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199 Cards in this Set
- Front
- Back
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"white yellow membrane like plaques" with fibrin deposits (caused by enterotoxin B)
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C. diff - can present up to 4 wks after antibiotics
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envelope glycoprotein 22 nm in diameter forming spheres & tubules; infected hepatocytes may excrete enormous quanities
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HBsAg
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bacteria transmitted from animals (pets, farms, lab workers)
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campylobacter can be
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necrotic skin wound with erythematous & edematous border, necrotic center; gram positive rods
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cutaneous anthrax -
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acute bacterial arthritis - in sexually active --> ______ , in children/non-active --> ______
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in sexually active --> n. gonnorhea, in children/non-active --> staph aureus
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ETEC toxin is similar to what other toxin?
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LT is similar to cholera toxin ETEC causes diarrhea, LT & ST toxins; ; Labile in the Air (cAMP) Stable on the Ground (cGMP)
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latex agglutination tests for polysaccharide capsule; cryptococcus will show budding yeast; does not have mold form
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Cryptococcus meningitis in HIV patients;
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endocarditis; catalase negative, grows in 6.5% NaCl & bile (think enteric, bile) --> ______ ; what kind of procedure might this be associated with
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enterococcus, endocarditis (distinguish this from mutans by 6.5% NaCl); "genitourinary manipulation has been known to cause enterococcal endocarditis"
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necrotic skin patches in pt receiving chemo; presents w/fever, chills, sob
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ecthyma gangrenosum - occurs in neutropenic patients, pseudomonas colonizes perivascular area, toxins destroy & cause vascular insufficiency,
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african immigrant - patchy areas of skin anesthesia, hypopigmentation of UE, nerve biopsy many bacteria invading shwann cells -->
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Mycobacterium Tuberculosis; Tuberculoid TB --> skin thickening, patchy hypopigmentation, lionine facies, paresthesis / regional anesthesia, testicular destruction, blindness
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gram neg sepsis
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LPS causes gram neg sepsis not actively excreted but released w/lysis,Lipid A is the toxic part; activates macrophages to release TNF-alpha & IL-1 widespread
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tetanus - what route does toxin take?
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toxins travel retrograde in motorneurons to the spinal cord (Tetanus goes to the Top) to inhibit release of inhibitory neurotransmitters
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Tzank test positive --> ; Tx w/what drug? What is MOA?
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herpes; tx active flairs with nucleoside analogs (acyclovir), which incorporate themselves into the viral DNA & terminate replication; phosphorylation by viral thymidine kinase required for activity
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Serum testing for treponema -->
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screening with nontreponema test looking for cardiolipin (VRDL, RPR); SLE can give false positive
confirmatory test with treponemous test for antigen (FTA-ABS, MHA-TP) |
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facial pain, headache, black necrotic eschar in nasal cavity of diabetic --> ? How do you confirm dx / what will you see?
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mucormycosis; confirm dx w/mucosal biopsy; broad non-septate hyphae w/rt angle branching (WIDE branching in diabetics [associate w/overweight])
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foreign child w/febrile maculopapular rash starting head spreads to trunk & extremities -->
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rubella or rubeola; add postauricular lymphadenopathy --> rubella (german measles); rubella is a togavirus (togas rub horses)
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HBV vaccine - what do you see?
