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90 Cards in this Set
- Front
- Back
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periodic involuntary deviation of head to rt, accompanied by mm pain in neck, suppressed by placing hand on chin?
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dystonia
MC focal -cervical dystonia SPASMODIC TORTICULLIS -belpharospasm - involuntary forcible closure of eyelids -writer's cramp |
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sudden brief shock-like mm contraction?
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Myoclonus
physiologic - hiccups & hypnotic jerks (while falling asleep) pathologic - epilepsy, CJD |
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hematuria in sickle cell trait? Also seen in?
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Papillary necrosis
also seen in - diabetes, analgesic nephropathy, severe obstructive pyelo "acute colickly flank pain, gross hematuria, passage of tissue fragments" |
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what does ___ relay?
-VPL -VPM -lateral geniculate body -medial geniculate body |
Thalamus relay
VPL - spinothalamic (pain & temp) and medial lemniscus (position & proprio) -to primary somatosensory cortex, brodmann 3, 1 &2 VPM - trigeminal & gustatory (to primary sensory cortex, Brodmann 1,2,3) lateral geniculate - light (from optic nerve to optic radiations to visual cortex, calcarine sulcus) medial geniculate - sound (from superior olivary & inferior colliculus to auditory cortex temporal lobe, Brodmann 41 & 42) |
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what is the MOA of?
-Polyenes (nystatin) -Echinocandins (caspofungin, micafungin) -Griseofulvin |
polyenes (amphotericin B, nystatin) - bind ergosterol molecules in fungal cell membranes, lysis
Echinocandins (caspofungin & micafungin) - inhibit synthesis of glucan component of fungal cell wall griseofulvin - interact w/microtubles, inhibit mitosis, used for dermatophyte infections |
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antifungal for dermatophyte infections? (microsporum, epidermophytin, trichophyton)
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Griseofulvin (think greasy skin)
interacts w/fungal cell microtubules, inhibiting mitoses accumulates in keratin-containing tissues |
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MC location of urethral injury w/pelvic fx? w/saddle injury?
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pelvic fx - posterior urethra (proximal to prostate)
-associated w/boggy high riding prostate, pelvic fx results in hematoma below prostate w/upward displacement saddle injury (falling on bike crossbar) - anterior urethra (distal to prostate - bulbous urethra) |
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38 yo man w/long hx of pain & stiffness in both shoulders & knees, brown spots on sclearae & diffuse darkening of helix of ears?
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Alkaptonuria
deficiency in homogentisic acid oxidase (homogentisic acid --> methylacetoacetate) autosomal recessive accumulated homogentisic acid accumulates in CT, during adulthood deposits in clera & ear cartilage deposition in large joints & spine urine turns black when exposed to air |
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tx for lung abscesses in alcoholic?
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clindamycin (covers anaerobic, oral flora)
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tx for bacterial STD?
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ceftriaxone - N. meningitidis
azithromycin (single dose) or doxycycline (multiple) - Chlamydia simultaneous |
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tx for pustule spreading to involve several hair ollicles?
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penicillinase-resistant penicillincs (nafcillin, methicillin, oxacillin)
NOT for MRSA, wiill cover s. epi & non mrsa s. aureus |
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nafcillin to tx?
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empiric tx of skin & soft tissue infections --> s. aureus
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Cheyne-Stokes respiration?
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cyclic breathing of apnea followed by gradually increasing tidal volumes
CHF or neuro dz (stroke, brain tumor NOT sleep apnea (ventilation remains nearly constant w/no cyclical variation) |
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in 2nd & 3rd trimesters what produces estrogen & progesterone?
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progesterone - placenta
estrogen - fetal adrenal gland (w/placenta) *note, beta-hCG falls in 2nd & 3rd trimester, was only req to maintain corpus luteum |
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aldolase B deficiency?
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Aldolase B - fructose metabolism
fructose intolerance hypoglycemia following fructose ingestion due to phosphate trapping in F-6-p restrict fructose and sucrose |
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MCC of viral acute hemorrhagic cystitis outbreaks in children?
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Adenovirus (males in particular)
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what mediates liver injury in HBV?
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cytotoxic CD8 t lymphocytes responding to viral antigen on cell surface
virus does not have direct cytotoxic effect (though in integrative phase integration of DNA increases risk of HCC) |
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toxicity of doxyrubicin? Earliest histologic change? Tx?
