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109 Cards in this Set
- Front
- Back
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cauliflower like mass in sigmoid colon, "velvety appearance"?
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villous adenoma
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Peutz-Jegher syndrome?
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multiple hamartomatous polyps (GI), black spots on skin & mucosa of young patinet
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do hamartomatous polyps cause secretory diarrhea?
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no
can cause bleeding and intussusception though |
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are villous or tubular adenomatous polyps more dysplastic?
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villous adenomas tend to be larger, sessile, and more severy dysplastic than tubular adenomas
cause bleeding, secretory diarrhea, and partial intstinal obstruction |
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does MEN1 predisopose to gastric ulcers?
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yes, via hypergastrinemia from pancreas
3P's - parathyroidism (hyper), peptic ulcer (gastrin secreting tumor), and pituitary adenoma |
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spindle cells w/hair-like glial processes assoc w/microcysts, mixed w/granular eosinphilic bodies and rosenthal fibers?
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pilocytic astrocytoma
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what is adiponectin?
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cytokine secreted by fat tissue, however, levels are inversely correlated to fat percentage in adults
low in type 2 diabetes helps to reverse effects of insulin resistance |
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how do thiazolidinediones exert their effect?
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used for diabetes, decrease insulin resistance
bind PPAR-gamma (peroxisome proliferator activated receptor gamma) transcriptional regulator of lipid metabolism, importatnly this upregulates ADIPONECTIN |
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infection characteristic of sickle cell patients? Why?
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salmonella osteomyelitis - b/c fxnlly asplenic (followed by e. coli)
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bacteria - Vi antigen? K antigen?
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capsule antigens
Vi - salmonella (virulence) K - E. coli |
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why are envelop IgG antibodies not protective against HCV?
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envelop proteins vary their antigenic structure
HCV has hypervariable region, also lacks 3'-5' exonuclease proofreading (virion encoded RNAP) |
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loss of anocutaneous reflex indicates compression in what vertebral segments?
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S2-S4, inovlement of the pudendal nerve
assoc w/cauda equina syndrome (not sure about cona medullaris? Cona medularis also has saddle anesthesia, but doesn't say anything about reflex..) |
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what spinal segments does bowel & bladder dysfunction correspond to?
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S3-S5 roots
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systolic ejection murmur accentuated by standing?
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hypertrophic obstructive cardiomyopathy
venous return is reduced, decreasing LV EDV & SV, increasing systolic ejection murmur (this wouldn't occur w/aortic stenosis presumably?) |
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early diastolic decrescendo murmur decreased by amyl nitrite?
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aortic regurgitation
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late diastolic murmur eliminated by atrial fibrillation?
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mitral and/or tricuspid stenosis
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wide and fixed (does not vary w/respiration) splitting of S2?
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atrial septal defect
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maneuver to distinguish between aortic stenosis and hypertrophic obstructive cardiomyopathy?
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systolic ejection murmur in both
standing will increase hypertrophic obstructive cardiomyopathy click |
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what is the normal ppO2 in the alveoli?
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104 mmHg
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physostigmine, neostigmine, edrophonium - which ones penetrate BBB?
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physostigmine
neostigmine & edrophonium are quaternary amines limiting CNS penetration |
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how do sulfonylreas work?
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bind regulatory Katp channel in pancreatic beta cells
close channels depolarizing cell --> insuline release |
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how does metformin work?
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decreases enzyme activity responsible for gluconeogensis located in hepatic microsomes
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what differentiates carcinoma from dysplastic?
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reversibility of changes
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what is the mechanism of ethosuximide? Which cells?
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decreases Ca current in thalamic neurons?
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what anti-epileptic blocks NMDA receptors in hippocampal neurons?
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Valproic acid blocks NMDA receptors affecting potassium current
also affects Na & GABA receptors |
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what cells use biphosphoglycerate mutase? Why? What enzyme would normally use this substrate?
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erythrocytes, divert to 2,3-BPG to help w/oxygen loading/unloading
normally phosphoglycerate kinase would use 1,3-BPG -->3 phosphoglycerate to produce ATP, this is sacrificed |
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what does acanthosis describe? Seen in?