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ppl vaccinated for HBV are positive for anti-HBsAg, negative for HBsAg; if they had actually contracted HBV and cleared it would also have anti-HBcAg IgG
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DIC & bilateral hemmorhagic destruction of adrenal glands -->
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Waterhouse Friedrichson Syndrome; meningococcal sepsis (neisseria)
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Pseudomons & Diphtheria toxin both act by:
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ribosylating and inactivating elongation factor 2 (exotoxin A)
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Strept bovis endocarditis is associated with:
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GI lesions (colon cancer
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flat red skin lesion with central clearing
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erythema chronica migrans; borrelia burgdorferi
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hyper or hypo-pigmented skin patches becoming more noticeable after tanning
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malesthesia furfur; pityriasis (aka tinea) versicolor; KOH scraping --> "spaghetti & meatball" hyphae "cigar butt"; selenium shampoo
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MCC acute otitis media, sinusitis, & bacterial conjunctivitis in childhood:
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1.) stept pneumo, 2.) Non-typable haemoph infl, 3.) moraxella cataralis
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Haemophilus influenza B vaccine reduces:
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meningitis, pneumonia, sepsis, epiglotitis in children; given at 2 mos
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cherry red epiglottitis
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haemophilus influenza B
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fever, sore throat, drooling, progressive airway obstruction, & stridor in infant
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presenting sx of epiglottitis; haemophilus influenza B
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Shigella vs Salmonella vs E. Coli
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Shigella is non-motile (where Salmonella is motile & produces H2S); Shigella produces acid (where E. Coli produces gas)
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penile lesions, draining ulcers, painful inguinal lymph nodes, fever, red eyes; cell scrapings --> inclusion bodies
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chlamydia trachomatis, lymphogranuloma venerum (L1-L3 serotypes); Africa, Asia, Carribean, South America
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gram positive clustered bacteria (oropharynx); POLAR GRANULES staining with ANILINE dye
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Corynebacterium Diphtheria
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young male w/joint / long bone pain
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hematogenous osteomyelitis; staph aureus most commonly in kids, followed by strept group A
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CSF: high WBC, lymphocyte predominant, glucose nl or slightly decreased, protein elevated but < 150
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Viral Meningitis
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MCC Viral Meningitis
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Enteroviruses (Coxsackievirus, Echovirus, Poliovirus, Enterovirus)
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HBV is in what body secretions?
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All except stool
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When does anti-HBsAg ab level rise?
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After virus is cleared, once HBsAg levels have dropped; asymptomatic
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HDV requires HBV for?
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envelop coating; once acquired it can penetrate hepacocytes & replicate
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Picornoviridae - Rhinovirus, Coxsackie, Echo, Polio, Hep A - which is acid sensitive?
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rhinovirus is acid sensitive; picornoviridae = rhinovirus & enteroviruses (others); enteroviruses can withstand acid, colonize GI
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22 yo male, atypical lymphocytes, fever & joint pain; partially dbl stranded circular DNA virus w/RNA dependent DNA polymerase
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HBV
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HIV viral protein glycosylated & cleaved into 2 smaller prtns; what is it responsible for?
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absorption by target cells (gp160 --> gp120 + gp41); gp120 binds CD4 for absorption; gp41 stabilizes gp120
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6 day old infant w/HBsAg & HBeAg positive; risk for chronicity, replication speed, and liver damage?
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high risk for chronic infection, high replication rate, histologically mild liver damage; typically transmission from mother occurs in birth canal, may occur transplacentally
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What cytokine promotes class switching to IgE? (context of latex exposure then hypersensitivity)
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IL-4; HOT Tbone stEAk; produced by Th2
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Pt w/IL-12 receptor deficiency has recurrent infections, how to tx?
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IFN-gamma; both TH-12 & IFN-gamma stimulate the Th1 pathway; IFN-gamma is necessary for macrophage activation to kill intracellular organisms (mycobacteria in this case)
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Killed virus vaccine prevents infeciton how?
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Promotes humoral response (as opposed to cytotoxic), antibodies prevent entry into the cell;
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Salk vs Sabin - which is live which is killed?
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salK = Killed, & is sulking about it; sabin is live, savin' lives
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Delayed separation of umbilical cord; indolent skin infections & gingivitis
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Leukocyte Adhesion Defect; (decreased expression of integrins) - think umbilical cord adheres, problems with ADHESION
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Difference between Myeloperoxidase deficiency & CGD
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CGD lacks NADPH oxidase, but some organisms produce their own hydrogen peroxide so Myeloperoxide creates free radicals and kills; if myeloperoxide is deficient however, neither catalase pos nor neg organisms will be killed
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4 yo male recurrent skin/resp infections; light skin silvery hair; horizontal nystagmus, monocyte & neutrophils have giant cytoplasmic granules
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Chediak-Higashi; phagasome-lysosomal fusion defect, neurological abnormalities & partial albinism - (abnl melanin storage in melanocytes)
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Severe reaction to O negative blood, what happened?
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Selective Ig deficiency; IgA deficient is most common, must give blood products lacking IgA
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newborn - hemoglobin level 6; many nucleated erythrocytes, autopsy shows many sites of extramedullary hematopoiesis
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erythroblastosis fetalis; materinal IgG against fetal RBC (Type II hypersensitivity); Tx - during pregnancy anti-RhD, after birth exchange transfusion
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How long until infants immune systems mature and can produce Ig?
