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66 Cards in this Set

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foci of hemorrhage & necrosis in mamillary bodies & gray matter around 3rd & 4th ventricle? Dx by testing what enzyme?
Wernicke syndrome
thiamine deficiency --> inbaility to utilize glucose
dx thiamine deficiency by measuring erythrocyte transketolase activity
triad -opthalmoplegia, -ataxia, -confusion
thiamine is a cofactor for what enzymes?
pyruvate dehydrogenase (pyruvate --> acetyl-CoA)
alpha-ketoglutarate dehydrogenase (citric acid cycle)
transketolaste (hexose monophosphate, pentose --> glyceraldehyde)
testing what enzyme activity can dx thiamine deficiency?
erythrocyte transketolase
what happens if give a patient w/chronic thiamine deficiency a glucose infusion?
acute cerebral damage
need to give thiamine along w/glucose
what are chi-squared test, t-test, and ANOVA test for?
chi-squared - comparing PROPORTIONS, how many fall into each category
t-test - comparing MEAN values
ANOVA - comparing means of 3+ variables
novel asthma therapy for pts resistant to steroid management?
Anti-IgE antibodies subQ (omalizumab)
leukotriene antagonists & theophylline have NOT been shownt o be effective
29 yo man w/dbl vision, ptosis, difficulty swallowing, nausea, & dry mouth
3 hours later his wife has similar sx - what is it?
botulism
key is has motor symptoms, but not the additional sx of mm fasciculation, CNS effects, & muscarinic signs (miosis, bronchospasm, bradycardia, lacrimation & salivation) that might be expected w/anticholinesterase poisoning
right non-pupil-sparing 3rd nerve palsy arises from what lesion? (unilateral headache, eye pain, diplopia, dilated nonreactive pupil, ptosis w/ipsilateral eye in down & out position(
aneurysm of right posterior or superior cerebellar arteries --> compression
neonate develops shrill crying, tremor, rhinorrhea, sneezing, & diarrhea, myoclonic jerks & rapidly progressing seizures - what's going on?
acute neonatal narcotic withdrawal
opium sodium as a diluted tincture is treatment of choice (can be given orally)
most reliable auscultory indicator of severity of mitral stenosis?
A2-opening snap interval
shorter the more severe the stenosis
how does Amphotericin B cause toxicity in humans? What is seen?
binding cholesterol to some degree
nephrotoxicity, hypokalemia, hypomagnesemia
what gram positive cocci produces dextrans from glucose?
Viridins streptococci
this helps them attach to damaged valves
increased orotic acid excretion is typical of what enzyme disorder?
ornithine transcarbamoylase deficiency
MC disorder of the urea cycle
how is lidocaine (class IB) different from other class I anti-arrythmics in terms of AP graph?
shortens phase 3 repolarization
has less pronounced effect on phase 0 depolarization (rapid binding, rapid release)
name the arrythics for class 1A? Class 1B? Class 1C?
class 1A - Disopyramide, Quinidine, Procainamide (Double Quarter Pounder)
class 1B - Lidocain, Tocainide, Mexiletine (Lettuce, Tomato, Mayo)
class 1C - Moricizine, Flecainide, Propafenone (more fries please)
characteristics of 1A, B, & C arrythmics on phase 0 & action potential length?
1A - intemediate inhibition of phase 0 depol, prolongation of phase 3 repolarization
1B - weak inhibition of phase 0 depol, shortens phase 3 repol
1C - strong inhibition of phase 0 depol, no change to phase 3 repol
how does the fick principle calculate CO? (using what variables)
CO = oxygen consumption / AV oxygen difference
how does N-acetylcysteine aerosol help tx of CF patients?
REDUCING intermolecular disulfide bridges within mucous glycoproteins, loosening the thick sputum
nodular densities and eggshell calcifications of hilar nodes indicate exposure to?
silica
what is the MCC cause of fetal hydronephrosis?
uretopelvic junction inadequate recnalization (should be done before 8-10th week when metanephros begins producing urine)
how is RAS activated? What pathway that responds to growth factor is it part of?
binding of GTP
