Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
60 Cards in this Set
- Front
- Back
|
What would expect to find in a pt with a lesion of CN XII? CN X?
|
Difficulty swallowing & speaking
CN XII tongue deviates towards side of lesion CN X tongue deviates away from side of lesion |
|
|
What are some of the distinctive clinical features of Williams syndrome?
|
Congenital micro-deletion of long arm of chromosome 7 (deleted region includes Elastin gene)
Distinctive “elfin” facies, mental retardation, well-developed verbal skills, cheerful disposition, extreme friendliness with strangers, cardiovascular problems |
|
|
On which cells would you find CD3 molecules? On which cells would you find CD4 molecules? To what do CD4 molecules bind? On which cells would you find CD8 molecules? To what do CD8 molecules bind?
|
CD3 complex – cluster of polypeptides associated with a T-cell receptor
CD4 – helper T cells, bind MHC II on antigen-presenting cells CD8 – cytotoxic T cells, bind MHC I on virus-infected cells |
|
|
What causes the S1, S2, S3, and S4 heart sounds?
|
S1 sounds – tricuspid & mitral valve closing
S2 sounds – aortic & pulmonic valve closing S3 – in early diastole during rapid ventricular filing phase; associated with increased filling pressures & dilated ventricles (normal in children) S4 – “atrial kick” – late diastole; high atrial pressure; assoc. w/ventricular hypertrophy; left atrium must push against stiff LV wall |
|
|
Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each?
|
Neostigmine → post-op & neurogenic ileus, urinary retention, myasthenia gravis, NMJ blockade reversal
Pyridostigmine → myasthenia gravis (long acting); does not penetrate CNS Edrophonium → Diagnosis of myasthenia gravis (extremely short acting) Physostigmine → glaucoma (crosses BBB → CNS) & atropine overdose Echothiophate → glaucoma |
|
|
What are the main differences between nephritic syndrome and nephrotic syndrome?
|
Nephritic syndrome = inflammatory process involving glomeruli, leading to hematuria, azotemia, RBC casts in urine, oliguria, hypertension, & proteinuria (< 3.5 g/day)
Nephrotic syndrome = presents with massive proteinuria (> 3.5g/day, frothy urine), hyperlipidemia, edema |
|
|
What are the acidic and basic amino acids? Where can you find high concentrations of basic amino acids? Why are these amino acids found in these areas?
|
Acidic amino acids – Asp & Glu
Basic amino acids -Arg, Lys, & His Arg & Lys are increased in histones, which bind negatively charged DNA |
|
|
What bacteria are known for causing bloody diarrhea?
|
Campylobacter, Salmonella, Shigella, Entero-hemorrhagic E. coli, Entero-invasive E. coli, Yersinia enterocolitica, C. difficile (both watery & bloody)
|
|
|
What nerve injury would you suspect in a pt with the following motion deficits?
• foot drop (loss of dorsiflexion) • loss of plantar flexion • loss of knee jerk • loss of hip adduction |
•foot drop (loss of dorsiflexion) → Common peroneal
•loss of plantar flexion → Tibial •loss of knee jerk → Femoral •loss of hip adduction → Obturator |
|
|
What are the leading causes of death in infants?
|
Congenital anomalies, short gestation/low birth weight, sudden infant death syndrome, maternal complications of pregnancy, respiratory distress syndrome
|
|
|
What is the equation for determining a drug’s volume of distribution?
|
Volume of distribution (Vd) = amount of drug in the body / plasma drug concentration
- Low Vd (4-8L) distribute in blood - Medium Vd distribute in extracellular space or body water - High Vd (> body weight) distribute in tissues |
|
|
What are the clinical features of hyperammonemia?
|
Tremor, slurring of speech, somnolence, vomiting, cerebral edema, blurring of vision
|
|
|
What are the clinical features of hyperammonemia?
|
Tremor, slurring of speech, somnolence, vomiting, cerebral edema, blurring of vision
|
|
|
What changes in sleep patterns and sexual anatomy are seen in the elderly?
