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62 Cards in this Set
- Front
- Back
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pseudomonas toxin is similar to? Shiga toxin is similar to?
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Pseudomons & Diptheria exotoxin A act on EF-2
Shig-like toxins (vero toxins) are produced by EHEC, they inhibit the 60S ribosomal subunit preventing tRNA binding |
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15 yo male has kyphoscoliosis & high plantar arch, what will he experience? He did have a brother that died of heart failure at 25
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Friedreich ataxia (autosomal recessive)
"frataxin" gene (nl mitochondria fxn) gat ataxia degeneration of dorsal column & dorsal root ganglia (position & vibration) kyphoscoliosis & foot abnormalities (pes cavus) hypertrophic cardiomyopathy & CHF diabetes |
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I say kyphosis, you say…
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friedreich ataxia
homocystinuria osteoperosis |
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nosebleeds w/several spider-like lesions on oral mucosa & face/arms?
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Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia)
autosomal dominant skin mucous membranes (lips, oronasopharynx, resp tract, GI, urinary) rarely in the brain, liver, & spleen can rupture causing epistaxis, GI bleeding, hematuria |
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"tram track calcifications" on radiograph of skull?
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Sturge-Weber syndrome (encephalotrigeminal angiomatosis)
rare congenital neurocutaneous disorder cutaneous facial angiomas as well as leptomeningeal angiomas mental retardation, seizures, hemiplegia, skull radiopacities |
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patient w/seizure demonstrates kidney, liver, & pancreatic cysts, cutaneous angiofibromas present on exam, CNS shows cortical & subependymal hamartomas?
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Tuberous sclerosis (autosomal dominant)
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indications for carbamazepine?
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seizure disorders
trigeminal neuralgia bipolar disorder |
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non-selective betablockers (names)?
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propranolol, timolol, nadolol
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effect of adrenergics on the pancreas? Risk of blockade in diabetics?
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alpha2 - inhibit insulin secretion
beta-2 - promote insulin secretion, promote glucagon secretion (done by circulating epinephrine vs symp nn NE, little bit of time between) -need to mobilize glucose from liver (glucagon) and use it in mm (insulin) beta blockers mask the signs & sx of hypoglycemia which might develop in a diabetic (sympathetic mediated) also prevent liver from mobilizing sugar |
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intestinal atherosclerosis?
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diminishes blood supply
during digestion (shortly after meals!) intestinal hypoperfusion can be very painful! Not responsive to antacids! |
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HIV patient started on new med, develops hyperglycemia? Other side effects?
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Protease inhibitors (eg Indinavir)
Lipodystrophy - fat deposition on back & abdomen Hyperglycemia - increaed insulin resistance, frank diabetes possible Inhibition of P-450 enzymes |
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why use azithromycin in HIV pts?
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tx & prophylax Mycobacterium avium intracellulare infections (MAC)
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why use TMP-SMX in HIV pts?
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prevention & tx of Pneumocystis jiroveci pneumoniae
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alcoholic has prolonged coag lab not correcting w/vitamin K administration - why? What lab to follow?
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liver dz - not synthesizing coag factors
(not vitamin K deficient b/c supplement didn't help) factor VII will be first to become deficient follow w/PT |
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hemibalismus from stroke - what brain area?
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subthalamic nucleus on contralateral side
(NOT caudate, that is Huntington's) |
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drug induced lupus - drugs are metabolized how? Examples?
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N-acetylation in liver
genetic slow acetylators are at high risk hydralazine & procainamide are classic examples |
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difficulty releasing doorknob & handshake? Associated findings?
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Myotonic muscular dystrophy (autosomal dominant)
(2nd MC dystrophy after duchenne) trinucleotide repeat expansion (CTG) in gene for myotonia-protein kinase type 1 fibers more affected myotonia - abnl slow relaxation of mm cataracts in all pts, frontal balding & gonadal atrophy common |
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large lymphocyte w/RBCs indenting into its surface?
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EBV mononucleosis
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acidophilic bodies in viral hepatitis?
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apoptotic bodies, or councilman bodies
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salicylate overdose findings?
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first an acute respiratory alkalosis, from stimulation of medullary respiratory center --> hyperventillation
a few hours later, an anion gap metabolic acidosis develops (decreased HCO3 blood levels) pH could be anywhere depending on course of specific circumstance and timing |
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deficiency in forming complement membrane attack complex exposes particular risk to what infection?
