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5010 Cards in this Set

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Autosomal recessive diseases (11)
1. CF 2. albinism 3. alpha 1 antitrypsin deficiency 4. phenylketonuria 5. thalassemias 6. sicke cell anemia 7. glycogen storage diseases 8. mucopolysaccharidoses (except Hunter's) 9. sphingolipidoses (except Fabry's) 10.infant polycystic kidney disease 11. hemochromatosis
_____are associated with low golic acid intake during pregnancy.
Neural tube defects
90% of adult polycystic kidney disease cases are due to mutation in _____.
APKD1 (on chromosome 16)
95% of Down's syndrome cases are due to what?
meiotic nondisjunction of homologous chromosomes (4% due to Robertsonian translocation and 1% due to Down mosaicism)
A patent ductus arteriosus is maintained by what 2 things?
PGE synthesis and low oxygen tension
Abnormalities associated with Marfan's syndrome:
1. Skeletal: tall with long extremities, hyperextensive joints, long tapering fingers and toes 2. Cardiovascular: cystic medial necrosis of the aorta, aortic incompetence, aortic dissection, aortic aneurysm, floppy mitral valve Ocular: subluxation of lenses
Adult polycystic kidney disease is associated with what other diseases or disorders?
polycystic liver disease BERRY ANEURYSMS mitral valve prolapse
Babies with Fetal Alcohol Syndrome are at higher risk for developing what other problems?
pre and postnatal developmental retardation microcephaly facial abnormalities limb dislocation heart and lung fistulas
Becker's muscular dystrophy is due to____.
dystrophin gene mutations (not deletions) Becker's is less severe.
Besides pulmonary infections, what are some other consequences of CF?
infertility in males fat-soluable vitamin deficiencies (A,D,E,K)
Causes of female pseudohermaphroditism:
excessive and inappropriate exposure to androgenic steroids during early gestation (i.e., congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)
Characteristic murmur with a patent ductus arteriosus.
continuous, 'machine-like'
Characteristics of Adult polycystic kidney disease:
always bilateral massive enlargement of kidneys due to multiple large cysts patients present with pain, hematuria, HTN, and progressive renal failure
Characteristics of Duchenne's MD:
onset before age 5 weakness begins in the pelvic girdle muscles and progresses superiorly pseudohypertrophy of calf muscles due to fibrofatty replacement of muscle cardiac myopathy use of Gower's maneuver
Characteristics of female pseudohermaphroditism:
ovaries present but external genitalia are virilized or ambiguous
Characteristics of Fragile X syndrome:
macro-orchidism (enlarged testes), long face with a large jaw, large everted ears, and autism
Characteristics of Hereditary Sperocytosis:
spheroid erythrocytes hemolytic anemia increased MCHC splenectomy is curative
Characteristics of male pseudohermaphroditism:
testes present, but external genitalia are female or ambiguous.
Children may do this to increase venous return with R-to-L shunt.
squat
Compare the cholesterol levels of heterozygores and homozygotes with familial hyperchlosterolemia:
Heterozygotes (1 : 500) cholest. levels around 300mg/dL Homozygotes (very rare) cholest. levels over 700 mg/dL.
Complications associated with homozygous familial hypercholesterolemia:
severe atherosclerotic disease early in life tendon xanthomas (classically in the Achilles tendon) Myocardial Infarction before age 20
Congenital heart defects are often due to which infection?
rubella
Cri-du-chat syndrome results from a congenital deletion on which chromosome?
short arm of chromosome 5 46 XX or XY, 5p-
Define Meningocele:
meninges herniate through spinal canal defect picture on p. 229
Define Meningomyelocele:
meninges and spinal cord herniate through spinal canal defect picture on p.229
Define pseudohermaphroditism:
disagreement between the phenotypic (external genitalia) and gonadal (testes vs. ovaries) sex.
Define Spina bifida occulta:
failure of bony spinal canal to close, but no structural herniation. (usually seen at lower vertebral levels) picture on p. 299 (2002 edition)
Describe a true hermaphrodite:
46 XX or 47 XXY both ovary and testicular tissue present; ambiguous genitalia
Describe Eisenmenger's syndrome:
Uncorrected VSD, ASD, or PDA leads to progressive pulm. HTN. As pulm. resistance increases, the shunt changes from L to R to R to L, which causes late cyanosis (clubbing and polycythemia).
Does coarctation of the aorta affect males or females most commonly?
3:1 males to females
Down's syndrome is associated with increased or decreased levels of AFP?
decreased
Elevated ___ in amniotic fluid is evidence of a neural tube defect.
AFP (alpha fetal protein)
Explain the adult type of coarctation of the aorta and give some associated symptoms.
aortic stenosis distal to ductus arteriosus (postductal) aDult is Distal to Ductus associated with notching of the ribs, hypertension in upper extremities, weak pulses in lower extermities (check femoral pulse)
Explain the infantile type of coarctation of the aorta. What is it commonly associated with?
aortic stenosis proximal to insertion of ductus arteriosus (preductal) 'INantile, IN close to the heart.' associated with Turner's syndrome
Explain the pathogenesis of eisenmeinger's syndrome
In fetal period, shunt is R to L (normal). In neonatal period, lung resistance decreases and shunt becomes L to R with subsequent RV hypertrophy and failure (abnormal).
Explain the transposition of the great vessels.
Aorta leaves RV (anterior) and pulmonaryt trunk leaves LV (posterior) this leads to separation of systemic and pulmonary circulations.
Familial Adenomatous Polyposis features:
Colon becomes covered with adenomatous polyps after puberty 'FAP' F= five (deletion on chromosome 5) A= autosomal dominant inheritance P= positively will get colon cancer (100% without resection)
Findings in Von Recklinghausen's disease:
café-au-lait spots, neural tumors, Lisch nodules (pigmented iris hamartomas), skeletal disorders (scoliosis), and increased tumor susceptibility
Findings of Cri-du-chat syndrome:
microcephaly, severe Mental Retardation, high pitched crying/mewing -(Cri-du-chat is French for cry of the cat), cardiac abnormalities
Findings with Huntington's disease:
depression progressive dementia choreiform movements caudate atrophy dec. levels of GABA and Ach in the brain
Frequency of L-toR shunts:
VSD>ASD>PDA
Gender identity is based on what two things?
1. external genitalia 2. sex of upbringing
Genetic anticipation of Fragile X syndrome may be shown by what?
Triplet repeat (CGG)n
Highest risk of development of fetal alcohol syndrome at __ to ___ weeks.
3 to 8
How does CF present in infancy?
Failure to thrive
How is CF diagnosed?
increased concentration of Cl- ions in sweat test
How is MD diagnosed?
muscle biopsy increased serum CPK
Huntington's disease manifests between the ages of :
20 and 50
Incidence and characteristics and Turner's syndrome:
1 in 3000 births short stature, ovarian dysgenesis, webbed neck, coarction of the aorta
Incidence and characteristics of double Y males:
1 in 1000 births phenotypically normal, very tall, severe acne, antisocial behavior (seen in 1-2%)
Incidence and characteristics of Edward's syndrome:
1 in 8000 births severe MR, rocker bottom feet, low-set ears, micrognathia, congenital heart disease, clenched hands (flexion of fingers), prominent occiput. Death usually occurs within 1 year of birth.
Incidence and characteristics of Klinefelter's syndrome:
1 in 850 births testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution
Incidence and characteristics of Patau's syndrome:
1 in 6000 births severe MR, microphthalmia, microcephaly, cleft lip/palate, abnormal forebrain structures, polydactly, congenital heart disease Death usually occurs within 1 year of birth.
Marfan's is due a mutation in which gene?
fibrillin
Mechanism of Fetal Alcohol Syndrome may be :
inhibition of cell migration
Most common form of male pseudohermaphroditism is ____.
testicular feminization (androgen insensitivity) results from a mutation in the androgen receptor gene (X linked recessive); blind-end vagina
Name 3 examples of L-to-R shunts. (late cyanosis) 'blue kids'
1. VSD (ventricular septal defect) 2. ASD (atrial septal defect 3. PDA (patent ductus arteriosus)
Name 3 examples of R-to-L shunts. (early cyanosis) 'blue babies'
The 3 T's' 1. Tetralogy of Fallot 2. Transposition of great vessels 3. Truncus arteriosus
Name 7 common congenital malformations
1. heart defects 2. Hypospadias (when the urethral canal is open on the undersurface of the penis or on the perineum) 3. Cleft lip w/ or w/out cleft palate 4. congenital hip dislocation 5. Spina Bifida 6. Anencephaly 7. Pyloric stenosis
Name 8 autosomal-dominant diseases:
1. Adult polycystic kidney disease 2. Familial hyperchloresterolemia (type IIA) 3. Marfan's syndrome 4. Von Recklinghausen's disease (NFT1) 5. Von Hippel-Lindau disease 6. Huntington's disease 7. Familial Adenomatous Polyposis 8. Hereditary Sperocytosis
Name an X-linked recessive muscular disease that leads to accelerated muscle breakdown.
Duchenne's Muscular Dystrophy
Name the 4 components of Tetralogy of Fallot.
PROVe' 1. Pulmonary Stenosis 2. RVH (right ventricular hypertrophy) 3. Overriding aorta (overrides the VSD) 4. VSD (ventricular septal defect)
Neural tube defects (spina bifida and anencephaly) are associated with increased levels of ___ in the amniotic fluid and maternal serum.
AFP (alpha fetal protein)
Newborns of mothers who consumed significant amounts of alcohol (teratogen) during pregnancy are at risk for _______.
fetal alcohol syndrome (the number one cause of congenital malformations in the U.S.)
Patau's syndrome = trisomy ___
13 (hint: Puberty - 13)
Pathogenesis of Cystic Fibrosis:
defective Cl- channel --> secretion of abnormally thick mucus that plugs lungs, pancreas, and liver --> recurrent pulmonary infections (Pseudomonas species and Staph aureus), chronic bronchitis, bronchiectasis, pancreatic insufficiency (malabsorption and steatorrhea), meconium ileus in newborns.
Patients with Tetralogy of Fallot often suffer _________.
cyanotic spells
Pyloric stenosis is associated with______.
polyhydramnios; projectile vomiting
T/F: Trisomy 21 is associated with advanced maternal age.
True (from 1 in 1500 births in women<20 to 1 in 25 births in women>45)
Tetralogy of Fallot leads to early cyanosis from a R-to-L shunt across the ____.
VSD
The defect in Von Recklinghausen's disease is found on which chromosome?
17 (hint: 17 letters in Recklinghausen's)
The gene responsible for Huntington's disease is located on chromosome__.
4 ; triplet repeat disorder
The incidence of neural tube defects is decreased by maternal ingestion of what?
folate
Transposition of great vessels is a common congenital heart disease in offspring of _____ mothers.
diabetic
Transposition of great vessels is not compatible with life unless what is present?
a shunt that allows adequate mixing of blood (VSD, PDA, or patent foramen ovale)
Trisomy 18 is also known as______.
Edward's syndrome (hint: Election age = 18)
Turner's syndrome is the most common cause of what?
primary amenorrhea
Von Hippel-Lindau disease characteristics:
hemangioblastomas of retina/cerebellum/medulla about half of affected individuals develop multiple bilateral renal cell carcinomas and other tumors
Von Hippel-Lindau disease is associated with the deletion of what gene?
VHL gene (tumor suppressor) on chromosome 3 (3p)
What are some findings of Down's syndrome?
mental retardation flat facial profile prominent epicanthal folds simian crease duodenal atresia congenital heart disease (most common malformation is endocardial cushion defect) Alzheimer's disease in individuals over 35 increased risk of ALL
What does a heart with Tetralogy of Fallot look like on x-ray?
boot-shaped due to RVH
What gender genetic disorder has been observed with increases frequency among inmates of penal institutions?
Double Y males (XYY)
What is different about the juvenile form of polycystic kidney disease?
it is recessive
What is Gower's maneuver?
requiring assistance of the upper extermities to stand up (indicates proximal lower limb weakness)
What is the cause of Duchenne's MD?
a deleted dystrophin gene (hint: 'D' for deletion)
What is the cause of Tetralogy of Fallot?
anterosuperior displacement of the infundibular septum
What is the incidence of Down's syndrome?
1 in 700 births
What is the most common cause of early cyanosis?
Tetralogy of Fallot
What is the most common chromosomal disorder and cause od congenital mental retardation?
Down's syndrome (trisomy 21)
What is the most common congenital cardiac anomaly?
VSD
What is the most common lethal genetic disease of Caucasians?
Cystic Fibrosis
What is the second most common cause of mental retardation?
Fragile X syndrome
What is the underlying cause of Cystic Fibrosis?
Autosomal - recessive defect in CFTR gene on chromosome 7
What is the underlying cause of Familial hypercholesterolemia?
defective or absent LDL receptor leading to elevated LDL
What is used to close a patent ductus arteriosus? What is used to keep it open?
Indomethacin PGE (may be necessary to sustain life in conditions such as transposition of the great vessels)
Which gene is affected in Fragile X?
methylation and expression of the FMR 1 gene is affected in this X-linked disorder
Which genetic gender disorder has an inactivated X chromosome (Barr body)?
Klinefelter's syndrome
Why are female carriers of X-linked recessive disorders rarely affected?
because of random inactivation of X chromosomes in each cell
X-linked recessive disorders (10)
1. Fragile X 2. Duchenne's MD 3. hemophilia A and B 4. Fabry's 5. G6PD deficiency 6. Hunter's syndrome 7. ocular albimism 8. Lesch-Nyhan syndrome 9. Bruton's agammaglobulinemia 10. Wiscott-Aldrich syndrome
XO =
Turner's syndrome (think: 'hugs and kisses' -XO- from Tina Turner)
XXY =
Klinefelter's syndrome one of the most common causes of hypogonadism in males
Approximately what percentage of brain tumors arise from metastasis?
0.5
Are basal cell carcinomas invasive?
Locally invasive but rarely metastasize
Are Ewing's sarcomas likely to metastasize?
Yes. They are extremely aggressive with early metastasis. However, they are responsive to chemotherapy.
Are meningiomas resectable?
Yes
Are squamous cell carcinomas of the skin invasive?
Locally invasive but rarely metastasize
Are the majority of adult tumors supratentorial or infratentorial?
Supratentorial
Are the majority of childhood tumors supratentorial or infratentorial?
Infratentorial
Common histopathology often seen in squamous cell carcinomas of the skin?
Keratin pearls
Define anaplasia
Abnormal cells lacking differentiation; like primitive cells of the same tissue. Often equated with undifferentiated malignant neoplasms. Tumor giant cells may be formed.
Define dysplasia
Abnormal growth with loss of cellular orientation, shape, and size in comparison to normal tissue maturation. It is reversible but is often a preneoplastic sign.
Define hyperplasia
Increase in the number of cells (reversible)
Define metaplasia
One adult cell type is replaced by another (reversible). It is often secondary to irritation and/or environmental exposure (e.g. squamous metaplasia in the trachea and bronchi of smokers)
Define neoplasia
Clonal proliferation of cells that is uncontrolled and excessive
Do oncogenes cause a gain or loss of function?
Gain of function
Do tumor suppressor genes cause a gain or loss of function?
Loss of function. Both alleles must be lost for expression of disease
Does a melanoma have a significant risk of metastasis?
Very significant risk! The depth of the tumor often correlates with the risk of metastasis.
From what cells do meningiomas most commonly arise?
Arachnoid cells external to the brain
Give 2 examples of a benign tumor of epithelial origin.
1. Adenoma 2. Papilloma
Give 2 examples of a malignant tumor of mucosal epithelial origin.
1. Adenocarcinoma 2. Papillary carcinoma
Give 2 examples of malignant tumors of blood cell (mesenchymal) origin.
1. Leukemia 2. Lymphoma
Give an example of a benign tumor of blood vessel (mesenchymal) origin.
Hemangioma
Give an example of a benign tumor of bone (mesenchymal) origin.
Osteoma
Give an example of a benign tumor of more than one cell type.
Mature teratoma
Give an example of a benign tumor of skeletal muscle (mesenchymal) origin.
Rhabdomyoma
Give an example of a benign tumor of smooth muscle (mesenchymal) origin.
Leiomyoma
Give an example of a malignant tumor of blood vessel (mesenchymal) origin.
Angiosarcoma
Give an example of a malignant tumor of bone (mesenchymal) origin.
Osteosarcoma
Give an example of a malignant tumor of more than one cell type.
Immature teratoma
Give an example of a malignant tumor of skeletal muscle (mesenchymal) origin.
Rhabdomysarcoma
Give an example of a malignant tumor of smooth muscle (mesenchymal) origin.
Leiomyosarcoma
Give an example of a neoplasm associated with Down's Syndrome.
Acute Lymphoblastic Leukemia (ALL)
How are tumor markers used?
Tumor markers are used to confirm diagnosis, to monitor for tumor recurrence, and to monitor the response to therapy. They should not be used as a primary tool for diagnosis.
How is prostatic adenocarcinoma most commonly diagnosed?
Digital rectal exam (detect hard nodule) or by prostate biopsy
How often do primary brain tumors undergo metastasis?
Very rarely
In what population is osteochondroma most often found?
Usually men under the age of 25
In which age group is prostatic adenocarcinoma most common?
Men over the age of 50
Is malignant transformation in osteochondroma common?
Malignant transformation to chondrosarcoma is rare
Name 1 common tumor staging system.
TNM system T= size of tumor, N=node involvement, and M=metastases
Name 3 herniation syndromes that can cause either coma or death when the herniations compress the brainstem
1. Downward transtentorial (central) herniation 2. Uncal herniation 3. Cerebellar tonsillar herniation into the foramen magnum
Name 4 factors that predispose a person to osteosarcoma.
1. Paget's disease of bone 2. Bone infarcts 3. Radiation 4. Familial retinoblastoma
Name 4 possible routes of herniation in the brain
1. Cingulate herniation under the falx cerebri 2. Downward transtentorial (central) herniation 3. Uncal herniation 4. Cerebellar tonsillar herniation into the foramen magnum
Name 5 primary brain tumors with peak incidence in adulthood.
1. Meningioma 2. Glioblastoma multiforme 3. Oligodendroglioma 4. Schwannoma 5. Pituitary adenoma
Name 5 primary brain tumors with peak incidence in childhood.
1. Medulloblastoma 2. Hemangioblastoma 3. Ependymomas 4. Low-grade astrocytoma 5. Craniopharyngioma
Name 5 sites from which tumor cells metastasize to the brain.
1. Lung 2. Breast 3. Skin (melanoma) 4. Kidney (renal cell carcinoma) 5. GI
Name a common histopathological sign of basal cell carcinoma nuclei
The nuclei of basal cell tumors have 'palisading' nuclei
Name a population at a greater risk for melanoma.
Fair-skinned people (blue eyes and red hair have also been considered as factors)
Name the 5 primary tumors that metastasize to the liver
1. Colon 2. Stomach 3. Pancreas 4. Breast 5. Lung
Name two of the most common sites of metastasis after the regional lymph nodes
The liver and the lung
Name two presenting sequelae of a pituitary adenoma.
1. Bitemporal hemianopsia (due to pressure on the optic chiasm) 2. Hypopituitarism
On which chromosome is the p53 gene located?
17p
On which chromosome is the Rb gene located?
13q
On which chromosomes are the BRCA genes located?
BRCA 1 is on 17q and BRCA 2 is on 13q
Out of the 6 primary tumors that metastasize to bone, which two are the most common?
Metastasis from the breast and prostate are the most common
What 2 cancers are associated with EBV?
1. Burkitt's lymphoma 2. Nasopharyngeal carcinoma
What 2 neoplasms are associated with AIDS?
1. Aggressive malignant lymphomas (non-Hodgkins) 2. Kaposi's sarcoma
What 2 neoplasms are associated with Autoimmune disease (e.g. Hashimoto's thyroiditis, myasthenia gravis, etc.)?
Benign and malignant thymomas
What 2 neoplasms are associated with Paget's disease of bone?
1. Secondary osteosarcoma 2. Fibrosarcoma
What 2 neoplasms are associated with Tuberous sclerosis (facial angiofibroma, seizures, and mental retardation)?
1. Astrocytoma 2. Cardiac rhabdomyoma
What are 2 characteristic findings in carcinoma in situ?
1. Neoplastic cells have not invaded the basement membrane 2. High nuclear:cytoplasmic ratio and clumped chromatin
What are 2 characteristic findings of an invasive carcinoma?
1. Cells have invaded the basement membrane using collagenases and hydrolases 2. Able to metastasize if they reach blood or lymphatic vessels.
What are 2 neoplasms associated with Xeroderma pigmentosum?
1. Squamous cell carcinoma of the skin 2. Basal cell carcinoma of the skin
What are 3 disease findings associated with Alkaline Phosphatase?
1. Metastases to bone 2. Obstructive biliary disease 3. Paget's disease of bone
What are 6 primary tumors that metastasize to bone?
1. Kidney 2. Thyroid 3. Testes 4. Lung 5. Prostate 6. Breast
What are a common histopathological finding of meningiomas?
Psammoma bodies. These are spindle cells concentrically arranged in a whorled pattern.
What are ependymomas?
Ependymal cell tumors most commonly found in the 4th ventricle. May cause hydrocephalus
What are the steps in the progression of neoplasia?
1. Normal 2. Hyperplasia 3. Carcinoma In Situ/Preinvasive 4. Invasion
What are two signs of bone metastases in prostatic adenocarcinoma?
An increase in serum alkaline phosphatase and PSA (prostate-specific antigen)
What are two useful tumor markers in prostatic adenocarcinoma?
Prostatic acid phosphatase and prostate-specific antigen (PSA)
What can be associated with the risk of melanoma?
Sun exposure
What cancer is associated with HBV and HCV (Hep B and C viruses)?
Hepatocellular carcinoma
What cancer is associated with HHV-8 (Kaposi's sarcoma-associated herpes virus)?
Kaposi's carcinoma
What cancer is associated with the HTLV-1 virus?
Adult T-cell leukemia
What cancers are commonly associated with HPV (human papilloma virus)?
Cervical carcinoma, penile, and anal carcinoma
What causes the local effect of a mass?
Tissue lump or tumor
What causes the local effect of a nonhealing ulcer?
Destruction of epithelial surfaces (e.g. stomach, colon, mouth, bronchus)
What causes the local effect of a space-occupying lesion?
Raised intracranial pressure in brain neoplasms. Also seen with anemia due to bone marrow replacement.
What causes the local effect of bone destruction?
Pathologic fracture or collapse of bone
What causes the local effect of edema?
Venous or lymphatic obstruction
What causes the local effect of hemorrhage?
Caused by ulcerated area or eroded vessel
What causes the local effect of inflammation of a serosal surface?
Pleural effusion, pericardial effusion, or ascites
What causes the local effect of obstruction in the biliary tree?
Jaundice
What causes the local effect of obstruction in the bronchus?
Pneumonia
What causes the local effect of obstruction in the left colon?
Constipation
What causes the local effect of pain?
Any site with sensory nerve endings. Remember that tumors in the brain are usually painless.
What causes the local effect of perforation of an ulcer in the viscera?
Peritonitis or free air
What causes the local effect of seizures?
Tumor mass in the brain.
What causes the localized loss of sensory or motor function?
Compression or destruction of nerve (e.g. recurrent laryngeal nerve by lung or thyroid cancer causes hoarseness)
What causes the paraneoplastic effect gout?
Hyperuricemia due excess nucleic acid turnover (secondary to cytotoxic therapy of various neoplasms)
What causes the paraneoplastic effect of Cushing's disease?
ACTH or ACTH-like peptide (secondary to small cell lung carcinoma)
What causes the paraneoplastic effect of hypercalcemia?
PTH-related peptide, TGF-a, TNF-a, IL-2 (secondary to squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma, multiple myeloma, and bone metastasis)
What causes the paraneoplastic effect of Lambert-Eaton syndrome?
Antibodies against presynaptic Ca2+ channels at NMJ (Thymoma, bronchogenic carcinoma)
What causes the paraneoplastic effect of Polycythemia?
Erythropoietin (secondary to renal cell carcinoma)
What causes the paraneoplastic effect of SIADH?
ADH or ANP (secondary to small cell lung carcinoma and intracranial neoplasms)
What chemical carcinogen is commonly associated with the centrilobar necrosis and fatty acid change?
CCL4
What chemical carcinogen is commonly associated with the esophagus and stomach?
Nitrosamines
What chemical carcinogen is commonly associated with the lungs?
Asbestos (Causes mesothelioma and bronchogenic carcinoma)
What chemical carcinogen is commonly associated with the skin (squamous cell)?
Arsenic
What chemical carcinogen(s) are commonly associated with the liver?
Aflatoxins and vinyl chloride
What is a chondrosarcoma?
Malignant cartilaginous tumor.
What is a common genetic finding in Ewing's sarcoma?
11;22 translocation
What is a common gross pathological sign seen in Ewing's sarcoma?
Characteristic 'onion-skin' appearance of bone
What is a common origin of a chondrosarcoma?
May be of primary origin or from osteochondroma
What is a common sign found on the x-ray of a person with osteosarcoma?
Codman's triangle (from elevation of periosteum)
What is a craniopharyngioma?
Benign childhood tumor. Often confused with pituitary adenoma because both can cause bitemporal hemianopsia. Calcification of the tumor is common.
What is a Ewing's sarcoma?
Anaplastic small cell malignant tumor.
What is a giant cell tumor?
Locally aggressive benign tumor around the distal femur, proximal tibial region.
What is a gross pathological sign of basal cell carcinoma?
Pearly papules
What is a helpful mnemonic to remember the neoplasm associated with Down's Syndrome?
We ALL go DOWN together.
What is a helpful mnemonic to remember the site of metastasis to the brain?
Lots of Bad Stuff Kills Glia
What is a helpful mnemonic to remember the types of cancer that metastasize to the liver?
Cancer Sometimes Penetrates Benign Liver
What is a helpful mnemonic to remember what tumors metastasize to bone?
BLT with a Kosher Pickle
What is a Hemangioblastoma?
Most often a cerebellar tumor. Associated with von Hippel Lindau syndrome when found with retinoblastoma.
What is a low-grade astrocytoma?
Diffusely infiltrating glioma. In children, it is most commonly found in the posterior fossa.
What is a medulloblastoma?
Highly malignant cerebellar tumor. A form of primitive neuroectodermal tumor (PNET). Can compress 4th ventricle causing hydrocephalus
What is a neoplasm associated with actinic keratosis?
Squamous cell carcinoma of the skin
What is a neoplasm associated with Barrett's esophagus (chronic GI reflux)?
Esophageal adenocarcinoma
What is a neoplasm commonly associated with chronic atrophic gastritis, pernicious anemia, and postsurgical gastric remnants?
Gastric adenocarcinoma
What is an oligodendroglioma?
A relatively rare, slow growing, benign tumor.
What is CEA (carcinoembryonic antigen)?
Very nonspecific antigen produced by 70% of colorectal and pancreatic cancers and by gastric and breast carcinoma
What is considered a precursor to squamous cell carcinoma?
Actinic keratosis
What is considered to be a precursor to malignant melanoma?
Dysplastic nevus
What is meant by the term tumor grade?
Histologic appearance of the tumor. Usually graded I-IV based on degree of differentiation and number of mitoses per high-power field.
What is meant by the term tumor stage?
Based on site an size of primary lesion, spread to regional lymph nodes, and presence of metastases.
What is the characteristic appearance of a giant cell tumor on an x-ray?
Characteristic 'double bubble' or 'soap bubble' appearance
What is the common histopathology associated with Ependymomas?
Characteristic perivascular rosettes. Rod-shaped blepharoblasts (basal ciliary bodies) found near the nucleus.
What is the common histopathology associated with Hemangioblastoma?
Foamy cells and high vascularity are characteristic. Can produce EPO and lead to polycythemia.
What is the common histopathology associated with medulloblastomas?
Rosettes or perivascular pseudorosette pattern of cells
What is the common histopathology associated with oligodendrogliomas?
Fried egg' appearance of cells in tumor. Often calcified.
What is the common histopathology associated with schwannoma?
Antoni A=compact palisading nuclei; Antoni B=loose pattern
What is the common histopathology found in Glioblastoma multiforme?
Pseudopalisading' tumor cells border central areas of necrosis and hemorrhage
What is the differentiation pattern of normal cells?
Basal to apical differentiation
What is the histopathology commonly associate with giant cell tumors?
Spindle-shaped cells with multi-nucleated giant cells.
What is the most common benign bone tumor?
Osteochondroma
What is the most common location of basal cell carcinoma of the skin?
Usually found in sun-exposed areas of the body.
What is the most common location of osteosarcoma?
Commonly found in the metaphysis of long bones
What is the most common organ to 'send' metastases?
The lung is the most common origin of metastases. The breast and stomach are also big sources.
What is the most common organ to receive metastases?
Adrenal glands. This is due to their rich blood supply. The medulla usually receives metastases first and then the rest of the gland.
What is the most common population to have chondrosarcoma?
Men age 30-60 years old
What is the most common primary brain tumor?
Glioblastoma multiforme (grade IV astrocytoma)
What is the most common primary malignant tumor of bone?
Osteosarcoma
What is the most common type of pituitary adenoma?
Prolactin secreting
What is the most likely population to have Ewing's sarcoma?
Boys under 15 years old.
What is the origin of a craniopharyngioma?
Derived from the remnants of Rathke's pouch
What is the origin of a Pituitary adenoma?
Rathke's pouch
What is the origin of the Schwannoma?
Schwann cell origin. Often localized to the 8th cranial nerve (acoustic schwannoma). Bilateral schwannoma found in NF2.
What is the peak incidence of giant cell tumor?
20-40 years old
What is the peak incidence of osteosarcoma?
Men 10-20 years old
What is the prognosis for Glioblastoma multiforme?
Prognosis is grave. Usually only have a year life expectancy.
What is the second most common primary brain tumor?
Meningioma
What is the third most common primary brain tumor?
Schwannomas
What neoplasias are associated with a-fetoprotein?
Hepatocellular carcinoma and nonseminomatous germ cell tumors of the testis.
What neoplasias are associated with B-hCG?
Hydatidiform moles, Choriocarcinomas, and Gestational trophoblastic tumors.
What neoplasias are associated with CA-125?
Ovarian and malignant epithelial tumors
What neoplasias are associated with S-100?
Melanoma, neural tumors, and astrocytomas
What neoplasm is associated with Cirrhosis (due to alcoholism, Hep B, or Hep C)
Hepatocellular carcinoma
What neoplasm is associated with Dysplastic nevi?
Malignant melanoma
What neoplasm is associated with Immunodeficiency states?
Malignant lymphomas
What neoplasm is associated with Plummer-Vinson syndrome (atrophic glossitis, esophageal webs, and anemia; all due to iron deficiency)
Squamous cell carcinoma of the esophagus
What neoplasm is associated with ulcerative colitis?
Colonic adenocarcinoma
What oncogene is associated with breast, ovarian, and gastric carcinomas?
erb-B2
What oncogene is associated with Burkitt's lymphoma?
c-myc
What oncogene is associated with colon carcinoma?
ras
What oncogene is associated with Follicular and undifferentiated lymphomas (inhibits apoptosis)?
bcl-2
What tumor marker is associated with Prostatic carcinoma?
PSA (Prostatic acid phosphatase)
What tumor suppressor gene is associated with Retinoblastoma and osteosarcoma?
Rb gene
What type of metastases are common in the late stages of prostatic adenocarcinoma?
Osteoblastic metastases in bone
What type of neoplasm is associated with Acanthosis nigricans (hyperpigmentation and epidermal thickening)
Visceral malignancies (stomach, lung, breast, and uterus)
What type of skin cancer is associated with excessive exposure to sunlight or arsenic exposure?
Squamous cell carcinoma
Where are chondrosarcomas usually located?
Pelvis, spine, scapula, humerus, tibia, or femur.
Where are Ewing's sarcomas most commonly found?
Diaphysis of long bones, pelvis, scapula, and ribs
Where are Glioblastoma multiformes found?
Cerebral hemispheres
Where do giant cell tumors most commonly occur?
At epiphyseal end of long bones
Where do meningiomas most commonly occur?
Convexities of hemispheres and parasagital region
Where do oligodendrogliomas most often occur?
Most often found in the frontal lobes
Where do osteochondromas commonly originate?
Long metaphysis
Where do squamous cell carcinomas most commonly occur?
Hands and face
Where does prostatic adenocarcinoma most commonly arise?
From the posterior lobe (peripheral zone) of the prostate gland
Which has more prognostic value: tumor stage or grade?
Stage
Which is more common: metastasis to bone or primary tumors of bone?
Metastatic bone tumors are far more common than primary tumors
Which is more common: metastasis to the liver or primary tumors of the liver?
Metastasis to the liver is more common
Which tumor suppressor gene is associated with most human cancers and the Li-Fraumeni syndrome?
p53
Which tumor suppressor genes are associated with breast and ovarian cancer?
BRCA 1 and 2
___% of African-Americans carry the HbS trait, and ___% have the disease.
8%; 0.2
________ = defect of platelet aggregation
Glanzmann's thrombasthenia
________ disease = defect of platelet adhesion
Bernard-Soulier
_____= activation of coagulation cascade leading to microthrombi and global consumption of platelets, fibrin, and coagulation factors.
DIC (Disseminated intravascular coagulation)
2 therapies for sickle cell anemia:
1. Hydroxyurea (increased HbF) 2. bone marrow transplantation
50% of Hodgkin's cases are associated with which virus?
EBV
7 causes of normocytic normochromic anemia:
1. hemorrage 2. enzyme defects (e.g., G6PD deficiency, PK deficiency) 3. RBC membrane defects (e.g., hereditary spherocytosis) 4. Bone Marrow disorders (e.g., aplastic anemia, leukemia) 5. Hemoglobinopathies (e.g., sickle cell) 6. Autoimmune hemolytic anemia 7. Anemia of chronic disease
Antiplatelet antibodies and increased megakaryocytes are seen in ____.
ITP
Auer rods, myeloblasts, adults =
AML
bcl-2 activation is associated with which translocation and which lymphomas?
t(14;18) - Follicular lymphomas
bcr-abl hybrid is associated with which translocation and which leukemia?
t(9;22) - CML
Blood smear of a Multiple Myeloma patient would show what?
RBCs stacked like poker chips (rouleau formation)
Burkitt's lymphoma: '______' appearance associated with what virus? endemic where?
starry sky' EBV Africa
c-myc activation is associated with which translocation and which lymphoma?
t(8;14) - Burkitt's
Causes of aplastic anemia:
radiation, benzene, chloramphenicol, alkylating agents, antimetabolites, viral agents (HCV,CMV,EBV, herpes zoster-varicella), Faconi's anemia, idiopathic (immune-mediated, primary stem cell defect)
Causes of platelet abnormalities:
ITP, TTP, drugs, DIC
CFU-GM (colony forming unit-granulocyte-monocyte) gives rise to which cells?
monocytes, neutrophils and basophils
CLL is very similar to what lymphoma?
SLL (small lymphocytic lymphoma)
Coagulation factor defects (macrohemorrage) cause: (3)
1. Hemarthroses (bleeding into joints) 2. easy bruising 3. prolonged PT and/or PTT
Common cause of macrocytic megalobalstic anemia:
Vit. B12/folate deficiency
common in children, lymphoblasts, most responsive to therapy =
ALL
Compare Multiple Myeloma with Waldenstrom's macroglobinemia:
Waldenstrom's also has an M spike, but large amounts of IgM are produced (not IgA or IgG), no lytic lesions
Complications often seen in homozygotes (sickle cell disease) include:
aplastic crisis (due to B19 parvovirus infection) autosplenectomy inc. risk of encapsulated organism infection Salmonella osteomyelitis painful crisis (vaso-occlusive) and splenic sequestration crisis
Describe the RBCs of a parient with Hereditary spherocytosis.
RBCs are small, round, with no central pallor less membrane therefore increased MCHC
FAB classification L1:
ALL-null, ALL-common
FAB classification L2:
ALL- T
FAB classification L3:
ALL- B
FAB classification M1:
AML (without maturation)
FAB classification M2:
AML (with maturation)
FAB classification M3:
acute promyelocytic leukemia
FAB classification M4:
acute myelomonocytic leukemia
FAB classification M5:
acute monocytic leukemia
FAB classification M6:
acute erythroleukemia
FAB classification M7:
acute megakaryocytic leukemia
General considerations of leukemias:
increased number of circulating leukocytes in blood bone marrow infiltrates of leukemic cells leukemic cell infiltrates in liver, spleen, and lymph nodes also common
Genetics associated with Burkitt's lymphoma:
t(8;14) c-myc gene moves next to heavy chain Ig gene (14)
Hb Barts =
Gamma 4 tetramers, lacks all 4 alpha globin genes
Hb Barts results in what?
hydrops fetalis and intrauterine fetal death
Hb H =
Beta 4 tetramers, lacks 3 alpha globin genes
Hereditary spherocytosis causes intrinsic, extravascular hemolysis due to a _____ defect.
spectrin
Hereditary spherocytosis is associated with what other problems?
gallstones, splenomegaly, anemia and jaundice
Hereditary spherocytosis is distinguished from warm antibody hemolysis by what test?
Direct Coomb's test (Hereditary spherocytosis is Coomb's negative)
Hodgkin's or NHL: which is associated with HIV & immunosuppression?
NHL
Hodgkin's or NHL: which is associated with mediastinal lymphadenopathy?
Hodgkin's
Hodgkin's or NHL: which one displays a bimodal distribution?
Hodgkin's (young and old)
How does Multiple Myeloma affect calcium levels?
destructive bone lesions cause hypercalcemia (punched-out lytic bone lesions can be seen on x-ray)
In _____, the alpha globin chain is underproduced.
alpha thalassemia
In _____, the beta chain is underproduced.
Beta-minor thalassemia (heterozygote)
In ______, the beta chain is absent.
Beta-major thalassemia (homozygote)
In anemia of chronic disease, are these values increased or decreased? 1. TIBC 2. ferritin 3. serum iron 4. storage iron in marrow macrophages 5. % sat.
1. dec. 2. inc. 3. dec. 4. inc. 5. normal
In Beta Thalassemia, cardiac failure is often due to what?
secondary hemochromatosis (due to transfusions)
In which hemorrhagic disorder is PT increased?
DIC
In which hemorrhagic disorders is PTT increased? (4)
1. Hemophilia A 2. Hemophilia B 3. von Willibrand's disease 4. DIC
increased or decreased in iron deficiency anemia? 1. TIBC 2. ferritin 3. serum iron
1. increased 2. decreased 3. decreased
Is Hodgkin's more common in men or women?
men (except nodular sclerosing type)
Lab findings of DIC:
increased PT and PTT, increased fibrin split products (D-dimers), decreased platelet count
Lymphoblastic lymphoma commonly presents with what?
ALL and mediastinal mass
Lymphomas derived from the B cell lineage:
ALL (B cell) Lymphoblastic lymphoma, CLL (B) Lymphocytic lymphoma, Follicular center cell lymphoma, Immunoblastic lymphoma (B), Plasmacytoid lymphocytic lymphoma and myeloma
Lymphomas derived from the T cell lineage:
ALL (T cell) Lymphoblastic lymphoma, CLL (T) Lymphocytic lymphoma, Immunoblastic lymphoma (T), Sezary syndrome and mycosis fungoides
Macrocytic anemia is defined as MCV>____.
100
Marrow failure due to leukemia can lead to (3)
1. anemia (dec. RBCs) 2. infections (dec. WBCs) 3. hemorrhage (decreased platelets)
Microcytic, hypochromic anemia = MCV<____.
80
most commonly associated with Philadelphis chromosome, myeloid stem cell proliferation, may accelerate to AML =
CML
Name 3 coagulopathies:
1. Hemophilia A 2. Hemophilia B 3. von Willibrand's disease
Name 3 etiologies of microcytic, hypochromic anemia:
1. iron deficiency 2. Thalassemias 3. lead poisoning
Name 5 hemorrhagic disorders that exhibit increased bleeding time.
1. Qualitative platelet defects 2. Vascular bleeding 3. Thrombocytopenia 4. Von Willibrand's disease 5. DIC
Name 5 types of NHL:
1. Small lymphocytic lymphoma 2. Follicular lymphoma (small cleaved cell) 3. Diffuse large cell 4. Lymphoblastic lymphoma 5. Burkitt's lymphoma
Name 9 chronic myeloid leukemias:
CML, Polycythemia rubra vera, CML, Myelofibrosis, idiopathic thrombocythemia, (chronic monocytic, chronic myelomonocytic, eosinophilic, chronic erythroid) *last 4 are rare*
Nodal involvement and spread of Hodgkin's vs. NHL:
Hodgkin's: localized, single group of nodes, extranodal rare, contiguous spread NHL: multiple, peripheral nodes, extranodal involvement common, noncontiguous spread
Normal values: 1. TIBC 2. Serum iron 3. % sat.
1. TIBC 250-400 micro grams/ dl 2. 50-150 3. 20-50 %
older adults, lymphadenopathy, hepatosplenomegaly, few symptoms, indolent course, increased smudge cells in peripheral blood smear, warm Ab autoimmune hemolytic anemia =
CLL
Other causes of macrocytic anemia (2)
1. drugs that block DNA synthesis (e.g., sulfa drugs, AZT) 2. marked reticulocytosis
Pathologic features of aplastic anemia:
pancytopenia with normal cell morphology, hypocellular bone marrow with fatty infiltration
Peak incidence of NHL between what ages?
20-40
Philadelphia chromosome=
t(9;22), bcr-abl
Plasma cells in Multiple Myeloma produce large amounts of what?
IgG (55%) and IgA (25%)
Platelet abnormalities (microhemorrage) lead to: (4)
1. mucous membrane bleeding 2. petechiae 3. purpura 4. prolonged bleeding time
PMNs are hypersegmented in ____ .
Vit. B 12 and folate deficiencies
PT and PTT: which one measures the intrinsic and which one measures the extrinsic path?
PT (extrinsic) PTT (intrinsic)
Rank the prognoses of the different types of Hodgkin's:
NS and LP = excellent MC = intermediate LD = poor
Schistocytes are characteristic of ___.
TTP
Sickle cell heterozygotes (sickle cell trait) are relatively ____-resistant.
malaria; (balanced polymorphism)
Symptoms of aplastic anemia:
fatigue, malaise, pallor, purpura, mucosal bleeding, petechiae, infection
Thalassemia is prevalent in which populations?
Mediterranean (hint: thalassa=sea. Think, thalaSEAmia)
The lymphoid stem cell gives rise to: (2)
T cells and B cells
The majority of NHL involve T cells or B cells?
B cells (except lymphoblastic T cell origin)
Treatment of aplastic anemia:
withdrawal of offending agent, allogenic bone marrow transplantation, RBC and platelet transfusion, G-CSF or GM-CSF
What are 2 indications of hemolysis?
1. decreased serum haptoglobin 2. increased serum LDH
What are constitutional signs/symptoms?
(mostly seen in Hodgkin's) low grade fever, night sweats, weight loss
What are some other causes of DIC?
gram-negative sepsis, transfusion, trauma, malignancy, acute pancreatitis, and nephrotic syndrome
What genetics are involved with follicular lymphoma (small cleaved cell)?
t(14;18) bcl-2 expression
What is another Beta chain mutation in which patients have a milder disease than Hb SS patients?
HbC defect. patients can be HbC or HbSC (1 of each mutant gene)
What is aplastic anemia?
pancytopenia characterized by severe anemia, neutropenia, and thrombocytopenia caused by destruction of multipotent myeloid stem cells, with inadequate production or release of differentiated cell lines.
What is compensatorily increased in both forms of Beta Thalassemia?
fetal hemoglobin (it is inadequate, however)
What is found in the urine of patients with Multiple Myeloma?
Ig light chains (Bence Jones protein)
What is it called when CML --> AML?
blast crisis
What is the characteristic cell of Hodgkin's lymphoma?
Reed-Sternberg cell (decreased numbers of RS cells indicates a better prognosis)
What is the M spike?
the monoclonal immunoglobin spike on serum electrophoresis
What is the most common bleeding disorder?
von Willibrand's disease
What is the most common cause of DIC?
obstetric complications
What is the most common primary tumor arising within bone in adults?
Multiple Myeloma
What is the name of a chronic T cell leukemia?
Sezary syndrome
What mutation causes sickle cell anemia?
a single AA replacement in the Beta chain (normal glutamic acid with valine)
What other problems result from Multiple Myeloma?
renal insufficiency, increased susceptibility to infections, anemia, and amyloidosis
What precipitates sickling of cells?
low oxygen or dehydration
What test is used to confirm Hereditary spherocytosis?
osmotic fragility test
What test is used to distinguish between immune vs. non-immune RBC hemolysis?
Direct Coomb's test
What type of cell is cancerous in Multiple Myeloma and what does it resemble?
Monoclonal plasma cell, 'fried egg' appearance
Which 2 hemorrhagic disorders have decreased platelet counts?
1. thrombocytopenia 2. DIC
Which 2 types of NHL occur in children?
lymphoblastic lymphoma, and Burkitt's lymphoma (20% of diffuse large cell type too)
Which Beta Thalassemia results in severe anemia?
Beta Thal. major, (requires blood transfusions)
Which coagulation factors are a part of the intrinsic and which are a part of the extrinsic path?
(extrinsic) = Factors II, V, VII, and X (intrinsic) = all factors except VII and XIII
Which coagulation factors are deficient in each of the Hemophilias?
Hemophilia A (factor VIII deficiency) Hemophilia B (factor IX deficiency)
Which one is associated with neurological problems, folate deficiency or Vit. B12 deficiency?
Vit. B12
Which type of Hodgkin's accounts for 6% of cases and which type is the most rare.
LP (lymphocyte predominant) - 6% LD (lymphocyte depleted) - rare
Which type of Hodgkin's commonly affects males under 35?
LP
Which type of Hodgkin's commonly affects older males and is associated with disseminated disease?
LD
Which type of Hodgkin's has the most Reed Sternberg cells?
Mixed Cellularity
Which type of Hodgkin's is characterized by collagen banding?
NS (nodular sclerosing)
Which type of Hodgkin's is the most common? (65-75%)
NS (nodular sclerosing)
Which type of Hodgkin's is the second most common? (25%)
MC (mixed cellularity)
Which type of Hodgkin's primarily affects young adults, women>men?
NS
Which type of NHL clinically presents like CLL?
small lymphocytic lymphoma
Which type of NHL is difficult to cure?
follicular lymphoma
Which type of NHL is most common in children?
Lymphoblastic lymphoma (very aggressive)
Which type of NHL is the most common type in adults?
follicular lymphoma (small cleaved cell)
Which types of NHL involve T cells?
Lymphoblastic lymphoma (immature T cells) 20% of Diffuse large cell NHL (mature T cells)
With iron overload (hemosiderosis) are values increased or decreased? 1. TIBC 2. serum iron 3. %sat.
1. TIBC normal 2. Serum iron increased 3. % sat. increased (100%) -see charts on p.238 of 2002 edition-
A patient with gallstones may present with Charcot's triad. What comprises the triad?
(1)epigastric/RUQ pain (2)fever (3)jaundice
Failure of copper to circulate in what form causes Wilson's disease?
ceruloplasmin
How can one distinguish between Dubin-Johnson syndrome and Rotor's syndrome?
Rotor's syndrome presents similarly, except less severely and no black liver(as seen in Dubin-Johnson)
How does Budd-Chiari syndrome progress(in the liver)?
Congestive liver disease
How does cirrhosis/portal hypertension(HTN) affect liver histology?
diffuse fibrosis, destroying normal structure, with nodular regeneration
How does Hirschsprung's disease first present?
Chronic constipation early in life
How does one diagnose gallstones?
ultrasound
How does one differentiate liver nodules, in the case of cirrhosis?
micronodular(<3mm and uniform) macronodular(>3mm and varied)
How does one treat gallstones?
cholecystectomy
How is achalasia evidenced on a Barium swallow?
Bird beak'--dilated esophagus with an area of distal stenosis.
How is hepatocellular carcinoma spread?
like renal cell carcinoma, hematogenously
How is the hyperbilirubinemia in Dubin-Johnson syndrome different than in the other 2 hyperbilirubinemias(Gilbert's or Crigler-Najjar(type 1))?
Dubin-Johnson syndrome-- conjugated hyperbilirubinemia (due to defective liver excretion)
How would you expect a Gilbert's syndrome patient to present?
Asymptomatically, with an elevated unconjugated bilirubin
In PUD, how can H.pylori be treated?
triple therapy (metronidazole, bismuth salicylate, amoxicillin or tetracycline with or without a proton pump inhibitor
In what fatal childhood hepatoencephalopathy is there an association with viral infections(VZV,influ.B) and salicylates?
Reye's syndrome
In Wilson's disease, where does copper accumulate(3)?
(1)Liver (2)Brain (3)cornea
Is chronic pancreatitis strongly associated with alcoholism?
YES
Is the dilation proximal, at, or distal to the aganglionic segment?
Proximal (results in a 'transition zone')
Low-fiber diets are associated with which of the following?
diverticulosis
To what cancer is a chronic gastritic patient predisposed?
Gastric carcinoma
What 3 common findings are evident in a Reye's patient?
(1)fatty liver (2)hypoglycemia (3)coma
What are 2 anti-androgen effects of liver cell failure?
gynecomastia loss of sexual hair
What are 2 extraintestinal manifestations of Crohn's?
migratory polyarthritis erythema nodosum
What are 2 main symptoms and a histological sign of Duodenal ulcers?
(1)pain Decreases with meals, (2)weight gain, hypertrophy of Brunner's glands
What are 2 main symptoms of Gastric ulcers?
pain Greater with meals, weight loss
What are 2 signs of Crigler-Najjar syndrome(other than hyperbilirubinemia)?
jaundice kernicterus(bilirubin deposition in the brain)
What are 2 types of Inflammatory Bowel Disease?
Crohn's disease Ulcerative colitis
What are 2 types of peptic ulcer disease(PUD)?
gastric ulcer duodenal ulcer
What are 3 associations of Budd-Chiari Syndrome?
(1)pregnancy (2)polycythemia rubra vera (3)hepatocellular carcinoma
What are 3 neuro effects of liver cell failure?
(1)asterixis, (2)scleral icterus, (3)coma
What are 3 types of gallstones?
(1)Cholesterol stones (2)Mixed stones (3)Pigment stones
What are 4 potential complications of PUD?
(1)bleeding, (2)penetration, (3)perforation, (4)obstruction
What are 4 signs of congestive liver disease?
(1)hepatomegaly (2)ascites (3)abdominal pain (4)eventual liver failure
What are 5 GI and 2 GU effects of portal HTN?
(1)esophageal varices(->hematemesis), (2)melena, (3)splenomegaly, (4)caput medusae, (5)ascites and (1)testicular atrophy, (2)hemorrhoids
What are 5 possible consequences of acute pancreatitis?
(1)DIC (2)ARDS (3)Diffuse fat necrosis (4)hypocalcemia (5)pseudocyst formation
What are possible causes of acute pancreatitis(GET SMASHeD)?
Gallstones Ethanol Trauma Steroids Mumps Autoimmune disease Scorpion sting Hyperlipidemia Drugs
What are possible etiologies of hemochromatosis?
primary(autos. Recessive) secondary to chronic transfusion therapy
What are risk factors for esophageal cancer(ABCDEF)?
Achalasia, Barrett's esophagus, Corrosive esophagitis, Diverticuli, Esophageal web, Familial
What are some complications of Crohn's(4)?
(1)strictures, (2)fistulas, (3)perianal disease, (4)malabsorption-nutritional depletion
What are some complications of ulcerative colitis(3)?
(1)severe stenosis, (2)toxic megacolon, (3)colorectal carcinoma
What are the 2 types of chronic gastritis?
Type A(fundal) Type B(antral)
What are the 3 forms of Diverticular disease?
(1)diverticulum, (2)diverticulosis, (3)diverticulitis
What are the 4 risk factors for gallstone development?
(1)Female (2)Fat (3)Fertile (4)Forty
What are the ABCD characteristics of Wilson's?
Asterixis Basal ganglia degeneration Cirrhosis, Ceruloplasmin decrease, Corneal deposits(Kayser-Fleischer rings), Carcinoma(hepatocell.), Choreiform movements Dementia
What are the characteristic 4 A's of type A gastritis?
Autoimmune disorder characterized by Autoantibodies to parietal cells, pernicious Anemia, Achlorhydria
What are the respective etiologies of Crohn's and Ulcerative colitis(UC)?
infectious(Crohn's) autoimmune(UC)
What can achalasia arise from and lead to?
A secondary form can arise from Chagas' disease; can lead to progressive dysphagia.
What can hemochromatosis lead to(2)?
(1)CHF (2)hepatocellular carcinoma
What cell tumor marker is elevated in hepatocellular carcinoma?
Alpha FetoProtein(AFP)
What disorder is characterized by increased iron deposition in many organs(up to 50g)?
hemochromatosis
What happens to hepatocytes as a result of alcoholic hepatitis?
they become swollen and necrotic
What happens when cholesterol and bilirubin overwhelm solubilizing bile acids and lecithin?
Gallstones
What histological changes, other than to hepatocytes, does one see in liver hepatitis?
neutrophil infiltration, Mallory bodies(hyaline), increased fat, and sclerosis around the central vein
What is a mnemonic for Barrett's esophagus?
BARRett's = Becomes Adenocarcinoma, Results from Reflux.
What is Barrett's esophagus?
The replacement of glandular stratified squamous with gastric columnar epithelium in distal esophagus.
What is failure of lower esophageal sphincter relaxation due to?
Achalasia is due to the loss of the myenteric plexus.
What is hepatic vein or IVC occlusion with centrilobular congestion and necrosis?
Budd-Chiari syndrome
What is recommended for patients over 50, in terms of CRC screening?
screen these patients over 50 with stool occult blood test
What is the cause of diverticulosis?
increased intraluminal pressure and focal weakness in the colonic wall
What is the classic triad of hemochromatosis?
(1)micronodular pigment cirrhosis (2)'bronze' diabetes (3)skin pigmentation
What is the discerning characteristic for type B gastritis?
Type B is caused by a Bug(H. pylori)
What is the embryonic cause of Hirschsprung's disease?
failure of neural crest migration
What is the etiology of duodenal ulcers?
H.pylori(100%)--lower mucosal protection or increased gastric acid secretion
What is the etiology of gastric ulcers?
H.pylori(70%), NSAIDS both lower mucosal protection vs. gastric acid
What is the gross morphology of Crohn's?
transmural inflamm. COBBLESTONE mucosa, creeping FAT, bowel wall thickening(string sign on x-ray), linear ulcers, fissures
What is the gross morphology of ulcerative colitis?
mucosal inflamm. Friable mucosal pseudopolyps with freely hanging mesentery
What is the incidence of diverticulosis in the elderly?
over 60y/o, 50%
What is the microscopic morphology of Crohn's?
noncaseating granulomas
What is the microscopic morphology of ulcerative colitis?
crypt abscesses and ulcers
What is the mnemonic for Crohn's?
For Crohn's, think of a FAT old CRONE SKIPping down a COBBLESTONE road.
What is the most common clinical sign of acute pancreatitis?
epigastric abdominal pain radiating to the back
What is the most common primary malignant tumor of the liver in adults?
hepatocellular carcinoma
What is the most common type of gallstone?
mixed stones
What is the primary cause of macronodules in the liver?
significant liver injury leading to hepatic necrosis(e.g. Infections, drug-induced)
What is the primary cause of micronodules in the liver?
metabolic(e.g. Alcohol)
What is the prognosis for pancreatic adenocarcinoma?
~6months (very aggressive--often already spread at presentation)
What is the term for inflamm. of diverticula?
diverticulitis
What is the term used for congenital megacolon characterized by loss of parasympathetic ganglion cells?
Hirschsprung's disease
What is the term used to describe breath that smells like a freshly opened corpse, as seen in liver cell failure?
fetor hepaticus
What is the term used to describe having many diverticula?
diverticulosis
What is the treatment for Crigler-Najjar syndrome?
plasmaphoresis phototherapy
What is the treatment of hemochromatosis?
repeated phlebotomy deferoxamine
What is the treatment of Wilson's disease(1 drug)?
penicillamine
What is the typical presentation of a patient with pancreatic adenocarcinoma(5 signs)?
(1)Abdominal pain radiating to the back (2)Weight loss (3)Anorexia (4)Migratory thrombophlebitis(Trousseau's Sd) (5)Pancreatic duct obstruction(palpable gallbladder)
What is the usual location of Crohn's?
Terminal ileum, small intestine, colon (but any part can be affected)-- often SKIP lesions, rectal sparing
What is the usual location of ulcerative colitis?
colon (with continuous lesions and rectal involvement)
What lab values are characteristic in alcoholic hepatitis?
SGOT(AST)/SGPT(ALT) > 1.5,usually (A Scotch and Tonic=AST elevation)
What lab values are characteristic in hemochromatosis?
increased ferritin and transferrin saturation
What labs are elevated in acute pancreatitis?
amylase lipase(higher specificity)
What part of the GI tract is most frequently involved in diverticulosis?
sigmoid colon
What risk group has an increased incidence of PUD by 2X?
smoking
What type of stones are seen in patients with RBC hemolysis,alcoholic cirrhosis,biliary infection?
pigment stones
When do patients with Crigler-Najjar syndrome(type I) usually present?
early in life(often die within a few years)
Where are pancreatic tumors most often located?
pancreatic head (with obstructive jaundice)
Where is the pain associated with diverticulitis?
left lower quadrant
Which of the following are effects of liver cell failure? Anemia, hypercoagulation,spider nevi, jaundice, gynecomastia,bleeding tendency, ankle edema
all, except hyper coagulation
Which of the following are risk factors for colorectal cancer(CRC): age,smoking,personal and family history of colon cancer, low-fiber diet, hereditary non-polyposis CRC?
all, except for smoking
Which of the following are risk factors for colorectal cancer: colorectal villous adenomas, chronic inflamm.bowel disease, familial adenomatous polyposis,Peutz-Jeghers?
all, except for Peutz-Jeghers
Which of the following is a blind pouch leading off the GI tract lined by mucosa, muscularis, serosa? Diverticulosis, diverticulum, diverticulitis
diverticulum
Which of the following is a common association between cholesterol stones and pigment stones: obesity,Crohn's,cystic fibrosis,age,clofibrate, estrogens,multiparity,rapid weight loss?
advanced age
Which of the following is associated with perforation, peritonitis, abscesses, or bowel stenosis?
Diverticulitis
Which of the following is associated with stress:Gilbert's, Dubin-Johnson syndrome, or Crigler-Najjar(type 1)?
Gilbert's
Which of the following syndromes have a mildly decreased UDP-glucuronyl transferase: Gilbert's or Crigler-Najjar(type 1)?
Gilbert's(Crigler-Najjar has an absence of UDP-glucuronyl transferase)
Which type of liver nodule is associated with an increased risk of hepatocellular carcinoma?
macronodules
With what 6 diseases does hepatocellular carcinoma have an association?
(1)Hepatitis B (2)Hepatitis C (3)Wilson's (4)Hemochromatosis (5)alpha 1 antitrypsin deficiency (6)alcoholic cirrhosis
With what cancer is achalasia associated?
Increased risk for esophageal cancer.
An FEV1/FVC ratio greater than 80% indicates what form of pulmonary disease?
Restrictive lung disease
Are bronchogenic carcinoma metastases common?
Yes, very common
Decreased FEV1/FVC ratio are the hallmark of what kind of pulmonary disease?
COPD
How does interstitial fibrosis create a restrictive lung disease?
It causes increased recoil (decreased compliance), thereby limiting alveolar expansion.
How does lung cancer commonly present? (5)
- Cough - Hemoptysis - Bronchial obstruction - Wheezing - Pneumonic 'coin' lesion on x-ray
How does surfactant deficiency cause NRDS?
It leads to an increase in surface tension, resulting in alveolar collapse
How to you treat NRDS?
- Maternal steroids before birth - Artificial surfactant for infant
Identify: ivory-white pleural plaques in the lung.
Ferruginous bodies
In COPD, are lung volumes increased, decreased, or normal?
Increased (increasedTLC, increased FRC, increased RV)
In restrictive lung disease, are lung volumes increased, decreased, or normal?
Decreased
In what occupations is asbestosis most commonly seen? (2)
Shipbuilders and plumbers
Name three 'triggers' of asthma.
- Viral URIs - Allergens - Stress
Name three characteristics of Horner's syndrome?
- Ptosis - Miosis - Anhidrosis
Name two extrapulmonary (poor breathing mechanics) causes of restrictive lung disease.
- Poor muscular effort: polio, myasthenia gravis - Poor apparatus: scoliosis
Name two pulmonary (poor lung expansion) causes of restrictive lung disease.
- Defective alveolar filling: pneumonia, ARDS, pulmonary edema - Interstitial fibrosis
Patients with asbestosis are at increased risk for what? (2)
Pleural mesothelioma and bronchogenic carcinoma
T/F Bronchiectasis is associated with bronchial obstruction, cystic fibrosis, and poor ciliary motility.
TRUE
T/F In obstructive (not restrictive) lung disease, FEV1 and FVC are reduced.
False, FEV1 and FVC are reduced in both
T/F Restricted lung expansion causes decreased total lung capacity and increased vital capacity.
False, decreased VC and TLC
T/F Smokers with asbestosis have a decreased risk of developing cancer.
False, it increases synergistically
What are asbestos fibers coated with hemosiderin in the lung?
Ferruginous bodies
What are the characteristics of lobar pneumonia?
Intra-alveolar exudate -> consolidation; may involve entire lung
What are the clinical findings of chronic bronchitis? (3)
- Wheezing - Crackles - Cyanosis
What are the clinical findings of emphysema? (4)
- Dyspnea - Decreased breath sounds - Tachycardia - Decreased I/E ratio
What are the symptoms and complications of interstitial lung fibrosis?
- Symptoms: gradual progressive dyspnea and cough - Complications include cor pulmonale (can be seen in diffuse interstitial pulmonary fibrosis and bleomycin toxicity)
What bronchogenic carcinoma is associated with ectopic hormone production (ADH, ACTH) and may lead to Lambert-Eaton syndrome?
Small cell carcinoma
What bronchogenic carcinoma is associated with ectopic PTH-related peptide production?
Squamous cell carcinoma
What bronchogenic carcinoma is most common?
Adenocarcinoma
What bronchogenic carcinoma is thought not to be related to smoking?
Bronchioalveolar carcinoma
What bronchogenic carcinomas are clearly linked to SSmoking?
SSquamous cell carcinoma and SSmall cell carcinoma
What bronchogenic carcinomas usually express tumors that arise centrally? (2)
- Squamous cell carcinoma - Small cell carcinoma
What bronchogenic carcinomas usually express tumors that arise peripherally? (3)
- Adenocarcinoma - Bronchioalveolar carcinoma - Large cell carcinoma--undifferentiated
What carcinoma occurs in the apex of the lung and may affect the cervical sympathetic, causing Horner's syndrome?