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~6 months; in firsrt 6 months infants are dependent on maternal IgG
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18 yo infant several resp infections, thrombocytopenia, eczematous rash?
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Wiskott-Aldrich Syndrome; TIE (thrombocytopenia, infections, eczema) - T & B cell deficiency; X-linked
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effect of corticosteroids on neutrophils?
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increased neutrophils; caused by "demargination"
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liver transplant - develops desquamating rash & bloody diarrhea, why?
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Graft T-cells (from liver) attacking host (Graft vs Host Dz)
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43 yo white man mm wkness worst in shoulders/hips; trouble getting out of chair & brushing hair; increased sarcolemma MHC I & CD8+ lymphocyte infiltration; what is it?
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Polymyositis; (increased CK & anti-Jo); immune mediated inflammatory myopathy triggered by unknown, possibly viral, antigen (possibly mm injury results in antigens taken up by macrophages & presented as foreign)
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Proximal mm weakness = ?
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Polymyositis
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Eaton Lambert
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paraneoplastic (small cell lung cancer); mm weakness improving w/activity; antibodies against presynaptic Ca channels
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Polymyalgia rheumatica
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bilateral stiffness of shoulder/pelvic girdle mm, fever, weight loss, increased ESR
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Palpable skin lesions, abdominal pain, arthralgias, renal involvement
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Henloch-Schonlein Purpura; MCC vasculitis in 3-10 yo, IgA immune complexes (antigen stim of bacteria/virus precedes); "leukocytoclastic vasculitis"
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non-gonnococcal urethritis, conjunctivitis, & arthritis - what is this? What is it likely to be associated with?
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Reiter's syndrome (classic triad); sacroilitis; MCC asymmetric arthretis of lower extremities in young men; associated w/GU or GI infection; HLA-B27 associated; Chlamydia, Salmonella, Shigella, campylobacter, or Yersinia associated
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Curschmann's spirals
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asthma; shed epithelium from mucous plugs
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what cells regenerate lung epithelium following injury?
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type II pneumocytes; their other major fxn is pulmonary surfactant secretion
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where does pseudostratified columnar ciliated epithelium stop?
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at the level of respiratory bronchioles becomes cuboidal ciliated; cilia are absent from terminal alveolar ducts
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a stab wound just superior to the clavical risks damaging?
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lung; it extends superior to the clavical through the thoracic aperature
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why is there tachycardia w/tension pneumo?
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increased intrathoracic pressure decreases venous return and thus CO
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ansa cervicalis arise from? Innervates?
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C1, C2, C3; innervates sternohyoid, sternothyroid, & omohyoid; might be injured by penetrating trauma superior to the cricoid cartilage
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what cells release elastase?
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neutrophils & alveolar macrophages; centriacinar emphysema associated w/smoking
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what do clara cells do?
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secrete CCSP (clara cell secretory protein) - inhibits neutrophil recruitment & activation, & neutrophil dependent mucin production
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how does streptomycin inhibit mycobacterial growth?
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AMINOGLYCOSIDE; interferes w/initiation step of prtn synthesis; binds 30S subunit & changes structure
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what antibiotics interefere with translocation?
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erythromycin & clindamycin
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what prevents binding of amino-acyl tRNA to A site?
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tetracycline
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failed sterilization of mechanical ventilators leads to pneumoniae caused by what bugs?
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e. coli, klebsiella, acinetobacter, pseudomonas
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nitroblue tetrazolium testing is used for what?
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tests for NADPH oxidase activity; fails to turn blue if deficient, as is the case in Chronic Granulomatous Disease; at risk for infection by Catalase positive organisms
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why neutrophils of patients with CGD still kill catalase negative organisms?
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hydrogen peroxide produced by the organisms accumulates in the phagosome
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lecithiniase is produced by what organism?
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clostridium perfrinogens; it is alpha toxin or phospholipase C - lyses erythrocyts platelets luekocytes & endothelial cells, in part responsible for the rapid necrotizing
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how is chronic granulomatous disease inherited genetically?
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X-linked
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what PFTs are expected in emphysema?
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decreased FEV1/FVC ratio; increased TLC, decreased diffusional capacity
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Dz incidence tables - what goes top & bottom? Negative predictive value?