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Neisseria (meningitidis)
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petechial skin rash on trunk, spreading to include palms & soles?
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Neisseria-induced small-vessel vasculitis
especially affects palms & soles |
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I say eggshell calcification, you say?
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silica exposure
echinococcus hydatid cysts |
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nasal lesion?
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ASA induced asthma
CF Wegener's EBV associated nasopharyngeal carcinoma cocaine |
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Echinococcus is? Causes? Tx? Risk w/tx?
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MCC hydatid cysts in humans
-sheep & dog exposure, part of tapeworm life cycle encapsulated calcified cyst "eggshell calcification" surgery to remove cyst could result in spillage --> ANAPHYLAXIS adjunctive chemo w/mebendazole or albendazole then surgery is tx of choice -also they talk about injecting et-OH |
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absolute contraindication for metformin?
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renal failure
risk of lactic acid accumulation -metformin increases intestinal production of lactate by anaerobic glycolysis, & inhibits lactate use in gluconeogenesis at the same time contraindicated in any situation that might precippitate lactic acidosis - liver dysfxn, CHF, alcoholism, sepsis |
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where does VDJ / VJ recombination occur? Where does isotype switching occur?
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B-cells:
VDJ (heavy chain) & VJ (light chain) switching occurs in BONE MARROW isotype switching occurs in germinal center follicles in lymph nodes -this is where B-cell proliferation occurs |
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what determines an atherosclerotic plaques likelihood to rupture? How do macrophages affect this?
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the strength of the fibrous cap
-strengthed by increased collagen macrophages weaken the cap by secreating METALLOPROTEINASES -chronic intimal inflammation weakens b/c activates macrophages |
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long term sequelae of hydrocephalus in an infant?
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LE spasticity from stretching of periventricular pyramidal tracts
visual disturbances learning disabilities |
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difference between synergistic & permissive action of substances?
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Synergistic - both have independent actions, add together (& sum is greater than components)
Permissive - one of the agents doesn't cause the effect by itself, but does augment the effect of the other |
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what is hydralazine?
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direct acting arteriolar dilator
poorly characterized mechanism associated w/drug-induced lupus |
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cystic dilations of medullary collecting ducts? Complications?
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Medullary sponge kidney (MSK)
-relatively common, benign can get KIDNEY STONES, painless hematuria, or UTI DON’T confused w/ADPKD, cysts in ADPKD are not confined to the medullary ducts |
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recurrent kidney stones in young patient, urine sample shows hexagonal crystals (pathognomonic) and the sodium cyanide-nitroprusside test turns red/purple?
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Cystinuria
defect in renal proximal tubules, decreased resorption of aa cystine these crystals form in acidic urine tx is to alkalinize urine think about inborn error of metabolism w/recurrent kidney stones in young patient |
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66 yo man w/recently discovered lung mass develops dizziness, dysarthria, limb ataxia worsening over 2 weeks, is admitted ot the hospital but worsens and dies. Autopsy shows extensive cerebellar purkinje cell degeneration - what's going on?
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A paraneoplastic, autoimmune phenomenon where antibodies against the tumor cells are cross-reacting with the body's own healthy organs and tissues
paraneoplastic cerebellar degeneration MC seen w/cancers of lung, breast, ovary, uterus, & lymphoma |
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what is sulfasalazine? Used for?
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combination of sulfapyridine (antibacterial) & 5-aminosalicylic acid (anti-inflammatory)
-activated by colonic bacteria used for ulcerative colitis, Crohn's |
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what is metoclopramide? Used for?
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D2 receptor antagonist
used for diabetic & post-surgery gastroparesis increases resting tone, contractility, LES tone, motility does not influence colon transport time contraindicated in small bowel obstructio or Parkinsons |
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how to tx female UTI?
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3 day course of fluoroquinolone, or TMP-SMX
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patient w/anemia, kidney biopsy shows eosinophilic casts & atrophic tubules, elevated creatinine?
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Multiple Myeloma
eosinophilic casts = bence jones proteins precipitated w/Tamm Horsfall prtn (NOT eosinophilic CELLS) also are directly toxic to tubules, showing atrophy |
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what color is hemosiderin?
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golden yellow brown pigment
it is an aggregation of ferritin micelles |
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what is lipofuscin? Apperance?
