Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
80 Cards in this Set
- Front
- Back
|
histology of duchenne's muscular dystrophy?
|
light microscopy - proximal mm - variation in mm fiber shape & size, regenerating fibers, increased CT
distal mm (calf) hypertrophy initially to make up for proximal weakness, later they are replaced by fat & CT, this change = "pseudohypertrophy" |
|
|
what markers are indicative of small cell lung cancer?
|
neuroendocrine markers (in distinguishing from other lung cancers
-neuron-specific enolase -chromogranin -synaptophysin -some express neurofilaments makes sense, b/c small cell carcinomas frequently synthesize hormone-like substances suggesting neuroendocrine derivation |
|
|
what markers suggest non-small cell lung carcinoma?
|
EGF-receptors
mucin surfactant associated proteins |
|
|
what does leukocyte common antigen (CD45, LCA) a good marker for?
|
differentiating malignant lymphomas from poorly differentiated neoplasms of other types
|
|
|
bilirubin in urine?
|
conjugated bilirubin
unconjugated bilirubin is poorly soluble so binds albumin, is not excreted |
|
|
1 month old child w/persistent jaundice, mm rigidity, lethargy & seizures?
|
Cirgler-Najjar syndrome type 1 (autosomal recessive)
genetic lack of UGT (uridine diphosphate-glucorynltransferase) in endoplasmic reticulum, needed to catalyze bile glucoronidation unconjugated hyperbilirubinemia develops indirect levels approximate 20-25 mg/dL, but can rise to 50 gradually deposited into various tissues, including the brain can cause kernicterus (bilirubin encephalopathy) - potentially fatal (severe jaundice, neuro impairment) |
|
|
removing right-sided ovarian mass, surgeon should ligate what structure?
|
suspensory ligament
it supplies the nerves, arteries, & veins to the ovary |
|
|
what is contained in round ligament of uterus?
|
it contains artery of SampOn
rarely is a source of major bleeding |
|
|
what ligament contains the uterine artery?
|
the transverse cervical ligament, aka cardinal ligament
from cervic & lateral fornix of vagina to lateral pelvic walls requires ligation during radical hysterectomy |
|
|
24 yo male post surgery to correct scoliosis develps severe nausea & recurrent billous vomiting?
|
Superior Mesenteric Syndrome
presents w/signs of bowel obstruction SMA & aorta nl form 45 degree angle, if decreases to < 20 can entrap TRANSVERSE portion of duodenum occurs w/diminished mesenteric fat, pronounced lordosis, or surgical correction of scoliosis |
|
|
what is HbC? Hb bart? HbA2?
|
HbC is abnl hemoglobin w/lysine residue subsituted for glutamic acid in beta-globin chain
Hb bart is 4 gamma chains, found in homozygous alpha thalassemia, high O2 affinity, incompatible with life HbA2 is alpha2delta2, nl varient levels of 2-5% |
|
|
what are the levels of fetal Hb at birth? When does it switch?
|
HbF ~7--90% at birth
gradually replaced by HbA during first 6 months of life |
|
|
how to distinguish familial hypocalciuric hypercalcemia vs hyperparathyroidism?
|
both have high Ca & PTH
familial has low urinary Ca defective calcium sensing receptor on parathyroid cells |
|
|
tell me about siADH - lab findings? (hormones, Na, K, H20, Uosm) PE findings?
|
siADH causes inappropriate water retention
body responds by decreasing RAAS axis (decrease aldo) equilibrate around near nl body volume hyponatremic (Na wasting) Uosm > Serum K+ is not super low free water ~ nl (compensated) do NOT have elevated B-type natriuretic peptide do not have marked PE signs can be caused by small cell lung cancer |
|
|
in collagen synthesis, what steps occur outside the cell?
|
cleaving of the C & N terminal regions, followed by cross-linking of monomers facilitated by oxidative deamination of lysine & hydroxylysine residues by lysyl oxidase
note, the triple helix is formed in the cell w/disulfide bonds between C-terminals note, there is an N-terminal cleavage intracellularly of the hydrophobic sequence that directed it to the RER |
|
|
rifampin monotherapy is indicated for?
