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84 Cards in this Set
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what are entacapone and tolcapone?
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COMT inhibitors, the main enzyme responsible for levodopa degradation
entacapone inhibits peripheral methylation tolcapone inhibits both peripheral & central methylation, & is associated w/HEPATOTOXICITY |
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fever w/GI upset, hepatosplenomegaly, & "rose spots" on abdomen? pathophys of this organism's infection?
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typhoid fever - Salmonella typhi & paratyphi
travel associated can have possible hemorrhagic enteritis w/bowel perforation later in course salmonella penetrate both enterocyte transporters & via phagocytosis by M cells in Peyer's patches phagocytosed by macrophages and survive intracellularly can go to liver, spleen, & bone marrow |
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seizure drug associated w/generalized lymphadenopathy?
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Phenytoin
pseudolymphoma w/a serum sickness like syndrome |
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child has bowed legs, a rachitic rosary, Harrison's sulci, & craniotabes - what do bones look like histologically?
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increase in unmineralized osteoid and widening between osteoid seams
"osteoid matrix accumulation around trabeculae" osteoid is the unmineralized organic portion of bone matrix that forms prior to maturation of bone tissues |
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mosaic of lamellar bone, irregular sections of lamellar bone linked by areas of previous bone resportion, "cement lines"?
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paget's disease
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how to tx HIV patient w/VZV?
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thymidine kinase deficient VZV isolates tend to be obtained exclusively from AIDS patients
best tx with -foscarnet - pyrophosphate analog viral DNA polymerase inhibitor -Cidofovir -nucleotide analogue of cytosine monophosphate CIDOFOVIR does NOT require activation by viral thymidine kinase, instead just cellular kinases |
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direct glycoprotein 2b3a inhibitors?
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eptifibatide
tirofiban abciximab |
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what is argatroban?
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a direct thrombin inhibitor
used for ppl w/heparin induced thrombocytopenia |
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patient admitted w/unstable angina, 4 days later develops severe foot pain & right toe paleness, labs reveal platelets of 60,000 - what's going on? Tx?
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Heparin induced thrombocytopenia
leads to paradoxical thrombosis rather than bleeding, more commonly use direct thrombin inhibitor to tx - argatroban do NOT use either low nor high molecular weight heparain, d/c immediately! |
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what is standard therapy for CHF? What increases overal survival? How?
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ACE inhibitors, digoxin, a diuretic, & spironolactone
spironolactone increases survival probably by blocking neurohormonal effects of aldosterone (ventricular remodeling --> cardiac fibrosis) b/c low doses not the diuretic effect |
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what is triamtrene?
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potassium sparing diuretic
blocks Na channels in distal tubule & collecting duct very mild diuretic, NOT commonly used for tx pulm congestion or fluid retention in CHF |
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who has highest risk of lupus?
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women of childbearing age
black > white, asian |
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hematologic abnlities in lupus?
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anemia from autoimmune hemolysis, type 2
warm IgG antibodies to RBC spherocytosis positive direct Coombs test extravascular hemolysis SLE-associated thrombocytopenia identical to pathogen of ITP |
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clinical course of strawberry hemangiomas?
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benign, quite common
initially grow as child does regress spontaneously at or before puberty (95% of time by age 7) |
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bluiesh neoplasm underneath nail bed?
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either glomus tumor (glomangioma) or subungual melanoma
glomus is the vasculature control of temperature regulation for skin surface (shunt away from skin when cold, too skin when hot) |
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how does cutaneous involvement in Langerhans cell histiocytosis present?
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erythematous papules, nodules, and/or scaling plaques
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what is vitiligo? Histological finding? Associations?
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flat, well circumscribed macules & patches of absent pigment
histology demonstrates loss of melanocytes & complete absence of melanin pathogenesis unclear, strong association w/autoimmune conditions |
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MCC of bacteriemia in sickle cell patients? Osteomyelitis?