|
- Sleep patterns – decr. REM sleep, decr. Slow-wave sleep, incr. sleep latency, incr. awakenings during the night
- Men – slower erection/ejaculation, longer refractory period - Women – vaginal shortening, thinning & dryness |
|
|
Describe the probe and sample to which the probe binds in the following molecular biology techniques: Southern blot, Northern blot, and Western blot.
|
- Southern blot = Labeled DNA probe binds DNA sample
- Northern blot = Radioactive DNA probe binds sample RNA - Western blot = labeled antibody binds sample protein |
|
|
What are the diagnostic criteria for major depressive episode? What changes in sleep patterns are seen in pts with depression?
|
“SIG E CAPS”
- Sleep disturbance - Loss of interest (anhedonia) - Guilt or feelings of worthlessness - Loss of energy - Appetite or weight changes - Psychomotor retardation or agitation - Suicidal ideations - Depressed mood Sleep patterns of depressed patients: - Decreased slow wave sleep - Decreased REM latency - Increased REM early in sleep cycle - Increased total REM sleep - Repeated nighttime awakenings - Early-morning awakenings |
|
|
What is the clinical definition of chronic bronchitis?
|
(“Blue Bloater”) - Productive cough for > 3 consecutive months in >2 years. Disease of small airways
|
|
|
Which neoplasm is most commonly responsible for the hormone paraneoplastic syndrome? (FA p218)
-ACTH → Cushing’s syndrome -PTH-related peptide → hypercalcemia -erythropoietin → polycythemia -ADH → SIADH |
-ACTH → Cushing’s syndrome - small cell lung carcinoma
-PTH-related peptide → hypercalcemia - squamous cell lung carcinoma, renal cell carcinoma, & breast carcinoma -erythropoietin → polycythemia - renal cell carcinoma, hemangioblastoma -ADH → SIADH – small cell lung carcinoma & intracranial neoplasms |
|
|
What is the blood supply to the embryonic foregut, midgut, and hindgut? What adult structures arise from these primitive guts?
|
- Foregut – Celiac artery → Stomach to proximal duodenum; liver, gallbladder
- Midgut – SMA → distal duodenum to proximal 2/3 of transverse colon - Hindgut – IMA → distal 1/3 of transverse colon to upper portion of rectum; splenic flexure is watershed region |
|
|
Which tract of the spinal cord relays sensory information from the body? Which tract relays pain and temperature sensation? Which tract relays motor sensation to the body?
|
Sensory info – dorsal column – medial lemniscal pathway
Pain & temp sensation – spinothalamic tract Motor sensation to body – lateral corticospinal tract |
|
|
What is most common tumor of the salivary gland? What is the most common malignant tumor?
|
Most common tumor is pleomorphic adenoma of parotid gland
Most common malignant tumor is mucoepidermoid carcinoma |
|
|
What is the difference between a case-control study, a cohort study, and a clinical trial? (FA p60) Which studies use odds ratios, and which use relative risks?
|
Case control study – Compares a group of people with disease to a group without
- Observational & retrospective – asks, “What happened?” - Uses odds ratio (OR) Cohort study – Compares a group with a given risk factor to a group without to assess whether the risk factor increases likelihood of disease - Observational & prospective – asks, “What will happen? - Uses relative risks (RR) Clinical trial – Experimental study involving humans; Compares therapeutic benefits of 2 or more treatments, or of treatment & placebo; Highest-quality study when randomized, controlled & double-blind |
|
|
Three days ago you hospitalized a 40-year-old male for myocardial infarction. He has been given all of the usual medications. Today you notice that his platelet count is 30,000. What do you suspect is the cause of his low platelets?
|
Heparin-induced thrombocytopenia – heparin binds to platelets, causing autoantibody production that destroys platelets & over-activates remaining ones, resulting in thrombocytopenic, hypercoagulable state
|
|
|
What are the different etiologies of Cushing’s syndrome? How is the level of ACTH different in each?
|
- Increased cortisol due to variety of causes
- Pituitary adenoma (Cushing’s disease) – Incr ACTH - Adrenal hyperplasia/neoplasia – decr. ACTH - Ectopic ACTH production (e.g. small cell lung cancer) – incr. ACTH production - Iatrogenic (chronic steroid use) – decr. ACTH; most common etiology |
|
|
Which virus is responsible for the following disease?
