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50 Cards in this Set

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HPV-associated oncogenesis is attributed to which viral proteins?
E6 & E7
HPV strains responsible for CIN (intraepithelial neoplasia of the cervix) = 16, 18, 31, 33, 35
Which tumor suppressor is targeted in cervical cancer?
E6 gene products target p53
Risk factors for cervical dysplasia?
#1 = Multiple sex partners
- Smoking
- Early sexual intercourse
- HIV infection
What cell is a sign of HPV infection? What are its characteristics?
Koilocyte = Immature squamous cell with:
- Dense, irregularly staining cytoplasm
- Perinuclear clearing ("halo")
- Pyknotic nucleus ("raisinoid")
What is a pyknotic nucleus?
The chromatin has condensed in the nucleus as part of the process of apoptosis.
Seen in koilocytes in cervical condyloma / HPV infection.
What are Clue Cells and when are they seen?
Clue cells are squamous cells covered with bacilli.
They are seen in Pap smear specimens from women with bacterial vaginosis (Gardnerella vaginalis)
What are Parabasal Cells? When do you encouter them?
Paraasal cells are round cells with:
- Basophilic cytoplasm
- Finely granular chromatin
- No visible nucleoli
- High N/C ratio

They are found in Pap smears from post-menopausal and post-partum women.
What type of cell is present in a normal Pap smear and what are its characteristics?
Glandular endocervical cells.

They are columnar cells with:
- Vacuolated or granular cytoplasm
- Prominent cell borders
- Occasional nucleoli
- Form "honeycomb pattern" in clusters
What drugs slow the progression and reduce the mortality in patients with CHF? How?
Beta-blockers, particularly CARVEDILOL (non-selective ß + α1).
Beta-blockers decrease cardiac work by:
- Slowing ventricular rate
- Decreasing afterload
What is the cause and what are the common characteristics of Turner Syndrome?
Cause: Loss of parental X during MITOSIS; can be complete monosomy (45XO), mosaicism, or partial deletion of one X chromosome.

Commonly = Short, webbed neck, low posterior hairline
Urogenital = Streak ovaries, horseshoe kidney
Cardiac = Coarctation of the aorta, bicuspid aortic valve
Lymphatic = Lymphedema in feet/hands, cystic hygroma
What are examples of trinucleotide repeat expansion diseases?
Huntington (CAG)
Fragile X (CGG)
Myotonic dystrophy (CTG)
What genetic diseases feature uniparental disomy of the same chromosome?
Chromosome 15:
- Prader-Willi (2 x maternal)
- Angelman (2 x paternal)

AngelMAN = 2 copies from MAN
What type of mutation is associated with Familial hypercholesterolemia?
Frameshift mutation
What is a major source of nosocomial infections for patients w/ implanted foreign bodies like replacement heart valves (or indwelling catheters)?
Staphylococcus epidermidis.

Normal skin flora. Can colonize by producing polysaccharide slime that allows them to adhere to foreign-body surfaces.

Tx = Vancomycin (empirically) w/ or w/o Rifampin/Gentamycin

In heart valve, can cause indolent endocarditis and if untreated --> intracardial abscess, dehiscence of valve, and septic embolization.
Injury sustained when falling on outstretched hand and results in pain, flattening of the deltoid, and sensory loss over the deltoid?
Anterior dislocation of the humerus.

This causes axillary nerve to be injured (innervates deltoid and teres minor, sensation overlying the lateral arm & deltoid)
What 2 nerves are possibly injured after falling with an outstretched hand?
Axillary and Radial Nerves.

Axillary d/t anterior dislocation of the humerus.

Radial d/t spiral mid-shaft fractureo of the humerus.
What are the components of the Rotator Cuff?
SItS
S = Supraspinatus
I = Infraspinatus
t = teres minor
S = Subscapularis
A newborn with lethargy, vomiting, tachypnea and labs that show large anion gap metabolic acidosis, ketosis, hypoglycemia, and markedly elevated methylmalonic acid in serum and urine?
There is a problem with the isomerization reaction that converts Methylmalonyl CoA --> Succinyl CoA (which enters the TCA cycle).

The reaction uses Methylmalonyl CoA Isomerase and B12.
Most common congenital heart disease to cause early cyanosis?
Tetrology of Fallot
What are the 4 parts of the Tetrology of Fallot?
imPROVe
(patients squat to imPROVe symptoms)
P = Pulmonary Stenosis*
R = RVH
O = Overriding aorta
V = VSD

* extent of pulmonary stenosis is most important determinant of prognosis
Embryological cause of the Tetrology of Fallot?
Tetrology of Fallot is caused by anterosuperior displacement of the infundibular septum.
A stab wound in the 5th intercostal space at the mid-clavicular line would strike what structure?
Left lung.

The lateral border of the heart comes to that point too, but it is behind the lung and the left ventricle would only be injured if the stab wound was deep.
What congenital abnormality is associated w/ Valproate use?
Neural tube defects.

Inhibit maternal folate absorption in the intestine.

Valproate is an anti-epileptic.
What congenital abnormality is associated with Down Syndrome?
Duodenal atresia.