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increased thickness of stratum spinosum (between granular & basal layer)
Psoriasis commonly associated w/acanthosis |
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what does dyskeratosis describe? Seen in?
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abnormal, premature keratinization of individual keratinocytes, strongly eosinophilic & may have small basophilic nuclear remnant
found in dz such as squamous cell carcinoma |
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what does hyperparakeratosis describe? Seen in?
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retention of nuclei in startum corneum --> signals incomplete keratinization
nl on mucous membranes suggests abnormality (actinic keratosis) in other areas |
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what does hypergranulosis describe? Seen in?
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excessive granulation in stratum granulosom of epidermis
seen in lichen planus |
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what does spongiosis describe? Seen in?
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epidermal accumulation of edematous fluid in intercellular spaces (spongiosis)
intercellular bridges become more distinctive, intraepidermal vesicles by tearing of desmosomes may result superficial perivascular infiltrate of lymphocytes/eosinophils seen in eczematous dermatitis (allergic contact dermatitis, atopic dermatitis, drug-related eczematous dermatitis, photo-eczematous dermatitis, primary irritatn dermatitis) |
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what does tRNA have at it's 3' end?
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CCA sequence
3' hydroxyl group is binding site for a.a. |
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RNA molecule consists of 90 nucleotides, contains dihydrouracil, thymidine, and acetylcytosine?
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tRNA
contain 74-93 nucleotides |
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what is the early pathogenesis of AAA?
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intimal (fatty) streak of atherosclerosis
composed of intimal lipid-filled foam cells (derived from macrophages & smooth mm cells engulfing LDL) |
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what about HBV infection predisposes to hepatocellular carcinoma?
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integration of viral DNA into host genome is considered a trigger of neoplastic changes
(some talk of IGF-II and IGF-Ireceptors, maybe p53 suppression by accumulated products) |
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translocation associated w/Burkitt's lymphoma? Product? Cellular activity?
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translocation of c-myc oncogene from 8 to 14 t(8,14)
c-myc is a nuclear phosphoprotein that functions as a transcription activator |
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diffuse infiltrate of lymphoid cells w/numerous mitotic figures, interspersed macrophages surrounded by clear spaces?
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"starry sky", Burkitt lymphoma
t(8,14) c-myc (tyrosine kinase) |
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translocation of follicular lymphoma?
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t(14,18) - IgH heavy chain to bcl2 (apoptosis inhibitor)
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translocation of CML?
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t(9,22) - c-able to bcr - philadelphia chromosome
Bcr-abl encodes prtn inhibiting apoptosis & promoting mitogenesis, and increased tyrosine kinase activity |
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translocation of mantle cell lymphoma?
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t(11
14) - cyclin D1 locus on 11 to IgHeavy locus on 14 increased cyclin D1 a promoter of G1 to s-phase |
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what chromosome is Ig heavy chain on?
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chromosome 14, associated w/many of the lymphoma translocations
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humoral mid-shaft fx damages what artery/nerve?
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deep brachial artery
radial nerve (forearm extensors) |
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humoral surgical neck fx?
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dmg anterior circumflex humeral artery
axillary nerve |
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supracondylar fx of humerus?
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brachial artery - is anteromedial in groove of bicep (which branches into radial & ulnar)
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biopsy of fungus reveals intracellular - oval? Round?
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oval yeast forms w/in macrophages - histoplasma capsulatum
round endospores w/in sphereule - coccidioidies immitis |
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MCC cancer in women as of 2011? (excluding skin)
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breast > lung > colon
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drug of choice for hairy cell luekemia?
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cladribine
purine analog reisstant to degradation by adenosine deaminase causes DNA strand breaks, penetrates CNS well, excreted in urine |
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coronary artery bypass grafting - use what vessel for bypassing LAD? What vessel for others?