-croup in children -common cold (2 viruses) -#1 cause of fatal diarrhea in children -bronchiolitis in infants (especially premature) |
-croup in children → Parainfluenza
-common cold (2 viruses) → Rhinovirus & Coronavirus -#1 cause of fatal diarrhea in children → Rotavirus -bronchiolitis in infants (especially premature) → Respiratory Syndactyl Virus |
|
|
How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug?
|
- 4 half-lives to reach 94% of steady state
- Half-live passed on volume of distribution / clearance of drug |
|
|
What structures of the inner ear are responsible for the sensation of linear and angular acceleration?
|
Utricle & saccule contain maculae – detect linear acceleration
Semicircular canals contain ampullae – detect angular acceleration |
|
|
What is the basic equation for cardiac output? What is the Fick principle? What factors affect stroke volume?
|
Cardiac output = Stroke volume * Heart rate
Fick principle: CO = rate of O2 consumption / (arterial O2 content – venous O2 content) Stroke volume = CO/HR = End-diastolic volume – End-systolic volume |
|
|
What are the two most common causes of chronic renal failure?
|
Hypertension & diabetes
|
|
|
What is the most common cause of Erb-Duchenne palsy? What are the characteristic findings of Erb-Duchenne palsy?
|
Traction or tear of upper trunk of brachial plexus (C5 & C6 roots), follows blow to shoulder or trauma during delivery
Findings: “Waiter’s tip” – limb hangs by side (paralysis of abductors), medially rotated (paralysis of lateral rotators), forearm is pronated (loss of biceps) |
|
|
What are the signs and symptoms of poliomyelitis? If you suspected polio in a pt with yours, where would you seek to obtain a viral sample from the pt?
|
Poliovirus transmitted by fecal-oral route. Replicates in oropharynx & small intestine before spreading through bloodstream to CNS, where it leads to destruction of cells in anterior horn of spinal cord → lower motor neuron destruction
Sx: malaise, headache, fever, nausea, abdominal pain, sore throat; LMN lesions → muscle weakness & atrophy, fasciculations, fibrillation & hyporeflexia CSF w/lymphocytic pleocytosis w/slight elevation of protein (w/no change in CSF glucose); Virus recovered from stool or throat |
|
|
What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make?
|
-RNA polymerase I → rRNA
-RNA polymerase II → mRNA -RNA polymerase III → tRNA |
|
|
How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content?
|
2 umbilical arteries – return deoxygenated blood from fetal internal iliac arteries to placenta
1 umbilical veins – supplies oxygenated blood from placenta to fetus - Highest oxygen content |
|
|
What are Brunner’s glands? What are Peyer’s patches? How can these structures help you identify the location from which a histological specimen was taken?
|
Brunner’s glands secrete alkaline mucus to neutralize acid contents entering duodenum from stomach
- Located in duodenal submucosa (only GI submucosal glands) - Hypertrophy seen in peptic ulcer disease Peyer’s patches – Un-encapsulated lymphoid tissue in lamina propria & submucosa of small intestine - Contain specialized M cells that take up antigen – secretory IgA |
|
|
What is the classic triad of symptoms in multiple sclerosis? With what disorders do pts with multiple sclerosis commonly present?
|
- Classic triad: Scanning speech, Intention tremor/incontinence/internuclear ophthalmoplegia, Nystagmus
- Pts can present w/optic neuritis (sudden loss of vision), MLF syndrome (Internuclear ophthalmoplegia), hemiparesis, hemisensory symptoms, or bladder/bowel incontinence |
|
|
What is the rate-limiting enzyme for ketone synthesis? for cholesterol synthesis?
