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71 Cards in this Set
- Front
- Back
Delirium vs Dementia
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Delirium: acute in onset, causes global memory impairment; fluctiations in consciousness (waxing and waning); REVERSIBLE
Dementia: gradual onset, intact consciouness, progressive decline; irreversible. |
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Diplopia
Dysphagia Dysphonia |
Botulism
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Describe the steps by which ammonia becomes urea.
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Why accounts for the formation of wrinkles?
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Decreased collagen fibril production-->leads to lack of intrinsic reticular support
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Muscles of mastication:
Which are they? Nerve responsible Skull foramen |
Masseter, medial pterygoid, temporalis
Lateral pterygoid (opens jaw) All innervated by third division of CN V--Mandibular Nerve of Trigeminal Exist through foramen ovale |
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Sensation of nasal cavity/maxillary teeth:
Nerve responsible Skull foramen |
Second division of trigeminal nerve--Maxillary
Exits via foramen rotundum |
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Why does reperfusion injury occur?
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Cell membrane damage secondary to oxygen free radical generation, mitochondrial damage, inflammation
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Identify cell.
Contents of granules? |
Bilobed nucleus-->eosinophil
(note: nphils are multi-lobulated) Granules = major basic protein (potent antihelminthic capable of damaging epithelial and endothelial cells) |
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Role of vitamin K in coagulation
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Activates coagulation factors II, VII, IX, X
Note this isn't synthesis. Liver has already synthesized these factors, Vitamin K is needed for activation. |
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Which coagulation factor has the shortest half-life?
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Factor VII (extrinsic PW)
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Prolonged PT does not correct with Vitamin K supplementation
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Liver Dz; likely due to Factor VII deficiency.
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N-acetylcysteine:
MOA in CF |
Mucolytic agent that loosens thick sputum by cleaving disulfide bonds within mucus glycoproteins.
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Classical Pathway (of complement):
Which Immunoglobulins are involed? Which Immunoglobulin is more effective at initiating the pathway? Describe the pathway. |
IgG and IgM
Classical PW: C1 must bind either two molecules of IgG or IgM (easier with IgM because IgM travels as pentamer!) C1 molecule binds Fc region of heavy immunoglobulin chain near hinge. |
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Draw the structure of an immunogloblin.
Label binding sites, constant/variable regions. |
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Which pharmacologic agents can treat the inflammatory component of asthma?
Which is most potent? |
Corticostroids (fluticasone)
Leukotrienes (Zileuton) Steroids are strongest |
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Draw the sensory innervations of the arm, foream, and hand.
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Note:
Median antebrachial cutaneous n = ulnar n Ignore axillary innervations |
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Draw the light reflex pathway that results in pupil constriction.
Describe what changes occur in MS. |
Afferent (sensory) limb of light reflex PW is Optic Nerve
Efferent limb lies in psymp fibers of oculomotor nerve. When optic nerve damaged (as in MS), light in eye will cause neither pupil to constrict bc nerve can't sense light; however, light in contralateral eye will cause both pupils to constrict (bc motor function of iris is conserved). |
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HIV:
Virus Type Requirements for replication |
RNA virus
With help of viral reverse transcriptase, can convert RNA genome into cDNA. In cDNA form, viral genome incorporated into host cell by viral integrase. Once integrated, cDNA genome is a provirus. |
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AZT:
Specific MOA in HIV |
2 Mechs:
1) Completely inhibits reverse transcriptase 2) Incorporated into viral genome as thymidine analog. Since AZT lacks a 3'-OH group, it's impossible to make 5'-->3' Phosphodiester linkage |
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35 year-old female
Symmetric swelling of proximal interphalangeal, metacarpal, knee, and ankle joints Pain resolves in one month Diagnosis |
Parvovirus
Very similar presentation to RA, but RA is not self-resolving! |
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Label and provide embryonic origin.
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A: SVC; cardinal veins
B: AA; truncus arteriosus C: Pulmonary Trunk; truncus arteriosus D: Esophagus (mesoderm?) E: Descending Aorta--fusion of embryonic right and left dorsal aortas (sounds low yield to me!) |
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What critical factor determines coronary blood flow?
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Duration of diastole
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Describe pulmonary defense mechanisms of inhaled particles based on size.
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10-15 µm: trapped in upper respiratory tract
2.5-10 µm: trapped in trachea/bronchi-->mucociliary transport <2µm: reach terminal bronchioli and alveoli; phag'd by macs |
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Anaphylaxis:
Type of Hypersensitivity Reaction Serum Elevations |
Type 1 (rapid!)
Results from widespread mast cell degranulation and resultant histamine release. Tryptase also released since it's an enzyme specific to mast cells (often used as marker of mast cell activation). Elevated histamine and tryptase. |
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Mutation in beta-globin gene results in replacement of G by C three bases upstream from AUG.
Effect: molecular and medical |
This is the Kozak sequence; plays role in initiation of translation.