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Streptococcus pneumo
followed by hemophilus influenza (asplenic) MCC of osteomyelitis is salmonella > s aureus or e coli |
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man w/colon cancer has nephrotic syndrome, glomerular capillary wall thickening w/o increased cellularity - what is wrong w/kidney? Other associations?
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membranous glomerulopathy
1.) systemic dz - diabetes, solid tumors (lung, colon), immunologic disorders (SLE) 2.) drugs - gold, penicillamine, NSAID 3.) infections - hep B, hep C, malaria, syphilis most cases are idopathic histology - uniform, diffuse thickening of glomerular capillary wall on light microscopy w/o increased cellularity dense deposits between basement membrane & epithelial cells, protrusions rememble "spikes" when stained w/silver - IgG and C3 |
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glomerulus shows uniform diffuse thickening of glom capillary wall on light microscopy, w/o increased cellularity, dense deposits between BM & epithelial cells w/protrusions resembling "spike and dome" stained w/silver?
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the granular deposits contain IgG and C3
this is membranous glomerulopathy |
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how is acid secretion inhibited after a meal?
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ileum & colon release peptied YY, which binds enterochromaffin-like cell receptors
this inhibits gastrin stimulated histamine release from ECLs |
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what factors are variables in MAC for inhaled anesthetics?
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ambient temperature & age of patient
MAC given for 40 yo patients decreases with increasing age |
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what is the function BRCA1/2 gene products?
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tumor suppressor genes
gene repair & regulation of cell cycle BRCA-1 is on chromosome 17 autosomal dominant 70-80% lifetime risk ovarian cancer risk increased by 40% |
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what is the APC gene responsible for?
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cell attachment
mutation is associated w/decreased expression of D-cadherin (e-cadherin mutations are associated w/gastric cancers) |
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"rust colored sputum"?
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strept pneumo
"lancet-shaped gram positive diplococci" optichin sensitive (?) |
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hernia inferior to inguinal ligament? borders? occur in? complications?
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femoral hernia
lateral to pubic tubercle & lacunar ligament medial to femoral vein more common in females, tend ot occur on right side prone to incarceration & strangulation direct & indirect hernias are superior to inguinal ligament direct hernias are medial to inferior epigastric vessels indirect hernias are lateral to inferior epigastric vessels |
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borders of Hesselbach's triangles?
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lateral - inferior epigastrics
medial - rectus abdominis mm sheath inferior - inguinal ligament these are the direct hernias indirect are on the lateral side of the epigastric vessels femoral are inferior to inguinal ligament (mc in female on rt) |
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old lady falls & hip hurts, most likely artery to be damaged?
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femoral neck fracture - can damage blood supply of femoral head & neck
MC w/displaced fx MEDIAL FEMORAL CIRCUMFLEX artery provides majority of blood supply to femoral head & neck injury can cause avascular necrosis also supplied by lateral fem circumflex, superior & inferior gluteal arteries |
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pt has weak wrist extension but sensation intact, what nn damaged? Where? Course from spine to terminal pt?
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Radial nn damaged via radial head subluxation, "nursemaid's elbow"
common injury in children - sudden outward pulling of extended & pronated arm radial head subluxation damages deep branch of radial nn - weakness of forearm extensors, wrist drop, doesn't contian sensory here radial nerve comes from posterior cord, innervates extensor compartment of upper arm enters forearm divides at lateral epidondyle of the humerus -superficial branch is purely sensory (radial half of dorsal hand) -deep branch innervates forearm extensors |
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what is carcinoembryonic antigen (CEA) elevated in?
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colorectal cancer
best used as aid in staging & planning b/c is high in many benign dz |
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what is expected to accompany blue/white spots on buccal mucosa in immigrant child?
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this is measles, rubeola
CCCK - cough, coryza, conjunctivities, koplik spots |
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pulsus paradoxus - found in? describe presentation?
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acute cardiac tamponade, constrictive pericarditis, severe obstructive lung dz, restrictive cardiomyopathy
"decrease in BP > 10 mmHg on inspiration" man comes in BP cuff at 100 can hear korotkoff sounds only during expiration at 78 sounds are heard throughout respiratory cycle think - when inspire are increasing return to right heart, pushing septum over towards left, b/c heart is restricted no room to compensate, diminished LV stroke volume |
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what regulates the body's iron stores?
