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71 Cards in this Set

  • Front
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Delirium vs Dementia
Delirium: acute in onset, causes global memory impairment; fluctiations in consciousness (waxing and waning); REVERSIBLE

Dementia: gradual onset, intact consciouness, progressive decline; irreversible.
Diplopia
Dysphagia
Dysphonia
Botulism
Describe the steps by which ammonia becomes urea.
Why accounts for the formation of wrinkles?
Decreased collagen fibril production-->leads to lack of intrinsic reticular support
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
Sensation of nasal cavity/maxillary teeth:
Nerve responsible
Skull foramen
Second division of trigeminal nerve--Maxillary

Exits via foramen rotundum
Why does reperfusion injury occur?
Cell membrane damage secondary to oxygen free radical generation, mitochondrial damage, inflammation
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)
Role of vitamin K in coagulation
Activates coagulation factors II, VII, IX, X

Note this isn't synthesis. Liver has already synthesized these factors, Vitamin K is needed for activation.
Which coagulation factor has the shortest half-life?
Factor VII (extrinsic PW)
Prolonged PT does not correct with Vitamin K supplementation
Liver Dz; likely due to Factor VII deficiency.
N-acetylcysteine:
MOA in CF
Mucolytic agent that loosens thick sputum by cleaving disulfide bonds within mucus glycoproteins.
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.
Draw the structure of an immunogloblin.

Label binding sites, constant/variable regions.
Which pharmacologic agents can treat the inflammatory component of asthma?

Which is most potent?
Corticostroids (fluticasone)
Leukotrienes (Zileuton)

Steroids are strongest
Draw the sensory innervations of the arm, foream, and hand.
Note:
Median antebrachial cutaneous n = ulnar n
Ignore axillary innervations
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).
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.
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
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!
Label and provide embryonic origin.
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!)
What critical factor determines coronary blood flow?
Duration of diastole
Describe pulmonary defense mechanisms of inhaled particles based on size.
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
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.
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
Pick's Disease:
Pathophys
Presentation
Pronounced atrophy in frontal lobe

Manifests with progressive dementia, BEHAVIORAL DISINHIBITION, speech difficulties--dysarthria (impaired articulation), aphasia, echolalia
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
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
Cryptococcus:
Stains
Mucicarmine
India Ink
cryptococcus
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!
Which viruses exhibit a phospholipid membrane similar to that of human cell membranes?
Viruses that bud through host membrane will have phospholipid membrane similar to human cells!

This includes most enveloped nucleocapsid viruses:
-HCV (flavivirus)
-Mumps (paramyxovirus)
Which viruses exhibit a phospholipid membrane to that of a nuclear membrane?
Viruses that bud through host nucleur membrane:
Herpesvirus, including CMV!
Carbolfuschsin
= aniline dye used in acid-fast stain
Which bacteria appear under acid-fast stain?
Mycobacterium
Nocardia
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.
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.
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.
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
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.
Which diuretics cause hypokalemia and hypercalcemia?

Provide examples.

Where do they work?
Thiazides: HCTZ, chlorothiazide, indapamide, metolazone

WORK IN DCT!!!!
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!!!
What is the most potent class of diuretic?
LOOPS!

Not a whole lot of Na is filtered in DISTAL TUBULES so thiazides are whimpy!
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)
Anti-CD 20 Drug
Rituximab
Anti-BCR/ABL Drug
Imatinib
Anti-TNF-alpha Drug
Infliximab
Effect of citrate on calculi
Citrate will bind free (inoized) calcium and prevent it from precipitating (form stone); this will in turn facilitate its excretion
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
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
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
How does colitis-associated carcinoma differ from sporadic colorectal carcinoma?
-Younger patients
-Progress from flat/non-polypoid dysplasia
-Early p53 mutation, late APC mutation (ooposite of sporadic dz)
-Distributed within proximal colon
-MULTIFOCAL
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
Congenital bilateral absence of vas deferens
Cystic Fibrosis
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
What nutrients are not provided in breast milk?
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
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
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)
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.
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
How is tumor lysis syndrome prevented?
Allopurinol
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.
What is a normal junctional rhythm?
45-55 (no P wave!)
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
Define reassortment.
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.
Define transformation.
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.
Define interference.
Inhibition by one virus of the replication and/or release of a second virus that is infecting the same cell.
Yellow-green vaginal discharge
Flagellated
Trichomonas
Gray vaginal discharge
Numerous squamous epithelial cells covered with adherent bacteria
Gardnerella vaginalis

(CLUE CELL)
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.
How is Oxymetazoline (Afrin) similar to Nitroglycerin?
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!