombs Test

Diagnosis?

Back 542

Autoimmune Hemolytic Anemia

(IgG or IgM coating the cells)

Front 543

What drug can trigger warm agglutinins and thus, hemolytic anemia?

Back 543

α-methyldopa

Front 544

-What does a Direct Coombs Test look for?

Back 544

Agglutination occurs if patient's RBCs are coated with Ig

Front 545

What does an Indirect Coomb's Test look for?

Back 545

agglutination if patient's serum has anti-RBC surface Ig

( + in Erythroblastosis Fetalis)

Front 546

Schistocytes confirm ____ destruction of RBCs

Back 546

mechanical destruction

(DIC, HUS, Malignant HTN, Prothetic Valves)

Front 547

How does pregnancy affect transferrin, and TIBC

Back 547

↑ Transferrin

↓ TIBC

-Normal Ferritin + Serum Fe++

Front 548

anti-GpIIb/IIIa antibodies

anti-platelet antibodies

Back 548

Idiopathic Thrombocytic Purpura

Tx: Splenectomy (kills site of Ab production)

Front 549

What are some common things you see in platelet abnormalities?

Back 549

Mucous membrane bleeding, epitaxis, petechiae, purpura

**↑ Bleeding Time**

Front 550

This platelet disorder results from defiency of the ADAMS13 enzyme.

ADAMS13 cleaves vWF multimers into smaller monomers for degredation

-Larger vWF multimers result in abnormal platelet adhesion and microthrombi

↑ Megakaryocytes in marrow biospy

Back 550

Thrombotic Thrombocytopenic Purpura

-normal PT+ PTT

**↑ Bleeding time***

Front 551

ADAMS13 (vWF metalloprotease) deficiency

Back 551

Thrombotic Thrombocytopenic Purpura

**See schistocytes on blood smear!!**

Front 552

Tx: for von Willebrand's Disease?

Back 552

Desmopressin

↑ vWF release

Front 553

What is the most common inherited bleeding disorder?

Back 553

von Willebrand Disease

Decreased vWF

Front 554

What do Bleeding time, PT and PTT look like in von Willebrand's Disease?

Back 554

↑ Bleeding time

Normal PT

↑ PTT

(↑ PTT = vWF stabilizes factor VIII)

Front 555

Abnormal ristocetin test

Back 555

von Willebrand's Disease

Front 556

What is the best screening test for DIC?

Back 556

↑ D-dimer

(derived from splitting cross-linked fibrin)

Front 557

Anti-platelet 4 antibodies

Back 557

Heparin-induced thrombocytopenia

(destroyed platelet fragments may activate and cause a thrombus)

Front 558

What will PT, PTT and Bleeding time look like in a patient with Disseminated Intravascular Coagulation (DIC)

Back 558

↑ PT

↑ PTT

↑ Bleeding time (low platelet count)

Front 559

What happens in Protein C + S deficiency?

Back 559

No inactivation of factors V and VIII, continuous clot formation

Front 560

What might you see after a rattlesnake bite?

Back 560

DIC

(venom activates coagulation)

Front 561

(+) Reed Sternberg Cells

-Localized nodal involvement

Back 561

Hodgkin's Lymphoma

Front 562

What is the most common form of Hodgkin's Lymphoma?

Back 562

Nodular Sclerosing type

Front 563

(+) CD 34

Marker for which type of cells?

Back 563

Hematopoeitic Stem Cells

Front 564

Neutrophilic Left Shift is characterized by what CD marker?

Back 564

↓ CD-16 (↓Fc receptors)

-------------------------------------------

During an infection, you are pumping out PMNs to deal with it...

Some of them are immature, so they will have ↓CD-16

Front 565

What can you give to a neutropenic patient to boost PMN production

Back 565

GMCSF +GCSF

(colony stimulating factors)

Front 566

Hodgkin Lymphoma Vs. Non-Hodgkin:

See eosinophilia due to ↑ IL-5

Back 566

Hodgkin Lymphoma

Front 567

Which bacteria produces lymphocytosis-promoting factor which blocks circulating lymphocytes from leaving blood?

Back 567

Bordetella pertussis

(WBCs can't get into Lymph nodes)

Front 568

(+) Monospot test

Back 568

EBV

Front 569

(-) Monospot test

Back 569

CMV

Front 570

What is the most common cause of inherited hypercoagulability?

Back 570

Factor V Leiden

(mutated factor V can't be degraded by protein C)

Front 571

Reed-Sternberg cells are (+) for CD__ and CD__

Back 571

CD15

CD30

Front 572

Pt. presents with a solitary enlarging cervical lymph node.

Biopsy shows:
-lymph node is divided by sclerosing bands

-Reed Sternberg cells are present in lacunar-lakes (Lacunar cells)

Back 572

Nodular Sclerosis

Front 573

Which type of Hodkgin's Lymphoma has the ↑ number of Reed-Sternberg cells?

Back 573

Mixed Cellularity

Front 574

Which form of Hodkgin's Lymphoma occurs in males under 35?

Back 574

Lymphocyte Predominant

(excellent prognosis, not a lot of RS cells)

Front 575

Non-Hodgkin's Lymphoma:

t (8;14)

Back 575

Burkitt's Lymphoma

c-myc gene

Front 576

Non-Hodgkin's Lymphoma:

-Most common Non-Hodgkin's Lymphoma

Back 576

Large B-cell lymphoma

Front 577

Non-Hodgkin's Lymphoma:

t (11;14)

Back 577

Mantle Cell Lymphoma

-Deactivates Cyclin D1 gene

Front 578

Non-Hodgkin's Lymphoma:

t (14 ;18)

Back 578

Follicular Lymphoma

(+) bcl-2 (decreases apoptosis)

(-) Tingible Body Macrophages

Front 579

"Starry Sky" appearance on microscopy

Back 579

Burkitt Lymphoma (NHL)

Front 580

What "M-spike" is seen in Waldenstom's macroglobulinemia?

Back 580

⇈IgM

-IgM forms pentamers and creates hyperviscosity of the blood

Front 581

What cytokine is increased in Multiple Myeloma?

Back 581

⇈ IL-6

**Stimulates plasma cell growth**

Front 582

What are calcium levels like in Multiple Myeloma?

Back 582

Hypercalcemia

**Plasma cells (+) RANK ligand which (-) osteoblasts and (+) osteoclasts**

Front 583

(+) TdT

Back 583

ALL

Front 584

(+) TdT

-CD10, CD19, CD20

Back 584

B-ALL

Front 585

-Neoplastic proliferation of naive B cells

**Smudge Cells**

-Warm Ab Hemolytic Anemia

- (+) CD5, CD20

Back 585

CLL


-------------------------------

CD5 normally present on T cells!!!

Front 586

(+) TRAP

-Bone marrow fibrosis

-B-cells are trapped in red pulp of spleen

Back 586

Hairy Cell Leukemia

Front 587

Neoplastic Proliferation of CD4 T cells

-Infiltrate the skin and cause rash, plaques and nodules

-Aggregates in epidermis are called Pautrier Microabcesses**

-Can spread to blood, causes **Sezary Syndrome** --> lymphocytes with cerebreform nuclei (look like brain)

Back 587

Mycosis Fungioides

Front 588

Acute Leukemia that is PAS (+)

Back 588

ALL

Front 589

-Auer Rods --> (+) Myeloperoxidase Stain

-CD13/33

PAS (-)

Back 589

AML

Front 590

M3 AML subtype responds to ____

Back 590

All-trans-retinoic acid (Vit. A)

-causes differentiation of myeloblasts

Front 591

Treatment of M3 AML may cause ____

Back 591

DIC

Front 592

Tranlocation for M3 subtype of AML?

Back 592

t (15;17)

RAR (retinoic acid receptor)

Front 593

t (9 ; 22)

(-) Leukocyte Alkaline Phosphatase (LAP)

Back 593

CML

-Philadelphia Chromosome

(incudces BCR-ABL fusion protein with increased tyrosine kinase activity)

Front 594

What drug is used to treat CML?

Back 594

Imatinib

Front 595

Peroxidase (+) inclusions seen in granulocytes and myeloblasts

Back 595

Auer Rods (AML)

(Particularly AML M3)

Front 596

-Cells functionally immature and do not stimulate T-cells

(+) S-100

(+) CD1a

**Birbeck Granules**

Back 596

Langerhans Histiocytosis

Front 597

Tx: for Heparin over-dose?

Back 597

Protamine Sulfate

Front 598

MOA of Heparin?

Back 598

Cofactor for activation of Antithrombin

Front 599

MOA of LMWH (enoxaparin)?

Back 599

inhibits factor Xa

Front 600

MOA of Lepirudin, Bivalirudin?

Back 600

Inhibit thrombin

(Leech Saliva derivatives)

Front 601

Warfarin MOA?

Back 601

Interferes with synthesis and γ-carboxylation of Vit. K dependent factors

(1972 + C&S)

Front 602

What is the antidote for a thrombolytic overdose?

Back 602

Aminocaproic Acid

Front 603

Thrombolytics are contraindicated in patients with _____

Back 603

an active bleed

(think brain aneurysm)

Front 604

MOA: thrombolytics ?

Back 604

Aid in concersion of plasminogen to plasmin --> cleaves thrombin and fibrin

Front 605

This anticancer drug causes myelosuppression that is reversible by leucovorin

Back 605

MTX

(leucovorin is a folinic acid analog)

Front 606

This anticancer drug causes myelosuppression that is NOTreversible by leucovorin

Must use **thymidine** instead

Back 606

5-FU

Front 607

How does the body metabolize 6-mecaptopurine (6-MP)?

Back 607

Xanthine Oxidase

**AVOID ALLOPURINOL**

Front 608

Name the cancer drug:

-Forms a complex between topoisomerase II and DNA

Back 608

Etoposide

Front 609

Name the cancer drug:

-Alkylates DNA

Toxicity = pulmonary fibrosis

Back 609

Busulfan

Front 610

Name the cancer drug:

-Fragments DNA

Toxicity = Pulmonary Fibrosis

Back 610

Bleomycin

Front 611

Name the cancer drug:

-Blocks purine synthesis

-metabolized by xanthine oxidase

Back 611

6-MP

Front 612

Name the cancer drug:

-Cross-links DNA

Toxicities: Nephrotoxic/Ototoxic

Back 612

Cisplatin

Front 613

Name the cancer drug:

-Nitrogen mustard, alkylates DNA

Back 613

Cyclophosphamide

Front 614

Name the cancer drug:

-Folic acid analog that inhibits dihydrofolate reductase

Back 614

MTX

Front 615

Name the cancer drug:

-Prevents tubulin disassembly

Back 615

Paclitaxel/Taxols

Front 616

Name the cancer drug:

-Intercalates DNA, creates free radicals

Toxicity: cardiotoxic***

Back 616

Doxorubicin

Daunorubicin

Front 617

Name the cancer drug:

DNA alkylating agents used in brain cancer

Back 617

Nitrosoureas

(cross CNS)

Front 618

Name the cancer drug:

-prevents tubulin assembly

-Toxicity: CNS, paralytic ileus

Back 618

Vincristine/ Vinblastine

Front 619

Name the cancer drug:

Inhibits thymidylate synthase --> decreases nucleotide synthesis

Back 619

5-FU

(pyrimidine analog)

Front 620

Name the cancer drug:

SERM, blocks estrogen binding to Estrogen (+) receptors

Back 620

Tamoxifen/Raloxifen

Front 621

Name the cancer drug:

-Monoclonal Ab against HER-2 (erb-2)

Back 621

Trastuzumab

Front 622

Name the cancer drug:

Inhibitor of PRPP synthetase

Back 622

6-MP

Front 623

What drugs are used for testicular cancer?