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Hepcidin, synthesized in the liver
this is what controls how much iron the enterocytes store (ferritin) or transport into circulation (ferroportin) via divalent metal transporter 1 (DMT-1) hepcidin levels downregulate ferroportin (degraded) hepcidin levels are decreased by low iron levels or hypoxia |
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skin infection is resistant to nafcillin but sensitive to vanco, what is mechanism of resistance?
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alteration of penicillin binding protein
oxacillin, nafcillin, and methicillin are penicillinase-stable, so that's not how this is resistant not the multi-drug pump, that is how bugs become resistant to tetracyclines & sulfonamides |
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electrophoresis of 3 Hbs all migrating at different rates?
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HbA migrates quickly towards annode
HbS moves less quickly, b/c of substiution of non-polar valine for negative gluatmic acid HbC migrates slower still, b/c of substitution of positive lysine for glutamate all these are occuring on beta chains |
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what is nitroprusside moa? Toxicity? Remedy?
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direct release of NO causes mixed veno & arterio dilation
used for malignant / emergent HTN toxicity is cyanide & thiocyanate poisoning (also released) - altered mental status & lactic acidosis give sodium thiosulfate for cyanide toxicity donates additional sulfur to liver rhodanase to enhance metabolism & detox of cyanide to thiocyanate |
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antihypertensive not commonly used that can cause sadness & hopelessness? Associated PE Findings?
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reserpine - blocks packaging of adrenergic mediators in presynaptic vesicles
causes pharmacologic sympathectomy predisposes to depression b/c depletes NE & serotonin from presynaptic vesicles associated w/nasal congestion & increased gastric acid secretion leading to peptic ulcer |
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what is Enoxaparin? MOA?
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it's LMW heparin
binds and activates anti-thrombin III, which then binds factor Xa & stops it from converting prothrombin-thrombin indicated in ST depression w/burning substernal pain |
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man recently dx w/lung cancer presents w/difficulty standing, proximal mm weakness, what's going on?
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Lambert-Eaton syndrome
associated w/small cell lung cancer antibodies against presynaptic Ca channels resembles Myasthenia gravis except: -it improves during day w/exercise (as opposed to worse) -proximal mm first (as opposed to extraoccular) myasthenia gravis is against post-synaptic AChR |
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what do ppl w/Barett's esophagus have increased risk of developing? What does barett's look like histologically?
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adenocarcinoma of the esophagus
Barett's is a metaplasia of stratified squamous --> columnar epithelium w/goblet cells (resembling intestine) |
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people w/active leprosy have what response to heat killed M. leprae injection? (lepromin skin test)
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if tuberuloic leprosy will have positive test
-well contained, good Th1 CD4 response (& macrophages) if lepromatous leprosy, won't be positive? -poor cell mediated response, get limbs falling off and so on |
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big side effect of clozapine? What is clozapine's moa?
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agranulocytosis
seizures also can occur it's used often for treatment resistant schizophrenic pts for both positive & negative sx acts on D4 receptors |
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what antipsychotic causes prolonged QT?
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Ziprasidone
follow ECGs |
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what does chronic rejection of lung transplant cause? What is it called?
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inflammation of small bronchioles
"bronchiolitis obliterans" contrasts to that of renal transplant, where chronic rejection is primarily vascular obliteration |
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what is abetalipoproteinemia? How does it present? What does it look like histologically?
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impaired synthesis of ApoB, inabiility to transport lipids from the intestine
autosomal recessive 5 yo caucasian boy hospitlized, failure to thrive, bulky & greasy stool "malabsorption, neuro deficiencies, progressive ataxia in first few years of life" get abnl RBC membranes from lack of lipid, acanthocytes (thorny projections) lack of lipid in neuron membranes lead to neuro abnliteis serum levels of all lipids are decreased histology - excessive lipids stored in intestinal epithelium cells, characteristic "foamy" appearance to cytoplasm |
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thiazide diuretics cause what side effects?