Will prevent mRNA binding to ribosomes and result in THALASSEMIA INTERMEDIA Less clinically severe than beta-thal major: results in hypochromic, MICROCYTIC ANEMIA |
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Pick's Disease:
Pathophys Presentation |
Pronounced atrophy in frontal lobe
Manifests with progressive dementia, BEHAVIORAL DISINHIBITION, speech difficulties--dysarthria (impaired articulation), aphasia, echolalia |
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Urine turns black when exposed to room air
Diagnosis Pathophys |
Alkaptonuria
Accumulation of homogentisic acid in urine, oxidized as it sits in room air and turns black |
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38 year-old male
h/o bilateral joint stiffness Brown spots on sclerae Diffuse darkening of helix of ears Diagnosis Pathophys Biochemical pathway |
Alkaptonuria; deficiency of homogentisic acid oxidase
Accumulated homogentisic acid causes pigment deposits in Connective Tissue throughout body Deposits in joints cause ankylosis and motion restriction |
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Cryptococcus:
Stains |
Mucicarmine
India Ink |
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cryptococcus
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45 year-old male
Hemoptysis h/o successfully treated tuberculosis Fibrous cavity filled with hyphae Diagnosis |
Colonizing aspergillosis
Remember: aspergillus will occupy old lung cavities! |
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Which viruses exhibit a phospholipid membrane similar to that of human cell membranes?
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Viruses that bud through host membrane will have phospholipid membrane similar to human cells!
This includes most enveloped nucleocapsid viruses: -HCV (flavivirus) -Mumps (paramyxovirus) |
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Which viruses exhibit a phospholipid membrane to that of a nuclear membrane?
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Viruses that bud through host nucleur membrane:
Herpesvirus, including CMV! |
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Carbolfuschsin
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= aniline dye used in acid-fast stain
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Which bacteria appear under acid-fast stain?
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Mycobacterium
Nocardia |
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What is wound contracture?
How does it arise? |
During wound healing, excessive matrix metalloproteinase activity and myofibroblast accumulation in wound margins can result in contracture.
Contracture produces deformities of the wound and surrounding tissues--most often at palms, soles, anterior thorax, serious burn sites. |
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54 year-old female
Exertional dyspnea, fatigability Ataxia Marked decrease in vibration sense Diagnosois Pathophys Lab findings |
B12 deficiency (obvs)
B12 serves as cofactor for methylmalonyl CoA (catalyzed methylmalonyl Coa-->succinyl Coa (the final product of fatty acid oxidation before it enters TCA)) Deficiency of B12 leads to elevated methylmalonic acid, which results in myelin synthesis abnormalities. |
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What are patients with silicosis at risk of acquiring?
Why? |
At risk of acquiring Tb because, for some reason, there's a disruption in macrophage phagolysosomes by internalized silica particles.
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15 year-old male
Gait instability Frequent falls Lower extremity ataxia Diagnosis Pathophys Other features of presentation |
Friedrigh actaxia (AR condition)
Posterior columns and spinocerebellar tracts show degeneration Loss of sensory cells of DRG also seen Wide-based gait with difficulty maintaining balance is characteristic, also see: -Hypertrophic CM (leading to cardiac arrhythmias and CHF) -Kyphoscoliosis, pes cavus (foor deformity), hammertoes -DM |
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Acarbose:
MOA Use What other drug has this MOA? |
Acarbose = alpha-glucosidase inhibitor; decreases activity of membrane-bound disaccharidases on intestinal brush border.
Carbs absorbed as monosaccharides, so inhibition of alpha-glucosidases will prevent disaccharide breakdown and allow for delay in carbohydrate absorption. Other drug that does this is miglitol. |
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Which diuretics cause hypokalemia and hypercalcemia?
Provide examples. Where do they work? |
Thiazides: HCTZ, chlorothiazide, indapamide, metolazone
WORK IN DCT!!!! |
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Which diuretics cause hypokalmia but not hypercalcemia?
Provide examples. Where do they work? |
Loop diuretics: furosemide, bumetanide, torasemide, ethacrynic acid
Work in ASCENDING LOOP OF HENLE. ASCENDING!!! |
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What is the most potent class of diuretic?
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LOOPS!
Not a whole lot of Na is filtered in DISTAL TUBULES so thiazides are whimpy! |
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54 year-old male
Smoker Skin is become darker Irregular mass on right lung field Diagnosis Pathophys |
Small Cell Carcinoma secreting ACTH (and/or vasopressin)
Excessive ACTH-->hypercortisolism-->not inhibited by high dose steroids! ALSO: ACTH DIRECTLY stimulates melanotropin receptors due to similarity with alpha-MSH (dark skin) |
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Anti-CD 20 Drug
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Rituximab
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Anti-BCR/ABL Drug
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Imatinib
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Anti-TNF-alpha Drug
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Infliximab
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Effect of citrate on calculi
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Citrate will bind free (inoized) calcium and prevent it from precipitating (form stone); this will in turn facilitate its excretion
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Long-thoracic nerve:
Effect of damage What situations would cause damage? |
Winged scapula
Any trauma or surgery in axillary region, ex: mastectomy with LN dissection |
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Violent stretch between head and shoulder:
Effect |
Damage to upper trunk of brachial plexus-->Erb-Duchenne palsy (results from damage to MCN and suprascapular nerves); i.e., waiter's tip
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Thyroidectomy:
Associated nerve injuries based on incision site |
Recurrent laryngeal during ligation of INFERIOR thyroid artery
Damage to external branch of superior laryngeal during ligation of SUPERIOR thyroid artery |
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How does colitis-associated carcinoma differ from sporadic colorectal carcinoma?