|
Ketone synthesis – HMG-CoA synthetase
Cholesterol synthesis – HMG-CoA reductase |
|
|
What class of drugs is used in the treatment of ADHD, narcolepsy, and obesity?
|
Amphetamine
|
|
|
What is the definition of first-degree heart block?
|
PR interval prolonged (>200 msec); Asymptomatic
|
|
|
What is the classic presentation of a patient with gonococcal arthritis?
|
- Presents as a monoarticular, migratory arthritis with an asymmetrical pattern
- Affected joint is swollen, red & painful |
|
|
What is the difference between malingering and factitious disorder?
|
- Malingering – pt continuously fakes or claims to have a disorder in order to attain a specific gain (e.g. avoiding work, obtaining drugs). Avoids treatment by medical personnel; complaints cease after gain (vs. factitious dx)
- Patient consciously creates physical &/or psychological sx in order to assume “sick role” and get medical attention – e.g. Munchausen’s syndrome |
|
|
What are the rate-limiting enzymes for the following metabolic processes?
•glycogen synthesis •glycogen breakdown •fatty acid synthesis •fatty acid oxidation |
•glycogen synthesis → Glycogen synthase
•glycogen breakdown → Glycogen phosphorylase (glycogenolysis) •fatty acid synthesis →. Acetyl-CoA carboxylase (ACC) •fatty acid oxidation → Carnitine acyltransferase I |
|
|
Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in pts with benign prostatic hyperplasia (BPH)?
|
Alpha-1 selective: Prazosin, Terazosin, Doxazosin
|
|
|
What are the risk factors for colon cancer?
|
Colorectal villous adenomas, chronic inflammatory bowel disease (esp. ulcerative colitis, incr. age), Familial adenomatous polyposis (FAP), HNPCC (Lynch syndrome), past medical or family history;
Screen patients > 50 years of age with stool occult blood test & colonoscopy |
|
|
What is the difference between prevalence and incidence?
|
Prevalence – total cases in a population at a given time
Incidence – total new cases in population over a given time period |
|
|
What physiology accounts for the automaticity of the AV and SA nodes?
|
Phase 4 = slow diastolic depolarization – membrane potential spontaneously depolarizes as Na+ conductance increases (I(f) different from I(Na)).
The slope of phase 4 in SA node determines heart rate. ACh decreases the rate of diastolic depolarization & decreases heart rate, while catecholamines increase depolarization & increase heart rate. Sympathetic stimulation increases the chance that I(f) channels are open. |
|
|
How does the emphysema caused by smoking differ from the emphysema caused by alpa-1-antitrypsin deficiency?
|
Centriacinar – caused by smoking
Panacinar – alpha-1-antitrypsin deficiency (also liver cirrhosis) |
|
|
What is the difference between Meissner’s corpuscle and a Pacinian corpuscle?
|
Meissner’s corpuscle – Glabrous (hairless) skin; Dynamic fine touch (e.g., manipulation), adapt quickly
Pacinian corpuscle – Deep skin layers, ligaments & joints; Vibration, pressure |
|
|
What syndrome causes the triad of sterility, bronchiectasis, and recurrent sinusitis? What is the primary defect in this syndrome?
|
Kartagener’s syndrome
Immotile cilia due to a dynein arm defect. Results in male & female infertility (sperm immobile), bronchiectasis, & recurrent sinusitis (bacteria & particles not pushed out); associated with situs inversus |
|
|
In which glomerular disease would you expect to see the following changes?