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Dz incidence on top; test results on vertical; Neg predictive = d/[c+d] (true neg over true neg + false neg)
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how does negatie predicitve value change with prevalence?
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NPV is inversely proportional to prevalence,
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enlarged, centrally located epithelial cell - intranuclear & cytoplasmic inclusions; context: lung transplant pt 4mos post transplant - sob cough fever, diffuse infiltrates
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Cytomegalovirus, lookup picture
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How can mycobacterium become resistant to isoniazid?
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1.) decreased activity of catalase-peroxidase, which is necessary for activation of isonizid; 2.) mutation of the required peptide sequence for binding
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What bacteria found in the soil can survive boiling?
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spore forming bacteria - bacillus & clostridium; killed by autoclaving
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which polio vaccine is approved in the US?
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only the inactivated salk vaccine
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flunisolide therapy is initiated - what is it for? What complications occur and how can they be prevented?
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it's steroid aerosol for asthma, oral candidiasis can occur, oral rinsing instructions are necessary
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What bacterial immunizations require conjugation to toxoid?
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Capsular bacteria - Strep pneumoniae, neisseria meningitidis, haemophilus influenza B
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what drug inhibits fungal wall composition? What side effects does it have?
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itraconazole (inhibit demethylation of lanosterol into ergosterol); inhibits P450 enzymes important to many other drugs
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big name p450 metabolized drugs?
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warfarin, cyclosporin, tacrilomus, phenytoin, isoniazid, rifampin, oral hypoglycemics, etc
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what drugs induce cytochrome oxidases that result in decreased levels of -azoles for fungal tx?
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rifampin and a bunch of PSYCH drugs (phenytoin, carbamazepine, phenobarbital)
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congenital defect - oxygen "step-up" from RA to RV? Findings?
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VSD; finding would be holosystolic murmur at left sternal border
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what sO2 would be found w/ASD? Physical exam finding?
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oxygen step up from vena cava to RA; fixed splitting of S2
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spike & dome carotid pulse upstroke?
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hypertrophic obstructive cardiomyopathy - dynamic LV outflow tract obstruction
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what happens to blood & the heart with inspiration?
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decreased thoracic pressure --> increased venous return to RIGHT heart; INCREASED PULMONARY VESSEL CAPACITY --> decreased blood return to LEFT HEART
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most important prognostic factor in tetrolagy of fallot?
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degree of pulmonic stenosis
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pulmonary infarct characteristic?
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almost always hemorrhagic, b/c of dual blood supply (would be difficult to be ischemic)
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pulmonary infarct in IV drug user?
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septic emboli from tricuspid endocarditis; s. aureus & pseudomonas are MCC in this population
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reliability vs precision
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essentially the same (contrast to accurate)
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adult homeless man; increasing fatigue exertional dyspnea; LE edema, decreased sensation over feet/legs?
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wet Beriberi - high output CHF; thiamine (B1) deficient
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verapamil effect on AV & SA node?
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slows diastolic (?) depolarization - [phase 0; calcium channel blocker]
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what drugs increase the threshold potential of cardiac pacemaker cells?
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Only class I (A-C)
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what drugs prolong repolarization of cardiac pacemakers?
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class IA, IC, III
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what drugs shorten the action potential of cardiac pacemakers?
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class IB
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carpopedal spasms soon after birth, absent thymic shadow, narrowing of the aortic arch - what dz? What embryological structure?
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DiGeorge's Syndrome; 3rd & 4th PHARYNGEAL pouch; - associated w/hypoPTH from parathyroid aplasia - hypocalcemia & tetany; aortic arch abnormalities
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sildafenil and nitroglycerine together?
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nitrates + phosphodiesterase inhibitors cause cGMP accumulation; profound hypotension; absolutely contraindicated
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hypotension, JVD, distant/muffled heart sounds (& tacchycardia)
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Becks triad - cardiac tamponade; loss of palpable pulse could be due to pulsus paradoxus
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34 yo female w/progessive exertional sob & coronary sinus dilation?
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pulmonary HTN; coronary sinus communicates with RA, if RA pressure goes up can cause coronary sinus dilation
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antiarrhythmic decrease the outward flow of an ion active in the late phase of cardiac myocte action potential?
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class III - K channel blockers; ibutilide, sotalol, betyu…?, amiodarone, dofetilide
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65 yo man loses conciousness while buttoning shirt, which nerve is stimulated?