Pancoast's tumor
What causes bronchiectasis?
Chronic necrotizing infection of bronchi
What causes neonatal respiratory distress syndrome (NRDS)?
Surfactant deficiency
What cells make surfactant and when is it made most abundantly in fetuses?
Type II pneumocytes most abundantly after 35th week of gestation
What COPD has a productive cough for greater than three months in two years and hypertrophy of mucus-secreting glands in the bronchioles (Reid index greater than 50%)?
Chronic bronchitis
What COPD is characterized by dilated airways, purulent sputum, recurrent infections, and hemoptysis?
Bronchiectasis
What COPD is due to an enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls?
Emphysema
What COPD is due to bronchial hyperresponsiveness which causes reversible bronchoconstriction?
Asthma
What does inhaled asbestos do to the lungs?
It causes diffuse pulmonary interstitial fibrosis
What is the composition of surfactant:
Dipalmitoyl phosphatidylcholine
What is the difference in FEV1/FVC ratios between obstructive and restrictive lungs diseases?
FEV1 and FVC are reduced in both, but in obstructive the FEV1 is more dramatically reduced, resulting in a decreased FEV1/FVC ratio
What is the leading cause of cancer death?
Lung cancer
What is the SPHERE (acronym) of complications associated with lung cancer?
Superior vena caval syndrome Pancoast's tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal symptoms (hoarseness) Effusions (pleural or pericardial)
What kind of pulmonary diseases are caused by a inhibition of air flow resulting in air trapping in the lungs?
Obstructive lung diseases (COPD)
What organisms are is the most frequent cause of lobar pnuemonia?
Pneumococcus
What organisms are the most frequent cause of bronchopnuemonia? (4)
- S. aureus - H. flu - Klebsiella - S. pyogenes
What organisms are the most frequent cause of interstitial (atypical) pnuemonia? (3)
- Viruses (RSV, adenoviruses) - Mycoplasma - Legionella
What specific type of emphysema is caused by alpha-1-antitrypsin deficiency?
Panacinar emphysema (and liver cirrhosis)
What specific type of emphysema is caused by smoking?
Centriacinar emphysema
What test is used to measure in utero lung maturity?
The lecithin-to-sphingomyelin ratio in the amniotic fluid, usually less than 1.5 in neonatal respiratory distress syndrome
What type of lung cancer can cause carcinoid syndrome?
Carcinoid tumor
What type of pneumonia is characterized by acute inflammatory infiltrates from bronchioles into adjacent alveoli with a patchy distribution affecting more than one lobe?
Bronchopneumonia
What type of pneumonia is characterized by diffuse patchy inflammation localized to interstial areas at alveolar walls and involves more than one lobe?
Interstitial (atypical) pneumonia
Where does bronchogenic carcinoma commonly metastasize and how does it present? (3)
- Brain (epilepsy) - Bone (pathologic fracture) - Liver (jaundice, hepatomegaly)
Why does alpha-1-antitrypsin deficiency cause emphysema?
Increased elastase activity
Define epilepsy.
Epilepsy is a disorder of recurrent seizures.
Define syrinx.
Tube, as in syringe
Describe a myoclonic seizure.
Quick,repetitive jerks
Describe a tonic-clonic seizure.
Alternating stiffening and movement (grand mal)
Describe a tonic seizure.
Stiffening
Describe an absence seizure.
A blank stare (petit mal- it's in 1st aid this way!!)
Describe an atonic seizure.
drop' seizures
Describe Broca's aphasia.
Broca's is nonfluent aphasia with intact comprehension. BROca's is BROken speech.
Describe Horner's syndrome.
Sympathectomy of face (lesion above T1). Interruption of the 3-neuron oculosympathetic pathway.
Describe Wernicke's aphasia.
Wernicke's is fluent aphasia with impaired comprehension. Wernicke's is Wordy but makes no sense.
How do patients present with a subarachnoid hemorrhage?
Worst headache of my life'
How do pts present with MS?
-Optic neuritis (sudden loss of vision) - MLF syndrome (internuclear ophthalmoplegia) -Hemiparesis -Hemisensory symptoms -Bladder/bowel incontinence
How does it spread?
Through the bloodstream to the CNS
How does Werdnig-Hoffman disease present?
At birth as a 'floppy baby'
How is Huntington's disease inherited?
Autosomal dominant
How is the polio virus transmitted?
Fecal-oral route
How is the prevalence of MS geographically distributed?
Higher prevalence with greater distance from the Equator
In what persons is subdural hemorrhage often seen?
Elderly individuals, alcoholics, and blunt trauma
T/F. Partial seizures can not generalize.
False- Partial seizures can generalize.
What are 2 common organisms that target the brain in AIDS pts?
1. Toxo!Toxo!Toxo! 2. Cryptococcus
What are 2 degenerative diseases of the cerebral cortex?
1. Alzheimer's 2. Pick's disease
What are 2 degenerative diseases that affect the basal ganglia and brain stem?
1. Huntington's disease 2. Parkinson's disease
What are 3 degenerative disorders of the motor neuron?
1. Amyotrophic lateral sclerosis (ALS) 2. Werdnig-Hoffman disease 3. Polio
What are associated with Guillain-Barre?
1. Infections (herpesvirus or C. jejuni) 2. Inoculations 3. Stress
What are neurofibrillary tangles?
Abnormally phosphorylated tau protein
What are some demyelinating and dysmyelinating diseases?
1. Multiple sclerosis (MS) 2. Progressive multifocal leukoencephalopathy (PML) 3. Postinfectious encephalomyelitis 4. Metachromatic Leukodystrophy 5. Guillain-Barre syndrome
What are the 4 types of intracranial hemorrhages?
1. Epidural hematoma 2. Subdural Hematoma 3. Subarachnoid hemorrhage 4. Parenchymal hematoma
What are the 5 types of generalized seizures?
1. Absence 2. Myoclonic 3. Tonic-clonic 4. Tonic 5. Atonic
What are the clinical symptoms of Huntington's disease?
Dementia, chorea
What are the clinical symptoms of Parkinson's disease?
TRAP= Tremor (at rest) cogwheel Rigidity Akinesia Postural instability (you are TRAPped in your body)
What are the clinical symptoms of Tabes dorsalis?
-Charcot joints -Shooting pain -Argyll-Robertson Pupils -Absence of deep tendon reflexes
What are the common causes of seizures in adults?
-Tumors -Trauma -Stroke -Infection
What are the common causes of seizures in children?
-Genetic -Infection -Trauma -Congenital -Metabolic
What are the common causes of seizures in the elderly?
-Stroke -Tumor -Trauma -Metabolic -Infection
What are the lab findings in Guillain-Barre syndrome?
Elevated CSF protein with normal cell count ('albumino-cytologic dissociation')
What are the lab findings in poliomyelitis?
-CSF with lymphocytic pleocytosis with slight elevation of protein -Virus recovered from stool or throat
What are the pathological signs of glioblastoma multiforme (GBM)?
-Necrosis -Hemorrhage -Pseudo-palisading
What are the signs of LMN lesions seen in poliomyelitis?
-Muscle weakness and atrophy -Fasciculations -Fibrillation -Hyporeflexia
What are the symptoms of Horner's?
1. Ptosis 2. Miosis 3. Anhidrosis and flushing of affected side of face
What are the symptoms of poliomyelitis?
-Malaise -Headache -Fever -Nausea -Abdominal pain -sore throat
What area of the brain is affected by generalized seizures?
Diffuse area
What artery is compromised in an epidural hematoma?
Middle meningeal artery
What blood vessels are affected in subdural hemorrhages?
Rupture of bridging veins
What causes a parenchymal hematoma?
-HTN -Amyloid angiopathy -Diabetes Mellitus -Tumor
What causes poliomyelitis?
Poliovirus
What chemical can Parkinson's disease be linked to?
MPTP, a contaminant in illicit street drugs
What clinical symptoms are present with syringomyelia?
Bilateral pain and temperature loss in the upper extremities with preservation of touch sensation
What clinical symptoms are present?
-Symmetric ascending muscle weakness beginning in the distal lower extremities -Facial diplegia in 50% of cases -Autonomic fx may be severely affected
What congenital malformation is often associated with syringomyelia?
Arnold Chiari Malformation
What damage does cryptococcus cause in the brain?
Periventricular calcifications
What damage does toxoplasma cause in the brain?
Diffuse (intracerebral) calcifications
What diseases are berry aneurysms associated with?
-Adult polycystic kidney disease -Ehlers-Danlos syndrome -Marfan's syndrome
What do partial seizures affect?
One area of the brain
What does rupture of a berry aneurysm lead to?
Stroke
What does the spinal tap show in a subarachnoid hemorrhage?
Bloody or xanthochromic
What event is the rupture of the middle meningeal artery secondary to?
Temporal bone fracture
What genes is the familial form of Alzheimer's associated with?
Genes are chromosomes 1, 14, 19 and 21
What is a complex partial seizure?
Impaired awareness
What is a degenerative disorder of the Spinocerebellar tract?
Friedrich's ataxia (olivopontocerebellar atrophy)
What is anhidrosis?
Absence of sweating
What is another name for Guillain-Barre syndrome?
Acute idiopathic polyneuritis
What is another symptom of Werdnig-Hoffman disease?
Tongue fasciculations
What is another term for Broca's aphasia?
Expressive aphasia
What is another term for Wernicke's aphasia?
Receptive aphasia
What is miosis?
Pupil constriction
What is PML associated with?
JC virus
What is ptosis?
Slight drooping of the eyelids
What is the classic triad of MS?
SIN 1. Scanning speech 2. Intention Tremor 3. Nystagmus
What is the common name for ALS?
Lou Gehrig's disease
What is the course of a subdural hemorrhage?
Venous bleeding (less pressure) with delayed onset of symptoms
What is the course of MS?
In most pts, the course is remitting and relapsing
What is the incidence of brain tumors in adults?
Metastases> Astrocytoma (including glioblastoma)> Meningioma
What is the incidence of brain tumors in children?
Astrocytoma> Medulloblastoma> Ependymoma
What is the most common cause of dementia in the elderly?
Alzheimer's disease
What is the most common complication of a berry aneurysm?
Rupture of the aneurysm
What is the most common site for a berry aneurysm?
The bifurcation of the anterior communicating artery
What is the pathogenesis of Guillain-Barre syndrome?
Inflammation and demyelination of peripheral nerves and motor fibers of ventral roots (sensory effect less severe than motor)
What is the pathogenesis of Tabes dorsalis?
Degeneration of the dorsal columns and dorsal roots due to tertiary syphilis.
What is the pathology of Alzheimer's?
Associated with senile plaques (beta-amyloid core) and neurofibrillary tangles
What is the pathology of Huntington's disease?
Atrophy of the caudate nucleus
What is the pathology of MS?
-Periventricular plaques -Preservation of axons -Loss of oligodendrocytes -Reactive astrocytic gliosis -Increased protein (IgA) in CSF
What is the pathology of Parkinson's disease?
Associated with Lewy bodies and depigmentation of the substantia nigra
What is the pathology of Pick's disease?
Associated with Pick bodies, intracytoplasmic inclusion bodies
What is the pathology of poliomyelitis?
Destruction of anterior horn cells, leading to LMN destruction
What is the pathology of syringomyelia?
Softening and cavitation around the central canal of the spinal cord.
What is the prognosis for a pts diagnosed with a GBM?
Very poor
What is the second most common cause of dementia in the elderly?
Multi-infarct dementia
What is the shape of GBMs?
Butterfly' glioma
What neural deficits are present in Tabes dorsalis?
Impaired proprioception and locomotor ataxia
What neural tracts are damaged?
Crossing fibers of the spinothalamic tract
What neurons are affected in ALS?
Both the upper and lower motor neurons
What neurons are affected in Polio?
Lower motor neurons only
What seizures are categorized as simple partial?
Awareness intact -Motor -Sensory -Autonomic -Psychic
What tumor is Horner's syndrome associated with?
Pancoast's tumor
Where are most brain tumors located in adults?
70% are supratentorial (cerebral hemispheres)
Where are most childhood brain tumors located?
70% below tentorium (cerebellum)
Where do berry aneurysms occur?
At the bifurcations in the Circle of Willis
Where does it initially replicate?
The oropharynx and small intestine
Where does the 3 neuron oculosympathetic pathway project from?
The hypothalamus
Where does the 3 neuron oculosympathetic pathway project to?
1. Interomediolateral column of the spinal cord 2. Superior cervical (sympathetic) ganglion 3. To the pupil, smooth muscles of the eyelids and the sweat glands
Where is Broca's area located?
Inferior frontal gyrus
Where is Pick's disease specific for?
The frontal and temporal lobes
Where is the aopE-4 allele located?
Chromosome 19
Where is the most common site of syringomyelia?
C8-T1
Where is the p-App gene located?
21
Where is Wernicke's area located?
Superior Temporal Gyrus
Which demyelinating disease is seen in 2-4% of AIDS patients?
PML
Define Ankylosing spondylitis?
Chronic inflammatory disease of spine & large joints, sacroilitis, uveitis, & aortic regurgitation
Define Ankylosing spondylitis?
Chronic inflammatory disease of spine & large joints, sacroilitis, uveitis, & aortic regurgitation
Define Celiac sprue
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
Define Celiac sprue
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
Define Gout.
Precipitation of monosodium urate crystals into joints due to hyperuricemia.
Define Gout.
Precipitation of monosodium urate crystals into joints due to hyperuricemia.
Define Scleroderma
Excessive fibrosis & collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV & GI systems & kidney
Define Scleroderma
Excessive fibrosis & collagen deposition throughout the body; commonly sclerosis of the skin, but also of CV & GI systems & kidney
Define Sicca syndrome.
dry eyes, dry mouth, nasal & vaginal dryness, chronic bronchitis, reflux esophagitis
Define Sicca syndrome.
dry eyes, dry mouth, nasal & vaginal dryness, chronic bronchitis, reflux esophagitis
In what population is ankylosing sponsylitis more commonly found?
males (10-30 year old)
In what population is ankylosing sponsylitis more commonly found?
males (10-30 year old)
In what population is Celiac sprue more commonly found?
Assoc. w/ people of northern European descent
In what population is Celiac sprue more commonly found?
Assoc. w/ people of northern European descent
In what population is Goodpasture's syndrome more commonly found?
Men 20-40 y/o
In what population is Goodpasture's syndrome more commonly found?
Men 20-40 y/o
In what population is gout more commonly found?
Men
In what population is gout more commonly found?
Men
In what population is Osteoarthritis more commonly found?
Common in older patients
In what population is Osteoarthritis more commonly found?
Common in older patients
In what population is pseudogout more commonly found?
> 50 y/o, both sexes equally
In what population is pseudogout more commonly found?
> 50 y/o, both sexes equally
In what population is Reiter's syndrome more commonly found?
Strong predilection for males
In what population is Reiter's syndrome more commonly found?
Strong predilection for males
In what population is Rheumatoid arthritis more commonly found & what the common autoimmune factor present?
- Common in females - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
In what population is Rheumatoid arthritis more commonly found & what the common autoimmune factor present?
- Common in females - 80% of RA pt's have positive rheumatoid factor (anti-IgG Ab)
In what population is sarcoidosis more commonly found?
black females
In what population is sarcoidosis more commonly found?
black females
In what population is scleroderma more commonly found?
75% female
In what population is scleroderma more commonly found?
75% female
In what population is Sjogren's syndrome more commonly found?
females between the ages of 40 & 60
In what population is Sjogren's syndrome more commonly found?
females between the ages of 40 & 60
In what population is SLE more commonly found?
90% are female & between ages 14 & 45. More common & severe in black females
In what population is SLE more commonly found?
90% are female & between ages 14 & 45. More common & severe in black females
What are the 2 major categories of scleroderma & what findings are they assoc w/?
Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab CREST syndrome: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly & Telangiectasia; limited skin involvement, often confined to fingers & face. More benign clinical course - assoc w/ anticentromere Ab
What are the 2 major categories of scleroderma & what findings are they assoc w/?
Diffuse scleroderma: widespread skin involvement, rapid progression, early visceral involvement. Assoc. w/ anti-Scl-70 Ab CREST syndrome: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly & Telangiectasia; limited skin involvement, often confined to fingers & face. More benign clinical course - assoc w/ anticentromere Ab
What are the associated sx's & risks for Sjogren's syndrome?
- Parotid enlargement - incr risk of B-cell lymphoma - Assoc. w/ RA
What are the associated sx's & risks for Sjogren's syndrome?
- Parotid enlargement - incr risk of B-cell lymphoma - Assoc. w/ RA
What are the characteristic findings in Celiac sprue?
Blunting of villi, lymphocytes in the lamina propria, & abnormal D-xylose test
What are the characteristic findings in Celiac sprue?
Blunting of villi, lymphocytes in the lamina propria, & abnormal D-xylose test
What are the common characteristics of Sarcoidosis?
immune-mediated, widespread noncaseating granulomas & elevated serum ACE levels
What are the common characteristics of Sarcoidosis?
immune-mediated, widespread noncaseating granulomas & elevated serum ACE levels
What are the common gross findings in Goodpasture's syndrome?
pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
What are the common gross findings in Goodpasture's syndrome?
pulmonary hemorrhages, renal lesions, hemoptysis, hematuria, crescentic glomerulonephritis
What can cause gout?
Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
What can cause gout?
Lesch-Nyan disease, PRPP excess, decreased excretion of uric acid, or G6PD deficiency. Also assoc. w/ the use of thiazide diuretics which competitively ingibit the secretion of uric acid.
What causes pseudogout?
deposition of calcium pyrophosphate crystals w/in the joint space
What causes pseudogout?
deposition of calcium pyrophosphate crystals w/in the joint space
What CV disease state can be caused by SLE?
SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) & do not embolize
What CV disease state can be caused by SLE?
SLE causes LSE (Libman-Sacks Endocarditis): vavular vegetations found on both sides of valve (mitral valve stenosis) & do not embolize
What drugs can induce a commonly reversible SLE-like syndrome?
- procainamide - INH - phenytoin - hydralazine
What drugs can induce a commonly reversible SLE-like syndrome?
- procainamide - INH - phenytoin - hydralazine
What immune marker aids in dx?
90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
What immune marker aids in dx?
90% of cases are assoc w/ B27 (gene which codes for HLA MHC-I)
What is characteristic about gout crystals?
needle-shaped & negatively berefringent.
What is characteristic about gout crystals?
needle-shaped & negatively berefringent.
What is characteristic about pseudogout crystals?
basophilic, rhomboid crystals
What is characteristic about pseudogout crystals?
basophilic, rhomboid crystals
What is Reiter's syndrome?
a seronegative spondyloarthropath w/ a HLA-B27 link
What is Reiter's syndrome?
a seronegative spondyloarthropath w/ a HLA-B27 link
What is the 'classic triad' for Reiter's syndrome?
1. Urethritis (Can't pee) 2. Conjunctivities & ant. uveitis (Can't see) 3. Arthritis (Can't climb a tree)
What is the 'classic triad' for Reiter's syndrome?
1. Urethritis (Can't pee) 2. Conjunctivities & ant. uveitis (Can't see) 3. Arthritis (Can't climb a tree)
What is the 'classic triad' for Sjogren's syndrome?
1. dry eyes (conjunctivitis, xerophthalmia) 2. dry mouth (dysphagia, xerostomia) 3. arthritis
What is the 'classic triad' for Sjogren's syndrome?
1. dry eyes (conjunctivitis, xerophthalmia) 2. dry mouth (dysphagia, xerostomia) 3. arthritis
What is the classic pathology for Osteoarthritis?
Mechanical: wear & tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, & Heberden's nodes (DIP)
What is the classic pathology for Osteoarthritis?
Mechanical: wear & tear of joints leads to destruction of articular cartilage, subchondral bone formation, sclerosis, osteophytes, eburnation, & Heberden's nodes (DIP)
What is the classic pathology for Rheumatoid arthritis?
Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
What is the classic pathology for Rheumatoid arthritis?
Autoimmune: inflammatory d/o affecting synovial joints, w/ pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules, ulnar deviation, subluxation.
What is the Classic presentation for Osteoarthritis?
pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
What is the Classic presentation for Osteoarthritis?
pain in weight-bearing joints after use (e.g.- at the end of the day), improving w/ rest. No systemic sx's
What is the classic presentation for Rheumatoid arthritis?
morning stiffness improving w/ use, symmetric joint involvement & systemic symptoms: fever, fatigue, pleuritis, pericarditis
What is the classic presentation for Rheumatoid arthritis?
morning stiffness improving w/ use, symmetric joint involvement & systemic symptoms: fever, fatigue, pleuritis, pericarditis
What is the common immunologic finding for Goodpasture's syndrome?
Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
What is the common immunologic finding for Goodpasture's syndrome?
Anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
What is the common tx for gout?
allopurinol, probenecid, colchicine, & NSAID's.
What is the common tx for gout?
allopurinol, probenecid, colchicine, & NSAID's.
What is the common tx for pseudogout?
no tx
What is the common tx for pseudogout?
no tx
What is the descriptive acrynym for Sarcoidosis?
GRAIN Gammaglobulinemia Rheumatoid arthritis ACE incr. Interstitial fibrosis Noncaseating granulomas
What is the descriptive acrynym for Sarcoidosis?
GRAIN Gammaglobulinemia Rheumatoid arthritis ACE incr. Interstitial fibrosis Noncaseating granulomas
What is the useful memory tool for Goodpasture's syndrome?
there are TWO Good Pastures for this disease: Glomerulus & Pulmonary. Also, a type II (TWO) hypersensitivity disease
What is the useful memory tool for Goodpasture's syndrome?
there are TWO Good Pastures for this disease: Glomerulus & Pulmonary. Also, a type II (TWO) hypersensitivity disease
What sx's is sarcoidosis commonly associated w/?
restrictive lung disease, bilateral hilar lypmphadenopathy, erythema nodosum, Bell's palsy, epithelial granulomas containing microscopic Schaumann & asteroid mobies, uveoparotitis, & hypercalcemia (due to elevated conversion of vit. D to its active form in epithelioid macrophages)
What sx's is sarcoidosis commonly associated w/?
restrictive lung disease, bilateral hilar lypmphadenopathy, erythema nodosum, Bell's palsy, epithelial granulomas containing microscopic Schaumann & asteroid mobies, uveoparotitis, & hypercalcemia (due to elevated conversion of vit. D to its active form in epithelioid macrophages)
What the common pattern of psudogout presentation?
Usually affects large joints (classically the knee)
What the common pattern of psudogout presentation?
Usually affects large joints (classically the knee)
Where is gout commonly manifested?
Asymmetric joint distribution. Favored manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon)
Where is gout commonly manifested?
Asymmetric joint distribution. Favored manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon)
Addison's disease is characterized by what (remember 4 A's)?
Adrenal Atrophy and Absence of hormone production; involves All three cortical divisions
All MEN syndromes have what mode of inheritance?
Autosomal Dominant
An increased risk of carcinoma with atypical cells is seen in which type of fibrocystic breast disease?
Epithelial hyperplasia
Blood filled, 'chocolate cysts' are seen in what condition?
Endometriosis
Carcinoid tumors result in what recurrent symptoms? (4)
- diarrhea - cutaneous flushing - asthmatic wheezing - right-sided valvular disease
Cretin means 'Christ-like,' why is that name used?
Those affected were considered so mentally retarded as to be incapable of sinning.
Diabetic ketoacidosis (DKA) is caused by what?
Excess fat breakdown (usually due to an increase in insulin requirements) and increased ketogenesis from the increase in free fatty acids, which are then made into ketone bodies
Do leiomyosarcomas derive from other known tumors?
No, they usually arise de novo
From where do leiomyosarcomas often protrude?
Cervix
How do you treat carcinoid syndrome?
Treat with octreotide
How do you treat postmenopausal osteoporosis?
Estrogen replacement therapy
Hydatiform moles result in an increase in what hormone?
Beta-HCG
Increase in what substance is seen in the urine due to carcinoid tumors?
5-HIAA
Is ACTH increased or decreased when increased cortisol is due to a primary adrenal hyperplasia or neoplasia?
Decreased
Is ACTH increased or decreased when increased cortisol is due to an iatrogenic etiology?
Decreased
Is ACTH increased or decreased when increased cortisol is due to Cushing's disease?
Increased
Is ACTH increased or decreased when increased cortisol is due to ectopic ACTH production (e.g., carcinoid)?
Increased
Is plasma renin low or high in primary hyperaldosteronism?
Low
Is plasma renin low or high in secondary hyperaldosteronism?
High
Leiomyomas are sensitive to what?
Estrogen
Name 3 common tests for evaluating DM?
- Fasting serum glucose - Glucose tolerance test - HbA1c
Name 3 specific example of large vessel atherosclerosis due to DM?
- Coronary artery disease - Peripheral vascular occlusive disease and gangrene - Cerebrovascular disease
Name five possible causes of secondary hyperaldosteronism?
1. Renal artery stenosis 2. Chronic renal failure 3. CHF 4. Cirrhosis 5. Nephritic syndrome
Name four causes of SIADH.
Ectopic ADH CNS disorders/head trauma Pulmonary disease Drugs
Name four common presenting symptoms of benign prostatic hyperplasia.
1. Increased frequency of urination 2. Nocturia 3. Difficulty starting and stopping the stream of urine 4. Dysuria
Name four important chronic manifestations of DM.
- Small vessel disease - Large vessel atherosclerosis - Neuropathy - Cataracts, glaucoma
Name four risk factors of endometrial carcinoma.
1. Prolonged estrogen use 2. Obesity 3. Diabetes 4. HTN
Name four treatment modalities for polycystic ovarian syndrome.
- Weight loss - OCPs - Gonadotropin analogs - Surgery
Name six risk factors of breast disease.
1. Gender 2. Age 3. Early first menarche (under 12) 4. delayed first pregnancy (over 30) 5. Late menopause (over 50) 6. Family history of first degree relative with breast cancer at a young age.
Name some of the acute manifestations of Diabetes Mellitus (DM)? (7)
- Polydipsia - Polyuria - Polyphagia - Weight loss - DKA (type1) - Hyperosmolar coma (type 2) - Unopposed secretion of GH and Epi (exacerbating hyperglycemia)
Name syndrome: increased LH due to peripheral estrogen production leads to anovulation and may manifest in amenorrhea, infertility, obesity, and hirsutism.
Polycystic ovarian syndrome
Name the autoimmune hyperthyroidism with TSH receptor antibodies, opthalmopathy, pretibial myxedema, and diffuse goiter.
Graves' disease
Name the benign breast tumor: most common tumor under 25 years; small, mobile, firm mass with sharp edges.
Fibroadenoma
Name the benign breast tumor: tumor of lactiferous ducts; presents with nipple discharge.
Intraductal papilloma
Name the benign breast tumor: large, bulky mass of connective tissue and cysts; breast surface has 'leaflike' appearance.
Cystosarcoma phyllodes
Name the disease caused by primary deficiency of aldosterone and cortisol due to adrenal atrophy?
Addison's disease
Name the histologic type of fibrocystic breast disease: fluid-filled.
Cystic
Name the histologic type of fibrocystic breast disease: hyperplasia of breast stroma.
Fibrosis
Name the histologic type of fibrocystic breast disease: increase in number of epithelial cell layers in terminal duct lobule.
Epithelial hyperplasia
Name the histologic type of fibrocystic breast disease: increased acini and intralobular fibrosis.
Sclerosing
Name the histologic type of malignant breast disease: cheesy consistency of tumor tissue due to central necrosis.
Comedocarcinoma
Name the histologic type of malignant breast disease: eczematous patches on nipple.
Paget's disease
Name the histologic type of malignant breast disease: lymphatic involvement; poor prognosis.
Inflammatory
Name the histologic type of malignant breast disease: most common carcinoma; firm, fibrous mass.
Infiltrating ductal
Name three characteristics of inappropriate ADH secretion (SIADH).
1. Excessive water retention 2. Hyponatremia 3. Serum hypo-osmolarity with urine osmolarity > serum osmolarity
Name three fractures commonly seen due to osteoporosis.
1. Vertebral crush fractures 2. Distal radius (Colle's) fractures 3. Vertebral wedge fractures
Pheochromocytomas may be associated with what 3 diseases?
1. Neurofibromatosis 2. MEN type II 3. MEN type III
T/F A partial hydatiform mole is commonly triploid or tetraploid.
TRUE
T/F DKA is common in Type 1 DM.
TRUE
T/F DKA is common in Type 2 DM.
False, rare
T/F Endometriosis often manifests with severe menstrual-related pain and often with infertility?
TRUE
T/F Fibrocystic breast disease usually does not indicate increased risk of carcinoma.
TRUE
T/F Genotype of a complete hydatiform mole is 46, XX and is purely maternal in origin.
False, it is 46, XX and Purely Paternal in origin
T/F Glucose intolerance in Type 1 DM is severe.
TRUE
T/F Insulin is always necessary to treat Type 1 DM.
TRUE
T/F Insulin is always necessary to treat Type 2 DM.
False, sometimes
T/F Leiomyomas often present with multiple tumors.
TRUE
T/F Leiomyomas often transform into malignant tumors.
False, it is rare
T/F Leiomyomas progress to leiomyosarcomas.
FALSE
T/F Leiomyosarcomas: highly aggressive, have a tendancy to recur, and have an increased incidence in blacks.
TRUE
T/F Risk of breast disease is increased by fibroadenoma and nonhyperplastic cysts.
FALSE
T/F Type 1 diabetes is often associated with obesity.
FALSE
T/F Type 1 diabetes is polygenic and strongly due to genetic disposition?
False. It is polygenic and only weakly associated with genetic disposition, whereas Type 2 is strongly associated.
T/F Women with endometrial hyperplasia are at increased risk for endometrial carcinoma which tends to manifest with vaginal bleeding?
TRUE
Urinary VMA levels and plasma catecholamines are elevated due to what neoplasms?
Pheochromocytoma
What are the clinical effects of increased cortisol? (9)
- hypertension - weight gain - moon facies - truncal obesity - buffalo hump - hyperglycemia (insulin resistance) - skin changes (thinning striae) - osteoporosis - immune suppression
What are the clinical effects of primary hyperaldosteronism? (4)
- Hypertension - Hypokalemia - Metabolic alkalosis - Low plasma renin
What are the episodic hyperadrenergic symptoms (5 P's) due to pheochromocytomas?
- Pressure - Pain (headache) - Perspiration - Palpitations - Pallor/diaphoresis
What are the primary hormonal causes of DM?
Insulin deficiency (or inefficiency) and glucagon excess
What are the six 'Rule of 10's' associated with pheochromocytomas?
- 10% Malignant - 10% bilateral - 10% extraadrenal - 10% calcify - 10% kids - 10% familial
What are theorized causes for Types 1 and 2 DM?
Type 1 - viral or immune destruction of pancreatic beta cells Type 2 - Increased resistance to insulin
What benign breast tumor increases in size and tenderness with pregnancy?
Fibroadenoma
What breast disease is common in postmenopausal women and arises from mammary duct epithilium or lobular glands?
Malignant tumors (carcinoma)
What causes Cushing's Syndrome?
Increased cortisol
What causes sporadic cretinism?
Defect in T4 formation or developmental failure in thyroid formation.
What condition can produce all these symptoms: cold intolerance, hypoactivity, weight gain, fatigue, lethargy, decreased appetite, constipation, weakness, decreased reflexes, myxedema (facial/periorbital), dry, cool skin, and coarse, brittle hair?
Hypothyroidism
What condition can produce all these symptoms: heat intolerance, hyperactivity, weight loss, chest pain/palpitations, arrhythmias, diarrhea, increased reflexes, warm, moist skin, and fine hair?
Hyperthyroidism
What condition is associated with the expressions 'honeycombed uterus' and 'cluster of grapes' appearance?
Hydatiform mole
What condition is caused by increased bone resorption due to decreased estrogen levels (seen postmenopausal by 10-15 years)?
Type 1 Osteoporosis
What condition is characterized by non-neoplastic endometrial glands/stroma in abnormal locations outside the uterus?
Endometriosis
What disease is characterized by intense thirst and polyuria together with an inability to concentrate urine with fluid restriction owing to lack of ADH or to a lack of renal response to ADH. Caused by lithium demeclocycline.
diabetes insipidus
What disease may be due to an age-related increase in estradiol with sensitization of the prostate to the growth promoting effects of DHT? It is characterized by nodular enlargement of the periurethral lobes of the prostate gland compressing the urethra into a vertical slit?
Benign prostatic hyperplasia
What diuretic acts as an aldosterone antagonist used to treat primary hyperaldosteronism?
Spironolactone
What endocrine pathology may produce these findings: pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue?
Cretinism
What fractures cause acute back pain, loss of height, and kyphosis?
Vertebral crush fractures
What gynecologic tumor is often bulky with areas of necrosis and hemorrhage?
Leiomyosarcoma
What is a pathologic ovum resulting in cystic swelling of chorionic villi and proliferation of chorionic epithelium?
Hydatiform mole
What is an abnormal endometrial gland proliferation usually caused by excess estrogen stimulation?
Endometrial hyperplasia
What is the 'Rule of 1/3s' for carcinoid tumors?
1/3 metastasize 1/3 present with second malignancy 1/3 multiple
What is the etiology of Cushing's Syndrome caused by Cushing's disease?
Primary pituitary adenoma
What is the etiology of primary hyperaldosteronism (Conn's syndrome)?
An aldosterone-secreting tumor
What is the etiology of small vessel disease due to DM?
Diffuse thickening of the basement membrane
What is the most common gynecologic malignancy, with a peak age of 55-65 y/o?
Endometrial carcinoma
What is the most common of all tumors in females?
Leiomyoma
What is the most common site of ectopic endometrial tissue?
Ovary
What is the most common tumor of the adrenal medulla in adults?
Pheochromocytoma
What is the most common tumor of the adrenal medulla in children?
Neuroblastoma
What is the most common tumor of the appendix?
Carcinoid tumor
What is the pathophysiology of secondary hyperaldosteronism?
Kidney perception of low intravascular volume results in an overactive renin-angiotensin system.
What metabolic reaction is responsible for the chronic manifestations of DM?
Nonenzymatic glycosylation
What neoplasms secrete high levels of serotonin (5HT) that does not get metabolized by the liver due to liver metastases?
Carcinoid tumors (neuroendocrine cells) especially of the small bowel
What non-selective, irreversible alpha blocker is used to treat pts with pheochromocytomas?
Phenoxybenzamine
What phenotypic difference can distinguish between primary and secondary causes of Addison's disease?
Primary insufficiency results in hyperpigmentation due to increased MSH.
What substance causes cataract formation in DM patients?
Sorbitol accumulation
What syndrome is caused by a gastrin-secreting tumor that is usually located in the pancreas, causes recurrent ulcers, and may be associated with MEN type 1?
Zollinger-Ellison syndrome
What three organs (3 P's) are involved in MEN type I?
- Pancreas - Pituitary - Parathyroid
What type of respirations are seen in diabetic ketoacidosis?
Kussmaul respiration
Where (and in what forms) is small vessel disease from DM seen most prominently?
- Retinopathy - hemorrhage, exudates, and microaneurysms - Nephropathy - nodular sclerosis, progressive proteinuria, chronic renal failure, arteriosclerosis leading to HTN
Where does endemic cretinism occur?
Wherever endemic goiter is prevalent (lack of dietary iodine).
Whether the complications of diabetes Q. as it does is
life threatening mucormycosis, Rhizopus infection, cerebral edema, cardiac arrhythmias, heart failure
Which type of Multiple Endocrine Neoplasia (MEN) is associated with medullary carcinoma of the thyroid, pheochromocytoma, and oral and intestinal ganglioneuromatosis (mucosal neuromas)?
Type III (formerly MEN IIb)
Which type of Multiple Endocrine Neoplasia (MEN) is associated with medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor, or adenoma?
Type II (Sipple's syndrome)
Which type of Multiple Endocrine Neoplasia (MEN) is associated with pancreas (e.g. ZE syndrome, insulinomas, VIPomas), parathyroid and pituitary tumors?
Type I (Wermer's syndrome)
Which type of osteoporosis affects men and women over 70 y/o?
Type 2 (Senile) Osteoporosis
Why is intracellular myoinositol depleted in DM?
Hyperglycemia increases intracellular sorbitol (which is associated with depletion) and may also directly inhibit myoinositol uptake
Will total T4, free T4, and T3 uptake be increased or decreased (respectively) in primary hyperthyroidism?
All increased - Increased total T4 - Increased free T4 - Increased T3 uptake
Will total T4, free T4, and T3 uptake be increased or decreased (respectively) in primary hypothyroidism?
All decreased (remember: TSH is increased) - Decreased total T4 - Decreased free T4 - Decreased T3 uptake
Will TSH be increased or decreased in primary hyperthyroidism?
Increased
Will TSH be increased or decreased in primary hypothyroidism?
Increased
Are most pericardial effusions serous or hemorrhagic?
serous
Bacterial endocarditis of which valve is associated with IV drug abuse?
Tricuspid
Characterize EKG changes in an MI
ST elevation (transmural ischemia) and Q waves (transmural infarct)
characterize the AST levels in an MI
elevated 1-3 days post MI. Nonspecific enzyme found in heart, liver, and skeletal muscle
Characterize the cardiac troponin I levels in an MI.
Elevated between 4 hrs. and 7-10 days post MI most specific protein marker for MI
Characterize the CK-MB levels in an MI
elevated in the first 24 hrs. post MI
Characterize the LDH1 levels in an MI
elevated from 2 to 7 days post MI
Describe a mitral prolapse murmur?
Most frequent valvular lesion, esp. in young women. Late systolic murmur ending with 2nd heart sound
Describe a mitral regurgitation murmur?
High pitched holosystolic (continuous sound throughout systole)
Describe a mitral stenosis murmur
Rumbling late diastolic murmur when LA>>LV during diastole. Begins in late diastole
Describe a vent. Septal defect (VSD) murmur.
holosystolic murmur (continuous throughout systole)
Describe an aortic regurgitation murmur
high-pitched 'blowing' murmur, beginning immediately in diastole. Wide pulse pressure
Describe an aortic stenosis murmur
Crescendo-decrescendo systolic murmur, with LV>>aortic pressure during systole. Follows an 'ejection click,' and ends before 2nd heart sound
Describe an patent ductus arteriosus (PDA) murmur.
Continuous machine-like murmur. Loudest at the time of 2nd heart sound
Describe the bacterial growths in subacute bact. Endocarditis.
Small vegetations on congentially abnormal valves
Describe the bacterial growths of acute bact. endocarditis?
Large vegetations on previously normal valves
Describe the onset of Staph. Aureus endocarditis.
rapid, acute onset
Describe the onset of Streptoccus viridans endocarditis.
Insidious, subacute onset
During what weeks of pregnancy does preeclampsia present?
20 weeks gestation to 6 weeks postpartum
How can pericarditis progress?
It can resolve without scarring or it can lead to chronic adhesive or chronic constrictive pericarditis
How does atherosclerosis progress?
1. Fatty streaks in arteries 2. Proliferative plaques 3. Complex atheromas
How does Prinzmental's variant angina present?
chest pain at rest
How does stable angina present?
chest pain with exertion
How does syphilis change the aorta?
Causes dilation of the aorta and valve ring. Can result in aortic aneurysm or aortic valve incompetence
How does unstable/crescendo angina present?
Worsening chest pain
To what does HTN predispose one?(5)
Coronary heart dz, CVA, CHF, renal dz, and aortic dissection
What are associations of preeclampsia?(3)
1. Hemolysis 2. Elevated LFT (liver fxn test) 3. Low platelets
What are clinical features of preeclampsia?(6)
1. Headache 2. Blurred vision 3. Abdominal pain 4. Edema of face and extremities 5. Altered mentation 6. Hyperreflexia
What are complications from an MI?(7)
1. Card. Arrhythmia(90%) 2. LV failure and pul. Edema (60%) 3. Thromboembolism: mural thrombus 4. Cardiogenic shock 5. Physical trauma 6. Fibrinous pericarditis 7. Dressler's syndrome
What are complications of bacterial endocarditis?(4)
1. Chordae rupture 2. Glomerulonephritis 3. Suppurative pericarditis 4. Emboli
What are examples traumatic MI complications?(4)
1. Vent wall rupture 2. Interventricular. Septum rupture 3. Papillary muscle rupture (4-10 days post-MI) 4. Cardiac tamponade (heart compression)
What are fat emboli associated with?(2)
Long bone fractures and liposuction
What are Janeway lesions?
Small erythematous lesions on palms or soles
What are nonbacterial causes of endocarditis?(2)
Secondary to metastasis or renal failure (marantic/thrombotic endocarditis)
What are olser nodes?
tender raised lesions on finger or toe pads
What are possible manifestations of ischemic heart disease?(4)
1. Angina(CAD narrowing> 75%) 2. Myocardial infarction 3. Sudden cardiac death 4. Chronic ischemic heart disease
What are risk factors for hypertension?(6)
Increased age, obesity, diabetes, smoking, genetics, race (black>white>asian)
What are Roth's spots?
round white spots on retina surrounded by hemorrhage
What are some atherosclerosis symptoms?
Agina and claudication. Can be asymptomatic
What are some risk factors for preecalmpsia?(4)
1. Preexisting HTN 2. Diabetes 3. Chronic renal dz 4. Autoimmune dz
What are the 2 major causes of HTN?
1.Primary (essential) HTN, related to ?CO and ?TPR 2. Secondary HTN, usually related to renal dz
What are the 3 most common sites of an MI?
LAD>RCA>circumflex
What are the 3 types of angina in ischemic heart dz?
stable angina, prinzmetal's variant, and unstable/crescendo
What are the 7 types of heart murmurs?
1. Aortic stenosis 2. Aortic regurgitation 3. Mitral stenosis 4. Mitral regurgitation 5. Mitral prolapse 6. Vent. Septal defect 7. Patent ductus arteriosus
What are the causes/associations of cardiogenic shock?
A large infarct with a high incidence of mortality
What are the complications of atherosclerosis?(6)
aneurisms, ischemia, infarcts, peripheral vasc dz thrombus, and emboli
What are the etiologies of dilated cardiomyopthy? (6)
1. Chronic alcohol abuse 2. Beriberi (wet) 3. Coxacke virus B postviral myocarditis 4. Cocaine use 5. Chagas dz. 6. Doxirubicin toxicity
What are the finding in temporal arteritis?
1. Unilateral headache 2. Jaw claudication 3. Impaired vision 4. Systemic involvement with polymyalgia rheumatica (in 50% of patients)
What are the findings in Buerger's dz?
Intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynauld's phenom.), severe pain in affected part; may lead to gangrene.
What are the findings in pericarditis?(4)
1. Pericardial pain 2. Friction rub 3. EKG changes 4. Pulsus paradoxicus
What are the findings of Wegener's granulomatosis?(3)
1. C-ANCA positive 2. CXR reveals large nodular lesions 3. Hematuria and red cell casts
What are the major causes of restrictive/obliterative cardiomyopathy?(4)
1. Sarcoidosis 2. Amyloidosis 3. Endocardial fibroelastosis 4. Endomyocardial fibrosis (Loffler's)
What are the possible lab findings in preeclampsia?(2)
thrombocytopenia and hyperuricemia
What are the risk factors of atherosclerosis?(4)
smoking, HTN, diabetes mellitus, and hyperlipidemia
What are the signs and symp of rheumatic fever or rheumatic heart dz?(7)
1. Fever 2. Erythema marginatum 3. Valvular damage 4. ESR increase 5. Polyarthritis 6. Subcutaneous nodules 7. Chorea
What are the signs and symp. of bacterial endocarditis?(8)
JR= NO FAME 1. Janeway lesions 2. Roth's spots 3. Nail bed hemorrhages 4. Osler nodes 5. Fever 6. Anemia 7. Murmur 8. Emobli
What are the signs of polyarteritis nodosa?(7)
1. Cotton wool spots 2. Microaneurysms 3. Pericarditis 4. Myocarditis 5. Palpable purpura 6. Elevated ESR 7. P-ANCA positive serum
What are the symptoms of a pulmonary embolus? (3)
Chest pain, tachypnea, and dyspnea
What are the symptoms of an MI?(5)
Severe retrosternal pain, pain in left arm or jaw, shortness of breath, fatigue, and adrenergic symptoms
What are the symptoms of polyarteritis nodosa?(6)
fever, weight loss, malaise, abdominal pain, myalgia, and HTN
What are the symptoms of Takaysu's arteritis?(6)
Fever, arthritis, night sweats, myalgia, and skin nodules
What are the symptoms of Wegeners granulomatosis? (7)
1. Perforation of nasal septum 2. Chronic sinusitis 3. Otitis media 4. Mastoiditis 5. Cough 6. Dyspnea 7. Hemoptysis
What are the types of emboli?(6)
1. Fat 2. Air 3. Thrombus 4. Bacteria 5. Amniotic fluid 6. Tumor
What can cause pericarditis?(4)
1. Infection 2. Ischemic heart dz 3. Chronic renal failure leading to uremia 4. Connective tissue dz
What causes acute bact. Endocarditis?
Staphyloccus aureus
What causes cardiac dilation in CHF?
greater ventricle end-diastolic volume
What causes dyspnea on exertion in CHF?
failure of LV output to increase during exercise
What causes hepatomegaly in CHF?
increased central venous press.?increased resistance to portal flow. Rarely leads to 'cardiac cirrhosis.'
What causes othopenea (dyspnea when supine) in CHF?
Pooling of blood in lungs when supine adds volume to congested pul. Vasculature system; increased venous return not put out by left ventricle.
What causes Paroxysmal nocturnal dyspnea and pulmonary edema in CHF?
Failure of left heart to keep up with rt. Heart output ?acute rise pul. Venous and capillary press. ? transudation of fluid
What causes prinzmental's variant angina?
coronary artery spasm
What causes pulmonary congestion in CHF?
LV failure?increased pul. Venous press.? pul. Venous distention and transudation of fluid. Presence of hemosiderin-laden macrophages (heart failure cells).
What causes pulmonary emboli?
95% of pulmonary emboli arise from deep leg veins
What causes rheumatic fever?
Pharyngeal infection with group A, ? hemolytic streptococci leads to cross reactivity with self (not due to direct effects of bacteria)
What causes stable angina?
atherosclerosis
What causes sudden cardiac death?
Most commonly from lethal arrhythmia
What causes the edema seen in CHF?
RV failure?increased venous press.? fluid transudation
What causes unstable/crescendo angina?
thrombosis in a branch of the coronary artery
What happens 2-4 days after an MI?(5)
1. Infarct appears pale 2. Tissue surrounding infarct shows acute inflammation 3. Dilated vessels (hyperemia) in infarct 4. Neutrophil emigration 5. Extensive coagulative necrosis
What happens 5-10 days after an MI?(4)
1. A hyperemic boarder forms around the infarct 2. The infarct shows central softening with brown/yellow color 3. An outer zone (ingrowth of granulation tissue) forms around infarct 4. Neutrophils and macrophages infiltrate infarcted tissue
What happens by 7 weeks post-MI?(3)
1. The Occluded artery causing the MI is recanalized 2. The infarct area is gray/white 3. The infarcted tissue shows contracted, complete scarring
What happens to contractility, cardiac output, and effective atrial blood volume in CHF?
all decrease
What happens to renal blood flow in CHF?
decreases
What happens to renin, angiotensin II, and aldosterone in CHF
all increase
What happens to sympathetic nervous activity in CHF?
increases
What happens to the heart 1 day after an MI?(5)
1. Appearance of a pale infarcted area 2. Coagulative necrosis in the infarct 3. Release of necrotic cells in the blood 4. Beginning of neutrophil emigration 5. Artery supplying infarcted tissue is occluded
What happens to urinary excretion of water and Na in CHF?
decrease
What happens to venous pressure in CHF?
increases
What histologic part of the aorta is affected by syphilis?
vasa vasorum
What is 'pulseless disease'?
Takayasu's arteritis
What is a red infarct?
A hemorrhagic infarct associated with reperfusion of infarcted tissue
What is an association of polyarteritis nodosa?
Hepatitis B infection (30% of patients)
What is Buerger's disease?
Known as smoker's disease and thromboangitis obliterans; idiopathic, segmental, thrombosing vasculitis of intermediate and small peripheral arteries and veins.
What is chronic ischemic heart dz?
Progressive onset of CHF over several years due to chronic ischemic myocardial damage
What is Dressler's syndrome?
an autoimmune phenomenon resulting in fibrinous pericarditis several weeks post-MI
What is eclampsia?
The addition of seizures to the preeclampsia triad
What is fibrinous pericarditis?
A friction rub of the pericardium usually 3-5 days post-MI
What is hypertrophic cardiomyopathy (formerly IHSS: idiopathic hypertrophic subaortic stenosis)?
Familial hypertrophy, usually asymmetric, involving the interventricular septum
What is polyarteritis nodosa?
Necrotizing immune complex inflammation of small or medium-sized muscular arteries, typically involving renal or visceral vessels.
What is preeclampsia?
A triad of HTN, protenuria, and edema that occurs in pregnancy
What is sudden cardiac death?
death from cardiac causes within 1 hr. of onset of symptoms
What is Takayasu's arteritis?
Thickening of aortic arch and proximal great vessels causing weak pulses in extremities and ocular disturbances.
What is temporal arteritis?
Vasculitis that affects medium and small arteries, usually branches of the carotid artery.
What is the appearance of a heart with hypertrophic cardiomyopathy?
Walls of LV are thickened, chamber becomes banana shaped on echocardiogram
What is the appearance of an aorta affected by syphilis?
Tree bark appearance
What is the incidence of preeclampsia?
7% of pregnant women
What is the inheritance pattern of hypertrophic cardiomyopathy?
AD
What is the most common cardiomyopathy?
Dilated (congested) cardiomyopathy (90%)
What is the most common heart tumor
metastases
What is the most common primary cardiac tumor in adults?
Myxoma
What is the most common primary cardiac tumor in children
rhabdomyoma
What is the most common vasculitis?
temporal arteritis
What is the treatment for Buerger's dz?
stop smoking
What is the treatment for temporal arteritis?
Responds well to steroids
What is the treatment of eclampsia?
IV Magnesium sulfate and diazepam This is a medical emergency
What is the treatment of polyarteritis nodosa?
Corticosteroids, azathioprine, and/or cyclophosphamide
What is the treatment of preeclampsia?
Deliver the fetus ASAP. Otherwise rest, salt restriction, treatment of HTN
What is the treatment of wegener's granulomatosis?
cyclophosphamide, corticosteroids, and/or methotrexate
What is the x-ray appearance of a heart with dilated myopathy?
Dilated: looks like a balloon
What is Wegner's granulomatosis?
Focal necrotizing vasculitis and granulomas in the lung and upper airway with necrotizing glomerulonephritis
What kind of effusions are found in pericarditis associated with TB or malignancy?
hemorrhagic
What kind of effusions are found in pericarditis associated with renal failure?
Serous of fibrinous
What lab finding is seen in Takayasu's arteritis or temporal arteritis?
elevated ESR
What part of the heart/vasculature can be damaged by syphilis?
Aortic root and ascending aorta
What percentage of HTN is primary?
0.9
What percentage of HTN is secondary?
0.1
What population is associated with death from hypertrophic cardiomyopathy?
young athletes
What predisposes one to deep vein thromosis?(3)
Virchow's triad: 1. Stasis 2. Hypercoagulability 3. Endothelial damage
What stage of syphilis can affect the heart?
tertiary
What symptoms are associated with CHF?(8)
1. Ankle and sacral edema 2. Hepatomegaly (nutmeg liver) 3. Pulmonary congestion 4. Dyspnea on exertion 5. Paroxysmal nocturnal dyspnea 6. Pulmonary edema 7. Orthopnea (dyspnea when supine) 8. Cardiac dilation
What tests are used to diagnose an MI?(5)
1. EKG (the gold standard) 2. Cardiac troponin I 3. CK-MB 4. LDH1 5. AST
What type of bacterial endocarditis is associated with dental procedures?
Subacute endocarditis from Strep. Viridans infection
What type of embolus is associated with DIC?
amniotic fluid, especially postpartum
What types of infections cause pericarditis?
Viruses, TB, pyogenic bacteria; often by direct spread from lung or mediastinal lymph node
What visual complication can temporal arteritis cause?
occlusion of ophthalmic artery leading to blindness
Where do myxomas occur?
90% occur in the atria, mostly LA. Myxomas are described as a 'ball valve' obstruction.
Where do pale infarcts occur?
Solid tissues with single blood supply: brain, heart, kidneys, and spleen
Where do red infarcts occur?
Loose tissue with collaterals: lungs or intestine
Where does a MI usually occur?
In the left anterior descending coronary artery
Where histologically does atherosclerosis occur?
The elastic arteries and medium to large muscular arteries
Where, anatomically, does atherosclerosis most occur?(4)
abdominal aorta>coronary art>popliteal art>carotid art
Which valve is most frequently involved in bacterial endocarditis?
Mitral
Which valves are most affected by rheumatic heart dz?
mitral>aortic>>tricuspid (high pressure valves most affected)
Who gets Takayasu's arteritis?
Primarily affects young Asian females
Who gets temporal arteritis?
Affects elderly females
Define renal failure.
Failure to make urine and excrete nitrogenous wastes
How do you calculate anion gap?
Na-(Cl + HCO3) = 8-12 mEq/L
How do you treat minimal change disease?
Responds well to steroids
How does acute poststreptococcal glomerulonephritis resolve?
Spontaneously
How does renal cell carcinoma spread metastically?
Invades the IVC and spreads hematogenously
How does transitional cell carcinoma present?
Hematuria
How does Wilms' tumor present?
Huge, palpable flank mass
In what epidemiological group is renal cell carcinoma most common?
Men ages 50-70
T/F: Ammonium magnesium phosphate kidney stones are radiopaque
TRUE
T/F: Calcium kidney stones are radiopaque.
TRUE
T/F: Calcium kidney stones do not recur.
FALSE
T/F: Cystine kidney stones are radiopaque.
FALSE, cystine stones are radiolucent
T/F: Transitional cell carcinoma is cured by surgical removal.
False, transitional cell carcinoma often recurs after removal
T/F: Uric acid kidney stones are radiopaque
FALSE, uric acid stones are radiolucent
What additional sx are seen in a pt with acute streptococcal glomerulonephritis?
Peripheral and periorbital edema
What age group is poststreptococcal glomerulonephritis most common?
Children
What are 4 causes of hypoventilation?
1. Acute lung disease 2. Chronic lung disease 3. Opioids, narcotics, sedatives 4. Weakening of respiratory muscles
What are the 2 forms of renal failure?
Acute and chronic
What are the 2 main symptoms present in Goodpasture's syndrome?
Hemoptysis, hematuria
What are the 4 major types of kidney stones?
1. Calcium 2. Ammonium magnesium phosphate 3. Uric acid 4. Cystine
What are the 5 nephritic syndromes?
Acute poststreptococcal glomerulonephritis Rapidly progressive (crescentic) glomerulonephritis Goodpasture's syndrome Membranoproliferative glomerulonephritis Berger's disease
What are the 5 nephrotic syndromes?
1. Membranous glomerulonephritis 2. Minimal change disease (lipoid nephrosis) 3. Focal segmental glomerular sclerosis 4. Diabetic nephropathy 5. SLE
What are the causes and signs of calcium ion deficiency?
-Kids- rickets -Adults- osteomalacia -Contributes to osteoporosis -Tetany
What are the causes and signs of phosphate toxicity?
-Low serum calcium ion -can cause bone loss -renal stones
What are the causes of chloride ion deficiency?
Secondary to emesis, diuretics, renal disease
What are the causes of metabolic acidosis?
-Diabetic ketoacidosis -Diarrhea -Lactic Acidosis -Salicylate OD -Acetazolamide OD
What are the causes of respiratory acidosis?
-COPD -Airway obstruction
What are the causes of respiratory alkalosis?
-High altitude -Hyperventilation
What are the characteristics of acute poststreptococcal glomerulonephritis seen with immunofluorescence?
Granular pattern
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the electron microscope?
Subepithelial humps
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the light microscope?
Glomeruli enlarged and hypercellular neutrophils 'lumpy-bumpy'
What are the characteristics of rapidly progressive (crescentic) glomerulonephritis seen on LM and IF?
Crescent-moon shape
What are the clinical features of renal cell carcinoma?
-Hematuria -Palpable mass -Secondary polycythemia -Flank pain -Fever
What are the clinical symptoms of a nephritic syndrome?
I' = inflammation; hematuria, hypertension, oligouria, azotemia
What are the clinical symptoms of nephrotic syndromes?
O = proteinuria Hypoalbuminuria Generalized edema Hyperlipidemia
What are the consequences of renal failure?
1. Anemia 2. Renal osteodystrophy 3. Hyperkalemia 4. Metabolic acidosis 5. Uremia 6. Sodium and water excess 7. Chronic pyelonephritis 8. HTN
What are the factors associated metabolic alkalosis?
-Increased pH -Increased PCO2 -Increased HCO3-
What are the factors associated with metabolic acidosis?
-Decreased pH -Decreased PCO2 -Decreased HCO3-
What are the factors associated with respiratory acidosis?
-Decreased pH -Increased PCO2 -Increased HCO3-
What are the factors associated with respiratory alkalosis?
-Increased pH -Decreased PCO2 -Decreased HCO3-
What are the functions of calcium ion?
-Muscle contraction -Neurotransmitter release -Bones, teeth
What are the functions of sodium ion?
-Extracellular fluid -Maintains plasma volume -Nerve/muscle function
What are the functions of the chloride ion?
-Fluid/electrolyte balance -Gastric acid -HCO3/Cl shift in RBC
What are the functions of the magnesium ion?
-Bones, teeth -Enzyme cofactor
What are the functions of the phosphate ion?
-ATP -nucleic acids -Phosphorylation -Bones, teeth
What are the functions of the potassium ion?
-Intracellular fluid -Nerve/muscle function
What are the signs of magnesium ion deficiency?
-Diarrhea -Alcoholism
What are the signs of magnesium ion toxicity?
-Decreased reflexes -Decreased respirations
What are the signs of phosphate deficiency?
-Kids- rickets -Adults- osteomalacia
What are the signs of potassium ion toxicity?
-EKG changes -Arrhythmia
What bugs cause ammonium magnesium phosphate kidney stones?
Urease-positive bugs such as Proteus vulgaris or Staphylococcus
What calcium molecules form calcium kidney stones?
Calcium oxalate or calcium phosphate or both
What can excess Na and water cause?
CHF and pulmonary edema
What can the hyperkalemia associated with renal failure lead to?
Cardiac arrhythmias
What causes metabolic alkalosis?
1. Vomiting 2. Diuretic use 3. Antacid use 4. Hyperaldosteronism
What causes renal osteodystrophy?
Failure of active vitamin D production
What characteristics of Berger's disease are seen with IF and EM?
Mesangial deposits of IgA
What characteristics of focal segmental glomerular sclerosis are seen with the LM?
Segmental sclerosis and hyalinosis
What characteristics of Goodpasture's syndrome are seen with IF?
Linear pattern Anti-glomerular basement membrane antibodies
What characteristics of Membranoproliferative glomerulonephritis are seen with the EM?
subendothelial humps 'tram track'
What characteristics of membranous glomerulonephritis are seen with IF?
Granular pattern
What characteristics of membranous glomerulonephritis are seen with the EM?
Spike and Dome'
What characteristics of membranous glomerulonephritis are seen with the LM?
Diffuse capillary and basement membrane thickening
What characteristics of minimal change disease are seen with the EM?
Foot process effacement
What characteristics of minimal change disease are seen with the LM?
Normal glomeruli
What characteristics of SLE are seen with the LM?
Wire-loop appearance with extensive granular subendothelial basement-membrane deposits in membranous glomerulonephritis pattern
What defines metabolic acidosis?
-pH less than 7.4 -PCO2 less than 40 mm Hg
What defines metabolic alkalosis with compensation?
-pH greater than 7.4 -PCO2 greater than 40 mm Hg
What defines respiratory acidosis?
-pH less than 7.4 -PCO2 greater than 40mm Hg
What defines respiratory alkalosis?
-pH greater than 7.4 -PCO2 less than 40 mm Hg
What diseases often cause uric acid kidney stones?
Diseases with increased cell proliferation and turnover, such as leukemia and myeloproliferative disorders
What disorders can lead to hypercalcemia and thus kidney stones?
1. Cancer 2. Increased PTH 3. Increased vitamin D 4. Milk-alkali syndrome
What disorders cause an increased anion gap?
1. Renal failure 2. Lactic acidosis 3. Ketoacidosis (DM) 4. Aspirin ingestion
What disorders cause metabolic acidosis and normal anion gap?
1. Diarrhea 2. Glue sniffing 3. Renal tubular acidosis 4. Hyperchloremia
What disorders make up the WAGR complex?
Wilms' tumor Aniridia Genitourinary malformation mental-motor Retardation
What does potassium deficiency cause?
-Weakness -Paralysis -Confusion
What factors are associated with transitional cell carcinoma?
Exposure to cyclophosphamide, smoking, phenacetin, and aniline dyes
What genetic disorder and mutation are associated with renal cell carcinoma?
Renal cell carcinoma is associated with von Hippel-Lindau and gene deletion in chromosome 3
What genetic disorder is associated with Wilms' tumor?
Deletion of tumor suppression gene WT-1 on chromosome 11
What is a common cause of adult nephrotic syndrome?
Membranous glomerulonephritis
What is acute renal failure often due to?
Hypoxia
What is Berger's disease?
IgA nephropathy -Mild disease -Often postinfectious
What is chronic failure due to?
HTN and diabetes
What is the 2nd most common type of kidney stone?
Ammonium magnesium phosphate
What is the cause of magnesium ion deficiency?
Secondary to malabsorption
What is the cause of metabolic alkalosis?
Vomiting
What is the cause of potassium ion deficiency?
Secondary to injury, illness or diuretics
What is the cause of sodium deficiency?
Secondary to injury or illness
What is the compensatory mechanism of metabolic alkalosis?
Hypoventilation
What is the compensatory mechanism of respiratory alkalosis?
Renal HCO3- secretion
What is the compensatory response to metabolic acidosis?
Hyperventilation
What is the compensatory response to respiratory acidosis?
Renal HCO3- reabsorption
What is the course of membranoproliferative glomerulonephritis?
Slowly progresses to renal failure
What is the course of rapidly progressive (crescentic) glomerulonephritis?
Rapid course to renal failure from one of many causes
What is the Henderson-Hasselbalch equation?
pH = pKa + log [(HCO3-)/(0.03*PCO2)]
What is the most common cause of childhood nephrotic syndrome?
Minimal change disease (lipoid nephrosis)
What is the most common renal malignancy of early childhood (ages 2-4)?