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cumulative dose-related cardiomyopathy
anthracycline chemos (doxorubicin, daunorubicin, epirubicin, idarubicin) free radicals cause dmg in myocardium swelling of sarcoplasmic reticulum Tx - DEXRAZOXANE presents w/sx CHF |
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acute orchitis bacterial cause?
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young adults - c. trachomatis, n. gonorrhoeae
older pts - e. coli |
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hernias - indirect vs direct?
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indirect - incomplete obliteration of processus vaginalis
-inguinal hernia into testes, similar to hydrocele (but just fluid in latter) direct hernia - protrusion through Hesselbach triangle on anterior abdominal wall |
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duration of action of: diazepam, temazepam, chlordiazepoxide, oxazepam, alprazolam, flurazepam, estazolam, clorazepate, alprazolam, lorazempam, triazolam?
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short acting (<10 hrs)
-alprazolam, triazolam, oxazepam, (zolpidem) medium (10-20) -estazolam, lorazepam, temazepam long (days) -chlordiazepoxide, clorazepate, diazepam, flurazepam shorter acting = higher risk of dependence, more withdrawl long acting = daytime drowsiness, risk of falls |
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anti-centromere antibodies?
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CREST syndrome
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antimitochondrial antibodies?
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primary biliary cirrhosis
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anti-Fc IgG antibodies?
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rheumatoid arthritis
rheumatoid factor is IgM against IgG Fc |
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lupus autoantibodies? Specificity?
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ANA - virtually all patients w/SLE, & other CT dz, sensitive
anti-dsDNA - SLE only, specific, only ~60% of SLE anti-Smith (anti-snRNPs) - ~20-30% SLE, also highly specific |
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causes of digital clubbing?
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primary, lung cancer (large-cell), TB, CF, bronchiectasis, pulm HTN, empyema, other lung dz, cyanotic congenital heart, inflammatory bowel dz (crohn, ulcerative colitis), hyperthyroidism, malabsorption
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what is linkage disequilibrium?
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when 2 allele loci are inherited TOGETHER in same haplotype (gamete) more or less often than would be expected, given random chance
can occur even if genes are on diff chromosomes |
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digoxin effects heart in what 2 ways?
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increased contractility - Na/K ATPase
decreased HR - increases Parasympathetic tone |
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first & second line tx for atrial fibrillation (w/rapid ventricular response)?
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1st - calcium channel blockers - diltiazem
2nd - digoxin - slows AV conduction |
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ALS genetic implication? Clinical findings? Tx?
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Genetic - mutation of gene for copper-zink superoxide dismutase (SOD1)
LMN (dmg to anterior horns) & UMN (demyelination of tracts) sx tx - Riluzole, decreases glutamate release |
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friedrich ataxia - presentation? Associations?
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autosomal recessive, 5-15 yo
difficulty walking hypertrophic cardiomyopathy, kyphoscoliosis,foot abnlities, diabetes mellitus |
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what is tx for women w/PCOD that desire fertility? MOA?
other important tx? |
Clompiphene
estrogen receptor modulator that decreases negative feedback inhibition on hypothalamus by circulating estrogen increases gonadotropin production spirinolactone for tx of hirsutism progesterone (or OCP) to portect against endometrial hyperplasia (unopposed high estrogen) |
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what is ataxia telangectasia?
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autosomal recessive defect in DNA-repair genes
cerebellar ataxia, oculocutaneous telangectasias, repeated sinpulmonary infections, increased incidence of malignancy DNA of pts is hypersensitive to ionizing radiation |
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disorders causing deficient DNA repair enzymes
hypersensitivity to ionizing radiation? hypersensitive to UV radiation? hypersensitive to DNA cross-linking agents? generalized chromosomal instability? defect in DNA mismatch-repair enzyme? |
ionizing radiation sensitive - ataxia telangectasia
UV sensitive - xeroderma pigmentosum, increased risk skin cancer cross-linking sens - Fanconi's anemia general chrom instabil - Bloom syndrome - susceptible to neoplasms DNA mismatch repair defect - HNPCC - colon cancer |
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what nn is at risk during ligation of thyroid artery?