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glossopharyngeal (carotid baroreceptors; responds to both increase & decrease); not vagus b/c that is aortic arch baroceptors (not hit by shirt buttoning), responds only to increased BP
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functional heart murmurs
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caused by acute hemodynamical changes, in absence of any structural lesions
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how is ARDS defined?
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acute onset lung dysfxn, pulmoary edema, normal LA pressure, & paO2/FI02 < 200
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what is the pathophys of ARDS?
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damage to endothelial cells lining pulmonary capillaries --> leakage of fluid into alveoli (exudative stage); damage from inflammatory cytokines & neutrophils (DAD - diffuse alveolar damage)
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what are the stages of ARDS?
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exudative stage --> proliferative stage (type II pneumocytes) --> fibrotic stage
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mesangial expansion, glomerular basement membrane thickening, & glomerular sclerosis?
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diabetic nephropathy; if glomercular sclerosis is nodular --> kimmelstiel-wilson lesion (look up images)
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what can nephropathies can occur from analgesic abuse?
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characterized by marked thickening of the vasa recta capillaries & intermittent tubular necrosis; eventually papillary necrosis, focal & segmental glomerulosclerosis, & interstitial infiltration and fibrosis can occur
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where is the conduction speed of cardiac action potential greatest?
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purkinje fibers > atrial myocytes > ventricular myoctes > AV node
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bone tumor most often associated w/Paget's? radiographic findings?
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Osteosarcoma; destruction of normal trabecular bone pattern, mixed radiodense & radiolucent areas, periosteal new bone formation, lifting of cortex, Codman's triangle; adjacent soft tissue demonstrates ossification in a "sunburst pattern"
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lump in throat w/o physical, endoscopic, or radiologic findings?
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globus hystericus;
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esophageal outpouchings are called? Caused by?
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Zenker's diverticula; caused by motor abnormalities of the esphagus
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needle-shaped, monosodium urate crystals?
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Gout, negatively birefringent (yellow when parallel to slow Xray; positive birefringence is blue)
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whorled pattern smooth mm bundles w/intervening connective tissue
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leiomyoma
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23 yo woman w/abdominal pain that precedes her menses?
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endometriosis, presence of endometrial glands and stroma outside the uterus; biopsy --> look up picture
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what vitamin supplement is contraindicated in pregnancy?
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Vitamin A, can be teratogenic - microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, spontaneous abortion; found in - liver, kidney, egg yolk, butter
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DNA electrophoresis reveals fragmentation in multiples of 180 bases?
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DNA laddering - apoptosis; specific endonucleases during karyorrhexis cleave DNA at internucleosomal linker regions at 180 bp intervals
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what is: physostigmine? Phentolamine? Atropine? Pralidoxime?
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physostigmine - AChE inhibitor; pralidoxime - antidote to organophosphates (AChE inhibitors) reactivates phosphorylated cholinesterases; phentolamine - alpha adrenergic antagonist
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what group has a reaction to benzos? Why? What?
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elderly, slower metabolized; confusion, anterograde amnesia, & psychomotor retardation, paradoxical agitation/aggresion, weakness/vertigo/syncope
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confusion, blurred vision, dry mucous membranes, intense thirst?
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anticholinergic toxicity (atropine, anti-histamines, antipsychotics, tricyclic antidepressants) - hot as a hare, red as a beet, blind as a bat, mad as a hatter; AMS all over board - confusion, excitation, disorientation, delirum, psychosis
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mutation identified in multiple offspring but neither parent?
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germline mosaicism; multiple children suggest # of mosaic germ cells is high
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what is fish oil supplementation recommended for?
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refractory hypertriglyceridemia
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azurophilic, needle-shaped cytoplasmic inclusion
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auer rod; AML-3 t(15;17)
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clinical features of acute promyelocitic leukemia?
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Disseminated intravascular coagulation; pancytopenia - weakness, fatigue, infections, hemorrhagic findings [t(15;17)
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t(15;17)
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AML, auer rods
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t(9;22)
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CML
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t(8;14)
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ALL
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t(12;21)
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ALL
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t(14;18)
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FL - follicular lymphoma (not specific); "centrocytes" - malignant cells w/notches or clefts
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what cytokine is produced exclusively by antigen-stimulated T lymphocytes?