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-Younger patients
-Progress from flat/non-polypoid dysplasia -Early p53 mutation, late APC mutation (ooposite of sporadic dz) -Distributed within proximal colon -MULTIFOCAL |
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41 year-old female
Low grade fever Pallor, fatigability Protein in WBCs shows affinity for Vitamin A Diagnosis Pathophys Treatment |
Acute Promyelocytic Leukemia (M3); WBCs produce aberant protein w/affinity for retinoic acid
Results from t(15;17) mutaiton, resulting in formation of PML/RAR-alpha Tx: All-trans-retinoic acid (ATRA) stimulates differentiation of myeloblasts into mature granulocytes |
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Congenital bilateral absence of vas deferens
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Cystic Fibrosis
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30 year-old male
Hypersensitivity to intradermal injection of tobacco extract Exertional calf pain Diagnosis Pathophys |
THromboangitis obliterans (Buerger's dz)
Segmental thrombosing VASCULITIS extending into contiguous veins, and nerves, encasing them in fibrous tissue |
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What nutrients are not provided in breast milk?
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Vitamins D and K
Note: Vitamin K usually given at birth to prevent hemorrhagic dz of newborn Darker skinned infants require more sunlight exposure to produce adequate vitamin D |
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7 year-old male
Recent immigrant Ataxia, clonus, visual problems RNA virus containing hemagglutinin in capsid Diagnosis Risks |
Measles--enveloped RNA virus, member of PARAMYXOVIRIDAE
Presents with prodromal fever, cough, coryza (runny nose), conjuctivitis, maculopapular rash Complications: encephalitis, pneumonia, acute otitis |
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Subacute sclerosing encephalitis:
Cause Labs |
Complication of measles; occurs years after recovery from initial infection
Labs show bands of Ab's to measles in CSF. NO ANTIBODIES TO M COMPONENT OF MEASLES (unusual bc most measles viruses express this. scientists think it's a form of measles causing panencephalitis) |
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Positive skew:
What does it mean? |
Mean is greater than median
Means that small numbers predominate in dataset and long slop of curve (tail) extends in positive direction. In negative skew, larger numbers predominate and slop of curve extends in negative direction. |
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2e year-old male
Started on high-dose acyclovir Cr increases from 0.9 to 3.4 Diagnosis Treatment |
Acyclovir concentration in collecting duct exceeded solubility, resulting in crystallization and renal tubular damage (known as acyclovir nephrotoxicity)
Tx (and prevention): Adequate hydration |
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How is tumor lysis syndrome prevented?
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Allopurinol
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What is intrapleural pressure like when airway pressure = 0?
Under what circumstances does airway pressure = 0? |
Remember, the chest wall wants to expand and the lungs want to collapse.
So when the compliance of the chest balances the compliance of the lungs, the airway pressure = 0. This is known as FUNCTIONAL RESERVE CAPACITY. At the FRC, the INTRAPLEURAL (not airway pressure) is actually about -5. It's negative because it has two forces pulling on it in opposite directions. |
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What is a normal junctional rhythm?
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45-55 (no P wave!)
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Define recombination.
Example. |
Exchange of genes between two chromosomes via crossing over w/homologous regions.
Resulting progeny will have traits not present simultaneously in either parent virus. Ex: two mutant viruses not individually infective, but when enter same cell at once, their progeny can infect. Viruses must be non-fragmented, non-segmented, doublestranded DNA such as ADENOVIRUS |
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Define reassortment.
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Changes in genomic composition that occur when host cells are co-infected w/segmented viruses that exchange whole genome segments.
Causes sudden alterations in surface antigens of progeny, as observed in influenza. |
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Define transformation.
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Uptake of naked DNA by prokaryotic/eukaryote; in virology, it's incorporation of viral DNA into a host cell chromosome.
No genomic change in progeny. |
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Define interference.
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Inhibition by one virus of the replication and/or release of a second virus that is infecting the same cell.
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Yellow-green vaginal discharge
Flagellated |
Trichomonas
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Gray vaginal discharge
Numerous squamous epithelial cells covered with adherent bacteria |
Gardnerella vaginalis
(CLUE CELL) |
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IgA Protease:
Function Specific bacteria |
Neisseria (gonorrhoeae and meningitidis)
IgA Protease allows bacterial penetration of mucosa. Note this enzyme cleaves secretory IgA, which exists on mucosal surfaces to bind and inhibit action of pili and fimbriae as well as other cell surface antigens that normally mediate mucosal adherence and penetration. |
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How is Oxymetazoline (Afrin) similar to Nitroglycerin?
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Both can result in rebound syx.
Afrin depletes nasal mucosa vessels of NE while nitroglycerin depletes NO from cells. Need drug free intervals for both! |