Wilms' tumor
What is the most common renal malignancy?
Renal cell carcinoma
What is the most common tumor of the urinary tract system?
Transitional cell carcinoma
What is the primary disturbance in respiratory acidosis?
Increased PCO2
What is the primary disturbance of metabolic acidosis?
HCO3- decrease
What is the primary disturbance of metabolic alkalosis?
Increased HCO3-
What is the primary disturbance of respiratory alkalosis?
Decreased PCO2
What is the sign of calcium ion toxicity?
Delirium
What is the sign of sodium ion toxicity?
Delirium
What lesions are seen on the LM in diabetic nephropathy?
Kimmelstiel-Wilson lesions
What might an elevated anion gap indicate?
MUD PILES 1. Methanol 2. Uremia (chronic renal failure) 3. Diabetic ketoacidosis 4. Paraldehyde or Phenformin 5. Iron tablets or INH 6. Lactic acidosis (CN-, CO, shock) 7. Ethanol or Ethylene glycol 8. Salicylates
What paraneoplastic syndromes are associated with renal cell carcinoma?
Ectopic EPO, ACTH, PTHrP, and prolactin
What severe complications may kidney stones lead to?
Hydronephrosis Pyelonephritis
What social factor increases the incidence of renal cell carcinoma?
Smoking
What type of hypersensitivity contributes to the pathogenesis of Goodpasture's syndrome?
Type II hypersensitivity
Where can transitional cell carcinoma occur?
-Renal calyces -Renal pelvis -Ureters -Bladder
Where does renal cell carcinoma originate?
Renal tubule cells, polygonal clear cells
Which kidney stone is often secondary to cystinuria?
Cystine
Which kidney stone is strongly associated with gout?
Uric acid kidney stones
Which of the nephrotic syndromes are worse in HIV pts?
Focal segmental glomerular sclerosis
Which type of kidney stones constitute the majority of kidney stones (80-85%)?
Calcium
Why are ammonium magnesium phosphate kidney stones often associated with UTIs?
Ammonium magnesium phosphate stones can form large struvite calculi that can be a nidus for UTIs
Why does renal failure cause anemia?
Failure of EPO production
Why does renal failure cause metabolic acidosis?
Due to decreased acid secretion and decreased generation of HCO3-
Define/Describe Alcoholism:
-Physiologic tolerance and dependence with syptoms of withdrawal when intake is interrupted. -Continued drinking despite medical and social contraindications and life disruptions.
In alcoholics, what causes Wernicke-Korsakoff syndrome?
Vitamin B1 (thiamine) deficiency
Is Korsakoff's syndrome reversible?
NO
Wernicke-Korsakoff syndrome is associated with periventricular hemorrage/necrosis in which part of brain?
Mamillary bodies
What are the accompanying symptomes of Alcoholic cirrhosis?
-Jaundice -Hypoalbuminemia -Coagulation factor deficiencies -Portal hypertension -Peripheral edema and ascites -Encephalopathy -Neurologic manifestations (e.g., asterixis, flapping tremor of the hands)
What are the bodily effects of ethanol? (3)
-Toxicity (especially in the brain) -Fatty liver -Increased NADH/HAD
What are the effects of increased NADH/NAD (from ethanol use)? (4)
-Increases lactate/pyrubate -Inhibits gluconeogenesis -Inhibits fatty acid oxidation -Inhibits glycerophosphate dehydrogenase leading to elevated glycerophosphate
What are the long term consequences of alcohol use?
-Alcoholoic hepatitis and cirrhosis -Pancreatitis -Dilated cardiomyopathy -Peripheral neuropathy -Cerebellar degeneration -Wernicke-Korsakoff syndrome -Testicular atrophy and hypertension -Mallory-Weiss syndrome
What are the symptoms of alcohol withdrawel?
-tremor -tachycardia -hypertension -malaise -nausea -delerium tremens
What is Korsakoff's syndrome?
Progression of Wernicke's encephalopathy to memory loss, confabulation, and confusion
What is Mallory-Weiss syndrome?
Longitudinal lacerations at the gastroesophageal junction caused by excessive vomitting with failure of Lower Esophageal Sphincter relaxation that could lead to fatal hematemesis.
What is the treatment for Wernicke-Korsakoff syndrome?
IV vitamin B1 (thiamine)
What is the triad of symptoms for Wernicke's encephalopathy?
1. Psychosis 2. Ophthalmoplegia 3. Ataxia
What supportive group has been mose successful in sustaining abstinence?
Alcoholics Anonymous (sorry… it was in the book :)
What treatment is used to condition the patient negatively against alcohol use?
Disulfiram
Actinic keratosis
Often precedes squamous cell carcinoma
Addison's
Autoimmune (infection is the second most common cause)
Albumino-cytologic dissociation
Guillain-Barre (increased protein in CSF with only modest increase in cell count)
Aneurysm, dissecting
HTN
Anti-basement membrane
Goodpasture's syndrome
Anti-centromere antibodies
Scleroderma (CREST)
Anti-double-stranded-DNA antibodies (ANA antibodies)
SLE (type III hypersensitivity)
Anti-epithelial cell
Pemphigus vulgaris
Anti-gliadin antibodies
Celiac disease
Anti-histone Antibodies
Drug-induced SLE (cf. SLE)
Anti-IgM antibodies
Rheumatoid arthritis
Anti-mitochondrial antibodies
Primary biliary cirrhosis
Anti-neutrophil antibodies
Vasculitis
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
Aortic aneurysm, abdominal & descending aorta
Atherosclerosis
Aortic aneurysm, ascending
Tertiary syphilis
Arachnodactyly
Marfan's syndrome
Argyll-Robertson pupil
Neurosyphilis
Aschoff bodies
Rheumatic fever
Atrophy of the mamillary bodies
Wernicke's encephalopathy
Auer rods
Acute myelogenous leukemia (especially the promyelocytic type)
Autosplenectomy
Sockle cell anemia
Babinski sign
Upper motor neuron lesion
Bacteremia/pneumonia (IVDA)
Staphylococcus aureus
Bacteria associated with cancer
Helicobacter pylori
Bacteria found in GI tract
Bacteroides (second most common is Escherichia coli)
Bacterial meningitis (adults)
Neisseria meningitidis
Bacterial meningitis (elderly)
Streptococcus pneumoniae
Bacterial meningitis (kids)
Haemophilus influenza type B
Bacterial meningitis (newborns)
Escherichia coli
Baker's cyst in popliteal fossa
Rheumatoid arthritis
Bamboo spine' on xray
Ankylosing spondylitis
Basophilic stippling of RBC's
Lead poisoning
Bence-Jones proteins
Multiple myeloma (kappa or lambda Ig light chains in urine) Waldenstrom's macroglobinemia (IgM)
Bilateral hilar adenopathy, uveitis
Sarcoidosis
Birbeck granules on EM
Histiocytosis X (eosinophilic granuloma)
Bloody tap on LP
Subarachnoid hemorrhage
Blue-domed cysts
Fibrocystic change of the breast
Blue bloater'
Chronic bronchitis
Blue sclera
Osteogenesis imperfecta
Boot-shaped heart on x-ray
Tetralogy of Fallot; RV hypertrophy
Bouchard's nodes
Osteoarthritis (PIP swelling secondary to osteophytes)
Boutonniere's deformity
Rheumatoid arthritis
Brain tumor - supratentorial (kids)
Craniopharyngioma
Brain tumor (adults)
Astrocytoma (including glioblastoma multiforme) > mets > meningioma > Schwannoma
Brain tumor (kids)
Medullobastoma (cerebellum)
Branching rods in oral infection
Actinomyces israelii
Breast cancer
Infultrating ductal carcinoma (in the US, one in nine women will develop breast cancer)
Breast mass
Fibrocystic change (in post-menopausal women, carcinoma is the most common)
Breast tumor (benign)
Fibroadenoma
Brown tumor'of bone
Hemorrhage causes brown color of osteolytic cysts: Hyperparathyroidism; Osteitis fibrosa cystica (von Recklinghausen's disease)
Brushfield's spots
Down syndrome
Bruton's lines
Lead poisoning
Bug in debilitated, hospitalized pneumonia patient
Klebsiella
C-ANCA
Wegerner's granulomatosis
Café au lait spots on skin
Neurofibromatosis
Calf pseudohypertrophy
Duchenne's muscular dystrophy
Call-Exner bodies
Granulosa/thecal cell tumor of the ovary
Cancer associated with AIDS
Kaposi's sarcoma
Cardiac primary tumor (adults)
Myxoma (4:1 left to right atrium; 'ball & valve')
Cardiac primary tumor (kids)
Rhabdomyoma
Cardic tumor (adults)
Mets
Cardiomegaly with apical atrophy
Cagas' disease
Cardiomyopathy
Dilated cardiomyopathy
Cerebriform nuclei
Mycosis fungoides (cutaneous T-cell lymphoma)
Chancre
Primary syphilis (not painful)
Chancroid
Haemophilus ducreyi (painful)
Charcot's triad
Multiple sclerosis (nystagmus, intention tremor,scanning speech); Cholangitis (jaundice, RUQ, fever)
Charcot-Leyden crystals
Bronchial asthma (eosinophil membranes)
Cherry-red spot on macula
Tay-Sachs, Niemann-Pick disease, central retinal artery occlusion
Chevostek's sign
Hypocalcemia (facial muscle spasm upon tapping)
Cheyne-Stokes respirations
Central apnea in CHF & increased ICP
Chocolate cysts'
Endometriosis (frequently involve both ovaries)
Chromosomal disorder
Down syndrome (associated with ALL, Alzheimer's dementia, & endocardial cushion defects)
Chronic arrhythmia
Atrial fibrillation (associated w/ high risk of emboli)
Chronic atrophic gastritis
Predisposition to gastric carcinoma
Clue cells
Gardnerella vaginitis
Codman's triangle on x-ray
Osteoasarcoma
Cold agglutinins
Mycoplasma pneumoniae; Infectious mononeucleosis
Cold intolerance
Myxedema
Condyloma lata
Secondary syphilis
Congenital adrenal hyperplasia
21-Hydroxylase deficiency
Congenital cardiac anomaly
VSD
Constrictive pericarditis
Tuberculosis
Continuous machinery murmur
Patent ductus arteriosus
Coronary artery involved in thrombosis
LAD > RCA > LCA
Cotton wool spots
Chronic hypertension
Cough, conjunctivitis, coryza + fever
Measles
Councilman bodies
Toxic or viral hepatitis
Cowdry type A bodies
Herpes virus
Crescents in Bowman's capsule
Rapidly progressive crescentic glomerulonephritis
Cretinism
Hypothyroidism/iodine deficit
Currant-jelly sputum
Klebsiella
Curschmann's spirals
Bronchial asthma (whorled mucous plugs)
Cushing's syndrome
Corticosteroid therapy (second most common cause is excess ACTH secretion by pituitary)
Cyanosis (early; less common)
Tetralogy of Fallot, transposition of great vessels, truncus arteriosus
D-dimers
DIC
Death in CML
Blast crisis
Death in SLE
Lupus nephropathy
Dementia
Alzheimer's (second most common is multi-infarct)
Demyelinating disease
Multiple sclerosis
Depigmentation of neurons in substantia nigra
Parkinson's disease (basal ganglia disorder -- rigidity, resting tremor, bradykinesia)
Dermatitis, dementia, diarrhea
Pellagra (Niacin, vitamin B3 deficiency)
Diabetes insipidus + exopthalmos + lesions of skull
Hand-Schuller-Christian disease
DIC
Gram-negative sepsis, obstetric complications, cancer, burns trauma
Dietary deficit
Iron
Dog or cat bite
Pasteurella multocida
Donovan bodies
Granuloma inguinale
Ejection click
Aortic/pulmonic stenosis
Elastic skin
Ehlers-Danlos syndrome
Epiglottitis
Haemophilus influenza type B
Erythema chronicum migrans
Lyme disease
Esophageal cancer
Squamous cell carcinoma
Fat, female, forty, & fertile'
Acute cholecystitis
Fatty liver
Alcoholism
Ferruginous bodies
Asbestosis
Food poisoning
Staphylococcus aureus
Ghon complex
Secondary TB
Ghon focus
Primary TB
Glomerularnephritis (adults)
IgA nephropathy (Berger's disease)
Gower's maneuver
Duchenne's (use of patient's arms to help legs pick self off the floor)
Group affected by cystic fibrosis
Caucasians (fat-soluble vitamin deficiencies, mucous plugs/lung infections)
Gynecologic malignancy
Endometrial carcinoma
Hair on end' appearance on x-ray
Beta-thalassemia
Hampton's hump on x-ray
Pulmonary embolism
HbS
Sickle cell anemia
HCG elevated
Choriocarcinoma; Hyadatidiform mole (occurs with & without embryo)
Heart murmur
Mitral valve prolapse
Heart valve (rheumatic fever)
Mitral valve (aotric is second)
Heart valve in bacterial endocarditis
Mitral
Heart valve in bacterial endocarditis in IVDA
Tricuspid
Heberden's nodes
Osteoarthritis (DIP swelling secondary to osteophytes)
Heinz bodies
G6PD deficiency
Helminth infection (US)
Enterobius vermicularis (Ascaris lumbricoides is second most common)
Hematoma - epidural
Rupture of middle meningeal artery (arterial bleeding is fast)
Hematoma - subdural
Rupture of bridging veins (trauma; venous bleeding is slow)
Hemochromocytosis
Multiple blood transfusions (can result in CHF, and increases risk of hepatocellular carcinoma)
Hepatic cirrhosis
EtOH
Hepatocellular carcinoma
Cirrhotic liver (often associated with hepatitis B & C)
Hereditary bleeding disorder
Von Willebrand's
Heterophil antibodies
Infectious mononucleosis (EBV)
Hgb F
Thalassemia major
High output cardiac failure (dilated cardiomyopathy)
Wet beriberi (thiamine, vitamin B1 deficiency)
HLA-B27
Reiter's syndrome, ankylosing spondylitis
HLA-DR3 or DR4
DM type 1 (caused by autoimmune destruction of beta cells)
Holosystolic murmur
VSD, tricuspid regurgitation
Homer-Wright rosettes
Neuroblastoma
Honeycomb lung on x-ray
Interstitial fibrosis
Howell Jolly bodies
Splenectomy (or non-functional spleen)
Hyperphagia + hypersexuality + hyperorality + hyperdocile
Kluver-Bucy syndrome (amygdala)
Hyperpigmentation of skin
Primary adrenal insufficiency (Addison's disease)
Hypersegmented neutrophils
Macrocytic anemia
Hypertension + hypokalemia
Cushing & Conn syndromes
Hypertension, secondary
Renal disease
Hypochromic microcytosis
Iron-deficiency anemia
Hypoparathyroidism
Thyroidectomy
Hypopituitarism
Adenoma
Increase alpha-fetoprotein in amniotic fluid/maternal serum
Anencephaly; Spina bifida
Increased uric acid levels
Gout; Lesch-Nyhan; Myeloproliferative disorders; Loop & thiazide diuretics
Infection in blood transfusion
Hepatitis C
Infection in burn victims
Klebsiella
Intussesception
Adenovirus (cause hyperplasia of Peyer's patches)
Janeway lesions
Endocarditis
Jarisch-Herxheimer reaction
Syphilis; over-aggressive treatment of an symptomatic patient that causes symptoms due to rapid lysis
Kaposi's sarcoma
Homosexual AIDS patients (not associated with IVDA acquired HIV/AIDS)
Kayser-Fleischer rings
Wilson's disease
Keratin pearls
Squamous cell carcinoma
Kidney stones
Calcium = radiopaque (2nd most common is ammonium = radiolucent; formed by urease positive organisms like Proteus vulgaris or Staphylococcus)
Kimmelstiel-Wilson nodules
Diabetic nephropathy
Koilocytes
HPV
Koplik spots
Measles
Kussmaul hyperpnea
Diabetic ketoacidosis
Lens dislocation + aortic dissection + joint hyperflexibility
Marfan's disease (fibrillin deficit)
Leukemia (adults)
AML
Lewy bodies
Parkinson's disease
Lines of Zahn
Arterial thrombus
Lisch nodules
Neurofibromatosis (von Recklinghausen's disease)
Liver disease
Alcoholic liver disease
Location of brain tumors (adults)
Supratentorial
Location of brain tumors (kids)
Infratentorial
Low serum ceruloplasmin
Wilson's disease
Lucid interval
Epidural hematoma
Lumpy Bumpy' appearance of glomeruli on immunoflourescence
Poststreptococal glomerulonephritis
Lysosomal storage disease disorder
Gaucher's
Lytic bone lesions on x-ray
Multiple myeloma
Machine-like' murmur
PDA
Male cancer
Prostatic carcinoma
Malignancy associated with infectious fever
Hodgkin's
Malignant skin tumor
Basal cell carcinoma (rarely metastasizes)
Mallory bodies
Alcoholic liver disease
McBurney's sign
Appendicitis
Mental retardation
Down syndrome (Fragile X is the second most common cause)
Mets to bone
Breast, lung, thyroid, testes, prostate
Mets to brain
Lung, breast, skin (melanoma), kidney (renal cell carcinoma), GI
Mets to liver
Colon, gastric, pancreatic, breast, & lung carcinomas
MI
Atherosclerosis
Mitral valve stenosis
Rheumatic heart disease
MLF syndrome (INO)
Multiple sclerosis
Monoclonal antibody-spike
Multiple myeloma (called the M protein; usually IgG or IgA); MGUG; Waldenstrom's (M Protein = IgM) macroglobulinemia
Motor neuron disease
ALS
Myocarditis
Coxsackie B
Myxedema
Hypothyroidism
Necrotizing vasculitis (lungs) & necrotizing glomerulitis
Wegener's & Goodpasture's (hemoptysis & glomerular disease)
Needle-shaped, negatively bifringent crystals
Gout
Negri bodies
Rabies
Neoplasm (kids)
ALL (2nd most common is cerebellar medulloblastoma)
Nephritis + cataracts + hearing loss
Alport syndrome
Nephrotic syndome (kids)
Minimal change disease (associated with infections/vaccinations; treat with corticosteroids)
Nephrotic syndrome
Membranous glomerulonephritis
Nephrotic syndrome (adults)
Membranous glomerulonephritis
Neurofibrillary tangles
Alzheimer disease
No lactation postpartum
Sheehan's syndrome
Nutmeg liver
Congestive heart failure
Obstruction of male urinary tract
BPH
Occupational exposure to asbestos
Malignant mesothelioma
Oncogene involved in cancer
p53 Suppressor
Opening snap
Mitral stenosis
Opportunistic infection in AIDS
PCP
Organ receiving mets
Adrenal glands (due to rich blood supply)
Organ sending mets
Lung > breast, stomach
Orphan Annie cells
Papillary carcinoma of the ovary
Osler's nodes
Endocarditis
Osteomyelitis
Staphylococcus aureus
Osteomyelitis in patients with sickle cell disease
Salmonella
Osteomyelitis with IVDA
Pseudomonas
Ovarian tumor (benign)
Hamartoma
Ovarian tumor (malignant)
Serous cystadenoma
Owl's eye
CMV
P-ANCA
Polyarteritis nodosa
Painless jaundice
Pancreatic cancer (head)
Palpable purpura on legs & buttocks
Henoch-Schonlein purpura
Pancreatic tumor
Adenocarcinoma (head of pancreas)
Pancreatitus (acute)
EtOH and gallstones
Pancreatitus (chronic)
EtOH (adults), cystic fibrosis (kids)
Pannus
Rheumatiod arthritis
Patient with ALL/CLL/AML/CML
ALL - Child / CLL - Adult over 60 / AML - Adult over 60 / CML - Adult 35-50
Patient with Hodgkin's
Young male (except nodular sclerosis type - female)
Patient with minimal change disease
Young child
Patient with Reiter's
Male
Peau d'orange
Carcinoma of the breast
Pelvic inflammatory disease
Neisseria gonorrhoeae (monoarticular arthritis)
Periosteal elevation on x-ray
Pyogenic osteomyelitis
Philadelphia chromosome (bcr;abl)
CML (may sometimes be associated with AML)
Pick bodies
Pick's disease
Pink puffer'
Emphysema (centroacinar (smoking), panacinar (alpha1-antitrypsin deficiency))
Pituitary tumor
Prolactinoma (2nd - somatotropic 'acidophilic' adenoma)
Pneumonia, hospital-acquired
Klebsiella
Pneumonia, in CF, burn infection
Pseudomonas aeruginosa
Podagra
Gout (MP joint of hallux)
Podocyte fusion
Minimal change disease
Polyneuropathy preceded by GI or respiratory infection
Guillian-Barre syndrome
Polyneuropathy, cardiac pathology, & edema
Dry beriberi (thiamine, vitamine B1 deficiency)
Port-wine stain
Hemangioma
Posterior anterior 'drawer sign'
Anterior cruciate ligament injury
Preventable blindness
Chlamydia
Preventable cancer
Lung cancer
Primary amenorrhea
Turner's (XO)
Primary bone tumor (adults)
Multiple myeloma
Primary hyperaldosteronism
Adenoma of adrenal cortex
Primary hyperparathyroidism
Adenomas (followed by: hyperplasia, then carcinoma)
Primary hyperparathyroidism
Adenoma
Primary liver tumor
Hepatoma
Psammoma bodies
Caused by apoptosis of tumor cells with dystrophic calcification & found in: Papillary adenocarcinoma of the thyroid (most common cancer of the thyroid); Serous papillary cystadenocarcinoma of the ovary; Meningioma, Mesothelioma
Pseudopalisade tumor cell arrangement
Glioblastoma multiforme
Pseudorosettes
Ewing's sarcoma
Ptosis, miosis, anhidrosis
Horner's syndrome (Pancoast's tumor)
Pulmonary hypertension
COPD
Pus, empyema, abscess
Staphylococcus aureus
Rash on palms & soles
Secondary syphilis; Rocky Mountain Spotted Fever
RBC's in urine
Bladder carcinoma
RBC casts in urine
Acute glomerulonephritis
Recurrent pulmonary Pseudomonas and Staphylococcus aureus infections
Cystic fibrosis
Red urine in the morning
Paroxysmal nocturnal hemoglobinuria
Reed-Sternberg cells
Hodgkin's lymphoma
Reid index (increased)
Chronic bronchitis
Reinke crystals
Leydig cell tumor
Renal cell carcinoma + cavernous hemangiomas + adenomas
Von Hippel - Lindau disease
Renal epithelial casts in urine
Acute toxic/viral nephrosis
Renal tumor
Renal cell carcinoma - associated with von Hippel-Lindau & acquired polycystic kidney disease; paraneoplastic syndromes (erythropoietin, renin, PTH, ACTH)
Rhomboid crystals, positively bifringent
Pseudogout
Rib notching
Coarctation of aorta
Right-sided heart faulure
Left-sided heart failure
Right heart failure due to a pulmonary cause
Cor pulmonale
Roth spots in retina
Endocarditis
Rouleaux formation (RBC's)
Multiple myeloma
Russell bodies
Multiple myeloma
S3
Left to right shunt (VSD, PDA, ASD); Mitral regurgitation; LV failure (CHF)
S4
Aortic stenosis, hypertrophic subaortic stenosis
Schiller-Duval bodies
Yolk sac tumor
Schwarzman reaction
Neisseria meningitidis
Secondary hyperparathyroidism
Hypocalcemia of chronic renal failure
Senile plaques
Alzheimer's disease
Sexually transmitted disease
Chlamydia
Sheehan's syndrome
Postpartum pituitary infarction
SIADH
Small cell carcinoma of the lung
Signet ring cells
Gastric carcinoma
Simian crease
Down syndrome
Site of diverticula
Sigmoid colon
Site of metastasis
Regional lymph nodes
Site of metastasis (2nd most commond)
Liver
Sites of atherosclerosis
Abdominal aorta > coronary > popliteal > carotid
Skin cancer
Basal cell carcinoma
Skip lesions
Crohn's
Slapped cheeks
Erythema infectiosum (fifth disease)'
Smith antigen
SLE
Smudge' cell
CLL
Soap bubble on x-ray
Giant cell tumor or bone
Spike & dome on EM
Membranous glomerulonephritis
Splinter hemorrhages in fingernails
Endocarditis
Starry-sky pattern
Burkitt's lymphoma
Stomach cancer
Adenocarcinoma
Strawberry tongue'
Scarlet fever
Streaky ovaries
Turner's syndrome
String sign on x-ray
Crohn's disease
Subepithelial humps on EM
Poststreptococal glomerulonephritis
Suboccipital lymphadenopathy
Rubella
Sulfur granules
Actinomyces israelii
Surgical wound
Staphylococcus aureus
Swollen gums, bruising, poor wound healing, anemia
Scurvy (ascorbic acid, vitamin C deficiency) - vitamin C is necessary for hydroxylation of proline & lysine in collagen synthesis
Systolic ejection murmur (crescendo-decrescendo)
Aortic valve stenosis
t(14; 18)
Follicular lymphomas (bcl-2 activation)
t(8;14)
Burkitt's lymphoma (c-myc activation)
t(9;22)
Philadelphia chromosome, CML (bcr-abl hybrid)
Tabes dorsalis
Tertiary syphilis
Target cells
Thalassemia
Tendon xanthomas (classically Achilles)
Familial hypercholesterolemia
Testicular tumor
Seminoma
Thumb sign on lateral x-ray
Epiglottitis
Thymoma
Myasthenia gravis (present in 20% of those with MG)
Thyroid cancer
Papillary carcinoma
Thyroidization of kidney
Chronic bacterial pyelonephritis
Tophi
Gout
Tracheoesophageal fistula
Lower esophagus joins trachea/upper esophagus - blind pouch
Tram-track' appearance on LM
Membranoproliferative glomerulonephritis
Traumatic open wound
Clostridium perfringens
Trousseau's sign
Visceral cancer; pancreatic adeneocarcinoma (migratory thrombophlebitis); Hypocalcemia (carpal spasm)
Tumor in men
Prostate carcinoma
Tumor in women
Leiomyoma (estrogen dependent)
Tumor of infancy
Hemangioma
Tumor of the adrenal medulla (adults)
Pheochromocytoma (benign)
Tumor of the adrenal medulla (kids)
Neuroblastoma (malignant)
Type of Hodgkin's
Mixed cellularity (versus: lymphocytic predominance, lymphocytic depletion, nodular sclerosis)
Type of non-Hodgkin's
Follicular, small cleaved
Type of pituitary adenoma
Prolactinoma
UTI
Escherichia coli
UTI (young women)
Staphylococcus saprophyticus
Vasculitis
Temporal arteritis (risk of ipsilateral blindness due to thrombosis of ophthalmic artery)
Viral encephalitis
HSV
Virchow's node
Left supraclavicular node enlargement from metastatic carcinoma of the stomach
Virchow's triad
Pulmonary embolism (triad = blood stasis, endothelial damage, hypercoag.)
Vitamin deficiency (US)
Folic acid (pregnant women are at high risk; body stores only 3-4 month supply)
Waxy casts
Chronic end-stage renal disease
WBC's in urine
Acute cystitis
WBC casts in urine
Acute pyelonephritis
Wire loop' appearance on LM
Lupus nephropathy
Worst headache of my life'
Berry aneurysm - associated with adult polycystic kidney disease
Xanthochromia (CSF)
Subacrachnoid hemorrhage
Xerostomia + arthritis + keratoconjunctivitis sicca
Sjogren's syndrome
(T/F) The outer membrane for G+ and the cell membrane for G- act as major surface antigens.
FALSE: they DO act a major surface antigens BUT the outer mb for G- and the cell membrane for G+
Are endotoxins heat stable?
yes, stable at 100C for 1 hr.
Are endotoxins secreted from cells?
NO
Are endotoxins used as antigens in vaccines?
no, they don\'t produce protective immune response
Are exotoxins heat stable?
no, destroyed rapidly at 60C (exception: Staphylococcal enterotoxin)
Are exotoxins secreted from cells?
YES
Are exotoxins used as antigens in vaccines?
Yes, TOXOIDS are used as vaccines
Describe the chemical composition of peptidoglycan.
Sugar backbone with cross-linked peptide side chains.
Describe the major components of a G- cell wall.
inner and outer lipid bilayer membranes - thin layer of peptidoglycan - periplasmic space - contains lipopolysaccharide, lipoprotein and phospholipid
Describe the major components of a G+ cell wall.
one lipid bilayer membrane - thick layer of peptidoglycan - contains teichoic acid
Describe the process of conjugation.
DNA transfer from one bacterium to another.
Describe the process of transduction.
DNA transfer by a virus from one cell to another
Describe the process of transformation.
purified DNA is taken up by a cell
Does endotoxin induce and antigenic response?
no, not well
Does exotoxin induce and antigenic response?
Yes, induces high-titer antibodies called antitoxins
Give two general functions of peptidoglycan
Gives rigid support - protects against osmotic pressure
How are Group A and Group B Strep primarily differentiated?
Group A are Bacitracin sensitive - Group B are Bacitracin resistant
How are the pathogenic Neisseria species differentiated?
on the basis of sugar fermentation
How are the species of Streptococcus primarily differentiated?
on the basis of their HEMOLYTIC capabilities
List the four phases of the bacterial growth curve.
Lag phase - log (exponential) phase - stationary phase - death phase
Name 2 G- rods that are considered slow lactose fermenters.
Citrobacter and Serratia
Name 3 G- rods that are considered fast lactose fermenters.
1) Klebsiella 2) E. coli 3) Enterobacter
Name 3 G- rods which are lactose nonfermenters and Oxidase(-)?
Shigella, Salmonella, Proteus
Name 4 bacteria that use IgA protease to colonize mucosal surfaces.
1) Strep. pneumoniae 2) Neisseria meningitidis 3) Neisseria gonorrhea 4) H. flu
Name 4 genus of bacteria that are G- \'coccoid\' rods.
1) H. flu 2) Pasteruella 3) Brucella 4) Bordetella pertussis
Name 6 bacteria that don\'t Gram\'s stain well?
Treponema - Rickettsia - Mycobacteria - Mycoplasma - Legionella pneumophila - Chlamydia
Name four genus of bacteria that are G+ rods.
1) Clostridium (an anaerobe) 2) Coynebacterium 3) Listeria 4) Bacillus
Name seven G+ bacteria species that make exotoxins.
1) Corynebacterium diphtheriae 2) Clostridium tetani 3) Clostridium botulinum 4) Clostridium perfringens 5) Bacillus anthracis 6) Staph. aureus 7) Strep. pyogenes
Name three diseases caused by exotoxins.
Tetanus - botulism - diptheria
Name three G- bacteria species that make exotoxins.
1) E. coli 2) Vibrio cholerae 3) Bordetella pertussis
Name three Lactose-fermenting enterics.
Eschericia, Klebsiella, Enterobacter
Name two diseases caused by endotoxins.
Meningococcemia - sepsis by G(-) rods
Name two type of Strep that exhibit alpha hemolysis?
S. pneumoniae - Viridans strep. (e.g. S. mutans)
Name two types of Strep. that are non-hemolytic (gamma hemolysis).
Enterococcus (E. faecalis) and Peptostreptococcus (anaerobe)
Name two types of Strep. that exhibit beta hemolysis.
Group A Strep. (GAS) and Group B Strep. (GBS)
Teichoic acid induces what two cytokines?
TNF and IL-1
What are the effects of erythrogenic toxin?
it is a superantigen - it causes rash of Scarlet fever
What are the effects of streptolysin O?
it is a hemolysin - it is the antigen for ASO-antibody found in rheumatic fever
What are the effects of the exotoxin secreted by Bacillus anthracis? (1)
one toxin in the toxin complex is an adenylate cyclase
What are the effects of the exotoxin secreted by Bordetella pertussis? (3)
Stimulates adenylate cyclase by ADP ribosylation - causes whooping cough - inhibits chemokine receptor, causing lymphocytosis
What are the effects of the exotoxin secreted by Clostridium botulinum?
blocks release of acetylcholine: causes anticholenergic symptoms, CNS paralysis; can cause \'floppy baby\'
What are the effects of the exotoxin secreted by Clostridium perfringens?
alpha toxin is a lecithinase - causes gas gangrene - get a double zone of hemolysis on blood agar
What are the effects of the exotoxin secreted by Clostridium tetani?
blocks release of the inhibitory NT glycine; causes \'lockjaw\'
What are the effects of the exotoxin secreted by Corynebacterium diphtheria? (3)
1) inactivates EF-2 by ADP ribosylation 2) pharyngitis 3) \'pseudomembrane\' in throat
What are the effects of the exotoxin secreted by E. coli? (2)
this heat labile toxin stimulates adenylate cyclase by ADP ribosylation of G protein - causes watery diarrhea
What are the effects of the exotoxin secreted by Staph. aureus?
superantigen; induces IL-1 and IL-2 synthesis in Toxic Shock Syndrome; also causes food poisoning
What are the effects of the exotoxin secreted by Vibro cholerae? (3)
Stimulates adenylate cyclase by ADP ribosylation of G protein - increases pumping of Cl- and H2O into gut - causes voluminous rice-water diarrhea
What are the general clinical effects of endotoxin?(2)
fever, shock
What are three primary/general effects of endotoxin (especially lipid A)?
1) Acivates macrophages 2) Activates completment (alt. pathway) 3) Activates Hageman factor
What are two exotoxins secreted by Strep. pyogenes?
Erythrogenic toxin and streptolysin O
What are two functions of the pilus/fimbrae?
Mediate adherence of bacteria to the cell surface - sex pilus forms attachment b/t 2 bacteria during conjugation
What are two species of Gram (-) cocci and how are they differentiated?
1) Neisseria memingitidis: maltose fermenter 2) Neisseria gonorrhoeae: maltose NONfementer
What bacteria produces a blue-green pigment?
Pseudomonas aeruginosa
What bacteria produces a red pigment?
Serratia marcescens (\'maraschino cherries are red\')
What bacteria produces a yellow pigment?
Staph. aureus (Aureus= gold in Latin)
What culture requirements do Fungi have?
Sabouraud\'s agar
What culture requirements do Lactose-fermenting enterics have?
MacConkey\'s agar (make pink colonies)
What culture requirements does B. pertussis have?
Bordet-Gengou (potato) agar
What culture requirements does C. diphtheriae have?
Tellurite agar
What culture requirements does H. flu have?
chocolate agar with factors V (NAD) and X (hematin)
What culture requirements does Legionella pneumophia have?
Charcol yeast extract agar buffered with increased iron and cysteine
What culture requirements does N. gonorrhea have?
Thayer-Martin (VCN) media
What G- rod is a lactose nonfermenter and is Oxidase+ ?
Pseudomonas
What is a function of the plasma membrane in bacterial cells.
site of oxidative and transport enzymes
What is a toxoid?
exotoxin treated with formaldehyde (or acid or heat); retains antigeniciy but looses toxicity
What is an acronym for remembering 6 bacteria that don\'t Gram\'s stain well?
TRMMLC: These Rascals May Microscopically Lack Color
What is meant by alpha, beta, and gamma hemolysis?
On a Blood agar plate: alpha= complete; clear - beta= partial; green - gamma= no hemolysis; red
What is the chemical composition of a glycocalix?
polysaccharide
What is the chemical composition of bacterial ribosomes?
RNA and protein in 30S and 50S subunits
What is the chemical composition of endotoxin?
Lipopolysaccharide
What is the chemical composition of exotoxin?
polypeptide
What is the chemical composition of spores?
keratin-like coat - dipicolinic acid
What is the funciton and chemical composition of the flagellum?
for motility - made of protein
What is the function of a glycocalix?
mediates adherence to surfaces, especially foreign surfaces (i.e. catheters)
What is the function of spores?
provides resistance to dehydration, heat, and chemicals
What is the major chemical composition of the capsule?
Polysaccharide (*except Bacillus anthracis, which contains D-Glutamate)
What is the major function of the capsule?
antiphagocytic
What is the mode of action of endotoxin?
includes TNF and IL-1
What is the nature of the DNA transferred in conjugation?
Chromosomal or plasmid
What is the nature of the DNA transferred in transduction?
Any gene in generalized transduction; only certain genes in specialized transduction
What is the nature of the DNA transferred in transformation?
Any DNA
What is the periplasm? Where is it found?
the space between the inner and outer cell membranes found in G(-) bacteria.
What is the primary test to subcatergorize G- rods?
are they Lactose Fermenters?
What is the source of endotoxins?
cell wall of most G- bacteria (think N-dotoxin=gram Negative)
What is the source of exotoxins?
certain species of some G+ and G- bacteria
What is the unique chemical component of Gram (-) cell membranes?
Lipopolysaccharide
What is the unique chemical component of Gram + cell membranes?
Teichoic acid
What is used to stain Legionella?
Use silver stain.
What species is Group A Strep?
S. pyogenes
What species is Group B Strep?
S. agalactiae
What stain is amyloid and gives an apple-green birefringence in polarized light?
Congo red
What stain is used for acid fast bacteria?
Ziehl-Neelsen
What stain is used for Borrelia, Plasmodium, trypanosomes, and Chlamydia?
Giemsa\'s
What stain is used for Cryptococcus neoformans?
India ink
What stains gylcogen, mucopolysaccharides and is used to diagnose Whipple\'s disease?
PAS (periodic acid Schiff)
What test distinguishes Staph. and Strep?
Staph. are Catalase (+) and are in clusters - Strep. are Catalase (-) and are in chains
What test distinguishes Staph. aureus from Staph. epidermidis and Staph. saprophyticus?
S. aureus is Coagulase (+) - S. epidermidis and S. saprophyticus are Coagulase (-)
What two things distinguish S. pneumoniae from Viridans Strep.?
S. pneumoniae: have Capsule; Optochin Sensitive - Viridans strep: No capsule; Optochin Resistant
What type of enzymes allows certain bacteria to colonize mucosal surfaces?
IgA proteases
When endotoxin activates complement, what are the secondary effects?
C3a: hypotension, edema - C5a: neutrophil chemotaxis
When endotoxin activates Hageman, what are the secondary effects?
coagulation cascade: DIC
When endotoxin activates macrophages, what 3 cytokines are released and what are the secondary effects?
IL-1--fever - TNF--fever, hemmoragic tissue necrosis - Nitic oxide--hypotension, shock
Where are the genes for endotoxin located?
on the bacterial chromosome
Where are the genes for exotoxin located?
on a plasmid or in a bacteriophage
Where are the spores of Clostridium botulinum found?
canned food - honey
Where is LPS found?
in the outer membrane of G (-) cell walls
Which has a higher toxicity: exotoxin or endotoxin?
EXOTOXIN: fatal dose is ~1ug! (for endotoxin, fatal dose is hundreds of micrograms)
Which type of Neisseria ferment Glucose only?
Gonococci (Glucose= Gonococci)
Which type of Neisseria ferment maltose and glucose?
Meningococci (MaltoseGlucose= MeninGococci)
Which types of transfer can eukaryotic cells do?
only transformation
Which types of transfer can prokaryotic cells do?
all 3: conjugation, transduction, and transformation
Why don\'t Mycobacteria Gram\'s stain well?
high lipid content cell wall requires acid-fast stain
Why don\'t Mycoplasma Gram\'s stain well?
no cell wall
Why don\'t Rickettsia, Chlamydia, and Legionella Gram\'s stain well?
they are intracellular (Legionella is Mainly intracellular)
Why don\'t Treponema Gram\'s stain well?
too thin to be visualized (use darkfield microscopy and antibody staining)
Name 5 species of bacteria that are transmitted to humans from animals.(Acronym: BBugs From Your Pet.)
Borrelia burgdorferi - Brucella spp. - Francisella tularensis - Yersinia pestis - Pasteurella multocida
All Rickettsiae (except one genus) are transmitted by what type of vector?
arthropod (Coxiella is atypical: transmitted by aeresol)
Are G(-) bugs resistant to Pen G? to ampicillin? to vancomycin?
G- bugs are resistant to PenG but may be susceptible to pen. derivative like ampicillin. The G- outer mb inhibits entry of PenG and vancomycin.
Are Strep. pneumoniae sensitve to optochin? Are Viridans strep.?
Strep. pneumoniae is optochin-Sensitive - Viridans streptococci is optochin-Resistant
Are Strep. pyogenes Bacitracin-sensitive?
YES.
Are Viridans strep. alpha, beta, or non-hemolytic?
alpha
Because of drug resistance, what in an alternate treatment combination for leprosy?
rifampin with dapsone and clofazimine
Besides the rash, what other body systems are affected by Lyme disease? (3)
joints -CNS -heart
Describe lab-findings for Pseudomonas aeruginosa.
Aerobic, G(-) rod. - Non-lactose fermenting - Oxidase positive - Produces pyocyanin (blue-green pigment)
Describe the disease associated with M. avium-intracellulare.
often resistant to multiple drugs; causes disseminated disease in AIDS.
Describe the H. flu vaccine. When is it given?
contains type b capsulare polysaccharide conjugated to diphtheria toxoid or other protein. -Given b/t 2m and 18m.
Describe the typical findings with diarrhea caused by enterotoxigenic E. coli. (3)
1) Ferments lactose 2) watery diarrhea 3) no fever/leukocytosis
Describe the typical findings with Vibro cholerae. (3)
1) Comma-shaped organisms 2) rice-water stools 3) no fever/leukocytosis
Do Streptococcus pneumonia have catalase? Do Viridans Strep. have catalase?
NO. both are catalase -
Enterococci are hardier than nonenterococcal group D bacteria. What lab conditions can they grow in?
6.5% NaCl (used as lab test)
Following primary infection with TB, if preallergic lymphatic or hematogenous dissemination occurs, what follows?
-dormant tubercle bacilli form in several organs - REACTIVATION can occur in adult life
Following primary infection with TB, if severe bacteremia occurs, what follows?
Miliary tuberculosis and possibly death
Following primary infection with TB, if the lesion heals by fibrosis, what is the result?
Immunity and hypersensitivity---> tuberculin positive
Following primary infection with TB, under what conditions would the lesion likely progress to lung disease?
HIV, malnutrition. This progressive lung disease can rarely lead to death.
Following primary infection with TB, what are 4 possible courses the disease could take?
1) Heals by fibrosis 2) Progressive lung disease 3) Severe bacteremia 4) Preallergic lymphatic or hematogenous dissemination
Give 3 examples of obligate anaerobes.
Clostridium - Bacteroides - Actinomyces
Give 3 types of infection Pseudomonas aeruginosa is commonly responsible for.
1) burn wound infection 2) nosocomial pneumonia 3) pneumonia with cystic fibrosis
Give 4 examples of encapsulated bacteria.
1) Strep. pneumoniae 2) Haemophilus influenza (especially b) 3) Neisseria memingitidis 4) Klebsiella pneumoniae
H. flu causes what? (4)
Epiglottitis -Meningitis -Otitis media -Pneumonia (haEMOPhilus)
How are Borrelia visualized?
using aniline dyes (Wright\'s or Giemsa stain) in light microscopy
How are Mycobacteria visualized in the lab?
acid-fast stain =Ziehl-Neelson
How are Treponema visualized?
by dark-field microscopy
How can secondary tuberculosis in the lung occur?(2)
1) Reinfection of partially immune hypersensitized hosts (usu. adults) =exogenous source 2) Reactivation of dormant tubercle bacilli in immunocompromised or debilitated hosts =endogenous source
How can you remember that Viridans strep are resistant to optochin?
they live in the mouth and are not afraid of the (opto-)CHIN
How does primary syphilis present?
with a painless chancre (localized disease; 2-10 wks).
How does secondary syphilis present?
disseminated disease (1-3m later) with constitutional symptoms, maculopapular rash, condylomata lata (genital lesions)
How does tertiary syphilis present?
gummas (granulomas), aortitis, neurosyphilis (tabes dorsalis), Argyll-Robertson pupil
How does the bacterium cause the disease?
via exotoxin encoded by beta-prophage; exotoxin inhibits protein synthesis via ADP-ribosylation of EF-2
How does the rash with typhus differ from the rash with RMSF?
typhus: maculopapillary rash BEGINS ON TRUNCK, moves peripherally -RMSF: macules progressing to petichiae BEGIN ON HANDS &FFET and move inward.
How is Brucellosis/Undulant fever transmitted?
dairy products, contact with animals
How is Cellulitis transmitted?
Animal bite; cats, dogs
How is H. flu transmitted?
aeresol
How is Legionnaires\' disease diagnosed in lab?
use silver stain (doesn\'t Gram stain well) -culture with charcoal yeast extract with iron and cysteine.
How is Legionnaires\' disease transmitted?
aeresol transmission from envirnomental water source habitat (NO human-to-human transmission).
How is Lyme disease transmitted?
Tick bite; Ixodes ticks that live of deer and mice
How is Shigella spread?
food, fingers, feces, and flies\'
How is the Plague transmitted?
Flea bite; rodents, especially prairie dogs
How is Tuleremia transmitted?
Tick bite; rabbits, deer
Is Bacillus anthracis G+ or G-? What is its morphology?
It is a G+, spore-forming rod
Is there an animal reservoir for leprosy?
Yes, armadillos in the US
List 5 findings associated with rheumatic fever. (Hint: PECCS)
Polyarthritis - Erythema marginatum -Chorea - Carditis - Subcutaneous nodules
List the \'ABCDEFG\' of diphtheria.
ADP ribosylation -Beta-prophage -Corynebacterium - Diphtheria - Elongation Factor 2 - Granules
Name 2 alpha-hemolytic bacteria.
Strep. pneumoniae - Viridans streptococci
Name 2 bugs that cause diarrhea but NOT fever and leukocytosis?
E. coli and Vibro cholerae
Name 2 disease processes that can be caused by enterococci.
1) UTI 2) subacute endocarditis
Name 2 species of enterococci.
Enterococcus faecalis -Enterococcus faecium
Name 2 symptoms of diphtheria.
pseudomembraneous pharyngitis (grayish white membrane) - lymphadenopathy
Name 3 spore forming bacteria.
Bacillus anthracis - Clostridium perfringens - C. tetani
Name 4 beta-hemolytic bacteria.
1) Staph. aureus 2) Strep. pyogenes (GAS) 3) Strep. agalactiae (GBS) 4) Listeria monocytogenes
Name 4 lactose-fermenting enteric bacteria.
Klebsiella -E. coli -Enterobacter Citrobacter (think Lactose is KEE for first three listed)
Name 4 obligate aerobic bacteria.
Norcardia - Pserudomonas aeruginosa - Mycobacterium tuberculosis - Bacillus
Name 5 bugs that cause watery diarrhea.
1) Vibrio cholerae 2) enterotoxigenic E. coli 3) viruses (rotavirus) 4) protozoa (Cryptosporidium and (5) Giardia)
Name 6 bugs that cause bloody diarrhea.
1) Salmonella 2) Shigella 3) Campylobacter jejuni 4) enterohemorrhagic/enteroinvasive E.coli 5) Yersinia enterocilitica 6) Entamoeba histolytica (a protozoan)
Name 7 faculatative intracellular bacteria.
1) Mycobacterium 2) Brucella 3) Francisella 4) Listeria 5) Yersinia 6) Legionella 7) Salmonella
Name three genera of spirochetes.
Borrelia (big size) - Leptospira -Treponema (think: BLT; B is big)
Name two lab tests used to detect syphilis?
VDRL and FTA-ABS
Name two non-lactose fermenting bacteria that invade intestinal mucosa and can cause bloody diarrhea.
Salmonella and Shigella
Name two obligate intracellular bacteria.
Rickettsia and Chlamydia (Hint: \'stay inside when its Really Cold.\')
RMSF is endemic to what part of the US?
the East Coast (in spite of the name)
Spore are formed by certain species of what type of bacteria?
Gram+ rods, usually in soil; form spores only when nutrients are limited
T/F Chlamydia are obligate intracellular parasites that cause mucosal infections.
TRUE
T/F Chlamys means cloak.
TRUE (intracellular)
T/F Enterobacteriaceae are oxidase negative and are glucose fermenters.
TRUE
T/F H. pylori infection is a risk factor for peptic ulcer and gastric carcinoma.
TRUE
T/F Penicillin is not an effective treatment against Mycoplasma pneumoniae.
TRUE Mycoplama are naturally resistant b/c they have no cell wall.
T/F Pseudomonas produces both endotoxin and exotoxin.
TRUE: endotoxin---> fever, shock -exotoxin---> inactivates EF-2
T/F Rickettsiae are obligate intracellular parasites and need CoA and NAD.
TRUE
T/F Some enterococci are resistant to PenG.
FALSE: ALL enterococci are naturally resistant to Pen/cephlosporins.
T/F Spores have no metabolic activity.
TRUE
T/F: S. aureus food poisoning is due to the ingestion of bacteria that rapidly secrete toxin once they enter the GI tract.
FALSE: rapid onset of S. aureus food poisoning is due to injestion of PREFORMED toxin
The Weil-Felix reaction usually tests positive for what two diseases? Negative for what? Cross reacts with what?
Positive: typhus and RMSF -Negative: Q fever -Cross-reacts: with Proteus antigen
Think COFFEe for Enterobacteriaceae. What does that stand for?
Capsular -O-antigen -Flagellar antigen -Ferment glucose -Enterobacteriaceae
What\'s a pneumonic for remembering 4 obligate aerobes?
Nagging Pests Must Breath (=Norcardia - Pserudomonas aeruginosa - Mycobacterium tuberculosis - Bacillus
What (6) infections can Pseudomonas aeruginosa cause?
burn-wound infections -Pneumonia (esp. in cystic fibrosis) -Sepsis (black skin lesions) -External Otitis (swimmer\'s ear) - UTI -hot tub folliculitis
What 2 bugs can cause bloody diarrhea, fever, and leukocytosis, but do not ferment lactose?
Salmonella and Shigella
What animals carry Lyme disease?
The Ixodes tick transmits it. - Deer are required for tick life cycle. - Mice are important resservoirs.
What anitbody class is necessary for an immune response to encapsulated bacteria?
IgG2.
What are 2 disease processes caused by Viridans strep and what species are responsible?
1) dental caries: Strep. mutans 2) bacterial endocarditis: Strep. sanguis
What are 2 options for triple thearpy treatment of H. pylori?
(1) bismuth (Pepto-Bismal), metronidazole, and tetracyclin or amoxicillin. OR (2) metronidazole, omeprazole, and clarithromycin (#2 is more expensive)
What are 3 advantages/differences between VDRL and FTA-ABS?
FTA-ABS is 1) more specific 2) positive earlier in disease 3) remains positive longer than VDRL
What are 3 disease processes caused by Strep. pyogenes?
1) Pyogenic--pharyngitis, cellulitis, skin infection 2) Toxigenic--scarlet fever, TSS 3) Immunologic--rheumatic fever, acute glomerulonephritis
What are 4 biological false positives for VDRL?
1) Viruses (mono, hepatitis) 2) Drugs 3) Rheumatic fever and rheumatic arthritis 4) Lupus and leprosy (=VDRL)
What are 4 clinical symptoms of \'walking\' pneumonia?
1) insidious onset 2) headache 3) nonproductive cough 4) diffuse interstitial infiltrate
What are 4 clinical symptoms of TB?
1) fever 2) night sweats 3) weight loss 4) hemoptysis
What are 5 areas that can be affected by extrapulmonary TB?
1) CNS (parenchmal tuberculoma or meningitis) 2) Vertebral body (Pott\'s disease) 3) Lymphadenitis 4) Renal 5) GI
What are the culture requirement for H. flu?
culture on chocolate agar with factor V (NAD) and X (hematin). [Think: \'Child has \'flu\'; mom goes to five (V) and dime (X) store to buy chocolate.\']
What are the lab findings with Chlamydia?
cytoplasmic inclusions on Giemsa fluorescent antibody-stains smear
What are the symptoms of RMSF? (3)
1) rash on palms and soles (migrating to wrists, ankles, then trunck) 2) headache 3) fever
What are the three stages of Lyme disease?
1) erythema chronicum migrans, flu-like symptoms 2) neurologic and cardiac manefestations 3) autoimmune migratory polyarthritis
What are the two forms of chlamydia?
1) Elementary body (small, dense): Enters cell via endocytosis 2) Initial or Reticulate body: Replicates in the cell by fission
What are the two forms of leprosy (or Hansen\'s disease)?
1) lepromatous- failed cell-mediated immunity, worse 2) tuberculoid- self-limited.
What are two drugs that could be used to treat \'walking\' pneumonia?
tetracycline or erythromycin
What are two drugs that could treat Chlmydia?
erythromycin or tetracycline
What are two lab findings associated with \'walking\' pneumonia?
1) X-ray looks worse than patient 2)High titer of cold agglutinins (IgM)
What are usually associated with pseudomembraneous colitis?
Clostridium difficile; it kills enterocytes, usu. is overgrowth secondary to antibiotic use (esp. clindamycin or ampicillin)
What bacteria are G+, spore-forming, anaerobic bacilli?
Clostridia
What bacteria causes a malignant pustule (painless ulcer); black skin lesions that are vesicular papules covered by a blak eschar?
Bacillus anthracis
What bacteria exhibits a \'tumbling\' motility, is found in unpasteurized milk, and causes meningitis in newborns?
Listeria monocytogenes
What bacteria is catalase(-) and bacitracin-resistant?
Strep. agalactiae
What bacteria is catalase(-) and bacitracin-sensitive?
Strep. pyogenes
What bacteria is catalase+ and coagulase+?
Staph. aureus
What bacteria produces alpha-toxin, a hemolytic lecithinase that causes myonecrosis or gas gangrene?
Clostridium perfringens
What bacterium causes Cellulitis?
Pasteurella multocida
What bacterium causes leprosy?
Mycobacterium leprae
What bacterium causes Lyme disease?
Borrelia burgdorferi
What bacterium causes the Plague?
Yersinia pestis
What bacterium causes Tularemia?
Francisella tularensis
What bacterium causes Undulant fever?
Brucella spp. (a.k.a. Brucellosis)
What bug causes atypical \'walking\' pneumonia?
Mycoplama pneumoniae
What bug causes gastroenteritis and up to 90% of duodenal ulcers?
Helicobacter pylori
What bug causes Legionnaire\'s disease?
Legionella pneumophila
What bug is associated with burn wound infections?
Pseudomonas aeruginosa
What bug is comma- or S-shaped and grows at 42C, and causes bloody diarrhea with fever and leukocytosis?
Campylobacter jejuni
What bug that causes diarrhea is usually transmitted from pet feces (e.g. puppies)?
Yersinia enterocolitica
What causes tetanus? (give bacteria and disease process)
Clostridium tetani: exotoxin produced blocks glycine release (inhibitory NT) from Renshaw cells in spinal cord
What causes the flu?
NOT H. flu -it is caused by influenza virus
What chemical is found in the core of spores?
dipicolinic acid
What coccobacillus causes vaginosis: greenish vaginal discharge with a fishy smell; nonpainful?
Gardnerella vaginalis
What disease does Bordetella perussis cause? How?
Whooping cough: toxin permanently disables G-protein in respiratory mucosa (turns the \'off\' off);ciliated epithelial cells are killed; mucosal cells are overactive.
What disease does Vibrio cholerae cause? How?
Cholera: toxin permanently activates G-protein in intestinal mucosa (turns the \'on\' on) causing rice-water diarrhea
What disease is caused by Borrelia?
Lyme Disease
What disease is caused by Clostridium botulinum? What pathophys. does it cause?
Botulism: associated with contaminated canned food, produces a preformed, heat-labile toxin that inhibits ACh release---> flaccid paralysis.
What diseases (2) are caused by Treponema?
Syphilis (T. pallidum) -yaws (T. pertenue; not and STD)
What diseases can be caused by Staph. aureus?
Inflammatory disease: skin infections, organ abcess, pneumonia - Toxin-mediated disease: Toxic Shock Syn., scalded skin syndrome (exfoliative toxin), rapid onset food poisoning (enterotoxins)
What do Chlamydia trachomatis serotypes A, B, and C cause?
chronic infection, cause blindness in Africa (ABC= Africa / Blindness / Chronic
What do Chlamydia trachomatis serotypes D-K cause? (3)
urethritis/ PID - neonatal pneumonia -neonatal conjuctivitis
What do Chlamydia trachomatis serotypes L1,L2, and L3 cause?
lymphogranuloma venereum (acute lymphadentis: positive Frei test)
What do RMSF, syphilis, and coxsackievirus A infection have in common?
rash on palm and sole is seen in each (coxasackievirus A =hand, foot, and mouth disease)
What does catalase do? Which bacteria have it?
it degrades H2O2, an antimicrobial product of PMNs. - Staphlococci make catalase; Strep. do NOT.
What does the H-antigen represent?
H: flagellar antigen, found on motile species
What does the K-antigen represent?
K: capsular, relates to virulence
What does the O-antigen represent?
O-antigen is the polysaccharide of endotoxin (found on all species)
What does VDRL detect? (It detects non-specific antibody that reacts with what?)
detects antibody that reacts with beef cardiolipin
What drug of choice is used to treat Norcardia? Actinomyces? (Acronym: SNAP)
Sulfa for Norcarida, Actinomyces gets Penicillin
What enteric bacterial infection may be prolonged with antibiotic treatment?
Salmonellosis
What enzyme allows H. pylori to creat an alkaline environment?
urease (cleaves urea to ammonia); used in urease breath test
What family includes E. coli, Salmonella, Klebsiella, Enterobacter, Serratia, and Proteus?
Enterobacteriaceae
What family of bacteria uses the O-, K-, and H-antigen nomenclature?
Enterobacteriaceae
What function does the capsule serve? (2: one for the bacterium, one other)
1) antiphagocytic 2) antigen in vaccines (Pneumovax, H. flu b, meningococcal vaccines)
What G+ anaerobe causes oral/facial abscesses with \'sulfur granules\' that may drain through sinus tracts in skin?
Acinomyces israelii
What G+ and also weakly acid fast aorobe found in soil causes pulmonary infections in immunocompromised patients?
Norcardia asteroides
What general type of bacteria are normal flora in GI tract but pathogenic elsewhere?
Anaerobes
What general type of bacteria grow pink colonies on MacConkey\'s agar?
Lactose-fermenting enteric bacteria
What is a Ghon complex and in whom does it occur?
Occurs in Primary TB (usually a child) -Ghon complex= draining Hilar nodes and Ghon focus, exudative parenchymal lesion (usu. in LOWER lobes of lung)
What is a lab diagnosis of diphtheria based on?
G+ rods with metachromatic granules; grows on tellurite agar. (Coryne=club shaped)
What is a major difference between Salmonella and Shigella observable in the lab?
Salmonella are motile; Shigella are nonmotile
What is a positive Quellung reaction?
if encapsulated bug is present, capsule SWELLS when specific anticapsular antisera are added.
What is notable about Chrmydia psittaci?
has an avian reservoir
What is one reason M. leparae infects skin and superficial nerves?
It likes cool temperatures
What is the classic symptom of Lyme Disease?
erythema chronicum migrans, an expanding \'bull\'s eys\' red rash with central clearing.
What is the classic triad of symptoms associated with Rickettsiae?
1) headache 2) fever 3) rash (vasiculitis)
What is the common manifestation of secondary TB?
Fibrocaseous cavitary lesion usu. in APICIES of lung
What is the common site of infection for Mycobacterium tuberculosis?
the apicies of the lung (which have the highest PO2)
What is the D.O.C. to treat Gardnerella vaginalis?
Metroidazole
What is the DOC for treating rickettsial infections?
tetracycline
What is the DOC for treatment of most rickettsial infections?
tetracycline
What is the DOC to treat Lyme Disease?
tetracycline
What is the DOC to treat syphilis?
Penicillin G
What is the drug of choice for H. flu meningitis? What DOC for prophylaxis in close-contacts?
Treat meningitis with CEFTRIAXONE; Rifampin for prophylaxis.
What is the drug of choice for Legionaires\' disease?
Erythromycin
What is the morphology of H. flu?
Small G(-) (coccobacillary) rod
What is the morphology of H. pylori?
Gram (-) rod
What is the primary drug used to treat leprosy?
dapsone (toxicity is hemolysis and methemoglobinemia)
What is the recommended treatment for Pseudomonas aeruginosa infection?
aminoglycoside plus extended-spectrum penicillin (e.g. piperacillin or ticarcillin)
What is the source of infection and the bacterium that causes endemic typhus?
R. typhi; from fleas
What is the source of infection and the bacterium that causes epidemic typhus?
R. prowazekii; from human body louse
What is the source of infection and the bacterium that causes Q fever?
Coxiella burnetii; from inhaled aersols
What is the source of infection and the bacterium that causes Rocky Mountain Spotted Fever?
Rickettsia rickettsii; from tick bite
What is the toxin responsible for TSS is Staph. aureus?
TSST-1; it is a superantigen that binds to class II MHC and T-cell receptors---> polyclonal T-cell activation
What is the unique component found in Mycoplamsa bacterial membranes?
cholesterol
What is the unique feature of Chlamydiae cell walls?
its peptidoglycan wall lacks muramic acid
What is woolsorter\'s disease?
inhalation anthrax; can cause life-threatening pneumonia
What lab test assays for antirickettsial antibodies?
Weil-Felix reaction
What Lancefield Antigen Group are enterococci in?
Group D
What Lancefield Antigen Group are Viridans strep in?
They are non-typealbe. They do not have a C-carbohydrate on their cell wall to be classified by.
What level of disinfection is required to kill spores?
autoclaving; they are highly resistant to destruction by heat and chemicals
What populations are most likely to get Mycoplama pneumoniae infection?
patients younger than age 30 - military recruits - prisons
What rickettsial disease is atypical in that it has no rash, no vector, negative Weil-Felix reaction, and its causative organism can survive outside for a long time?
Q fever (Coxiella burnetii)
What species are associated with food poisoning in contaminated seafood?
Vibrio parahaemolytica and Virbrio vulnificus
What species causes diphtheria?
Corynebacterium diptheriae
What species is associated with food poisoning in improperly canned foods (bulging cans)?
Clostridium botulinum
What species is associated with food poisoning in meats, mayonnaise, and custard?
Staphylococcus aureus (this food poisoining usu. starts quickly and ends quickly)
What species is associated with food poisoning in poultry, meat, and eggs?
Salmonella
What species is associated with food poisoning in reheated meat dishes?
Clostridium perfringens
What species is associated with food poisoning in reheated rice?
Bacillus cereus (\'Food poisoning from reheated rice? Be serious!\')
What species is associated with food poisoning in undercooked meat and unpasteurized juices?
E. coli 0157-H7
What species of Mycobacteria causes pulmonary, TB-like symptoms?
M. kansasii
What strain of Haemophilus influenza causes most invasive disease?
capsular type b
What symptoms are associated with M. scrofulaceum
cervical lymphadenitis in kids
What test differentiates Viridans from S. pneumoniae?
Viridans are resistant to optochin; S. pneu. are sensitive to optochin
What two bugs secrete exotoxins that act via ADP ribosylation of G-proteins, permanently activating adenyl cyclase (resulting in increased cAMP)?
