Ms2 - Test 5 - Week 5

Front 1

What is the cause of the increase in GFR early on in diabetic nephropathy?

Back 1

Dilatation of glomerular afferent arterioles

Front 2

What is the first clinical marker for diabetic kidney disease?

Back 2

Microalbuminuria (30-299 mg)

Front 3

What is the first physical manifestation of diabetic nephropathy (stage 2)?

Back 3

Dependent pitting edema

Front 4

What is the single most important step to prevent progressive nephropathy in type 1 and 2 diabetes?

Back 4

Blood Pressure Reduction

Front 5

True or False

Nonproliferative diabetic retinopathy does not cause clinically significant visual loss

Back 5

True

Unless macular edema occurs

Front 6

What causes the vascularization in proliferative diabetic retinopathy?

What are the 3 angiogenic substances in proliferative diabetic retinopathy?

Back 6

Retinal ischemia

VEGF, Epo, Bradykinin

Front 7

If a patient has intact reflexes, but bilateral sensory loss, and superficial burning pain are large or small fibers involved?

Back 7

Small unmeylinated C fibers

Front 8

What is the single most important mechanism leading to erectile dysfunction in diabetes?

Back 8

Impaired NO release

Front 9

Gallstones found in diabetes are most often composed of what?

Back 9

Cholesterol

Front 10

What is the 1st morphologic change in pre-diabetic nephropathy?

What is the morphologic equivalence of stage II DKD?

What is the 1st functional change in pre-diabetic nephropathy?

What is the functional manifestation of stage II DKD?

Back 10

Hypertrophy is the 1st morphologic change (both glomeruli & tubules hypertrophy) = increased GFR

Kimmelstein Wilson nodules & shrunken kidneys

An elevated GFR is the 1st functional change

Macroalbuminuria (>300 mg/dL)

Front 11

Activation of what, leads to increased ECM protein synthesis in the glomerular basement membrane?

Back 11

TGF-Beta

Front 12

What are 4 treatment modifications that can stop the progression of stage 1 to stage 2 Diabetic Kidney Disease?

Back 12

BP control <125/75 (MOST important!)

LDL cholesterol control

Tight glucose control

Dietary protein

Front 13

What is the main mediator that causes proliferative retinopathy in diabetics?

What increases this mediator?

Back 13

Increased PAI-1

Hyperinsulinemia

Front 14

What are 2 causes of charcot join osteoarthropathy?

Back 14

Repetitive trauma to an insensitive foot

AV shunting = ischemia

Front 15

What class of drugs are the DOC in overweight patients with type 2 diabetes?

What is the MOA?

Back 15

Biguanides - Metformin

Inhibit hepatic and renal gluconeogensis

Front 16

What class of diabetic drugs will most likely cause hypoglycemia when used as monotherapy?

Back 16

Insulin Secretagogues (Glyburide)

Front 17

What diabetic drug should be avoided in patients who like to consume alot of ethanol acutely?

Back 17

Biguanides - Metformin

Front 18

What 3 conditions can you give a vaccine after exposure, b/c it has a long latent period?

Back 18

Small pox

Chicken pox

Rabies

Front 19

How long must one wait to administer a live vaccine if it was missed when given w/ others?

Back 19

4 weeks

Front 20

What type of vaccination can present with encephalopathy within 7 days of being administered?

Back 20

Pertussis vaccine

Front 21

Pregnant women and immune suppressed adults should NEVER receive which vaccines?

Back 21

Varicella

MMR

Herpes zoster

Front 22

What is the only vaccine that is contraindicated in HIV pt's that have a CD4 >200?

Back 22

Herpes zoster

Front 23

What is the leading cause of bacterial meningitis in the U.S.?

What other condition does this cause in toddlers/infants?

Back 23

Strep. pneumoniae


Otitis media

Front 24

What kind of Pneumococcal vaccine should be given to a pt w/ HIV/AIDS?