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insoluble yellow-brown pigment composed of lipids & phospholipids complexed w/prtns
"wear & tear" |
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how to tx CMV retinitis?
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ganciclovir
guanine nucleoside analogue greater affinity than acyclovir against CMV DNA CMV retinitis occurs in HIV pts CD4 < 50 |
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zidovudine + ganciclovir?
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neutropenia & anemia
they both cause marrow suppression, & ganciclovir often given to AIDS pts so… ganciclovir interferes w/human DNA synth more than acyclovir zidovudine can bind & inhibit some mammalian cellular & mitochondrial DNA polymerases |
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treatment for cutaneous anthrax?
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ciprofloxacin
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tx for cervicofacial actinomycosis following dental manipulation?
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long term penicillin tx & surgical debridement
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where does HSV-1 encephalitis occur? What signs are noticed? If fatal, what does autopsy show?
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occurs in TEMPORAL lobe
sx - aphasia, olfactory hallucinations, personality changes macroscopic examination shows edema & hemorrhagic necrosis |
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23 yo male 2 day hx of fevere, confusion - impaired speech, change in personality, and olfactory hallucinations?
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temporal lobe encephalitis --> HSV-1
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elevated gamma-glutamyltransferase?
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indicates a hepatic, biliary, or pancreatic problem
helps distinguish alk phosphotase as from one of these etiologies, and not from bone |
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tx for absences seizures?
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ethosuximide (blocks T-type Ca2+ channels)
valproic acid can be used too, preferred if it's combined w/tonic clonic |
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what seizures can phenytoin tx?
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tonic-clonic seizures, status epilepticus
inhibits neuronal high-freq firing of action potentisls by blocking Na channels |
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what seizures can phenobarbital tx?
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generalized tonic-clonic
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tx for complex partial seizures?
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Carbamazepine
also useful for generalized tonic-clonic seizures can cause agranulocytosis or aplastic anemia |
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what seizures can valproic acid tx?
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tonic-clonic seizures
also absence seizures |
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what seizures does carbamazepine tx?
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drug of choice for complex partial
can also tx generalized tonic-clonic can cause agranulocytosis or aplastic anemia |
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what is Bosentan?
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oral endothelin receptor antagonist
approved for tx of pulmonary HTN |
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t(15,17) is charecteristic of? Associations? What is the gene product?
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AML (acute promyelocityc leukemia, type 3)
associated w/DIC fusion gene is formed PML/RAR-alpha, unable to signal for proper cellular differentiation as the nl retinoic acid receptor can RAR gene transfers from 17 to join PML (promyelocytic leukemia) gene on 15 |
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stress related ulcers?
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acute stress
-proximal duodenum - Curling ulcer -occurs in burns, reduced plasma volume --> sloughing of gastric mucosa esophagus, stomach, or duodenum in association w/high ICP --> Cushing ulcers, particularly prone to perforation -purportedly ICP stimulates vagal nuclei to cause ulcers |
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what is mucicarmine stain used for?
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to detect polysaccharide capsule of cryptococcus neoformans
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anti-centromere antibodies? Anti-topoisomerase antibodies?
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anti-centromere --> CREST
Calcinosis Raynaud's Esophageal dysmotility Sclerodactyly Telangiectasias anti-Scl (topoisomerase) --> diffuse scleroderma (systemic sclerosis) |
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child w/ALL has respiratory trouble?
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likely has a mediastinal mass (associated w/T-cell ALL, the minority of cases)
this can cause superior vena cava syndrome compressing the great vessels, or might compress the esophagus causing dysphagia, or might compress trachea leading to dyspnea & stridor |
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antipsychotics causing side effects related to eye?
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Thioridazine - retinal deposits resembling retinitis pigmentosa
Chlorpromazine - Corneal deposits |
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ACL vs PCL attachments?
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Femur LAMP - lateral anterior, medial posterior
ACL attaches to lateral epicondyle (medial surface) of femur & goes to anterior portion of intercondylar tibia PCL attaches to medial epicondyle (lateral surface) of femur, & goes back to posterior part of intercondylar area of tibia |
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first line tx for narcolepsy?
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Modafinil, a non-ampheataimine stimulant
MOA unclear, thought to enhance dopaminergic signaling Amphetamines are second line |