Back 623

Etoposide

Bleomycin

Cisplatin

"Eradicate Ball Cancer"

Front 624

What anti-cancer drug can be applied topically for basal-cell cancers?

Back 624

5-FU

Front 625

What anticancer drug is preferred to treat childhood tumors:

-Ewing Sarcoma
-Wilm's Tumor
-rhabdomyosarcoma

Back 625

Dactinomycin

Front 626

Name the cancer drug:

Inhibits ribonucleotide reductase

Back 626

Hydroxyurea

Front 627

Name the cancer drug:

Toxicity = Hemorrhagic Cystitis

Back 627

Cyclophosphamide

(prevent with MESNA)

Front 628

Name the cancer drug:

-antibody against protein kinases displayed in CML

Back 628

Imitinab

Front 629

What are the muscles of the rotator cuff?

What movements are they responsible for?

Back 629

Supraspinatus - ABducts

Infraspinatus - LATERALLY rotates

teres minor - LAT rotation and ADducts

Subscapularis = MEDIALLY rotates, ADducts

Front 630

What are the layers of the epidermis?

Back 630

Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basalis

Front 631

What landmark would you useto give a pudendal nerve block?

Back 631

Ischial Spine

Front 632

The ACL is connected to the ____ tibia

Back 632

anterior tibia

Front 633

The PCL is connected to the ___ tibia

Back 633

posterior tibia

Front 634

A patient presents with pain in the forearm and a characteristic weakness of the pincer movement of the thumb and index finger.

What nerve has been damaged?

Back 634

Ant. interosseous n.

(branch of median nerve)

Front 635

What is the "million dollar nerve"?

Damage here you would lose the ability to grasp things (loss of opposition of the thumb with the fingers)

Back 635

recurrent branch of median n.

------------------------------------------
innervates "OAF":
Opponens Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis

Front 636

What forms the "roof"of the carpal tunnel?

Back 636

flexor retinaculum

Front 637

Back 637

Front 638

A patient fell on an outstretched hand and now experiences:

-↓ ABduction and ADduction of fingers

-↓ ADduction of thumb

-↓ Externsion of 4th-5th digits

What bone was fractured?

Back 638

Hook of Hamate

(lesion to distal ulnar nerve)

Front 639

The dorsal lumbricles ___ the fingers

The palmar lumbricles ___ the finger

Back 639

Dorsal = ABduct

Palmar = ADduct

**DAB**
**PAD**

Front 640

A patient has with a knee injury:

↓ Foot INVERSION

↓ PLANTAR FLEXION

↓ Toe Flexion

-Sensory deficit on sole of foot

-What nerve is damaged?

Back 640

Tibial (L4-S2)

Front 641

A patient presents with trauma to the lateral leg:

↓ Foot EVERSION

↓ DORSIFLEXION

↓ Toe flexion

**FOOT DROP/FOOT SLAP**

↓ Sensation on anteriolateral leg and top of foot

Back 641

Common Peroneal Nerve (L4-S2)

Front 642

Damage to which nerve will result in Trendelenberg Gait?

(Contralateral hip drops when standing on leg ispilateral to lesion)

Back 642

Superior Gluteal n. (L4-S1)

Front 643

A patient presents saying they have trouble climbing stairs and rising from a seated position. What nerve do you suspect is damaged?

Back 643

Inferior Gluteal n. (L5-S2)

Front 644

What type of ossification occurs in long bones? (bone growth)

Back 644

**Endochondral ossification**

-Cartilaginous model made first

-O-blasts and O-clasts replace cartilage model with woven bone to lamellar bone

Front 645

What type of ossification occurs in flat bones? (bone growth)

-Facial bones
-Skull
-Pelvis
-Ear bones
-Ribs
-Vertebrae

Back 645

**Membranous Ossification**

-Woven bone is formed directly without cartilage, later remodeled to lamellar bone

Front 646

Achondroplasia results in failure of longbone growth
(↓ endochrondral ossification)

-There is a constitutive activation in the _____ receptor that inhibits chondrocyte proliferation.

-Autosomal Dominant inheritance

Associated with **advanced paternal age**

Back 646

FGR3
(fibroblast growth factor receptor)

Front 647

Postmenopausal/Type 1 Osteoporosis is caused by ↓ ____ levels

Back 647

↓ Estrogen levels

Tx:
-Vit D. + Calcium
-Calcitonin
-PULSATILE PTH
-Bisphosphonates

**Glucocorticoids are CONTRAINDICATED**

Front 648

Explain the mutation that occurs in Achondroplasia

Back 648

**ACTIVATING MUTATION**of FGF3

***ACTIVATING***

Front 649

Why are the sclera blue in a patient with Osteogenesis imperfecta?

Back 649

↓ Sclera collagen reveals **choroidal veins**

Front 650

-Failure of normal bone resorption
↓
THICK, WEAK BONE

-Commonly due to loss of **Carbonic Anhydrase III**

-Hearing/Vision problems fromimpinged CNs

-Hydrocephalus from narrow foramen magnum

-**Renal tubular acidosis**
↓
Lack of CA results in ↓ reabsorption of HCO3-

Back 650

Osteopetrosis

Tx: Marrow Transplant

Front 651

What causes the following sequelae of Rickets:

Pigeon Breast Deformity

Frontal Bossing

Rachitic Rosary

Bowing of the Legs

Back 651

**Osteoid Deposition**

-Rachitic Rosary
↓
osteoid deposition at costochondral junction

Front 652

What will the labs for Ca++, Phosporus, PTH and Alkaline Phosphatase look like in Osteomalacia or Rickett's Disease
(low Vit. D.)

Back 652

↓ Ca++

↓ Phosphorus

↑ PTH

↑ Alkaline Phosphatase

(Vit D. needed for Ca+ and P absorption in gut)

Front 653

What will the labs for Ca++, Phosporus, PTH and Alkaline Phosphatase look like in Osteoporosis?

Back 653

All NORMAL****

Front 654

Loss of trabecular bone mass

-Can occur with Menopause (↓ Estrogen)

-Or increased age (>70)

Back 654

Osteoporosis

Front 655

-Mosaic Patter of Lamellar Bone
("Puzzle Pieces"

-Bone pain

-Increased hat size

-Hearing loss

-Lion like facies

Only abnormal lab is ↑ Alkaline Phosphatase

Back 655

Paget's Dz of Bone

-Imbalance b/t osteoclast and osteoblast function

-----------------------------------

Osteoclasts go crazy and reabsorb tons of bone.

Osteoblasts see whats going on and try to build new bone at the same time.

The osteoclast tires out and you are left with osteoblasts laying down crappy bone that is THICK and SCLEROTIC

Front 656

What will the labs for Ca++, Phosporus, PTH and Alkaline Phosphatase look like in Paget's Dz of Bone?

Back 656

All normal except for ↑ Alkaline Phosphatase****

Front 657

"Chalk-stick fractures"

-High-output cardiac failure due to ↑ AV shunts through crappy bone

Back 657

Paget's Dz of Bone

Front 658

Cystic bone spaces are filled with brown fibrous tissue

-Brown Tumors

-Caused by HYPERparathyroidism
↓
Increased Bone resorption

Back 658

Osteitis fibro cystica

**HIGH PTH**

Front 659

A patient with longstanding HYPERparathyroidism presents with "bone pain"

-You do a bone biopsy and see Cystic bone spaces are filled with brown fibrous tissue **BROWN TUMORS**

-You diagnose Osteitis fibro cystica

What lab findings do you expect for Ca++, Phosphorus, PTH, and alkaline phosphatase?

Back 659

↑ Ca++

↓ Phosphorus

↑↑ PTH

↑ Alkaline Phosphatase

Front 660

Where does osteomyelitis occur in children?

Back 660

metaphysis

Front 661

Where does osteomyelitis occur in adults?

Back 661

epiphysis

Front 662

Where do bacteria seed in osteomyelitis in:

Children?

Adults?

Back 662

Children = METAPHYSIS

ADULTS = EPIPHYSIS

Front 663

What drugs would you use for a patient with Paget's Dz of Bone?

Back 663

Calcitonin --> ↓ osteoclast activity

Bisphosphonates -->↓ osteoclast activity

Front 664

Which drugs can lead to increased risk of avascular necrosis?

Back 664

Corticosteroids

Front 665

Bone Tumors:

Benign tumor of bone

-arises on surface of **FACIAL BONES**

- a/w **GARDNER SYNDROME (FAP)**

Back 665

Osteoma

Front 666

Bone Tumors:

Benign tumor of osteoblasts

Arises in cortex of long bones (femur)

- Bone pain that ***resolves with aspirin**

- <2cm mass with radiolucent core coming off the side of the bone

Back 666

Osteoid Osteoma

Front 667

Bone Tumors:

-Similar to Osteoid osteoma but is larger --> >2cm

-Arises in vertebrae

- Bone pain that **DOES NOT** respond to aspirin

Back 667

Osteoblastoma

Front 668

Bone Tumors:

-Tumor of bone with overlying cartilage cap

-Arises as a lateral projection of the **growth plate** (metaphysis)

-Bone is continuous within marrow space

Back 668

Osteochondroma

**M/C benign bone tumor**

Front 669

Bone Tumors:

-Malignat proliferation of osteoblasts

**Risk Factors**
Familial retinoblastoma
Paget Dz
Radiation exposure

-Arises in **METAPHYSIS**

- Destructive "Sunburst pattern" and Codman's Triangle (lifting of periosteum)

Back 669

Osteosarcoma

Front 670

Bone Tumors:

Bone biopsy reveals pleomorphic cells that produce osteoid

Back 670

Osteosarcoma

Front 671

Most common bone tumor in children?

Back 671

Osteosarcoma

Front 672

Bone Tumors:

-Composed of mutli-nucleated giant cells

-Young adults

- Grows in **epiphysis of long bones**

-"Soap bubble" on X-ray

Back 672

Giant Cell Bone Tumor

Front 673

Bone tumors:

The malignant cells in Ewing Sarcoma are derived from ___

Back 673

Neuroectoderm

Front 674

Bone Tumors:

-Arises in DIAPHYSIS of long bones

-"Onion Skin" appearance on Xray

-Biopsy reveals **small, blue cells resembling lymphocytes**

-t (22; 11)

Back 674

Ewing Sarcoma

Front 675

Bone tumors:

-What does bone biopsy show in a Ewing Sarcoma?

Back 675

**small, blue cells resembling lymphocytes**

Front 676

Chondromas = benign tumor of cartilage.

-They usually occur in the ____ and ___ (What bones)

Back 676

Medulla of Hands and Feet

Front 677

Chondrosarcoma =malignant

-Ususally occurs in the ___ or ____

Back 677

Medulla of pelvis and central skeleton

Front 678

Hallmark of this joint disease is synovitis leading to formation of pannus tissue

-Pannus = inflammed granulation tissue

Back 678

Rheumatoid Arthritis

Front 679

Osteophyte formation in DIP and PIP

Back 679

Osteoarthritis

DIP = Herbeden Node

PIP = Bourchard's Node

Front 680

Joints:

Ig M antibody against the Fc portion of IgG

Back 680

Rheumatoid Arthritis

**rheumatoid factor**

Front 681

Which finger joint does Rheumatoid Arthritis spare?