Back 24

PCV13 & PSV23

Front 25

What vaccine is contraindicated in patients that are allergic to eggs or have a prior history of Guillain-Barre?

Back 25

Influenza vaccine

Front 26

A lead level above what number is considered lead poisoning?

Back 26

>10 micrograms/dL

Front 27

What is the major cause of injury death among those ages 25-64?

Back 27

Poisoning/overdose

Front 28

What are the top 5 most common causes of death in U.S.?

Back 28

Heart dz > Cancer > Lung dz > Stroke > Unintentional Injury

Front 29

What is bacteria is the most common cause of cellulitis?

What enzyme does it release that aids in its spread and pathogenesis?

Back 29

Strep. pyogenes

Hyaluronidase

Front 30

What bacteria most commonly causes scalded skin syndrome?

What toxin does it release that causes the bullae by cleaving the upper epidermis?

Back 30

Staph. aureus

Exfoliatin

Front 31

What organism is the cause of both cellulitis and erysipelas?

How can you tell the difference b/w them?

Back 31

Strep. Pyogenes (Group A Strep)

Cellulitis - ill defined margin
Erysipelas - well defined margin

Front 32

What is the toxin that mediates the skin desquimation seen in toxic shock syndrome?

Back 32

TSST-1 from Staph aureus

S. pyogenes can also cause this but via direct tissue invasion & destruction

Front 33

What organism is the most common cause of gas gangrene?

What is the mediator it produces which hydrolyzes lipids in cell membranes -> lysis and death?

Back 33

C. perfingens

Lecithinase (alpha toxin)

Front 34

What kind of herpes virus is responsible for erythematous papules that rapidly involve into vesicles, that are in all stages of development?

Back 34

HHV -3 (Varicella Zoster Virus = Chicken pox)

Front 35

What herpes virus is the leading cause of congenital deafness and mental retardation?

Back 35

HHV - 5 (Cytomegalovirus)

Front 36

If a 6 year old boy presents with symmetric palpable purpura in the legs and buttocks along with joint pain, what is the most probable diagnosis?

What is the cause of the purpura?

Back 36

Henoch-Schonlein Purpura


IgA immune complex deposition in small vessels

Front 37

What is the cause of a vesicular rash that has an all out simultaneous outbreak?

What if the vesicular rash appears in waves?

Back 37

Smallpox


Probably chicken pox

Front 38

What is the only vesicular rash that does not spread through respiratory aerosols?

What is the only vesicular rash that can spread through stool?

Back 38

Herpes Simplex


Coxsackie A - b/c it is a picornavirus

Front 39

What is the protein target of the Staph. aureus exotoxin A & B, that causes the peeling of skin in sheets in SSSS?

Back 39

Desmoglein 1

Front 40

What organism is the cause of a rash that is WORSE in skin folds (pastia lines) = confluent petechia in armpits, groins, elbows or knees?

Back 40

Strep. pyogenes via erythrogenic toxins A and C

Front 41

What is the cause of a blotchy maculopapular rash that can lead to serious birth defects (PDA, cataracts, and deafness)?

What is the cause of the rash and arthralgia that they can have?

Back 41

Rubella (German measels) - a Togavirus

Immune complexes

Front 42

True or False

Herpes infections/vesicles are painful

Back 42

True

Front 43

What is the cause of a generalized rash that develops abruptly after a fever ends?

Back 43

HSV 6 & 7 - due to immune complexes

Front 44

What is the cause of a diffuse macular or papular rash that appears on trunks as well as on palms and soles?

What is the organism involved?

Back 44

Secondary syphilis


Treponema pallidum

Front 45

If a patient presents with “rose spots” & abdominal pain, what is the most likely microbiologic organism involved?

Back 45

Salmonella enterica

Front 46

What is the microbiologic agent that causes a rash begins on ankles & wrists & spreads centrally as well as to the palms and soles?

Back 46

Rickettsia rickettsii = Rocky Mountain Spotted Fever