•foot process effacement (electron microscope) •wire-loop appearance (light microscope) •mesangial deposits of IgA (electron microscope) •crescent-moon shaped lesion (light microscope) •segmental sclerosis and hyalinosis (light microscope) |
•foot process effacement (electron microscope) → Minimal change disease (lipoid nephrosis)
•wire-loop appearance (light microscope) → Diffuse proliferative glomerulonephritis (due to SLE), Diabetic glomerulonephropathy (Kimmelsteil-Wilson lesions) •mesangial deposits of IgA (electron microscope) → Berger’s disease (IgA glomerulopathy) •crescent-moon shaped lesion (light microscope) → Rapidly progressive (crescentic) glomerulonephritis •segmental sclerosis and hyalinosis (light microscope) →Membranous glomerulonephritis (diffuse membranous glomerulopathy)? |
|
|
What clinical scenario is most commonly seen in Reye’s syndrome? What are the characteristics of Reye’s syndrome?
|
Rare, often fatal childhood hepatoencephalopathy.
Findings: fatty liver (microvesicular fatty change), hypoglycemia, coma. Associated with viral infection (esp VZV & influenza B) that has been treated with salicylates. Aspirin is not recommended for children |
|
|
What would you expect to find in the synovial fluid of a pt with gout? with pseudogout?
|
Gout – Precipitation of monosodium urate crystals into joints – Crystals are needle shaped & negatively birefringent = yellow crystals under parallel light (blue = perpendicular
Pseudogout – Deposition of calcium pyrophosphate crystals within the joint space. Forms basophilic, rhomboid crystals that are weakly positively birefringent = blue under parallel light (yellow = perpendicular) |
|
|
What effects do prostaglandins and Thromboxane have on platelet aggregation?
|
Prostaglandins have no effect on platelet aggregation
Thromboxane increases platelet aggregation Prostacyclin decreases platelet aggregation |
|
|
When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus?
|
Fetus most susceptible in 3rd – 8th weeks of pregnancy. Before week 3: all-or-none effects. After week 8: growth & function affected.
ACE inhibitors → renal damage |
|
|
Distinguish the following types of organ transplant rejection.
(Mechanism & Time Frame) hyperacute rejection acute rejection chronic rejection |
hyperacute rejection: Antibody mediated due to presence of preformed antidonor antibodies in the transplant recipient; Occurs within minutes after transplantation
acute rejection: Cell mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs weeks after transplantation. Reversible with immunosuppressants such as cyclosporine & OKT3 chronic rejection: T-cell & antibody-mediated vascular damage (obliterative vascular fibrosis); occurs months to years after transplantation. Irreversible; Class I-MHC(non-self) is perceived by CTLs as class I-MHC(self) presenting a non-self antigen |
|
|
What is Zollinger-Ellison syndrome?
|
Gastrin-secreting tumor of pancreas or duodenum. Causes recurrent ulcers. May be associated w/MEN type I
|
|
|
What type of collagen is abnormal in patients with Alport’s syndrome?
|
Due to variety of gene defects resulting in abnormal type IV college. Most common form is X-linked recessive.
Characterized by progressive hereditary nephritis & deafness. May be associated with ocular disturbances. Type IV college is an important structural component of the basement membrane of the kidney, ears, & eyes |
|
|
In which order elimination is the rate of elimination proportional to the drug concentration?
|
First-order elimination – constant fraction of drug eliminated per unit time
|
|
|
What is the most common tumor of the adrenal medulla in adults? in children?
|
Pheochromocytoma is most common tumor of adrenal medulla in adults.
Neuroblastoma is most common tumor of adrenal medulla in children |
|
|
What lab abnormalities would you expect to see in a pt with SIADH?
|
Excessive water retention, Hyponatremia, Urine osmolarity > Serum osmolarity
|
|
|
What drugs are used in the treatment of Parkinson’s disease?
|
Bromocriptine (ergot alkaloid & partial dopamine agonist) → Antagonize dopamine receptors
Amantadine → may increase dopamine release, also used as an antiviral L-dopa/carbidopa (converted to dopamine in CNS) → increases dopamine Selegiline (selective MAO type B inhibitor) & COMT inhibitors → prevent dopamine breakdown Benztropine (antimuscarinic; improves tremor & rigidity but has little effect on bradykinesia) → Curb excess cholinergic activity |