|
meningococcal exposure
|
|
|
how to treat Mycobacterium avium complex?
|
macrolide (clarithromycin or azithromycin) with rifampin & ethambutol
|
|
|
how to tx staph endocarditis?
|
aggressively
IV penicillins (eg nafcillin) & an aminoglycoside (gentamicin) if MRS suspected or prevalent in community, then Vancomycin & rifampin or aminoglycoside |
|
|
urge incontinence in 50 yo female? Tx?
|
overactive bladder syndrome, uninhibited bladder contractions (detrusor instability)
tx w/muscarinic antagonism (M3) eg - oxybutynin |
|
|
class IB anti arrythmics? Use for?
|
lidocain, mexiletine, tocainide
useful for selectivity for rapidly & frequently depolarizing cells useful in arrhythmias occuring during ischemic cardiac event (B = best for MI) shortening action potential & phase 3 repolarization little effect on rapidity of phase 0 depolarization |
|
|
class IA anti arrythmics? Used for?
|
Qunidine is the major drug
used for tachyarrhythmias in atria & AV junction have affinity for non-resting sodium channels between 1B (low) & 1C (high) slow both phase 0 depolarization and phase 3 repolarization |
|
|
joint pain and cardiac murmur?
|
rheumatic heart dz
antibodies against M-prtns of certain strains of streptococci cross react w/glycoprtn antigens on heart |
|
|
nasal ulcer & hematuria?
|
Wegener's granulomatosis & polyangiitis
upper resp tract (sinusitis, nasal ulceration), lower resp tract (hemoptysis), kidneys (RPGN) c-ANCA pauci-immune, b/c no anti-GBM antibodies |
|
|
malar rash & pleural effusion?
|
SLE
circulating immune complex nephritis ANA positive - NOT specific anti-dsDNA & smith - specific |
|
|
dysphagia & sclerodactyly?
|
CREST syndrome
calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia anti-centromere antibodies |
|
|
goodpastures vs alports?
|
goodpastures - antiGBM antibodies against alpha3-chain collagen type 4
-get rapidly progressive glomerulonephritis alport - genetic defect in collagen type 4 gene |
|
|
pathophys of goodpasture's? renal histology?
|
anti-GBM antibodies targeting alpha3-chain of type IV collagen
RPGN (rapidly progressive glomerulonephritis) - crescent formation w/fibrin deposition "linear" IgG and C3 deposition |
|
|
pilocytic astrocytoma vs medulloblastoma on radiograph?
|
both are tumors of children seen in cerebellum area (often)
pilocytic astrocytoma (rosenthaal fibers) - both cystic & solid components medulloblastoma (sheets of small blue cells w/hyperchromatic nuclei & scant cytoplasm) - always solid |
|
|
CMV causing the following conditions are present in which populations?
mononucleosis retinitis hepatitis pneumonia odynophagia |
mononucleosis - MC manifestation of CMV in immunocompetent hosts (but still less common than EBV)
retinitis - CMV in HIV patients diarrhea & hepatitis - disseminated CMV in immunocompromised CMV pneumonitis - organ transplant esophagitis - HIV pts |
|
|
pt w/nocturanl cough has esophageal biopsy w/eosinophils & neutrophils present?
|
GERD
|
|
|
monoclonal antibody for ERB-2 positive breast cancer?
|
anti-Her2 mab (Erb2 = HER2/neu) - trastuzumab
|
|
|
BCL2 associated w/what cancer?
|
follicular lymphoma
|
|
|
what are the stimulus transmitters for acid secretion from parietal cells?
|
Acetylcholine, histamine, gastrin
|
|
|
MM weakness w/…
CD8 + lymphocyte mediated nerve fiber demyelination? Skeletal mm damage? circulating antibodies against cell surface receptors? |
CD8+ nn fiber demyelination - Guillain Barre
CD8+ skeletal mm dmg - polymyositis antibodies against cell surface receptors - myasthenia gravis |
|
|
vessels MC involved in atherosclerotic plaques?