Vibrio cholerae - Bordetella pertussis
What two genera of G+ rods form long branching filaments resembling fungi?
Acinomyces and Nocardia
What type of bacteria are difficult to culture, produce gas in tissue (CO2 and H2), and are generally foul-smelling?
Anaerobes
What type of bacteria is associated with rusty sputum, sepsis in sickle cell, and splenectomy?
Pneumoccocus
What type of E. coli are associated with bloody diarrhea?
enterohemmoragic/ enteroinvasive E. coli
What type of immunologic response is elicited by a Salmonella infection?
monocyte response
What types of infection can chlamydia cause? (4)
arthritis - conjunctivitis - pneumonia - nongonococcal urethritis
What virulence factor of Staph. aureus binds Fc-IgG, inhibiting complement fixation and phagocytosis?
Protein A
What virulence factor of Strep. pyogenes also serves as an antigen to which the host makes antibodies?
M-protein
What will likely be visible under the microscope in the case of Gardnerella vaginallis infection?
Clue cell, or vaginal epithelial cells covered with bacteria
Where are Viridans strep. found (reservoir)?
normal flora of oropharynx
Where are when is Lyme disease common?
common in northeast US in summer months
Which disease/toxin causes lymphocytosis? (Cholera or Pertussis)
Pertussis toxin: by inhibiting chemokine receptors
Which has an animal reservoir? (Salmonella or Shigella)
Salmonella: poultry, meat, eggs
Which is more specific for syphilis: VDRL or FTA-ABS?
FTA-ABS is more specific
Which is more virulent? (Salmonella or Shigella)
Shigella (10^1 organisms vs. Salmonella 10^5 organisms)
Which is motile? (Salmonella or Shigella)
Salmonella (think: salmon swim)
Which species of chlamydia causes and atypical pneumonia? How is it transmitted?
C. pneumonia -transmitted via aeresol
Which two species of chlamydia infect only humans?
C. trachomatis -C. pneumoniae
Why are anaerobes susceptible to oxygen?
they lack catalase and/or oxidase and are susceptible to oxidative damage
Why does TB usually infect the upper lobes of the lung?
M.tuberculosis is an aerobe; there is more oxygen at the apicies
Why must rickettsia and chlamydia always be intracellular?
they can\'t make their own ATP
Are most fungal spores asexual?
yes
Are most P. Carinii infections symptomatic?
no, most of are asymptomatic
Are the above mentioned systemic mycoses dimorphic?
yes, except coccioidomycosis which is a spherule in tissue
How do the S. Schenckii yeast appear in the pus?
Cigar-shaped budding yeast
How do you diagnose cryptosporidium?
cysts on acid fast stain
How do you diagnose giardiasis?
Trophozoites or cysts in stool
How do you get P. Carinii?
Inhalation
How do you treat systemic mycoses?
fluconazole or ketoconazole for local infection, amphotericin B for systemic infection
How do you Tx S. Schenckii?
Itraconazole or Potassium Iodide
How does Aspergillus appear microscopically?
Mold with septate hyphae that branch at a V-shaped (45 degree angle) , they are NOT dimorphic
How does Mucor species appear microscopically?
It is a mold with irregular nonseptate hyphae branching at wide angles>90 degrees
How does Paracocciodioidomycosis appear histologically?
Captain\'s wheel\' appearance (like on a sailboat)
How is Clonorchis sinensis transmitted and what disease results?
undercooked fish; causes inflammation of the biliary tract
How is Schistosoma transmitted and what disease results?
snails are host; cercariae penetrate skin of humans; causes granulomas, fibrosis, and inflammation of the spleen and liver
How is Ancylostoma Duodenale transmitted and what disease results?
Larvae penetrate skin of feet; intestinal infection can cause anemia
How is Ascaris Lumbricoides transmitted and what disease results?
Eggs are visible in feces; intestinal infection
How is cryptosporidium transmitted?
Cysts in Water
How is Dracunculus medinensis transmitted and what disease results?
In drinking water; sink inflammation and ulceration
How is E. granulosis transmitted and what disease results?
Eggs in dog feces cause cysts in liver; causes anaphylaxis if echinococcal antigens released from cysts
How is E. Histolytica transmitted?
Cysts in Water
How is Enterobius Vermicularis transmitted and what disease results?
food contaminated with eggs; intestinal infections; causes anal pruritus
How is giardia transmitted?
Cysts in Water
How is Loa loa transmitted and what disease results?
Transmitted by deer fly; causes swelling the in the skin (can see worm crawling in conjunctiva)
How is malaria dx?
Blood smear
How is malaria transmitted?
mosquito (Anopheles)
How is Onchocerca volvulus transmitted and what disease results?
transmitted by female blackflies; causes river blindness
How is Paragonimus Westermani transmitted and what disease results?
Undercooked crab meat; causes inflammation and secondary bacterial infection of the lung
How is Sporothrix schenckii appear under the scope?
Dimorphic fugus that lives on vegetation
How is Strongyloides Stercoralis transmitted and what disease results?
larvae in soil penetrate the skin; intestinal infection
How is T. Canis transmitted and what disease results?
food contaminated with eggs; causes granulomas (if in retina=blindness)
How is T. Solium transmitted and what disease results?
undercooked pork tapeworm; causes mass lesions in the brain, cysticercosis
How is T. Vaginalis transmitted?
sexually
How is Toxo transmitted?
cysts in meat or cat feces
How is Trichinella Spiralis transmitted and what disease results?
undercooked meat, usually pork; inflammation of muscle, periorbital edema
How is Wucheria transmitted and what disease results?
female mosquito; causes blockage of lymphatic vessels (elephantiasis)
In what cells do you find histoplasmosis?
macrophages
Is Pneumocystis Carinii a yeast?
Yes, but originally classified as a Protozoa
Microscopically how does Candida appear?
budding yeast with pseudohyphae, germ tube formation at 37 degrees C)
Name 3 Trematodes (Flukes) .
Schistosoma, Clonorchis sinensis, Paragonimus Westermani
Name 4 opportunistic fungal infections.
Candida Albicans, Aspergillus fumigatus, Cryptococcus Neoformans, Mucor and Rhizopus species
Name 4 systemic mycoses.
Coccidiomycosis, Histoplasmosis, Paracoccidioidomycosis, Blastomycosis
Name two asexual spores transmitted by inhalation.
Hisoplasmosis and Coccidiodomycosis
Name two Cestodes (Tapeworms) .
Taenia Solium, and Echinococcus Ganulosus
What agar is used to culture for systemic mycoses?
Sabouraud\'s Agar
What are Conidia?
asexual fungal spores (ex. Blastoconidia, and arthroconidia)
What are some common Candida infections?
Thrush in Immunocompromised pts (neonates, patients on steroids, diabetics and AIDS pts) , endocarditis in IV drug users, vaginitis (high pH, Diabetes, post-antibiotic) , diaper rash, disseminated candidiasis (to any organ)
What are some infections caused by cryptococcus?
Cryptococcal meningitis, cryptococcosis
What are the 10 Nematodes (roundworms) we are concerned with?
Ancylostoma duodenale (hookworm) , Ascaris Lumbricoides, Enterobius Vermicularis (pinworm) , Strongyloides stercoralis, Trichinella Spiralis, Dracunculus Medinensis, Loa loa, Onchocerca Volvulus, Toxocara Canis, Wucheria Bancrofti
What are the 4 B\'s of Blastomycosis?
Big, Broad-Based, Budding
What are the diseases caused by Cryptosporidium?
Severe diarrhea in AIDS, Mild disease (watery diarrhea) in non-HIV
What are the diseases caused by Toxoplasma?
Brain Abscess in HIV and birth defects
What are the infections caused by Aspergillus?
Ear fungus, Lung cavity Aspergilloma (\'fungus ball\') , invasive aspergillosis.
What can systemic mycoses mimic?
TB (granuloma formation)
What disease are caused by Entamoeba Histolytica?
Amebiasis: bloody diarrhea, dysentery, liver abscess, RUQ pain
What disease does Mucor species cause?
Mucormycosis
What disease does Pneumocystis carinii cause?
Pneumocystis Carinii Pneumonia
What disease does Sporothrix Schenckii cause?
Sprotricosis
What disease does Trypanosoma Cruzi casue?
Chaga\'s Disease (heart disease)
What disease is caused by Giardia Lamblia?
Giardiasis: bloating, flatulence, foul-smelling diarrhea
What disease is caused by Leishmanina donovani?
Visceral Leishmaniasis (Kala-azar)
What disease is caused by P. Carinii?
Diffuse interstitial pneumonia in HIV
What disease is caused by the plasmodium species (vivax, ovale, malariae, falciparum) ?
Malaria: cyclic fever, headache, anemia, splenomegaly
What disease is caused by Trypanosma Gambiense and Rhodesiense?
African Sleeping sickness
What disesase does Trichomonas Vaginalis cause?
Vaginitis: foul-smeilling, greenish discharge; itching and burning
What do you tx P. Carinii with?
TMP-SMZ, or pentamidine, or dapsone
What do you use to culture cryptococcus?
Asabouraud\'s Agar
What do you use to Diagnose E. Histolytica?
Serology and/or trophozoites or cysts in stool
What do you use to stain Cryptococcus?
India Ink
What do you use to tx cryptosporidium?
nothing
What do you use to Tx Giardiasis?
Metronidazole
What do you use to tx T. Vaginalis?
Metronidazole
What do you used to dx P. Carinii?
Lung biopsy or lavage, methenamine silver stain
What do you used to Tx Candida Albicans?
Nystatin for superficial infection, Amphotericin B for systemic
What does Alba mean?
white
What does dimorphic mean?
fungi that are mold in the soil (low temp) and yeast in tissue (higher/body temp 37 C)
What is diagnositic for L. donovani?
Macrophages containg amastigotes
What is diagnositic of T. Vaginalis?
Trophozoites on wet mount
What is histoplasmosis associated with?
bird or bat droppings
What is the progression of S. Schenckii infection?
traumatic introduction into the skin, typically by a thorn (\'rose gardner\'s\' disease) , causes local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis) . Little systemic illness.
What is the vector for L. donovani?
Sandfly
What is the vector for T. Cruzi?
Reduviid Bug
What is the vector for T. Gambiense and Rhodesiense?
Tstese fly
What is used to dx African sleeping sickness?
Blood smear
What is used to dx T. Cruzii?
blood smear
What is used to dx toxoplasma?
serology and biopsy
What is used to treat D. Medinensis?
Niridazole
What is used to Treat E. Histolytica?
Metronidazole and Iodoquinol
What is used to tx african sleeping sickness?
Suramin for bloodborne disease or melaroprol for CNS penetration
What is used to tx Ancylostoma duodenale?
Mebendazole/pyrantel pamoate
What is used to tx Ascaris Lumbricoides?
Mebendazole/pyrantel pamoate
What is used to tx Clonorhis sinensis?
Praziquantel
What is used to tx E. Granulosus?
Albendazole
What is used to tx E. Vermicularis?
Mebendazole/pyrantel pamoate
What is used to tx L. Donovani?
Sodium Stibogluconate
What is used to tx Loa loa?
diethylcarbamazine
What is used to tx malaria?
Chloroquine ( primaquine for vivax, ovale) , sulfadoxine + pyrimethamine, mefloquine, quinine
What is used to tx O. Volvulus?
Ivermectin
What is used to tx Paragonimus Wetermani?
Praziquantel
What is used to tx S. Stercoralis?
Ivermectin/thiabendazole
What is used to tx schistosoma?
Praziquantel
What is used to tx T. Canis?
diethylcarbamazine
What is used to tx T. Cruzii?
Nifurtimox
What is used to tx T. Spiralis?
Thiabendazole
What is used to tx taenia solium infection?
Praziquantel/niclosamide; albendazole for cysticercosis
What is used to tx toxoplasma?
sulfadiazine + pyrimethamine
What is used to tx W. Bancrofti?
diethylcarbamazine
What patient population is susceptible to Mucor disease?
Ketoacidotic patients and Leukemic patients
What stain do you use for lung tissue when you are detecting P. Carinii?
silver
What state predisposes you to P. Carinii infection?
Immunosuppression
What test can be used to detect polysaccharide capsular antigen of Cryptococcus?
latex agglutination test
What types of infections can Candida Albicans cause?
systemic or superficial fungal in fections
When do you start prophylaxis in HIV patients?
when the CD4 drops below 200 cells/mL
Where do the mucor and rhizopus species fungi proliferate?
in the walls of blood vessels and cause infarction of distal tissue
Where is Blastomycosis endemic?
States east of the Mississippi River and Central America
Where is Coccidioidomycosis endemic?
SWUS, California (San Joaquin Valley or destert (desert bumps) \'Valley fever\')
Where is Histoplasmosis endemic?
Mississippi and Ohio River valleys
Where is Paracoccioidomycosis endemic?
Rural Latin America
All viruses are haploid except _________?(1)
Retroviruses, which have two identical ssRNA molecules (diploid).
Bites from what 3 animals are more prone to rabies infection than a bite from a dog?
Bat, Raccoon, and Skunk
Define complementation?
When one of 2 viruses that infects the cell has a mutation that results in a nonfunctional protein. The nonmutated virus \'complements\' the mutated one by making a functional protein that serves both viruses.
Define genetic drift.
Minor changes based on random mutations.
Define genetic shift.
Reassorment of viral genome (such as when human flu A virus recombines with swin flu A virus.)
Define phenotypic mixing?
When virus A acquires virus B coat proteins and acts like virus B buts its progeny will have virus A genome and coat.
Define reassortment?
-When viruses with segmented genomes (eg. influenza virus) exchange segments. -High frequency recombination. Cause of worldwide pandemics.
Define recombination?
Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology.
Describe its incubation period and whether or not it has a carrier.
-Short incubation period (3 weeks) -No carriers
Describe its incubation period and whether or not it has a carrier.
-Long incubation (3 months) - has carriers
Describe the general concept of bacterial super infection which can occur with influenza infection?
A life-threatening illness where a bacterial infection is superimposed on an existing viral infection.
Describe the genetic and physical properties of influenza virus?
-Enveloped -ssRNA virus with segmented genome -prone to genetic changes
Describe the migration of rabies within the CNS.
It migrates in a retrograde fashion within the CNS up n. axons.
Describe the physical shape and duration of incubation for rabies.
-Bullet-shaped capsid (illus. in book) -long incubation period (wks. - 3 months)
Describe the technique and purpose for performing a Tzanck test?
-assay for herpes -make a smear of an opened skin vesicle to detect multinucleated giant cells
Describe whether or not it has a carrier.
has carriers
Does HDV have carriers?
Yes
Explain the concept of a slow virus infection.
Virus exists in patient for months to years before it manifests as clinical disease.
From the following selection which classes are considered infectious and which aren\'t: dsDNA, ds RNA, (-)ssRNA, (+)ssRNA.
-Infectious: dsDNA (except poxviruses and HBV) and (+)ssRNA -Noninfectious: dsRNA and (-)ssRNA
HCV is a common form of hepatitis in what US population?
IV drug users
How does a Monospot test work?
It detects heterophil antibodies by agglutination to sheep RBC\'s
How is RNA translated and processed in picornaviruses?
RNA is translated into one long polypeptide that is cleaved by proteases into many small proteins.
How many segments and what sense is the RNA genome of influenza viruses?
-8 segments -negative sense
How may serotypes do paramyxoviruses have except parainfluenza which has ___?
-1 -4
Into what class RNA or DNA to all segmented viruses fall?
RNA
Killed vaccines induce what type of immunity?
Humoral, with no possibility of the virus reverting to virulence
Live attenuated vaccines induce what type of immunity?
Humoral and Cellular -with a risk of the virus reverting to virulence
Mneumonic for rotavirus symptoms: ROTA
Right Out The Anus
Mneumonic: Hep D:
Defective, Dependent on HBV
Mneumonic: Hep E:
Enteric, Expectant mothers, Epidemics
Mneumonic: Hep A:
Asymptomatic (usually)
Mneumonic: Hep B:
Blood-borne
Mneumonic: picoRNAvirus
pico = \'small\' RNA viruses
Name 2 common bacterial infections in AIDS pts.
TB, M. avium-intracellulare complex
Name 2 common protozoan infections in AIDS pts.
Toxoplasmosis, cryptosporidiosis
Name 3 members of the arborvirus family.
Flavivirus, Togavirus, and Bunyavirus
Name 3 possible sequelae of measles infection?
-SSPE -encephalitis -giant cell pneumonia (rare;found in immunocompromised persons)
Name 4 common fungal infections in AIDS pts.
-Thrush (Candida ablicans) -cryptococcosis (cryptococcal meningitis) -histoplasmosis -Pneumocystis pneumonia
Name 4 common viral infections in AIDS pts.
-HSV -VZV -CMV -progressive multifocal leukoencephalopathy (JC virus)
Name 4 herpesviruses using the mneumonic: Get herpes in a CHEVrolet.
-CMV -HSV -EBV -VZV
Name 4 main segmented viruses using the mneumonic BOAR.
-Bunyaviruses -Orthomyxoviruses (influenza virus) -Arenaviruses -Reoviruses
Name eveloped DNA viruses (3). HPH
-Hepadna -Pox -Herpes
Name naked DNA viruses (3). PAP
-Parvo -Adeno -Papova \'You need to be naked for a PAP smear.\'
Name the 3 naked RNA viruses Naked CPR).
-Calcivivirus -Picornavirus -Reovirus
Name the characteristic cytoplasmic inclusions seen in neurons infected with rabies.
Negri bodies
Name the DNA enveloped viruses (3).
-Herpesviruses (herpes simplex virus types 1 and 2, VZV, CMV, EBV) -HBV -smallpox virus
Name the DNA nucleocapsid viruses (2).
Adenovirus, Papillomaviruses
Name the DNA viruses using the mneumonic \'HHAPPPy viruses.\'
-Hepadnavirus -Herpesviruses -Adenovirus -Parvovirus -Papovavirus -Poxvirus
Name the illness caused by rabies and 2 primary symptoms.
Encephalitis, fatal is not prevented, with seizures and hydrophobia.
Name the members of the PaRaMyxovirus using the letters in bold (4 viruses).
-Parainfluenza -RSV -Measles -Mumps
Name the recombinant vaccine available (1).
HBV (antigen = recombinant HBsAg)
Name the RNA enveloped viruses (9).
-Influenza viruses -parainfluenza viruses -RSV -measles -mumps -rubella -rabies -HTLV -HIV
Name the RNA nucleocapsid viruses (3).
-Enteroviruses (poliovirus, coxsackievirus, echovirus, hepatitis A virus) -rhinovirus -reovirus.
Name the vaccines that are killed (4).
-rabies -influenza -hepatitis A -SalK=Killed
Name the vaccines that are live attenuated (6).
-MMR -Sabin polio -VZV -yellow fever
Of these 3 markers (HBsAg, HBsAb, HBcAg), which ones are positive in each of the 4 phases below: (acute disease, window phase, complete recovery, chronic carrier).
-HBsAg, HBcAg -HBcAg -HBsAb, HBcAg -HBsAg, HBcAg
On HIV, what is gp41 and gp120?
envelope protein
On HIV, what is p24? (illus. p. 205)
rectangular nucleocapsid protein
Roughly, what are the time periods for acute, latent, and immunodeficient stages of HIV?
Acute: 1-3 months Latent: 3 months-3years Immunodefic.: 3 yrs.-death (diagram p. 205 that follows serologic course).
Statement: HEV resembles HAV in:
course, severity, and incubation,
Use the mneumonic PERCH to name members of the Picornavirus family.
-Poliovirus -Echovirus -Rhinovirus -Coxsackievirus -Hepatitis A
Viral nucleic acids with (choose) same/different nucleic acids as host are infective alone; others require special enzymes (contained in intact virion.)
same
What 2 antigens are used to classify influenza?
Neuraminadase, Hemagglutinin
What age group is the primary target of paramyxoviruses?
children
What antiviral treatment is approved for influenza A (especially prophylaxis) but not for influenza B & C
Amantadine and Rimantadine
What antiviral treatment is approved for influenza A and B?
Zanamivir
What are Councilman bodies and what are they pathomneumonic for?
acidophilic inclusions seen in the liver of those with yellow fever
What are the 3 C\'s of measles?
-Cough -Coryza -Conjunctivitis
What are the 4 C\'s of HCV.
Chronic, Cirrhosis, Carcinoma, Carriers
What are the 4 most common diseases caused by prions?
-Creutzfeldt-Jakob disease (CJD: rapid progressive dementia) -kuru -scrapie (sheep -\'mad cow disease\'
What are the causes of SSPE and PML in immunocompromised pts.
-Late sequelae of measles -Reactivation of JC virus
What are the classic symptoms of yellow fever?
-high fever -black vomitous -jaundice
What are the common diseases (1) and routes of transmission(1) for HHV-8?
-Kaposi\'s sarcoma (HIV pts.) -sexual contact
What are the common diseases (2) and routes of transmission(2) for EBV?
-infectious mono, Burkitt\'s lymphoma -resp. secretions, saliva
What are the common diseases (2) and routes of transmission(2) for HSV-2?
-herpes genitalis, neonatal herpes -sexual contact, perinatal
What are the common diseases (3) and routes of transmission(1) for VZV?
-varicella zoster (shingles) -encephalitis -pneumonia
What are the common diseases (3) and routes of transmission(2) for HSV-1?
-gingivostomatitis keratoconjunctivitis temporal lobe encephalitis herpes labialis -respiratory secretions and saliva
What are the common diseases (3) and routes of transmission(6) for CMV?
-congenital infection, mono, pneumonia -congenital, transfusion, sexual contact, saliva, urine, transplant
What are the general characteristics of a prion?
infectious agent that does not contain RNA or DNA, consists only of protein
What are the major viruses of the paramyxovirus family? (4)
-parainfluenza (croup) -RSV -Measles -Mumps
What are the primary symptoms of the mumps virus? (MOP)
-aseptic Meningitis -Orchitis -Parotitis (mumps give you bumps = parotitis)
What are the primary viruses of the picornavirus family? (PERCH)
-Poliovirus -Echovirus -Rhinovirus -Coxsackievirus -Hepatitis A
What are two classic illness caused by arborviruses?
-dengue fever (break-bone fever) -yellow fever
What general form of encephalopathies do prions present as?
spongiform encephalopathies
What genetic property does segmentation afford viruses and how does this play into flu epidemics?
-Segmentation allows reassorment to occur in RNA viruses -this contributes to antigenic shifts which cause most flu pandemics.
What group has a high mortality rate from HEV?
pregnant women
What hematologic finding is characteristic of mono?
abnormal circulating cytotoxic T cells (atypical lymphocytes)
What is HBcAb, and what does it indicate?
Antibody to HBcAg; IgM HBcAb indicates recent disease
What is HBcAg?
Antigen associated with core of HBV
What is HBeAb, and what does it indicate?
Antibody to e antigen; indicates low transmissibility
What is HBeAg, and what does it indicate?
it is a 2nd different antigen marker of HBV core; indicates transmissibility (HBeAg=Beware)
What is HBsAb, and what does it do?
Antibody to HBsAg; provides immunity to hepatitis B
What is HBsAg, and what does it indicate?
Antigen found on surface of HBV; continued presence indicates carrier state
What is IgM HAVAb, and what is it used to detect?
IgM antibody to HAV; best test to detect active hepatitis A
What is meant by the \'window period\' in HBV infection, and what is positive in this period?
It is the period between disappearance of HBsAg and appearance of Anti-HBs; HBcAb is pos. during this period.
What is the classic vector for arborvirus?
Arthropods (mosquitos, ticks, etc.) ARBOR=Arthropod Borne
What is the function of reverse transcriptase in HIV?
synthesize dsDNA from RNA for integration into host genome.
What is the major mode of protection from influenza virus?
Killed viral vaccine which is reformulated each year and is given to those in high risk of infection (elderly, health-workers, etc.)
What is the method behind ELISA/Western blot and during what period of HIV infection are they often negative?
look for abs to viral proteins; false negatives common in first 1-2 months of infection
What is the mneumonic for remembering the Tzanck smear?
Tzanck heavens I don\'t have herpes.
What is the only DNA virus that is not double stranded?
Parvoviridae (ssDNA)
What is the only RNA virus that has dsRNA?
Reoviridae [\'repeatovirus\' (reovirus) is dsRNA]
What is the viral cause of the common cold?
-Rhinovirus, 100+ serotypes -Rhino has a Runny nose.
What neurologic infection can picornaviruses (except rhinoviruses and hepatitis A viruses) cause?
Aseptic Meningitis
What physical finding is diagnostic for measles?
Koplik spots (bluish-gray spots on buccal mucosa)
What population should not receive a live vaccine?
Those who are immunocompromised and their close contacts.
What reproductive complication can mumps cause?
sterility; especially after puberty
What shape are all the DNA viruses? Which virus (1) is the exception?
-Icosahedral -Poxvirus (complex)
What test is used to make the presumptive dx of HIV, and then, which test confirms the dx?
ELISA (sensitive w/ high false + and low threshold); Western blot (specific, high false - rate with high threshold)
What tests are gaining popularity for monitoring drug tx efficacy in HIV?
PCR/viral load tests
What type of genome does HIV have?
diploid RNA
What type of nucleic acid structure does rotavirus have?
segmented dsRNA
What type of transcription occurs and what type of polymerase does it possess?
-Reverse transcription -the virion contains an RNA-dependent DNA polymerase
What type of virus is HAV and how is it transmitted?
-RNA picornavirus -fecal-oral route
What type of virus is HBV and how is it transmitted?
-DNA hepadnavirus -parenteral, sexual, and maternal-fetal routes
What type of virus is HCV and how is it transmitted?
-RNA flavivirus -via blood and resembles HBV in its course and severity
What type of virus is HDV and what is special about its envelope?
-delta agent, it is a defective virus -requires HBsAg as its evelope
What type of virus is HEV and how is it transmitted?
-RNA calicivirus -enteric transmission; causes water-borne epidemics
What variant of dengue fever is found in Southeast Asia?
hemorrhagic shock syndrome
What virus causes and what are the classic symptoms of mononucleosis?
-EBV -fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (esp. posterior auricular nodes)
What virus causes yellow (=flavi) fever, and what is its vector and reservoirs (2)?
-flavivirus -Aedes mosquitos -monkey or human reservoir
What virus is the most common global cause of infantile gastroenteritis and acute diarrhea (in the US).
Rotavirus
Where do enveloped viruses acquire their envelopes, and what virus is the exception to this rule?
-Plasma membrane -Herpesviruses which acquire their envelope from the nuclear membrane
Where in the cell do DNA viruses replicate, and which virus is the exception to this rule?
-Nucleus -exception: poxvirus in cytoplasm (carries DNA-dependent RNA polymerase)
Where in the cell do RNA viruses replicate, and what 2 viruses are the exception to this rule?
-Cytoplasm -exception: influenza virus and retroviruses
Which marker tests are appropriate for each phase of hepatitis infection: Incubation, Prodrome/acute illness, Early Convalescence, Late Convalescence.
-HBsAg -HBsAg (Anti-HBc) -Anti-HBc -Anti-HBs (anti-HBc)
Which two DNA viruses don\'t have a linear genome? (they\'re circular)
Papovaviruses and Hepadnaviruses
Which two hepatitis viruses follow the fecal-oral route?
A and E; \'The vowels hit your bowels.\'
Which two hepatitis viruses predispose to hepatocellular carcinoma?
HBV and HCV
Why is mono called the \'kissing disease?\'
-Peak incidence occurs during peak kissing years 15-20 yo -(saliva transmission)
3 main roles of Ig binding to bacteria
- opsonization - neutralization - complement activation
A defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity or similar enzymes is indicative of what immune deficiency disease?
Chronic granulomatous disease
After exposure to what 4 things are preformed (passive) antibodies given?
Tetanus toxin, Botulinum toxin, HBV, or Rabies.
All nucleated cells have what class of MHC proteins?
class I MHC proteins
Anaphylaxis, asthma, or local wheal and flare are possible manifestations of which type of hypersensitivity?
Type I
Anti-gliadin autoantibodies are associated with what disease?
Celiac disease
Anti-Scl-70 autoantibodies are associated with what disease?
diffuse Scleroderma
Autoimmune hemolytic anemia, Rh disease (erythroblastosis fetalis), and Goodpasture\'s syndrome are examples of what kind of hypersensitivity reaction?
type II hypersensitivity
Class I major histocompatibilty complex consists of …
1 polypeptide, with B2-microglobulin
Class II major histocompatibilty complex consists of …
2 polypeptides, an a and a B chain
Cytotoxic T cells have CD(?), which binds to class (?) MHC on virus-infected cells.
CD8 binds to class I MHC
Define acute transplant rejection.
Cell-mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs weeks after transplantation.
Define adjuvant.
Adjuvants are nonspecific stimulators of the immune response but are not immunogenic by themselves.
Define chronic transplant rejection.
Antibody-mediated vascular damage (fibrinoid necrosis)--irreversible. Occurs months to years after transplantation.
Define hyperacute transplant rejection.
Antibody-mediated due to the presence of preormed anti-donor antibodies in the transplant recipient. Occurs within minutes after transplantation.
Define Ig allotype.
Ig epitope that differs among members of the same species (on light or heavy chain)
Define Ig idiotype.
Ig epitope determine by the antigen-binging site (specific for a given antigen-binding site)
Define Ig isotype.
Ig epitope common to a single class of Ig (5 classes, determined by the heavy chain)
Give 3 classic examples of bacteria with antigen variation.
(1) Salmonella (2 flagellar variants) (2) Borrelia (relapsing fever) (3) Neisseria gonorrhoeae (pilus protein)
Give 3 examples of possibly causes for SCID?
(1) failure to synthesize class II MHC antigens (2) defective Il-2 receptors (3) adenosine deaminase deficiency
Goodpasture\'s syndrome is associated with what kind of autoantibodies?
anti-basement membrane antibodies.
Helper T cells have CD(?) which binds to class (?) MHC on antigen-presenting cells.
CD4 binds to class II MHC
How does Bruton\'s agammaglobulinemia usually present?
as bacterial infections in boys after about 6 months of age, when levels of maternal IgG antibody decline
How is active immunity acquired?
Active immunity is induced after exposure to foreign antigens. There is a slow onset with long-lasting protection.
How is passive immunity acquired?
by receiving preformed antibodies from another host. Antibodies have a short life span, but the immunity has a rapid onset.
IL-4 promotes the growth of B cells and the synthesis of what 2 immunoglobulins?
IgE and IgG
In what immune deficiency do neutrophils fail to respond to chemotactic stimuli?
Job\'s syndrome
In what T-cell deficiency do the thymus and parathyroids fail to develop owing to failure of development of the 3rd and 4th pharyngeal pouches?
Thymic aplasia (DiGeorge syndrome)
Job\'s syndrome is associated with high levels of what immunoglobulin?
IgE
MHC I Ag loading occurs in __(1?)__ while MHC II Ag loading occurs in __(2?)__?
(1) in rER (viral antigens) (2) in acidified endosomes.
Primary biliary cirrhosis has what kind of autoantibodies?
anti-mitochondrial antibodies
Role of TH1 cells?
produce IL-2 (activate Tc cells and further stimulate TH1 cell) and g-interferon (activate macrophages)
Role of TH2 cells?
produce IL-4 and IL-5 (help B cells make Ab)
Sensitized T lymphocytes encounter antigen and then release lymphokines which leads to macrophage activation\' in what hypersensitivity reaction?
Type IV
TB skin test, transplant rejection, and contact dermatitis are examples of what type of hypersensitivity reaction?
Type IV
The 3 kinds of MHC class I genes are…
A, B, and C
The 3 kinds of MHC class II genes are…
DP, DQ, DR
The Fc portion of immunoglobulins are at the __?__ terminal.
The carboxy terminal
What 2 cytokines are secreted by macrophages?
IL-1 and TNF-a
What 2 kinds of autoantibodies are specific for systemic lupus?
Anti-dsDNA and anti-Smith
What 3 cytokines are classified as \'acute phase cytokines\'?
IL-1, IL-6, and TNF-a
What 3 ways do interferons interfere with viral protein synthesis?
(1) alpha and beta interferons induce production of a second protein that degrades viral mRNA (2) gamma interferons increase MHC class I expression and antigen presentation in all cells (3) activates NK cells to kill virus-infected cells.
What affect do the acute phase cytokines have on fat and muscle?
mobilization of energy reserves to raise body temperature
What affect do the acute phase cytokines have on the bone marrow?
Incr. Production of Colony stim. Factor (CS) which leads to leukocytosis
What affect do the acute phase cytokines have on the hypothalamus?
increase body temperature
What antibody isotype can cross the placenta?
IgG
What are 3 types of antigen-presenting cells?
macrophages, B cells, and dendritic cells
What are the maim symptoms of serum sickness an at what period of time following Ag exposure?
fever, urticaria, arthralgias, proteinuria, lymphadenopathy 5-10 days after Ag exposure
What are the major symptoms of graft-vs.-host disease?
maculopapular rash, jaundice, hepatosplenomegaly, and diarrhea.
What B- and T- cell deficiency, assoc. with IgA deficiency, presents with cerebellar problems and spider angiomas?
ataxia-telangiectasia
What causes the tissue damage associated with Serum sickness?
formation of immune complexes of foreign particles and Abs that deposit in membranes where they fix complement
What class of MHC proteins are the main determinants of organ rejection?
class II MHC
What complement components can cause anaphylaxis?
C3a and C5a
What components of the alternative complement pathway make the C3 convertase?
C3b, Bb
What components of the alternative complement pathway make the C5 convertase?
C3b, Bb, and 3b
What components of the classic complement pathway make the C3 convertase?
C4b, C2b
What components of the classic complement pathway make the C5 convertase?
C4b, 2b, and 3b
What components of the complement pathway are deficient in Neisseria sepsis?
The MAC complex--(C5b, C6, C7, C8, C9)
What cytokines attract and activate neutrophils?
TNF-a and B
What disease is associated with a X-linked defect in a tyrosine-kinase gene associated with low levels of all classes of immunoglobulins?
Bruton\'s agammaglobulinemia
What disease is associated with anti-epithelial cell autoantibodies?
Pemphigus vulgaris
What disease is associated with anti-microsomal autoantibodies?
Hashimoto\'s thyroiditis
What does a deficiency of C1 esterase inhibitor cause (in the complement cascade)?
angioedema because of overactive complement
What does a deficiency of C3 cause (in the complement cascade)?
can lead to severe, recurrent pyogenic sinus and respiratory tract infections.
What does deficiency of decay-accelerating factor (DAF) in the complement cascade cause?
leads to paroxysmal nocturnal hemoglobinuria (PNH)
What does Job\'s syndrome classically present with?
recurrent \'cold\' (noninflamed) staphylococcal abscesses
What does TNF-a stimulate dendritic cells to do during the acute phase response?
TNF-a stimulates their migration to lymph nodes and their maturation for the initiation of the adaptive immune response.
What elements of the complement cascade made the Membrane Attack Complex (MAC)?
C5b, C6, C7, C8, and C9
What Ig is found in secretions as a monomer or a dimer?
IgA
What Ig is found in secretions as a monomer or a pentamer?
IgM
What immune deficiency disease has an autosomal-recessive defect in phagocytosis that results from microtubular and lysosomal defects of phagocytic cells?
Chediak-Higashi disease
What immune deficiency is associated with elevated IgA levels, normal IgE levels, and low IgM levels?
Wiskott-Aldrich syndrome
What immune deficiency presents with tetany owing to hypocalcemia, congenital defects of the heart and great vessels, and recurrent viral, fungal, and protozoal infections?
Thymic aplasia (DiGeorge syndrome)
What immunoglobulin isotype has the lowest concentration in serum?
IgE
What immunoglobulin isotype is involved in type-I hypersensitivity reactions?
IgE
What immunoglobulin isotype is produced in the primary response to an antigen and is on the surface of B cells?
IgM
What immunoglobulin isotype mediates immunity to worms?
IgE
What immunoglobulin isotype prevents the attachment of bacteria and viruses to mucous membranes?
IgA
What immunoglobulins bind and activate the classic complement pathway?
IgG and IgM (the Fc portion)
What interleukin induces naive helper T-cells to become TH1 cells?
IL-12
What interleukin induces naive helper T-cells to become TH2 cells?
IL-4
What interleukin stimulates the growth of both helper and cytotoxic T-cells?
IL-2
What is Chronic mucocutaneous candidiasis?
T-cell dysfunction specifically against Candida albicans.
What is important about the CD3 complex?
It is a cluster of polypeptides associated with a T-cell receptor and is important in signal transduction.
What is the cellular process that causes type I hypersensitivity?
Ag cross-links IgE on presensitized mast cells and basophils, triggering the release of vasoactive amines.
What is the cellular process that causes type II hypersensitivity?
IgM, IgG bind to Ag on \'enemy\' cell, leading to lysis (by complement) or phagocytosis (its cytotoxic).
What is the main antibody in the secondary immune response?
IgG
What is the most abundant immunoglobulin isotype?
IgG
What is the most common selective immunoglobulin deficiency?
selective IgA deficiency
What is the rise in temperature during the acute phase response help do (3 things?)
(1) increase specific immune response (2) increase antigen processing (3) decrease viral and bacterial replication
What is the triad of symptoms seen with Wiskott-Aldrich syndrome?
recurrent pyogenic infections, eczema, and thrombocytopenia
What kind of autoantibodies are associated with CREST/Scleroderma?
anti-centromere antibodies
What kind of autoantibodies are known as rheumatoid factor?
anti-IgG antibodies
What kind of immunity (antibody-mediated or cell mediated) is involved in autoimmunity?
antibody-mediated immunity (B cells)
What kind of immunity (antibody-mediated or cell mediated) is involved in graft and tumor rejection?
cell mediated immunity (T cells)
What kind of transplant rejection is reversible with immunosuppressants such as cyclosporin and OKT3?
acute transplant rejection
What kinds of adjuvants are included in human vaccines?
aluminum hydroxide or lipid
What kinds of cells have class II MHC proteins?
antigen-presenting cells (e.g. macrophages and dendritic cells)
What parasites have antigen variation?
trypanosomes (programmed rearrangement)
What symptoms characterize the Arthus reaction and what causes them?
edema, necrosis, and activation of complement due to the Ag-Ab complexes that form in the skin following intradermal injection of Ag.
What type of cell secretes IL-3?
activated T-cells
What type of cells does gamma interferon stimulate?
macrophages
What type of hypersensitivity reaction is the Arthus reaction?
type III
Where does the alternative complement pathway occur?
On microbial surfaces
Where does the classic complement pathway occur?
antigen-antibody complexes
Where is the defect in SCID?
the defect is in early stem-cell differentiation, leading to B- and T-cell deficiency
Which interleukin causes fever?
IL-1
Which interleukin enhances the synthesis of IgA?
IL-5
Which interleukin stimulates the production and activation of eosinophils?
IL-5
Which interleukin supports the growth and differentiation of bone marrow stem cells?
IL-3
Which is the only type of cell-mediated hypersensitivity reaction, and thus not transferable by serum?
Type IV
Wiskott-Aldrich syndrome is a defect in the ability to mount what immune response?
an IgM response to capsular polysaccharides of bacteria.
With what disease are anti-histone autoantibodies associated?
drug-induced lupus
With what disease are anti-nuclear antibodies associated?
systemic lupus
Aspiration pneumonia is usually caused by…
- Anaerobes
Atypical pneumonia is usually caused by…
- Mycoplasma - Legionella - Chlamydia
Bug Hints: Branching rods in oral infection =
Actinomyces israelii
Bug Hints: Currant jelly sputum =
Klebsiella
Bug Hints: Dog or cat bite =
Pasteurella multocida
Bug Hints: Pediatric Infection =
H. influenzae (including epiglottitis)
Bug Hints: Pneumonia in CS, burn infection =
P. aeruginosa
Bug Hints: Pus, Empyema, Abscess =
S. aureus
Bug Hints: Sepsis/Meningitis in Newborn =
Group B strep
Bug Hints: Surgical wound =
S. aureus
Bug Hints: Traumatic open wound =
C. perfringens
Incidence of what cause of mengitis has decreased with a vaccine?
Incidence of H. influenze meningitis has decreased greatly with introduction of H. influenzae vaccine in the last 10-15 years
Most osteomyelitis occurs in what age group?
children
Neonatal pneumonia is usually caused by…
- Group B streptococci - E. coli
Nosocomial pneumonia is usually caused by…
- Staphylococcus - gram-negative rods
PID includes what disorders in the body?
salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess
PID is likely caused by what two organisms? What are the characteristics of the disease caused by each organism?
-Chlamydia trachomatis: subacute, often undiagnosed - N. gonorrhoeae:acute, high fever
Pneumonia in immunocompromised patients is caused by…
- Staphylococcus - gram-negative rods - fungi - viruses - Pnemumocystis carinii (with HIV)
Pneumonia in the alcoholic/IV drug user is usually caused by…
- S. pneumoniae - Klebsiella - Staphylococcus
Postviral pneumonia is usually caused by…
- Staphylococcus - H. influenzae
Salpingitis is a risk factor for…
- ectopic pregnancy - infertility -chronic pelvic pain - adhesions
UTIs are found in men in which 2 age groups?
Babies with congenital defects and Elderly with enlarged prostates
UTIs are mostly caused how?
by ascending infections
What\'s the likely cause of osteomyelitis in a pt where you have no other information?
S. aureus
What 2 pathogens likely cause nosocomial infections associated with urinary catherization?
E. coli, Proteus mirabilis
What 2 pathogens likely cause nosocomial infections in the newborn nursery?
CMV, RSV
What 3 UTI-causing organisms are often nosocomial and drug-resistant?
- Serratia marcescens - Enterobacter cloacae - Klebsiella pneumoniae - Proteus mirabilis - Pseudomonas aeruginosa
What 7 organisms are associated with UTIs?
- Serratia marcescens - Staphylococcus saprophyticus - E. coli - Enterobacter cloacae - Klebsiella pneumoniae - Proteus mirabilis - Pseudomonas aeruginosa [HINT: SEEKS PP]
What abnormal lab result is often seen in osteomyelitis patients?
elevated ESR
What are 4 clinical findings of Pyelonephritis?
- fever - chills - flank pain -CVA tenderness [c/c with UTI]
What are 4 clinical findings of UTIs?
- diysuria - frequency - urgency - suprapubic pain [c/c with pyelonephritis]
What are the 2 most common causes of nosocomial infections?
- E. coli causes UTI - S. aureus causes wound infection
What are the 3 most common causes of UTI in young ambulatory women?
1. E. coli (50-80%) 2. Staphylococcus saprophyticus (10-30%) 3. Klebsiella (8-10%)
What are the common causes of hospital-acquired UTIs?
- E. coli - Proteus - Klebsiella - Serratia - Pseudomonas
What are the common causes of meningitis in 6-60y/o?
- N. MENINGITIDIS - Enteroviruses - S. pneumoniae - HSV
What are the common causes of meningitis in 60+ y/o?
- S. PNEUMONIAE - Gram-negative rods - Listeria
What are the common causes of meningitis in children (6mo-6y/o)?
- S. pneumoniae - N. meningitidis - H. influenzae B - Enteroviruses
What are the common causes of meningitis in HIV pts?
- Cryptococcus - CMV - toxoplasmosis (brain abscess) JC virus (PML)
What are the common causes of meningitis in newborns (0-6mos)?
- GROUP B STREPTOCOCCI - E. COLI - Listeria
What are the common causes of osteomyelitis in those with prosthetic replacements?
S. aureus and S. epidermidis
What are the common causes of pneumonia in adults 18-40 y/o?
- Mycoplasma - C. pneumoniae - S. pneumoniae
What are the common causes of pneumonia in adults 40-65 y/o?
- S. pneumoniae - H. influenzae - Anaerobes - Viruses - Mycoplasma
What are the common causes of pneumonia in children (6wk-18y)?
- Viruses (RSV) - Mycoplasma - Chlamidia pneumonia S. pneumoniae
What are the common causes of pneumonia in the elderly?
- S. pneumoniae - Anaerobes - Viruses - H. influenzae - Gram-neg. rods
What are the CSF finings in bacterial meningitis (pressure, cell type, protein and sugar levels)?
- Pressure: incr. - Cell type: incr. PMNs - Protein: incr - Sugar: decr
What are the CSF finings in bacterial meningitis (pressure, cell type, protein and sugar levels)?
- Pressure: nl or incr. - Cell type: incr. lymphocytes - Protein: nl - Sugar: nl
What are the CSF finings in fungal/TB meningitis (pressure, cell type, protein and sugar levels)?
- Pressure: incr. - Cell type: incr. lymphocytes - Protein: incr - Sugar:decr.
What are the dominant normal florae in the colon?
B fragilis > E. coli
What are the dominant normal florae in the vagina?
Lactobacillus, colonized by E. coli and group B strep
What are the predisposing factors of UTIs?
- flow obstruction - kidney surgery - catherization - gynecologic abnormailities - diabetes - pregnancy
What infections are dangerous in pregnancy?
- Toxoplasma - Rubella - CMV - HSV/HIV -Syphilis [HINT: ToRCHeS]
What is chandelier sign?
Cervical motion tenderness associated with PID
What is the 2nd leading cause of community-acquired UTI in sexually active women?
Staphylococcus saprophyticus
What is the characterisitc of Trichomonas on a slide?
motile on wet prep
What is the common cause of osteomyelitis in drug addicts?
Psudomonas aeruginosa
What is the common cause of osteomyelitis in most people?
S. aureus
What is the common cause of osteomyelitis in sickle cell pts?
Salmonella
What is the common cause of osteomyelitis in the sexually active?
N. gonorrhoeae
What is the common cause of osteomyelitis in the vertebra?
M. tuberculosis
What is the dominant normal flora contributes to dental plaque?
S. mutans
What is the dominant normal flora in the nose?
S. aureus
What is the dominant normal flora in the oropharynx?
viridans streptococci
What is the dominant normal flora on the skin?
S. epidermidis
What is the most common STD in the U.S.?
Chlamydia trachomatis causes 3-4 million cases per year
What organism can you presume is causing a nosocomial infection if respiratory equipment or burns are involved?
Psudomonas aeruginosa
What organism is the leading cause of UTI and shows a metallic sheen on EMB agar?
E. coli
What pathogen is associated with hyperalimentation?
Candida albicans
What pathogen is associated with water (ie. aerosols)?
Legionella
What pathogen likely causes nosocomial infections in the renal dialysis unit?
HBV
What population does not have any flora?
Neonates delivered by csarean section have no flora but are rapidly colonized after birth
What ratio is UTIs found more in women vs. men? Why?
10 to 1 because women have short urethrae more likely to be colonized by fecal flora
What STD is associated with Argyll-Robertson pupil?
3\' Syphilis
What STD is associated with clue cells?
Garnerella
What STD is associated with Genital warts and loilocytes? What is the causative agent?
- Condylomata acuminata - HPV 6 and 11
What STD is associated with jaundice? What is the causative agent?
- Hepatitis B - HBV
What STD is associated with opportunistic infections, Kaposi\'s sarcoma, lymphoma? What is the causative agent?
- AIDS -HIV
What STD is associated with painful penile, vulvar or cervical ulcers? What\'s the causative agent?
-Genital Herpies - HSV-2
What STD is associated with painful ulcers, lymphadenopathy, rectal strictures? What is the causative agent?
- Lymphogranuloma venereum - Chlamydia trachomatis
What STD is associated with urethritis, cervicitis, conjuntivitis, Reiter\'s syndrome PID? What is the causative agent?
Chlamydia - Chlamydia trachomatis
What STD is associated with vaginitis? What is the causative agent?
-Trichomoniasis - Trichomonas vaginalis
What STD is characterized by painful genital ulcer? What is the causative agent?
- chancroid - Haemophilus ducreyi
What STD is likely in a patient with a painless chancre? What causes it?
- 1\' Syphilis - Treponema pallidum
What STD is likely in a patient with fever, lymphadenopathy, skin rashes, condylomata lata? What causes it?
- 2\' Syphilis - Treponema pallidum
What STD is likely in a patient with gummas, tabes dorsalis, general paresis, aortitis, Argyll-Robertson pupil? What causes it?
- 3\' Syphilis - Treponema pallidum
What STD is likely in a patient with urethritis, cervicitis, PID, prostatitus, epididymitis, arthritis? What organism causes it?
- Gonorrhea - Neisseria gonorrhoeae
What UTI-causing organism has a bue-green pigment, fruity odor and is usually nosocomial and drug-resistant?
Pseudomonas aeruginosa
What UTI-causing organism is characterized by a large mucoid capsule and viscous colonies?
Klebsiella pneumoniae
What UTI-causing organism is mobile, causing \'swarming\' on agar and also produces urease and is associated with struvite stones?
Proteus mirabilis
What UTI-causing organism sometimes produces a red pigment, is often nosocomial and drug-resistant?
Serratia marcescens
A common side effects of INF treatment is?
Neutropenia
Antimicrobial prophylaxis for a history of recurrent UTIs
TMP-SMZ
Antimicrobial prophylaxis for Gonorrhea
Ceftriaxone
Antimicrobial prophylaxis for Meningococcal infection
Rifampin (DOC), minocycline
Antimicrobial prophylaxis for PCP
TMP-SMZ (DOC), aerosolized pentamidine
Antimicrobial prophylaxis for Syphilis
Benzathine penicillin G
Are Aminoglycosides Teratogenic?
Yes
Are Ampicillin and Amoxicillin penicillinase resistant?
No
Are Carbenicillin, Piperacillin, and Ticarcillin penicillinase resistant?
No
Are Cephalosporins resistant to penicillinase?
No, but they are less susceptible than the other Beta lactams
Are Methicillin, Nafcillin, and Dicloxacillin penicillinase resistant?
Yes
Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis, the only agent used as solo prophylaxis against TB
Common side effects associated with Clindamycin include?
Pseudomembranous colitis (C. difficile), fever, diarrhea
Common toxicities associated with Fluoroquinolones?
GI upset, Superinfections, Skin rashes, Headache, Dizziness
Common toxicities associated with Griseofulvin are…...?
Teratogenic, Carcinogenic, Confusion, Headaches
Describe the MOA of Interferons (INF)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Do Tetracyclines penetrate the CNS?
Only in limited amounts
Does Ampicillin or Amoxicillin have a greater oral bioavailability?
AmOxicillin has greater Oral bioavailability
Does Amprotericin B cross the BBB?
No
Does Foscarnet require activation by a viral kinase?
No
Foscarnet toxicity?
Nephrotoxicity
Ganciclovir associated toxicities?
Leukopenia, Neutropenia, Thrombocytopenia, Renal toxicity
How are INFs used clinically?
Chronic Hepatitis A and B, Kaposi\'s Sarcoma
How are Sulfonamides employed clinically?
Gram +, Gram -, Norcardia, Chlamydia
How are the HIV drugs used clinically?
Triple Therapy\' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax, P.ovale) treated?
Primaquine
How can Isoniazid (INH)-induced neurotoxicity be prevented?
Pyridoxine (B6) administration
How can the t1/2 of INH be altered?
Fast vs. Slow Acetylators
How can the toxic effects fo TMP be ameliorated?
With supplemental Folic Acid
How can Vancomycin-induced \'Red Man Syndrome\' be prevented?
Pretreat with antihistamines and a slow infusion rate
How do Sulfonamides act on bacteria?
As PABA antimetabolites that inhibit Dihydropteroate Synthase, Bacteriostatic
How do the Protease Inhibitors work?
Inhibt Assembly of new virus by Blocking Protease Enzyme
How does Ganciclovir\'s toxicity relate to that of Acyclovir?
Ganciclovir is more toxic to host enzymes
How does resistance to Vancomycin occur?
With an amino acid change of D-ala D-ala to D-ala D-lac
How is Acyclovir used clinically?
HSV, VZV, EBV, Mucocutaneous and Genital Herpes Lesions, Prophylaxis in Immunocompromised pts
How is Amantadine used clinically?
Prophylaxis for Influenza A, Rubella ; Parkinson\'s disease
How is Amphotericin B administered for fungal meningitis?
Intrathecally
How is Amphotericin B used clinically?
Wide spectrum of systemic mycoses: Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor
How is Chloramphenical used clinically?
Meningitis (H. influenza, N. meningitidis, S. pneumoniae), Conserative treatment due to toxicities
How is Foscarnet used clinically?
CMV Retinitis in IC pts when Ganciclovir fails
How is Ganciclovir activated?
Phosphorylation by a Viral Kinase
How is Ganciclovir used clinically?
CMV, esp in Immunocompromised patients
How is Griseofulvin used clinically?
Oral treatment of superficial infections
How is Leishmaniasis treated?
Pentavalent Antimony
How is Ribavirin used clinically?
for RSV
How is Rifampin used clinically?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone when used of Leprosy 3. Used in combination with other drugs
How is Trimethoprim used clinically?
Used in combination therapy with SMZ to sequentially block folate synthesis
How is Vancomycin used clinically?
For serious, Gram + multidrug-resistant organisms
How would you treat African Trypanosomiasis (sleeping sickness)?
Suramin
In what population does Gray Baby Syndrome occur? Why?
Premature infants, because they lack UDP-glucuronyl transferase
Is Aztreonam cross-allergenic with penicillins?
No
Is Aztreonam resistant to penicillinase?
Yes
Is Aztreonam usually toxic?
No
Is Imipenem resistant to penicillinase?
Yes
Is Penicillin penicillinase resistant?
No - duh
IV Penicillin
G
Mnemonic for Foscarnet?
Foscarnet = pyroFosphate analog
MOA for Penicillin (3 answers)?
1)Binds penicillin-binding proteins 2) Blocks transpeptidase cross- linking of cell wall 3) Activates autolytic enzymes
MOA: Bactericidal antibiotics
Penicillin, Cephalosporins, Vancomycin, Aminoglycosides, Fluoroquinolones, Metronidazole
MOA: Block cell wall synthesis by inhib. Peptidoglycan cross-linking (7)
Penicillin, Ampicillin, Ticarcillin, Pipercillin, Imipenem, Aztreonam, Cephalosporins
MOA: Block DNA topoisomerases
Quinolones
MOA: Block mRNA synthesis
Rifampin
MOA: Block nucleotide synthesis
Sulfonamides, Trimethoprim
MOA: Block peptidoglycan synthesis
Bacitracin, Vancomycin
MOA: Block protein synthesis at 30s subunit
Aminoglycosides, Tetracyclines
MOA: Block protein synthesis at 50s subunit
Chloramphenicol, Erythromycin/macrolides, Lincomycin, Clindamycin, Streptogramins (quinupristin, dalfopristin)
MOA: Disrupt bacterial/fungal cell membranes
Polymyxins
MOA: Unkown
Pentamidine
MOA:Disrupt fungal cell membranes
Amphotericin B, Nystatin, Fluconazole/azoles
Name common Polymyxins
Polymyxin B, Polymyxin E
Name several common Macrolides (3)
Erythromycin, Azithromycin, Clarithromycin
Name some common Sulfonamides (4)
Sulfamethoxazole (SMZ), Sulfisoxazole, Triple sulfas, Sulfadiazine
Name some common Tetracyclines (4)
Tetracycline, Doxycycline, Demeclocycline, Minocycline
Name the common Aminoglycosides (5)
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
Name the common Azoles
Fluconazole, Ketoconazole, Clotrimazole, Miconazole, Itraconazole
Name the common Fluoroquinolones (6)
Ciprofloxacin, Norfloxacin, Ofloxacin, Grepafloxacin, Enoxacin, Nalidixic acid
Name the common Non-Nucleoside Reverse Transcriptase Inhibitors
Nevirapine, Delavirdine
Name the common Nucleoside Reverse Transcriptase Inhibitors
Zidovudine (AZT), Didanosine (ddI), Zalcitabine (ddC), Stavudine (d4T), Lamivudine (3TC)
Name the Protease Inhibitors (4)
Saquinavir, Ritonavir, Indinavir, Nelfinavir
Name two classes of drugs for HIV therapy
Protease Inhibitors and Reverse Transcriptase Inhibitors
Name two organisms Vancomycin is commonly used for?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Oral Penicillin
V
Resistance mechanisms for Aminoglycosides
Modification via Acetylation, Adenylation, or Phosphorylation
Resistance mechanisms for Cephalosporins/Penicillins
Beta-lactamase cleavage of Beta-lactam ring
Resistance mechanisms for Chloramphenicol
Modification via Acetylation
Resistance mechanisms for Macrolides
Methylation of rRNA near Erythromycin\'s ribosome binding site
Resistance mechanisms for Sulfonamides
Altered bacterial Dihydropteroate Synthetase, Decreased uptake, or Increased PABA synthesis
Resistance mechanisms for Tetracycline
Decreased uptake or Increased transport out of cell
Resistance mechanisms for Vancomycin
Terminal D-ala of cell wall replaced with D-lac; Decreased affinity
Side effects of Isoniazid (INH)?
Hemolysis (if G6PD deficient), Neurotoxicity, Hepatotoxicity, SLE-like syndrome
Specifically, how does Foscarnet inhibit viral DNA pol?
Binds to the Pyrophosphate Binding Site of the enzyme
The MOA for Chloramphenicol is ……………..?
Inhibition of 50S peptidyl transferase, Bacteriostatic
Toxic effects of TMP include………?
Megaloblastic anemia, Leukopenia, Granulocytopenia
Toxic side effects of the Azoles?
Hormone synthesis inhibition (Gynecomastia), Liver dysfunction (Inhibits CYP450), Fever, Chills
Toxicities associated with Acyclovir?
Delirium, Tremor, Nephrotoxicity
What additional side effects exist for Ampicillin?
Rash, Pseudomembranous colitis
What antimicrobial class is Aztreonam syngergestic with?
Aminoglycosides
What are Amantadine-associated side effects?
Ataxia, Dizziness, Slurred speech
What are Aminoglycosides synergistic with?
Beta-lactam antibiotics
What are Aminoglycosides used for clinically?
Severe Gram - rod infections.
What are common serious side effects of Aminoglycosides and what are these associated with?
Nephrotoxicity (esp. with Cephalosporins), Ototoxicity (esp. with Loop Diuretics)
What are common side effects of Amphotericin B?
Fever/Chills, Hypotension, Nephrotoxicity, Arrhythmias
What are common side effects of Protease Inhibitors?
GI intolerance (nausea, diarrhea), Hyperglycemia, Lipid abnormalities, Thrombocytopenia (Indinavir)
What are common side effects of RT Inhibitors?
BM suppression (neutropenia, anemia), Peripheral neuropathy
What are common toxic side effects of Sulfonamides? (5)
-Hypersensitivity reactions -Hemolysis -Nephrotoxicity (tubulointerstitial nephritis) -Kernicterus in infants Displace other drugs from albumin (e.g., warfarin)
What are common toxicities associated with Macrolides? (4)
GI discomfort, Acute cholestatic hepatitis, Eosinophilia, Skin rashes
What are common toxicities associated with Tetracyclines?
GI distress, Tooth discoloration and Inhibition of bone growth in children, Fanconi\'s syndrome, Photosensitivity
What are common toxicities related to Vancomycin therapy?
Well tolerated in general but occasionally, Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing=\'Red Man Syndrome\'
What are Fluoroquinolones indicated for? (3)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
What are major side effects of Methicillin, Nafcillin, and Dicloxacillin?
Hypersensitivity reactions
What are Methicillin, Nafcillin, and Dicloxacillin used for clinically?
Staphlococcus aureus
What are Polymyxins used for?
Resistant Gram - infections
What are the Anti-TB drugs?
Rifampin, Ethambutol, Streptomycin, Pyrazinamide, Isoniazid (INH)
What are the clinical indications for Azole therapy?
Systemic mycoses
What are the clinical uses for 1st Generation Cephalosporins?
Gram + cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae (PEcK)
What are the clinical uses for 2nd Generation Cephalosporins?
Gram + cocci, Haemophilus influenza, Enterobacter aerogenes, Neisseria species, P. mirabilis, E. coli, K. pneumoniae, Serratia marcescens ( HEN PEcKS )
What are the clinical uses for 3rd Generation Cephalosporins?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
What are the clinical uses for Aztreonam?
Gram - rods: Klebsiella species, Pseudomonas species, Serratia species
What are the clinical uses for Imipenem/cilastatin?
Gram + cocci, Gram - rods, and Anerobes
What are the Macrolides used for clinically?
-Upper respiratory tract infections -pneumonias -STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) -Mycoplasma, Legionella,Chlamydia, Neisseria
What are the major structural differences between Penicillin and Cephalosporin?
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
What are the major toxic side effects of Imipenem/cilastatin?
GI distress, Skin rash, and Seizures at high plasma levels
What are the major toxic side effects of the Cephalosporins?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram-like reaction with ethanol (those with a methylthiotetrazole group, e.g., cefamandole)
What are the side effects of Polymyxins?
Neurotoxicity, Acute renal tubular necrosis
What are the side effects of Rifampin?
Minor hepatotoxicity, Drug interactions (activates P450)
What are toxic side effects for Metronidazole?
Disulfiram-like reaction with EtOH, Headache
What are toxicities associated with Chloramphenicol?
Aplastic anemia (dose independent), Gray Baby Syndrome
What conditions are treated with Metronidazole?
Giardiasis, Amoebic dysentery (E. histolytica), Bacterial vaginitis (Gardnerella vaginalis), Trichomonas
What do Aminoglycosides require for uptake?
Oxygen
What do you treat Nematode/roundworm (pinworm, whipworm) infections with?
Mebendazole/Thiabendazole, Pyrantel Pamoate
What drug is given for Pneumocystis carinii prophylaxis?
Pentamidine
What drug is used during the pregnancy of an HIV + mother?, Why?
AZT, to reduce risk of Fetal Transmission
What drug is used to treat Trematode/fluke (e.g., Schistosomes, Paragonimus, Clonorchis) or Cysticercosis
Praziquantel
What is a common drug interaction associated with Griseofulvin?
Increases coumadin metabolism
What is a mnemonic to remember Amantadine\'s function?
Blocks Influenza A and RubellA; causes problems with the cerebellA
What is a prerequisite for Acyclovir activation?
It must be Phosphorylated by Viral Thymidine Kinase
What is a Ribavirin toxicity?
Hemolytic anemia
What is an acronym to remember Anti-TB drugs?
RESPIre
What is an additional side effect of Methicillin?
Interstitial nephritis
What is an occasional side effect of Aztreonam?
GI upset
What is Clindamycin used for clinically?
Anaerobic infections (e.g., B. fragilis, C. perfringens)
What is clinical use for Carbenicillin, Piperacillin, and Ticarcillin?
Pseudomonas species and Gram - rods
What is combination TMP-SMZ used to treat?
Recurrent UTIs, Shigella, Salmonella, Pneumocystis carinii pneumonia
What is combined with Ampicillin, Amoxicillin, Carbenicillin, Piperacillin, and Ticarcillin to enhance their spectrum?