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IL-2; causes growth & differentiation of: T-cells, B-cells, NK-cells & macrophages
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where do Kaposi's sarcomas first present?
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HIV associated; present as multiple blue-violet plaques on feet & legs before spreading proximally; can also develop on mucosal membranes of face & genitals
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what is the main concern with both anterior & posterior dislocations of the knee?
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damage to the popliteal artery; the tibial nerve & common peroneal nerve are also at risk, but popliteal artery more so. It is located deep w/in the popliteal fossa, close to articular surfaces of the joint, & is tightly fixed proximal by the adductor magnus & distally by the soleus (susceptible to traction forces)
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blunt trauma to the lateral knee could damage?
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the common peroneal nerve, which courses superficially & laterally around the head of the fibula
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what is a common cause of tibial nerve injury?
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penetrating trauma to the popliteal fossa
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34 yo female 2 days postpartum via spontaneous vaginal delivery; lower abdominal pain, temp 37.9, BP 110/70, pulse 110, resp 18, tender uterus & foul-smelling discharge - what's going on? What organism?
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Endometritis; Bacteroides most common organism, but can be mixed aerobic/anaerobics; can complicate both spontaneous & C-sections
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painful erupted vesicles on an erythematous base
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herpes zoster, reaction of VZV in dorsal root ganglion; neuropathic pain & isolated to single dermatome
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how is VEGF signal transduced?
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tyrosine kinase
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how is PDGF signal transduced?
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tyrosine kinase
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chronic nasal discharge, occasional headaches, atrophic nasal mucosa, thinned nasal septum?
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substance (cocaine) abuse; can lead to perforation of nasal septum; also assoc w/oropharyngeal ulcers & osteolytic sinusitis
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heminephrectomy, what happens to other kidney GFR in response?
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increases so total GFR is ~80% of previous; 4-6 weeks; within 1 week already to 65-70%
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where in the penis do phosphodiesterase-5 inhibitors work?
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corpas cavernosum; relaxation of the venous sinus smooth mm; be able to identify corpora cavernosa on cross section
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craniopharyngioma visual defects - what do you expect?
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bitemporal hemianopsia; tumors of the sella turcica (craniopharyngiomas, pituitary adenomas) apply pressure to the optic chiasm
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what are craniopharyngiomas?
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suprasellar tumors arising from remnants of Rathke's pouch; present in 2nd-3rd decade w/headaches, papilledema, signs of pituitary failure, cranial nerve dysfxn
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what tissues produce HCO3 in response to stimulus?
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exocrine pancrease, biliary epithelial cells (HCO3 exceeds Cl] - stim by secretin which is made by S endocrine cells of the duodenal mucosa in response to acid;
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difference between Acute stress disorder & PTSD?
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PTSD sx > 4 weeks; ASD < 4 wks
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sx of psychosis for varying durations - dx?
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< 1 month - psychotic episode; 1-6 mos - schizophreniform disorder; >6 mos - schizophrenia
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persistent "magical thinking, odd beliefs (telepathy, superstition, bizarre fantasies, preoccupations); lack close friends"
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schizotypal personality disorder
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no desire for close relationships, solitary activities, emotionally detached, unmoved by praise/criticism
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schizoid personality disorder
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how to calculate the false positive ratio?
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1 - specificity
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how to calculate NNT?
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1 / ARR; ARR = Experimental Event Rate - Control ER
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what is characteristic of Acute Intermittent porphyria?
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intermittent episodes of abdominal pain; urine will darken upon standing in sunlight, skin photosensitivity is ABSENT
new medication causes neurological manifestations caused by DEFICIENCY of HMB synthase (early in the diagram) conversion of porphobilinogen to hydroxymethylbilane |
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meningitis w/sx of seizures, personality changes, & psychosis?
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temporal lobe encephalitis; MCC is HSV-1; may also have seizure/olfactory hallucination; tx: IV acyclovir
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30 yo man difficulty swallowing; facial & tongue fasciculations; X-linked pedigree
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Kennedy Dz - X-linked bulbospinal muscular atrophy; trinucleotide repeat, anticipation
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what is the 3rd heart sound?
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result of blood turbulence w/in ventricle during period of rapid diastolic filling; in adults most commonly occurs in the setting of cardiac failure (systolic or diastolic)
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pleural fluids - definitions for exudate vs transudate?