Back 681

DIP

**HY**

Front 682

Arthritis and morning stiffness that lasts for more than 30 minutes and improves with use

Back 682

Rheumatoid Arthritis

Front 683

Explain the swan-neck deformity seen in Rheumatoid Arthritis

Back 683

Front 684

Describe the Boutonniere deformity seen in Rheumatoid Arthritis

Back 684

Front 685

-Joint pain/stiffness with psoriasis

"sausage" fingers or toes

- "pencil in cup" deformity on X-ray

(+) HLA B27

Back 685

Psoriatic Arthritis

Front 686

Aortic regurgitation (Aortitis)

(+) HLA-B27

Back 686

Ankylosing

-Bamboo spine

-Sacroilitis

Front 687

(+) HLA-B27

-Conjunctivitis

-Urethritis

-Arthritis

Back 687

Reactive Arthritis
(Reiter's Syndrome)

-"Can't see, can't pee, can't climb a tree"

- Post GI or chlamydial infections

Front 688

Why does SLE cause false (+) syphilis tests (RPR/VDRL)?

Back 688

Anti-phospholipid antibodies cross-react with cardiolipin used in tests

Front 689

Epithelial granulomas containing Schaumann and asteroid bodies

Back 689

Sarcoidosis

Front 690

-Bilateral hilar lymphadenopathy

-erythema nodosum

-Elevated ACE levels**

-Elevated 1-alpha-hydroxylase --> INCREASED VIT. D activation in epithelial macrophages

Back 690

Sarcoidosis

-Most common in black women

Front 691

-Bilateral hilar lymphadenopathy

-Non-caseating granulomas in lungs ***

Back 691

Sarcoidosis

Front 692

-Skeletal Muscle Dz:

-Involves skin + skeletal muscle

-Bilateral PROXIMAL muscle weakness

-Often associated with carcinoma

- "Malar rash" or "Heliotrope Rash" (under eyes)

-Grotton papules (red) on elbows, fingers and knees

**Perifasicular atrophy**

Back 692

**Dermatomyocitis**

(+) Anti-Jo 1 antibodies

(+) ANA

Front 693

(+) Anti-Jo 1 antibodies

(+) ANA

Back 693

Dermatomyositis

Polymoyositis

Front 694

-Inflammatory disorder of skeletal muscle

-resembles Dermatomyositis

-**Endomysial inflammation** seen on muscle biopsy

Back 694

Polymyositis

(+) Anti-Jo 1 antibodies

(+) ANA

Front 695

A keloid scar is characterized by excess type ___ collagen

Back 695

type III

Front 696

Auto-antibodies to pre-synaptic Ca++ channels which decrease ACh release

Back 696

Lambert Eaton

-Seen with small cell CA in lung***

Front 697

Increased Stratum spinosum

Decreased Stratum Granulosum

(+) Auspitz sign

Back 697

Psoriasis

Front 698

Hyperpigmentation of face associated with pregnancy

Back 698

Melasma

Front 699

What layer of epidermis does S. aureus exotoxin destroy keratinocyte attachments in during Scalded Skin Syndrome

Back 699

Stratum Granulosum

-Generalized erythematous rash with sloughing of upper layers of the epidermis

Front 700

Deposits of IgA at tips of dermal papillae

-pruritic papules and vesicles

-Seen in **Celiac Dz**

Back 700

Dermatitis Herpetiformis

Front 701

Wickham Striae seen in oral mucosa

-biopsy reveals "Sawtooth" inflammation at the dermal/epidermal junction

Back 701

Lichen Planus

-associated with Hep C

Front 702

Pruritic, Purple, Polygonal Papules

-"Sawtooth" infiltrate of lymphocytes at dermal/epidermal junction

-Associated with Hepatitis C

Back 702

Lichen Planus

Front 703

Inflammatory lesions of subQ fat.

-usually on anterior shins

Back 703

**Erythema nodosum**

Associated

Front 704

Patient develops a "Herald Patch"

-followed days later by "Christmas Tree" distribution rash

Back 704

pityriasis rosea

Front 705

What is the most common skin cancer overall?

Back 705

Basal Cell CA

-rolled edges

-Central ulceration

-"Pearly papules"

Front 706

Patient presents with a lesion on the nose:


-rolled edges

-Central ulceration

-"Pearly papules"

-Biopsy shows **palisading nuclei**

Back 706

Basal Cell CA

(almost never metastasizes)

Front 707

Very common skin cancer associated wtih exposure to sunlight and arsenic.

Back 707

Squamous cell CA

Front 708

Patient who works outside as a landscaper presents with an ulcerative red lesion on his face.

Biopsy show **keratin pearls**

Back 708

Squamous cell CA

Front 709

A dysplastic nevus is a precursor to _____

Back 709

Melanoma

-Asymmetry
-Borders (irregular)
-Color Variation
-Diameter (>6mm)

Front 710

Tumor marker for Malignant Melanoma?

Back 710

S-100

Front 711

____ is a precursor to squamous cell CA in skin

Back 711

Acatinic keratosis

Front 712

Corticosteroids block _____ and prevent Membrane lipids (phosphatidylinosinotol) from converting to Arachidonic acid

Back 712

Phospholipase A2

Front 713

Arachidonic Acid is converted to Hydroperoxides ---> Leukotrienes by _________

Back 713

Lipoxygenase

Front 714

Prostacyclins (PG12) vs. Prostaglandins (PGE2)

↓ Platelet aggregation

↓ Vascular tone

↓ Bronchial tone

↓ Uterine Tone

Back 714

Prostacyclins (PGI2)

Front 715

Prostacyclins (PG12) vs. Prostaglandins (PGE2)

↑ Uterine tone (contraction)

↓ Bronchial tone

↓ Vascular tone

Back 715

Prostaglandins (PGE2)/(PGF2)

Front 716

How does Thromboxane A2 affect:

-Platelet aggregation

-Vascular tone

-Bronchial tone

Back 716

↑ Platelet aggregation

↑ Vascular tone

↑ Bronchial tone

Front 717

What is the main action of LTB4 (leukotriene)?

Back 717

PMN Chemotaxis

Front 718

What effect do leukotrienes have on bronchial tone?

Back 718

↑ Bronchial tone

Front 719

Prostacyclins Vs. Prostaglandins

-Which ↑ uterine tone?

Back 719

Prostaglandins ↑ Uterine Tone

Front 720

Prostacyclins Vs. Prostaglandins

-Which ↓ uterine tone?

Back 720

Prostacyclins ↓ uterine tone

Front 721

This drug blocks Lipoxygenase from forming Leukotrienes

Back 721

Zileutron

Front 722

These drugs block leukotriene receptors

Back 722

Zafirlukast

Montelukast

Front 723

These drugs are good to use in patients with RA or osteoarthritis that also have a gastric ulcer

Back 723

COX-2 inhibitors = Celecoxib

-NO GASTRIC SIDE EFFECTS

Front 724

This OTC drug has antipyretic and analgesic properties, but LACKS anti-inflammatory properties.

Reversibly inhibits COX in CNS

Back 724

Acetaminophen

Front 725

This drug inhibits uric acid resorption in the in the PCT

Useful in gout

Back 725

Probenecid

Front 726

These two drugs inhibit xanthine oxidase and can be used for gout.

Back 726

Allopurinol

Febuxostat

Front 727

Why can't a person taking Allopurinol also use Azithioprine or 6-mecaptapurine?

Back 727

They are metabolized by xanthine oxidase and can build to toxic levels

Front 728

This drug is used for acute gout and stabilizes tubulin to inhibit polymerization and impair leukocyte chemotaxis and degranulation.

Back 728

Colchicine

Front 729

An elderly patient presents with a raised discolored plaque on his right arm.

It appears **waxy** and "stuck on"

-Biopsy shows **keratin pseudocysts**

Back 729

Seborrheic Keratosis

Front 730

The "Leser-Trelat" sign is the sudden onset of multicle seborrheic keratoses and suggests underlying ___ carcinoma

Back 730

GI tract

Front 731

What causes the pigmentation seen in freckles?

-Small tan to brown maculae with darkness that increases with exposure to sunlight.

Back 731

**melanosomes***

(NOT MELANOCYTES!!)

Front 732

Which form of UV light causes DNA damage?

Back 732

UV-B

Front 733

Vitiligo is the loss of skin pigmentation. It is due to the autoimmune destruction of _____

Back 733

melanocytes

Front 734

Patient presents with firm, pink umbilicated papules.

-Associated with poxvirus

Back 734

Molluscum contagiosum

-See **molluscum bodies** in keratinocytes

Front 735

This nerve controls:

-Biceps
-Brachialis

**Felxion at the elbow**

Back 735

Musculocutaneous n.

Front 736

This nerve controls:

-Brachioradialis
-Extensors of wrist and fingers
-**SUPINATORS**
-Triceps

**Extensors + Supinators**

Back 736

Radial N.

Front 737

This nerve controls pronation of the forearm

Back 737

Median n.

Front 738

During muscle contraction, what receptor opens the sarcoplasmic reticulum?

Back 738

ryanodine receptor


(coupled with Dihydropyridine receptor and activated by depolarization coming down T-tubule)

Front 739

During muscle contracytion, Ca++ binds to troponin C causing a conformational change.

This allows _____ to mov eout of the way to allow actin/myosin cycling

Back 739

tropomyosin

Front 740

Describe the venous drainage of the LEFT ovary/testicle

Back 740

Left ovary/testicle→left gonadal v. → left renal vein → IVC

Front 741

Describe the venous drainage of the RIGHT ovary/testicle

Back 741

Right ovary/testicle → Right gonadal vein → IVC

Front 742

Varicoceles most commonly occur in the (left/right) testicle

Back 742

left testicle

--------------------------------

The left spermatic vein hits the left renal vein at a 90 degree angle

Flow is more backed up on the left

Left testicle also hangs lower due to this reason

Front 743

What lymph nodes do the ovaries/testicles drain to?

Back 743

PARA-AORTIC

Front 744

Which ligament holds the Ovarian vessels?

Back 744

Suspensory Ligament of the Ovaries

(Connects ovaries to lateral pelvic wall)

Front 745

Which ligament holds the uterine vessels?

Back 745

Cardinal Ligament

(Connects cervix to side-wall)

Front 746

Which uterine ligament is a derivative of of the gubernachulum?

Back 746

Round ligament of uterus

(connects uterine fundus to labia majora and runs through the inguinal canal by passing through deep ring)

Front 747

What is the histology of the endocervix?

------------------**transition zone**

What is the histology of the ectocervix?

Back 747

Endocervix = simple columnar

Ectocervix = stratified squamous

Front 748

Which male reproductive cells:

-Secrete inhibin → inhibits FSH

-Secrete Androgen Binding Protein → Maintains testosterone levels

-Form blood-testis barrier via tight junctions

-Produce anti-mullerian hormone

Back 748

Sertoli Cells

-grow and nourish sperm

Front 749

Male reproductive cells:

-stimulated by FSH

Back 749

Sertoli

Front 750

Male reproductive cells:

Stimulated by LH

Back 750

Leydig cells

(+) Testosterone

Front 751

Female Reproductive:

-The ___ cell is stimulated by LH

-It has 17α-hydroxylase which converts cholesterol into Andostenedione

Back 751

Theca Cell

**no Aromatase --> can't convert Andostenedione to Estrogen**

Front 752

Female Reproductive:

-The _____ cell is stimulated by FSH

- It converts Andostenedione to Estrogen via Aromatase

Back 752

Granulosa Cell

**no 17α-hydroxylase ***

Front 753

Estrogen receptros are expressedin the ____ of a cell

Back 753

cytoplasm

Move to nucleus when bound by a ligand

Front 754

Which layers of the endumetrium are shed during menstruation?