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extenral branch of the superior laryngeal, innervates the cricothyroid mm
all other mm are innervated by the recurrent laryngeal nn Vagus --> Superior Laryngeal nn and Recurrent laryngeal nn Superior Laryngeal nn --> --External branch --> cricothyroid mm --internal branch --> sensory innervation above vocal cords Recurrent laryngeal nn --> all laryngeal mm except cricothyroid, sensory innervation below vocal cords |
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what cardiac drug requires a drug-free period every day to avoid tolerance?
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nitrates
ppl ussually take them for angina in the morning & afternoon, but not at night |
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what enzymes are defective in Xeroderma pigmentosum?
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UV-specific endonuclease deficiency
autosomal recessive |
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layers of young bone, middle to external?
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diaphysis --> metaphysis --> epiphyseal cartilage --> eiphysis
epiphyseal cartilage = "growth plate" responsible for linear growth when epiphysis fuses w/metaphysis growth plate is closed & linear growth stops |
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what is somatomedin C?
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insulin like growth factor 1 (IGF-1)
stimulated by GH |
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where is the ulnar nn classically damaged? What deformity results?
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near medial epicondyle of humerous, or
Guyon's canal, near the hook of the hamate and pisiform bone in the wrist results in "claw hand" deformity |
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what does fx of the surgical neck of the humerus clasically damage?
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axillary nn
paralysis of deltoid & teres minor mm loss of sensation of lateral upper arm |
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what does radial head subluxation classically damage?
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deep branch of the radial nn
weakness or paralysis of many of the mm of the extensor compartment of the forarm |
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what types of cells proliferate in choriocarcinoma?
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trophoblastic, both cytotrophoblasts and syncytiotrophoblasts
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MCC e coli bacteremia in 72 yo man from skilled nursing facility?
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UTI
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MCC of bacteria infecting biliary tree?
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E. Coli, Klebsiella, Enterobacter, Enterococci
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what is Cilostazol?
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also dypyridamole
phosphodiesterase inhibitor used for intermittent claudication additionally inhibits platelet aggregation direct arterial vasodilator superior to ASA in tx of peripheral artery dz |
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what do you see on MRI with MS? What's going on there?
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characteristic plaques, variable distribution of the slcerotic plaques accounts for the variety of neurologic manifestations
main pathologic process is demyelination, with the following changes in the plaques 1.) axon demyelination 2.) depletion of oligodendrocytes (myelin producing cells of CNS) 3.) Accumulation of lipid-laden macrophages (phagocytize products of myelin breakdown) 4.) Fibrillyar astrocytes (astrocyte proliferation rxn to injury) 5.) infiltration by lymphocytes & monocytes |
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what is sertraline?
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SSRI
sexual dysfxn |
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what antidepressent OD can cause cardiac arrythmicas? What other side effects do they have?
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TCAs
quinidine like effect w/prolongation of QRS & QT interval urinary retention seizures (from antihistamine, antimuscarinic, and anesthetic properties) orthostatic HTN via antagonism of alpha-adrenergic receptors |
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hx of choking spells, dysphagia, & coughing, diverticula seen on barium study, what's going on?
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symptoms of "high dysphagia" w/difficulty swallowing, choking at the throat, are result of CRICOPHARYNGEAL DYSFUNCTION
get a zenker diverticuli herniating at the point of mm weakness (posterior hypopharynx) note, this diverticula has only mucosa, it is false, or pulsion, diverticulum true diverticula are seen at mid-portion of esophagus, resulting from mediastinal lymphadenitis (TB, fungal infection) can result from scarring and traciton of the esophagus |
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patient w/malabsorption and a papulovesicular rash on extensor surfaces?
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Dermatitis herpetiformis
strong association w/Celiac's |
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what is dermatitis herpetiformis?
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strongly associated w/celiac dz
rare condition, presenting w/erythematous, pruritic papules, vesicles, and bullae appearing bilaterally and symmetrically on extensor surfaces (elbows, knees, upper back, buttocks) men more frequently affected than women gliadin induced IgA and IgG antibodies cross reacted w/reticulin, prtn in anchoring fibrils of epidermal basement membrane |
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what are the 5 P's of lichen planus?
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Polygonal, planar, pruritic, purplish, plaques on hands, trunk & legs
finely reticulated scale "Wickham's striae" may be present on plaque surface |
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what is erythema multiforme?
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acute onset of a spectrum of lesions (papules, urticarial plaques, blisters, targets) arising on limbs & extremities, especially PALMS
MC in children & young adults when classic target lesions are ID'd, it's herpes simplex most often drugs & pathogens are associated w/the other forms |
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1 year old african american boy rushed to ED b/c acutely developed welling of both hands and feet?