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to bypass LAD left internal mamillary (thoracic) artery is preferred
to bypass other vessels/multiples use saphenous vein, harvested at superficial medial thigh, just below pubic tubercle |
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baby w/flacid LE & absent ankle reflexes, poorly developed lumbar spine & sacrum - what is this? caused by what factor during pregnancy?
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caudal regression syndrome, ranges from anal atresia to sirenomelia, classically sacral agenesis causing these sx
related to poorly controlled maternal diabetes (not the only factor) |
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what teratogenic effects does vitamin A have?
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craniofacial abnormalities, posterior fossa CNS dfects, auditory defects, abnlities of great vessels
-similar to those in DiGeorge's |
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bacillus anthracis toxin is similar to what other bacterial toxin?
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lethal factor & edema factor
edema factor is adenylate cyclase causing massive increases in intracellular cAMP similar to bordetella pertussis toxin called "extracellular adenylate cyclase" |
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what are calcitonin levels in chronic renal failure?
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despite relative hypocalcemia, calcitonin levels are increased b/c excretion of calcitonin is impaired
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how do distinguish between the diastolic murmurs of mitral stenosis and LV hypertrophy?
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mitral stenosis - opening snap in EARLY diastole
LV hypertrophy - late diastole (pre-systolic), when atria is contracting against suddenly elevated Edpressure caused by poor filling of ventricle with decreased compliance |
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what is the MOA of trimethoprim? What other drugs target this?
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inhibit dihydrofolate reductase, preventing reduction of folic acid thus decreasing tetrahydrofolate
methotrexate, pyrimethamine (anti-malarial) |
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how does sulfamethoxazole work?
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structural analog of PABA (para-aminobenzoic acid)
competes w/PABA to inhibit dihydrofolic acid synthesis, an intermediate step in formation of tetrahydrofolate used for sequential block w/trimethoprim sulfamethoxazole block is first (dihydrofolate syntehesis), trimethoprim is second (dihydrofolate reductase, uses substrate) S first, then T (alphabetical) |
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MC mm injured in rotator cuff? Maneuver to test?
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supraspinatous, vulnerable to injury by impingement between acroion & head of humerus
responsible for first 15 degrees of abduction empty can supraspinatus test - abduction to 90 degrees and flex them to 30 degrees, thumb pointing at floor - downward pressure elicits pain & unilateral weakness |
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mm of the rotator cuff?
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SITS
supraspinatus, infraspinatus, teres minor, subscapularis |
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how does ADH relate to bleeding?
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DDAVP (desmopressin) increases von Willibrand factor release form endothelial cells w/in 30-60 minutes
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what does von Willebrand's factor do? Secreted from where?
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endothelial cells secrete vWF
circulates in multimers attached to VIII, increasing stability vWF augments platelet binding to endothelial cells, forming platelet plug DDAVP (desmopressin) increases vWF release from endothelial cells |
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what nitrate (for chronic tx of stable angina) has greatest oral bioavailability?
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isosorbide MONOnitrate, which is an active metabolite of isosorbide dinitrate (~100%)
both isosorbide dinitrate & nitroglycerin undergo substantial first pass metabolism by liver |
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what does pseudopalisading necrosis look like? What is it characteristic of?
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(if you can't pull up mental picture google it)
basically lucent / necrotic area surrounded by dark layer of cells "palisading?" characteristic of Gliblastoma Multiforma expect necrosis & vascular proliferation |
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what skin cells have "tennis racket" granules?
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Langerhans cells
stellar cells, birbeck granules (tennis racket), myeloid surface markers to interact closely w/T-cells (NOT Langhan's cells - giant horseshoe multinucleated granulomatous inflam) |
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addition of what chemical causes sickling of sickle-trait RBCs?
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sodium metabisulfite, the "sickling test"
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child in first year of life losing motor skills - "foamy histiocytes"" in liver, spleen, & skin?
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Niemann-Pick, sphyngomyelin accumulation, hepatomegaly
also will see blindness by 1, cherry red spot on macula death by age 3 |
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deficiency of what vitamin can lead to squamous metaplasia of "specialized epithelia"?