part of the MAP-kinase pathway (GF tyrosine kinase --> SOS --> activate RAS --> activation of RAF (some kind of kinase?) --> MAP kinase kinase activation --> MAP kinase activation --> influence gene transcription
how is RAS mutated? What results?
RAS mutation results in inability to hydrolyze GTP
constitutive activation is associated w/development of malignant tumors
mayonaisse associated food poisoning?
Staph aureus
usually getting at preformed heat-stable exotoxin
in cases of dilation, what cardiac chamber can impinge on the esophagus causing occasional dysphagia?
Left atrium
what type of glands are responsible for sweat? What about odor assoc w/sweating?
Apocrine glands secrete sweat in enclosed vesicles, 2ndary to bacteria can result in odor
Eccrine glands secrete sweat as chloride & sodium directly to the skin surface
what possible toxicitiy do rosiglitazone and pioglitazone have? (thiazolidinediones, for diabetes)
hepatotoxicity, check LFTs, could also exacerbet CHF by fluid retention
also useful for tx metabolic syndrome, nonalcoholic fattly liver disease, polycystic ovarian dz (ones w/insulin resistance)
first pharyngeal arch?
first aortic arch regresses (except for portion of maxillary artery)
trigeminal nerve
second pharyngeal arch?
second aortic arch (not much for vasculature)
facial nerve (VII) - mm facial expression, some ear & hyoid assoc structures
*stapedial artery, but this typically regresses
third pharyngeal arch?
common & proximal internal carotid arteries
glossopharyngeal nerve IX - parts of hyoid bones, stylopharyngeus mm
fourth pharyngeal arch?
first part of true aortic arch & subclavian arteries
superior laryngeal BRANCH of vagus (X) - mm of pharynx & soft palate, a few of laryngeal mm
fifth pharyngeal arch?
obliterated during fetal development
sixth pharyngeal arch?
pulmonary arteries & ductus arteriosus
recurrent laryngeal BRANCH of the vagus nn (X) - most of the mm of larynx
what is the MCC mitral stenosis?
fibrosis of valve leaflets in chronic rheumatic heart dz (99%)
what CV defects are seen in tertiary syphillus?
AORTIC - aortitis, aortic aneurysm, aortic regurgitation
pt w/MI is resuscitated, next day develop oliguria & muddy brown casts - where is damage most likely?
Acute Tubular Necrosis - proximal tubules in thick ascending limb of Henle
MUDDY BROWN CASTS pathognomonic for ATN
muddy brown casts?
acute tubular necrosis
proximal tubules most likely in ischemic causes
ureters in the pelvis run lateral to? Medial to?
lateral to internal iliac vessels
medial to gonadal vessels
ureters cross over what vessels? Under what vessels?
ureters cross UNDER gonadal artery & vein midway between kidney & pelvic inlet
ureters pass OVER external iliacs to gain access to pelvis
as ureters leave kidneys what structure do they run along?
initially on top of psoas mm
sx of vasculitis w/hypersensitivity to intradermally injected tobacco extract?
Buerger's dz - thromboangiitis obliterans
exhibits segmental vasculitis extending into contiguous veins & nerves
heavy smokers before age 35
most common in Israel, Japan, & India
typical of tibial & radial arteries
vasculitis w/granulomatous inflammation of the media?
temporal (giant cell) arteritis
medium to small branches of the carotid, especially temporal arteries
vasculitis w/transmural inflammation of arterial wall w/fibrinoid necrosis?
polyarteritis nodosa
segmental vasculitis extending into contiguous veins and nerves?
Buerger's
what defense protein does staph aureus have? How does it work?
Protein A - binds the Fc portin of IgG at the complement binding site, preventing complement activation
what mutation causes hereditary pancreatitis?
mutation in trypsinogin at the inactivating site
prevents inactivation of any inadvertantly activated trypsin in the pancreas
(nl trypsinogen that is inadvertently activated is inactivated by PSTI (pancreatic secretory trypsin inhibitor) or trypsin iteslf)
isolate of strep pneumo is incubated w/radiolabeled ceftriaxone & electrophoresed - shows 5 bands, what are they? Another strep pneumo only showed 2 bands, why?
Penicillin binding proteins, such as transpeptidases
the other culture had structural changes to some of the penicillin binding proteins