Back 754

-Stratum compactum
-Stratum spongiosum

-------------------------------------------
Endometrial layers from top to bottom:

-Stratum compactum
-Stratum spongiosum
-Stratum basalis (not shed)

Front 755

Which hypothalamic nucleus is involved with ovulation?

Back 755

Arcuate Nucleus

Front 756

Which female sex hormone:

-stimulates endometrial glandular secretions and spiral artery development

-produces thick cervical mucous

-Inhibits LH +FSH

- ↓ estrogen receptor expressivity

Back 756

**Progesterone**

-Produced by the CORPUS luteum for about 14 days (luteal phase)

-Will die if no fertilization occurs

-beta-hCG from placenta will maintain the corpus luteum for 6 weeks until the placenta can take over progesterone production

Front 757

This female sex hormone:

↓ myometrial excitability

(+) uterine smooth muscle relaxation

↑ Body Temperature

Back 757

Progesterone

Front 758

GnRH is synthesized and released by the _____ of the hypothalamus

Back 758

Arcuate Nucleus

Front 759

The luteal phase of menstruation is about ____ days

Back 759

14 days

(lifespan of corpus luteum)

Front 760

When do fetal oocytes complete meiosis I ?

Back 760

After ovulation --> secondary oocytes

-------------------------------------------

Then, they are stuck in Meiosis II Metaphase unless fertilization occurs

Front 761

Primary fetal oocytes are arrested in _____ of Meosis I

Back 761

Prophase of Meiosis I

Front 762

Where does fertilization normally take place?

Back 762

Ampulla of Fallopian Tube

Front 763

When does implantation occur?

Back 763

~ day 6

Front 764

After implantation, what cells produce βhCG?

Back 764

Syncytiotrophoblasts of placenta

Front 765

A decrease in _____ after delivery helps to induce lactation

Back 765

Progesterone

Front 766

What is partly responsible for decreased fertility in a breast-feeding mother?

Back 766

**Prolactin**

-maintains lactation

- 95% contraceptive action

Front 767

What are the hormonal levels of estrogen, FSH, LH and GnRH like durinf Menopause?

Back 767

↓ Estrogen

⇈ FSH

↑ LH (no surge d/t low estrogen)

↑ GnRH

Front 768

Testicular Atrophy

Euchnoid Body Shape

Tall, long extremities

Gynecomastia, female hair distribution

Back 768

Klinefelters

(47 XXY)

**Presence of inactivated C "Barr Body"**

Front 769

Do patients with Turner Syndrome have a Barr-body?

Back 769

No

Front 770

If a patient presents with pre-eclampsia before 20 weeks of pregnancy, what should you rule out?

Back 770

Molar Pregnancy

Front 771

↑ βhCG

"Honey-combing" of uterus with "cluster of grapes" appearance

-Abnormal uterine size

Back 771

Hydatidiform Mole

Front 772

-Autosomal recessive

-Inability to convert testosterone to DHT

-Ambiguous genitalia until puberty when ↑ testosterone causes maculinization and growth of external genitalia

Back 772

5α-reductase deficiency

Front 773

-Defective development of GnRH cells and olfactory placode

- ↓ synthesis of GnRH in hypothalamus

-Anosmia

- lack of secondary sexual characteristics

Back 773

Kallman Syndrome

Front 774

This type of hydatidiform mole is 100% paternal origin

Back 774

Complete

(2 sperm + empty egg)

Front 775

A young female presents with two bilateral bumps in her labia majora

-You notice no pubic hair development

-Labs show ↑ testosterone, ↑ estrogen, ↑ LH

Back 775

Androgen Insensitivity Syndrome

**defect in androgen receptor**

- female external genitalia with rudimentary vagina

-no uterus or fallopian tubes

Front 776

Complete hydatidiform moles run the chance of developing into what malignancy?

Back 776

Choriocarcinoma

Front 777

What is the DOC for eclampsia?

Back 777

IV Magnesium Sulfate
+
Diazepam for seizures

Front 778

Over 20 week mark in pregnancy

-HTN + proteinuria + Edema

Back 778

Pre-eclampsia

Front 779

Over 20 week mark in pregnancy

HTN + proteinuria + Edema + Seizures

Back 779

Eclampsia

Front 780

What causes the symptoms seen in Pre-eclampsia and Eclampsia?

Back 780

-Placental ischemia

- due to impaired vasodilation of spiral arteries resulting in ↑ vascular tone

Front 781

Use of what drug is linked with Abruptio placentae?

Back 781

cocaine

Front 782

-Premature detachment of placenta from attachment site

-PAINFUL bleeding in 3rd trimester

Back 782

Abruptio placentae

Front 783

-Defective decidua basalis due to prior C-section or placenta previa

-Placenta attaches to myometrium

-***Massive bleeding after delivery**

Back 783

Placenta accreta

Front 784

-Attachment of placenta to lower uterine segment

**May occlude os**

-Painless bleeding during any trimester of pregnancy

-History of multiparity or C-section

Back 784

Placenta previa

**Deliver with C-section**

Front 785

-Fetal vessels crossing or running in close proximity to the inner cervical os.

These vessels course within the membranes (unsupported by the umbilical cord or placental tissue) and are at risk of rupture when the supporting membranes rupture

Back 785

Vasa previa

Front 786

A 17 year old female presents with severe abdominal pain.

She has a (+) βhCG and endometrial biopsy shows **decidualized endometrium with NO chorionic villi**

Back 786

Ectopic Pregnancy

Tx: MTX

Front 787

endometrial biopsy shows **decidualized endometrium with NO chorionic villi**

Back 787

Ectopic Pregnancy

Front 788

Name 2 causes of polyhydramnios

Back 788

1) Esophageal/Duodenal Atresia

2) Anencephaly

(Also maternal diabetes)

Front 789

What is a common cause of oligohydramnios in a Mother with a male fetus?

Back 789

posterior urethral valves

Front 790

HPV 16 --> E6 gene inhibits ___

Back 790

p53 suppressor gene

Front 791

HPV 18 --> E7 gene inhibits ____

Back 791

Retinoblastoma suppressor gene

Front 792

What is the #1 risk factor for cervical cancer?

Back 792

Multiple Sexual Partners

(increase risk of HPV)

Front 793

Cervical biopsy shows koilocytes with "raisinoid" nuclei and peri-nuclear hallows

Back 793

HPV --> cervical CA

Front 794

-Endometrial gland/stroma outside of normal location

-presents as pain during menstruation

-Most commonly affects ovaries and leads to **Chocolate cysts**

- May present as:

**pelvic pain (uterine ligaments)**

**Pain on defecation (Pouch of Douglas)**

**Painful intercourse**

Back 794

Endometriosis

-Uterus is NORMAL size

Front 795

-Endometrial glands implanted within myoetrium of the uterus

-Menorrhagia, dysmenorrhea, pelvic pain

-Uterus is ENLARGED

Back 795

Adenomyosis

-Uterus is ENLARGED

(basically, it's endometriosis of the uterus)

Front 796

-Postmenopausal vaginal bleeding

-Results from excess estrogen stimulation throughout lifetime

-Abnormal endometrial gland proliferation

Back 796

Endometrial Hyperplasia

Front 797

What is the most likely cause of Endometriosis?

Back 797

Retrograde menstruation with ectopic implantation on other tissues

Front 798

Risk factors for endometrial hyperplasia?

Back 798

↑ Estrogen Exposure

-nullparity
-early menarche
-late menopause
-granulosa cell tumor
-PCOS
-Hormone replacement therapy

Front 799

What is the most common gynecologic malignancy?

Back 799

Endometrial CA

Front 800

What is the most common tumor in women?

Back 800

Leiomyoma

Front 801

What ethnic group has ↑ incidence of Leiomyomas?

Back 801

Blacks

Front 802

-Benign smooth muscle tumor

- ↑ size with pregnancy

- ↓ size after menopause

-**Whorled pattern of smooth muscle bundles**

Back 802

Leiomyoma

Front 803

"gun-powder" nodules found outside endometrium

Back 803

Endometrial implants

Front 804

Of all the gynecological malignancies, which has the worst prognosis?

Back 804

Ovarian CA

Front 805

-Malignant proliferation of smooth muscle arising from the myometrium

-usually seen in post menopausal women

- areas of necrosis and hemorrhage

Back 805

Leiomyosarcoma

-do NOT arise from Leiomyomas!!!

Front 806

Risk factors for endometrial carcinoma?

Back 806

-HTN
-Obesity
-Nullparity
-Diabetes
- lAte menopause

"HONDA"

Front 807

Common side effect of Clomiphene

(partial estrogen agonist that can lead to ovulation)

Back 807

Vision disturbances

Front 808

What is the LH:FSH ratio seen in PCOS?

Back 808

2:1

Front 809

Why is FSH decreased in PCOS?

Back 809

There is ↑ conversion of testosterone (from theca hyperplasia) to ESTRONE.

Estrone feedback inhibits FSH resulting in cystic degredation of the follicles

Front 810

What can you give to a woman with PCOS to ↓ LH and androgenesis?

Back 810

low-dose OCP

medroxyprogesterone

Front 811

What can you give to a woman with PCOS to decrease acne and hirsutism?

Back 811

Spironolactone

Front 812

What is the most common ovarian mass in young women?

Back 812

Follicular cyst

Front 813

A dermoid ovarian cyst is a mature teratoma. They are filled with various types of tissue such as fat, bone, teeth cartilage and are derived from _____ tissue

Back 813

Ectodermal tissue

Front 814

Fetal tissue is present in a _____ hydatidiform mole

Back 814

Partial Mole

Front 815

How many chromosomes are present in a partial hydatidiform mole?

Back 815

69

-Normal ovum fertilized by 2 sperm

Front 816

How many chromosomes are present in a complete hydatidiform mole?

Back 816

46

Front 817

Ovarian Germ Cell Tumors:

Malignant germ cell tumor that is equivalent to a male seminoma

-tumor is composed of sheets of large shells with clear cytoplasm and central nuclei

-**Most common malignant germ cell tumor in females**

Back 817

Dysgerminoma

***a/w Turner's Syndrome!!***

Front 818

Tumor marker for Dysgerminoma?

(Ovarian germ cell tumor)

Back 818

↑ LDH ***

Front 819

Ovarian Germ Cell Tumor:

-Malignant tumor of tropoblasts and synsychioblasts

-mimics placental tissue

-NO CHORIONIC VILLI PRESENT ***

-⇈ βhCG

Back 819

Choriocarcinoma

Front 820

Ovarian Germ Cell Tumor:

-Aggressive malignancy in ovaries (testes in boys)

-Yellow, friable masses

- Histology resembles glomeruli (**Schiller Duval Bodies**)

**↑ AFP**

Back 820

Yolk Sac/Endometrial Sinus Tumor

Front 821

What is the most common germ cell tumor in females?