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hyperuricemia - can precipitate acute gouty arthritis
hypercalcemia - increase renal calcium resorption, can be useful for tx nephrolithiasis hyperglycemia hyperlipidemia |
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chronic lymphedema is RF for what malignancy?
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angiosarcoma
predisposes to this, Stweart-Treves syndrome histology - infiltration of dermis w/slit like abnl vascular spaces |
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transmural inflammation of arterial wall w/fibrinoid necrosis?
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polyarteritis nodosa
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granulomatous inflammation of the media?
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temporal (giant cell) arteritis (ESR up, resolves w/steroids)
takayasu arteritis (aortic arch) |
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how does n-acetylcysteine help in acetominophen toxicity?
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acts as glutathione substitute binding toxic metabolite
also provides sulfhydryl groups to enhance nontoxic sulfation elimination |
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mutation of the HIV pol and env genes confer what?
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pol mutation - resistance to reverse transcriptase and protease inhibitors
env (structural glycoproteins) - enables escape from host neutralizing antibodies |
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what comprises the MHC class I molecule? Class II?
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MHC class I - heavy chain & beta-2-microglobulin
MHC class II - alpha & beta polypeptide chains |
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what is Murphy's sign?
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PE maneuver, have patient exhale, put hand up under right costal space, have inhale - if they stop and have 'catch' in their breath that is positivie
indicative of cholecystitis |
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what is porcelain gallbladder?
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ring of calcification on radiography
indicative of gallbladder carcinoma |
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what is acute acalculous cholecystitis? Results from? Seen in?
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acute inflammation of gallbladder w/o gallstones
secondary to gallbladder stasis or ischemia commonly seen in hospitalized & severely ill |
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12 yo male w/ataxia, episodic erythematous & pruritic skin lesions and loose stools. Lab eval shows loss of neutral aromatic amino acids in urine - what is it? Tx?
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Hartnup dz, give niacin
tryptohan is essential aa & precursor for nicotinic acid, serotonin, & melatonin |
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ulceration of the posterior wall of the duodenal bulb puts what structure at risk?
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gastroduodenal artery
can be a life threatening hemorrhage |
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metallic sheen on eosin methylene blue agar, & hemolysis on blood agar? Motile
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E. coli
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most important virulence factor for e. coli causing UTI? Meningitis?
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UTI - fimbriae, adhesion to uroepithelial cells
meningitis - K-1 capsular antigen |
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what is the O antigen?
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cell wall Outer membrane polysaccharide used to classify gram-negative bacteria
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in addition to protecting against oxidative stress, what fxn does G6PD have?
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provides NADPH, which is used for:
FA & cholesterol biosynthesis drug metabolism steroid biosynthesis the oxidative portion of HMP shunt primarily occurs in tissues active in reductive biosynthesis |
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where is CCK produced? What does it do?
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CCK produced by cells of duodenum & jejunum when fat-protein-rich chyme enters duodenum
increases pancreatic enzyme secretion increases gallbladder contraction decreases gastric emptying |
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what happens to K+ at each portion of the kidney?
PCT loop Henle collecting duct |
PCT - absorption of ~2/3 of filtered K
loop of Henle - further reabsorption (~20% of filtered load) the above are at fixed rate, do not play significant role in regulation cortical collecting duct extra potassium is reabsorbed via H/K ATPases, but secretion can be promoted by: -high dietary K -aldosterone -alkalosis (to preserve H+, which freely exchanges) -thiazide diuretics (increased flow) potasium is regulated in cortical collecting ducts, other sites are relatively constant |
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what is terbinafine? Moa? Used for?
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antifungal
inhibits squalene epoxidase, which then inhibits synthesis of ergosterol of fungal membrane "squealing turbines" used for topical infections, dermatophytosis |
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how to calculate confidence intervals?