Clavulanic acid
What is Fluconazole specifically used for?
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
What is Imipenem always administered with?
Cilastatin
What is Ketoconazole specifically used for?
Blastomyces, Coccidioides, Histoplasma, C. albicans; Hypercortisolism
What is Metronidazole combined with for \'triple therapy\'? Against what organism?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
What is Metronidazole used for clinically?
Antiprotozoal: Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis Anaerobes: Bacteroides, Clostridium
What is Niclosamide used for?
Cestode/tapeworm (e.g., D. latum, Taenia species Except Cysticercosis
What is Nifurtimox administered for?
Chagas\' disease, American Trypanosomiasis (Trypanosoma cruzi)
What is the chemical name for Ganciclovir?
DHPG (dihydroxy-2-propoxymethyl guanine)
What is the clinical use for Ampicillin and Amoxicillin?
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
What is the clinical use for Nystatin?
Topical and Oral, for Oral Candidiasis (Thrush)
What is the clinical use for Penicillin?
Bactericidal for: Gram + rod and cocci, Gram - cocci, and Spirochetes
What is the major side effect for Ampicillin and Amoxicillin?
Hypersensitivity reactions
What is the major side effect for Carbenicillin, Piperacillin, and Ticarcillin?
Hypersensitivity reactions
What is the major toxic side effect of Penicillin?
Hypersensitivity reactions
What is the memory aid for subunit distribution of ribosomal inhibitors?
Buy AT 30, CELL at 50\'
What is the memory key for Isoniazid (INH) toxicity?
INH: Injures Neurons and Hepatocytes
What is the memory key for Metronidazole\'s clinical uses?
GET on the Metro
What is the memory key for organisms treated with Tetracyclines?
VACUUM your Bed Room\'
What is the memory key involving the \'4 R\'s of Rifampin?\'
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
What is the MOA for Acyclovir?
Inhibit viral DNA polymerase
What is the MOA for Amphotericin B?
Binds Ergosterol, forms Membrane Pores that Disrupt Homeostatis
What is the MOA for Ampicillin and Amoxicillin?
Same as penicillin. Extended spectrum antibiotics
What is the MOA for Carbenicillin, Piperacillin, and Ticarcillin?
Same as penicillin. Extended spectrum antibiotics
What is the MOA for Clindamycin?
Blocks Peptide Bond formation at the 50S subunit, Bacteriostatic
What is the MOA for Methicillin, Nafcillin, and Dicloxacillin?
Same as penicillin. Act as narrow spectrum antibiotics
What is the MOA for Metronidazole?
Forms toxic metabolites in the bacterial cell, Bactericidal
What is the MOA for Nystatin?
Binds ergosterol, Disrupts fungal membranes
What is the MOA for Rifampin?
Inhibits DNA dependent RNA polymerase
What is the MOA for the Aminoglycosides?
Inhibits formation of Initiation Complex, causes misreading of mRNA, Bactericidal
What is the MOA for the Azoles?
Inhibit Ergosterol synthesis
What is the MOA for the Cephalosporins?
Beta lactams - inhibit cell wall synthesis, Bactericidal
What is the MOA for the Fluoroquinolones?
Inhibit DNA Gyrase (topoisomerase II), Bactericidal
What is the MOA for the Macrolides?
Blocks translocation, binds to the 23S rRNA of the 50S subunit, Bacteriostatic
What is the MOA for the Tetracyclines?
Binds 30S subunit and prevents attachment of aminoacyl-tRNA, Bacteriostatic
What is the MOA for Trimethoprim (TMP)?
Inhibits bacterial Dihydrofolate Reductase, Bacteriostatic
What is the MOA for Vancomycin?
Inhibits cell wall mucopeptide formation, Bactericidal
What is the MOA of Amantadine?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
What is the MOA of Aztreonam?
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
What is the MOA of Foscarnet?
Inhibits Viral DNA polymerase
What is the MOA of Ganciclovir?
Inhibits CMV DNA polymerase
What is the MOA of Griseofulvin?
Interferes with microtubule function, disrupts mitosis, inhibits growth
What is the MOA of Imipenem?
Acts as a wide spectrum carbapenem
What is the MOA of Isoniazid (INH)?
Decreases synthesis of Mycolic Acid
What is the MOA of Polymyxins?
Bind cell membrane, disrupt osmotic properties, Are Cationc, Basic and act as detergents
What is the MOA of Ribavirin?
Inhibits IMP Dehydrogenase (competitively), and therefore blocks Guanine Nucleotide synthesis
What is the MOA of the RT Inhibitors?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
What is the most common cause of Pt noncompliance with Macrolides?
GI discomfort
What is treated with Chloroquine, Quinine, Mefloquine?
Malaria (P. falciparum)
What microorganisms are Aminoglycosides ineffective against?
Anaerobes
What microorganisms are clinical indications for Tetracycline therapy?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme\'s) Rickettsia Tularemia
What microorganisms is Aztreonam not effective against?
Gram + and Anerobes
What musculo-skeletal side effects in Adults are associated with Floroquinolones?
Tendonitis and Tendon rupture
What neurotransmitter does Amantadine affect? How does it influence this NT?
Dopamine; causes its release from intact nerve terminals
What organism is Imipenem/cilastatin the Drug of Choice for?
Enterobacter
What organisms does Griseofulvin target?
Dermatophytes (tinea, ringworm)
What parasites are treated with Pyrantel Pamoate (more specific)?
Giant Roundworm (Ascaris), Hookworm (Necator/Ancylostoma), Pinworm (Enterobius)
What parasitic condition is treated with Ivermectin?
Onchocerciasis (\'river blindness\'--rIVER-mectin)
What populations are Floroquinolones contraindicated in? Why?
Pregnant women, Children; because animal studies show Damage to Cartilage
What should not be taken with Tetracyclines? / Why?
Milk or Antacids, because divalent cations inhibit Tetracycline absorption in the gut
What Sulfonamides are used for simple UTIs?
Triple sulfas or SMZ
When is HIV therapy initiated?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
When is Rifampin not used in combination with other drugs?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Where does Griseofulvin deposit?
Keratin containing tissues, e.g., nails
Which Aminoglycoside is used for Bowel Surgery ?
Neomycin
Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Which individuals are predisposed to Sulfonamide-induced hemolysis?
G6PD deficient individuals
Which RT inhibitor causes Megaloblastic Anemia?
AZT
Which RT inhibitors cause a Rash?
Non-Nucleosides
Which RT inhibitors cause Lactic Acidosis?
Nucleosides
Which Tetracycline is used in patients with renal failure? / Why?
Doxycycline, because it is fecally eliminated
Who\'s your daddy?
B.W. !!!, Ha. Good Luck on Boards
Why are Methicillin, Nafcillin, and Dicloxacillin penicillinase resistant?
Due to the presence of a bulkier R group
Why is Cilastatin administered with Imipenem?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
List the mechanism, clinical use, & toxicity of 5 FU.
-S-phase anti-metabolite Pyr analogue -Colon, solid tumors, & BCC/ -Irreversible myelosuppression
List the mechanism, clinical use, & toxicity of 6 MP.
-inhibits HGPRT (pur. Syn.) - Luk, Lymph,
List the mechanism, clinical use, & toxicity of Bleomycin.
-DNA intercalator -testicular & lymphomas -Pulmonary fibrosis mild myelosuppression.
List the mechanism, clinical use, & toxicity of Busulfan.
-Alkalates DNA -CML -Pulmonary fibrosis hyperpigmentation
List the mechanism, clinical use, & toxicity of Cisplatin.
-Alkalating agent -testicular,bladder,ovary,&lung -Nephrotoxicity & CN VIII damage.
List the mechanism, clinical use, & toxicity of Cyclophosphamide.
-Alkalating agent -NHL, Breast, ovary, & lung. - Myelosuppression, & hemorrhagic cystitis.
List the mechanism, clinical use, & toxicity of Doxorubicin.
-DNA intercalator -Hodgkin\'s, myeloma, sarcoma, and solid tumors -Cardiotoxicity & alopecia
List the mechanism, clinical use, & toxicity of Etoposide.
-Topo II inhibitor(GII specific) -Oat cell of Lung & prostate, & testicular -Myelosuppression & GI irritation.
List the mechanism, clinical use, & toxicity of Methotrexate.
-S-phase anti-metabolite folate analogue -Luk, Lymp, sarc, RA, &psoriasis / -Reversible myelosuppression
List the mechanism, clinical use, & toxicity of Nitrosureas.
-Alkalate DNA -Brain tumors -CNS toxicity
List the mechanism, clinical use, & toxicity of Paclitaxel.
-MT polymerization stabilizer -Ovarian & breast CA -Myelosupperession & hypersensitivity.
List the mechanism, clinical use, & toxicity of Prednisone.
-Triggers apoptosis -CLL, Hodgkin\'s in MOPP -Cushing-like syndrome
List the mechanism, clinical use, & toxicity of Tamoxifen.
-Estrogen receptor antagonist -Breast CA -increased endometrial CA risk
List the mechanism, clinical use, & toxicity of Vincristine.
-MT polymerization inhibitor(M phase) -MOPP, lymphoma, Willm\'s & choriocarcinoma -neurotoxicity and myelosuppression
Which cancer drugs effect nuclear DNA (4)?
-Alkalating agents+cisplatin -Doxorubicin+Dactinomycin -Bleomycin -Etoposide
Which cancer drugs inhibit nucleotide synthesis(3)?
- Methotrexate - 5 FU - 6 mercaptopurine
Which cancer drugs work at the level of mRNA(2)?
-Steroids -Tamoxifen
Which cancer drugs work at the level of proteins(2)?
-Vinca alkaloids(inhibit MT) -Paclitaxel
ACE inhibitors- clinical use?
hypertension, CHF, diabetic renal disease
ACE inhibitors- mechanism?
reduce levels of Angiotensin II, thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
ACE inhibitors- toxicity?
fetal renal damage, hyperkalemia, Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower Angiotensin II (CAPTOPRIL)
Acetazolamide- clinical uses?
glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness
Acetazolamide- mechanism?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self-limited sodium bicarb diuresis and reduction of total body bicarb stores.
acetazolamide- site of action?
proximal convoluted tubule
Acetazolamide- toxicity?
hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
Acetazolamide causesÉ?
ACIDazolamide\' causes acidosis
Adenosine- clinical use?
DOC in diagnosing and abolishing AV nodal arrhythmias
ADH antagonists- site of action?
collecting ducts
adverse effect of Nitroprusside?
cyanide toxicity (releases CN)
adverse effects of beta-blockers?
impotence, asthma, CV effects (bradycardia, CHF, AV block), CNS effects (sedation, sleep alterations)
adverse effects of Captopril?
fetal renal toxicity, hyperkalemia, Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems, Rash, Increased renin, Lower Angiotensin II (CAPTOPRIL)
adverse effects of Clonidine?
dry mouth, sedation, severe rebound hypertension
adverse effects of ganglionic blockers?
severe orthostatic hypotension, blurred vision, constipation, sexual dysfunction
adverse effects of Guanethidine?
orthostatic and exercise hypotension, sexual dysfunction, diarrhea
adverse effects of Hydralazine?
nausea, headache, lupus-like syndrome, reflex tachycardia, angina, salt retention
adverse effects of Hydrochlorothiazide?
hypokalemia, slight hyperlipidemia, hyperuricemia, lassitude, hypercalcemia, hyperglycemia
adverse effects of Loop Diuretics?
K+ wasting, metabolic alkalosis, hypotension, ototoxicity
adverse effects of Losartan?
fetal renal toxicity, hyperkalemia
adverse effects of Methyldopa?
sedation, positive Coombs\' test
adverse effects of Minoxidil?
hypertrichosis, pericardial effusion, reflex tachycardia, angina, salt retention
adverse effects of Nifedipine, verapamil?
dizziness, flushing, constipation (verapamil), nausea
adverse effects of Prazosin?
first dose orthostatic hypotension, dizziness, headache
adverse effects of Reserpine?
sedation, depression, nasal stuffiness, diarrhea
Amiodarone- toxicity?
pulmonary fibrosis, corneal deposits, hepatotoxicity, skin deposits resulting in photodermatitis, neurologic effects, consitpation, CV (bradycardia, heart block, CHF), and hypo- or hyperthyroidism.
antidote?
slowly normalize K+, lidocaine, cardiac pacer, and anti-Dig Fab fragments
Beta Blockers- CNS toxicity?
sedation, sleep alterations
Beta Blockers- CV toxicity?
bradycardia, AV block, CHF
Beta Blockers- site of action?
Beta adrenergic receptors and Ca2+ channels (stimulatory)
BP?
decrease
BP?
decrease
Bretyllium- toxicity?
new arrhythmias, hypotension
Ca2+ channel blockers- clinical use?
hypertension, angina, arrhythmias
Ca2+ channel blockers- mechanism?
block voltage dependent L-type Ca2+ channels of cardiac and smooth muscle- decreasing contractility
Ca2+ channel blockers- site of action?
Cell membrane Ca2+ channels of cardiac sarcomere
Ca2+ channel blockers- toxicity?
cardiac depression, peripheral edema, flushing, dizziness, constipation
Ca2+ sensitizers\'- site of action?
troponin-tropomyosin system
Cautions when using Amiodarone?
check PFTs, LFTs, and TFTs
class IA effects?
increased AP duration, increased ERP increased QT interval. Atrial and ventricular.
class IB- clinical uses?
post MI and digitalis induced arrhythmias
class IB- effects?
decrease AP duration, affects ischemic or depolarized Purkinje and ventricular system
class IB- toxicity?
local anesthetic. CNS stimulation or depression. CV depression.
class IC- effects?
NO AP duration effect. useful in V-tach that progresses to V-fib and in intractable SVT LAST RESORT
class IC- toxicity?
proarrhythmic
class II- effects?
decrease the slope of phase 4, increase PR interval (the AV node is particularly sensitive)
class II- mechanism?
blocking the beta adrenergic receptor leads to decreased cAMP, and decreased Ca2+ flux
class II- toxicity?
impotence, exacerbation of asthma, CV effects, CNS effects, may mask hypoclycemia
Class III- effects?
increase AP duration, increase ERP, increase QT interval, for use when other arrhythmics fail
class IV- clinical use?
prevention of nodal arrhythmias (SVT)
class IV- effects?
decrease conduction velocity, increase ERP, increase PR interval
class IV- primary site of action?
AV nodal cells
class IV- toxicity?
constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression), and torsade de pointes (Bepridil)
classes of antihypertensive drugs?
diuretics, sympathoplegics, vasodilators, ACE inhibitors, Angiotensin II receptor inhibitors
clinical use?
angina, pulmonary edema (also, erection enhancer)
clinical use?
CHF, atrial fibrillation
contractility?
increase (reflex response)
contractility?
decrease
contraindications?
renal failure, hypokalemia, pt on quinidine
decrease Digitoxin dose in renal failure?
NO
decrease Digoxin dose in renal failure?
YES
Digitalis- site of action?
Na/K ATPase
Digoxin v. Digitoxin: bioavailability?
Digitoxin>95% Digoxin 75%
Digoxin v. Digitoxin: excretion?
Digoxin=urinary Digitoxin=biliary
Digoxin v. Digitoxin: half life?
Digitoxin 168hrs Digoxin 40 hrs
Digoxin v. Digitoxin: protein binding?
Digitoxin 70% Digoxin 20-40%
ejection time?
decrease
ejection time?
increase
EKG results?
inc PR, dec QT, scooping of ST, and T wave inversion
end diastolic volume?
decrease
end diastolic volume?
increase
Esmolol- short or long acting?
very short acting
Ethacrynic Acid- clinical use?
Diuresis in pateints with sulfa allergy
Ethacrynic Acid- mechanism?
not a sulfonamide, but action is the same as furosemide
Ethacrynic Acid- toxicity?
NO HYPERURICEMIA, NO SULFA ALLERGY; same as furosemide otherwise
Furosemide- class and mechanism?
Sulfonamide Loop Diuretic. Inhibits ion co-transport system of thick ascending loop. Abolishes hypertonicity of the medulla, thereby preventing concentration of the urine.
Furosemide- clinical use?
edematous states (CHF, cirrhosis, nephrotic syndrome, pulm edema), HTN, hypercalcemia
Furosemide- toxicity? (OH DANG)
Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout
Furosemide increases the excretion of what ion?
Ca2+ (Loops Lose calcium)
HDL effect?
no effect
HDL effect?
increase
HDL effect?
moderate increase
HDL effect?
increase
HDL effect?
DECREASE
how do we stop angina?
decrease myocardial O2 consumption by: 1-decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4-decreasing contractility 5-decreasing ejection time
HR?
increase (reflex response)
HR?
decrease
Hydralazine- class and mechanism?
vasodilator- increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Hydralazine- clinical use?
severe hypertension, CHF
Hydralazine- toxicity?
compensatory tachycardia, fluid retention, lupus-like syndrome
Hydrochlorothiazide- clinical use?
HTN, CHF, calcium stone formation, nephrogenic DI.
Hydrochlorothiazide- mechanism?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Hydrochlorothiazide- toxicity? (hyperGLUC, plus others)
Hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia, sulfa allergy.
Ibutilide- toxicity?
torsade de pointes
K+- clinical use?
depresses ectopic pacemakers, especially in digoxin toxicity
K+ sparing diuretics- clinical use?
hyperaldosteronism, K+ depletion, CHF
K+ sparing diuretics- site of action?
cortical collecting tubule
K+ sparing diuretics- toxicity?
hyperkalemia, endocrine effects (gynecomastia, anti-androgen)
LDL effect?
moderate decrease
LDL effect?
large decrease
LDL effect?
moderate decrease
LDL effect?
decrease
LDL effect?
decrease
loop diuretics (furosemide)- site of action?
thick ascending limb
Mannitol- clinical use?
ARF, shock, drug overdose, decrease intracranial/intraocular pressure
Mannitol- contraindications?
anuria, CHF
Mannitol- mechanism?
osmotic diuretic- increase tubular fluid osmolarity, thereby increasing urine flow
mannitol- site of action?
proximal convoluted tubule, thin descending limb, and collecting duct
Mannitol- toxicity?
pulmonary edema, dehydration
mechanism?
vasodilate by releasing NO in smooth muscle, causing and increase in cGMP and smooth muscle relaxation (veins>>arteries)
mechanism?
inhibits the Na/K ATPase, increasing intracellular Na+ decreasing the function of the Na/Ca antiport causing an increase in intracellular Ca2+
mechanism?
Na+ channel blockers. Slow or block conduction. Decreased slope in phase 4 and increased threshold for firing in abnormal pacemaker cells.
Mg+- clinical use?
effective in torsade de pointes and digoxin toxicity
MVO2?
decrease
MVO2?
decrease
name five in class II?
propanolol, esmolol, metoprolol, atenolol, timolol
name four HMG-CoA reductase inhibitors.
Lovastatin, Pravastatin, Simvastatin, Atorvastatin
name four in class IA.
Quinidine, Amiodarone, Procainamide, Disopyramide
name four in class III.
Sotalol, Ibutilide, Bretylium, Amiodarone
name three ACE inhibitors?
Captopril, Enalapril, Lisinopril
name three calcium channel blockers?
Nifedipine, Verapamil, Diltiazem
name three in class IB.
Lidocaine, Mexiletine, Tocainide
name three in class IC.
Flecainide, Encainide, Propafenone
name three in class IV.
Verapamil, Diltiazem, Bepridil
name three K+ sparing diuretics?
Spironolactone, Triamterene, Amiloride (the K+ STAys)
name two bile acid resins.
cholestyramine, colestipol
name two LPL stimulators.
Gemfibrozil, Clofibrate
Nifedipine has similar action to?
Nitrates
preferential action of the Ca2+ channel blockers at cardiac muscle?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
preferential action of the Ca2+ channel blockers at vascular smooth muscle?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Procainamide- toxicity?
reversible SLE-like syndrome
Quinidine- toxicity?
cinchonism: HA, tinnitus, thrombocytopenia, torsade de pointes due to increased QT interval
Ryanodine- stie of action?
blocks SR Ca2+ channels
selectivity?
slectively depress tissue that is frequently depolarized (fast tachycardia)
side effects/problems?
tastes bad and causes GI discomfort
side effects/problems?
expensive, reversible increase in LFTs, and myositis
side effects/problems?
red, flushed face which is decreased by ASA or long term use
side effects/problems?
myositis, increased LFTs
side effects/problems?
DECREASED HDL
Sotalol- toxicity?
torsade de pointes, excessive Beta block
Spironolactone- mechanism?
competitive inhibirot of aldosterone in the cortical collecting tubule
TG effect?
slight increase
TG effect?
decrease
TG effect?
decrease
TG effect?
large decrease
TG effect?
no effect
thiazides- site of action?
distal convoluted tubule (early)
toxicity?
tachycardia, hypotension, headache - \'Monday disease\'
toxicity?
nausea, vomiting, diarrhea, blurred vision, arrhythmia
Triamterene and amiloride- mechanism?
block Na+ channels in the cortical collecting tubule
Verapamil has similar action to?
Beta Blockers
what two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
Hydralazine and Minoxidil
which diuretics cause acidosis?
carbonic anhydrase inhibitors, K+ sparing diuretics
which diuretics cause alkalosis?
loop diuretics, thiazides
which diuretics decrease urine Ca2+?
thiazides, amiloride
which diuretics increase urine Ca2+?
loop diuretics, spironolactone
which diuretics increase urine K+?
all except the K+ sparing diuretics Spironolactone, Triamterene, Amiloride
which diuretics increase urine NaCl?
all of them
Acetaminophen has what two clinical uses and lacks what one clinical use of the NSAIDs?
Acetaminophen has antipyretic and analgesic properties, but lacks anti-inflammatory properties.
Can Heparin be used during pregnancy?
Yes, it does not cross the placenta.
Can Warfarin be used during pregnancy?
No, warfarin, unlike heparin, can cross the placenta.
Does Heparin have a long, medium, or short half life?
Short.
Does Warfarin have a long, medium, or short half life?
Long.
For Heparin what is the 1. Structure 2. Route of administration 3. Onset of action 4. Mechanism of action 5. Duration of action 6. Ability to inhibit coagulation in vitro 7. Treatment for overdose 8. Lab value to monitor 9. Site of action
Heparin 1. Structure - Large anionic polymer, acidic 2. Route of administration - Paranteral (IV, SC) 3. Onset of action - Rapid (seconds) 4. Mechanism of action - Activates antithrombin III 5. Duration of action - Acute (hours) 6. Ability to inhibit coagulation in vitro - Yes 7. Treatment for overdose - Protamine sulfate 8. Lab value to monitor-aPTT (intrinsic pathway) 9. Site of action - Blood
For Warfarin what is the 1. Structure 2. Route of administration 3. Onset of action 4. Mechanism of action 5. Duration of action 6. Ability to inhibit coagulation in vitro 7. Treatment for overdose 8. Lab value to monitor 9. Site of action
Warfarin 1. Structure - Small lipid-soluble molecule 2. Route of administration -Oral 3. Onset of action - Slow, limited by half lives of clotting factors 4. Mechanism of action - Impairs the synthesis of vitamin K-dependent clotting factors 5. Duration of action - Chronic (weeks or months) 6. Ability to inhibit coagulation in vitro - No
For Warfarin what is the (continued):
7. Treatment for overdose - IV vitamin K and fresh frozen plasma 8. Lab value to monitor - PT 9. Site of action - Liver
Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Rare.
List five common glucocorticoids.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Secretion of what drug is inhibited by Probenacid used to treat chronic gout?
Penicillin.
The COX-2 inhibitors (celecoxib, rofecoxib) have similar side effects to the NSAIDs with what one exception?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
What are are the Sulfonylureas (general description) and what is their use?
Sulfonylureas are oral hypoglycemic agents, they are used to stimulate release of endogenous insulin in NIDDM (type-2).
What are five advantages of Oral Contraceptives (synthetic progestins, estrogen)?
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
What are five disadvantages of Oral Contraceptives (synthetic progestins, estrogen)?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression, weight gain, nausea, HTN 5. Hypercoagulable state
What are five possible toxic effects of Aspirin therapy?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye\'s syndrome 5. Tinnitus (CN VIII)
What are five toxicities associated with Tacrolimus (FK506)?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
What are four advantages of newer low-molecular-weight heparins (Enoxaparin)?
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
What are four clinical activities of Aspirin?
1. Antipyretic 2. Analgesic 3. Anti-inflammatory 4. Antiplatelet drug.
What are four clinical uses of glucocorticoids?
1. Addison\'s disease 2. Inflammation 3. Immune suppression 4. Asthma
What are four conditions in which H2 Blockers are used clinically?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger-Ellison syndrome
What are four H2 Blockers?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
What are four Sulfonylureas?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
What are four thrombolytics?
1. Streptokinase 2. Urokinase 3. tPA (alteplase), APSAC (anistreplase)
What are four unwanted effects of Clomiphene use?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
What are nine findings of Iatrogenic Cushing\'s syndrome caused by glucocorticoid therapy?
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
What are signs of Sildenafil (Viagra) toxicity?
Headache, flushing , dyspepsia, blue-green color vision.
What are the clinical uses for Ticlopidine, Clopidogrel?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
What are the four conditions in which Omeprazole, Lansoprazole is used?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger-Ellison syndrome
What are three clinical uses of the Leuprolide?
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
What are three clinical uses of the NSAIDs?
1. Antipyretic 2. Analgesic 3. Anti-inflammatory
What are three common NSAIDS other than Aspirin?
Ibuprofen, Naproxen, and Indomethacin
What are three complications of Warfarin usage?
1. Bleeding 2. Teratogenicity 3. Drug-drug interactions
What are three possible complications of Heparin therapy?
1. Bleeding 2. Thrombocytopenia 3. Drug-drug interactions
What are three possible toxicities of NSAID usage?
1. Renal damage 2. Aplastic anemia 3. GI distress
What are three toxicities of Leuprolied?
1. Antiandrogen 2. Nausea 3. Vomiting
What are three toxicities of Propylthiouracil?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
What are three types of antacids and the problems that can result from their overuse?
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia, rebound acid increase - All may cause hypokalemia
What are three unwanted effects of Mifepristone?
1. Heavy bleeding 2. GI effects (n/v, anorexia) 3. Abdominal pain
What are two Alpha-glucosidase inhibitors?
1. Acarbose 2. Miglitol
What are two clinical uses of Azathioprine?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
What are two conditions in which COX-2 inhibitors might be used?
Rheumatoid and osteoarthritis.
What are two Glitazones?
1. Pioglitazone 2. Rosiglitazone.
What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
What are two processes Corticosteroids inhibit leading to decreased inflammation?
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
What are two toxicities associated with Cyclosporine?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
What are two toxicities of the Glitazones?
1. Weight gain 2. Hepatotoxicity (troglitazone)
What are two toxicities of the Sulfonylureas?
1. Hypoglycemia (more common with 2nd-generation drugs: glyburide, glipizide) 2. Disulfiram-like effects (not seen with 2nd-generation drugs).
What are two types of drugs that interfere with the action of Sucralfate and why?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
What can result due to antacid overuse?
Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
What enzyme does Zileuton inhibit?
Lipoxygenase
What enzymes are inhibited by NSAIDs, acetaminophen and COX II inhibitors?
Cyclooxygenases (COX I, COX II).
What is a common side effect of Colchicine used to treat acute gout, especially when given orally?
GI side effects. (Note: Indomethacin is less toxic, more commonly used.)
What is a common side effect of Misoprostol?
Diarrhea
What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
What is a possible toxicity of Alpha-glucosidase inhibitors used in type-2 diabetes?
GI disturbances.
What is a possible toxicity of Ticlopidine, Clopidogrel usage?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
What is a sign of toxicity with the use of thrombolytics?
Bleeding.
What is action of insulin in the liver, in muscle, and in adipose tissue?
1. In liver, increases storage of glucose as glycogen. 2. In muscle, stimulates glycogen and protein synthesis, and K+ uptake. 3. In adipose tissue, facilitates triglyceride storage.
What is are two clinical uses of Cyclosporine?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Antileukotriene; blocks leukotriene receptors.
What is the category and mechanism of action of Zileuton in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
What is the category of drug names ending in -ane (e.g. Halothane)
Inhalational general anesthetic.
What is the category of drug names ending in -azepam (e.g. Diazepam)
Benzodiazepine.
What is the category of drug names ending in -azine (e.g. Chlorpromazine)
Phenothiazine (neuroleptic, antiemetic).
What is the category of drug names ending in -azol (e.g. Ketoconazole)
Antifungal.
What is the category of drug names ending in -barbital (e.g. Phenobarbital)
Babiturate.
What is the category of drug names ending in -caine (e.g. Lidocaine)
Local anesthetic.
What is the category of drug names ending in -cillin (e.g. Methicillin)
Penicillin.
What is the category of drug names ending in -cycline (e.g. Tetracycline)
Antibiotic, protein synthesis inhibitor.
What is the category of drug names ending in -ipramine (e.g. Imipramine)
Tricyclic antidepressant.
What is the category of drug names ending in -navir (e.g. Saquinavir)
Protease inhibitor.
What is the category of drug names ending in -olol (e.g. Propranolol)
Beta antagonist.
What is the category of drug names ending in -operidol (e.g. Haloperidol)
Butyrophenone (neuroleptic).
What is the category of drug names ending in -oxin (e.g. Digoxin)
Cardiac glycoside (inotropic agent).
What is the category of drug names ending in -phylline (e.g. Theophylline)
Methylxanthine.
What is the category of drug names ending in -pril (e.g. Captopril)
ACE inhibitor.
What is the category of drug names ending in -terol (e.g. Albuterol)
Beta-2 agonist.
What is the category of drug names ending in -tidine (e.g. Cimetidine)
H2 antagonist
What is the category of drug names ending in -triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
What is the category of drug names ending in -tropin (e.g. Somatotropin)
Pituitary hormone.
What is the category of drug names ending in -zosin (e.g. Prazosin)
Alpha-1 antagonist
What is the category, desired effect, and adverse effect of Isoproterenol in the treatment of Asthma?
Nonspecific beta-agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
What is the category, desired effect, and period of use of albuterol in the treatment of Asthma?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
What is the category, desired effect, and possible mechanism of Theophylline in treating Asthma?
Methylzanthine; desired effect is bronchodilation, may cause bronchodilation by inhibiting phosphodiesterase, enzyme involved in degrading cAMP (controversial).
What is the category, mechanism of action, and effect of Ipratroprium in Asthma treatment?
Muscarinic antagonist; competatively blocks muscarinic receptors, preventing bronchoconstriction.
What is the category, mechanism of action, and particular use of beclomethasone and prednisone in Asthma treatment?
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
What is the category, method of use, and adverse effects of Salmeterol in Asthma treatment?
Beta 2 agonist; used as a long-acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
What is the clincial use for Misoprostol?
Prevention of NSAID-induced peptic ulcers, maintains a PDA.
What is the clinical use for Clomiphene?
Treatment of infertility.
What is the clinical use for Heparin?
Immediate anticoagulation for PE, stroke, angina, MI, DVT.
What is the clinical use for Sildenafil (Viagra)?
Erectile dysfunction.
What is the clinical use for Sucralfate?
Peptic ulcer disease.
What is the clinical use for Warfarin?
Chronic anticoagulation.
What is the clinical use of Mifepristone (RU486)?
Abortifacient.
What is the clinical use of Tacrolimus (FK506)?
Potent immunosuppressive used in organ transplant recipients.
What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
What is the enzyme inhibited, the effect of this inhibition, and the clinical use of the antiandrogren Finasteride?
Finasteride inhibits 5 Alpha-reductase, this decreases the conversion of testosterone to dihydrotestosterone, useful in BPH
What is the lab value used to monitor the effectiveness of Heparin therapy?
The PTT.
What is the lab value used to monitor the effectiveness of Warfarin therapy?
The PT.
What is the main clinical use for the thrombolytics?
Early myocardial infarction.
What is the mecanism of action of Sucralfate?
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid, pepsin, and bile.
What is the mecanism of action of the COX-2 inhibitors (celecoxib, rofecoxib)?
Selectively inhibit cyclooxygenase (COX) isoform 2, which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 which helps maintain the gastric mucosa.
What is the mecanism of action, effective period, and ineffective period of use for Cromolyn in treating Asthma?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor, used in prostate carcinoma.
What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
Inhibit steroid synthesis, used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
What is the mechanism of action of Acetaminophen?
Reversibly inhibits cyclooxygenase, mostly in CNS. Inactivated peripherally.
What is the mechanism of action of Allopurinol used to treat chronic gout?
Inhibits xanthine oxidase, decresing conversion of xanthine to uric acid.
What is the mechanism of action of Aspirin?
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
What is the mechanism of action of Clomiphene?
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary, which stimulates ovulation.
What is the mechanism of action of Colchicine used to treat acute gout?
Depolymerizes microtubules, impairing leukocyte chemotaxis and degranulation.
What is the mechanism of action of Cyclosporine?
Binds to cyclophilins (peptidyl proline cis-trans isomerase), blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
What is the mechanism of action of Heparin?
Heparin catalyzes the activation of antithrombin III.
What is the mechanism of action of Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
What is the mechanism of action of Misoprostol?
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
What is the mechanism of action of NSAIDs other than Aspirin?
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
What is the mechanism of action of Omeprazole, Lansoprazole?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
What is the mechanism of action of Probenacid used to treat chronic gout?
Inhibits reabsorption of uric acid.
What is the mechanism of action of Sildenafil (Viagra)?
Inhibits cGMP phosphodiesterase, casuing increased cGMP, smooth muscle relaxation in the corpus cavernosum, increased blood flow, and penile erection.
What is the mechanism of action of the Alpha-glucosidase inhibitors?
Inhibit intestinal bursh border Alpha-glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
What is the mechanism of action of the glucocorticoids?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
What is the mechanism of action of the H2 Blockers?
Reversible block of histamine H2 receptors
What is the mechanism of action of the Sulfonylureas?
Close K+ channels in Beta-cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
What is the mechanism of action of the thrombolytics?
Directly of indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin-bound plasminogen to plasmin.)
What is the mechanism of action of Ticlopidine, Clopidogrel
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
What is the mechanism of action of Warfarin (Coumadin)?
Warfarin interferes with the normal synthesis and gamma-carboxylation of vitamin K-dependent clotting factors II, VII, IX, and X, Protein C and S via vitamin K antagonism.
What is the mechanism of Azathioprine?
Antimetabolite derivative of 6-mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
What is the mechanism of Leuprolide?
GnRH analog with agonist properties when used in pulsatile fashion and antagonist properties when used in continuous fashion, causing a transient initial burst of LH and FSH
What is the mechanism of Tacrolimus (FK506)?
Similar to cyclosporine; binds to FK-binding protein, inhibiting secretion of IL-2 and other cytokines.
What is the memory key for the action of Sildenafil (Viagra)?
Sildenafil fills the penis
What is the memory key for the effect of aluminum hydroxide overuse?
AluMINIMUM amount of feces.
What is the memory key for the effect of magnesium hydroxide overuse?
Mg = Must go to the bathroom.
What is the memory key to remember which pathway (extrinsic vs. intrinsic) and which lab value Warfarin affects?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
What is the possible mechanism and effect of Metformin in treating diabetes?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
What is the specific clinical use of Indomethacin in neonates?
Indomethacin is used to close a patent ductus arteriosus.
What is used to reverse the action of Heparin?
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
What patients are at risk for life threatening hypotension when taking Sildenafil (Viagra)?
Those patients who are taking nitrates.
What process does Zafirlukast interfere with?
Leukotrienes increasing bronchial tone.
What type of gout is treated with Allopurinol?
Chronic gout.
What type of gout is treated with Colchicine?
Acute gout.
What type of gout is treated with Probenacid?
Chronic gout.
What type of patient should not take Misoprostol and why?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Which H2 Blocker has the most toxic effects and what are they?
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
Why are the Sulfonylureas inactive in IDDM (type-1)?
Because they require some residual islet function.
Acetaldehyde is metabolized by Acetaldehyde dehydrogenase, which drug inhibs this enzyme?
-Disulfram & also sulfonylureas, metronidazole
Explain pH dependent urinary drug elimination?
-Weak Acids>Alkinalize urine(CO3) to remove more -Weak bases>acidify urine to remove more
How do you treat coma in the ER (4)?
-Airway -Breathing -Circulation -Dextrose(thiamine &narcan) -ABCD
In coma situations you rule out what (7)?
-Infections -Trauma -Seizures -CO -Overdose -Metabolic -Alcohol (IT\'S COMA)
List some specifics of lead poisoning(4)?
-A57Blue lines in gingiva& long bones -Encephalopathy & Foot drop -Abdominal colic / -Sideroblastic anemia
List the specific antidote for this toxin: Acetaminophen
-N-acetylcystine
List the specific antidote for this toxin: Amphetamine
-Ammonium Chloride
List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
-Atropine & pralidoxime
List the specific antidote for this toxin: Antimuscarinic (anticholinergic)
-Physostigmine salicylate
List the specific antidote for this toxin: Arsenic (all heavy metals)
-Dimercaprol, succimer
List the specific antidote for this toxin: Benzodiazepines
-Flumazenil
List the specific antidote for this toxin: Beta Blockers
-Glucagon
List the specific antidote for this toxin: Carbon monoxide
-100% oxygen, hyperbaric
List the specific antidote for this toxin: Copper
-Penicillamine
List the specific antidote for this toxin: Cyanide
-Nitrate, hydroxocobalamin thiosulfate
List the specific antidote for this toxin: Digitalis
-Normalize K+, Lidocaine, & Anti-dig Mab
List the specific antidote for this toxin: Heparin
-Protamine
List the specific antidote for this toxin: Iron
-Deferoxamine
List the specific antidote for this toxin: Lead
-EDTA, dimercaprol, succimer, & penicillamine
List the specific antidote for this toxin: Methanol & Ethylene glycol
-Ethanol, dialysis, & fomepizole
List the specific antidote for this toxin: Methemoglobin
-Methylene blue
List the specific antidote for this toxin: Opioids
-B51Naloxone / naltrexone (Narcan)
List the specific antidote for this toxin: Salicylates
-Alkalinize urine & dialysis
List the specific antidote for this toxin: TPA & Streptokinase
-Aminocaproic acid
List the specific antidote for this toxin: Tricyclic antidepressants
-NaHCO3
List the specific antidote for this toxin: Warfarin
-Vitamin K & fresh frozen plasma
What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
-Acetaldehyde -Nausea, vomiting, headache, & hypotension
What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
-Oxalic acid -Acidosis & nephrotoxicity
What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
-Formaldehyde & formic acid -severe acidosis & retinal damage
Which drug(s) cause this reaction: Adrenocortical Insufficiency
-Glucocorticoid withdrawal
Which drug(s) cause this reaction: Agranulocytosis (3)?
-Cloazapine -carbamazapine -colchicine -PTU
Which drug(s) cause this reaction: Anaphylaxis?
-Penicillin
Which drug(s) cause this reaction: Aplastic anemia (5)?
-Chloramphenicol -benzene -NSAIDS -PTU -phenytoin
Which drug(s) cause this reaction: Atropine-like side effects?
-Tricyclic antidepressants
Which drug(s) cause this reaction: Cardiac toxicity?
-Daunorubicin & Doxorubicin
Which drug(s) cause this reaction: Cinchonism (2)?
-Quinidine -quinine
Which drug(s) cause this reaction: Cough?
-ACE inhibitors (Losartan>no cough)
Which drug(s) cause this reaction: Cutaneous flushing (4)?
-Niacin -Ca++ channel blockers -adenosine -vancomycin
Which drug(s) cause this reaction: Diabetes insipidus?
-Lithium
Which drug(s) cause this reaction: Disulfram-like reaction (4) ?
-Metronidazole -certain cephalosporins -procarbazine -sulfonylureas
Which drug(s) cause this reaction: Drug induced Parkinson\'s (4) ?
-Haloperidol -chlorpromazine -reserpine -MPTP
Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
-Chlorpromazine -thioridazine -haloperidol
Which drug(s) cause this reaction: Fanconi\'s syndrome?
-Tetracycline
Which drug(s) cause this reaction: Focal to massive hepatic necrosis (4)?
-Halothane -Valproic acid -acetaminophen -Amantia phalloides
Which drug(s) cause this reaction: G6PD hemolysis(8)?
-Sulfonamides -INH -ASA -Ibuprofen -primaquine -nitrofurantoin /-pyrimethamine -chloramphenicol
Which drug(s) cause this reaction: Gingival hyperplasia?
-Phenytoin
Which drug(s) cause this reaction: Gray baby syndrome?
-Chloramphenicol
Which drug(s) cause this reaction: Gynecomastia (6) ?
-Cimetidine -ketoconazole -spironolactone -digitalis -EtOH -estrogens
Which drug(s) cause this reaction: Hepatitis?
-Isoniazid
Which drug(s) cause this reaction: Hot flashes?
-Tamoxifen
Which drug(s) cause this reaction: Neuro and Nephrotoxic?
-polymyxins
Which drug(s) cause this reaction: Osteoporosis (2)?
-Corticosteroids -heparin
Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
-aminoglycosides -loop diuretics -cisplatin
Which drug(s) cause this reaction: P450 induction(6)?
-Barbiturates -phenytoin -carbamazipine -rifampin -griseofulvin -quinidine
Which drug(s) cause this reaction: P450 inhibition(6)?
-Cimetidine -ketoconazole -grapefruit juice -erythromycin -INH -sulfonamides
Which drug(s) cause this reaction: Photosensitivity(3)?
-Tetracycline -amiodarone -sulfonamides
Which drug(s) cause this reaction: Pseudomembranous colitis?
-Clindamycin
Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
-Bleomycin -amiodarone -busulfan
Which drug(s) cause this reaction: SLE-like syndrome
-Hydralazine -Procainamide -INH -phenytoin
Which drug(s) cause this reaction: Stevens-Johnson syn. (3) ?
-Ethosuxamide -sulfonamides -lamotrigine
Which drug(s) cause this reaction: Tardive dyskinesia?
-Antipsychotics
Which drug(s) cause this reaction: Tendonitis and rupture?
-Fluoroquinolones
Which drug(s) cause this reaction: Thrombotic complications?
-Oral Contraceptives
Which drug(s) cause this reaction: Torsade de pointes (2) ?
-Class III antiarrhythmics (sotalol) -class IA (quinidine)
Which drug(s) cause this reaction: Tubulointerstitial Nephritis (5)?
-Sulfonamides -furosemide -methicillin -rifampin -NSAIDS (ex. ASA)
Describe first-order kinetics?
Constant FRACTION eliminated per unit time.(exponential)
Describe Phase I metabolism in liver(3)?
-reduction, oxy, & hydrolysis -H2O sol. Polar product -P450
Describe Phase II metabolism in liver(3)?
-acetylation, glucuron.,& sulfation -Conjugation -Polar product
Explain differences between full and partial agonists(2).
- Act on same receptor - Full has greater efficacy
Explain potency in relation to full and partial agonists(2).
- partial agonist can have increased, decreased, /A21or equal potency as full agonist. - Potency is an independent factor.
How do spare receptors effect the Km?
- ED 50 is less than the Km (less than 50% of receptors)
How do you calculate maintenance dose?
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
How does a competitive antagonist effect an agonist?
-Shifts the curve to the right -increases Km
How does a noncompetitive antagonist effect an agonist?
- Shifts the curve down -reduces Vmax
Name the steps in drug approval(4)?
-Phase I (clinical tests) -Phase II -Phase III -PhaseIV (surveillance)
Steady state concentration is reached in __#half-lifes
In 4 half-lifes= (94%) T1/2 = (0.7x Vd)/CL
What is the definition of zero-order kinetics? Example?
-Constant AMOUNT eliminated per unit time. -Etoh &ASA
What is the formula for Clearance (CL)
CL= (rate of elimination of drug/ Plasma drug conc.)
What is the formula for Volume of distribution (Vd)
Vd= (Amt. of drug in body/ Plasma drug conc.)
What is the loading dose formula?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
A 12yo patient was treated for a reaction to a bee sting, what drug provides the best coverage of sympathomimetic receptors?
Epinephirine(Alpha1,2 and Beta 1,2)
A 57 yo heart failure pt develops cardiac decompensation, what drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
Dopamine
A fellow passenger on a Carnival cruise ship looks pale and diaphoretic, what antimuscarinic agent would you give them?
scopolamine
A group of pts are rushed into the ER complaining of excessive sweating, tearing, salivation, HA, N and V, muscle twitching, difficulty breathing and diarrhea. What drug would be the most effective immediate tx
Atropine pts are suffering from Cholinestrase inhibitor poisining(Nerve gas/Organophosphate poisining)
As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt, what do you use
Succinylcholine
By what mechanism does this drug help
Prevents the release of Ca from SR of skeletal muscle
Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease, why??
Centrally acting alpha agonist, thus causing a decrease in central adrenergic outflow, spairing renal blood flow
Cocaine casues vasoconstriction and local anesthesia by what mechanism
Indirect agonist, uptake inhibitor
Cocaine shares is mechanism of action with what antidepressant
TCA
Dobutamine used for the tx of shock acts on which receptors
Beta1 more than B2
Guanethidine enhances the release of Norepi?
No, it inhibits the release of Nor Epi
How does angiotensin II affect NE release?
It acts presynaptically to increase NE release.
How does botulinum toxin result in respiratory arrest?
Prevents the release of ACh, which results in muscle paralysis.
How does dantrolene work?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
How does NE modulate its own release? What other neurotransmitter has this same effect?
NE acts presynaptically on alpha-2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
How would hemicholinium treatment affect cholinergic neurons?
Hemicholinium inhibits the transport of choline into the nerve, thus inhibiting formation of ACh.
How would you reverse the effect of a neuromuscular blocking agent?
Give an antichloinesterase - neostigmine, edrophonium, etc
If a patient is given hexamethonium, what would happen to his/her heart rate?
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out, but the SA node has an intrinsic pace of 100 beats/min, which is normally checked by vagal stimulation.
Isopoterenol was given to a patient with a developing AV block, why?
Stimulates beta adrenergic receptors
Norepi feedbacks and inhibits the presynaptic receptor by what mechanism
Binding to the presynaptic alpha 2 release modulating receptors
Reserpine will block the syntheis of this drug and but not its precursor.
Blocks Norepi, but not Dopamine
These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
Amphetamine and Ephedrine
What anticholinesterase crosses the blood-brain-barrier?
physostigmine
What antimuscarinic agent is used in asthma and COPD?
Ipratropium
What antimuscarinic drug is useful for the tx of asthma
Ipratropium
What are the classic symptoms of cholinesterase inhibitor poisoning (parathion or other organophosphates)?
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation = DUMBBELS; also abdominal cramping
What are the clinical indications for bethanechol?
Activates cholinergic receptors on bladder and bowel smooth muscle, alleviating post-op and neurogenic ileus and urinary retention.
What are the clinical indications for neostigmine?
Post-op and neurogenic ileus and urinary retention, myasthenia gravis, and reversal of neuromuscular junction blockade (post-op) through anticholinesterase activity.
What are the indications for using amphetamine?
narcolepsy, obesity, and attention deficit disorder (I wouldn\'t recommend this)
What are the nondepolarizing neuromuscular blocking drugs?
Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rapacuronium
What are the phases of succinylcholine neuromuscular blockade?
Phase 1 = prolonged depolarization, no antidote, effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked, an anticholinesterase is the antidote for this phase.
What are two indirect acting adrenergic agonists?
amphetamine and ephedrine
What beta 2 agonist will help your 21yo Astma pt?
Albuterol, tertbutaline
What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
Botulinum
What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
Edrophonium
What cholinomimetics might your pt be taking for his glaucoma
Carbachol, pilocarpine, physostigmine, echothiophate
What class of drug is echothiophate? What is its indication?
anticholinesterase glaucoma
What conditions would you use dantrolene?
In treatment of malignant hyperthermia, due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome, a toxicity of antipsychotic drugs.
What drug is used to diagnose myasthenia gravis?
edrophonium (extremely short acting anticholinesterase)
What drugs target this enzyme
Neostigmine, pyridostigmine edrophonium physostigmine echothiophate
What effect would atropine have on a patient with peptic ulcer disease?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
What effect would atropine have on the preganglionic sympathetic activation of sweat glands? Would this person sweat?
None. No, because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Acetylcholinesterase; ACh is broken down into choline and acetate.
What enzyme is responsible for the degredation of Ach
Acetylcholine esterase
What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
What is the clinical utility of clonidine?
Treatment of hypertension, especially with renal disease (lowers bp centrally, so flow is maintained to kidney).
What is the clinical utility of cocaine?
The only local anesthetic with vasoconstrictive properties.
What is the difference between the affinity for beta receptors between albuterol/terbutaline and dantroline?
Dobutamine has more of an affintiy for beta-1 than beta-2, and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse, and is used in treatment of acute asthma.
What is the difference in receptor affinity of epinephrine at low doses? High doses?
Prefers beta\'s at low doses, but at higher doses alpha agonist effects are predominantly seen.
What is the effect of epinephrine infusion on bp and pulse pressure?
Increased systolic and pulse pressure, decreased diastolic pressure, and little change in mean pressure.
What is the effect of guanethidine on adrenergic NE release?
It inhibits release of NE.
What is the effect of norepinephrine on bp and pulse pressure?
Increases mean, systolic, and diastolic bp, while there is little change in pulse pressure.
What is the effect of TCA\'s on the adrenergic nerve?
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
What is the only depolarizing neuromuscular blocking agent?
Succinylcholine
What is the receptor affinity and clinical use of isoproterenol?
It affects beta receptors equally and is used in AV heart block (rare).
What makes this drug effective
It antagonizes Ach M receptors and decreases parasym (GI) rxn
What nondepolorizing agents could you have used
Tubocurarine, atra-, miv-, pan-,ve-, rapacuronium
What other substances regulate the Norepi nerve ending
Ach, AngiotensinII
What other syndrome can this drug tx
Neuroleptic malignant syndrome
What physiological effects was the Anes using Atropine to tx
SLUD (salivation, Lacrimation, urination, Defecation)as well as airway secretion, GI motility, acid secretions
What reversal agent could a Anes give to reverse the effects of Atropine
Bethanechol, Neostigmine, physostigmine
What side effect of using atropine to induce pupillary dilation would you expect?
Atropine would also block the receptors in the ciliary muscle, causing an impairment in accommodation (cycloplegia).
What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Norepinephrine (Alpha1,2 and beta 1)
What type of neurological blockade would hexamethonium create?
Hexamethonium is a nicotinic antagonist, and thus is a ganglionic blocker.
What would be the effect on blood pressure with infusion of the alpha -2 agonist clonidine?
Initially vasoconstriction would increase bp, but then it acts on central alpha-2 receptors to decrease adrenergic outflow resulting in decreased bp.
What would be the next drug that you would give and why
Pralidoxime, regenerates active cholinestrase
Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
atropine, homatropine, tropicamide
Which drug increases Sys BP w/o affecting Pulse Pressure
Epinephrine
Which of epi, norepi, or isoproterenol results in bradycardia?
Norepinephrine
Which of the following would atropine administration cause? Hypothermia, bradycardia, excess salivation, dry flushed skin, or diarrhea
Dry flushed skin, due to inhibition of sympathetic post-ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of what would be expected.
Which of these three drugs will cause a reflex bradycardia in your pt (Norepi, Epi, or Isoporterenol)
Norepinephrine
Which receptors does phenylephrine act upon?
alpha-1 > alpha-2; used as a pupil dilator, vasoconstrictor, and for nasal decongestion
While at a tail gait party, you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature, what should you do?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma, asthma, or hypotension.
Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
These B-2 agonists cause respiratory smooth muscle to relax.
Why does atropine dilate the pupil?
Blocking muscarinic receptors in the circular fibers of the eye, results in unopposed action of radial muscles to dilate.
Why does NE result in bradycardia?
NE increases bp, which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Why is carbachol and pilocarpine useful in treatment of glaucoma?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Why is pyridostigmine effective in the treatment of myasthenia gravis?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Why is reserpine effective in treating HTN?
Reserpine inhibits dopamine transport into vesicles, attenuating its conversion to NE by dopamine beta-hydroxylase.
Why is there a drop in systolic, mean, and diastolic bp with infusion of isoproterenol?
Stimulating beta receptors stimulates heart rate, but beta receptor induced vasodilation reduces peripheral resistance.
Why would a patient with cog-wheel rigidity and a shuffling gait be given benztropine?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Why would dopamine be useful in treating shock?
Receptors = D1=D2>beta>alpha, thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Why would you give a drug like pancuronium or succinylcholine?
Useful in muscle paralysis during surgery or mechanical ventilation.
Why would you use pralidoxime after exposure to an organophosphate?
Pralidoxime regenerates active cholinesterase.
Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
No, hemicholinum block the uptake of Choline and thus Ach synthesis
Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Would Hexamethonium be an effective substitute
No, hexamethonium targets Nicotinc receptors and will block Parasym, Sym, as well as Somatic systems
You tx your pt with halothane as well and he has also developed malignant hypothermia, what drug can you give
Dantrolene
Your patient develops a marked arrythmia due to a prolonged depolarization, can you tx this w/ Neostigmine
No cholinesterase inhibitors will potentiate the stimulating action of Succinlycholine
Your patient has acute angle glaucoma, does this affect your tx
Yes, Scopolamine would antagonize his glaucoma
Your patient wants an effective drug to treat his motion sickness, what would you prescribe
Scopolamine
Define anisocytosis.
varying cell sizes
Define poikilocytosis
varying cell shapes
From which cells do B cells arise?
stem cells in bone marrow
From which cells do plasma cells differentiate?
B cells
How can a Nissl stain be used to differentiate microglia from oligodendroglia?
Microglia are not discernable in a Nissl stain while oligodendroglia appear as small dark nuclei with dark chromatin
In what type of CNS tissue (white or grey) are oligodendroglia predominant?
white matter
Into what cell type does a monocyte differentiate in tissues?
Macrophages
Name 2 substances produced by an eosinophil.
histiminase and arylsulfatase
Name the three types of leukocytic granulocytes.
basophils, eosinophils, and neutrophils
Name the two types of mononuclear leukocytes.
lymphocytes and monocytes
What are 2 functions of T cell lymphocytes?
- cellular immune response - regulation of B lymphocytes and macrophages
What are 2 morphological features of microglia?
- small irregular nuclei - and relatively little cytoplasm
What are 3 examples of peripheral lymphoid tissue?
- follicles of lymph nodes - white pulp of spleen - unencapsulated lymphoid tissue
What are 3 functions of a macrophage?
- pagocytosis of bacteria, cell debris, and senescent red cells - scavenges damaged cells and tissues - can function as an antigen presenting cell
What are 3 morphological characteristics of monocytes?
- Large - Kidney-shaped nucleus - Extensive \'frosted glass\' cytoplasm
What are 4 characteristics of the plasma cell morphology?
- Off center nucleus - Clock face chromatin distribution - Abundant RER - Well developed Golgi apparatus
What are 4 morphologic characteristics of lymphocytes?
- Round - Small - Densely staining nucleus - Small amount of pale cytoplasm
What are 4 substances contained within the lysosomes of neutrophils?
- hydrolytic enzymes - lysozyme - myeloperoxidase - lactoferrin
What are 4 types of cells into which T cells differentiate?
- cytotoxic T cells (MHC I, CD8) - helper T cells (MHCII, CD4) - suppressor T cells - delayed hypersensitivity T cells
What are the 5 important causes for eosinophilia in humans?
Neoplastic, Asthma, Allergic process, Collagen vascular disease, and Parasites (pneumonic NAACP)
What are the blood cell diffenentiation names of the ACTIVE T CELL line beginning with the pluripotent hematopoietic stem cell? (4)
- Pluripotent hematopoietic stem cell - Lymphoblast - T cell - Active T cell
What are the blood cell differentiation names of the ERYTHROCYTE cell line beginning with pluripotent hematopoietic stem cell? (4)
- Pluripotent hematopoietic stem cell - Proerythroblast - Reticulocyte - Erythrocyte
What are the blood cell differentiation names of the MONOCYTE cell lines beginning with the pluripotent hematopoietic stem cell? (3)
- Pluripotent hematopoietic stem cell - Mono blast - Monocyte
What are the blood cell differentiation names of the NEUTROPHIL, EOSINOPHIL, and BASOPHIL cell lines beginning with the myeloblast stage? (6)
- Myeloblast - Promyelocyte - Myelocyte - Metamyelocyte - Stab cell - Neutrophil, eosinophil or basophil
What are the blood cell differentiation names of the PLASMA CELL line beginning with the pluripotent hematopoietic stem cell? (4)
- Pluripotent hematopoietic stem cell - Lymphoblast - B cell - Plasma cell
What are the blood cell differentiation names of the PLATELET CELL line beginning with the hematopoietic stem cell? (4)
- Pluripotento hematopoietic stem cell - Megakaryoblast - Megakaryocyte - Platelets
What are the components of the air-blood barrier?
- Type I pneumocyte - tight junction - endothelial cell
What are the steps of maturation of a B cell? (2 points)
- maturation in the marrow - migration to peripheral lymphoid tissue
What are the substances contained within the densly basophilic granules of the basophil? (4)
- Heparin (anticoagulant) - histamine (vasodilator) - vasoactive amines - Slow reacting substance of anaphylaxis
What are two basic morphological characteristics of neutrophils?
- multilobed nucleus - large, spherical azurophilic primary granules (lysosomes)
What are two important functions of a neutrophil?
- acute inflammmatory response of a cell - phagocytosis
What are two names for an increased number of red cells?
Erythrocytosis and polycythemia
What cell type closely resembles a mast cell?
basophil
What cranial nerves are commonly involved in an acoustic neuroma?
CN VII, VIII (association with internal acoustic meatus)
What disease is characterized by destruction of oligodendroglia?
Multiple sclerosis
What does CD stand for?
cluster of differentiation
What drug prevents mast cell degranulation?
Cromolyn sodium
What immunoglobulin can bind to the membrane of a mast cell?
IgE
What is a reticulocyte?
a baby (developing) erythrocyte
What is an important example of a Schwannoma?
Acoustic neuroma
What is another name for pulmonary sufractant?
DPPC (dipalmitoylphosphatidylcholine)
What is percentage of leukocytes in the blood exist as basophils?
less than 1%
What is the \'gap\' between the myelination segment of 2 Schwann cells called?
Node of Ranvier
What is the advantage of the large surface area:volume ratio in erythrocytes?
easy gas exchange (Oxygen and Carbon dioxide)
What is the basic morphologic structure of an erythrocyte?
Anucleate, biconcave
What is the basic morphology of an eosinophil? (2 things)
- bilobate nucleus - packed with large eosinophilic granules of uniform size
What is the embryologic origin of microglia?
mesoderm
What is the function of Interferon gamma with relation to macrophages?
macrophage activation
What is the function of microglia?
phagocytosis in CNS
What is the function of oligodendroglia?
myelination of multiple CNS axons
What is the function of pulmonary surfactant?
lowers alveolar surface tension and prevents atelectasis
What is the function of Schwann cells?
myelination of PNS (a Schwann cell myelinates only one PNS axon)
What is the importance of the lecithin:sphingomyelin ratio?
> 2.0 in fetal lung is indicative of fetal lung maturity
What is the importance of the physiologic chloride shift in erythrocytes?
Membranes contain the chloride bicarbonate antiport allowing the RBC to transport carbon dioxide from the the lung periphery for elimination.
What is the last segment of lung tissue in which ciliated cells are found?
respiratory bronchioles
What is the last segment of lung tissue in which goblet cells are found?
terminal broncioles (remember ciliated cells sweep away mucous produced by goblet cells and therefore run deeper)
What is the primary function of a basophil?
Mediates allergic reactions
What is the primary function of a leukocyte?
Defense against infections
What is the primary function of a mast cell?
Mediates allergic reactions
What is the primary function of a plasma cell?
production of large amounts of a specific antibody to a particular antigen
What is the primary source of energy for erythrocytes?
glucose (90% anaerobically degraded to lactate, 10% by HMP shunt)
What is the process of degranulation in mast cells?
release of histamine, heparin, and eosinophil chemotactic factors
What is the range of concentration for leukocytes in the blood?
4,000 - 10,000 cells per microliter
What is the response of an eosiniphil to antigen antibody complexes?
high degree of phagocytosis
What is the response of microglia to tissue dammage?
transformation into large ameboid phagocytic cells
What is the response to microglia infected with HIV?
fusion to form multinucleated giant cells in CNS
What is the survival time for an erythrocyte?
120 days
What pathognomonic change is seen in neutrophils of a person who is folate/vitamin B12 deficient?
hypersegmented polys
What percentage of leukocytes exist as eosinophils in the blood?
1 - 6%
What percentage of leukocytes exist as neutrophils in the blood?
40 - 75%
What percentage of leukocytes in blood are monocytes?
2 - 10%
What process occurs when type I pneumocytes are damaged?
Type II pneumocytes develop into type I
What substance in eosinophilic granules is primarily responsible for defense against helminths and protozoan infections?
major basic protein
Where is the site of maturation of T lymphocytes?
Thymus
Which cell type constituitively secretes pulmonary surfactant?
Type II pneumocyte
Which cell type lines the alveoli?
Type I pneumocyte
Which leukemia is the result of plasma cell neoplasm?
Multiple myeloma
Which type of hypersensitivity reaction is a mast cell involved in?
Type I hypersensitivity reaction
Which type of immunity do B cells exhibit?
humoral immunity
After arising from the floor of the primitive pharynx, where does the thryoid diverticulum go?
It descends down into the neck
After the first breath at birth, what causes closure of the ductus arteriosus?
An increase in oxygen
After the first breath at birth, what causes the closure of the foramen ovale?
A decrease resistance in pulmonary vasculature causes increased left atrial pressure vs. right atrial pressure
Although the diaphragm descends during development, it maintains innervation from ____?
C3-C5
An easy pneumonic to remember fetal erythropoiesis is?
Young Liver Synthesizes Blood
At what time in the course of development is the fetus most susceptible to teratogens?
Weeks 3-8
Deoxygenated blood from the SVC is expelled into the pulmonary artery and ____ ____ to the lower body of the fetus.
ductus arteriosus
Do the cardiovascular structures arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Do the chromaffin cells of the adrenal medulla arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Do the enterochromaffin cells arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Do the lungs arise from neural crest (ectoderm), mesoderm, or endoderm?
Endoderm
Do the lymphatics arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Do the melanocytes arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Do the neural crest cells arise from mesoderm, ectoderm, or endoderm?
Ectoderm
Do the odontoblasts arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Do the parafollicular (C) cells of the thyroid arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Do the Schwann cells arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Do the urogenital structures arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does blood arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does bone arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does muscle arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does the thyroid arise from neural crest (ectoderm), mesoderm, or endoderm?