Back 821

Cystic Teratoma

Front 822

Ovarian tumor that is composed of thyroid tissue

Back 822

Struma Ovarii

(a teratoma)

Front 823

Ovarian Germ Cell Tumor:

-Malignant tumor comprised of large, primitive cells

Back 823

Embryonal Tumor

Front 824

What gene mutations cause increased risk for Ovarian CA and Tumors?

Back 824

BRCA-1
BRCA-2
HNPCC

Front 825

Ovarian non-germ cell tumor:

-Benign, frequently bilateral

-have a **fallopian-tube** like epithelium

Back 825

Cystadenoma

Front 826

Ovarian non-germ cell tumor:

-Malignant, frequently bilateral

-**Psammoma bodies** seen on histology

Back 826

Serous Cystadenocarcinoma

**Psammoma Bodies**

Front 827

Ovarian non-germ cell tumor:

-Malignant

-Can result in **Pseudomyxoma peritonei**
-Intrapreitoneal accumulation of mucinous material from OVARIAN or APPENDICEALl tumors

Back 827

Mucinous Cystadenocarcinoma

Front 828

Ovarian non-germ cell tumor:

-multilocular cyst lined by mucous secreting epithelium

-Intestine-like tissue

Back 828

Mucinous Cystadenoma

Front 829

Ovarian non-germ cell tumor:

-Benign and unilateral

-**Bladder epithelium**

-Solid tumor with pale yellow/tan color that appears encapsulated

- ***Coffee-bean like nuclei****

Back 829

Brenner Tumor

Front 830

-Bladder epithelium in ovarian cyst


***Coffee-bean nuclei***

Back 830

Brenner Tumor

Front 831

Intraperitoneal accumulation of mucinous material from an ovarian or apendiceal tumor

Back 831

Pseudomyxoma peritonei

Front 832

Female Sex-chord stromal tumors:

-Bundles of spindle-shaped fibroblasts

- "Pulling sensation" in groin

**Meig's Syndrome**
Triad of: 1) ovarian fibroma 2) ascites 3) hydrothorax

Back 832

Fibroma

Front 833

Triad of:

-Ovarian fibroma
-Ascites
-Hydrothorax (pleural effusion)

Back 833

**Meig's Syndrome**

due to fibromas... Symptoms go away with removal of tumors

Front 834

Female Sex-chord stromal tumors:

-Secretes estrohen --> precocious puberty

-Can cause endometrial hyperplasia in adults

-Abnormal uterine bleeding

**Call-Exner Bodies** = small follicles with eosinophilic secretions

Back 834

Granulosa-Theca Cell Tumor

Front 835

GI malignancy that metastasizes to the ovaries causing:

**mucin-signet ring cells**

Back 835

Krukenberg Tumor

Front 836

What is Ashermann Syndrome?

(female repro)

Back 836

Secondary ammenorrhea due to loss of basalis and scarring

-Result of overly-aggressive dilation and curettage

Front 837

Cancer from the lower 2/3 of the vagina spreads to the ____ nodes

Back 837

inguinal nodes

Front 838

Cancer from the upper 1/3 of the vagina metastasizes to the _____ nodes

Back 838

Iliac nodes

Front 839

Reproductive Neoplasm:

-Malignant mesenchymal proliferation of immature skeletal muscle

-seen in children < 4

**Bleeding, "grape-like" mass on vagina (or penis)**

- Contains spindle-shaped **Rhabdomyoblasts** with cross-striations

- stain (+) for desmin and myogenin

Back 839

**Stroma botryoides**
(Embryonal rhabdomyosarcoma)

(+) Desmin stain

Front 840

A young child presents with:

**Bleeding, "grape-like" mass on vagina (or penis)**

- Biopsy stains (+) for **Desmin**

Back 840

**Stroma botryoides**
(Embryonal rhabdomyosarcoma)

Front 841

DES exposure in utero may lead to ______ in women

Back 841

Clear Cell Vaginal CA

Front 842

Breast tumors:

- Small, mobile firm mass with sharp edges

↑ Size and tenderness with pregnancy or menstruation

Regress after pregnancy/menstruation

Back 842

Fibroadenoma

**Benign**

-Bilateral

- Not a precursor to breast cancer

Front 843

What is the most common breast tumor in women under 35 years of age?

Back 843

Fibroadenoma

Front 844

Breast tumors:

-Small tumor that grows in lactiferous ducts

**Serous Bloody Nipple Discharge**

- Slight increased risk for carcinoma

Back 844

Intraductal Papilloma

-Benign

Front 845

**Serous Bloody Nipple Discharge**

Back 845

Intraductal Papilloma

Front 846

Breast tumors:

- Common in women in their 60's

-Large, bulky mass of connective tissue cysts

**Leaf-like** projections

Back 846

Phyllodes Tumor

-benign --> some may become malignant

Front 847

Where is cancer most commonly found in the breast?

Back 847

Upper-outer quadrant

Front 848

What is the single most important prognostic factor for breast cancer?

Back 848

Axillary Node Involvement

Front 849

What are some risk factors for breast cancer?

Back 849

↑ estrogen exposure

-early menarche, late menopause

-older age at 1st live birth

-obesity

Front 850

Breast Tumors:

-Malignant

- Fills ductal lumen

-Arises from ductal hyperplasia

**DOES NOT cross basement membrane**

Back 850

DCIS

-Non-invasive

Front 851

Breast Tumors:

-Malignant

-Ductal

**Caseous necrosis**

-Does not cross BM, it is a subtype of DCIS

Back 851

**Comedocarcinoma**

-non-invasive

Front 852

**Caseous necrosis** of Ductal lumen in breast

Back 852

**Comedocarcinoma**

-subtype of DCIS, non-invasive

Front 853

Breast Tumors:

-Firm, fibrous "rock-hard" mass

- Sharp margins and small, glandular duct-like cells

**Stellate Morphology**

Back 853

Invasive Ductal Carinoma

Front 854

Breast Tumors:

-Malignant

-Multiple, Bilateral

**Metastasis to peritoneum**

**Signet-ring cells**

Back 854

Invasive Lobular CA

- **Single file** patternof growth in lobules

-Lacks E-CADHERIN --> can't stick to ducts so they remain in the lobule

Front 855

This form of Breast CA. forms no calcifications on biopsy.

Discohesive cells **lack-e-cadherin** adhesion protein

Back 855

Lobular Carcinoma in Situ
or
Invasive Lobular CA

Front 856

-Nipple retraction (new retraction)

-Peau d'orange (dimpling)

-Neoplastic cells block lymphatic drainage (swollen breast)

Back 856

Inflammatory Breast CA

-50% survival

Front 857

Which breast cancer has the worst prognosis?

Back 857

Inflammatory Breast CA

Front 858

Eczematous patches on the the nipple that will not go away.

Epidermal biopsy show **large cells with clear halo**

Back 858

Paget's Disease of the breast

Front 859

The BRCA-1 mutation is associated with ____ and ____

Back 859

breast and ovarian CA

Front 860

The BRCA-2 mutation is associated with ________

Back 860

breast cancer in MALES****

Front 861

Why do lobular breast carcinomas have good prognoses and are treatable?

Back 861

They are Estrogen & Progesterone receptor (+)

Front 862

Breast Tumor:

-malignant

-Fleshy, cellular, lymphocytic infiltrate (lymphocytes + plasma cells)

-May mimic fibroadenoma on mammogram

Back 862

Medullary Breast CA

-good prognosis

Front 863

What drugs have a side-effect of gynecomastia?

Back 863

Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole

"Some Drugs Create Awesome Knockers"

Front 864

Extramammary Paget Disease can occur on the vulva.

It most be distinguished from Melanoma.

How would these two stain for PAS, Keratin and S100?

Back 864

**Pagets**
(+) PAS
(+) Keratin
(-) S100

**Melanoma**
(-) PAS
(+) Keratin
(+) S100

Front 865

Which is associated with underlying malignancy, Paget's Disease of the breast of Paget's diseaseof the vulva?

Back 865

Paget's Dz of Breast

Front 866

During BPH, which lobes of the prostate enlarge and cause compression of the ureter leading to urinary Sx?

Back 866

Lateral & Middle Lobes
(Periurethral)

Front 867

Is BPH considered pre-malignant?

Back 867

No

Front 868

↑ free prostate-specific antigen (PSA)

Back 868

Indicator for BPH

Front 869

↑ total PSA

↓ **fraction** of free PSA

Back 869

Prostate CA

Front 870

Prostate CA arises from the ____ lobe

Back 870

Posterior Lobe

Front 871

Testicular Germ Cell Tumors:

-Most common testicular tumor

Back 871

Seminoma

Front 872

Testicular Germ Cell Tumors:

-Most common testicular tumor

-PAINLESS

-Occurs in young males

-Cells are in lobules and have **fried egg**

Back 872

Seminoma

Front 873

Testicular Germ Cell Tumors:

-PAINFUL

-glandular/papillary pathology

- may be associated with ↑βhCG and ↑AFP

Back 873

Embryonal Carcinoma

Front 874

Testicular Germ Cell Tumors:

-Yellow, mucinous

-Resemble glomeruli (Schiller-Duval Bodies)

-↑AFP

Back 874

Yolk Sac Tumor

Front 875

Testicular Germ Cell Tumors:

-Malignant

-↑βhCG

-Disordered trophoblasts

-May metastasize to LUNGS**

-Gyencomastia from ↑βhCG

Back 875

Choriocarcinoma

Front 876

Testicular non-Germ Cell Tumors:

-Golden brown color, produces testosterone

-Precocious puberty in boys

-Gynecomastia in men

**Reinke Crystals** seen histologically

Back 876

Leydig-Cell Tumor

**Reinke Crystals***

Increased Testosterone

Front 877

What is the most common cause of prostatitis in older men?

Back 877

E.coli (#1)

Pseudomonas

Front 878

What is the most common cause of prostatitis in young men?

Back 878

N. gonorrhea

Chlamydia

Front 879

Which antidepressant causes priapism?

Back 879

Trazadone

Front 880

Not having a circucism puts men at risk for what cancer of the penis?

Back 880

Squamous cell CA

Front 881

Opening of urethra on the inferior surface of the penis.

-due to **failure of urethral folds to close**

Back 881

Hydrospadias

Front 882

Opening of urethra on the superior surface of the penis.

Due to **abnormal positioning of genital tubercle**

Back 882

**Epispadias**

-a/w bladder extrophy
(part of bladder outside of body)

Front 883

This drug is a GnRH analog with agonist properties when used in pulsatile fashion

-Pulsatile Use treats infertility***

-Normal use is for prostate cancer or uterine fibroids

Back 883

Leuprolide

Front 884

This drug is a testosterone receptor inhibitor that is used to treat Prostate CA

Back 884

Flutamide

Front 885

How does ketoconazole inhibit steroid synthesis and act as an antiandrogen drug?

Back 885

inhibits desmolase

Front 886

What type of drugs are clomiphene, tamoxifen and raloxifene?

Back 886

SERMs

Front 887

Which SERM drug acts as anagonist in bone and may treat osteoporosis?

Back 887

Raloxifene

Front 888

Anastrozole/Exemestane inhibit what enzyme?

-Used in postmenopausal women with breast cancer

Back 888

Aromatase Inhibitors

Front 889

This drug is a competitive inhibitor of progestins at the progesterone receptor.

Used in the termination of pregnancy along with Misoprostol (PGE2)

Back 889

Mifepristone

Front 890

How do OCPs treat acne in women?

Back 890

OCPs increase Estrogen
↓
Increased SHBG
↓
Decreased Testosterone --> ↓ Acne

Front 891

What β2 agonists are used to relax the uterus and prevent pre-mature uterine contractions?