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Vitamin A & it's active metabolite, retinoic acid
-maintains orderly differentiation of specialized epithelia (mucus-secreting columnar epithelia of ocular conjunctiva, respiratory & urinary tracts, & pancreatic & other exocrine ducts) -deficiency results in squamous metaplasia to a keratinizing epithelium eg - mucus secreting columnar epithelium, pancreatic ducts predisposed by CF pluggin |
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patient w/CF think about what vitamin deficiencies?
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fat solubles (ADEK) 2ndary to steatorrhea
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what does the MC cause of renal malignancy look like on histology?
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clear cell carcinoma, from renal tubular cells
polygonal cells w/abundant clear cytoplasm (packed w/glycogen & lipids) |
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2 MC sites of flora that cause infection of central venous catheters?
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patient's skin flora and bacteria on health care worker's hands
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what is apical displacement of tricuspid valve leaflets, decreased RV volume, & atrialization of RV in utero? What med can cause?
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Ebstein's anomaly, has been linked to Lithium
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what is the funciton of the posterior limb of the internal capsule?
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corticospinal motor
somatic sensory fibers visual & auditory fibers the genu "knee" carries corticobulbar fibers anterior limb carries thalamocortical fibers |
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fluorinated anesthetics increase blood flow to what organ?
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cerebral blood flow
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patient in MVA being resuscitated, transfused, shortly c/o difficulty breathing, chills, & pain in chest & back, dark colored urine is draining - what is this? How is it mediated?
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Acute hemolytic reaction, ABO incompatability
Type II hypersensitivity anti ABO antibodies leading to complement deposition & erythrocyte lysis --> anaphalytoxins cause vasodilation & shock develops within minutes |
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bicornate uterus results from what process?
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failure of paramesonephric ducts to fuse
nl paramesonephric ducts fuse to form uterine tubes, uterus, cervix, & superior 1/3 of vagina |
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what is anesthetic tension in arterial blood?
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the amount of anesthetic that is not dissolved in the blood
rises more rapidly for poorly soluble compounds, as indicated by low blood/gas partition coefficients (nitrous oxide) |
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what labs for PTH, phosphorus, & Ca++ in pts w/diarrhea of celiac's dz?
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they are vitamin D deficient (malabsorption)
low Ca++ & phosphorus high PTH |
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what is the difference between myocardial stunning and hibernation?
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stunning is a less severe form of ischemia-induced reversible loss of contractile function
brief ischemic episodes (<30min) followed by reperfusion, full recovery in hours to days reptitive episodes of stunning can result in hibernation (still reversible with reperfusion - CABG) |
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MCC indolent lymphoma in adults? Clinical course? Translocation?
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Follicular lymphoma is MC non-Hodgkin lymphoma in adults (B-cell origin)
"waxing & waning lymphadenopathy" t(14,18) --> bcl-2 oncogene overexpression |
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morphin induces what post-synaptic changes when injected into the spinal cord that decrease pain?
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binds mu receptor, causing G-prtn to activate potassium channels
K+ influx hyperpolarizes post-synaptic neurons & terminates pain transmission |
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does rectal drug administration bypass first pass metabolism?
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partially
2/3 of the drainage go thru middle & inferior rectal veins, but 1/3 goes through superior rectal veins and does go to the liver |
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how to tx pregnant woman w/DVT?
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heparin (activates antithrombin III, to bind Iia & Xa)
NOT coumadin, it is teratogenic |
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what distinguishes CML from leukemoid reaction?
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CML has low alkaline phosphate level
leukemoid reaction will have elevated or nl alkaline phosphate |
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what distinguishes CML from AML?
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AML will have increased # of myeloblasts, > 20% of nucleated cells, rather than "a few blasts"
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5 yo boy w/posterior fossa midline mass, biopsy "sheets of primitive cells & many mitotic figures"?
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medulloblastoma
expect cerebellar sx |
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what eye related nerves enter the orbit via the superior orbital fissure?
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CN III, CN V1, CN IV, CN VI, superior ophthalmic vein
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what passes through the foramen ovale?