Endoderm
Does the adrenal cortex arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does the ANS arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Does the celiac ganglion arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Does the dorsal root ganglion arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Does the dura connective tissue arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does the gut tube epithelium arise from neural crest (ectoderm), mesoderm, or endoderm?
Endoderm
Does the liver arise from neural crest (ectoderm), mesoderm, or endoderm?
Endoderm
Does the pancreas arise from neural crest (ectoderm), mesoderm, or endoderm?
Endoderm
Does the parathyroid arise from neural crest (ectoderm), mesoderm, or endoderm?
Endoderm
Does the pia arise from neural crest (ectoderm), mesoderm, or endoderm?
Neural Crest (Ectoderm)
Does the serous linings of body cavities arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does the spleen arise from neural crest (ectoderm), mesoderm, or endoderm?
Mesoderm
Does the thymus arise from neural crest (ectoderm), mesoderm, or endoderm?
Endoderm
From what does the ligamentum teres hepatis arise?
Umbilical vein
How does a bicornate uterus form?
Results from incomplete fusion of the paramesonephric ducts
How does a cleft lip form?
Failure of fusion of the maxillary and medial nasal processes
How does a cleft palate form?
Failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine process
How does a horseshoe kidney form?
Inferior poles of both kidneys fuse, as they ascend from the pelvis during development they get trapped under the inferior mesenteric artery, and remain low in the abdomen
How is meckel\'s diverticulum different than an omphalomesenteric cyst?
Omphalomesenteric cyst is a cystic dilatation of the vitelline duct
How long does full development of spermatogenesis take?
2 months
How many arteries and veins does the umbilical cord contain?
- 2 umbilical arteries (carries deoxygenated blood away from fetus) - 1 umbilical vein (oxygenated blood to fetus)
Is a primary spermatocyte 2N or 4N?
4N
Is a primary spermatocyte haploid or diploid?
Diploid, 4N
Is a secondary spermatocyte haploid or diploid?
Haploid, 2N
Is a secondary spermatocyte N or 2N?
2N
Is a speratogonium haploid or diploid?
Diploid, 2N
Is a spermatid haploid or diploid?
Haploid, N
Meiosis I is arrested in which phase until ovulation?
Prophase
Meiosis II is arrested in which phase until fertilization?
Metaphase (an egg MET a sperm)
Most oxygenated blood reaching the heart via IVC is diverted through the ____ ____ and pumped out the aorta to the head.
foramen ovale
The right common cardinal vein and right anterior cardinal vein give rise to what adult heart structure?
Superior vena cava
The stapedius muscle of the ear is formed by which branchial arch?
2nd
This type of bone formation consists of ossification of cartilaginous molds and forms long bones at primary and secondary centers.
Endochondral
True or False, blood in the umbilical vein is 100% saturated with oxygen?
False, it is 80% saturated
True or False, there are two types of spermatogonia?
True, type A & type B
What are the 1st branchial arch derivatives innervated by?
CN V2 and V3
What are the 2nd branchial arch derivatives innervated by?
CN VII
What are the 3rd branchial arch derivatives innervated by?
CN IX
What are the 4th and 6th branchial arch derivatives innervated by?
CN X
What are the cartilage derivatives (5) of the 4th and 6th branchial arches?
- Thyroid - Cricoid - Arytenoids - Corniculate - Cuneiform
What are the five 2\'s associated with meckel\'s diverticulum?
- 2 inches long - 2 feet from the ileocecal valve - 2% of the population - Commonly presents in the first 2 years of life - May have 2 types of epithelia
What are the rule of 2\'s for the 2nd week of development?
- 2 germ layers: epiblast & hypoblast - 2 cavities: amniotic cavity & yolk sac - 2 components to the placenta: cytotrophoblast & syncytiotrophoblast
What are the rule of 3\'s for the 3rd week of development?
3 germ layers (gastrula): ectoderm, mesoderm, endoderm
What can a persistent cervical sinus lead to?
A branchial cyst in the neck
What can be found in the cortex of the thymus?
It is dense with immature T cells
What can be found in the medulla of the thymus?
It is pale with mature T cells, epithelial reticular cells, and Hassall\'s corpuscles
What connects the thyroid diverticulum to the tongue?
The thyroglossal duct
What devlopmental contributions does the 5th branchial arch make?
None
What do the 2nd - 4th branchial clefts form, which are obliterated by proliferation of the 2nd arch mesenchyme?
Temporary cervical sinuses
What does aberrant development of the 3rd and 4th pouches cause?
DiGeorge\'s syndrome
What does the 1st aortic arch give rise to?
Part of the maxillary artery
What does the 2nd pharyngeal pouch develop into?
Epithelial lining of the palantine tonsils
What does the 3rd aortic arch give rise to?
Common carotid artery and proximal part of the internal carotid artery
What does the 4th pharyngeal pouch develop into?
Superior parathyroids
What does the 5th aortic arch give rise to?
Nothing
What does the 5th pharyngeal pouch develop into?
C cells of the thyroid
What does the 6th aortic arch give rise to?
The proximal part of the pulmonary arteries and (on left only) ductus arteriosus
What does the ductus arteriosus give rise to?
Ligamentum arteriosum
What does the ductus venosus shunt blood away from?
Liver
What does the first branchial cleft develop into?
The external auditory meatus
What does the foramen ovale give rise to?
Fossa ovalis
What does the left 4th aortic arch give rise to?
Aortic arch
What does the ligamentum venosum come from?
Ductus venosus
What does the notochord give rise to?
Nucleus Pulposus
What does the primitive atria give rise to?
Trabeculated left and right atrium
What does the primitive ventricle give rise to?
Trabeculated parts of the left and right ventricle
What does the right 4th aortic arch give rise to?
Proximal part of the right subclavian artery
What does the right horn of the sinus venosus give rise to?
Smooth part of the right atrium
What does the spleen arise from?
Dorsal mesentery, but is supplied by the artery of the foregut
What does the thymus arise from?
Epithelium of the 3rd branchial pouch
What does the thyroid diverticulum arise from?
The floor of the primitive pharynx
What does the truncus arteriosus give rise to?
The ascending aorta and pulmonary trunk
What does the umbilical arteries give rise to?
Medial umbilical ligaments
What ear muscle does the 1st branchial arch form?
Tensor tympani
What effect does 13-cis-retinoic acid have on the fetus?
Extremely high risk for birth defects
What effect does ACE inhibitors have on the fetus?
Renal Damage
What effect does iodide have on the fetus?
Congenital goiter or hypothyroidism
What effect does warfarin and x-rays have on the fetus?
Multiple anomalies
What effects does cocaine have on the fetus?
Abnormal fetal development and fetal addiction
What embryonic structure are the smooth parts of the left and right ventricle derived from?
Bulbus cordis
What embryonic structure does the coronary sinus come from?
Left horn of the sinus venosus
What embryonic structure does the median umbilical ligament come from?
Allantois (urachus)
What fetal landmark has developed within week 2 of fertilization?
Bilaminar disk
What fetal landmark has occurred within week 1 of fertilization?
Implantation
What fetal landmark has occurred within week 3 of fertilization?
Gastrulation
What fetal landmarks (2) have developed within week 3 of fertilization?
Primitive streak and neural plate begin to form
What five things arise from neuroectoderm?
- Neurohypophysis - CNS neurons - Oligodendrocytes - Astrocytes - Pineal gland
What four structures make up the diaphragm?
- Septum transversum - pleuroperitoneal folds - body wall - dorsal mesentery of esophagus
What four things arise from surface ectoderm?
- Adenohypophysis - Lens of eye - Epithelial linings - Epidermis
What four things does Meckel\'s cartilage (from the 1st arch) develop into?
- Mandible - Malleus - Incus - Sphenomandibular ligament
What four things does Reichert\'s cartilage (from the 2nd arch) develop into?
- Stapes - Styloid process - Lesser horn of hyoid - Stylohyoid ligament
What four things does the dorsal pancreatic bud become?
Body, tail, isthmus, and accessory pancreatic duct
What four things does the mesonephric (wolffian) duct develop into?
- Seminal vesicles - Epididymis - Ejaculatory duct - Ductus deferens
What induces the ectoderm to form the neuroectoderm (neural plate)?
Notochord
What is a hiatal hernia?
Abdominal contents herniate into the thorax due to incomplete development of the diaphragm
What is a hypospadias?
Abnormal opening of penile urethra on inferior side of penis due to failure of urethral folds to close
What is a single umbilical artery associated with?
Congenital and chromosomal anomalies
What is a urachal cyst or sinus a remnant of?
The allantois
What is an abnormal opening of penile urethra on superior side of penis due to faulty positioning of the genital tubercle?
Epispadias
What is associated with an epispadias?
Exstrophy of the bladder
What is Meckel\'s diverticulum?
Persistence of the vitelline duct or yolk sac
What is oligohydramnios associated with?
Bilateral renal agenesis or posterior urethral valves (in males)
What is oligohydramnios?
< 0.5 L of amniotic fluid
What is polyhydramnios associated with?
Esophageal/duodenal atresia, anencephaly
What is polyhydramnios?
> 1.5-2 L of amniotic fluid
What is Potter\'s syndrome?
Bilateral renal agenesis, that results in ologohydramnios causing limb and facial deformities and pulmonary hypoplasia (Babies with Potter\'s can’t pee in utero)
What is the acrosome of sperm derived from?
Golgi apparatus
What is the female homologue to the corpus spongiosum in the male?
Vestibular bulbs
What is the female homologue to the prostate gland in the male?
Urethral and paraurethral glands (of Skene)
What is the female homologue to the scrotum in the male?
Labia majora
What is the female homologue to the ventral shaft of the penis in the male?
Labia minora
What is the flagellum (tail) derived from?
One of the centrioles
What is the food supply of sperm?
Fructose
What is the male homologue to the glans clitoris in the female?
Glans penis
What is the male homologue to the greater vestibular glands (of Bartholin) in the female?
Bulbourethral glands (of Cowper)
What is the most common congenital anomaly of the GI tract?
Meckel\'s diverticulum
What is the most common ectopic thyroid tissue site?
The tongue
What is the normal remnant of the thyroglossal duct?
Foramen cecum
What is the postnatal derivative of the notochord?
The nucleus pulposus of the intervertebral disc
What is the site of T-cell maturation?
Thymus
What part of the gut is the pancreas derived?
Foregut
What suppresses the development of the paramesonephric ducts in males?
Mullerian inhibiting substance (secreted by the testes)
What teratogenic agent causes limb defects (\'flipper\' limbs)?
Thalidomide
What three structures does the 3rd pharyngeal pouch develop into?
- Thymus - Left inferior parathyroid - Right inferior parathyroid
What three things does the 1st pharyngeal pouch develop into?
- Middle ear cavity - Eustachian tube - Mastoid air cells
What three things does the paramesonephric (mullerian) duct develop into?
- Fallopian tube - Uterus - Part of the vagina
What three things does the ventral pancreatic bud become?
- Pancreatic head - uncinate process - main pancreatic duct
What two things occur during week 4 of fetal development?
Heart begins to beat, upper and lower limb buds begin to form
What type of bone formation is spontaneous without preexisting cartilage?
Intramembranous
What type of twins would have 1 placenta, 2 amniotic sacs, and 1 chorion?
Monozygotic twins
What type of twins would have 2 amniotic sacs and 2 placentas?
Monozygotic or dizygotic twins
What will DiGeorge\'s syndrome lead to?
T cell deficiency & hypocalcemia
When do primary oocytes begin meiosis I?
During fetal life
When do primary oocytes complete meiosis I?
Just prior to ovulation
When does fetal erythropoiesis occur in the bone marrow?
Week 28 and onward
When does fetal erythropoiesis occur in the liver?
Weeks 6-30
When does fetal erythropoiesis occur in the spleen?
Weeks 9-28
When does organogenesis occur in the fetus?
Weeks 3-8
Where does positive and negative selection occur in the thymus?
At the corticomedullary junction
Where does spermatogenesis take place?
Seminferous tubules
Where is the first place fetal erythropoiesis occurs and when does this take place?
Yolk sac (3-8 wk)
Which aortic arch does the stapedial artery and the hyoid artery come from?
2nd aortic arch
Which branchial arch are the greater horn of hyoid and the stylopharyngeus muscle derived from?
3rd branchial arch
Which branchial arch does Meckel\'s cartilage develop from?
1st arch
Which branchial arch forms the anterior 2/3 of the tongue?
1st arch
Which branchial arch forms the incus and malleus of the ear?
1st arch
Which ear bone(s) does the 2nd branchial arch form?
Stapes
Which embryonic tissue are branchial clefts derived from?
Ectoderm
Which embryonic tissue are branchial pouches derived from?
Endoderm
Which is more common a hypospadias or epispadias?
Hypospadias
Which muscles (3) are derivatives of the 4th branchial arch?
- Most pharyngeal constrictors - Cricothyroid - Levator veli palatini
Which muscles (4) are derivatives of the 2nd branchial arch?
- Muscles of facial expression - Stapedius - Stylohyoid - Posterior belly of digastric
Which muscles (8) are derivatives of the 1st branchial arch?
- Temporalis - Masseter - Lateral pterygoid - Medial pterygoid - Mylohyoid - Anterior belly of digastric - Tensor tympani - Tensor veli palatini
Which muscles are derivatives of the 6th branchial arch?
All intrinsic muscles of the larynx, except the cricothyroid
Which pharyngeal arch does Reichert\'s cartilage develop from?
2nd arch
Which teratogenic agent causes vaginal clear cell adenocarcinoma?
DES
Which two branchial arches form the posterior 1/3 of the tongue?
3rd and 4th arches
Which two embryonic tissues are branchial arches derived from?
Mesoderm and neural crests
Which week of fetal development have the genitalia taken on male/female characteristics?
Week 10
A common football injury caused by clipping from the lateral side will damage what structures (3 answers)?
--Medial collateral ligament --Medial meniscus --Anterior cruciate ligament
A lumbar puncture is performed at what landmark/
Iliac crest
A positive anterior drawer sign indicates damage to what structure?
Anterior cruciate ligament(ACL)
A pudendal nerve block is performed at what landmark?
Ischial spine
Abnormal passive abduction of the knee indicates damage to what structure?
Medial collateral ligament(MCL)
Anterior\' in ACL refers to what attachment?
Tibial
At what level is a lumbar puncture performed?
Between L3-L4 or L4-L5
Common peroneal nerve damage manifests what deficit?
Loss of dorsiflexion(Foot Drop)
Common peroneal, Tibial, Femoral, and Obturator nerves arise from what spinal cord segments (4 answers)?
--\'L4-S2 (common peroneal) --L4-S3 (tibial) --L2-L4 (femoral) and (obturator)
Coronary artery occlusion usually occurs where?
Left anterior descending artery (LAD)
Do the coronary arteries fill during systole or diastole?
Diastole
Erection and sensation of the penis is in what dermatomes?
S2-S4
Femoral nerve damage manifests what deficit?
Loss of knee jerk
How does the course of the left recurrent laryngeal nerve differ from that of the right?
The left wraps around the arch of the aorta and the ligamentum arteriosum while the right wraps around the subclavian artery.
How is the appendix located?
2/3 of the way from the umbilicus to the anterior superior iliac spine
How many lobes are in the right and left lungs and what are their names?
--Right has three (superior,middle,inferior) --Left has two (superior and inferior) and the lingula
Name five portal-systemic anastomoses.
1.Left gastric-azygous vv. 2.Superior-Middle/Inferior rectal vv. 3.Paraumbilical-inferior epigastric 4.Retroperitoneal-renal vv. 5.Retroperitoneal-paravertebral vv.
Name the 4 ligaments of the uterus.
--Suspensory ligament of ovaries --Transverse cervical (cardinal) ligament --Round ligament of uterus --Broad ligament
Name the hypothenar muscles.
--Opponens digiti minimi --Abductor digiti minimi --Flexor digiti minimi
Name the retroperitoneal structures (9).
1.Duodenum(2nd-4th parts) 2.Descending colon 3.Ascending colon 4.Kidney & ureters 5.Pancreas 6.Aorta 7.Inferior vena cava 8.Adrenal glands 9.Rectum
Name the rotator cuff muscles.
--Supraspinatus --Infraspinatus --teres minor --Subscapularis
Name the thenar muscles
--Opponens pollicis --Abductor pollicis brevis --Flexor pollicis brevis
Obturator nerve damage manifests what deficit?
Loss of hip adduction
Pain from the diaphragm is usually referred where?
Shoulder
Subarachnoid space extends to what spinal level?
S2
The area of the body that contains the appendix is known as what?
McBurney\'s point
The femoral triangle contains what structures from lateral to medial?
--Femoral nerve --Femoral artery --Femoral vein --Femoral Canal (lymphatics)
The inguinal ligament exists in what dermatome?
L1
The kneecaps exist in what dermatome?
L4
The male sexual response of ejaculation is mediated by what part of the nervous system?
Visceral and somatic nerves
The male sexual response of emission is mediated by what part of the nervous system?
Sympathetic nervous system
The male sexual response of erection is mediated by what part of the nervous system?
Parasympathetic nervous system
The nipple exists in what dermatome?
T4
The recurrent laryngeal nerve arises from what cranial nerve and supplies what muscles?
1.CN X 2.All intrinsic muscles of the larynx except the cricothyroid muscle.
The SA and AV nodes are usually supplied by what artery?
Right Coronary Artery (RCA)
The spinal cord ends at what level in adults?
L1-L2
The umbilicus exists in what dermatome?
T10
The xiphoid process exists in what dermatome?
T7
Tibial nerve damage manifests what deficit?
Loss of plantar flexion
What are hernias?
Protrusions of peritoneum through an opening, usually sites of weakness.
What are JG cells?
Modified smooth muscle of afferent arteriole in the juxtaglomerular apparatus of the kidney
What are the boundaries of the inguinal (Hesselbach) triangle?
--Inferior epigastric artery --Lateral border of the rectus abdominus --Inguinal ligament
What are the layers encountered from the outsided down to the brain?
--Skin --Connective tissue --Aponeurosis --Loose connective tissue --Pericranium --Dura mater --Subdural space --Arachnoid --Subarachnoid space --Pia mater --Brain
What are the manifestations of portal hypertension?
--Esophageal varices --Hemorrhoids --Caput medusae
What condition is usually associated with portal hypertension?
Alcoholic cirrhosis
What defect may predispose an infant for a diaphragmatic hernia?
Defective development of the pleuroperitoneal membrane
What gut regions and structures does the celiac artery supply?
1.Foregut 2.--Stomach to duodenum --liver --gallbladder --pancreas
What gut regions and structures does the IMA supply?
1.Hindgut 2.--Distal 1/3 of transverse colon to upper portion of rectum
What gut regions and structures does the SMA supply?
1.Midgut 2.--Duodenum to proximal 2/3 of transverse colon
What is a diaphragmatic hernia?
Abdominal retroperitoneal structures enter the thorax
What is a femoral hernia?
entrance of abdominal contents through the femoral canal.
What is a hiatal hernia?
Stomach contents herniate upward through the esophageal hiatus of the diaphragm
What is the arterial blood supply difference above and below the pectinate line?
--Superior rectal a. (Above) --Inferior rectal a. (Below)
What is the course of a direct inguinal hernia?
Through weak abdominal wall, into the inguinal triangle, medial to the inferior epigastric artery, through the external inguinal ring only.
What is the course of an indirect inguinal hernia?
Through the internal (deep) inguinal ring and the external (superficial) inguinal ring lateral to the inferior epigastric artery and into the scrotum
What is the course of the ureters?
Pass under uterine artery and under the ductus deferens
What is the function of Myenteric plexus? Submucosal plexus?
1.Coordinates motility along entire gut wall 2.Regulates local secretions, blood flow, and absorption
What is the function of the JG cells?
--secrete renin and erythropoietin
What is the innervation difference above and below the pectinate line?
--Visceral innervation (Above) --Somatic innervation (Below)
What is the innervation of the diaphram?
Phrenic nerve (C3,4,5)
What is the macula densa?
Sodium sensor in part of the distal convoluted distal tubule in the juxtaglomerular apparatus of the kidney
What is the Myenteric plexus also known as? Submucosal plexus?
1. Auerbach\'s plexus 2. Meissner\'s plexus
What is the pectinate line of the rectum?
Where the hindgut meets ectoderm in the rectum
What is the relationship of the two pulmonary arteries in the lung hilus?
Right anterior Left superior
What is the usual pathology above the pectinate line of the rectum?
Internal hemorrhoids (not painful) Adenocarcinoma
What is the usual pathology below the pectinate line of the rectum?
External hemorrhoids (painful) Squamous cell carcinoma
What is the venous drainage difference above and below the pectinate line?
--Superior rectal v. to IMV to portal system (Above) --Inferior rectal v. to internal pudendal v. to internal iliac v. to IVC (Below)
What layers of the gut wall contribute to motility (4)?
--Muscularis mucosae --Inner circular muscle layer --Myenteric plexus --Outer longitudinal muscle layer
What layers of the gut wall contribute to support (3)?
--Serosa --Lamina propria --Submucosa
What muscle opens the jaw?
Lateral pterygoid
What nerve innervates most of the \'glossus\' muscles and which is the exception?
1.Vagus Nerve (CNX) 2.Palatoglossus (innervated by hypoglossal n.)
What nerve innervates most of the \'palat\' muscles and which is the exception?
1.Trigeminal Nerve, Mandibular branch 2.Tensor veli palatini (innervated by vagus n)
What nerve innervates the muscles that close and open the jaw?
Trigeminal Nerve (V3)
What neurons do the GI enteric plexus contain?
Cell bodies of parasympathetic terminal effector neurons
What part of the heart does the LAD supply?
anterior interventricular septum
What spinal cord levels are vertebral disk herniation most likely to occur?
Between L5 and S1
What structure is in the femoral triangle but not in the femoral sheath?
--Femoral nerve
What structures are in the carotid sheath?
1.Internal Jugular Vein (lateral) --2.Common Carotid Artery (medial) --3.Vagus Nerve (posterior)
What structures are pierced when doing an LP?
1.Skin/superficial fascia 2.Ligaments(supraspinatous,interspinous,ligamentum flavum) 3.Epidural space 4.Dura mater 5.Subdural space 6.Arachnoid 7.Subarachnoid space--CSF
What structures do the broad ligament contain (4)?
--Round ligaments of the uterus --Ovaries --Uterine tubules --Uterine vessels
What structures make up the bronchopulmonary segment?
--Tertiary bronchus --Bronchial artery --Pulmonary artery
What structures perforate the diaphragm at what vertebral levels?
--IVC at T8 --esophagus, vagal trunks at T10 --aorta, thoracic duct, axygous vein at T12
What three muscles close the jaw?
--Masseter --Temporalis --Medial pterygoid
What usually provides the blood supply for the inferior left ventricle?
Posterior descending artery (PD) of the RCA
When do the JG cells secrete renin?
in response to decreased renal BP, decreased sodium delivery to distal tubule, and increased sympathetic tone
When is damage to the recurrent laryngeal nerve most likely to happen and what are its results(2 answers)?
1.Thyroid surgery 2.Hoarseness
Where is the CSF found?
Subarachnoid space
Where is the Myenteric plexus located? Submucosal plexus?
1.Between the inner and outer layers of smooth muscle in GI tract wall 2.Between mucosa and inner layer of smooth muscle in GI tract wall.
Which ligament contains the ovarian vessels?
Suspensory ligament of the ovary
Which ligament contains the uterine vessels?
Transverse cervical (cardinal) ligament
Which lung is the usual site of an inhaled foreign body?
Right lung
Which lung provides a space for the heart to occupy?
Left lung (in the place of the middle lobe)
Which meningeal layer is not pierced during an LP?
Pia mater
Who usually gets a direct inguinal hernia? indirect hernia (and why)?
1.Older men 2.Infants (failure of processus vaginalis to close)
What are the 3 layers of peripheral nerves? (inner to outer)
1) Endoneurium 2) Perineurium 3) Epineurium
Where is type I collagen found?(7)
1. bone 2. tendon 3. skin 4. dentin 5. fascia 6. cornea 7. late wound repair
Where is type II collagen found? (3)
1. cartilage (including hyaline) 2. vitreous body 3. nucleus pulposus.
What are the functions of the major structures of the inner ear bony labyrinth?
1. Cochlea- hearing 2. vestibule- linear acceleration 3. semicircular canals- angular acceleration.
What are the major structures of the inner ear bony labyrinth?
1. Cochlea 2. vestibule 3. semicircular canals
What are the major structures of the inner ear membranous labyrinth?
1. Cochlear duct 2. utricle. 3. saccule 4. semicircular canals.
Name two proteins involved in the structure of macula adherens.
1. Desmoplakin 2.Keratin
Name 6 functions of Golgi apparatus.
1. Distribution center of proteins and lipids from ER to plasma membrane, lysosomes, secretory vessicles 2. Modifies N-oligosaccharides on asparagine 3. Adds O-oligosaccharides to Ser and Thr residues 4. Proteoglycan assembly from proteoglycan core proteins 5. Sulfation of sugars in proteoglycans and of selected tyrosine on proteins
Name 6 functions of Golgi apparatus (continued answer)
6. Addition of mannose-6-phosphate to specific lysosomal proteins, which targets the protein to the lysosome
Name two proteins involved in the structure of zona adherens?
1. E-cadherins 2. actin filaments
Which cells are rich in smooth ER?
1. liver hepatocytes, 2. steroid hormone-producing cells of adrenal cortex.
Describe the immune response stimulated via Peyer\'s patches.
1. M cells take up antigen. 2. stimulated B cells leave Peyer\'s patch and travel through lymph and blood to lamina propria of intestine. 3. In lamina propria B cells differentiate into IgA-secreting plasma cells. 4. IgA receives protective secretory component. 5. IgA is transported across epithelium to gut to deal with intraluminal Ag.
Which cells are rich in rough ER?
1. Mucus-secreting goblet cells of small intestine, 2. antibody-secreting plasma cells.
What are the functions of the lymph node?
1. Nonspecific filtration by macrophages. 2. storage/proliferation of B and T cells 3. Ab production.
Where is type III collagen found? (5)
1. skin 2.blood vessels 3.uterus 4.fetal tissue 5.granulation tissue
Name five types of epithelial cell junctions.
1. zona occludens 2.zona adherens 3.macula adherens 4.gap junction 5.hemidesmosome
Describe microtubule arrangement of cilia.
9+2 arrangement of microtubules.
Describe the outer structure of a Peyer\'s patch.
A Peyer\'s patch is \'covered\' by single layer of cuboidal enterocytes, interspersed with specialized M cells (no goblet cells).
What is a lymph node? Include information on structural components.
A secondary lymphoid organ. Has many afferents, one or more efferents. With trabeculae. Major histological regions = Follicle, Medulla, Paracortex
What is the primary regulatory control of zona fasciculata secretion?
ACTH, hypothalamic CRH
What is the primary regulatory control of zona reticularis secretion?
ACTH, hypothalamic CRH
What are/is the primary secretory product of the zona glomerulosa?
aldosterone
What do Brunner\'s glands secrete?
alkaline mucus
What is the function of liver sinusoids?
Allow macromolecules of plasma full access to surface of liver cells through space of Disse.
What is the function of a gap junction?
Allows adjacent cells to communicate for electric and metabolic functions.
What is produced by alpha cells of the Islets of Langerhans?
alpha cells produce glucagon
What three cell types are found in Islets of Langerhans?
alpha, beta, and gamma cells
What type of cells are Nissl bodies found? In what parts of the cell?
Are found in neurons. Are not found in axon or axon hillock.
IN what area of the spleen are B cells found?
B cells are found within the white pulp of the spleen.
What is type IV collagen found? (1)
basement membrane or basal lamina
What is produced by beta cells of the Islets of Langerhans?
beta cells produce insulin
What is the only GI submucosal gland?
Brunner\'s glands
Describe the histological layers of the adrenal glands (outside to in)
Capsule, Zona glomerulosa, Zona fasciculata, Zona reticularis, Medulla.
What are/is the primary secretory product of the adrenal medulla?
Catecholamines (Epi, NE)
Memo to you.
Check out the picture in the book.
Memo to you.
Check out the picture in the book. p. 105
What do the medullary cords consist of?
Closely packed lymphocytes and plasma cells.
What is the most common type of collagen?
Collagen Type I - 90%
What is the most abundant protein in the human body?
Collagen.
Define Islets of Langerhans.
Collections of endocrine cells.
What is the function of hemidesmosomes?
Connect cells to underlying extracellular matrix.
What are/is the primary secretory product of the zona fasciculata?
cortisol, sex hormones.
What is another name for macula adherens?
Desmosome
What is the effect of duodenal ulcers on Brunner\'s gland histology?
Duodenal ulcers cause hypertrophy of Brunner\'s glands.
How does dynein function in cilia function?
Dynein causes the bending of cilium by differential sliding of doublets.
What kind of protein is dynein?
Dynein is an ATPase.
Describe the role of dynein in cilia structure.
Dynein links peripheral 9 doublets of microtubules.
What makes endolymph?
Endolymph is made by the stria vascularis.
What is Endoneurium?
Endoneurium invests single nerve fiber of the peripheral nerve.
What is Epineurium?
Epineurium (dense connective tissue) surrounds entire never (fascicles and blood vessels)
What is type X collagen found? (1)
epiphyseal plate
Plasma is filtered on the basis of what properties?
Filtration of plasma occurs according to net charge and size.
How is the glomerular basement membrane formed?
From the fusion of endothelial and podocyte basement membranes.
What is produced by gamma cells of the Islets of Langerhans?
gamma cells produce somatostatin.
What is the mnemonic to remember layers and products of adrenal cortex?
GFR (Glomerulosa, Fasciculata, Reticularis) corresponds to Salt (Na+), Sugar (glucocorticoids) and Sex (androgens) The deeper you go, the sweeter it gets.
What is the function of hair cells?
Hair cells are the sensory elements in both the cochlear and vestibular apparatus.
Name a protein involved in the structure of hemidesmosomes.
Integrin.
What is another name for zona adherens?
Intermediate junction.
Describe the histological structure of sinusoids of the liver.
Irregular \'capillaries\' with round pores 100-200 nm in diameter and no basement membrane.
What is the function of smooth ER?
Is the site of steroid synthesis and detoxification of drugs and poisons
What is the function of rough ER?
Is the site of synthesis of secretory (exported proteins and of N-linked oligosaccharide addition to many proteins.
What part of pancreas are the Islets of Langerhans concentrated?
Islets of Langerhans are most numerous in the tail of pancreas.
What structural defect causes Kartagener\'s syndrome? What is the consequence?
Kartagener\'s syndrome is due to dynein arm defect. Results in immotile cilia.
Define Pacinian corpuscles.
Large, encapsulated sensory receptors found in deeper layers of skin at ligaments, joint capsules, serous membranes, mesenteries.
Where are Brunner\'s glands located?
Located in submucosa of duodenum
Describe the histologic structure of sinusoids of the spleen.
Long, vascular channels in red pulp. With fenestrated \'barrel hoop\' basement membrane.
What is the histologic change in lymph nodes during an extreme cellular immune response?
Lymph node paracortex becomes enlarged during extreme cellular immune response.
What is the histologic presentation of DiGeorge\'s syndrome?
Lymph node paracortex is not well developed in patients with DiGeorge\'s syndrome.
What kind of cells are found nearby the sinusoids of the spleen?
Macrophages
What are the major structures of the lymph node medulla?
Medulla consists of medullary cords and medullary sinuses.
What do medullary sinuses communicate with?
Medullary sinuses communicate with efferent lymphatics.
What do medullary sinuses consist of?
Medullary sinuses contain reticular cells and macrophages.
What is the function of Meissner\'s corpuscles?
Meissner\'s corpuscles are involved in light discriminatory touch of glabrous skin.
What is the histologic change in nephrotic syndrome? What is the consequence of this change?
Negative charge is lost. Plasma protein is lost in urine
What is the glomerular basement membrane coated with? (provides negative charge to filter).
Negatively charged heparan sulfate.
What is the most common tumor the adrenal medulla in children?
Neuroblastoma
What is the function of Pacinian corpuscles?
Pacinian corpuscles are involved in pressure, coarse touch, vibration, and tension.
What do the Islets of Langerhans arise from?
Pancreatic buds.
What specialized vascular structure is found in the lymph node paracortex? What is the function of this structure?
Paracortex contains high endothelial venules (HEV). T and B cells enter from the blood through the HEV.
What cells are found in the lymph node paracortex?
Paracortex houses T cells.
What is Perineurium?
Perineurium (permeability barrier) surrounds a fascicle of nerve fibers.
What is the most common tumor the adrenal medulla in adults?
Pheochromocytoma
Compare the consequences of pheochromocytoma vs. neuroblastoma on blood pressure
Pheochromocytoma causes episodic hypertension Neuroblastoma does NOT cause episodic hypertension
What is the space of Disse?
Pores in liver sinusoids allowing plasma macromolecules access to liver cell surfaces.
What is the primary regulatory control of adrenal medulla secretion?
Preganglionic sympathetic fibers
What is the function of zona occludens?
Prevents diffusion across intracellular space.
Describe the appearance and status of primary vs. secondary follicles.
Primary follicles are dense and dormant. Secondary follicles have pale central germinal centers and are active.
Describe the location of the lymph node paracortex.
Region of cortex between follicles and medulla.
What is the primary regulatory control of zona glomerulosa secretion?
Renin-angiotensin
What is the glomerular basement membrane responsible for?
Responsible for the actual filtration of plasma.
What is another name for type III collagen?
reticulin
What are Nissl bodies?
rough ER
Where in the inner ear are the ampullae found? What is the function of this structure?
Semicircular canals contain ampullae Functions in detecting angular acceleration.
What are/is the primary secretory product of the zona reticularis?
sex hormones (e.g. androgens)
What is the function of lymph node follicles?
Site of B-cell localization and proliferation.
Define macula adherens.
Small, discrete sites of attachment of epithelial cells.
Define Meissner\'s corpuscles.
Small, encapsulated sensory receptors found in dermis of palm, soles and digits of skin.
What is an M cell? What is it\'s function.
Specialized cell interspersed between the cuboidal enterocytes covering a Peyer\'s patch. M cells take up antigens.
Name the layers of epidermis from surface to base.
stratum Corneum, stratum Lucidum, stratum Granulosum, stratum Spinosum, stratum Basalis.
What is the location of zona adherens?
Surrounds the perimeter just below zona occludens.
What is the function of Nissl bodies?
Synthesize enzymes (e.g. ChAT) and peptide neurotransmitters.
In what area of the spleen are T cells found?
T cells are found in the PALS and the red pulp of the spleen.
Which part of the cochlea picks up high frequency sound? Which picks up low frequency?
The base of the cochlea picks up high frequency sound the apex picks up low frequency sound
What is the bony labyrinth filled with? Describe its composition.
The bony labyrinth is filled with perilymph. Perilymph is Na+ rich, similar to ECF
What is the cause of I cell disease? What is the consequence?
The failure of addition of mannose-6-phosphate to lysosome proteins. These enzymes are secreted outside the cell instead of being targeted to the lysosome.
What is the membranous labyrinth filled with? Describe its composition.
The membranous labyrinth is filled with endolymph. Endolymph is K+ rich, similar to ICF.
What layer of the peripheral nerve must be rejoined in microsurgery for limb reattachment?
The perineurium must be rejoined in microsurgery for limb reattachment.
Where in the inner ear are the maculae found? What is the function of this structure?
The utricle and saccule contain maculae Functions in detecting linear acceleration.
How is the function of gap junctions accomplished?
Through a connection with central channels.
What is another name for zona occludens?
Tight junction.
What are mnemonics for remembering locations for type I, II and IV collagen?
Type ONE: bONE Type TWO: carTWOlage Type FOUR: under the FLOOR (basement membrane)
What is a Peyer\'s patch?
Unencapsulated lymphoid tissue found in lamina propria and submucosa of small intestine.
What type of infection may induce an extreme cellular immune response? What happens to the lymph node during such an immune response?
Viral response is an example. The paracortex enlarges.
According to the Homunculus man, place the following in order (from medial to lateral). hand, foot, tongue, face, trunk
foot, trunk, hand, face, tongue
(T or F) Can Bell\'s palsy occur idiopathically?
TRUE
(T or F) Can fasiculations be present in a LMN lesion?
TRUE
(T or F) Is the anterior nucleus of the thalamus part of the limbic system?
TRUE
(T or F) Is the cingulate gyrus part of the limbic system?
TRUE
(T or F) Is the Entrorhinal cortex part of the limbic system?
TRUE
(T or F) Is the hippocampal formation part of the limbic system?
TRUE
(T or F) Is the mammillary body part of the limbic system?
TRUE
(T or F) Is the septal area part of the limbic system?
TRUE
(T or F) Thoracic outlet syndrome results in atrophy of the interosseous muscles?
TRUE
(T or F) Thoracic outlet syndrome results in atrophy of the thenar and hypothenar eminences?
TRUE
(T or F) Thoracic outlet syndrome results in disappearance of the radial pulse upon moving the head to the opposite side?
TRUE
(T or F) Thoracic outlet syndrome results in sensory deficits on the medial side of the forearm and hand?
TRUE
A lesion of the globus pallidus causes what disease?
Wilson\'s disease
A lesion of the mammillary bodies (bilateraly) produces what?
Wernicke-Korsakoff\'s encephalopathy (confabulations, anterograde amnesia)
A lesion of the optic chiasm produces?
bitemporal hemianopsia
A lesion of the right dorsal optic radiation (parietal lesion) produces?
left lower quadrantic anopsia (a temporal lesion)
A lesion of the right Meyer\'s loop (temporal lobe) produces?
left upper quadrantic anopsia (a temporal lesion)
A lesion of the right optic nerve produces?
right anopsia
A lesion of the right optic tract produces?
left homonymous hemianopsia
A lesion of the right visual fibers just prior to the visual cortex produces?
left hemianopsia with macular sparing
A lesion of the Striatum can cause which 2 diseases?
Huntington\'s and Wilson\'s disease
A positive Babinski is an indicator for a (UMN or LMN) lesion?
UMN lesion
A rupture of the middle menigeal artery causes what type of hematoma? (epidural or subdural)
epidural hematoma
A rupture of the superior cerebral veins causes what type of hematoma? (epidural or subdural)
subdural hematoma
An aneurysm of the anterior communicating artery may cause what type of defects?
visual defects
An aneurysm of what artery may cause CN III palsy?
posterior communicating artery
Are D1 neurons in the basal ganglia inhibitory or excitatory?
Excitatory
Are D2 neurons in the basal ganglia inhibitory or excitatory?
Inhibitory
Beginning with anterior communicating artery describe the path around the circle of Willis.
ant. comm. - ACA - ICA - post. comm. - PCA - PCA - post. comm. - ICA - ACA - ant. comm.
Bell\'s Palsy is seen as a complication in what 5 things?
AIDS, Lyme disease, Sarcoidosis, Tumors, Diabetes (ALexander Bell with STD)
Brodmann\'s area 17 is?
principal visual cortex
Brodmann\'s area 22 is?
Wernicke\'s area (associative auditory cortex)
Brodmann\'s area 3,1,2 is?
principal sensory area
Brodmann\'s area 4 is?
principal motor area
Brodmann\'s area 41, 42 is?
primary auditory cortex
Brodmann\'s area 44, 45 is?
Broca\'s area (motor speech)
Brodmann\'s area 6 is?
premotor area
Brodmann\'s area 8 is?
frontal eye movement and pupilary change area
CN I has what function?
smell
CN I passes through what \'hole\'?
cribriform plate
CN II has what function?
sight
CN II passes through what \'hole\'?
optic canal
CN III has what 4 functions?
eye movement, pupil constriction, accommodation, eyelid opening
CN III inervates what 5 muscles.
medial rectus, superior rectus, inferior rectus, inferior oblique, levator palpebrae superioris
CN III passes through what \'hole\'?
superior orbital fissure
CN IV has what function?
eye movement
CN IV inervates what muscle.
superior oblique
CN IV passes through what \'hole\'?
superior orbital fissure
CN IX has what 4 functions?
posterior 1/3 taste, swallowing, salivation (parotid), monitoring carotid body and sinus
CN IX passes through what \'hole\'?
jugular foramen
CN V has what 2 functions?
mastication, facial sensation
CN V1 passes through what \'hole\'?
superior orbital fissure
CN V2 passes through what \'hole\'?
foramen rotundum
CN V3 passes through what \'hole\'?
foramen ovale
CN VI has what function?
eye movement
CN VI inervates what muscle.
lateral rectus
CN VI passes through what \'hole\'?
superior orbital fissure
CN VII has what 4 functions?
facial movement, anterior 2/3 taste, lacrimation, salivation(SL, SM glands)
CN VII passes through what \'hole\'?
internal auditory meatus
CN VIII has what 2 functions?
hearing, balance
CN VIII passes through what \'hole\'?
internal auditory meatus
CN X has what 5 functions?
taste, swallowing, palate elevation, talking, thoracoabdominal viscera
CN X passes through what \'hole\'?
jugular foramen
CN XI has what 2 functions?
head turning, shoulder shrugging
CN XI passes through what \'hole\'?
jugular foramen (descending) -- foramen magnum (ascending)
CN XII has what function?
tounge movements
CN XII passes through what \'hole\'?
hypoglossal canal
Complete the muscle spindle reflex arc by placing the following in order: alpha motor, Ia afferent, muscle stretch, extrafusal contraction, intrafusal stretch.
muscle stretch - intrafusal stretch - Ia afferent - alpha motor - extrafusal contraction
Extrafusal fibers are innervated by what motor neuron?
alpha motor neuron
From which 3 spinal roots does long thoracic nerve arises?
C5, C6, C7
General sensory/motor dysfunction and aphasia are caused by stroke of the? (ant. circle or post. circle)
anterior circle
Give 3 characteristics of a LMN lesion.
atrophy, flaccid paralysis, absent deep tendon reflexes
Give 3 charateristics of internuclear ophthalmoplegia (INO)
medial rectus palsy on lateral gaze, nystagmus in abducted eye, normal convergence.
Give 4 characteristics of an UMN lesion.
spastic paralysis, increased deep tendon reflexes, + Babinski, minor to no atrophy
Golgi tendon organs send their signal via what nerve?
group Ib afferents
Horner\'s Syndrome is present if the lesion in Brown-Sequard is above what level?
T1
How are the fibers of the corticospinal tract laminated? (legs/arms medial or lateral?)
arms- medial, legs-lateral
How are the fibers of the dorsal column laminated? (legs/arms medial or lateral?)
legs-medial, arms-lateral
How are the fibers of the spinothalmic tract laminated? (sacral/cervical medial or lateral?)
cervical-medial, sacral-lateral
How do glucose and amino acids cross the blood-brain barrier?
carrier-mediated transport mechanism
How does the hypothalamus control the adenohypophysis?
via releasing factors (ie. TRH, CRF, GnRF, etc.)
Huntington\'s patients typically have what type of movements?
Chorea
If the radial nerve is lesioned, what 2 reflexes are lost?
triceps reflex and brachioradialis reflex
If you break your humerus mid-shaft, which nerve would likely injure?
radial nerve
If you break your medial epicondyle of the humerus, which nerve would likely injure?
ulnar nerve
If you break your supracondyle of the humerus, which nerve would likely injure?
median nerve
If you break your surgical neck of the humerus, which nerve would likely injure?
axillary nerve
In a lesion of the radial nerve, what muscle is associated with wrist drop?
extensor carpi radialis longus
Intrafusal fibers are encapsulated and make up muscle spindles that send their signal via what nerve?
group Ia afferents
Intrafusal fibers are innervated by what motor neuron?
gamma motor neuron
Is Bell\'s palsy an UMN or a LMN lesion?
LMN
Is the Babinski reflex (positive or negative) when the big toe dorsiflexes and the other toes fan-out?
positive (pathologic)
Name 2 locations for lesions in Syringomyelia?
ventral white commissure and ventral horns
Name 3 locations for lesions in Vit.B12 neuropathy(Friedreich\'s ataxia)?
dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts
Name 7 functions of the hypothalamus?
Thirst/waterbalance, Adenohypophysis control, Neurohypophysis control, Hunger/satiety, Autonomic regulation, Temperature regulation, Sexual emotions. TAN HATS
Name the 4 foramina that are in the posterior cranial fossa?
internal auditory meatus, jugular foramen, hypoglossal canal, and foramen magnum.
Name the 5 foramina that are in the middle cranial fossa?
optic canal, superior orbital fissure, foramen rotundum, foramen ovale, and foramen spinosum.
Name the 5 functions of the Limbic system?
Feeding, Fighting, Feeling, Flight, sex (F--K) [the famous 5 F\'s]
Name the 5 segments of the brachial plexus in order from proximal to distal.
roots - trunks - divisions - cords - branches
Name the type of movement with slow writhing movements (esp. the fingers)?
Athetosis
Name the type of movement with sudden, jerky, purposeless movements?
Chorea
Name the type of movement with sudden, wild flailing of one arm?
Hemiballismus
Neurons from the globus pallidus have what action on the ventral anterior nucleus?
Inhibitory
Neurons from the striatum have what action on the globus pallidus?
Inhibitory
Place the following in order (from light entering the eye to reflex). Pretectal nuclei, pupillary constrictor muscle, retina, ciliary ganglion, Edinger-Westphal nuclei, CN II, CN III.
retina, CN II, pretectal nuclei, Edinger-Westphal nuclei, CN III, ciliary ganglion, pupillary constrictor muscle
Stimulation from the paraventricular nucleus cause the release of what hormone?
oxytocin
Stimulation from the supraoptic nucleus cause the release of what hormone?
ADH (vasopressin)
The Blood-Brain Barrier is formed by what 3 structures?
choriod plexus epithelium, intracerebral capillary endothelium, astrocytes. (First Aid says Arachnoid but the brains say that’s a typo)
The central retinal artery is a branch off what larger artery?
ophthalmic artery
The embryologic defect of having a cervical rib can compress what 2 structures?
subclavian artery and inferior trunk of the brachial plexus
The fasciculus cuneatus contains fibers from the upper or lower body?
upper extremities
The fasciculus gracilis contains fibers from the upper or lower body?
lower extremities
The hippocampal formation is connected to the mammillary body and septal area via what structure?
fornix
The hippocampus has input from what two areas?
entorhinal cortex, septal area
The hippocampus has output to what two areas?
mammillary body, septal area
The infraorbital nerve is a branch off what larger nerve?
CN V2
The Nucleus Ambiguus has fibers from what 3 CNs?
CN IX, X, XII
The Nucleus Solitarius has fibers from what 3 CNs?
CN VII, IX, X
Traction or tear of the superior trunk of the brachial plexus causes what syndrome?
Erb-Duchenne palsy (waiter\'s tip)
Vertigo, ataxia, visual deficits, and coma are caused by stroke of the? (ant. circle or post. circle)
posterior circle
Visual fibers from the lateral geniculate body terminate on the upper and lower banks of what fissure?
Calcarine fissure
What 1 nerve root is assoc. with the achilles reflex?
S1
What 1 nerve root is assoc. with the biceps reflex?
C5
What 1 nerve root is assoc. with the patella reflex?
L4
What 1 nerve root is assoc. with the triceps reflex?
C7
What 2 areas have sensation deficit in a lesion of the median nerve?
lateral palm/thumb and the radial 2 1/2 fingers
What 2 areas have sensation deficit in a lesion of the ulnar nerve?
medial palm and the ulnar 1 1/2 fingers
What 2 cutaneus nerves are lost in a lesion of the radial nerve?
posterior brachial cutaneous and posterior antebrachial cutaneous
What 2 spinal roots make up the inferior trunk of the brachial plexus?
C8, T1
What 2 spinal roots make up the superior trunk of the brachial plexus?
C5, C6
What 2 structures pass through the internal auditory meatus?
CN VII, VIII
What 2 symptoms are seen with a lesion of the musculocutaneus nerve?
difficulty flexing the arm, variable sensory loss
What 2 symptoms are seen with a lesion of the ulnar nerve?
weak intrinsic muscles of the hand, Pope\'s blessing
What 3 blood barriers does the body have?
blood-brain, blood-gas, blood-testis
What 3 muscles are lost in a lesion of the musculocutaneous nerve?
coracobrachialis, biceps brachii, and brachialis
What 3 muscles are lost in a lesion of the radial nerve?
triceps brachii, brachioradialis, and extensor carpi radialis longus
What 3 structures pass through the foramen magnum?
spinal roots of CN XI(ascending), brainstem, vertebral arteries
What 3 structures pass through the optic canal?
CN II, ophthalmic artery, central retinal vein
What 4 \'muscles\' does the radial nerve innervate?
Brachioradialis, Extensors of the wrist and fingers, Supinator, Triceps. (BEST)
What 4 areas is there decreased output in Parkinson\'s?
substantia nigra pars compacta, globus pallidus, ventral anterior nucleus, cortex
What 4 movements are limpaired in a lesion of the ulnar nerve?
wrist flextion, wrist addduction, thumb adduction, and adductiont of the 2 ulnar fingers
What 4 movements are lost in a lesion of the median nerve?
forearm pronation, wrist flexion, finger flexion, and several thumb movements
What 4 structures pass through the jugular foramen?
CN IX, X, XI(descending), jugular vein
What 4 things do the lateral striate arteries supply?
internal capsule, caudate, putamen, globus pallidus
What 5 spinal nerves that make up the brachial plexus?
C5, C6, C7, C8, T1
What 5 structures pass through the supperior orbital fissure?
CN III, IV, V1, VI, ophthalmic vein
What 5 types of cells make up the suportive cells of the CNS/PNS?
Astrocytes, Microglia, Oligodendroglia, Schwann cells, Ependymal cells.
What are 2 characteristics of Tabes Dorsalis?
impaired proprioception and locomotor ataxia
What are 3 clinical findings of the arm in Erb-Duchenne palsy?
arm hangs by the side, medially rotated, forearm is pronated
What are the 2 classic causes of Erb-Duchenne palsy?
blow to the shoulder and trauma during birth
What are the 3 classic symptoms of Horner\'s syndrome?
ptosis, miosis, anhydrosis
What are the 4 classic findings of Brown-Sequard syndrome?
ipsi motor paralysis(spastic), ipsi loss of dorsal column, contra loss of spinothalamic, ipsi loss of ALL sensation at the level of the lesion
What are the input and output of the anterior nucleus of the thalamus?
input - mammillary body, output - cingulate gyrus
What are the input and output of the cingulate gyrus?
input - anterior nucleus of the thalamus, output - entorhinal cortex
What are the input and output of the entorhinal cortex?
input - cingulate gyrus, output - hippocampal formation
What are the input and output of the mammillary body?
input - hippocampal formation, output - anterior nucleus of the thalamus
What are the input and output of the septal area?
input - hippocampal formation, output - hippocampal formation
What artery do the lateral striate branch off of?
internal carotid artery
What artery does the anterior inferior cerebellar artery branch off of?
basilar artery
What artery does the anterior spinal artery branch off of?
vertebral artery
What artery does the posterior inferior cerebellar artery branch off of?
vertebral artery
What artery does the superior cerebellar artery branch off of?
basilar artery
What artery supplies Broca\'s and Wernicke\'s speech areas?
middle cerebral artery
What artery supplies the medial surface of the brain (foot-leg area)?
anterior cerebral artery
What bone do all the foramina of the middle cranial fossa pass through?
sphenoid bone
What CN arises dorsally?
CN IV trochlear
What CN is the afferent limb of the pupillary light reflex?
CN II
What CN is the efferent limb of the pupillary light reflex?
CN III
What CNs lie medially at the brain stem?
CN III, VI, XIII (3 - 6 - 12)
What CNS/ PNS supportive cell has the following functions: central myelin production?
Oligodendroglia
What CNS/ PNS supportive cell has the following functions: inner lining of the ventricles?
Ependymal cells
What CNS/ PNS supportive cell has the following functions: peripheral myelin production?
Schwann cells
What CNS/ PNS supportive cell has the following functions: phagocytosis?
Microglia
What CNS/ PNS supportive cell has the following functions: physical support, repair, K+ metabolism?
Astrocytes
What disease does Tabes Dorsalis result from?
tertiary syphilis
What disorder results from a lesion in the medial longitudinal fasciculus (MLF).
Internuclear ophthalmoplegia (INO)
What embryologic defect is thoracic outlet syndrome caused by
by having a cervical rib.
What happens if a swinging light test is performed on a Marcus Gann pupil (afferent pupil defect)?
results in pupil dialation of the defective eye as the light is swung from the normal eye to the defective eye
What happens if you illuminate one pupil in a normal patient?
both eyes constrict (consensual reflex)
What hypo/hyper-kinetic disorder is marked by decreased serum ceruloplasm and Keyser-Fleischer rings in the eyes.
Wilson\'s disease
What is a Argyll Robertson pupil?
the eyes DO NOT constrict to light, but DO accommodate to near objects
What is affected in a central VII lesion (lesion above the facial nucleus - UMN)?
paralysis of the contralateral lower quadrant
What is affected in a peripheral VII lesion (lesion at or below the facial nucleus - LMN)?
paralysis of the ipsilateral face both upper and lower.
What is the common name for a peripheral VII lesion?
Bell\'s palsy
What is the consequence when your CNS stimulates the gamma motor neuron and the intrafusal fibers contract?
increased sensitivity of the reflex arc
What is the direct pathway from the striatum to the cortex?
The striatum to the substantia nigra pars reticularis /medial globus pallidus to the thalamus to the cortex (excitatory path)
What is the embryologic tissue origin of Microglia (ecto/meso/edo)?
Mesoderm
What is the indirect pathway from the striatum to the cortex?
The striatum to the lateral globus pallidus to the subthalamic nucleus to the substantia nigra/medial globus pallidus to the thalamus to the cortex (inhibitory pathway but still increases the thalamic drive)
What is the lesion in Brown-Sequard syndrome?
hemisection of the spinal cord
What is the most common circle of Willis aneurysm?
anterior communicating artery
What is the name for the small muscle fiber type that regulates muscle length?
Intrafusal fibers
What lesion produces coma?
reticular activating system
What lesion produces conduction aphasia, poor repetition w/ poor comprehension, and fluent speech?
Arcuate fasiculus
What lesion produces Kluver-Bucy syndrome (hyperorality, hypersexuality, disinhibited behavior)?
Amygdala (bilateral)
What lesion produces motor(expressive) aphasia with good comprehension?
Broca\'s area (motor speech)
What lesion produces personality changes and deficits in concentration, orientation, judgement?
frontal lobe - these are frontal release signs
What lesion produces sensory(fluent/receptive) aphasia with poor comprehension?
Wernicke\'s area (associative auditory cortex)
What lesion produces spatial neglect syndrome?
right parietal lobe -- contralateral neglect.
What lobe of the brain is the Broca\'s area in?
frontal
What lobe of the brain is the frontal eye movement and pupillary change area in?
frontal
What lobe of the brain is the premotor area in?
frontal
What lobe of the brain is the primary auditory cortex area in?
temporal
What lobe of the brain is the principal motor area in?
frontal
What lobe of the brain is the principal sensory area in?
parietal
What lobe of the brain is the principal visual cortex area in?
occipital
What lobe of the brain is the Wernicke\'s area in?
temporal
What midbrain structure is important in mitigating voluntary movements and making postural adjustments?
Basal Ganglia
What mineral causes the pathology of Wilson\'s disease
copper
What muscle depresses and extorts the eye?
inferior rectus
What muscle elevates and intorts the eye?
superior rectus
What muscle extorts, elevates, and adducts the eye?
inferior oblique
What muscle fiber type makes up the muscle bulk and provides the force for contraction?
Extrafusal fibers
What muscle intorts, depresses, and abducts the eye?
superior oblique
What muscle sensor senses tension and provides inhibitory feedback to alpha motor neurons?
golgi tendon organs
What muscular disorder is a medial longitudinal fasciculus syndrome associated with?
Multiple Sclerosis (MLF=MS)
What nerve is known as the great extensor nerve?
radial nerve
What neurotransmitter is decrease in Parkinson\'s disease
dopamine
What nucleus if typically lesioned in hemiballismus?
contralateral subthalamic nucleus
What nucleus of the hypothalamus controls circadian rhythms?
suprachiasmatic nucleus
What nucleus of the hypothalamus controls hunger?
lateral nucleus
What nucleus of the hypothalamus controls satiety?
ventromedial nucleus
What nucleus of the hypothalamus controls sexual emotions?
septate nucleus
What nucleus of the hypothalamus controls thirst and water balance?
supraoptic nucleus
What part of the hypothalamus (ant./post.) controls autonomic regulation?
anterior hypothalamus
What part of the hypothalamus (ant./post.) controls cooling when hot?
anterior hypothalamus
What part of the hypothalamus (ant./post.) controls heat conservation when cold?
posterior hypothalamus
What part of the ventral spinal cord is spared with complete occlusion of the ventral artery?
dorsal columns
What passes through the cavernous sinus? (nerves and artery
CN III, IV, V1, V2, VI, post-ganglionic SNS and the Internal carotid artery
What reflex is lost in a lesion of the musculocutaneous nerve?
biceps reflex
What structure passes through the foramen ovale?
CN V3
What structure passes through the foramen rotundum?
CN V2
What structure passes through the foramen spinosum?
middle meningeal artery
What structure passes through the hypoglossal canal?
CN XII
What symptom is seen with a lesion of the axillary nerve?
Deltoid paralysis
What symptom is seen with a lesion of the median nerve?
decreased thumb function
What syndrome is seen with a lesion of the long thoracic nerve?
Winged scapula
What syndrome is seen with a lesion of the lower trunk of the brachial plexus?
Claw hand
What syndrome is seen with a lesion of the posterior cord of the brachial plexus?
Wrist drop
What syndrome is seen with a lesion of the radial nerve?
Saturday night palsy
What syndrome is seen with a lesion of the upper trunk of the brachial plexus?
Waiter\'s tip (Erb-Duchenne palsy)
What two bones do all the foramina of the posterior cranial fossa pass through?
temporal and occipital bones
What two hypothalamic nuclei does the posterior pituitary(neurohypophysis) receive neuronal projections from?
supraoptic nucleus and paraventricular nucleus.
What type of fibers do the corticospinal tracts carry?
motor
What type of fibers do the dorsal columns carry?
sensory - pressure, vibration, touch, proprioception
What type of fibers do the spinothalmic tracts carry?
sensory - pain and temperature
What type of function does CN I have? (sensory, motor, or both)
sensory
What type of function does CN II have? (sensory, motor, or both)
sensory
What type of function does CN III have? (sensory, motor, or both)
motor
What type of function does CN IV have? (sensory, motor, or both)
motor
What type of function does CN IX have? (sensory, motor, or both)
both
What type of function does CN V have? (sensory, motor, or both)
both
What type of function does CN VI have? (sensory, motor, or both)
motor
What type of function does CN VII have? (sensory, motor, or both)
both
What type of function does CN VIII have? (sensory, motor, or both)
sensory
What type of function does CN X have? (sensory, motor, or both)
both
What type of function does CN XI have? (sensory, motor, or both)
motor
What type of function does CN XII have? (sensory, motor, or both)
motor
What type of lesion is seen in Amyotrophic Lateral Sclerosis?
combo of UMN and LMN lesions with no sensory deficit
What type of lesion is seen in Multiple Sclerosis?
random asymmetric lesions in mostly white matter of the cervical region
What type of lesion is seen in Poliomyelitis and is it genetic or acquired?
acquired LMN lesion causing flaccid paralysis
What type of lesion is seen in Werdnig-Hoffmann disease and is it genetic or acquired?
genetic LMN lesion causing flaccid paralysis (aka. Floppy infant disease)
What type of molecule can cross the blood-brain barrier most easily? (lipid/nonlipid, polar/nonpolar)
Lipid-soluable/nonpolar molecules
What vagal nuclei controls motor innervation to the pharynx, larynx, and upper esophagus?
Nucleus Ambiguus (Motor=aMbiguus)
What vagal nuclei controls visceral sensory in formation like taste and gut distention?
Nucleus Solitarius (Sensory=Solitarius)
What vagal nuclei sends parasympathetic fibers to the heart, lungs, and upper GI?
dorsal motor nucleus of CN X
What would happen temperature regulation if you lesioned your posterior hypothalamus?
lose the ability to conserve heat
What would happen temperature regulation if you lesioned your ventromedial nucleus of the hypothalamus?
have hyperphagia and become obese
When is a positive Babinski a normal reflex?
during the first year of life
Where is the lesion in a patient with hemiballismus?
Subthalamic nucleus
Where is the lesion in Parkinson\'s?
Substantia nigra pars compacta
Which CN is the only nerve that does not abut the wall in the cavernous sinus?
CN VI (abducens)
Which CNs pass through the middle cranial fossa?
CN II - VI
Which CNs pass through the posterior cranial fossa?
CN VII - XII
Which division of the facial motor nucleus has duel innervation? (upper or lower)
upper division
Which thalamic nucleus has a visual function?
Lateral Geniculate Nucleus (LGB)
Which thalamic nucleus has an auditory function?
Medial Geniculate Nucleus (MGB)
Which thalamic nucleus has pre-motor function?
Ventral Anterior Nucleus (VA)
Which thalamic nucleus has the function of body senses(proprioception, pressure, pain, touch, vibration)?
Ventral Posterior Lateral Nucleus (VPL)
Which thalamic nucleus has the function of facial sensation and pain?
Ventral Posterior Medial Nucleus (VPM)
Which thalamic nucleus is the primary motor cortex?
Ventral Lateral Nucleus (VL)
Which way does the head deviate in a unilateral lesion (LMN) of CN XI? (toward or away)
toward the lesion -- note: First-Aid is wrong in the book)
Which way does the jaw deviate in a unilateral lesion (LMN) of CN V? (toward or away)
toward the lesion
Which way does the patient tend to fall in a unilateral lesion (LMN) of the cerebellum? (toward or away)
toward the lesion
Which way does the tongue deviate in a unilateral lesion (LMN) of CN XII? (toward or away)
toward the lesion
Which way does the uvula deviate in a unilateral lesion (LMN) of CN X? (toward or away)
away from the lesion
Why does the arm hang by the side in Erb-Duchenne palsy?
paralysis of shoulder abductors
Why is L-dopa use for parkinsonism instead of dopamine?
L-dopa crosses the blood-brain barrier while dopamine does not.
Why is the arm medially rotated in Erb-Duchenne palsy?
paralysis of the lateral rotators
Why is the forearm pronated in Erb-Duchenne palsy?
loss of the biceps brachii
At which end of the tRNA is the aa bound?
The amino acid is covalently bound to the 3\' end of the tRNA.
Can RNA polymerase initiate chains?
Yes.
Define transition.
Substituting purine for purine or pyrimidine for pyrimidine.
Define transversion.
Substituting purine for pyrimidine or vice versa.
Define tRNA wobble.