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Exudate: protein pleural/serum > 0.5, LD pleural/serum > 0.6, or pleural LDH > 2/3 ULN serum LDH; transudates lack these features
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pleural fluid w/high amylase level?
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pancreatitis, pancreatic pseudocyst, esophageal rupture, lung adenocarcinoma
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pleural fluid w/low glucose content?
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malignancy, infection
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osmotic fragility?
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increased proportion of lysis as NaCl DECREASES (hypotonic environment causes lysis) - hereditary spherocytosis, see dense spherocytes w/o central pallor
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67 yo alcoholic w/confusion, irritability, shock like sensation radiates to feet on neck flexion; blood glucose 52; CC numbness of feet - decreased bilateral vibratory sensation, mm strength preserved - cause?
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Cobalamin deficiency (B12); this could have been caused by Folate administration; folate & B12 share hematologic abnormalities (megaloblastic anemia), but only B12 has the neuro abnormalities
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administer folate to a B12 deficient person?
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worsen demyelination and cause abnormal myelin synthesis
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germline mutations in RB1 gene? associated w/what other primary tumor?
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"hereditary" retinoblastoma; associated w/other primary tumors (eg - OSTEOSARCOMA)
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MCC infectious arthritis? In kids < 2? Teenagers? Sickle cell?
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N. gonorrhoeae, Staph, strept, haem inf, gram - bacilli (e coli, salmonella, pseudomonas); kids <2 - Haem influ, kids > 2 staph aureus; teenagers & early adulthood (espec women) - N gon; sickle cell - salmonella
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infant - facial abnlaities, mm spasms requiring Ca infusion; recurrent Candida infections?
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DiGeorge's (22q11; 3rd & 4th pharyngeal pouch) - defective T cells, tetany b/c absent PTH glands, cardiac & great vessel abnlities
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metabolic changes w/DKA? K? Na? Glucose?
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DKA - hyperkalemic; hyponatremia (osmotic load of glucose, in blood & diuresing); hyperglycemia; metabolic acidosis, ketonemia, sometimes hyperammonemia
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small posterior fossa, caudal displacement of medulla, hydrocephalus, lumbar myelomeningocele?
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Arnold-chiari malformation; downward displacement of elongated cerebellar tonsils thru foramen magnum
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androgen insensitivity - levels of testosterone? LH? FSH?
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testosterone elevated; LH & FSH normal
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phentolamine vs phenoxybenzamine?
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phentolamin nonselective alpha block (reversible) t.5=20 min; phenoxybenzamine non-comp irreversible alpha blocker t.5 = 24 hrs, 1 dose lasts 3-4 days
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common type of brain bleed in premature/RDS infants? Site?
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Interventricular hemorrhage; most often in germinal matrix
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ototoxic chemotherapeutic?
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Cisplatin - damage hair cells in cochlear membranous labyrinth; can cause tinnitus
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dyspnea, cough, chest pain, malaise a few weeks post pharm tx of ventricular arrythmia?
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amiodarone toxicity (interstitial pneumonitis occuring in isolation); check PFTs, LFTs, TFTs
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what do nitrates do to HR & SV?
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venodilate --> reduced preload & so reduced SV; compensatory increased HR
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allelic vs genetic vs phenotypic heterogeneity?
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allelic - diff mutations in same locus cause similar phenotypes; genetic (aka locus) - mutat of diff genes cause similar phenotypes; phenotypic - mut in the same gene result in diff phenotypes
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what is montelukast? Used for?
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anti-leukotriene med antagonizing leukotriene D4 activity; used for asthma
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43 yo man w/increasing fatigability, dry mouth, & impotence; PE - hepatomegaly, atrophic testes; fasting glucose = 252; urine pos for glucose but neg for ketones/prtn; "strange tan"?
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hemochromatosis; "bronze diabetes"; mildly elevated LFTs, elevated plasma iron (>50% sat of transferrin); elevated serum ferritin
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steps in indirect ELISA assay? (components, bottom up)
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antigen attached to well, pt serum added (abs to antigen bind) & washed; anti-human ab coupled to enzyme added; chromogen added (modified by the enzyme)
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bacterial resistance to antibiotic is diminished by addition of protons, what mechanism?
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drug efflux pump; usually coupled to H+ moving along concentration gradient OUT of the cell (some use Na or ATP though)
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point mutation in FGFR-3 on chromosome 4, what condition?