penicillins fxn by binding penicllin binding proteins, cephalosporins like ceftriaxone work by inhibiting transpeptidase
are ACEinhibitors good for BP control in pregnancy?
no
teratogenic
patient being treated for thrichomonas vaginitis that drinks alcohol might experience?
disulfiram like rxn
metronidazole + etOH causes this, metronidazole is commonly used to tx trichomonas vaginitis & bacterial vaginosis
what is commonly used to tx trichomonas vaginitis & bacterial vaginosis?
metronidazole
what can cause disulfiram like reaction?
metronidazole
cephalosporins
procarbazine
1st-gen sulfonylureas (tolbutamide, chlorpropramide)
21 lab worker w/rapid-onset breathing difficulties, palpiations, & flushed skin - accidental poisoning - what poison? How does antidote work?
Cyanide poisoning (rapidly developing cutaneous flushing, tachypnea, headache, tachycardia, nausea/vomiting, confusion weakness, respi & cardiac dysfxn may follow)

nitrates oxidize ferrous iron to ferric, Hb - metHb, which preferentially binds cyanide rescuing mitochondrial cytochromes

thiosulfate can also be used, combines w/CN to form thiocyanate (less toxic) which is excreted in urine
large prominent nucleoli indicate high activity of what enzyme?
RNA Polymerase I
nucleolus is round dense body in nucleus composed of proteins, ribosomal DNA and ribosomal RNA
once formed within nucleus, ribosomes are shuttled out of nucleus via nuclear pores
function of RNA Polymerase I? II? III?
RNAP I - synethsize rRNA, in the nucleus, very few regulatory factors
RNAP II - synthesize mRNA, highly regulated
RNAP III - tRNA, snRNPs, very few regulatory factors
what is done to minimize risk of transmission of active Hep B from mother to fetus?
passive immunization of all newborns w/HBIG, followed by active immunization w/recombinant HBV
typically transmission occurs in birth canal (but can cross placenta), HBeAg increases risk (from 20% to 95%)
if fetus is infected 80% chance to progress to chronic
what medication is used in diagnosing prinzmetal's angina?
ergonovine is most sensitive provocative dx test
ergot alkaloid that constricts vascular smooth mm by stimulating both alpha adrenergic & serotnergic receptors
this causes sx in patients w/hypercontractile coronary artery segments
what do Trosseau syndrome and NBTE (non bacterial endocarditis) have in common?
procoagulants from malignancy causing hypercoaguability

Trousseau's - migratory thrombophlebitis from tumor release procoagulant
MCC NBTE is hypercoaguable state, can be caused by mucininous adenocarcinomas (pancrease, lung)
how does size of particles correspond to clearance from lungs? What are the ranges?
10-15 um trapped in upper resp tract
2.5-10 um enter trachea/bronchi & cleared by mucociliar transport
< 2 um (pneumoconioses) reach terminal bronchioli & alveoli, phagocytized by macrophages
what artery does the middle meningeal branch from?
Maxillary
what is akithisia? What drugs can induce?
movement disorder w/inner restlessness & inability to sit or stand in one position
complication of anti-psychotic therapy
how long do baby's have a positive babinski reflex? Why?
up to 12 months
incomplete myelination of corticospinal tracts
what is cogwheel rigidity?
pulsing resistance to passive limb movement on PE
after radioactive material exposure w/heavy isotopes, what should be immediately administered to prevent tissue damage?
potassium iodide, may prevent absorption of radioactive iodine by competitive inhibition
iodide trapping of iodine in the follicle occurs via sodiume iodide symporter (NIS), it can also take up perchlorate, pertechnetate, and even radioacctive iodine
how does renal osteodystrophy work?
Chronic renal dz
decreased phosphate excretion results in elevated serum levels, which bind up Ca++ decreasing its availability

also, loss of parenchyma result in decrease calcitriol production (vitamin D)
PTH rises (MCC 2ndary hyperPTH) causing bone resorption (renal osteodystrophy) - bone pain & signs of osteopenia & soft tissue calcification
why is a clinical carcinoid syndrome necessarily benign?
if carcinoid tumor had stayed confined to the intestine, its secretory products would have been metabolized to the liver
therefore it must have metastasized for the products to not be metabolized and for the syndrome (cutaneous flushing, dizziness, diarrhea, dyspnea w/wheezing) to occur
what do increased levels of 5-HIAA (5-hydroxyindoleacetic acid) in 24 hour urine indicate?
carcinoid syndrome (serotonin metabolite)
for a given minute ventilation, where is the work of breathing minimized for restrictive lung diseases? Obstructive?
restrictive (increased elastic resistanc) - low tidal volumes, high respiratory rate
obstructive (increased airflow resistance) - lower rate, higher volume