Accurate base pairing is required only in the first 2 nucleotide positions of an mRNA codon, so codons differing in the 3rd \'wobble\' position may code for the same tRNA/amino acid.
Describe DNA replication.
Origin of replication: continuous DNA synthesis on leading strand and discontinuous (Okazaki fragments) on lagging strand. Primase makes an RNA primer on which DNA polymerase can initiate replication. DNA polymerase reaches primer of preceding fragment; 5\'®3\' exonuclease activity of DNA polymerase I degrades RNA primer; DNA ligase seals;
Describe DNA replication (continued answer)
3\'->5\' exonuclease activity of DNA polymerase \'proofreads\' each added nucleotide. DNA topoisomerases create a nick in the helix to relieve supercoils
Describe Euchromatin
Less condensed (vs. Heterochromatin), transcriptionally active
Describe Heterochromatin
Condensed, transcriptionally inactive
Describe key structural differences between nucleotides.
1) Purines (A,G) have 2 rings. 2) Pyrimidines (C,T,U) have 1 ring 3) Guanine has a ketone. 4) Thymine has a methyl
Describe single-strand, excision repair.
Excision repair-specific glycosylase recognizes and removes damaged base. Endonuclease makes a break several bases to the 5\' side. Exonuclease removes short stretch of nucleotides. DNA polymerase fills gap. DNA ligase seals.
Describe the difference between Eukaryotic Vs. Bacterial, viral and plasmid origin of replications
Eukaryotic genome has multiple origins of replication. Bacteria, viruses and plasmids have only one origin of replication.
Describe the main difference in eukaryotic and prokaryotic synthesis of RNA.
Eukaryotes have 3 different RNA polymerases (\'I, II, III synthesize RMT\') and prokaryotes have 1 RNA polymerase (which makes all 3 kinds of RNA).
Describe the method by which introns are removed from primary mRNA transcript.
Introns are precisely spliced out of primary mRNA transcripts. A lariat-shaped intermediate is formed. Small nuclear ribonucleoprotein particles (snRNP) facilitate splicing by binding to primary mRNA transcripts and forming spliceosomes.
Describe the number of bonds per purine-pyrimidine pair. Which is stronger?
G-C bond (3 H-bonds) A-T bond (2 H-bonds G-C bond is stronger
Describe the structure of Chromatin.
Condensed by (-) charged DNA looped around (+) charged histones (nucleosome bead). H1 ties the nucleosome together in a string (30 nm fiber)
Describe tRNA structure.
75-90 nucleotides, cloverleaf form, anticodon end is opposite 3\' aminoacyl end. All tRNAs both eukaryotic and prokaryotic, have CCA at 3\' end along with a high percentage of chemically modified bases. The amino acid is covalently bound to the 3\' end of the tRNA.
Does RNA polymerase have a proof reading function?
No.
How do purines and pyrimidines interact, molecularly?
Purines and pyrimidines pair (A-T, G-C) via H-bonds
How does RNA polymerase II open DNA?
RNA polymerase II opens DNA at promoter site (A-T rich upstream sequence- TATA and CAAT)
How is the original RNA transcript processed in eukaryotes? (3)
1) Capping on 5\' end (7-methyl G) 2)Polyadenylation on 3\' end ( =200 As) 3) Splicing out of introns
In eukaryotes, what must occur before an newly synthesized RNA transcript leaves the nucleus?
Only processed RNA is transported out the nucleus of eukaryotes.
Name 3 types of RNA
1) mRNA 2) rRNA 3) tRNA
Name the charged histones around which (-) charged DNA loops (nucleosome core).
H2A, H2B, H3, H4 histones
Name the enzyme responsible for the synthesis of RNA in prokaryotes.
RNA polymerase
Name the enzymes involved in ss-DNA repair. (5)
1) specific glycosylase. 2) endonuclease. 3) exonuclease. 4) Dan polymerase. 5) DNA ligase.
Name the enzymes responsible for the synthesis of eukaryotic RNA.
RNA polymerase I RNA polymerase II RNA polymerase III
What are exons?
Exons contain the actual genetic information coding for a protein
What are four types of mutations that can occur in DNA?
1) Silent 2) Missense 3) Nonsense 4) Frame shift
What are introns?
Introns are intervening noncoding segments of DNA
What are the four features of the Genetic Code?
1) Unambiguous 2) Degenerate 3) Commaless, non-overlapping 4)Universal
What atoms link aa in a protein chain?
Amino acids are linked N to C
What changes occur in DNA structure during mitosis?
In mitosis, DNA condenses to form mitotic chromosomes
What codon sequence is found at the 3\' end of all tRNAs?
All tRNAs, both eukaryotic and prokaryotic, have CCA at 3\' end.
What direction is DNA synthesized in?
5\' > 3\'. Remember that the 5\' of the incoming nucleotide bears the triphosphate (energy source for the bond). The 3\' hydroxyl of the nascent chain is the target.
What direction is protein synthesized in?
Protein synthesis also proceed in the 5\' to 3\' (5\' > 3\')
What direction is RNA synthesized in?
5\' > 3\'. Remember that the 5\' of the incoming nucleotide bears the triphosphate (energy source for the bond). The 3\' hydroxyl of the nascent chain is the target.
What does the AUG mRNA sequence code for?
AUG codes for methionin, which may be removed before translation is completed. In prokaryotes the initial AUG codes for a formyl-methionin (f-met).
What does the P in P-site stand for? What does the A in A-site stand for?
P-site: peptidyl; A-site: aminoacyl;
What does the statement, \'the genetic code is commaless\' mean? What is the exception to this rule?
The code is non-overlapping. The exception are some viruses
What does the statement, \'the genetic code is degenerate\' mean?
More than one codon may code for the same amino acid
What does the statement, \'the genetic code is unambiguous\' mean?
Each codon specifies only one amino acid
What does the statement, \'the genetic code is universal\' mean? What are the exceptions (4)?
The same code is used in all lifeforms. The exceptions are 1. mitochondria, 2. archaeobacteria, 3. Mycoplasma, 4. some yeasts
What enzyme is responsible for \'charging\' tRNA? How does it work?
Aminoacyl-tRNA synthetase. This enzyme (one per aa, uses ATP) scrutinizes aa before and after it binds to tRNA. If incorrect, bond is hydrolyzed by synthetase. The aa-tRNA bond has energy for formation of peptide bond.
What inhibits RNA polymerase II?
alpha-amanitin inhibits RNA polymerase II
What is a conservative missense mutation?
Mutation results in a different aa encoded, but that new aa is similar in chemical structure to the original code
What is a frameshift mutation? What is usually the effect on the encoded protein?
A change in DNA resulting in misreading of all nucleotides downstream. Usually results in a truncated protein.
What is a missense mutation?
Mutation results in a different aa encoded.
What is a nonsense mutation?
A change in DNA resulting in an early stop codon.
What is a promoter?
Site where RNA polymerase and multiple other transcription factors bind to DNA upstream from gene locus.
What is a silent mutation? What usually causes a silent mutation?
Mutation results in the same aa encoded. Often the base change is in the 3rd position of the codon
What is a snRNP? What is its function?
snRNP = small nuclear ribonucleoprotein. snRNPs facilitate splicing by binding to primary mRNA transcripts and forming spliceosomes.
What is an enhancer?
Stretch of Dan that alters gene expression by binding transcription facts. May be located close to, far from, or even within (an intron) the gene whose expression it regulates.
What is an Okazaki fragment?
The discontinuous DNA synthesized on the lagging strand during DNA replication
What is hnRNA?
hnRNA = heterogeneous nuclear RNA The initial RNA transcript is called hnRNA
What is responsible for the accuracy of amino acid selection during peptide synthesis?
Aminoacyl-tRNA synthetase and binding of charged tRNA to the codon are responsible for accuracy of amino acid selection.
What is the broad classification of nucleotides? (2)
Purines (A, G) and Pyrimidines (C, T, U)
What is the difference between hnRNA and mRNA?
hnRNA = the initial RNA transcript mRNA = capped and tailed transcript
What is the difference between thymine and uracil?
Uracil found in RNA Thymine found in DNA
What is the function of DNA ligase during DNA Replication?
DNA ligase seals synthesized DNA into a continuous strand
What is the function of DNA polymerase during DNA Replication? (2)
5\'®3\' exonuclease activity of DNA polymerase I degrades RNA primer; 3\'®5\' exonuclease activity of DNA polymerase \'proofreads\' each added nucleotide.
What is the function of DNA topoisomerase during DNA Replication?
DNA topoisomerases create a nick in the helix to relieve supercoils
What is the function of primase in DNA Replication?
Primase makes an RNA primer on which DNA polymerase can initiate replication.
What is the function of RNA polymerase I?
RNA polymerase I makes rRNA
What is the function of RNA polymerase II?
RNA polymerase II makes mRNA
What is the function of RNA polymerase III?
RNA polymerase III makes tRNA
What is the mRNA initiation codon?
AUG, or rarely GUG
What is the mRNA stop codons? (3)
UGA (U Go Away) UAA (U Are Away) UAG (U Are Gone)
What is the result of \'mischarged\' tRNA?
A mischarged tRNA (bound to wrong aa) reads usual codon but inserts wrong amino acid.
What is the role of endonuclease in ss-DNA repair?
Endonuclease makes a break several bases to the 5\' side.
What is the role of excision repair-specific glycosylase in ss-DNA repair
Recognizes and removes damaged base.
What is the role of exonuclease in ss-DNA repair?
Exonuclease removes short stretch of nucleotides.
What prevents an incorrect aa-tRNA pairing?
If incorrect, the aa-tRNA bond is hydrolyzed by aminoacyl-tRNA synthetase.
What role does histone H1 play in chromatin structure?
H1 ties the nucleosome together in a string (30nm fiber)
What supplies the energy for formation of peptide bond?
The aa-tRNA bond has energy for formation of peptide bond.
What would most likely be the result of a mutation of the promoter sequence?
Promoter mutation commonly results in dramatic decrease in amount of gene transcribed.
When is ATP used in protein synthesis? When is GTP used in protein synthesis?
ATP is used in tRNA charging, whereas GTP is used in binding of tRNA ribosome and for translocations.
When is recombination involved in DNA repair?
If both strands are damaged, repair may proceed via recombination with undamaged homologous chromosome.
Where does RNA processing occur in eukaryotes?
RNA processing occurs in the nucleus.
Which is the largest type of RNA?
mRNA (massive)
Which is the most abundant type of RNA?
rRNA (rampant)
Which is the smallest type of RNA?
tRNA (tiny)
Which nucleotide position in the codon has room for \'wobble\'?
Codons differing in the 3rd \'wobble\' position may code for the same tRNA/amino acid
How do you do a Northern Blot?
Electrophorese RNA on a gel transfer to a filter expose filter to a labeled DNA probe visualize the DNA probe annealed to the desired RNA
How do you do a Southern Blot?
Electrophorese DNA on a gel transfer to a filter and denature the DNA expose to a labeled DNA probe visualize probe annealed to desired DNA fragment
How do you do a Southwestern blot?
Separate protein by electrophoresis transfer to a filter expose to a labeled DNA probe visualize DNA bound to desired protein
How do you do a Western Blot?
Separate protein by electrophoresis transfer to a filter expose to a labeled antibody visualize Ab bound to desired protein
How do you do PCR? (4 steps)
1. Heat DNA to denature. 2. Cool DNA and let the primers aneal. 3. Heat-stable polymerase replicates DNA following each premer 4. Repeat
What are some genetic diseases detectable by PCR?(11)
SCID, Lesh-Nyhan, CF, familial hypercholesterolemia retinoblastoma, sickle cell, B-thalassemia, hemophilia A and B, von Willebrand\'s dz, lysosomal dz, and glycogen stroage dz
What gene is involved in cystic fibrosis?
CFTR
What gene is involved in familial hypercholesterolemia?
LDL-R
What gene is involved in Lesh-Nyhan syndrome?
HGPRT
What gene is involved in retinoblastoma
Rb
What gene is involved in SCID?
adenosine deaminase
What gene is involved in Sickle cell and ?-thal?
? globin gene
What is an ELISA (enzyme linke immunosorbant assay)?
Rapid lab test in which an antibody or an antigen (usually collected from a patient) is exposed to an Ag or Ab liked to to an enzyme. A positive test results in a Ag-Ab match and is usually indicated by a color change
What is PCR?
Lab procedure used to synthsize many copies of a desired fragment of DNA
Von Geirke\'s disease is a result of?
Glucose-6-phosphatase deficiency; also known as Type I Glycogen Storage disease
A build up of sphingomyelin and cholesterol in reticuloendothelial and parenchymal cells and tissues is found in what disease
Niemann-Pick disease
A child is born with multiple fractures and blue sclera what is the diagnosis
Osteogenesis imperfecta;disease of abnormal collagen synthesis resulting in fractures and translucent Conn tiss over chorioid causing the blue sclera
A congenital deficiency of tyrosinase would lead to
Albinism, can\'t synthesize melanin from tyrosine
A patient presents with cataracts, hepatosplenomegaly, and mental retardation, what is the Dx?
Galactosemia
A patient presents with corneal clouding and mental retardation that is, based on family history, inherited in an Autsomal recessive pattern, you impress your intern with a Dx of
Hurler\'s syndrome
A patient presents with 1. Hyperextensible skin 2. Tendency to bleed 3. Hypermobile joints you astutely Dx them with
Ehlers-Danlos syndrome
Absence of Galactosylceramide Beta-galactosidase leads to thebuild up of what compound in what disease
accumulation of galactocerebroside in the brain; Krabbe\'s disease
Absence of hexosaminidase A results in the acumulation of what molecule that is characteristic of what disease
GM2-ganglioside accumulation; Tay-Sachs disease
albinism increase risk of developing what
skin cancer
Autosomal dominant defects will effect what members of a family
male and female
Autosomal recessive disorders often result in what kind of defect/deficiencie?
enzyme deficiencies
Autosomal recessive disorders usually effect how many generations in a family?
usually only one generation
Bloom\'s syndrome is characterized by sensitivity to what as a result of
sensitivity to radiation as a result of a DNA repair defect
Creatine and Urea are both made from?
Arginine
Defects in structural genes often follow what pattern of inheritance?
Autosomal dominant
Defiency of arylsulfatase A results in the accumulation of what molecule where
sulfatide in the brain, kidney, liver, and peripherla nerves. Characteristic of Metachromatic Leukodystrophy
define genetic imprinting
when differences in phenotype depend on whether the mutation is of paternal or maternal origin
define incomplete penetrance
when not all individuals with a mutant genotype show the mutant phenotype
define Linkage Disequilibrium
the tendency for certain alleles at two linked loci to occur together more often thatn expected by chance, as measured in a population
define pleiotropy
one gene has more than one effect on an individual\'s phenotype, autosomal dominant defects are oftne pleiotropic
Define variable expression
nature and severity of the phenotype varies from one individual to another
Fanconi\'s anemia is caused by what typr of agents
cross-linking agents
Ganglioside is made up of what
Ceramide + oligosacharide + sialic acid
Gaucher\'s disease is caused by a deficiency of
Beta-glucocerebrosidase
Glucocerebroside accumulation in the brain, liver, spleen, and bone marrow are characteristic of
Gaucher\'s disease
Hglycine is used to make what important compound
Porphyrin which is then used to make Heme
Histamine is synthesized form what compound
Histidine
How does adenosine deaminase defiency cause SCID
Purine salvage pathway. ADA normal converts adenosine to inosine without it ATP & dATP build up inhibiting ribonucleotide reductase which prevents DNA synthesis lowering lymphocyte production
How is Lesch-Nyhan syndrome inheritied andwhat is the result and symptoms
X-linked recessive; increase in uric acid production. Retardation, self mutalation, aggression, hyperuricemia, gout, and choreathetosis
Hunter\'s syndrome is characterised by what biochemical problem and how is it inherited
deficiency of iduronate sulfatase; X-linked recessive mild form of Hurler\'s
In ataxia-telangiectasia DNA damage caused by what source cannot be repaired
X-rays
in G6PD deficiency the decrease in NADPH can lead to _____ if exposed to _____
hemolytic anemia;oxidizing agents( fava beans, sulfonamides, primaquine) and antituberculosis.
In PKU what builds up and what can be found in the urine
phenyalanine builds upe leading to phenylketones in the urine
In PKU, what amino acid becomes essential
tyrosine.
in the Hardy-Weinberg equation, what are the p and q and what is 2pq
p and q are each separate alleles; 2pq = heterozygote
no male to male transmission is characteristic of what type of genetic disorders?
X-linked recessive
Pompe\'s disease is caused by a defect in?
lysosomal alpha-1,4-glucosidase defiency
Sickle cell anemia is caused by what defect and what is it\'s prevalence
AR single missense mutation in the beta globin; 1:400 blacks
Siclkle cell anemia patients often present with
recurrent painful crisis and increased susceptibility to infections
Skin sensitivity to UV light secondary to a DNA repair defect is characteristic of what?
xeroderma pigmentosum
Sphingosine + fatty acid yields
ceramide
the COL1A gene mutation is associated with what disease and what type of mutation is this
Osteogenesis imperfecta;dominant negitive mutation
The main defect in Ataxia-telangiectasi is a ___
DNA repair defect
The most common form of Osteogenesis imperfecta has what genetic problem and inheritance
abnormal Collagen Type I synthesis;Autosomal dominant
the transporter for what amino acids is defective in cystinuria
COLA: Cys,Ornithine, Lysine and Arginine
Thymidine dimers are formed by exposure of DNA to UV light, are the dimers formed on the opposing strands of a DNA molecule or on the same side?
dimers are on same side
Tryptophan can be used to make what three chemicals
Niacin, \'Serotonin, melatonin
Type III Glycogen storage disease is a defiency of ?
deficiency of debranching enzyme alpha-1,6-glucosidase
What is the cause Tx and symptoms of Lactase intolerance?
Lactase defiency, avoid diary products or add lactse pills to diet symptoms bloating, cramps, osmotic diarrhea
What % of kids born to father with mitochondrial myopathie will be effected
none, mitochondrial myopathies are inherited from mitochondria which is only inherited from the mother
What are the clinical signs of Krabbe\'s disease
optic atrophy, spasticity, early death
What are the components of Cerebroside
Ceramide + glucose/galactose
What are the components of Sphingomyelin
Ceramide + phosphorylcholine
What are the components of sphingosine
serine + palmitate
What are the findings and treatment of pyruvate dehydrogenase
neurologic defects; increase intake of ketogenic nutrients
What are the findings in McArdles\'s disease and what is the problem
increased glycogen in skeletal muscle due to a Glycogen phosphorylase defiency strenuous exercise cause myoglobinuria and painful cramps
What are the findings in PKU and what is the treatment
Mental retardation, fair skin, eczema, musty body odor Tx. Decreasee phenylalanin (nutrasweet) and increase tyrosine
What are the findings in Pompe\'s disease and what is it alternate name
Cardiomegaly and systemic findings, leading to early death. Pompe\'s trashes the Pump. (Heart, Liver and muscle) Type II Glycogen storage disease
What are the findings in Von Gierke\'s disease
severe fasting hypoglycemia, increased glycogen in the liver
What are the four assumptions of the Hardy-Weinberg equilibrium
1.There is no mutation occuring at the locus 2. There is no selection for any of the geno types at the locus 3. Random mating 4. no migration in or out
What are the purely ketogneic amino acids
lysine and leucine
What are the signs and symptoms of essential fructosuria
asymptomatic, benign, Fructose appears in blood and urine
what are the signs and symptoms of Homocystinuria
Homocysteine accumulates in urine and cystine becomes essential Methionine and it\'s metabolites build up in blood Mental retardation, osteoporosis, dislocation of the lens
What are the symptoms of Alkaptonuria
Dark Urine from alkapton bodies; also connective tissue is dark, may have arthralgias. Bengin disease
What are the symptoms of Fructose intolerance
hypoglycmeia, jaundice, cirrhosis
What are the symptoms of Maple syrup Urine disease
CNS defects, mental retardation and death. Urine smells like maple syrup
What biological chemicals are derived form phenylalanine
tyrosine, thyroxine Dopa dopamine NE, Epinephrine and Melanin
What causes Essential Fructosuria
defect in fructokinase
What causes Lesch-Nyhan syndrome
Absence of HGPRTase, (normally converts hypoxanthine to IMP and guanine to GMP) Lacks Nucleotide Salvage (LNS)-purines
What do melanin and Norepinephrine have in common
both derived directly from dopamine Phenylalanine to tyrosine to Dopa to Dopamin
What does the term \'loss of heterozygosity\' mean
when one allele of an allele pair is lost. An example is when a patient inherits or develops a mutation in a tumor suppressor gene and the complimentary allele is then lost to deletion/mutation. The patient would not develop the cancer until the loss of the normal allele.
What enzyme defiencies are associated with hemolytic anemia
Glycolytic enzyme deficiencies 1. Hexokinase 2.glucose-phosphate isomerase 3.aldolase 4.triose-phosphate isomerase 5. phosphate-glycerate kinase enolase pyruvate kinase
What event in embryology can cause albinism
lack of migration of neural crest cells to skin (form melanocytes)
What genetic error can cause Severe Combined Immnuodeficiency (SCID)?
Adenosine deaminase deficiency
what group of people can be seen with pyruvate dehydrognease deficiency
alcoholics due to B1 defiecincy
What is a complication of cystinuria
cystine kidney stones
What is a dominant negitive mutation?
a mutation that exerts a dominant effect because the body cannot produce enough of the normal gene product with only one allele functioning normally
What is a good pnuemonic for the four glycogen storage diseases
Very-Von Gierke\'s Poor-Pompes Carbohydrate-Cori\'s Metabolism-McArdles
What is commonly associated with xeroderma pigementosa?
dry skin, melanoma and other cancers
What is crucail to the diagnosis of an Autosomal dominant disease?
Family history
What is genetic anticipation?
the severity of the diseas worsens or age of onset of disease is earlier in succeeding generations
What is inheritance of G6PD dfiency and what population is effected more often
X-linked recessive; blacks
What is NAD/NADP made form
Niacin, \'Serotonin, melatonin
What is osteogenesis imperfecta often confused with
child abuse
What is the biochemical defect in Metachromatic leukodystrophy and what is the inheritance pattern
deficiency of arylsulfatase A; Autosomal recessive
What is the biochemical defect in Nieman-Pick disease and how is it inherited
deficiency of Beta-glucocerebrosidase; autosomal recessive
What is the biochemical effect of G6PD defiency
decrease in NADPH which is necessary to reduce glutathione which in turn detoxifies free radicals and peroxides
What is the cause of Cystinuria and what are the signs/symptoms
inheritied defect o the tubular amino acid transporter for Cystine, ornithine, Lysine and Arginine in kidneys excess cystine in urine
What is the cause of Fabry\'s disease and what is the common clinical problem
Alpha-galactosidase A deficiency; gives accumulation of ceramide trihexoside causing renal failure
What is the cause of galactosemia?
Absence of galactose-1-phosphate uridyltransferase; accumualtion of toxic substances (galactitol)
What is the characteristic defect in Hurler\'s syndrome
Alpha-L-iduronidase defiency leads to corneal clouding and mental retardation
What is the characteristic findings in Neurofibromatosis
Multiple café-au-lait spots, neurofibromas increased tumor susceptibilty
What is the clinical picture of a patient with cystic fibrosis
pulmonary infections, exocrine pancreatic insufficiency, infertility in men
What is the clinical picture of Duchenne\'s muscular dystrophy
muscular weakness and degeneration
What is the defect in Maple Syrup Urine disease
decreased Alpha-ketoacid dehydrogenase. blocks degradation of branched amino acids Ile. Val. Leu
What is the epidemiology of lactose intolerance
Age-dependnet and/or hereditary (blacks and Asians)
What is the etiology of Homocystinuria
defect in cystathionine synthase. Two forms: 1. deficiency 2. decreased affinity of synthase for pyridoxal phosphate (cofactor)
What is the finding of Hunter\'s syndrome on H&P
mild mental retardation but no corneal clouding
What is the formula for Hardy-Weinberg equilibrium?
p^2 +2pq + q^2 =1 and p+q=1
What is the genetic mech. Of Cystic fibrosis and it\'s inheritance
AR; multiple loss-of-function mutations in a chloride channel
What is the genetic mechanism of Duchenne\'s muscular dystrophy
X-linked recessive;caused by multiple loss-of-funtion mutations in a muscle protein
What is the genetic mechanism of Fragile X MR
X-linked; progressive expansion of unstable DNA causes failure to express gene-encoding RNA-binding protein
what is the genetic mechanism of Neurofibromatosis
AD, multiple loss-of function mutations in a signaling molecule
What is the genetic problem in Down\'s Syndrome
trisomy 21 chromosomal imbalance
What is the inheritance of Krabbe\'s disease
Autosomal recessive
what is the inheritance pattern and carrier frequency in Tay-Sach\'s
Autosomal recessive; 1:30 in Jews of European descent and 1:300 in the general populaition
What is the inheritance pattern of Ehlers-Danlos syndrome
10 types of this syndrome Type IV-Auto Dominant Type VI-Auto Recessive Type IX- X-linked recessive
What is the inheritance pattern of Gaucher\'s disease
Autosomal recessive
What is the inheritance pattern of xeroderma pigmentosa
autosomal recessive
What is the inheritiance pattern of Fabry\'s disease
X-linked recessive
What is the lab symptoms of G6PD defiency
Heinz Bodies: altered hemoglobin precipitate in RBC
What is the most distinguishing finding in Tay-Sach\'s disease on Physical exam
cherry red Macula; these patients die by 3
What is the pathogneumonic cell type founde in Gaucher\'s disease
Gaucher\'s cells with the characteristic \'crinkled paper\' appearance of enlarged cytoplasm
What is the pattern of inheritance of Leber\'s hereditary optic neuropathy?
mitochondrial inheritance
What is the phenotype in Osteogenesis imperfecta
increased susceptibility to fractures;connective tissue fragility
What is the phenotype of Down\'s syndrome
Mental and growth retardation, dysmorphic features, internal organ anomalies especially heart problems
What is the phenotype of Fragile X
mental retardation, characteristic facial features, large testes
What is the predominant problem in Ehlers-Danlos syndrome
Faulty collagen synthesis
What is the prevalance of cystic fibrosis
1:2000 whites; very rare among Asians
What is the prevalandce of Neurofibromatosis
1:3000 with 50% being new mutations
What is the prevalence of Down\'s syndrome and what are the risk factors
1:800; increased risk with advanced maternal age
What is the prevalence of Duchenne\'s musc. dys.
1:300; 33% new mutations
What is the prevalence of Fragile X- associated mental retardation
1:1500 males: can be in feamales is a multi-step process
What is the prevalence of osteogenesis imperfecta
1:10000,
What is the prevalence of Phenylketonuria
1:10000
What is the priamry defect in Fructose intolerance and how is it inherited?
defiency of aldolase B, autosomal recessive
What is the primary defect in Alkaptonuria
congenital defiency of homogentisic acid oxidase in the degradative pathway of tyrosine
What is the primary defect(s) found in Phenylketoneuria
either 1.decreased phenylalanie hydroxylase or 2. decreased tetrahydrobiopterin cofactor
What is the rate-limiting enzyme in the Hexose-Monophosphate shunt?
Glucose-6-phosphate dehydrogenase
What is the result of pyruvate dehydrognease deficiency
backup of substrate (pyruvate and alanine) resulting in lactic acidosis
What is the specific defect in Xeroderma pigmentosa
defective excision repair such as uvr ABC exonuclease; have inability to repair thymidine dimer formed by UV light
What is the treament of Cystinuria and what is a possible consequence of not treating
Acetazolide to alkinlize the urine cystine kidney stones due to excess cysteine
What is the treatment of fructose intolerance?
decrease intake of both fructose and sucrose (glucose + fructose)
What is the treatment of Homocystinuria
1. For a defiency in cystathionine synthase tx by decrease Met and increase Cys in diet 2. for decreased affinity of synthase Tx by decrease vitamin B6 in diet
What is the Tx of galactosemia?
Exclude galactose and lactose (galactose +glucose) form diet
what offspring of females affected with a mitochondrial inherited disease will be effected?
all offspring can be effected
what percent of offspring from two autosomal recessive carrier parents will be effected?
0.25
what percent of sons of a heterazygous mother carrying an x-linked disease will be effected?
0.5
What period of life do autosomal dominant defects present in?
often present clinically after puberty
What three phenyl ketones build up in the urine of PKU patients
phenylacetate, phenyllactate, phenylpyruvate
What to thyroxine and Dopa have in common
both derived form tyrosine
What type of genetic error is usually more severe autosomal recessive or dominant?
AR disorders are often more severe
What type of inheritance is transmitted only through mothers?
mitochondrial
When do patients usually present with autosomal recessive disorders?
present in childhood
Why are RBC so susceptible to Glycolytic enzyme def.
RBC\'s metabolize glucose anaerobically (no mitochondria) and depends on glycolysis
Why do people with fructose intolerance become hypoglycemic?
deficent aldolase B causes the accumulation of Fructose 1-phosphate which acts as a phosphate sink and traps the phosphate. Decreased phosphate availability inhibits glycogenolysis and gluconeogenesis
X-linked recessive disease is aften more severe in
males
1,3-BPG
2,3-BPG via bisphosphoglycerate mutase
Acyl
coenzyme A, lipoamide
aldehydes
TPP
Arachidonate
prostaglandins, -thromboxanes, -leukotrienes
Associate the following signal molecule precursors.
j
At body pH, what AA are negatively charged?
Arg and Lys His is neutral at pH 7.4
At body pH, what AA are positvely charged?
Asp and Glu
ATP
cAMP via adenylate cyclase
By what rxn order kinetics does alcohol dehydrogenase operate?
zero order kinetics
CH(3) groups
SAM
Choline
CDP-choline
Choline
ACh via choline acetyltransferase
CO(2)
biotin
Contrast glucagon and insulin.
glucagon phosphorylates stuff, -turns glycogen synthase off and phosphorylase on
Contrast hexokinase and glucokinase.
hexokinase throughout the body, -GK in liver and has lower affinity but higher capacity for glucose
Contrast hexokinase and glucokinase.
only HK is feedback inhibited by G6P
Does insulin affect glucose uptake of brain, RBC\'s and liver?
No
Does insulin inhibit glucagon release by alpha cells of pancreas?
yes
electrons
NADH, NADPH, FADH(2)
Fructose-6-phosphate
fructose-1,6-bis-P via PFK (rate limiting step of glycolysis)
Glucose
UDP-Glucose
glutamate
GABA via glutamate decarboxylase (requires vit. B6)
GTP
cGMP via guanylate cyclase
How are ketone bodies excreted?
in urine
How are ketone bodies formed?
FA and AA converted to acetoacetate and b-hydroxybutyrate
How do the statin drugs work?
they inhibit HMG-CoA reductase
How does disulfiram work?
inhibits acetylaldehyde dehydrogenase
How does FA enter the cytosol?
via citrate shuttle
How does FA enter the mitochondria?
via the carnitine shuttle
How does lead affect heme synthesis?
inhibits ALA dehydratase and ferrochelatase prevents incorporation of Fe
How does the brain metabolize ketone bodies?
to 2 molecules of acetyl coA
How is bilirubin removed from the body?
collected by liver, conjugated with glucuronate excreted in bile
How is ethanol metabolized?
ethanol oxidized to acetylaldehyde by alcohol dehyd and NAD+ acetalaldehyde ox to acetate by acetylaldehyde and NAD+
How is FA entering the mitochondria inhibited?
by cytoplasmic malonyl-CoA
How is glutamate converted to a-ketogluturate
By the loss of amonium and reduction of NADP
How is glutamine converted to glutamate?
By the loss of amonium
How is heme catabolized?
scavenged from RBC\'s and Fe+2 is reused
How is LDL uptake undergone?
by target cells through receptor-mediated endocytosis
How is most plasma cholesterol esterfied?
LCAT(lecethin-cholesterol acyltransferase)
How is NAD+ generally used metabolically?
catabolic processes
How is NADPH generally used metabolically?
anabolic processes (steroid and FA synthesis), repiratory burst, P-450
How is TCA regulated?
by need for ATP and supply of NAD+
How many ATP\'s per acetyl CoA?
12
How many ATP equivalants are needed to generate glucose from pyruvate?
6
How many enzyme activities does pyruvate dehydrognase possess
3
How many moles of ATP are generated aerobically through G3P shuttle?
36 ATP
How many moles of ATP are generated aerobically through malate shuttle?
38 ATP
How many moles of ATP are generated anaerobically?
2 ATP
In what tissue does heme synthesis occur (2)?
liver and bone marrow
Insulin mneumonic
insulin moves glucose into cells
Is Serum C peptide present with exogenous insulin intake?
No
Kwashikor results from a protein deficient MEAL (mneumonic)
Malabsorption, Edema, Anemia, Liver (fatty)
Mnemonic for gluconeogenesis irreversible enzymes?
Pathway Produces Fresh Glucose
Mnemonic for SAM.
SAM the methyl donor man
Name 6 common products of pyruvate metabolism?
glucose, lactate, Acetyl CoA+CO2, OAA, Alanine
Name the activated carriers with associated moleclues (one carbon units).
tetrahydrofolates
phosphoryl
ATP
T/F. Uncouplers stop ATP production?
FALSE
Underproduction of heme causes what anemia?
microcytic hypochromic anemia
What AA are required during periods of growth?
Arg and His
What are clincial syndromes of this disorder?
xanthomas, atherosclerosis homozygotes MI by age 30
What are major pathways occur in the liver (8)?
most including gluconeogenesis, etc.
What are the activators of glycgenolysis?
cAMP, and calcium ion
What are the cofactors of pyruvate dehydrogenase (5)?
pyrophosphate, lipoic acid, CoA, FAD and NAD
What are the components of a cholymicron remnant?
TG, FFA and apo E
What are the components of a cholymicron?
TG, apo C-II, apo E, B-48, apo A
What are the components of IDL?
less TG, CE, B-100 and E
What are the components of LDL?
CE and B-100
What are the components of VLDL?
TG, Cholesterol ester, B-100, CII and E
What are the degradation product steps (3)?
heme to biliverdin to bilirubin
What are the effector hormones of cholesterol synthesis?
insulin increases, glucagon decreases
What are the effector hormones of glyc and pyr ox?
decreased glucagon and increased insulin
What are the effector hormones of glycogenolysis?
insulin decreases, epi and glucagon increases
What are the effector hormones of lipogenesis (2)?
insulin increases, glucagon decreases
What are the electron transport chain inhibitors?
rotenone, antimycin A, CN-, CO
What are the essential glucogenic/ketogenic AA?
Ile, Phe, Try
What are the essential gluconeogenic AA?
Met, Thr, Val, Arg, His
What are the essential ketogenic AA?
Leu and Lys
What are the irreversible enzymes of gluconeogenesis (4)?
-pyruvate carboxylase, -PEP carboxykinase,-fructose-1,6-bisphosphotase, -glu-6-phosphotase
What are the irreversible enzymes of glycolysis (4)?
-glucokinase/hexokinase,-PFK,-pyruvate kinase,-pyruvate dehdrogenase
What are the main substrates used by adipose tissue (2)?
-glucose, -lipoprotein triacylglycerol
What are the main substrates used by brain?
-glucose, -aa and ketone bodies when starved, -polyunsat FA in neonates
What are the main substrates used by heart?
FFA, -some glucose, -lactate, -ketone bodies, VLDL and cholymicrom triacylglycerol
What are the main substrates used by liver?
FFA, -glucose, -lactate, -glycerol, fructose, -AA
What are the major activators of gluconeogenesis?
Acetyl CoA for pyruvate carboxylase and cAMP for PEP carboxykinase and F-1,6-bis-P
What are the major activators of glycolysis and pyruvate oxidation?
AMP, fructose2,6-bis-P, fructose 1,6-bis-P in muscle, CoA, NAD, ADP and pyruvate
What are the major metabolic pathways of the adipose tissue (2)?
- esterfication of FA\'s - lipolysis
What are the major metabolic pathways of the brain (2)?
-glycolysis,-aa metabolism
What are the major metabolic pathways of the heart?
Aerobic pathways like B oxidation and TCA cycle
What are the major products of the adipose tissue (2)?
-FFA, -glycerol
What are the major products of the brain?
lactate
What are the major products of the liver (10)?
glucose,-VLDL,-HDL,-ketone bodies,-urea,-uric acid, -bile acids, -plasma proteins
What are the major regulatory enzymes of gluconeogenesis (3)?
pyruvate carboxylase, PEP carboxykinase and F-1,6-bis-P
What are the major regulatory enzymes of glycolysis and pyruvate oxidation?
PFK and pyruvate dehydrogenase
What are the major regulatory enzymes of cholesterol synthesis?
HMG-CoA reductase
What are the products of the liver in the fasting state?
glucose and ketone bodies
What are the products of the liver in the fed state?
glycogen and fats/VLDL
What are the products of the TCA cycle?
3NADH, 1FADH2, 2CO2, 1GTP per Acetyl CoA
What are the some causes of hyperbilirubinemia (4)?
massive hemolysis, -block in catabolism, -diplaced from binding sites on albumin, decreased excretion
What are the sources of hyperbilirubinemia (2)?
conjugated (direct/glucuronidated) and unconjugated(indirect/insoluble)
What are the specialist enzymes of muscle (2)?
-lipoprotein lipase, and well developed resp chain
What are the specialist enzymes of the adipose tissue (2)?
-lipoprotein lipase,-hormone sensitive lipase
What are the specialist enzymes of the heart (2)?
-lipoprotein lipase, -respiratory chain well-developed
What are the specialist enzymes of the liver?
-glucokinase,-glu-6-phosphotase,-glycerol kinase, -PEP carboxykinase, -fructokinase,-arginase,-HMG coA synthase and lyase, -7a-hydroxylase
What are the three sites in the electron transport chain for active proton transfer?
NADH dehydrogenase, Cyt b/c1, and cytochrome oxidase aa3
What can occur as an excess of cholymicrons (3)?
pancreatitis, lipemia retinalis and eruptive xanthomas
What can occur as an excess of VLDL?
pancreatitis
What catalyzes cholymicron to cholymicron remnant?
lipoprotein lipase
What catalyzes IDL to LDL?
hepatic TG lipase
What catalyzes VLDL to IDL?
lipoprotein lipase
What causes a hangover?
acetylaldehyde accumulates
What color is bilirubin and what is the condition of excess?
yellow, jaundice
What complex is pyruvate dehydrogenase similar to?
a-ketogluturate dehydrogenase complex
What do LT c4, D4 and E4 do (4)?
bronchconstriction, vasoconstriction, contract smooth muscle, increase vascular permeability
What does breath smell like during ketoacidosis?
fruity(acetone)
What does excess LDL cause(3)?
atherosclerosis, xanthomas, and arcus corneae
What does oligomycin do to ETC?
ATPase inhibitor that increases proton gradient but not ATP production
What does PGI stand for?
platelet gathering inhibitor
What does the COX pathway yield?
thromboxanes, prostaglandins and prostacyclin
What does the lipooxygenase pathway yield?
leukotrienes
What does this stand for?
Ornithine, citrulline, carbamoyl-p, aspartate, arginosuccinate, fumurate, arginine, urea
What enzyme catalyzes the rate limiting step of cholesterol syn.?
HMG-CoA reductase
What induces the PPP?
insulin
What is a major component of atherosclerotic plaque?
modified LDL
What is an uncoupling agent to the ETC?
2,4 DNP (dynamite)
What is cofactor required for methionine (SAM) regeneration?
vitamin B12
What is does PGI 2 inhibit (2)?
platelet aggregation and vasodilation
What is familial hyper-cholesteremia?
AD genetic defect in LDL receptor
What is Kwashikor?
protein malnutrition
What is LT B4?
neutrophil chemotactic agent
What is Marasmus?
Protein-calorie malnutrition resulting in tissue wasting
What is the activator of lipogenesis?
Citrate
What is the activator of PPP?
NADP+
What is the clinical picture of Kwashikor?
small child with swollen belly
What is the committed step of heme synthesis?
glycine+succ CoA to delta-aminolevulinate
What is the composition of ATP?
Base(adenine), ribose, 3 phosphoryls
What is the consequence of accumulated intermediates of heme synthesis?
porphyrias
What is the easy way to remember the cofactors of PDH complex?
First 4 B vitamins + lipoic acid
What is the effector hormone for glycogenesis?
Glucagon
What is the energy content of the 2 phosphoanhydride bonds?
7 kcal/mol each
What is the functiion of HDL (2)?
transfers cholesterol from periphery to liver acts as a repository for apoC and apoE
What is the functioin of lipoprotein lipase?
FA uptake to cells from choly\'s and VLDL\'s
What is the function of aminolevulinate (ALA) synthase ?
rate limiting step of heme synthesis converts succinyl CoA and glycine to ALA
What is the function of cholymicrons (2)?
delivers dietary TG to peripheral tissues delivers dietary cholesterol to liver
What is the function of hormone sensitive lipase?
degradation of stored TG\'s
What is the function of LDL?
delivers hepatic cholesterol to peripheral tissues
What is the function of phospholipase A2?
liberates arachidonic acid from cell membrane
What is the function of PPP (3)?
-produces ribose-5-P from G6P for nucleotide synthsesis,-produces NADPH,-part of HMP shunt
What is the function of SAM?
transfers methyl units to wide variety of receptors
What is the function of the Cori Cycle?
transfers excess reducing equivalants from RBC\'s and muscle to liver to allow muscle to function anaerobically
What is the function of Tx A2 (2)?
platelet aggregation and vasoconstriction
What is the function of VLDL?
Delivers hepatic TG to peripheral tisssue
What is the inhibitor of lipogenesis (2)?
long-chain acyl-CoA, -cAMP
What is the inhibitor of PPP?
NADPH
What is the limiting reagent of ethanol metabolism?
NAD+
What is the main substrate of fast twitch muscle?
glucose
What is the main substrate of slow twitch muscle?
ketone bodies, -FFA, -triacylglycerol
What is the major function of fast twitch muscle?
rapid movement
What is the major function of slow twitch muscle?
sustained movement
What is the major function of the a1 receptor?
increase vascular smooth muscle contraction
What is the major function of the a2 receptor (2)?
-decrease sympathetic outflow, -decrease insulin release
What is the major function of the B1 receptor (5)?
increase HR, -inc. conntractility, -inc. renin release,-inc. lipolysis, -inc. aq. Humor formation
What is the major function of the B2 receptor (3)?
vasodilation, bronchodilation, inc. glucagon release
What is the major function of the D1 receptor?
relax renal vascular smooth muscle
What is the major function of the D2 receptor?
modulate transmitter release, esp. in brain
What is the major function of the H1 receptor (4)?
increase mucous production, -contract bronchioles, -pruritis, -pain
What is the major function of the H2 receptor (4)?
increase gastric acid secretion
What is the major function of the liver?
service for the other organs and tissues
What is the major function of the M1 receptor?
CNS
What is the major function of the M2 receptor?
decrease heart rate
What is the major function of the M3 receptor?
increase exocrine gland secretions
What is the major function of the V1 receptor?
increase vascular smooth muscle contraction
What is the major function of the V2 receptor?
increase water permeability and reabsorption in the renal collecting tubules
What is the major inhibitor of glyc and pyr ox?
citrate (FA and ketone bodies) ATP and cAMP, -acetyl CoA, NADH, ATP
What is the major inhibitor of TCA?
ATP, long-chain acyl-coA
What is the major inhibitor of cholesterol synthesis (2)?
cholesterol and cAMP
What is the major inhibitor of glycogenesis?
ADP and AMP and F-2,6-bis-P
What is the major metabolic pathway of fast twitch muscle?
glycolysis
What is the major metabolic pathway of slow twitch muscle?
Aerobic pathways like B oxidation and TCA cycle
What is the major product of fast twitch muscle?
lactate
What is the major product of slow twitch muscle?
lactate
What is the major regulatory enzyme of glycogenolysis?
glycogen synthase
What is the major regulatory enzyme of lipogenesis?
acetyl CoA carboxylase
What is the major regulatory enzyme of pentose phosphate pathway (PPP)?
glucose-6-P dehydrogenase
What is the major regulatory enzyme of TCA?
citrate synthase
What is the mechanism for the ETC inhibitors?
directly block ETC, cause decreased proton gradient
What is the mechanism for the ETC uncoupler?
inc. membrane permeability, decreases proton gradient and increases O2 consmption
What is the mechanism of ethanol hypoglycemia?
NADH/NAD increases in liver causes diversion of pyruvate to lactate and OAA to malate inhibits gluconeogenesis and thus leads to hypoglycemia
What is the mnemonic for the various substrates of the TCA cycle?
Cindy Is Kinky So She Fornicates More Often
What is the mneumonic for essential AA?
PriVaTe TIM HALL
What is the mneumonic for major apolipoproteins?
A-1 Activates LCAT B-100 Binds to receptor C-II is a Cofactor for LPL E mediates Extra (remnant) uptake
What is the pneumonic for the Urea cylce substrates?
Ordinarily, Careless Crappers Are Also Frivolous About Urination
What is urobilinogen?
an intestinal intermediate reabsorbed to blood and excreted in urine as urobilin
What other physiological side affect occurs by this hypoglycemia?
fatty liver seen in chronic alcoholics
What rxn does pyruvate dehydrogenase catalyze?
pyruvate+NAD+CoA goes to acetyl-CoA +CO2+NADH
What second messenger system does Gi work through?
adenylcyclase reduces cAMP levels and protein kinase A is reduced
What second messenger system does Gq work through?
phospholipase C, PIP2 to IP3 and DAG DAG works through protein kinase C IP3 increases IC calcium ion
What second messenger system does Gs work through?
adenylcyclase converts ATP to cAMP to phosphorylate protein kinase A
What some properties of bilirubin (3)?
sparingly water soluble toxic to CNS transported by albumin
What step does this enzyme work on?
HMG-CoA to mevalonate
What suppresses glycogenesis?
insulin
What tissues require insulin for glucose uptake?
adipose and skeletal muscle
What type of metabolism occurs in the both (3)?
-gluconeogenesis, -urea cycle, heme synthesis
What type of metabolism occurs in the cytoplasm (5)?
glycolysis, -fatty acid synthesis, -HMP shunt, -protein synthesis (RER), -steroid synthesis (SER)
What type of metabolism occurs in the mitochondria (3)?
Beta oxidation, -Acetyl-CoA production, -Kreb\'s cycle
When are ketone bodies formed (2)?
during prolonged starvation diabetic ketoacidosis
Where are basic AA found in high amounts?
in Histones that bind to negative DNA
Where are cholymicrons made?
small intestine
Where are ketone bodies made?
liver
Where does FA degradation occur?
mitochondria, where it will be used
Where does FA synthesis occur?
cytosol
Where is ALA synthase found and what inhibits it?
mitochondria, heme
Where is HDL secreted from (2)?
liver and small intestine
Where is insulin made?
B cells of pancreas
Where is NADPH generated?
is a product of HMP shunt and the malate dehydrogenase rxn
Where is SAM generated?
From ATP and methionine
Where is VLDL made?
liver
Which ketone body is detected in urine test (1 only)?
acetoacetate
Carbon monoxide has a greater affinity for what molecule?
CO has 200x greater affinity for hemoglobin than for oxygen
Describe the subunits for hemoglobin?
hemoglobin is composed of 4 polypeptide subunits (2 alpha and 2 beta)
During the cycle of the sodium pump, it is __.
phosphorylated
How are enzymes regulated?
1. enzyme concentration alteration (syntesis and/or destruction) 2. covalent modification (eg. phosphorylation) 3. proteolytic modification (zymogen) 4. allosteric regulation (eg. feedback inhibition) 5. transcriptional regulation (eg. steroid hormones)
How does calcium cause skeletal muscle contraction?
Ca2+ -> activates troponin -> moves tropomyosin -> exposes actin-bining site -> allows actin-myosin interaction
How does calcium cause smooth muscle contraction?
Ca2+ -> binds to calmodulin because smooth muscle doesn\'t have troponins!
How does procollagen molecules become collagen fibrils?
procollagen molecules cleaved at terminal regions by peptidases to become insoluble tropocollagen, which aggregates to form fibrils procollagen molecules are exocytosed into extracellular space, where this process occurs
How is CO2 transported from tissue to lungs?
- binds to amino acids in globin chain (at N-terminus), not to heme - favors T form of Hb (thus promotes O2 unloading)
How is collagen fibillar structure reinforced?
by the formation of covalent lysine-hydroxylysine crosslinks between tropocollagen molecules
How is hemoglobin structure regulated?
increased Cl-, H+, CO2, DPG, and temperature favor T form (low affinity of O2)--shifting the dissociation curve to the right, leading to increased O2 unloading
Most cells are in which cell cycle phase?
G0
On what cellular stuctures are microtubules found?
flagella, cilia, mitotic spindles
On which cells is phosphotidylcholine (lecithin) a major component?
- RBC membranes - myelin - bile - surfactant (DPPC--dipalmitoyl phosphatidylcholine) - also used in the esterification of cholesterol
Only the cytoplasmic side of membrane contains what?
glycosylated lipids or proteins
The lower the Km, the (higher/lower/remains same) the affinity
higher
What are the 2 forms of hemoglobin?
- T (taut) form has low affininty for oxygen - R (relaxed) form has 300x higher affinity for oxygen Hb exerts positive cooperativity and negative allostery, accounting for the sigmoid-shaped O2 disassociation curve (which myoglobin doesn\'t have) [Hint: When you\'re RELAXED, you do your job better (carry more O2)]
What are the cell cycle phases?
Mitosis (Prophase-Metaphase-Anaphase-Telophase) G1 (Gap or Growth) S (Synthesis of DNA) G2 (Gap or Growth) G0 (quiescent G1 phase)
What are the characteristics of a microtubule?
- cylindrical structure 24nm in dia and variable length - helical array of polymerized dimers of alpha- and beta-tubulin (13 per circumference) - each dimer has 2 GTP bound - grows slowly, collapses quickly - involved in slow axoplasmic transport in neurons
What are the characteristics of competitive inhibitors?
- resemble substrates - bind reversibly to active sites of enzymes - high substrate concentrations overcomes effect of inhibitors - Vmax remains unchanges - Km increases compared to unhibited
What are the characteristics of noncompetitive inhibitors?
- doesn\'t resemble substrate - bind to enzyme but not necessarily at active site - inhibition can\'t be overcome by high substrate concentration - Vmax decreases - Km remains unchanged compared to uninhibited
What cell cycle phases are variable in duration?
G1 and G0
What drugs act on microtubules?
- mebendazole/thiabendazole (antihelmintic) -taxol (anti-breast cancer) - griseofulvin (antifungal) -cholchicine (anti-gout)
What drugs inhibits the sodium pump?
- Ouabain inhibits the pump by binding to the K+ site - cardiac glycosides (digoxin, digitoxin) also inhibit the pump, causing increased cardiac contractility
What is methemoglobinemia?
blood disorder where methemoglobin, an oxidized form of hemoglobin (ferric, Fe3+) that does not bind O2 as readily. Iron in Hb is normally in a reduced state (ferrous, Fe2+)
What is the difference between collagen fibril and collagen molecule?
fibril is made of molecules collagen fibril--many staggered collagen molecules linked by lysyl oxidase collagen molecule--3 collagen alpha chains, usually of Gly-x-y (x and y = pro, OH-pro, or OH-lys)
What is the first step in forming collagen from prolyl and lysyl residues? Where does it occur? What nutrient does it require?
hydroxylation endoplasmic reticulum vitamin C
What is the plasma membrane composition?
- cholesterol (~50%, promotes membrane stability) - phospholipids (~50%) - sphingolipids -glycolipids -proteins
What is the sodium pump?
Na-K ATPase
What molecules, how many of them, and in what direction are moved across the membrane by the sodium pump?
3 Na go out and 2 K go in
Where is the sodium pump?
on the membrane, with the ATP site on the cytoplasmic side of the pump
Which cell cycle phase is shorter in rapidly dividing cells?
rapidly dividing cells have a shorter G1 phase
Which cell cycle phase is usually shortest?
mitosis
Arthralgia\'s, fatigue, headaches, skin changes, sore throat, alopecia are symptoms foundin what vitamin deficiency
Vit A (Retinal)
How does sarcoidosis cause hypercalcemia?
in sarcoid, epitheliod macrophages convert vitamin D into it\'s active form leading to increased absorption of calcium
How many ATP are made from Niacin
Niacin=NAD niacin is B3=3 ATP
What are the characteristic findings seen in Riboflavin deficiencies
Riboflavin is B2 2 C\'s=cheilosis and Corneal vascularization and also Angular stomatitis
What are the fat soluble vitamins
D,A,K,E
What are the findings in Vit D excess?
Hypercalcemia, loss of appetite, stupor
What are the possible causes of hypercalcemia?
1. Vit D intoxication 2. Malignancy 3. Hyperparathyroidism 4. Milk-alkali syndrome 5. Sarcoidosis 6. Paget\'s disease of bone
What are the signs and symptoms of vit B12 deficiency?
1. Macrocytic megaloblastic anemia 2. Neurologic symptoms-optic neuropathy, subacute combined degeneration 3. glossitis
What are the signs of Biotin deficiency and what are possilble causes?
dermatitis, enteritis antiobiotic use and ingestion of raw eggs
What are the signs of Folate deficiency?
Macrocytic megaloblastic anemia sprue
What are the symptoms in Vit B5 deficiency
dermatitis, enterititis, alopecia, adrenal insufficiency
What are the symptoms of Pellagra
3 D\'s Diarrhea, Dermatitis, Dementia, and also Beefy glossitis
What are the usual causes of Vit B12 deficiency?
1. Malabsorption- Sprue, enteritis, Diphyllobthrium latum (Dr. Lohr\'s fish tapeworm) 2.lack of intrinsic factor (pernicious anemia) 3. Absence of the terminal ileum- Crohn\'s disease or surgery
What are the water soluble vitamins
B complex vitamins (B1,2,3,5,6,12), Vit C, Biotin, Folate
What can induce pyridoxine deficiency? Symptoms?
INH and oral contraceptives convulsion, hyperirritability
What clotting factors are Vit K dependent and what anti-clotting drug acts as a Vit K antagonist?
Factors II, VII, IX, X and Protein C and S Warfarin
what disease is characterized by polyneuritis, cardiac pathology and edema and what is the cause
Beriberi (Ber1BerI), due to Vit B1 deficiency
What diseases conditions are caused by Vitamin D deficiency?
Rickets in kids Osteomalacia in adults hypocalcemic tetany
What diseases is caused by Vit C deficiency and what are the findings?
Scurvy swollen gums, bruising, anemia, poor wound healing
What is B12 used for in the body?
Cofactor for homocysteine methylation and methylmalonyl-CoA handling
What is Niacin\'s function in the body and from what can it be derived
part of NAD, NADP and is derived from tryptophan
What is the active form of Vitamin D?
1,25 (OH)2 D3 = active form
What is the alternate name of Vit B3, problems in deficiency, common cause of defieciency
niacin Pellagra Hartnup disease, malignant carcinoid syndrome, and INH
What is the alternate name of vitamin B1 and what are the characteristic diseases of it\'s deficiency
Beriberi and Wernicke-Korsakoff syndrome
What is the folic acid precursor in bacteria and what antibiotics exploit this fact?
PABA is the precursor sulfa drugs and dapsone are PABA analogs
What is the form of vitamin D consumed in milk?
D2 = ergocalciferol
What is the form of Vitamin D found in sun-exposed skin?
D3 = cholecalciferol
What is the function and alternate name of Vit. B2
cofactor in oxidation and reduction (FAD,FMN) RiboFlavin
What is the function of Biotin?
Cofactor for carboxylations 1. Pyruvate to oxaloacetate 2. Acetyl-CoA to malonyl Co-A 3. Prprionyl-CoA to methylmalonyl-CoA
What is the function of folic acid?
coenzyme for 1-carbon transfer;methylation reactions important for the synthesis of nitrogenous bases in DNA and RNA
What is the function of Vit A, it\'s alternate name, and symptoms in deficiency
visual pigments (retinal) retinol night blindness and dry skin
What is the function of Vit B1
it becomes Thiamine Pyrophosphate (TPP) and is used in: oxidative decarboxylation of Alpha-keto acids (pyruvate, Alpha-ketoglutarate cofactor for tranketolase in the HMP shunt
What is the function of Vit B6
B6 (pyridoxine) is converted to pyridoxal phosphate a cofactore in transamination reactions (ALT & AST), decarboxylation, and trans-sulfuration
What is the function of Vit E?
antioxidant; especially in Erythrocytes where it protects them from hemolysis Vit E is for Erythrocytes
What is the function of vitamin C?
1. Cross linking of collagen-hydroxylation of proline and lysine in collagen synthesis keeping iron in the Fe2+ reduced state making it more absorbable 3. Cofactor for coverting dopamine to norepinephrine
What is the function of Vitamin D?
increase intestinal absorption of Calcium and phosphate
What is the function of Vitamin K?
catalyzes gamma-carboxylation of glutamic acid residues on various proteins concerned with clotting.
What is the most common vitamin deficiency in the United States?
Foilic Acid
What is the rule of 2\'s for Vit B2
2 F\'s, 2C\'s and 2ATP 2 F\'s=FAD&FMN 2 C\'s = signs of deficiency cheilosis and corneal vascularization oxidation of FADH2 leads to 2 ATP
What is the sotrage form of Vitamin D?
25-OH D3
What is the source of Vit B12 and what is B12\'s other name
found only in animal products cobalamin
What is vit B5\'s function and alternate name
constituent of CoA, part of fatty acid synthase. Cofactor for acyl transfers Pantothenate (Pantothen-A is in Co-A)
What manifestation is specific to wet beriberi?
high output cardiac failure (dilated cardiomyopathy)
What molecule in egg white binds up Biotin and causes deficiency
Avidin
What problems do you see in Vit K deficiency?
Neonatal hemorrhage with increased PT increased aPTT, but normal bleeding time in general, mild vitamin k deficiency will prolong PT and have normal PTT severe deficiency will prolong PT and PTT
What scenerios are vit B defieciencies often seen in
alcholism and malnutrition
What test is used to detect B12 deficiency
Schilling test
What two general types of things will cause fat soluble vitamin deficiency
Malabsorption syndromes ( cystic fibrosis and sprue) and mineral oil intake
What vitamins more commonly cause toxicity and why
fat soluble vitamins b/c these accumulate in fat
What water soluble vitamin does not wash out easily from the body
B12 which is stored in the liver
What will a defieciency in Vit E lead to?
Increased fragility of erythrocytes
Where is B12 synthesized and stored
synthesized only in microorganisms stored primarily in liver
Where is Vit K synthesized and what is one cause of Vit K deficiency?
synthesized by ntestinal flora prolonged broad spectrum antibiotic use can kill off the flora can cause a deficiency
Are hallucinations common in narcolepsy patients?
Yes. Both hypnagogic (just before sleep) and hypnopompic (with awakening) are both common.
Define cataplexy.
Sudden collapse (falls asleep) while awake.
Define sleep apnea.
Person stops breathing for at least 10 seconds during sleep.
Distinguish between central and obstructive sleep apnea.
In central sleep apnea, there is no respiratory effort. In Obstructive sleep apnea, there is respiratory effort against airway obstruction.
Does narcolepsy have a genetic component?
Yes. Studies have shown a strong genetic component of narcolepsy.
Does REM sleep increase or decrease with age?
Decreases
Extraocular movements during REM sleep are due to what portion of the brain?
Parapontine Reticular Formation/Conjugate Gaze Center
How often does REM sleep occur?
Every 90 minutes (duration may increase during the night)
Name 1 neurotransmitter change associated with Alzheimer\'s disease.
Decreased Ach
Name 1 neurotransmitter change associated with Parkinson\'s disease.
Decreased Dopamine
Name 1 neurotransmitter change associated with Schizophrenia
Increased Dopamine
Name 2 effects of stress on the body.
1. Induces production of FFA, 17-OH corticosteroids, lipids, cholesterol, and catecholamines 2. Affects water reabsorption, muscular tonicity, gastrocolic reflex, and mucosal circulation.
Name 2 neurotransmitter changes associated with depression.
Decreased NE and serotonin (5-HT)
Name 2 neurotransmitter changes associated with Huntington\'s disease.
Decreased GABA and Ach
Name 3 changes in sleep stages often found in people with depression.
1. Reduced slow-wave sleep 2. Decreased REM latency 3. Early morning awakening (important screening question)
Name 3 possible findings in non-REM sleep.
Sleepwalking, night terrors, and bedwetting
Name 4 physiological actions found in REM sleep.
Increased/variable pulse, rapid eye movements, increased/variable blood pressure, and penile/clitoral tumescence
Name 5 possible findings in REM sleep.
Dreaming, loss of motor tone, possible memory processing function, erection, and increased brain 02 use
Name 5 possible waveform patterns seen in the various sleep/wake stages.
Alpha, Beta (highest frequency, lowest amplitude), Theta, Delta (lowest frequency, highest amplitude), Sleep spindles with K-complexes
Name 7 functions of the frontal lobe.
Concentration, Orientation, Language, Abstraction, Judgment, Motor regulation, Mood
Name a possible chronic outcome of sleep apnea.
Chronic fatigue
Name five findings associated with sleep apnea.
Obesity, loud snoring, systemic/pulmonary HTN, arrhythmias, and possibly sudden death.
What 3 things does the differential diagnosis for sexual dysfunction include?
1. Drugs (e.g. antiHTN, neuroleptics, SSRIs, and ethanol) 2. Diseases (e.g. depression and diabetes) 3. Psychological (e.g. performance anxiety)
What is a common treatment for narcolepsy?
Stimulants (e.g. amphetamines)
What is a helpful mnemonic for the order of the corresponding waveform patterns in each stage of sleep?
At night, BATS Drink Blood.
What is considered the key to initiating sleep?
Serotonergic predominance of the raphe nucleus
What is narcolepsy?
Person falls asleep suddenly
What is the most notable change in function in a frontal lobe lesion?
Lack of social judgment
What is the principal neurotransmitter involved in REM sleep?
Ach
What medication shortens stage 4 sleep and can be used to treat enuresis?
Imipramine
What medication shortens stage 4 sleep and is useful in the treatment of night terrors and sleepwalking?
Benzodiazepines
What neurotransmitter can reduce REM sleep?
NE
What percentage of time is spent in REM sleep?
0.25
What percentage of time is spent in stage 1 sleep?
0.05
What percentage of time is spent in stage 2 sleep?
0.45
What percentage of time is spent in stage 3-4 sleep?
0.25
What phenomenon caused REM sleep to be known as \'paradoxical\' or \'desynchronized\' sleep?
The EEG pattern during REM sleep is the same as the EEG of a person that is awake and alert.
What waveform pattern is seen in a young adult who is awake (eyes open), alert, and has active mental concentration?