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dactylitis from sickle cell
as there is hemolysis, haptoglobin levels will be reduced |
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Podophyllin and etoposide have what MOA? What uses?
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inhibit Topoisomerase II's ability to seal double stranded breaks it induces
chromosomal breaks accumulate in dividing cells Topoisomerase I - makes single stranded nicks, relieving negative supercoiling Topoisomerase II - transient breaks in DNA strands simultaneously relieving postive & negative supercoiling Etoposide - testicular cancer & small cell lung cancer Podophyllin - topically for genital warts |
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difference between asthma and exercise induced asthma?
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allergens are a more common inciting factor for asthma
exercised induced asthma is incited by cold air and exercise by a non-immune mechanism if see eosinophils in sputum probably is asthma, avoid inciting allergens |
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alcoholic w/megaloblastic anemia - why does folate deficiency do this?
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deficiency in folate impairs syntehsis of purine & pyrimidine bases
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colon polyps - which are non neoplastic? Which neoplastic are worse?
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Non-neoplastic:
1. hyperplastic - well differentiated mucosal cells w/glands & crypts 2. Hamartomatous - mucosal glands, smooth mm, & CT, occur sporadically or in Peutaz-Jegher, or juvenile polyposis 3. inflammatory - in ulcerative colitis & crohn, composed of regenerating intestinal mucos 4. lymphoid polyps - in children, intestinal mucosa infiltrated w/lymphocytes ADENOMATOUS polyps are dysplastic and can transform into adenocarcinoma 1. degree of dysplasia 2 histological pattern - villous adenomas are more likely to become malignant than tubular (villains) 3. size - >4 cm have 40% risk, < 1 cm most likely benign |
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classify hemorrhagic skin lesions according to increasing size:
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petechiae (< 0.5 cm)
purpura (0.5-1 cm) ecchymoses ( at least 1 cm in diameter) |
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what is the bad side effect w/bupropion? What population is this worst in?
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seizures, especially at high doses
greater risk in pts w/preexisting seizure disorder, bulimia, or anorexia |
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drugs causing seizures?
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Bupropion (antidepressant)
Isoniazid (anti TB, if given w/o pyridoxine) Imipenem (antibiotic) |
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what is atenolol?
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beta blocker with selectivity for beta-1 receptors, at low doses
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what receptors do the juxtaglomerular cells have?
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beta-1
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wound with a fruity odor?
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Pseudomonas aeruginosa
gram negative rod pigments would also give wound exudates in a blue-green hue |
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what are the types of necrosis? Charactersitics? Examples?
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Coagulative necrosis:
-MC variant -relative preservation of cell outlines -most exogenous injuries (recluse spider) are coagulative -Organ ischemia classic example -cell cytoplasm --> eosinophilic (due to prtn denaturation), nucleu shrinks, chromatin clumping (pyknosis), fragmentation (karyorrhexis) and lysis Liquefactive necrosis -in the CNS, sites of ischemic stroke -fragmentation & phagocytized by macrophages, forming cystic cavity Fat necrosis -acute pancreatitis -saponification when FA combines w/Calcium Caseous necrosis -w/TB -"cheesy" appearance -consits of fragmented cells & acellular material |
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what is the morphology of Haemophilus influenza? What makes its capsule different from other encapsulated H. influenza?
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gram negative rod
capsule contains RIBOSE instead of hexose for it's carbohydrate component PRP capsule polyribosyl-ribitol-phosphate |
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bug grown on special medium, colonies appear black in color, intracellular polyphosphate granules detected on microscopy after methylene blue staining?
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C. diphtheria
metachromatic granules grown on cysteine-tellurite agar (or Loffler's medium) |
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use of blood agar containing bile & hypertonic saline?
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culture enterococci - E. faecalis & E. faecium
differentiates these from non-enterococci Group D strep including Strep bovis & Strep equinus (grow in bile but NOT hypertonic saline) |
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what is enfuvirtide?
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fusion inhibitor
binds heptad repeat 1 (HR1) of GP41 prevents gp41 from undergoing conformational changes necessary for viral membrane to fuse (HIV) |
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in skeletal mm what monitors force on mm? what monitors length of mm?