Back 891

Terbutaline

Ritodrine**

Front 892

******

This drug is an alpha blocker specific for the **α1A,D** receptor which is only found on the prostate!

Decrease smooth muscle contraction to help control urinary problems

**NO ORTHOSTATIC HYPOTENSION**

Back 892

Tamulosin

Front 893

-These drugs may cause impaired blue-green vision

Back 893

PDE Inhibitors

(Sildenafil)

Front 894

These drugs inhibit cGMP phosphodiesterasec--> ↑ smooth muscle relaxation --> ↑ blood flow to corpus cavernosum

Back 894

Sildenafil, vardenafil

(PDE Inhibitors)

Front 895

What is the name of a synthetic androgen drug that acts as a partial agonist at androgen receptors?

-Used for endometriosis and hereditary angioedema

Back 895

Danazol

Front 896

Learning in which a natural response (salivation) is elicited by a conditioned, or learned stimulus (bell) that was previously presented in conjunction with an unconditioned stimulus (food)

Back 896

Classical conditioning

Front 897

Learning in which a particular action is elicited because it produces a reward

Back 897

Operant Conditioning

Front 898

What are the 4 mature defense mechanisms?

Back 898

Sublimation

Altruism

Suppression

Humor

**SASH**

Front 899

What is anaclitic depression? Where is it seen

Back 899

Severe depression in an infant.

Seen in long-term deprivation of affection

Front 900

Who is the most likely person to physically abuse a child?

Back 900

Mother/Primary care-giver

Front 901

Who is the most likely person to sexually abuse a child?

Back 901

Known to victim, usually male

Front 902

Neurotransmitter Changes:

Alzheimer's

Back 902

↓ ACh

Front 903

Neurotransmitter Changes:

Depression

Back 903

↓Dopamine

↓Serotonin

↓NE

Front 904

Neurotransmitter Changes:

Huntington's Dz

Back 904

↓ GABA

↓ ACh

↑ Dopamine

Front 905

Neurotransmitter Changes:

Anxiety

Back 905

↑ NE

↓ GABA

↓Serotonin

Front 906

Neurotransmitter Changes:

Schizophrenia

Back 906

↑ Dopamine

Front 907

Neurotransmitter Changes:

Mania

Back 907

↑ NE

↑ Serotonin

Front 908

Neurotransmitter Changes:

Parkinson's Dz

Back 908

↓ Dopamine

↑ Serotonin

↑ ACh

Front 909

Which portion of the brain is responsible for memory/

Back 909

Hippocampus

Front 910

What psychosocial crisis is seen in young adults (18-35)

Back 910

Intimacy vs. Isolation

Front 911

What psychosocial crisis is seen in teens (12-18)?

Back 911

Identity vs. Role Confusion

Front 912

What psychosocial crisis is seen in infants (birth-18m)

Back 912

Trust vs. Mistrust

Front 913

What are the Kubler-Ross Stages of Grief? (5)

Back 913

Denial
Anger
Bargaining
Grief/Depression
Acceptance

**DABGA**

Front 914

Name the DSM_IV axes:

Back 914

I) Psychiatric Disorders

II) Intellectual disabilities/ Personality Disorders

III) General Medical Dx

IV) Psychosocial (stuff at home, work etc..)

V) Global Assessment Functioning

Front 915

What is the most common cause of CONGENITAL mental retardation?

Back 915

Down Syndrome

Front 916

What is the most common cause of mental retardation

(not congenital!)

Back 916

Fetal Alcohol Syndrome

Front 917

What eating disorder features enlarged parotid glands?

Back 917

Bulemia Nervosa

Front 918

Define alcohol abuse

Back 918

Continued alcohol use after recurrent, negative consequences

Front 919

What are the stages of behavioral change? (5)

Back 919

!) Precontemplation = +/- awareness, no thought in changing

2) Contemplation = desire to change

3) Preparation = intention to change

4) Action = begins to change

5) Maintenance = consistent change > 6 months

(Stage 6 is relapse)

Front 920

****Delirium vs. Dementia****

"Waxing, waning level of conciousness with acute onset"

Acute changes in mental status, ↓ attention span and level of arousal

Disorganized thinking

**Abnormal EEG**

Back 920

Delirium

-Reversible (check drugs)

Front 921

****Delirium vs. Dementia****

- Gadual decrease in cognition

-Consciousness IS NOT affected

-Memory Deficits

-Aphasia

-Impaired Judgment

**Normal EEG**

Back 921

Dementia

-Irreversible

Front 922

What is a hypnagogic hallucination?

Back 922

Hallucination while GOING to sleep

**HypnaGOgic

Front 923

What is a hypnopompic hallucination?

Back 923

Hallucination when waking from sleep

Front 924

_____ use is a risk factor for Schizophrenia in teens

Back 924

Marijuana

Front 925

In order to be diagnosed with Schizophrenia, a patient must have symptoms for at least ___ months

Back 925

6 months

Front 926

Schizophreniform disorder is diagnosed when a patient has symptoms for at least ___ months but less than ____ months

Back 926

at least 1 month

No more than 6 months

(more than 6 months is Schizophrenia)

Front 927

What is Schizoaffective disorder?

Back 927

at least 2 weeks of stable mood with psychotic symptoms
+
a major depressive, manic or mixed episode

Front 928

A brief psychotic disorder has symptoms of schizophrenia that last ______

Back 928

less than one month

Front 929

This is defined as a fixed, persistent, non-bizarre (could be plausible) belief system lasting more than 1 month.

Functioning isnot otherwise impaired.

Back 929

Delusional Disorder

Front 930

In order for a set of symptoms to be considered a "Manic" episode, they must be present for at least ______ and affect functioning

Back 930

at least 1 week

**AFFECTS FUNCTIONING**

Front 931

How do you distinguish a manic episode from a hypomanic episode.

Back 931

Manic = affects functioning

Hypomanic = doesn't affect functioning

Front 932

Cyclothymia is symptoms of dysthymia and hypomania, it is a milder form of bipolar disorder lasting at least ______

Back 932

2 years

Front 933

This is a milder form of depression lasting at least 2 years

Back 933

Dysthymia

Front 934

In order to be diagnosed with a major depressive episode, a patient must have symptoms for at least ____

Back 934

2 weeks

Front 935

What is a treatment option for pregnant women with major depressive disorder refractory to other treatments?

Back 935

Electroconvulsive Therapy

-SE: anterograde/retrograde amnesia

Front 936

A patient presents with hypersomnia, over-eating and mood reactivity (able to have a good mood).

He is sensitive to rejection.

Back 936

Atypical Depression

**M/C type of depression**

Front 937

Drug of choice for acute panic attacks?

Back 937

BZDs

Front 938

Drug of choice for "stage-fright"?

Back 938

Beta-blocker

Front 939

Go over Defense Mechanisms

Back 939

DIT-Psych Section (pg.16)

Front 940

What are the Cluster A Personality Disorders?

Back 940

Paranoid

Schizoid

Schizotypal

Front 941

What are the Cluster B Personality Disorders?

Back 941

Narcissistic

Histrionic

Borderline

Antisocial

Front 942

What are the Cluster C Personality Disorders?

Back 942

Avoidant

Dependent

Obsessive-Compulsive

Front 943

What sets Obsessive Compulsive Personality disorder apart from Obsessive Compulsive Disorder?

Back 943

People with OC Personality Disorder have no idea they have a problem

Front 944

What street drug causes Vertical + Horizontal nystagmus?

Back 944

PCP

Front 945

What are the "Mood Stabilizers" used in Bipolar disorder?

Back 945

Lithium
Carbamazepine
Valproic Acid

Front 946

Busiprone stimulates _____ receptors

Back 946

5-HT1A receptors

-Tx: General Anxiety Disorder

Front 947

Which antipsychotic drugs cause extrapyramidal symptoms?

(tardive dyskinesia)

Back 947

**1st Generation**
-Haloperidol
-Fluphenazine
Trifluoperazine

**Block D2 receptor**

Front 948

A patient who was recently prescribed antipsychotics presents with hyperpyrexia, rigidity, myoglobinuria and autonomic instability

Back 948

Neuroleptic Malignant Syndrome

**Treat with dantrolene + Dopamine agonist (bromocriptine)**

Front 949

These drugs primarily treat the positive symptoms of Schizophrenia

Back 949

Antipsychotics

Front 950

These drugs treat both positive and negative symptoms of schizophrenia (mostly negative)

Back 950

Atypical Antipsychotics

Front 951

This atypical antipsychotic may cause agranulocytosis

Back 951

Clozapine

Front 952

These atypical psychotics cause considerable weight gain

Back 952

Olanzapine/Clozapine

Front 953

This atypical antipsychotic prolongs the QT interval

Back 953

Ziprasidone

Front 954

What is an endocrine side effect of the typical antipsychotics?

Back 954

Hyperprolactemia

Front 955

haloperidol + "-azines"

Back 955

Antipsychotics (typical)

Front 956

MOA of Antipsychotics (typical)

Back 956

block D2 receptors

Tx: Schizophrenia, Tourettes

Front 957

Which atypical antipsychotic is used for OCD, anxiety disorder, depression, mania and Tourette's

Back 957

Olanzapine

Front 958

Which generation of antipsychotics has side effects of:

-Antimuscarinic = dry mouth, constipation

-Histamine = sedation

- α = HYPOtension

Back 958

2nd Generation Antipsychotics

-Chlorpromazine
-Thioridazine

Front 959

Which TCA can be used to treat bedwetting?

Back 959

imipramine

Front 960

Why do you want to try and avoid TCA use in the elderly?

Back 960

Antimuscarinic effects can cause confusion and hallucinations

**use nortryptyline**

Front 961

Which TCA has the largest antimuscarinic effect?

Back 961

Amitriptyline

Front 962

MOA of TCAs?

Back 962

block reuptake of NE and Dopamine

Front 963

Which antidepressant class causes the "Tri-C's" side effects of:

1) Convulsions

2) Coma

3) Cardiotoxicity (arrythmias)

Back 963

TCAs

Front 964

How do you treat TCA overdose?

Back 964

Alkalinize urine

**NaHC03**

Front 965

Antidepressants:

"iptyline" or "ipramine" + doxepin + amoxapine

Back 965

TCAs

Front 966

Antidepressants:

Fluoxetine
Paroxetine
Sertaline
Citalopram

Back 966

SSRIs

Front 967

What happens if a patient takes an SSRI and an MAO inhibitor at the same time?

Back 967

**Serotonin Syndrome**

-hyperthermia, myoclonus, CV collapse, flushing, diarrhea, seizures

Front 968

What is the antidote for Serotonin Syndrome?

Back 968

Cyproheptadine

(5-HT2 agonist)

Front 969

What type of drug would you use in a patient with Bulemia?

Back 969

SSRIs
-------------
Fluoxetine
Paroxetine
Sertaline
Citalopram

Front 970

What happens if you ingest tyramine while on an MAO inhibitor?

-Tranylcypromine
-Phenelzine
-Isocarboxazid
-Selegiline

Back 970

Hypertensive Crisis

Front 971

MAO inhibitors increase levels of which neurotransmitters?

Back 971

NE
Serotonin
Dopamine

Front 972

What is the MOA of Selegiline? Used in Parkinson's

Back 972

MAO-B inhibitor

Prevents the breakdown of levodopa!!