Beta waves
What waveform pattern is seen in a young adult who is awake but has his/her eyes closed?
Alpha waves
What waveform pattern is seen in a young adult who is in deeper (stage 2) sleep?
Sleep spindles and K-complexes
What waveform pattern is seen in a young adult who is in light (stage 1) sleep?
Theta waves
What waveform pattern is seen in a young adult who is in REM sleep?
Beta waves
What waveform pattern is seen in a young adult who is in the deepest, Non-REM (stage 3-4) sleep?
Delta waves
A person who is unable to remember things that occurred after a CNS insult has…?
Anterograde Amnesia
Anterograde amnesia caused by thiamine deficiency?
Korsakoff\'s amnesia
Are DT\'s life threatening?
Yes
Are the illness production and motivation in somatoform disorders consicous drives?
No
Bipolar I describes?
manic
Bipolar II describes?
hypomanic
Define a Manic episode.
Distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week
Define a panic disorder.
Discrete period of intense fear and discomfort peaking in 10 minutes with 4/5 characteristics
Define Anosognosia.
being unaware that one is ill
Define Autotopagnosia.
Being unable to locate one\'s own body parts
Define Conversion disorder.
symptoms suggest motor or sensory neurologic or physical disorder, but tests and PE are negative
Define depersonalization.
body seems unreal or dissociated
Define Personality disorder
when patterns become inflexible and maladaptive, causing impairment in social or occupational functioning or subjective distress
Define Personality trait.
an enduring pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts
Delusions are….
false beliefs not shared by other memebers of culture/subculture that are firmly maintained in spite of obvious proof to the contrary
Describe a Paranoid Personality
distrustful and suspicious; projection is main defense mech
Describe a Schizoid Personality.
voluntary social withdrawl; no psychosis; limited emotional expression
Describe a Schizotypal Personality.
interpersonal awkwardness, odd thought patterns and appearance
Does the person who has the phobia recognize their fear as excessive?
yes, they are exhibiting insight
Does the phobic fear interfere with normal routine?
yes
Hallucinations are….
perceptions in the absence of external stimuli
How are Cluster A personalities described?
as odd or ecentric; cannot develop meaningful social relationships; Weird
How are Cluster B personalities described?
Dramatic, emotional, or erratic; Wild
How are Cluster C personalities described?
Anxious and fearful, \'Worried\'
How is a major depressive disorder characterized?
Recurrent-requires 2 or more depressive episodes with a symptom free interval of 2 months
How is a major depressive episode characterized?
5 of the following for 2 weeks, including (1) depressed mood or (2) anhedonia: Sleep disturbances, Loss of Interest, Guilt, Loss of Energy, Loss of Concentration, Change in Appetite, Psychomotor retardation, Suicidal ideation, Depressed mood
How is maladaptive pattern of substance abuse defined?
3 or more of the above signs in 1 year
How is Schizophrenia described?
periods of psychosis and disturbed behavior lasting >6months,
How long does the disturbance due to PSSD last?
> 1 month and causes distress or social/occupational impairment
How many criteria sets exist for bipolar disorder?
6 separate criteria exist for bipolar disorders with combinations of manic, hypomanic, and depressed episodes
How many hallucination types are there? Name them.
7; Visual, Auditory, Olfactory, Gustatory, Tactile, Hypnagogic, Hypnopompic
How many heroin addicts are there in the US?
~500,000
How would you decribe a dependent personality?
submissive and clinging, excessive need to be taken care of, low self-confidence
How would you decribe an obsessive-compulsive?
preoccupation with order, perfectionism and control
How would you describe a Borderline personality?
unstable mood and behavior; impulsive, sense of emptiness
How would you describe a histrionic personality?
excessive emotionally, somatization, attention seeking, sexually provocative
How would you describe an Antisocial?
as having a disregard for and violation of rights of others, criminality
How would you describe an avoidant personality?
sensitive to rejection, socially inhibited, timid, feelings of inadequacy
How would you desribe a Narcissistic personality?
grandiosity; sense of entitlement, many demand \'top\' physician/best health care
If a patient consciously fakes or claims to have a disorder in order to attain a specific gain, how is this behavior described?
Malingering
Illusions are….
misinterpretation of actual external stimuli, ex. Mistaking coat rack for man
In what kind of disorder does a person consciously create symptoms in order to assume a sick role and get medical attention?
Factitious Disorder
Is Heroin prescribable?
NO, it is schedule I (ie. not prescribable)
Is the motivation concious in Munchausen\'s by proxy?
NO
Name the 5 subtypes of schizophrenia.
Disorganized, Catatonic, paranoid, Undifferentiated, Residual
Name the types of Cluster B personalities.
Antisocial, Borederline, Histrionic, Narcissistic
To be a manic episode what characteristic behaviors must be present?
3 or more of the following: Distractibility, Insomnia, Grandiosity, Flight of Ideas, Inc in Activity/pyschomotor agitation, Pressured Speech, Thoughtlessness
Whar are the signs of barbituate withdrawl?
Anxiety, seizures, delirium, life-threatening CV collapse
Whar are the signs of nicotine withdrawl?
Irritablility, headache, anxiety, weight gain, craving, tachycardia
Whare are the 4 A\'s of schizophrenia?
Ambivalence(uncertainty), Autism(self-preoccupation and lack of communication), Affect(blunted), Associations(loose)
Whare are the characteristics of Dementia?
development of mulitple cognitive deficits: memory, apahasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement
Whare are the signs of Benzodiazepine intox?
Amnesia, ataxia, somnolence, minor resp depression
Whare are the signs of caffeine intox?
restlessness, insomina, increased diuresis, muscle twitching, cardiac arrhythmias
Whare are the signs of Marijuana intox?
Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired jugdment, social withdrawl, increased appetite, dry mouth and hallucinations
Whare are the signs of PCP intoxication?
Belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis and delirium
What are 2 opioid comptetitive inhibitors?
Naloxane and Naltrexone
What are some common causes of delirium?
substance use/abuse or medical illness
What are some related diagnoses of Heroin addicts?
Hepatitis, abscesses, OD, hemorrhoids(reason enough to shy away), AIDS, and right-sided endocarditis
What are the 5 characteristics of panic?
Palipitations, Abdominal distress, Nausea, Increased perspiration, Chest pains, chills and choking
What are the 6 somatoform disorders?
conversion, somatoform pain disorder, hypochondriasis, somatization disorder, body dysmorphic disorder, pseudocyesis
What are the characteristics of Delirium?
Decreased attention span and level of arousal, disorganized thinking, hallucinations, illusions, misperceptions, disturbance of sleep-wake cycle, cognitive dysfxn
What are the etiologic factors for schizophrenia?
genetics and environment, genetics outweigh env
What are the maladaptive signs of substance use?
Tolerance, Withdrawl, Substance taken in larger amounts than intended, Persistent desire or attempst to cut down, lots of energy spent trying to obtain substance, withdrawl from responsibility, used continued in spite of knowing the problems that it cause
What are the negative symptoms of schizophrenia?
flat affect, social withdrawl, thought blocking, lack of emotion
What are the Positive symptoms of Schizophrenia?
Hallucinations, delusions, strange behavior and loose associations
What are the signs of alcohol use?
Disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts
What are the signs of alcohole withdrawl?
Tremor, Tachycardia, HTN, malaise, nausea, seizures, delirium tremens, tremulousness, agitation, hallucinations
What are the signs of Amphetamine intoxication?
Psychomotor agitation, impaired judgement, pupillary dilation, HTN, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever
What are the signs of Amphetamine withdrawl?
Post-use crash, including anxiety, lethargy, headache, stomach cramps, hunger, severe depression, dysphoric mood, fatigue, insomnia/hypersomnia
What are the signs of Barbiutate intox?
respiratory depression
What are the signs of benzo withdrawl?
Rebound anxiety, seizures, tremor, insomnia
What are the signs of caffeine withdrawl?
Headache, lethargy, depression, weight gain
What are the signs of cocaine intoxication?
Euphoria, psychomotor agitation, impaired judgment, tachycardia, pupillary dilation, HTN, hallucinations(including tactile:bugs on skin), paranoid ideations, angina, and sudden cardiac death
What are the signs of cocaine withdrawl?
Hypersomnolence, fatigue, depression, malaise, severe craving, suicidality
What are the signs of LSD intoxication?
Marked anxiety and depression, delusions, visual hallucinations and flashbacks
What are the signs of narcotic abstinence syndrome?
dilated pupils, lacrimation, rhinorrhea, sweating, yawning, irritability, and muscle aches
What are the signs of opioid intoxication?
CNS depression, nausea and vomiting, constipation, pupillary constriction, seizures
What are the signs of opioid withdrawl?
Anxiety, insomnia, anorexia, sweating/piloerection(cold turkey), fever, rhinorrhea, nausea, stomach cramps, diarrhea, flu-like symptoms, yawning
What are the signs of PCP withdrawl?
Recurrence of intoxication symptoms due to reabsorption in GI tract, sudden onset of severe, random, homicidal violence
What are the symptoms of DT\'s(in order of appearance)?
ANS Hyperactivity(tachycardia, tremors, and anxiety), Psychotic symptoms(hallucinations, delusions), confusion
What are the symptoms of nicotine intoxication?
Restlessness, insomnia, anxiety, arrhythmias
What are the types of Cluster A personalities?
Paranoid, Schizoid, Schizotypal
What are the types of Cluster C personalities?
Avoidant, Obsessive-Compulsive, Dependent
What are treatment options of phobias?
systematic desensitization
What can be confused with dementia in elderly?
depression
What complication result from ECT?
complications associated with anesthesia and retrograde amnesia
What does exposure to object of phobia evoke?
an anxiety response
What drug is used for long term maintenance of heroin detox?
Methadone
What else is classically associated with Korsakoff\'s?
Confabulations, ie. Making it up as you go along
What is a hallmark sign of heroin addiction?
track marks
What is a Hypomanic Episode?
it is like a manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization; no psychotic features
What is a pain somatoform disorder?
pain that is not explained completely by illness
What is a phobia?
fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or entity
What is a schizoaffective disorder?
a combo of schizophrenia and a mood disorder
What is a somatization disorder?
Varitey of complaints in multiple organ systems
What is Cyclothymic disorder?
milder form of bipolar lasting at least 2 years
What is dementia characterized by?
commonly irreversible memory loss
What is destroyed in Korsakoff\'s Amnesia?
Mamillary bodies(bilaterally)
What is drug of choice for bipolar?
Lithium
What is Dysthymia?
milder form of depression lasting at least 2 years
What is Electroconvulsive Therapy(ECT)?
a tx option for major depressive disorder refractory to other tx. It is painless and produces a seizure with transient memory loss and disorientation.
What is Hypochondriasis?
misinterpretation of normal physical findins, leading to preoccupation with and fear of having a serious medical illness in spite of medical reassurance
What is it called when a parent causes their child to become ill in order to receive attention?
Munchausen\'s by proxy
What is post-traumatic stress disorder?
when a person experienced or witnessed an event that involoved actual or threatened death or serious injury. The traumatic event is reexperienced; person persistently avoids stimuli associated with the trauma and experiences persistent symptoms of increas
What is primary gain?
what the symptom does for the patient\'s internal psychic economy
What is retrograde amnesia a complication of?
ECT-electroconvulsive therapy(shock)
What is secondary gain?
What the symptoms gets the patient(sympathy or attention)
What is tertiary gain?
what the caretaker gets
What is the criterion for dx of substance abuse?
One or more of the following in 1 year: Recurrent use resulting in failure to complete responsiblities, recurrent use in physically hazardous situations, recurrent legal problems, continued use in spite of persistent problems of use
What is the definition of substance abuse?
maladaptive pattern of use leading to clinically significant impairment or distress, symptoms have not met criteria for dependence
What is the difference between delusions and loos associations?
delusion is a disorder in the content of thought(the actual idea) where a loose association is a disorder in the form of thought(the way the idea is tied together)
what is the fear of heights?
acrophobia
what is the fear of marriage?
gamophobia
what is the fear of open places?
agoraphobia
what is the fear of pain?
algophobia
What is the Fifth A?
Auditory hallucinations
What is the inability to remember things that happened before CNS insult?
Retrograde Amnesia
What is the key to delirium diagnosis?
Waxing and waning level of conciousness that develops rapidly
What is the key to dementia diagnosis?
rule out delirium-patient is alert, no change in level of conciousness. More often gradual onset.
What is the lifetime prevalence for Major Depressive Disorder in Males and Females:
13% for males, and 21% for females
What is the lifetime prevalence for schizophrenia?
1.5%-(males/females, blacks/whites) presents earlier in men
What is the most common psych illness on medical and surgical floors?
Delirium, often reversible
What is the order of loss or orientation?
Time, place, and Person
What is the response to the traumatic event?
intense fear, helplessness or horror
What is the trigger for DT\'s?
alcohols withdrawl
What patient population will you see Korsakoff\'s?
Alcoholics
What questions do you have to answer when assessing an patient\'s orientation?
Is the patient aware of him/herself as a person? Does the patient know his/her name?
What syndrome is manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures?
Munchausen\'s
Whate is body dysmorpic disorder?
patient is convinced that part of one\'s own anatomy is malformed
Whate is pseudocyesis?
false belief of being pregnant associated with objective signs of pregnancy
When are the halluinations common?
Visual(acute organic brain syndrom), Auditory(Schizophrenia), Olfactory(aura of psychomotor epilepsy), Gustatory(rare), Tactile(DT\'s and Cocaine abusers), Hypnagogic(while going to sleep), Hypnopmpic(while waking from sleep)
When do DT\'s peak?
2-5 days after last drink
When must a painc disorder be dx?
in the context of the occurrence
Who are more likely to be antisocial, male or female?
male
Who are more likely to be borderline, male or female?
female
Who do you need to see to witness caffeine withdrawl approx every six weeks?
Blake Williams
Define Autonomy.
Obligation to respect pts as individuals and to honor their preferences in medical care
Legally, what does informed consent require?
- discussion of pertinent information- obtaining the patient\'s agreement to the plan of care- freedom from coercion
Pt autonomy vs. beneficence: when does autonomy win out?
If pt makes an informed decision, ultimately, the pt. has the right to decide.
What 3 proofs are required for a sucessful malpractice civil suit for neglegence?
- Dr. breach of duty to patient- pt. suffers harm- breach of duty causes harm Note--beyond reasonable doubt not needed, just more likely than not
What are the 4 exceptions to confidentiality?
- potential harm to others is serious- likelihood of harm is great- no alternative means exist to warn or to protect those at risk- Drs. Can take steps to prevent harm
What are the 4 exceptions to informed consent?
- pt. lacks decision-making capacity (not letally competent)- implied consent in an emergency- therapeutic privelege--withholding information when disclosure would severly harm the pt or undermine informed decision-making capacity- waver--pt. waves
What are the 5 signs of a pt\'s decision-making capacity?
- pt. makes and communicates a choice- pt. is informed- decision remains stable over time- decision consistent w/ pt\'s values and goals- decision not a result of delusions or hallucinations
What are the types of written advance directives?
- LIVING WILLS--pt. directs Dr. to withhold/withdraw life-sustaining tx if the pt develops terminal disease or enters a persisitent vegative state- DURABLE POWER OF ATTORNEY--pt designates a surrohate to make medical decisions in an event pt. loses deci
What is beneficence?
Dr. have special ethical responsibility to act in the pt\'s best interest. Pt. autonomy may conflict with beneficience
What is confidentiality?
Confidentiality respects pt. privacy and autonomy. Disclosure to family and friends should be guided by what pt. would want. Pt can waive right to confidentiality (i.e. to insurance co.)
What is nonmaleficence?
Do no harm. But, if benefits of intervention outweigh risks, pt may make an informed decision to proceed.
What must patients understand in informed consent?
- risks- benefits- alternatives, which includes no intervention
When is an oral directive valid?
Incapacitated patient\'s prior oral statements commonly used as guide, but problems arise from variance in interpretation. if pt was INFORMED, directive is SPECIFIC, pt. MAKES A CHOICE and decision is REPEATED over time, the oral directive is more valid.
At what ages does sexual abuse in children peak?
9 to 12 years of age
At what time (minutes after birth) do you run an APGAR score?
after 1 min. and 5 min., score 0-2 in 5 categories (10 is perfect score)
Define low birth weight
less than 2500g
Irreversible changes of long term deprivation of affection occurs after how long?
6 months
Physical abuse in children leads to how many deaths in the U.S.?
~3000 deaths/yr.
What are evidence of physical abuse in children?
- healed fractures on x-ray- cigarette burns- subdural hematomas- multiple bruises- retinal hemorrhage or detachment
What are evidence of sexual abuse in children?
genital/anal trauma, STDs, UTIs
What are the 5 changes in the elderly?
1. sexual changes: sexual interest does NOT decrease (men: slower erection/ejaculation, longer refractory period; women: vaginal shortening, thinning, dryness) 2. sleep patterns: decreased REM, decreased slow-wave sleep, increased sleep latency, increase
What are the 5 components of the APGAR score at birth?
- A= Apperance (color)- P= Pulse- G= Grimace (reflex irritability)- A= Activity (muscle tone)- R= Respiration
What are the 7 effects of long-term deprivation of affection?
1. Weak 2. Wordless 3. Wanting (socially) 4. Wary (lack trust) 5. Weight loss 6. anaclitic depression 7. physical illness [Hint: 5 W\'s and 2 more]
What are the development milestones at about 3 years old in preschool?
- group play- rides tricycle- copies line or circle drawing
What are the development milestones at about 4 years old in preschool?
- cooperative play- simple drawings (stick figure)- hops on 1 foot
What are the developmental milestones at about 12-14 months old in infancy?
#NAME?
What are the developmental milestones at about 15 months old in infancy?
- walking- few words- separation anxiety
What are the developmental milestones at about 3 months old in an infant?
- holds head up- social smile- Moro reflex disappears
What are the developmental milestones at about 4-5 months old in an infant?
- rolls on back- sits when propped
What are the developmental milestones at about 7-9 months old in infancy?
- stranger anxiety- sits alone- orients to voice
What are the developmental milestones during adolescence?
- abstract reasoning (formal operations)- formation of personality
What are the developmental milestones during the schoolage years (6-11y/o)?
- development of conscience (superego)- same-sex friends- identification with same-sex parent
What are the Kubler-Ross dying stages?
Denial-Anger-Barganing-Grieving-Acceptance, don\'t occur necessarily in this order [Hint: Death Arrives Brining Grave Adjustments]
What are the risks of low birth weight?
assoc. w/ gtr. Incidence of physical and emotional problems. Complications include:- infections- respiratory distress syndrome- necrotizing entercolitis- persistent fetal circulation
What can cause regression to younger behavior in children?
Stress:- physical illness- punishment- birth of new sibling- tiredness
What causes low birth weight?
prematurity or intrauterine growth retardation
What is anaclitic depression?
depression in an infant owing to continued separation from caregiver--can result in failure to thrive. Infant becomes withdrawn and unresponsive
What is grief?
normal bereavement characterized by shock, denial, guilt, and somatic symptoms, Typically lasts 6mo. to 1yr.
What is pathologic grief?
includes excessively intense or prolonged grief or grief that\'s delayed, inhibited, or denied
What is the result of severe long-term deprivation of affection?
death
When can a child parallel play?
Toddler, 24-48 months old
When does a child achieve core gender identity?
Toddler, 24-36 months old
When does a child achieve object permanence?
Toddler, 12-24 months old
When does a child achieve rapprochement?
Toddler, 18-24 months old
When does a child become toilet trained?
Preschool, 30-36 months old
When is adolescence for boys and for girls?
Boys: 13 years old Girls: 11 years old
Who is usually the abuser in physical abuse in children?
female primary caregiver
Who is usually the abuser in sexual abuse in children?
known to victim, usually male
Case-control studies are often?
Retrospective (case control)
Characteristics of a normal statistical distribution?
Gaussian = Bell Shaped ( mean=median=mode )
Country with highest divorce rate
U.S.
Define a bimodal distribution
Peaks on either side of the median
Define a Meta-analysis
Pooling data from several studies to achieve greater statistical power
Define a negative skew
Asymmetry with the tail on the left (mean<median<mode)
Define a positive skew
Asymmetry with the tail on the right (mean>median>mode)
Define Accuracy
The trueness of test measurements
Define Alternate Hypothesis
Hypothesis that there is some difference
Define Coefficient of Determination
r^2 (Correlation coefficient squared)
Define Correlation coefficient (r )
Always between -1 and 1. Absolute value indicates the strength of correlation.
Define Negative Predictive Value
Number of true negatives / number that tested neg. for disease
Define Positive Predictive Value
Number of true positives / number that tested pos. for disease or the prob. Of having a condition, given a pos. test
Define Precision
The consistency of a test (reliability), absence of random error
Define Primary Disease Prevention
Prevent occurrence, e.g., vaccination
Define Relative Risk
Disease risk in exposed group / disease risk in unexposed group; a/a+b / c/c+d
Define Reliability
Reproducibility of a test; repeat measurements are the same
Define Secondary Disease Prevention
Early detection of disease, e.g., Pap smear
Define SEM
Standard Error of the Mean; standard deviation / square root of n (sample size)
Define sensitivity
Number of true positives / all people with disease
Define specificity
Number of true negatives / number of all people w/o the disease
Define Tertiary Disease Prevention
Reduce disability form disease, e.g. insulin for diabetics
Define the Power of a study
Probability of rejecting a null hypothesis when it is false
Define Validity
Whether a test truly measures what it purports to measure; the appropriateness of a test
Do divorcees remarry frequently?
Yes
How do disease prevalence and positive predictive value relate?
Higher prevalence = Higher Positive Predictive Value
How do prevalence and incidence relate to disease length?
P>I for chronic diseases; P=I for acute diseases
How do SEM and Standard Deviation relate?
SD > SEM; as n increases, SEM decreases
How do you measure the \'power\' of a study or the probability that the study will see a difference if one exists?
1-beta
How does alpha relate to the Type I error?
It is the probability of making a Type I error, is equal to p (p is usually <.05)
How does beta relate to the Type II error?
Beta is the probability of making a Type II error
How many people >65
35,000,000 (approx. 13%)
If the 95% confidence interval for OR of RR includes 1, what does this mean?
That the study is inconclusive
In what age group will the greatest population increase be seen in?
Those >85
Increasing sample size will affect the Power of a study how?
By increasing the Power
Is divorce related to industrialization?
No
Is HIV positivity a reportable disease?
No
Marriages at high risk
Teenage marriages, Mixed religions, Low socio-economic status
Memory aid for Medicare/Medicaid
MedicarE=Elderly; MedicaiD=Destitute
Preventive services needed for Alcoholism
Influenza, pneumococcal immunizations; TB test
Preventive services needed for Diabetes
Eye, foot exams; Urine test
Preventive services needed for Drug Abuse
HIV, TB tests; hepatitis immunization
Preventive services needed for High-risk sexual behavior
HIV, Hep B, syphilis, gonorrhea, chlamydia tests
Preventive services needed for Homeless, Refugee, or Immigrant
TB test
Preventive services needed for Obesity
Blood glucose test
Random error yields poor?
Precision
Relative Risk is used for what kind of study?
Cohort
Systematic error yields poor?
Accuracy
U.S. population in 2000
300000000
Unlike specificity and sensitivity, what are predictive values dependent on?
Prevalence of disease in the population
What are risk factors for suicide?
White, male, alone, prior attempts, presence and lethality of plan, medical illness, alcohol or drug use, on 3 or more prescription meds.
What are the leading causes of death in AGE 1-14?
Injuries, cancer, congenital anomalies, homicide, heart disease
What are the leading causes of death in AGE 15-24?
Injuries, homicide, suicide, cancer, heart disease
What are the leading causes of death in AGE 25-64?
Cancer, heart disease, injuries, stroke, suicide
What are the leading causes of death in AGE 65+?
Heart disease, cancer, stroke, COPD, pneumonia
What are the leading causes of death in INFANTS?
Congenital anomalies, SIDS, short gestation, respiratory distress syndrome, maternal complications during pregnancy
What are the most common surgeries?
Dilation and curettage, hysterectomy, tonsillectomy, sterilization, hernia repair, oophorectomy, cesarean section, cholecystectomy
What are the reportable diseases?
AIDS, chickenpox, gonorrhea, hepatitis A and B, measles, mumps, rubella, salmonella, shigella, syphilis, and tuberculosis
What does a t-test check?
The difference between two means (Mr. T is mean)
What does an ANOVA analyze?
Variance of 3 or more variables (Analysis of Variance)
What does SAD PERSONS represent?
Sex (male), Age, Depression, Previous attempt, Ethanol, Rational thought, Sickness, Organized plan, No spouse, Social support lacking
What factors influence the Power of a study?
1)The total # of endpoints experienced by a population; 2) Difference in compliance between treatment groups
What is a case-control study?
Observational study. Sample chosen based on presence or absence of disease. Info collected about risk factors.
What is a Clinical trial?
Experimental study. Compares benefit of 2 or more treatments.
What is a Cohort study?
Observational study. Sample chosen based on presence or absence of Risk Factors. Subjects followed over time for disease development. (Framingham study)
What is a memory key for suicide risk factors?
SAD PERSONS
What is a Null Hypothesis?
Hypothesis of no difference, e.g., no assoc. between disease and risk factor
What is a pitfall of Meta-analysis?
Cannot overcome limitations of individual studies or bias in study selection
What is a Type I error (alpha)?
Stating that an effect of difference exists when one really does not
What is a Type II error (beta)
Stating that there is not an effect or difference when actually there is
What is an Odds Ratio used for?
Approximates relative risk when prevalence is not too high; OR = ad/bc
What is Chi-Square test used for?
To check differences between 2 or more percentages or proportions of categorical outcomes
What is desirable for confirmatory tests?
High specificity
What is desirable for screening tests?
High sensitivity is desirable for a screening test
What is incidence?
Number of new cases in a population per unit time
What is Medicaid?
Fed. And State assistance for those on welfare or who are indigent
What is Medicare Part A?
Hospital related
What is Medicare Part B?
Supplemental
What is Medicare?
Fed. Program for the Elderly
What is prevalence?
Total number of cases in a population at a given time (incidence x disease duration)
What is the False Negative Ratio?
1-sensitivity
What is the False Positive Ratio?
1-specificity
What is the highest quality study?
Clinical Trial
What is the p value?
The probability of making a Type I error.
What percent of medical costs will those >35 incur?
0.3
What type of studies are Odds Ratios used for?
Retrospective (case control)
When do divorces peak?
During the 2nd to 3rd year.
Which sex has the most surgeries?
Females
Are intelligence tests objective or projective tests?
Objective
Define acting out.
Unacceptable feelings and thoughts are expressed through actions
Define altruism.
Guilty feelings alleviated by unsolicited generosity toward others
Define classical conditioning.
Learning in which a natural response is elicited by a conditioned stimulus that previously was presented in conjunction with an unconditioned stimulus
Define denial.
Avoidance of awareness of some painful reality
Define displacement.
Process whereby avoided ideas and feelings are transferred to some neutral person or object
Define dissociation.
Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
Define ego defenses.
automatic and unconscious reactions to phychological stress
Define fixation.
Partially remaining at a more childish level of development
Define humor.
Appreciating the amusing nature of an anxiety-provoking or adverse situation
Define identification.
Modeling behavior after another person
Define isolation.
Separation of feelings from ideas and events
Define operant conditioning.
Learning in which a particular action is elicited because it produces a reward
Define projection.
An unacceptable internal impulse that is attributed to an external source
Define rationalization.
Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame
Define reaction formation.
Process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite
Define regression.
Turning back the maturational clock and going back to earlier modes of dealing with the world
Define repression.
Involuntary withholding of an idea or feeling from conscious awareness.
Define sublimation.
Process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one\'s value system.
Define suppression.
Voluntary (unlike other defenses) withholding of an idea of feeling from conscious awareness
Give an example of classical conditioning.
Pavlov\'s dogs (ringing of a bell provoked salivation in dogs)
Give an example of continuous reinforcement schedule.
A person gets upset when a vending machine doesn\'t work
Give an example of negative reinforcement of opperative conditioining.
a mouse presses a button to avoid shock (do not confuse with punishment)
Give an example of positive reinforcement of opperative conditioning.
a mouse presses a button to get food
Give an example of preconscious topography.
remembering your phone number
Give an example of variable ratio reinforcement schedules.
A person continuing to play a slot machine at a casino
Is IQ testing more highly correlated with genetics or school achievement?
School achievement
Name 4 characteristics of psychoanalysis.
-costly-lengthy-intensive-places great demands on the patient
What are Freud\'s three structures of the mind
-Id-Superego-Ego
What are the four factors in hopelessness?
-Sense of Impotence (powerlessness)-Sense of Guilt-Sense of Anger-Sense of loss/Deprivation leading to depression (Mnemonic IGAD!)
What are the immature ego defenses? (12)
Acting out, Disassociation, Denial, Displacement, Fixation, Identification, Isolation, Projection, Rationalization, Reaction formation, Regression, Repression
What are the MATURE ego defenses? (4)
-Sublimation-Altruism-Suppression-Humor (Mneumonic: Mature women wear a SASH)
What are the two most famous forms of intelligence testing?
Stanford-Binet and Wechsler
What are two factors with which IQ scores are correlated?
Genetics and school achievement
What is an example of acting out?
Temper tantrums
What is an example of altruism?
Mafia boss makes large donation to charity
What is an example of denial.
A common reaction in newly diagnosed AIDS and cancer patients
What is an example of displacement?
Mother yells at child because she is angry at her husband
What is an example of dissociation?
Extreme forms can result in multiple personalities (dissociative identity disorder).
What is an example of fixation?
Men fixating on sports games
What is an example of humor?
Nervous medical student jokes about the boards
What is an example of identification?
Abused child becomes an abuser
What is an example of isolation?
Describing murder in graphic detail with no emotional response
What is an example of projection?
A man who wants another woman thinks his wife is cheating on him
What is an example of rationalization?
Saying the job was not important anyway, after getting fired
What is an example of reaction formation?
A patient with libidinous thoughts enters a monastery
What is an example of regression?
Seen in children under stress (eg., bedwetting) and in patients on dialysis (eg., crying)
What is an example of sublimation?
Aggressive impulses used to succeed in business ventures
What is an example of suppression?
Choosing not to think about the USMLE until the week of the exam
What is negative reinforcement?
the removal of an aversive stimulus so as to increase behavior
What is positive reinforcement?
the desired reward which produces an action
What is the basic mechanism underlying all ego defenses?
Repression
What is the central goal of Freudian psychoanalysis?
To make the patient aware of what is hidden in his/her unconscious
What is the IQ criteria for diagnosis of mental retardation?
IQ lower than 70 (or 2 standard deviations below the mean)
What is the topographical term used in psychoanalysis to describe what you are not aware of?
Unconscious
What is the topographical term used in psychoanalysis used to describe what you are able to make conscious with effort?
Preconscious
What is the topographical term used in psychoanalysis used to describe what you are aware of?
Conscious
What number is defined as the mean for standard IQ testing?
100 (with a standard deviation of 15)
What term fist described by Freud is used to refer to repressed sexual feelings of a child for the opposite-sex parent, accompanied by rivalry with same-sex parent?
Oedipus complex
What term is used to describe the form of insight therapy developed by Freud which is often used for changing chronic personality problems?
Psychoanalysis
What thought structures is the Ego responsible for?
Bridge and mediator between the unconscious mind and the world (Think-Deals with conflict)
What thought structures is the Id responsible for? (3 things)
- Primal urges-sex-agression (Think-\'I want it\')
What thought structures is the Superego responsible for? (2 things)
- Moral values-conscience (Think-\'You know you cant have it\')
What type of behavior requires a continuous reinforcement schedule?
behavior which shows the most rapid extinction when not rewarded
What type of behavior requires a variable ratio reinforcement schedule?
behavior which shows the slowest extinction when not rewarded
Which is the conditioned (learned) stimulus in Pavlov\'s experiment?
ringing bell
Which is the natural response in Pavlov\'s experiment?
salivation
Which is the unconditioned stimulus in Pavlov\'s experiment?
food
At what concentration is the transport mechanism for glucose saturated?
300 mg/dL
Define effective renal plasma flow.
ERPF = U (PAH) x V/P (PAH) = C (PAH)
Define filtration fraction.
FF = GFR/ RPF
Define free water clearance.
C(H2O) = V- C(osm)
Define GFR.
GFR = U(inulin) x V/P (inulin) = C (inulin) GFR also equals the difference in (osmotic pressure of the glomerular capillary minus Bowman\'s space) and (hydrostatic pressure of the glomerular capsule minus Bowman\'s space).
Define renal blood flow.
RBF = RPF/1 - Hct
Define renal clearance.
Cx = UxV/Px The volume of plasma from which the substance is cleared completely per unit time.
Define urine flow rate.
V = urine flow rate C (osm) = U(osm)V/P(osm)
How are amino acids cleared in the kidney?
Reabsorption occurs by at least 3 distinct carrier systems, with competitive inhibition within each group.
How do NSAIDs cause renal failure?
By inhibiting the production of prostaglandins which normally keep the afferent arterioles vasodilated to maintain GFR
How high can the osmolarity of the medulla reach?
1200-1400 mOsm
How is ICF measured?
ICF = TBW - ECF
How is interstitial volume measured?
Interstitial volume = ECF - PV
How is PAH secreted?
Via secondary active transport
How is PAH transport mediated?
Mediated by a carrier system for organic acids
How much of the ECF is interstitial fluid?
Three-fourths
How much of the ECF is plasma?
One-fourth
How much of the total body water is part of intracellular fluid?
Two-thirds
How much of the total body water is part of the extracellular fluid?
One-third
If clearance of substance X is equal to GFR, what occurs?
There is no net secretion or reabsorption
If clearance of substance X is greater than GFR, what occurs?
Net tubular secretion of X
If clearance of substance X is less than GFR, what occurs?
Net tubular reabsorption of X
T/F. Secondary active transport of amino acids is saturable.
TRUE
What 3 layers form the glomerular filtration barrier?
1. Fenestrated capillary endothelium 2. Fused basement membrane with heparan sulfate 3. Epithelial layer consisting of podocyte foot processes
What actions does ADH have on the kidney?
-Increase water permeability of principle cells in collecting ducts -Increase urea absorption in CD -Increase Na/K/2Cl transporter in the thick ascending limb
What actions does AII have on the kidney?
-Contraction of efferent arteriole increasing GFR -Increased Na and HCO3 reabsorption in proximal tubule
What actions does aldo have on the kidneys?
-Increased Na reabsorption in distal tubule -Increased K secretion in DT -Increased H ion secretion in DT
What actions does ANP have on the kidney?
-Decreased Na reabsorption -Increased GFR
What actions does PTH have on the kideny?
-Increased Ca reabsorption -Decreased phosphate reabsorption -Increase 1,25-(OH)2 Vit D production
What activates 1 alpha-hydroxylase?
PTH
What are the 4 actions of angiotensin II?
1. Vasoconstriction 2. Release of aldo from adrenal cortex 3. Release of ADH from posterior pituitary 4. Stimulates hypothalamus to increase thirst
What are the 4 endocrine functions of the kidney?
1. EPO release 2. Vitamin D conversion 3. Renin release 4. Prostaglandins release
What are the consequences of a loss in the charge barrier?
-Albuminuria -Hypoproteinemia -Generalized edema -Hyperlipidemia
What competitively inhibits the carrier system for PAH?
Probenecid
What constricts the efferent arteriole?
Angiotensin II
What dilates the renal afferent arteriole?
Prostaglandins
What do the collecting ducts reabsorb in exchange for K or H?
Na ions
What does renin do?
Cleave angiotensinogen into angiotensin I
What does the anterior pituitary secrete?
-FSH and LH -ACTH -GH -TSH -MSH -Prolactin
What does the beta subunit do?
The beta subunit determines hormone specificity
What does the early distal convoluted tubule actively reabsorb?
-Na ions -Cl ions
What does the posterior pituitary secrete?
ADH and oxytocin
What does the secretion of prostaglandins from the kidney do?
Vasodilates the afferent arterioles to increase GFR
What does the thick ascending loop of Henle actively reabsorb?
-Na ions -K ions -Cl ions
What does the thick descending loop of Henle indirectly reabsorb?
-Mg ion -Ca ions
What effect does constriction of the efferent arteriole have?
-Decreased RPF -Increased GFR -FF increases
What effect does dilation of the afferent arteriole have?
-Increased RPF -Increased GFR - FF remains constant
What enzyme converts 25-OH Vit D to 1,25-(OH)2 Vit D?
1alpha-hydroxylase
What happens to glucose in the kidneys when glucose is at a normal level?
Glucose is completely reabsorbed in the proximal tubule.
What hormones act on the kidney?
1. ADH 2. Aldosterone 3. Angiotensin II 4. Atrial natriurtic Peptide 5. PTH
What inhibits constriction of the efferent arteriole by AII?
ACE inhibitors
What inhibits dilation of the afferent arteriole by prostaglandins?
NSAIDS
What is an important clinical clue to diabetes?
Glucosuria
What is angiotensin II\'s overall function?
To increase intravascular volume and increase blood pressure
What is passively reabsorbed in the thin descending loop of Henle?
Water via medullary hypertonicity (impermeable to sodium)
What is reabsorbed in the early distal tubule under the control of PTH?
Ca ions
What is the function of the early proximal convoluted tubule?
Reabsorbs all of the glucose and amino acids and most of the bicarbonate, sodium, and water
What is the oncotic pressure of Bowman\'s space?
Zero
What is the thick ascending loop of Henle impermeable to?
Water
What is the threshold for glucose reabsorption in the proximal tubule?
200 mg/dL
What may act as a \'check\' on the renin-angiotensin system in heart failure?
ANP
What part of the nephron secretes ammonia?
Early proximal convoluted tubule
What part of the pituitary is derived from neuroectoderm?
Posterior pituitary
What percentage of the body is water?
0.6
What regulates the reabsorption of water in the collecting ducts?
ADH
What secretes renin?
JG cells
What stimulates ADH secretion?
-Increased plasma osmolarity -Greatly decreased blood volume
What stimulates aldosterone secretion?
-Decreased blood volume (via AII) -Increased plasma K concentration
What stimulates angiotensin secretion?
Decreased blood volume (via renin)
What stimulates ANP secretion?
Increased atrial pressure
What stimulates EPO release?
Hypoxia
What stimulates PTH secretion?
Decreased plasma ca concentration
What stimulates renin release?
1. Decreased renal arterial pressure 2. Increased renal nerve discharge (Beta 1 effect)
What subunit do TSH, LH, FSH and hCG have in common?
Alpha subunit
What symptom is present once threshold is reached?
Glucosuria
What type of tissue is the anterior pituitary derived from?
Oral ectoderm
What value is used clinically to represent GFR?
Creatinine clearance
What variables are needed to calculate free water clearance?
-Urine flow rate -Urine osmolarity -Plasma Osmolarity
Where does ACE convert AI to AII?
Primarily the lung capillaries
Where does secondary active transport of amino acids occur?
In the proximal tubule
Where is EPO secreted?
Endothelial cells of the peritubular capillaries (kidney)
Where is paraaminohippuric acid secreted?
Proximal tubule
Which barrier is lost in nephrotic syndrome?
Charge barrier
Which layer filters by negative charge?
Fused basement membrane
Which layer filters by size?
Fenestrated capillary endothelium
Why does the nephron secrete ammonia?
Acts As a buffer for secreted H ions
Why is inulin sued to measure GFR?
Because it is freely filtered and is neither absorbed or secreted
Why is PAH used to calculate RPF?
PAH is secreted and filtered.
A 21-Beta-hydroxylase deficiency will result in what hormone deficiencies/excesses?
Decreased cortisol and mineralocorticoids (hypotension, hyperkalemia) Increased sex hormones (masculinization)
A deficiency of 17-alpha hydroxylase will result in an decrease in what hormone(s)?
Decreased sex hormones and cortisol
A deficiency of 17-alpha hydroxylase will result in an increase in what hormone(s)?
Aldosterone Produces hypertension, hypokalemia
A dopaminergic antagonist would be expected to have what effect prolactin secretion?
Stimulates prolactin secretion
A maturing graafian follicule can be found at what stage of the menstrual cycle?
During the proliferative phase (Around Day 7)
Angiotensin II has what effect on the adrenal cortex?
Stimulates aldosterone production by enhancing the activity of aldosterone synthase
Calcitonin\'s actions (synergize/oppose) the actions of PTH.
Oppose. Calcitonin acts faster than PTH to decrease serum Ca2+ levels.
Decreased cortisol levels as in any of the congenital adrenal hyperplasias will have what effect on ACTH?
ACTH levels will be increased contributing to increased skin pigmentation
Decreased phosphate will have what effect on Vit D?
Increased activated Vit D.
During the 2nd and 3rd trimester, one would expect the corpus luteum to be?
Degenerated. Shortly after the first trimester, the placenta makes estriol and progesterone.
Estradiol is converted from what precursor by what enzyme?
Aromatase converts Testosterone to Estradiol.
Estrogen is produced in what 4 locations in the body?
Corpus luteum, placenta, adrenal cortex, and testes
Estrogen levels are low/med/high during the just before the peak of the LH surge?
High. Estrogen switches to positive feedback of LH from negative so both increase.
Estrogens have what effect of LH secretion?
Complex effects. Early on estrogen has a negative effect that switches to positve just before the LH surge.
Estrogens have what effect of the follicle?
Estrogens stimulate growth of the follicle
Failure of brain maturation due to lack of thyroid hormone is known as?
Cretinism
Finasteride inhibits what step in testosterone metabolism?
Converstion of testosterone to DHT by 5-alpha reductase
Follicular growth is fastest during what part of the menstrual cycle?
During the second week od the proliferative phase (Days 7-14)
FSH stimulates what cells in the male?
Sertoli cells (spermatogenesis)
Hypocalcemia will have what effect on Vit D metabolism?
Decreased Ca2+ will increase PTH which will stimulate the kidney to produce more activated Vit D.
In addition to peripheral conversion, DHT is also produced in the?
Prostate
In what organ is Vitamin D3 produced?
The skin. Vit D requires sun exposure (UV light and heat)
Is testosterone considered to be anabolic or catabolic overall?
Anabolic
LH levels would be low/med/high at the time of ovulation (Day 14)
Low. The LH surge has already declined
LH stimulates what cells in the male?
Leydig cells (testosterone synthesis)
Name the two primary insulin independent organs?
Brain and RBC\'s take up glucose independent of insulin
Order the following with the most potent first: testosterone, androstenedione. DHT
DHT &gt; testosterone &gt; androstenedione
Order the following with the most potent first: estrone, estradiol, estriol.
Estradiol &gt; estrone &gt; estriol
Phosphate reabsortion in the kidneys is inhibited by what hormone?
PTH
Progesterone has what effect on body temperature?
Increases body temperature
Progestorone is used in combination with estrogen for what reason?
To decrease the risk of endometrial cancer associated with unopposed estrogen therapy
Prolactin has what effect on ovulation?
Prolactin inhibits ovulation by inhibiting the release/synthess of GnRH from the hypothalamus
PTH causes increased calcium reabsorption in what part of the kidney?
DCT
PTH is produced by what cell type?
Chief cells of the parathyroid glands
Sertoli cells stimulate spermatogenesis by producing what 2 factors in response to FSH?
Androgen-binding protein (ABP) - concentrates testosterone in the seminiferous tubules Inhibin - inhibits FSH secretion fro the ant pit
T/F - Glycolisis is promoted by the thyroid hormones
False. Thyroid hormones increase blood glucose levels by stimulating glycolgenolysis and gluconeogenesis.
T/F - PTH stimulates both osteoclasts and osteoblasts?
TRUE
T/F - Testosterone is the most active androgen in males and females?
False. 5-alpha reductase activates testosterone to DHT which is the most active androgen.
Testosterone acts as a negative inhibitor on what hormone from the brain?
GnRH
Testosterone is synthesized in what two locations?
Testis Adrenal Cortex
The hormone with the highest concentration during the secretory phase is?
Progesterone
The key inhibitor of prolactin release is?
Dopamine secreted from the hypothalamus Bromocriptine (Dopamine agonist has the same effect)
The parathyroid glands come from what embryonic structures?
The 3rd and 4th pharyngeal pouches
The primary estrogen produced by the ovary is?
Estradiol
The primary estrogen produced by the placenta is?
Estriol
Thick mucous production is the result of what sex hormone?
Progesterone Decreases sperm entry into the uterus
Throid Stimulating Immunoglobulin results in what disease?
Graves Disease (hyperthroidism)
Thyroid hormones acts synergistically with what hormone with respect to bone growth?
GH
TRH is produced in what region of the brain?
Hypothalamus
TSH levels in a hypothroid patient would be? Free T4?
Elevated TSH Decreased free T4
Unlike estrogen, what effect does progesterone have on the myometrium?
Progesterone decreases myometrial excitability to help maintain the pregnancy/facilitate fertilization
Vit D deficiency in kids cause what disease? Adults?
Rickets in kids Osteomalacia in adults
What 2 conditions other than pregnancy increase hCG?
Hydatidiform moles in women or choriocarcinoma
What adrenergic effects do the thyroid hormones have?
Beta-adrenergic effects
What are the symptoms of menopause?
HAVOC H = Hot flashes A V = Atrophy of the Vagina O = Osteoporosis C = Coronary Artery Disease
What cells produce calcitonin?
Parafollicular cells (C cells) of the thyroid
What does an elevated progesterone level indicate?
Ovulation
What effect do androgens have on growth of long bones.
During puberty, testosterone stimulates bone growth but eventually causes closure of the ephyseal plates
What effect do estrogens have on the endometrium? Myometrium?
Stimulate endometrial proliferation Increase myometrial excitability
What effect do estrogens have on the liver?
Increase hepatic synthesis of transport proteins
What effect do the thyroid hormones have on cardiac output? Heart rate? Contractility? Stroke Volume? Respiratory Rate?
Thyroid hormones increase: CO HR SV contractility and RR
What effect does Ca2+ have on bone?
Stimulates bone resorption of calcium.
What effect does progesterone have on FSH? On LH?
Progesterone is inhibitory to both gonadotrophins
What effect does progesterone have on the endometrium?
Progesterone stimulates the endometrial glands to become secretory and increases spiral artery development
What effect does PTH have on bone?
Increases bone resorption of Ca2+ and phosphate
What effect does thyroid hormone have on lipolysis?
Lipolysis is stimulated
What effect will low serum phosphate have the kidney?
The kidney will produce more 1-25-OH2 Vit D which will increase phosphate release from bone matrix and increase Ca2+ and phosphate absorption in the GIT
What enzyme deficiency will produce BOTH hypertension and masculinization of females?
11-Beta hydroxylase deficiency 11-deoxycorticosterone will act as a mineralocorticoid
What enzyme in the kidney is stimulated that affects vitamin D metabolism?
PTH stimulates 1-alpha-hydroxylase cause increased production of 1,25-(OH)2 vitamin D.
What happens to the corpus lutem if progesterone levels fall without fertilization?
The corpus luteum regresses and menstration occurs
What happens to the corpus lutem if progesterone levels with fertilization?
The corpus luteum is maintained by hCG acting like LH which maintains both estrogen and progesterone levels.
What hormonal changes are seen with untreated menopause with respect to estrogen, FSH, LH, GnRH?
Decreased estrogen Increased FSH (Greatly) Increased LH (No surge) Increased GnRH
What hormone predominates during the secretory phase of the menstrual cycle?
Progesterone
What is the key regulator of PTH secretion?
Decrease in free serum Ca2+ increases PTH secretion. Increased Ca2+ feedback inhibits PTH secretion.
What is the key regulator that increases Calcitonin secretion?
Increased serum Ca2+
What is the most common cause of congenital adrenal hyperplasia?
21-Beta hydroxylase deficiency
What is the physiologic source of hCG?
The syncytiotrophoblasts of the placenta
What is the primary organ that converts Vit D to 25-OH Vit D?
Liver
What is the primary source of androstenedione?
Adrenal glands
What is the role of calcitonin in normal calcium homeostasis?
Probably not important as PTH is the primary regulator of calcium homeostasis.
What is the VERY first molecule in the pathway for the synthesis of Aldosterone? Cortisol? Adrenal androgens?
Cholesterol
What is thought to be the cause of menopause?
Cessation of estrogen production due to decline in the number of follicles
What overall effects does PTH have on body electolytes?
PTH increases serum Ca 2+, decreases serum phosphates, increases urine phosphates
What signal from the body decreases TRH secretion?
Thyroid hormones, T3
What substance is used by the brain for energy during starvation?
Ketone bodies
What will the levels of Ca2+, phosphate, and alkaline phosphatase be in hyperparathyroidism?
Increased Ca2+, decreased phosphate, increased alkaline phosphatase
What will the levels of Ca2+, phosphate, and alkaline phosphatase be in osteoporosis?
No changes in Ca2+, phosphate, or alkaline phosphatase
What will the levels of Ca2+, phosphate, and alkaline phosphatase be in Paget\'s disease of bone?
Alkaline phosphatase increased with normal Ca2+ and phosphate
What will the levels of Ca2+, phosphate, and alkaline phosphatase be in renal insufficiency?
Decreased Ca2+, increased phosphate, and alkaline phosphates WNL
What will the levels of Ca2+, phosphate, and alkaline phosphatase be in Vit D intoxication?
Increased Ca2+ and phosphate with alkaline phosphatase WNL
Which ducts (Mullerian or Wolfian) are promoted by androgens?
Wolfian ducts are differentiated into the internal gonadal structures.
Why is hCG so useful for detecting pregnancy?
It is detectable in the blood and urine 8 days after successful fertilization.
Why is hormone replacement therapy used in postmenopausal women?
Decrease hot flashes and decrease bone loss. Decreased risk of heart disease could be on the boards but is no longer true (2001).
Will most steroids in the blood be bound or unbound?
Bound to specific binding globulins Steroids are lipophilic
You would expect the body temperature of a patient with hyperthroidism to be?
Elevated Thyroid hormone increases Na/K ATPase activity =&gt; increased consumption of O2 =&gt; increased temp
A decrease in PA O2 will have what effect on the pulmonary vasculature?
Causes hypoxic vasoconstriction that shifts blood awayfrom poorly ventilated regions
A value of infinity for V/Q indicates?
Blood flow obstruction
A ZERO value for V/Q indicates?
Airway obstruction
Bicarbonate in the RBC is transported out of the cell in exchange for what ion?
Cl- by a HCO3-/Cl- antiport
Cor pulmonale is the result of?
Pulmonary hypertension
Cor pulmonale will lead to what condition of the heart?
Right ventricular failure (jugular venous distention, edema, hepatomegaly)
Dissociation of CO2 from Hb upon oxygenation in the lungs is known as?
The Haldane effect
Exercise (increased cardiac output) will have what effect on V/Q to the apex?
The V/Q will approach 1 (from 3) as a result of dilation of vessels in the apex.
In the apex of the lung, V/Q should be &gt;1, =1, or &lt;1?
V/Q &gt; 1. NL = 3 which indicates wasted ventilation.
In the base of the lung, V/Q should be &gt;1, =1, or &lt;1?
V/Q &lt; 1. NL = 0.6 which indicates wasted perfusion.
In the perpheral tissue what factor helps unload oxygen by shifting the curve to the right?
Increased H+ (decreased pH) a.k.a. the Bohr effect
Increased 2,3-DPG will cause a shift in what direction of the oxygen-Hb dissociation curve?
The curve will shift RIGHT. This allows Hb to release more oxygen
Increased erythropoietin levels as a response to high altitudes will have what affect on the blood?
Increase hematocrit and Hb
Neonatal respiratory distress syndrome is due to a deficiency of what?
Surfactant (dipalmitoyl phosphatidylcholine, lecithin)
Perfusion is greatest in what part of the lung?
Both ventilation and perfusion are greater at the base than at the apex.
Recurrent TB grows best in what part of the lung? Why?
Apex because of high O2.
Surfactant role in the lungs is to do what?
Decrease alceolar surface tension
T/F - The pulmorary circulation is a high resistance, low compliance system.
F. It has low resistance and high compliance.
The conversion of CO2 to H2CO3 (Carbonic acid) is catalyzed by what RBC enzyme?
Carbonic Anhydrase
The kidneys would do what to compensate for respiratory alkalosis as a response to high altitude?
Excrete bicarbonate
The predominant form of CO2 transport from the tissues to the lungs is?
HCO3- (bicarbonate) accounts for 90%, followed by Hb bound CO2 (5%) and dissolved CO2 (5%)
TV+IRV+ERV = ? TV = tidal volume, IRV = inspirartory reserve volume, ERV = expiratory reserve volume
Vital capacity. VC is everything but the residual volume.
Ventilation is greatest in what part of the lung?
Both ventilation and perfusion are greater at the base than at the apex.
What 6 factors decrease O2 affinity to Hb/decrease P50? What direction does the O2-Hb dissociation curve shift?
Decrease metabolic needs, dcr PCO2, dcr temperature, increased pH, dcr 2,3-DPG, and Fetal Hb The curve shifts LEFT.
What are some potential side effects of ACE inhibitors?
Cough and angioedema due to decreased bradykinin
What cellular change could you expect as a response to high altitude?
Increased mitochondria
What enzyme in the lungs is a key enzyme in the renin-angiotensin system?
Angiotensin-converting enzyme (ACE) which converts Ang I to Ang II
What is expiratory reserve volume?
Air that can still be breathed out after normal expiration
What is FRC? How is it calculated?
FRC is the flume in the lungs after normal respiration and is the sum of RV +ERV.
What is inspiratory reserve volume?
Air in excess of the tidal volume that moves into the lungs with maximum inspiration
What is residual volume?
Air in the lung at maximal expiration
What is the bodies acute reponse to a change from low to high altitude?
Increase in ventilation
What is the difference between capacites and volumes in the lung?
Capacities are the sum of &gt;= 2 volumes.
What is the Total Lung Capacity? Normal Value?
IRV + TV + ERV + RV or VC + RV Normal would be ~ 6.0 L
What is tidal volume? What is a normal TV value?
Air that moves into the lung with each quiet expiration. 500 mL is normal
What would be the effect on the heart due to chronic hypoxic pulmonary vasoconstriction (High altitude)?
Right ventricular hypertrophy
Would you expect acidosis or alkalosis due as a response to high altitude? Metabolic or Respiratory?
Respiratory alakalosis
Exocrine secretion of zymogens by secretory acini is stimulated by what?
-Acetylcholine -CCK
Five effects of Parasympathetic GI Innervation:
1. Increase production of saliva 2. Increase gastric H+ secretion 3. Increases pancreatic enzyme and HCO3- secretion 4. Stimulates evteric nervous system to creat intestinal peristalsis 5. Relaxes sphincters
Five main components of gastric secretions and their sources?
-Mucus (Mucous cell) -Intrinsic factor (Parietal cell) -H+ (Parietal cell) -Pepsinogen (Chief cell) -Gastrin (G cell in antrum and duodenum)
Four categories of drugs that inhibit/decrease secretion of gastric acid:
1. Proton pump inhibitors (omeprazole) 2. H2 receptor antagonists (Rantidine, Cimetidine, Famotidine) 3. Anticholinergics 4. Prostaglandin receptor antagonists (Misoprostol)
Four effects of Sympathetic GI Innervation:
1. Increase production of saliva 2. Decreases splanchnic blood flow in fight-or-flight response 3. Decreases motility 4. Constricts Sphincters
Four functions of H+ secreted in the stomach?
-Kills bacteria -Breaks down food -Lowers pH to optimal range for pepsin function (conversion of pepsinoget) -Sterilizes chyme
Four functions of Samatostatin?
1. Inhibits Gastric acid and pepsinogen secretion 2. Inhibits pancreatic and small intestine fluid secretion 3. Gallbladder contraction 4. Release of both insulin and glucagon
From what cells is bile secreted?
hepatocytes
Function of Gastrin secreted in the stomach?
Stimulates secretion of HCl, IF, and pepsinogen (also stimulates gastric motility)
Function of Intrinsic factor secreted in the stomach?
Binding protein required for vitamin B12 absorption (in terminal ileum)
How do you treat Pancreatic Insufficiency?
-Limit fat intake -Monitor for signs of fat-soluble vitamin (A,D,E,K) deficiency
How does jaundice manifest in the body?
yellow skin and sclerae
How much urobilinogen is secreted per day?
4mg
In what form is bilirubin secreted by the kidney?
urobilirubin
In what form is bilirubin secreted in the feces?
stercobilin
Name as many Pancreatic enzymes as you can:
-alpha-amylase -lipase -phospholipase A -colipase -proteases (trypsin, chymotrypsin, elastase, carboxypeptidases) -trypsinogen (trypsin)
Name the major product of heme metabolism that is actively taken up ty hepatocytes:
Bilirubin
Name the organ and enzyme family involved in the production of bilirubin?
Nonerythroid enzymes in the liver
Name the three salivary secretory glands:
-Parotic -Submandibular -Sublingual
Name two potent stimulators of Gastrin:
1. Phenylalanine 2. Tryptophan
Secretin\'s nickname?
Nature\'s antacid
SEE PICTURE ON LAST PAGE OF GI PHYSIOLOGY!!!
SEE PICTURE ON LAST PAGE OF GI PHYSIOLOGY!!!
Three main functions of CCK?
1. Stimulates gallbladder contraction 2. Stimulates pancreatic enzyme secretion 3. Inhibits gastric emptying
Two functions of Secretin?
1. Stimulates pancreatic HCO3 secretion 2. Inhibits gastric acid secretion
Two functions of the mucus secreted in the stomach?
-Lubricant -protects surface from H+
What activates all the proteases?
trypsin
What are the products of oligosaccharide hydrolase action?
Monosaccharides (glucose, galactose, fructose)
What are the products of starch hydrolysis by pancreatic amylase?
Oligosaccharides, maltose and maltotriose
What are the products of the hydrolysis of carbohydrate alpha-1,4 linkages by salivary amylase?
maltose, maltotriose and alpha-limit dextrans
What are the three main functions of saliva?
1. Begin starch digestion 2. Neutralize oral bacterial acids which maintains dental health 3. Lubricate food
What are the two main sources of bilirubin in the body?
-Hepatic production by nonerythroid enzymes -Metabolism of heme from red blood cells (120 day life span) and incomplete or immature erythroid cells
What causes pain to worsen in Cholelithiasis?
Eating fatty foods which cause CCK release
What component of GI secretion is \'not essetial for digestion?\'
Gastric acid
What condition results from elevated bilirubin levels?
Jaundice
What disease is commonly associated with pancreatic insufficiency?
Cystic Fibrosis
What do pancreatic ducts secrete when stimulated by secretin?
-mucus -alkaline fluid
What does inadequate gastric acid cause?
Increased risk of Salmonella infections
What enzyme converts trypsinogen to trypsin?
enterokinase (a duodenal brushborder enzyme)
What enzyme hydrolyzes starch?
Pancreatic amylase
What enzyme is involved in the rate-limiting step in carbohydrate digestion?
Oligosaccaride hydrolases
What enzyme starts digestion and hydrolyzes alpha-1,4 linkages?
Salivary Amylase
What form are the proteases secreted in?
proenzyme form
What form is Alpha-amylase secreted in?
active form
What hormone decreases absorption of substances needed for growth)
Somatostatin
What inhibits the release of gastrin and secretin?
Somatostatin
What is pancreatic amylase in highest concentration?
In the duodenal lumen
What is the composition of bile? (5)
-bile salts -phospholipids -cholesterol -bilirubin -water
What is the fate of pepsinogen?
Broken down to pepsin (a protease) by H+
What is the function (fxn) of Pepsin?
Begins protein digestion (optimal pH = 1.0 - 3.0
What is the function of Alpha-amylase?
starch digestion
What is the function of proteases?
protein digestion
What is the function of VIP?
-pancreatic HCO3- secretion - intibition of gastric H+ secretion
What is the function on Nitrous Oxide?
Causes smooth muscle relaxation
What is the major stimulus for secretion of enzyme-rich fluid by pancreatic acinar cells?
Cholecystokinin
What is the major stimulus for zymogen release, but a poor stimulus for bicarbonate secretion?
Acetylcholine
What is the only types of carbohydrate that is absorbed?
Monosacharides
What is the primary location over bacterial conversion or conjugated bilirubin to urobilinogen?
Colon
What is Zollinger-Ellison syndrome? What is the main manifestation?
1. Hypersecretion of Gastrin 2. Peptic ulcers
What manifestations are seen in pancreatic insufficiency?
-malabsorption -stratorrhea (greasy, malodorous stool)
What regulates bicarbonate secretion?
Stimulated by secretin, potentiated by vagal input and CCK
What regulates CCK secretion?
Stimulated by fatty acids and amino acids
What regulates Gastrin secretion?
-Stimulated by stomach distension, amino acids, peptides, and vagus -Inhibited by secretin and stomach acid pH less than 1.5
What regulates secretion of secretin?
Stimulated by acid and fatty acids in lumen of duodenum
What regulates secretion of Somatostatin?
-Stimulated by acid -Inhibited by vagus
What special characteristic do bile salts possess?
They are amphipathic (contain both hydrophilic and hydrophobic domains)
What special characteristic does the conjugated form of bilirubin possess?
It is water soluble.
What substance stimulates ductal cells to secrete bicarbonate-rich fluid?
Secretin
What three enzymes aid in fat digestion?
1. Lipase 2. Phospholipase A 3. Colipase
What trasport is utilized in glucose absorption across cell membrane?
Sodium-glucose-coupled transporter
What two conditions are caused be autoimmune destruction of parietal cells?
-Chronic Gastritis -Pernicious Anemia
What type(s) of innervation stimulate salivary secretion?
BOTH Sympathetic and Parasympathetic
Where are the oligosaccharide hydrolase enzymes located?
At the brush border of the intestine
Where does bilirubin conjugation take place?
Liver
Where does glucose absorption occur?
Duodenum and proximal Jejunum
Where does heme catabolism take place?
In the Reticuloendothelial System
Where is bicarbonate secreted and what does it do?
-Surface mucosal cells of stomach and duodenum -Neutralizes acid -Present in the unstirred layer preventing autodigestion
Where is Cholecystokinin (CCK) secreted?
I cells of duodenum and jejunum
Where is Secretin secreted?
S cells of duodenum
Where is Somatostatin secreted?
D cells in pancreatic islets and GI mucosa
Where is Vasoactive Intestinal Peptide (VIP) secreted
Smooth muscle nerves of the intestines
Which component of bile makes up the greatest percentage?
Water (97%)
Which component of bile solubilizes lipids in micelles for absorption?
Bile salts
Which component of saliva begins starch digestion?
Alpha-amylase (ptyalin)
Which component of saliva lubricates food?
Mucins (glycoproteins)
Why do we need alkaline pancreatic juice in the duodenum?
To neutralize gastric acid, allowing pancreatic enzymes to function