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force on mm monitored by GTO
-arranged in series -exquisitively sensitie to increase in mm tension, insensitive to passive stretch -"extrafusal fibers" -Ib sensory neurons of GTO contact inhibitory neurons of spinal cord, which then inhibit alpha motor neurons muscle spindles (intrafusal mm fibers) monitor length -connected in parallel w/extrafusal ibers -mediate stretch relex (myotatic reflex) -measured w/DTRs -mm stretched, monosynaptic reflex activation of alpha motor neuron for same mm |
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common causes of SCID?
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MCC - X-linked
2nd MCC - Adenosine deaminase deficiency -this enzyme deaminated adenosine --> inosine -1st step in elimination of excess adenosine -adenosine accumulation is toxic to lymphocytes |
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what type of lung cancer does smoking generally cause?
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Squamous cell carcinoma
can have PTHrP w/it (humoral hypercalcemia of malignancy" |
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what is the MCC of "humoral hypercalcemia of malignancy"?
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usually due to overproduction of PTHrP
squamous cell lung cancer, others |
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in developing mitral regurgitation, if it is acute vs chronic there is a higher risk for?
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acute - marked pulmonary HTN and edema
chronic development - increase LA compliance, more prone to atrial enlargement, fibrillation, and mural thromboembolism |
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what is normal in a lymph node? What indicates malignancy?
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Normal - pleomorphism, increased mitoses, and nuclear changes are all commonly seen in lymphocytes of a reactive hyperplastic lymph node, not automatically malignant
predominantly monomorphic cell population indicative of malignancy characteristic of NON-Hodgkins lymphoma Hodgkin's lymphoma does demonstrate admixture of several lymphoid cell types w/in nodes, doesn't distinguish it from reactive hyperplasia, Reed-Sternberg cell does |
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how do combined OCPs prevent pregnancy?
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primary mode of action is suppression of synthesis of the gonadotropins FSH and LH in anterior pituitary
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combinations of drugs aimed at improving lipid profile that should be avoided?
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1.) statins + fibrates = increased risk of myopathy
--gemfibrozil - increases concentration of most statins --fenofibrate causes myopathy itself 2.) fibric acid derivaties + bile acid-binding resins = increased risk for cholesterol gallstones --increased cholesterol concentration in bile 3.) bile-acid sequesterant (cholestyramine) + statin = decreased statin absorption --dose at least 4 hours apart *simvistatin = statin w/highest risk of myopathy |
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how much O2 does myocardium extract from it's blood? What regulates flow?
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extracts 75-80% at rest, up to 90% at work
hypoxia and adenosine accumulation increase cardiac perfusion also, basal vascular tone modified by NO & beta adrenergic (vasodilation), and alpha adrenergic (vasoconstriction) |
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what condition is HbA2 elevated in? what implication does this have for diabtics?
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elevated in beta-thalassemia (minor & intermediate)
HbA1c measures A1, not A2 |
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Renal cell carcinoma (clear cell) arises from what part of the kidney? What does it look like macroscopically? Microscopically?
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epithelial cells of proximal renal tubules
macro - golden yellow mass micro - cells w/abundant clear cytoplasm (lipid filled) & eccentric nuclei |
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rouleaux formation on peripheral blood smear?
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multiple myeloma
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histone proteins?
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nucleosome core - 2x: H2A, H2B, H3, H4
H1 histones bind segments of DNA between nucleosomes, facilitate packaging of nucleosomes into more compact structure |
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infant w/signs of infection, bilateral wheezing, prolonged expiration, scattered rales? Tx?
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viral bronchiolitis
MCC is RSV tx is Ribaviran - nucleoside analog inhibiting guanine synthesis Ribavirin is active against RSV and hep C |
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Ribaviran?
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RSV and Hep C
nucleoside analog inhibits synthesis of guanine |
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Oseltamivir?
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influenza A & B
sialic acid analogue inhibits viral neuraminidases of influenza A and B |
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Ganciclovir?
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anti-herpesvirus guaninen nucleoside analogue
(structurally similar to gangciclovir) distinguished by its greater activity against CYTOMEGALOVIRUS DNA polymerase |
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Lamivudine?
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anti-retroviral nucleoside reverse transcriptase inhibitor to tx HIV
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Amantadine?
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impairs uncoatin gof inluenza A virion after host cell endocytosis
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interferon-alpha tx?
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used to combat HBV and HCV
naturally released by eukaryotic cells in response to viral infection |