|
predominantly large elastic arteries & in large or medium sized mm arteries
in order of decreasing freq abdominal aorta > coronary arteries > popliteal arteries > internal carotids (carotid sinus) > circle of Willis |
|
|
autoantibodies that react with tissue transglutaminase?
|
Celiac's (transGLUTaminase participates in metabolism of GLUTen)
|
|
|
what is C1 esterase inhibitor? If levels are low, what is contraindicated?
|
C1 esterase inhibitor prevents kallikrein from creating BRADYKININ from kininogen
it also is inhibits the complement cascade low C1 esterase level is diagnostic of herediatry angioedema bradykinin levels are high, so ACE INHIBITORS are contraindicated C3a and C5a also mediate angioedema (vasodilation, vascular permeability) and are also high |
|
|
another tx for sickle cell other than hydroxyurea?
|
Gardos channel blockers
the calcium-dependent potassium channels (Gardos) regulate K+ & water transport thru RBC membranes blocking channels decreases K & water efflux, preventing dehydration, reducing sickling |
|
|
unilateral ptosis & "down & out" gaze - where is lesion? MC cause?
|
CN III paralysis
compression (berry aneurysm, uncal herniation) or nerve ischemia (diabetes) |
|
|
growth media for telling what strep is what?
|
all strep are gram positive cocci, catalase negative
Alpha Hemolytic --optochin resistant, grows in bile --> Strep Viridans --optochin sensitive, NOT grow in bile --> Strep pneumo Beta Hemolygic --bacitracin resistant --> Group B strep --bacitracin sensitive --> Group A strep Gamma (no) Hemolysis --grows in bile AND NaCl --> Enterococci (E. faecium) --grows in bile, NOT NaCl --> Non-Enterococci (S. bovis) |
|
|
patient w/testicular tumor & hyperthyroidism?
|
non-seminomatous germ cell tumor --> teratoma
hCG levels are up (this could happen in small percentage of pts w/seminoma too) |
|
|
what bugs are 3rd gen cephalosporins active against?
|
Ceftriaxone
more active against gram NEGATIVE, less against gram positive |
|
|
patient had surgery for prosthetic heart valve & develops low-grade fevers (could be any implanted foreign body, indwelling catheter, etdc) - what infection to think about? What would gram stain reveal? What treatment?
|
Staph epidermidis is a major cause of infection in pts w/indwelling catheters, implanted foreign bodies
-colonize b/c produce polysaccharide slime see gram positive cocci in clusters, catalase positive, coagulase negative tx w/Vancomycin combined w/rifampin or gentamicin, or both (pending cultures) -start w/broad coverage before tailoring down |
|
|
35 yo white female has MI, coronary arteries appear nl, mitral valve leaflet thickening observed, w/masses on both sides?
|
Libman-Sachs endocarditis, associated with SLE
MI w/nl coronary arteries --> hypercoaguabily w/acute thrombosis or coronary vasospasm Lupus can both cause the vegetations on valve (25% of SLE) and hypercoaguability cause thrombosis (antiphospholipid antibody) |
|
|
when I say Libman-Sachs, you say?
|
endocarditis w/vegetations on both sides of mitral leaflets, associated w/SLE
can be associated w/hypercoaguability --> MI w/no coronary artery problems (except for the acute thrombosis of course) |
|
|
patient has lung vasculitis, severe asthma, & eosinophilia, arteries show transmural inflammation w/fibrinoid necrosis - what is the name of this?
|
Churg-Strauss syndrome
polyarteritis nodosa associated condition vascular lesions are necrotizing granulomas can cause coronary arteritis |
|
|
what is Churg Strauss syndrome?
|
polyarteritis nodosa associated condition with
-lung vasculitis -severe asthma -eosinophilia (often seen in atopic patients) vascular lesions are necrotizing granulomas which can cause coronary arteritis |
|
|
hereditary spherocytosis puts pts at risk for?
|
pigmented gallstones
|
|
|
what makes methadone good for tx heroin withdrawl?
|
its long half life
allows for prolonged effects to suppress withdrawal symptoms |
|
|
enlargement of gastric rugal folds in pt w/refractory peptic ulcer dz?