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mean, SD, Z-score, sample size
first, calculate standard error of the mean (SEM) = SD / square root (n) multiply SEM by z-score z-score = 1.96 for CI 95%, = 2.58 for CI 99% so, for 95% CI = 1.96*SD/square root (n) |
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how do bugs become resistant to aminoglycosides? (gentamicin)
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produce aminoglycoside-modifying enzymes that transfer different chemical groups (acetyl, adenyl, or phosphate)
on a plasmid |
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QT prolongation predisposes to?
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torsades de pointes
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high QRS voltage in precordial leads indicates?
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ventricular hypertrophy, should not cause an irregular rhythm
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QRS interval prolongation indicates?
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ventricular dyssnchrony or slowed intraventricular impulse conduction
common cause is bundle branch block heart rate usually regular |
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palpitation post binge-drinking?
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"holiday heart", episode of atrial fibrillation
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absent p waves?
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indicates atrial fibrillation
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main determinant of prognosis for bladder carcinoma?
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penetration of bladder wall
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in the gallbladder, what effect do bile salts have on gallstones? Phosphatidylcholine?
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they both decrease gallstone formation by keeping cholesterol soluble
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what drug to use in patient w/angina pectoris but allergic to aspirin?
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clopidogrel
warfarin is not indicated for angina pectoris (was thinking stroke prevention I guess) |
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what cells secrete intrinsic factor? How to ID on histology?
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parietal cells of stomach, also secrete acid
they are pink, in upper glandular layer, approximately midway between epithelial surface & BM at the bottom of the pits are the chief cells, secrete pepsinogen |
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smoker w/hemoptysis, pain in right scapula & arm, weakness in hand? other sx might expect? why?
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pancoast syndrome - tumor at lung apex
most often in superior sulcus (groove formed by subclavian vessels) invades multiple structures -pain in shoulder radiating to axilla & scapula MC sx, from involvement of lower brachial plexus -Horner's syndrome -compression of subclavian vessels - edema of UE -extension of tumor into intervertebral foramina - spinal cord compression, paraplegia |
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recurrent small lobar hemorrhages in right occipital & left parietal areas?
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cerebral amyloid angiopathy
-deposition of beta-amyloid into arterial wall unlike HTN strokes are less severe, and located in cerebral hemispheres & involve smaller areas of brain (HTN strokes tend to involve basal ganglia - lenticulostriate arteries) |
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sudden stabbing / electical pain in face in response to stimulus? other characteristics? tx?
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trigeminal neuralgia, particularly V2 or V3
lasts only a few seconds, occurs repeatedly, may occur for several months pathogenesis unclear tx - carbamazepine -inhibits neuronal high frequency firing |
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how will hyperchylomicronemia present?
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abdominal pain due to acute pancreatitis is most likely presentation
also get marked hyperlipidemia, lipemia retinalis, eruptive skin xanthomas (extensor surfaces of extremities) & heapatosplenomegaly |
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what is Berkson's effect? Pygmalion? Hawthorne?
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Berkson's bias - selection bias created by selecting hospitalized patients as control
Pygmalion effect - researches beliefs in efficacy of treatment that can potentially affect outcome Hawthorne effect - tendency of a study population to affect an outcome due to knowledge being studied |
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poor contractilce force on repeated mm stimulation?
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myasthenia gravis
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what chemotherapeutic causes tingling in hands & feet? What MOA?
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vinca alkaloids, eg vincristine
block microtubule formation by binding beta-tubulin cell specific cytotoxicity in M phase peripheral neuropathy is characteristic |
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direct, indirect, total bilirubin?
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direct = conjugated
indirect = unconjugated (in … un) totally = conjugated + unconjugated |
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on histology liver shows dense pigment composed of epinephrine metabolites within the lysosomes?
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Dubin-Johnson syndrome
defect in hepatic excretion of bilirubin glucoronides across canalicular membrane rare benign condition grossly liver is black conjugated chronic hyperbilirubinemia (direct) that is not associated w/hemolysis requires direct bilirubin fx of at least 50% for dx confirmation by evaluating urinary coproporphyrin I to be high no tx necessary, prognosis is excellent |