Front 973

MOA of SNRIs

-Venlafaxine
-Duloxetine

Back 973

block reuptake of NE, Serotonin

Front 974

Name the SNRIs

Back 974

-Venlafaxine
-Duloxetine

Front 975

Name the MAO inhibitors

Back 975

-Tranylcypromine
-Phenelzine
-Isocarboxazid
-Selegiline

Front 976

Name the SSRIs

Back 976

Fluoxetine
Paroxetine
Sertaline
Citalopram

Front 977

These drugs are used for:

-Depression
-OCD
-Bulemia
-Social Phobias
-PTSD

Back 977

SSRIs
------------
Fluoxetine
Paroxetine
Sertaline
Citalopram

Front 978

Which SNRI is indicated for diabetic peripheral neuropathy?

Back 978

duloxetine

Front 979

This atypical anti-depressant is used for insomnia.

High doses are needed for anti-depressant effects.

May cause ***priapism***

Back 979

Trazodone

Front 980

Does Buproprion have sexual side effects?

Back 980

No

-also used for smoking cessation

Front 981

Name 2 drugs used for smoking cessation

Back 981

Varenicline
Buproprion

Front 982

This Atypical-antidepressant is an α2 antagonist that ↑ release of NE + Serotonin

- it also stimulates 5-HT2 and 5-HT3 receptors

**Antihistamine affects may ↑ appetite**

**Sedation effects good for Depression + Insomnia**

Back 982

Mirtazapine

Front 983

What % of body weight is:

-Total Body Water?

-ICF?

-ECF?

Back 983

-Total Body Water = 60%

-ICF = 40%

-ECF = 20% (25% is plasma, 75% is interstitial)

Front 984

Where do the ureters pass near the vas deferens?

Back 984

Ureters go UNDER the vas deferens

Front 985

In a female, the ureters pass UNDER the ____ artey

Back 985

Uterine

Front 986

A loss of negative charge in the glomerular basement membrane will cause _____ syndrome

Back 986

NEPHROTIC syndrome

Front 987

Plasma volume is measured by radiolabeled _____

Back 987

albumin

Front 988

Extracellular volume is measured by _____

Back 988

inulin

Front 989

What is the equation for renal clearance?

Back 989

Cx = (Ux χ V)/Px

--------------------------------------

Cx < GFR = net tubular reabsorption of x

Cx > GFR = net tubular secretion of X

Front 990

Prostaglandins DILATE the AFFERENT arteriole

How does this affect GFR, RPF, FF?

Back 990

↑ GFR

↑ RPF

No change FF

Front 991

ACE inhibitors CONSTRICT the EFFERENT tuble.

How does this affect GFR, RPF, FF?

Back 991

↑ GFR

↓ RPF

↑ FF

Front 992

Renal:

There is CONSTRICTION at the afferent arteriole.

How does this affect GFR, RPF, FF?

Back 992

↓ GFR

↓ RPF

No change FF

Front 993

Renal:

There is CONSTRICTION at the EFFERENT arteriole

How does this affect GFR, RPF, FF?

Back 993

↑ GFR

↓ RPF

↑ FF

Front 994

Renal:

There is an INCREASE in plasma protein concentration.

How does this affect GFR, RPF, FF?

Back 994

↓ GFR

No change RPF

↓ FF

**Increased Viscosity**

Front 995

Renal:

There is a DECREASE in plasma protein concentration.

How does this affect GFR, RPF, FF?

Back 995

↑ GFR

No Change RPF

↑ FF

**Decreased Viscosity**

Front 996

Renal:

There is constriction of the ureter.

How does this affect GFR, RPF, FF?

Back 996

↓ GFR

No change RPF

↓ FF

Front 997

Glucose is reabsorped in the proximal tubule by ____/glucose cotransport

Back 997

Na+/glucose cotransport

Front 998

Hartnup's Disease is a deficiency of ____ transport which results in ↓ Vit. B3 (niacin) and PELLAGRA

Back 998

Tryptophan

---------------------------------------------

Pellagra
1) Diarrhea
2) Dermatitis
3) Dementia

Front 999

ADH binds to __ receptors at the collecting tubules of the nephron

Back 999

V2 receptors

Front 1000

Renal:

These drugs block the Na+/K+/2Cl- transporter in the Thick Ascending Loop of Henle

Back 1000

Loop Diuretics

Front 1001

Renal:

These drugs block the Na+/Cl- transporter in the Distal Convoluted Tubule

Back 1001

Thiazides

Front 1002

Renal:

Which drugs work in the Collecting Tubule to inhibit Na+/K+ exchange

Back 1002

Potassium Sparing Diuretics

Front 1003

How does ↑ sympathetic tone (β1) afect the JG cells?

Back 1003

↑ renin rlease

Front 1004

This hormone is released from the atria in response to ↑ volume.

Acts to "check" the RAAS system.

Relaxes smooth muscle via cGMP --> ↑GFR --> ↓ renin

Back 1004

ANP

Front 1005

How can NSAIDs cause renal failure?

Back 1005

↓ Prostaglandins needed to DILATE the afferent tubule in order to maintain GFR

Front 1006

What enzyme in the kidney converts:

25-OH Vit. D
↓
1,25 (OH)2 Vit. D?

Back 1006

1α-hydroxylase

Front 1007

Potassium Shifts:

- ↓ insulin

- β-blockers

- Acidosis/Extreme Excercise

- Hyperosmolarity

- Digitalis

- Cell Lysis

Back 1007

K+ shifts OUT OF CELL
↓
HYPERkalemia

---------------------------------------

- ↓ insulin (blocks Na/K ATPase)

- β-blockers (blocks Na/K ATPase)

- Acidosis/Extreme Excercise (↑ K/H exchange)

- Hyperosmolarity

- Digitalis (blocks Na/K ATPase)

- Cell Lysis

Front 1008

Potassium Shifts:

↑ Insulin

β-agonists

Alkalosis

Hypo-osmolarity

Back 1008

Potassium shifts INTO cell
↓
HYPOkalemia

-----------------------------------

↑ Insulin (↑ Na/K ATPase)

β-agonists (↑ Na/K ATPase)

Alkalosis (↑ K/H exchange)

Hypo-osmolarity

Front 1009

U waves on ECG

Flattened T waves

Back 1009

HYPOkalemia

Front 1010

What class of diuretic primarily affects Principle Cells in the Colecting Duct of the nephron?

Back 1010

K+ sparing diuretics

Front 1011

Does excess insulin cause hyperkalemia or hypokalemia?

Back 1011

Hypokalemia

Shifts K+ INto cells

Front 1012

oxalate crystals in urine

Back 1012

Ethylene Glycol Ingestion
↓
Acute Tubular Necrosis

Front 1013

What segement of the renal tubule is responsible for concentrating the urine?

Back 1013

collecting duct

Front 1014

What segement of the renal tubule is responsible for diluting the urine?

Back 1014

Thick Ascending Limb of Loop of Henle

(Impermeable to Water)

Front 1015

What segement of the renal tubule is the only site where glucose and amino acids are absorbed?

Back 1015

Proximal tubule

Front 1016

What segement of the renal tubule is the only portion where water resorption occurs in the Loop of Henle?

Back 1016

Thin Descending Limb

Front 1017

Urine osmolarity < Serum Osmolarity

Back 1017

Diabetes Insipidus

Front 1018

Subendothelial immune complex deposits in gomeruli

Back 1018

Membranoproliferative GN

**See Tram Tracking**

Front 1019

Subepithelial immune complexe deposits in glomeruli

Back 1019

Membranous GN

**Spikes and domes of BM***

Front 1020

Other than Polycystic Kidneys, what 3 other complications are associated with ADPKD?

Back 1020

MVP

Berry Aneurysm

Hepatic Cysts

Front 1021

What is the most common glomerular disease seen in HIV patients and Heroin users?

Back 1021

Focal Segmental Sclerosis

Front 1022

What is the most common nephrotic syndrome seen in adults?

Back 1022

Membranous GN

**Spikes and domes of BM***

Front 1023

Why are patients with a nephrotic syndrome in a hypercoaguble state?

Back 1023

Loss of Anti-thrombin III in urine

Front 1024

Crescents seen in urine

-Hemoptysis/Hematuria

Back 1024

Goodpastures

**Linear Immunoflouresence**

Front 1025

Crescents seen in urine

(+) p-ANCA

Back 1025

Microscopic polyangitis

Front 1026

Crescents seen in urine

(+) c-ANCA

Back 1026

Wegener's

Front 1027

What diseases are associated with Type I MPGN?

Back 1027

HBV

HCV

Front 1028

What autoantibody is associated with Type II MPGN?

Back 1028

C3 nephritic factor

Front 1029

If a patient with SLE presents with a nephrotic syndrome, what is the most likely diagnosis?

Back 1029

Membranous GN

**Spike and Dome**

Front 1030

What is the first step of nephrotic syndrome in a patient with Diabetes?

Back 1030

Non-enzymatic glycosylation of BM

Front 1031

What type of kidney stone would you see in a patient being treated for leukemia?

Back 1031

Uric Acid Stone

(high cell turnover)

Front 1032

This Cancer presents with hematuria, palpable mass and flank pain.

-May see polycythemia

Back 1032

Renal Cell CA

**May see polycythemia from ↑EPO**

Front 1033

What autosomal dominant disease is associated with bilateral cenal cell CA?

Back 1033

von Hippel Lindau

(deletion Chromosome 3)

Front 1034

What is the main rout of renal cell CA metastasis?

Back 1034

Spreads via IVC

Front 1035

Wilm's tumor is caused by a deletion of the WT1 gene on chromosome ____

Back 1035

chromosome 11

Front 1036

A patient complains of painless hematuria.

There are no casts in his urine

Back 1036

Transitional Cell CA

Front 1037

What organism can cause squamous cell carcinoma of the bladder?

Back 1037

Schistosoma hematobium

Front 1038

These agents may cause what type of cancer?

-Phenacetin
-Smoking
-Aniline dyes
-Cyclophosphamide

Back 1038

Transitional Cell CA

Front 1039

Bladder biospy shows:

"Papillary growth lined by transitional epithelium with mild nuclear atypia and pleomorphism"

Back 1039

Transitional Cell CA

Front 1040

What is the most common agent of pyelonephritis?

Back 1040

E. coli

Front 1041

What abnormality is required in order for a patient to have Chronic pyelonephritis?

Back 1041

Vesicourethral reflux

Front 1042

Renal imaging shows corticomedullary scarring, blunted calyx

- Biopsy reveals tubules contain eosinophilic casts that resemble thyroid follicles (Thyroidization of kidney)

(+) Vesicourethral reflux

Back 1042

Chronic pyelonephritis

Front 1043

Crush injuries can cause what renal problem?

Back 1043

Acute tubular necrosis

**d/t myoglobinuria**

Front 1044

granular, "muddy brown" casts in urine

Back 1044

Acute tubular necrosis

Front 1045

Waxy casts in urine

Back 1045

Renal Failure

Front 1046

How do the following K+ sparing diuretics work?

-Amiloride
-Triamterene

Back 1046

Block Na+ channels in the collecting duct

Front 1047

What effect do ACE inhibitors have on renin?

Back 1047

Increased renin

(you are decreasing AT II)

Front 1048

What effect do ACE inhibitors have on K+ levels

Back 1048

Hyperkalemia

(decrease aldosterone by blocking AT II formation)

Front 1049

Histology for type I pneumocytes?