|
caused by parietal cell hyperplasia due to excess gastrin stimulation
Zollinger Ellison syndrome |
|
|
tell me about fat embolism syndrome - findings? Pathophys? Patients this is seen in?
|
confusion (neuro abnlities), sob (hypoxemia), & petechiae on chest
shortness of breath - fat emboli occlude microvasculature -FFA release damages capillary endothelium & can lead to ARDS neurologic abnormalities - fab emboli microvascular occlusion in CNS, b/c ateriovenous shunts open w/the buildup of pulmonary arterial pressure petechiae - thrombocytopenia from platelet adherence to & coating of fat microglobules see in trauma patients w/BROKEN BONES can present a few days after |
|
|
(calculate) - what is clearance? Half life? Maintenance dose? Loading dose?
|
Clearance = volume of plasma cleared of a drug per unit time (shows how well drug is removed from circ)
half-life = Vd x ln(2) / CL = Vd x 0.7 / CL maintenance = Cp x CL / bioavailability loading dose = Vd x Cpss / bioavailability where Vd = total / Cp |
|
|
myxomatous change in arteries? What is this? What arteries does it occur in? what condition is it seen in? what does it appear like histologically? How can it be acquired?
|
cystic medial degeneration
"fragmentation of elastic tissue" and "separation of elastic and fibromuscular components of the tunica media by cleft-like spaces filled w/amorphous extracellular matrix" occurs in large, elastic arteries seen in Marfan's can be acquired from ingestion of beta-aminopropionitrile (chemical found in sweet peas) causing "angiolathyrism" changing elasticity of aorta mimicking myxomataous degeneration inhibits lysyl oxidase, necessary for crosslinking of elastin & collagen |
|
|
what is a false aneurysm? (pseudoaneurysm)
|
breach in contiinuity of all 3 layers of vessel (or heart)
blood leakage &/ hematoma forming outside vascular wall hematoma contained w/in sac of CT surrounding original pt of arterial wall rupture ex - leaks in anastamosis at sites of vascular grafts, postinfarction myocardial ruptures |
|
|
in Giant Cell arteritis what changes are seen to vessels?
|
granulomatous inflammation of media & fragmentation of internal elastic lamina
perhaps due to autoimmunity of elastin |
|
|
function of glycosylase & lyase in DNA repair?
|
in mismatch from deamination
glycosylase cleaves altered base out lyase cleaves 3' sugar (after) -think, lyase acts closer to ligase |
|
|
antibiotic that can cause acute tubular necrosis?
|
aminoglycosides
|
|
|
what is a cavernous hemangioma? What does it look like histologically? Signs/sx? Pathophys?
|
MC benign liver tumor
microscopically consists of cavernous, blood-filled vascular spaces of variable size, lined by single epithelial layer biopsy should NOT be performed, could cause fatal hemorrhage! most patients asymptomatic thought to be congenital malformations that enlarge by ectasia |
|
|
molecular problem in achondroplasia?
|
activating mutation of fibroblast growth factor RECEPTOR 3
growth is inhibited at epiphyseal growth plate -shot limbs -nl axial bones |
|
|
what are serum calcium & PTH levels in normal osteoperosis?
|
serum Ca & PTH are typically nl in primary osteoperosis
|
|
|
causes of pure red cell aplasia? (nl granulopoiesis & thrombopoiesis)
|
thymoma (removal can cure, chest CT indicated)
parvovirus (anti-B19 IgM antibodies) |
|
|
what does cyanide poisoning do to O2 % sat & content? CO poisoning? Met-Hb?
|
cyanide - inhibits cytochrome C, saturation & content go up (but can't be used)
CO - saturation & content decrease (competes w/O2 for binding) metHb (Fe3+) - causes pulse ox to read ~85%... -discrepency between ABG (PaO2) & pulse ox |
|
|
nitrogen atoms in urea come from what molecules? What is rate limiting enzyme of urea cycle & what activates it?
|
NH3 & aspartate
carbamoyl phosphate synthetase I, activated by N-acetylglutamate (NAG) |
|
|
MEN 1 vs 2A vs 2B?