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achondroplasia; shortened proximal extremities (w/nl trunk length) & enlarged head w/frontal bossing
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tumor w/t(11;22) translocation?
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Ewing sarcoma; pediatric population; EWS from 22 to FLI1 on 11
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deficiency of tyrosinine kinase in CD19 positive cells resulting in recurrent infections?
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Bruton agammaglobulinemia (Bruton's Tyrosine Kinase); X-linked, B-cells don't mature
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prohormone peptide has hydrophobic core seq, which is deleted; where does it accumulate?
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cytosol; signal targeting prtns into RER are N-terminal hydrophobic seq of 15-20 aa'
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infant w/increased branch chain aa in urine - which aa are branch chain? Name of dz? Deficient vitamine?
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Isoleucine, Leucine, Valine - Maple Syrup Urine Dz (I Love Vermont's maple syrup); defective in branched chain alpha-keto acid dehydrogenase complex, which uses B1 (thiamine) which is used for DECARBOXYLATION rxns
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infant w/hydrops fetalis born to parents from thailand w/strong FH of heminoglobinopathy?
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Hb Barts - severe form alpha thalassemia chracterized by 4 nonfxnl alpha globin loci; findings in thalassemia - microcytic & hypochromatic RBC, occasional target cells
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23 yo male w/nl 2ndary sex char, nl blood testosterone; but low testosterone in seminiferous tubuels in epididymis?
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low ABP (androgen-binding protein) - it is made by SERTOLI cells, in seminiferous tubules it binds testosterone, making it LESS LIPOPHILIC, concentrating testosterone in the luminal fluid
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what receptor does glucagon bind to?
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G-stimulator; results in stim of adenylate cyclase & increase cAMP
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how do adrenergic receptors mediate intracellular aciton? (1st step)
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qiss - a1 = Gq; a2 = Gi; b1 = Gs; b2 = Gs
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what does Red safranin O stain?
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cartilage, mast cell granules, mucin
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histology - cells surrounded by a glassy matrix of ground substance and collagen?
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cartilage; stained by Red safranin O
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what female repro structure is most likely to be found in the inguinal canal?
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round ligament of the uterus; it is remnant of the gubernaculum; projects from uterus thru inguinal canal into labia major
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what reactions take place to convert Tyrosine to Vanillylmandelic Acid?
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Tyrosine hydroxylated to DOPA; DOPA decarboxylated to Dopamine; Dopamine hydroxylated to norepinephrine; NE methylated to epinephrine; epinephrine methylated (COMT) to metanephrine; metanephrine oxidized by MOA to VMA (vanillylmandelic acid) [goes: hydroxy, decarboxy, hydroxy, methyl, methyl, oxy]
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changes in PaO2, PaCO2, & pH w/pulmonary embolism?
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if severe get V/Q mismatch w/areas of high AND low - PaO2 decreased (b/c of low V/Q areas); PaCO2 decreased (b/c of high V/Q areas); pH increases (2nd to CO2 changes? Tachypnea?)
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what is prostacyclin effect on platelets? What is its precursor?
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inhibits platelet fxns by increasing cAMP (Gs); precursor is PGH2, which is created by cycloxygenase from arachidonic acid
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what is the indication for H. pylori eradication in duodenal bulb ulcer?
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prevention of recurrence; malignant transformation is NOT associated w/duodenal ulcers; tx is triple therapy (ppi, clarithromycin, & metronidazole OR amoxicillin) also there is quadruple therapy
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what is the malignancy risk w/H. Pylori?
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MALT lymphoma & gastric adenocarcinoma; however, duodenal ulcers are NOT at risk for malignancy
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pt w/multiple brown spots on body since birth develops 2 soft, flesh colored, non tender papules on upper chest - are they malignant? What are they composed of?
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pt has NF-1; these are benign neurofibromas, growth of Schwann cells & other neural elements
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how do you explain a child NF1 whose biological parents do not exhibit signs?
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germline mosaicism/new mutation - NF1 is AD 100% penetrant, but does have variable expressivity
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rapid infusion of IV drug for endocarditis causes immediate pruritis & rash; this drug characteristically has a linear relationship between rate of infusion & histamine release, what drug?
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Vancomycin; "red man syndrome"; NOT IgE mediated, prevented by slower infusion rate
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