Back 1049

Squamous epithelium

Front 1050

Histology for type II pneumocytes?

Back 1050

Cuboidal

Front 1051

Which type of pneumocyte carries out gas exchange?

Back 1051

type I pneumocyte

Front 1052

Which type of pneumocyte is increased during episodes of lung damage?

Back 1052

type II pneumocyte

(proliferate to type I and type II pneumocytes)

Front 1053

In the lungs, these cells are nonciliated columnar with secretory granules.

Secrete a component of surfactant, degrade toxins, and act as reserve cells

Back 1053

Clara Cells

Front 1054

Where is the pulmonary artery located in relation to the Right Bronchus?

Back 1054

ANTERIOR

**RALS**

Front 1055

Where is the pulmonary artery located in relation to the Leftt Bronchus?

Back 1055

SUPERIOR

**RALS**

Front 1056

At what thoracic level does the IVC perforate the diaphragm?

Back 1056

T8

Front 1057

At what thoracic level does the esophagus and vagal branches perforate the diaphragm?

Back 1057

T10

Front 1058

At what thoracic level does the Aorta perforate the diaphragm?

Back 1058

T12

Front 1059

What extra muscles are used for inspiration in a person excercising heavily?

Back 1059

External Intercostals

Scalenes

SCM muscles

Front 1060

What serine protease activated bradykinin?

Back 1060

Kallikrein

Front 1061

What extra muscles are used for expiration in a person excercising heavily?

Back 1061

rectus abdominus

internal and external obliques

transversus abdominus

internal intercostals

Front 1062

What nerve innervates the latissimus dorsi muscle?

Back 1062

Thoracodorsal n.

Front 1063

The Taut form of Hb has a ____ affinity for oxygen

Back 1063

Lower affinity

(curve shift right)

Front 1064

The relaxed form of Hb has a _____ oxygen affinity

Back 1064

Higher affinity

(curve shift left)

Front 1065

Which form of Iron on Hb binds to oxygen better?

Fe++ or Fe+++

Back 1065

Fe++

----------------------------------

Reduced (ferrous) Fe3+ causes methhemoglobinuria. has a higher affinity for CN-

Tx: Methylene blue + Vit. C

Front 1066

What is the treatment for cyanide poisoning?

Back 1066

1) Nitrites --> oxidize Fe2+ to Fe3+ --> forms methemoglobin which binds to CN-

2) Thiosulfate --> binds to this CN compund--> converts to thiocyanate --> renally excreted

Front 1067

A patient presents with headache, blurry vision and a red tint to their skin.

Normal PaO2

Low SaO2

Back 1067

CO poisoning

---------------------------------

PaO2 (pulse ox) is normal because CO is binding to hemoglobin

SaO2 is decreased because CO binds Hb with GREATER affinity than O2

Front 1068

CO causes a ____ oxygen binding capacity with a ____ shift in the oxygen disassociation curve

Back 1068

decreased oxygen binding capacity

left shift in oxygen disassociation curve

Front 1069

Which way would the oxygen disassociation curve shift?

↑ CO2
↑ BPG
↑ Exercise
↑ Acid/Altitude (decreased pH)
↑ Temperature

Back 1069

Right Shift

------------------------------------

↓ O2 affinity causes oxygen unloading in states where tissues need the oxygen

Front 1070

Which way would the oxygen disassociation curve shift?

↓ CO2
↓ BPG
↓ Exercise
Alkalosis (increase pH)
↓ Temperature

Back 1070

Shift Left

---------------------------

↑ affinity for O2 means Hb will hang on to oxygen longer

Front 1071

How do the lungs respond in instances of ↓ PAO2 (arterial oxygen)?

Back 1071

Hypoxic Vasoconstriction

-shunts blood away from poorly ventilated regions of the lung to better ventilated regions of the lung

Front 1072

The area available for pulmonary perfusion _____ in emphysema

Back 1072

decreases

(less USABLE area)

Front 1073

Why does fibrosis cause poor difusion?

Back 1073

Membranes are too thick!

Front 1074

How does excercise affect venous PO2?

Back 1074

↓ venous PO2

Front 1075

What heart anomaly may occur in persons trapped at a high altitude?

Back 1075

RVH from increased hypoxic pulmonary vasoconstriction

Front 1076

During excercise, the V/Q ratio from the apex to the base of the lung becomes more _____

Back 1076

unified

(closer to V/Q=1)

Front 1077

A person who is on vacation in a high altitude may have what acid/base disoder?

Back 1077

Resp. Alkalosis

**Increased rate of breathing blows off CO2**

Front 1078

What gene mutation is present in patients with primary pulmonary HTN?

Back 1078

Inactivating mutation of BMPR2

(normally functions to inhibit vascular smooth muscle proliferation)

Front 1079

Name some drugs to treat pulmonary HTN

Back 1079

Bosentan

Ambriosentan

Sildenafil

Nifedipine (DHT CCB)

Front 1080

What is the best imaging study for Pulmonary Embolism?

Back 1080

Helical CT

Front 1081

(+) Homan's sign

Back 1081

Pain in calf with dorsiflexion of foot

**DVT***

Front 1082

Where do most pulmonary emboli arise from?

Back 1082

Deep leg veins

Front 1083

Hypertrophy of mucus secreting glands in the bronchioles

-Reid index > 50&

Wheezing, crackles, cyanosis

Back 1083

Chronic Bronchitis

Front 1084

Why do patients with emphysema use "pursed lip" breathing?

Back 1084

increases airway pressure to prevent airway collapse during respiration

Front 1085

Chronic, necrotizing infection of the bronchi

-permanently dilated airways

-purulent foul smelling sputum

-recurrent infections, hemoptysis

Back 1085

Bronchiectasis

Seen in:

CF
Kartagener's
Chronic smokers

Can increase risk of Aspergillosis

Front 1086

When do type II pneumocytes mature in utero and begin to make surfactant?

Back 1086

35 weeks

Front 1087

What musculoskeletal disease can cause restrictive lung disease if the Cobb Angle is > 50 degrees?

Back 1087

Scoliosis

Front 1088

Silicosis increases the risk for ____ infection

Back 1088

TB infection

Front 1089

What restrictive lung disease features an increase in ACE?

Back 1089

Sarcoidosis

Front 1090

Name 3 drugs that cause pulmonary fibrosis

Back 1090

Busulfan
Bleomycin
Amiodarone

Front 1091

____ is failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart

Back 1091

Cor Pulmonale

Front 1092

"golden brown fusiform rods resembling dumbells"

-found in alveolar macrophages

Back 1092

Asbestosis

Front 1093

"Egg-shell calcification of hilar lymph nodes"

Back 1093

Silicosis

Front 1094

What lung lobes does Asbestosis affect?

upper vs. lower

Back 1094

lower lung lobes

------------------------------------

Silicosis + Coal miners = upper lobes

Front 1095

dipalmitoyl phosphatidylcholine

Back 1095

surfactant

Front 1096

Risks for Infant ARDS?

Back 1096

Prematurity (less than 35 wk)

C-section

Maternal Diabetes (↑ insulin)

Front 1097

Why do you see polycythemia in sleep apnea?

Back 1097

↑ Hypoxia --> EPO --> Erythrocytosis

Front 1098

Trauma, sepsis, shock, gastric aspiration, pancreatitis, amniotic fluid embolism

↑ alveolar capillary permeability
↓
protein leaks into alveoli
↓
form intra-alveolar hyaline membrane

Back 1098

Acute Respiratory Distress Syndrome

-initial damage is d/t immune response to toxic substances

Front 1099

Which way does the trachea deviate in a patient with bronchial obstruction?

Back 1099

Toward side of destruction

Front 1100

In which lung cancer do you see a neoplasm of neuroendocrine "Kulchitsy Cells" --> small dark blue cells

-"salt & pepper" appearance

Back 1100

Small (Oat) Cell carcinoma

-Central

Front 1101

What is the most common lung cancer in non smoker and females?

**Develops in site of previous inflammation or injury**

Back 1101

Adenocarcinoma

-Peripheral

Front 1102

This Lung Cancer grows **along the airways**

-can present as pneumonia

-may lead to hypertrophic osteoarthropathy

Back 1102

Bronchioalveolar CA

Front 1103

Lung Cancer:

-Cavitation

Biopsy shows "keratin pearls and intracellular bridges"

Back 1103

Squamous Cell CA

-Central

Front 1104

Lung Cancer:

-Linked to smoking

-Cavitation

-PTHrP secretion acts like PTH

Back 1104

Squamous Cell CA

Front 1105

Lung Cancer:

-Peripheral

-Highly anaplastic and undifferentiated

-Biopsy:
**Pleomorphic Giant Cells with leukocyte fragments in cytoplasm**

Back 1105

Large Cell CA

Front 1106

Coal miners may have exposure to ___ which puts them at risk of developing lung cancer

Back 1106

Radon

Front 1107

Lung Tumor:

-may also present in the appendix

-can cause fibrous deposits on right heart valves, especially the tricuspid valve.

(May also cause pulmonary Stenosis, RHF)

Back 1107

Carcinoid Tumor

Front 1108

-Obstruction of the SVC that impairs blood drainage fromt he head ("facial plethora"), neck (JVD) and Upper extremities (UE)

Back 1108

SVC Syndrome

-common with Lung Tumors and thromboses

Front 1109

Pneumonia:

Which organisms may cause Bronchopneumonia?

-Acute inflammatory infiltrates from bronchioles to adjacent alveoli

See **Patchy infiltrates** involving one or more lobes

Back 1109

-S. aureus
-H. influenzae
-Klebsiella
-S. pyogenes

Front 1110

What organism cause interstitial pneumonia in infants and children?

Back 1110

RSV
Chlamydia (stacatto cough)

Front 1111

What organisms cause interstitial (atypical) pneumonia in adults?

Back 1111

Mycoplasma
Legionella
Chlamydia

Front 1112

Respiratory:

-Localized collection of pus within parenchyma

**Air fluid levels** seen on CXR

Back 1112

Lung abscess

-S. aureus
-Anaerobes
(Bacteroides, Fusobacterium, Peptostreptococcus)

Front 1113

Spontaneous pneumothorax occurs due to rupture of _____

Back 1113

apical blebs

Front 1114

Asthma drugs:

MOA of Theophylline?

Back 1114

Causes Bronchodilation

-inhibits PDE --> ↓ cAMP hydrolysis (breakdown)

**Blocks adenosine actions**

Front 1115

Asthma drugs:

This drug prevents release of mediators from Mast cells. Prophylaxis for asthma

Back 1115

Cromolyn

Front 1116

Which leukotriene receptor blocker can you use to treat asthma in a patient that is 1 year old?

Back 1116

Montelukast


-------------------------------
Have to be at least 5 yo for Zafirlukast

Front 1117

In asthma treatment, corticosteroids block the formation of almost all inflammatory cytokines.

They inactivate ____ the transcription factor for TNF-α

Back 1117

NF-κB

Front 1118

How does Bosentan reduce pulmonary hypertension?

Back 1118

Blocks endothelin-1 receptors

-decreased pulmonary vascular resistance

Front 1119

This drug is a synthetic codeine analog and has antitussive properties by blocking NMDA-glutamate receptors.

Mild opiod effect when used in excess

Back 1119

dextromethorphan

Front 1120

This drug is used as an expectorant in CF patients

Back 1120

**N-acetylcysteine**

-also used for acetaminophen overdose --> regenerates glutathione