|
MEN 1 - pituitary, PTH, pancrease
MEN 2A - medullary thyroid, PTH, pheocromo MEN 2B - oral/intestinal ganglioneuromatosis, medullary thyroid, pheochromo |
|
|
marfanoid habitus, thyroid nodule, & lesions in mouth?
|
MEN 2B (oral/intestinal ganglioneuromas, medullary thyroid carcinoma, pheocromos)
|
|
|
spider angiomata is caused by? Seen in?
|
estrogen
liver failure (alcoholic cirrhosis), pregnancy |
|
|
how to treat bacterial vaginosis?
|
oral metronidzole (topical regimens may be used)
|
|
|
hx of sun exposure, has small (<1 cm) scaly erythematous lesions on sun exposed areas, histology shows hyperkeratosis and parakeratosis? Malignancy risk?
|
actinic keratoses
small risk to progress to SQUAMOUS cell carcinoma "actinic keratoses are confined to epidermis, & are considered by some as equivalent to squamous cell carcinoma in situ" |
|
|
smooth mm cell antibodies associated with?
|
autoimmune hepatitis
|
|
|
what is phentolamine?
|
non-specific alpha 1 & 2 blocker
no beta blocking effects |
|
|
epinephrine works preferentially on which receptors at what levels?
|
fxns on all the adrenergic receptors
causes increase in systolic BP at any dose low dose - beta 2 > alpha 1 --> decrease DIASTOLIC BP high dose --> alpha 1 > beta 2 --> increase DIASTOLIC BP |
|
|
what MHC class do APCs presenting to T-cells have?
|
MHC II
recall, all extracellular antigen is presented thru MHC II |
|
|
patient w/parkinsons experiences "on & off" periods throughout the day, wants relief - what to do?
|
drug response is unpredictable
during on periods DOPA is high enough, it's good, during off DOPA fell too low, patient is often worse than w/no medication at all found that keeping dose constant minimizes these on-off effects raising dose provides no benefits to motor capabilities, it does make beneficial effects last longer & delay the off periods, but carries increased risk of diskinesia |
|
|
common cause & route of a hepatic abscess?
|
staph aureus thru hematogenous seeding
other routes include: -portal vein -arterial supply -ascending biliary tract infection (usually enteric gram neg bacilli & enterococci) -direct invasion from adjacent source (usually enteric gram-negative bacilli & enterococci) -penetrating injury |
|
|
esophageal biopsy shows solid nests of cells w/abundant eosinophilic cytoplasm & distinct borders, (whorled appearance imo)?
|
Squamous cell carcinoma of esophagus
areas of keratinization (keratin pearls) easily seen, indicate tumor hasn't lost the properties of the original tissue completely, yet (well-differentiated) |
|
|
MCC of spontaneous nipple discharge?
|
intraductal papilloma
bloody or serosanguinous discharge benign tumor of mammary duct of unknown etiology |
|
|
measuring the uptake of bromodeoxyuridine (thymidine analog) in brain tumors is useful for?
|
grading - determining the degree of differentiation & malignant potential
more uptake = more maligant, higher grade grading is important in CNS tumors, b/c they rarely metastasize (so staging isn't that helpful) |
|
|
how to tx mania? What is contraindicated?
|
Lithium & valproate are principal agents of tx
carbamazepine can also be used olanzapine can be used in acute manic phase of bipolar (it's an anti-psychotic) benzodiazepines might be used as ajunctive therapy for acute mania antidepressants are contraindicated, if given in depressive phase of bipolar disorder are likely to cause a rapid switch to mania |
|
|
patient w/mycoplasma pneumonia is tx and develops sequelae, what might that be? Pathophys?
|
can get mild anemia
some antigens are shared between RBC and m. pneumoniae wall antibodies that cross react are called "cold agglutinins" - able to agglutinate RBCs in vitro at low temp steven johnson syndrome & joint pain are other rare sequelae |
|
|
what are P bodies in relation to the genetic code?
|
distinct, cytoplasmic foci found w/in eukaryotic cells involved in mRNA regulation & turnover, also perhaps storage
fundamental role in translation repression & mRNA decay |