Hallmark is bilious vomiting w/o abdominal distention in 1st day of life.
What congenital abnormality is associated with Turner Syndrome?
Coarctation of the aorta & bicuspid aortic valves.

BP elevated in vessels that are proximal to coarctation.

BP and pulse reduced in vessels distal to coarctation.
What are the 2 types of Coarctation of the Aorta and what are their causes?
Infantile type is PREDUCTAL (stenosis is proximal to the insertion of the ductus arteriosus) and usually d/t Turner Syndrome.
INfantile = IN close to the heart

Adult type is POSTDUCTAL (stenosis distal to ligamentum arteriosum) and is associated with:
- Notching of the ribs
- HTN in upper extremities
- Weak pulses in lower extremities
aDult = Distal to Ductus
What congenital abnormalities are associated with Potter Syndrome?
Bilateral renal agenesis which leads to Oligohydramnios &:
- Face & limb deformities
- Pulmonary hypoplasia.

d/t malformation of the ureteric bud.
What is Ebstein's anomaly and what is it associated w/?
It's a congenital heart defect where the tricuspid valve is anteriorly displaced leading to an "atrialization" of much of the right ventricle.

It is associated with use of Lithium in the first trimester.
Abused drugs most associated with violent behavior?
1) Hallucinogens (Psychotomimetics):
- PCP/Angel Dust = phencyclidine
- LSD
2) Amphetamines
3) Cocaine

Belligerence/psychomotor agitation more common in PCP > LSD
What are characteristic signs of Aortic Regurgitation?
1) "Water-hammer" pulses (bounding pulses in femorals and carotids; d/t large pulse pressure)

2) de Musset sign = Head bobbing w/ each heart beat (d/t higher stroke volume, LVSV, reaching head/neck)
What kind of murmur is heard in a patient with Aortic Stenosis?
DIASTOLIC
immediate, high-pitched, "blowing"

(NOTE: Diastolic = ARMS)
What is a precaution needed when using inhaled / aerosolized corticosteroids and why?
Oral rinsing to prevent oropharyngeal candidiasis.

e.g. Aerosol Flunisolide
What are recommendations for patients using systemic glucocorticoid therapy?
Low sodium diet.
Fluid restriction.
What does an operon contain?
At least two regulatory sites:
- the Promoter
- the Regulator (operator)
What genes are in the lac operon?
Lac i = Repressor protein
Lac p = binding site for RNA polymerase
Lac o = binding site for Repressor protein

3 structural genes:
Lac z = ßgalactosidase (lac --> glu & gal)
Lac y = permease (increase permeability for lactose)
Lac a
How is the Lac operon activated?
When there is an abundance of lactose, lactose will bind to the Repressor protein.
How does the presence of glucose affect the lac operon?
Glucose decreases activity of Adenylyl Cyclase and therefore the amount of cAMP in the cell is depleted.

CAP (catabolite activator protein) is unable to complex w/ cAMP and therefore unable to be a (+) upregulator of the operon.
What regions of a gene do repressor proteins bind to?
Operator region.

Repressor --> Operator
What metabolic process is unique to S. aureus of all the Staphylococci?
Mannitol fermentation.
What property of Staph. saprophyticus allows it to be differentiated from other coagulase-negative Staph?
Novobiosin resistance.

The other coagulase-negative Staph are killed by Novobiocin.
What is the function of T-tubules and why are they important?
T-tubules are invaginations of the sarcolemma (muscle cell membrane).
Fx = transmit depolarization from sarcolemma --> sarcoplasmic reticulum

Absence would lead to uncoordinated contractions of myofibrils.
What is Rheumatoid Factor?
It's an IgM antibody against self IgG's.

Present in majority of RA pts.

Absent in seronegative spondylarthropathies
What are the seronegative spondylarthropathies?
Characterized as arthritis w/o rheumatoid factor.

PAIR
- psoriatic arthritis
- ankylosing spondylitis
- IBD
- reactive arthritis (Reiter's)
What genetic association do the seronegative spondylarthropathies share?
HLA-B27
(an HLA MHC Class I)

e.g. 90% of AS pts are HLA-B27+
Ini normal distribution, how many values fall w/in 1 SD of the mean? 2 SD's? 3 SD's?
1 SD = 68% (2/3)
2 SD = 95%
3 SD = 99.7%
How can you inactivate HAV?
- Chlorination
- Bleach (1:100)
- Formalin
- UV
- Boiling (85º, 1min)
Characteristics of HAV?
Picornavirus (RNA)
Fecal-oral

Alone, Asymptomatic, Acute
- No carrier
- Weeks

No HCC risk
What vessels are most affected by Nitroglycerine?
Large Veins.

Venodilation allows blood to collect in venous system (redistribution) and thus decrease preload / cardiac workload.
What part of the EKG is affected by ß-Blockers?
PR Interval (prolonged).

PR = the interval b/w beginning of Atrial depolarization and Ventricular depolarization.
What type of immune reaction is responsible for Type I DM?
Cellular immunity (destruction by T lymphocytes).

Anti-islet Ab's are present but believed to be d/t destruction of the ß-Cells by T-Cells.