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CN V3
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what passes through foramen lacerum?
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it's occluded by cartilage, only small unnamed vessels pass through
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what passes through inferior orbital fissure?
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CN V2, infraorbital vessels, & branches of sphenopalatine ganglion
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the corneal limb reflex is mediated by what nerves - afferent? Efferent?
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afferent - nasociliary branch of CN V1
efferent - temporal branch of CN VII |
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rhomboid crystals w/positive birefringence?
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calcium pyrophosphate deposition
pseudogout blue when parallel, yellow when perpendicular |
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"cobblestone" appearance of terminal ileum?
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chron's
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what immune cells are responsible for granuloma formation in Crohn's?
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Th-1 cells, mediate delayed hypersensitivity reactions & granuloma formation
produce IL-2 & IFN-gamma activating macrophages, synthesize TNF-alpha |
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which t-cells are involved in ulcerative colitis?
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Th2
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65 yo man w/widespread narrowing of renal arterioles, arteriolar walls homogeneously thickened & stain pink w/hemoxylin-eosin, this is characteristic of? (name appearance, then dz)
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hyaline ateriosclerosis
homogenous deposition of eosinophilic hyaline material in intima & media of small arteries/arteroles long standing non-malignant HTN and or diabetes |
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what motions does the obturator nerve innervate?
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adducter compartment of the thigh
(after dividing into anterior & posterior branches) anterior branch - gracilis, pectineus, adductors longus & brevis posterior branch - obturator externus & adductor magnus |
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what nerve innervates abduction of the thigh?
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superior gluteal nerve - tensor fascia lata
femoral nerve - sartorious |
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what nerve innervates flexion of the thigh?
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lumbar plexus - psoas
femoral nerve - iliacus superior gluteal nerve - tensor fascia lata |
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what nerve innervates extension of the thigh?
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inferior gluteal nerve - gluteus maximus mm
(exits via greater sciatic foramen below piriformis) |
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what nerve innervates extension of the leg?
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femoral nerve - quadriceps femoris mm
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carnitine wasting & deficiency results in lack of what reaction?
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necessary for shuttling fatty acids into mitochondria
will observe decreased acetoacetate levels |
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myoglobin rich glycogen poor fibers w/many mitochondria are characteristic of what type of mm?
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Type 1 - slow twitch
postural skeletal mm (soleus, paraspinal) ATP primarily from oxidative metabolism Type II - rapid forceful pulses of movmeent Type Iib - anaerobic glycogenolysis Type Iia - "fast twitch" intermediate between I and Iib |
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what nutritional considerations are given to gallbladder problems (plugging, etc)?
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malabsorption of fat / fat soluble vitamins
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what lung cancer is surgery not indicated for, even if it is localalized?
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small cell carcinoma
highly invasive, majority of pts have distant metastases at dx - no role for surgery, even when it is localized are sensitive to chemo & radiation (5 yr survival < 10%) |
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what are cromolyn & nedocromil?
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mast cell stabilizing agents
inhibit mast cell degranulation independt of stimuli present (2nd line tx for allergic rhinitis & bronchial asthma) |
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what is anti-IgE antibody?
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Omalizub
(good omEn) |
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what is zileuton?
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selective inhibitor of lipoxygenase pathway, decreasing formation of leukotrienes
(asthma) this is how steroids work too - inhibiting phospholipase A2 cleavage of membrane phospholipid |
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what is oxybutinin?
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anticholinergic agent
used for tx overactive bladder (urge incontinence) antispasmodic agent by providing antimuscarinic action to smooth mm cells |
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what is the MOA of niacin? How can SE be countered?
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decrease synthesis of hepatic TGs & VLDL
also decreases VLDL conversion to LDL, decreasing LDL increases HDL by 25-30% more than any other agent flushing can be prevented by pre-treatment w/aspirin |
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MC metastatic tumors to the brain?
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lung > breast > melanoma
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are melanocytes derived from same embryologic layer as epidermal cells?
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no
melanocytes - neural crest cells epidermal cells - surface ectoderm |
