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75 Cards in this Set
- Front
- Back
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What are the three structural genes of HIV and what does each encode?
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Pol: Enzymes
Gag: p24, p7 Env: gp160, gp120, gp41 |
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What's going on here?
What's required for this to occur? |
Arrow is pointing to a lymphoid follicle. Lymphoid follicle germ center is site of B-cell proliferation during immune response.
This is where B cells undergo isotype switching to other immunoglobulins, i.e., switch from IgM to IgG. Requires CD40 receptor on B cell and CD40-ligand on activated T cells. |
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What is the main immunoglobulin of primary response?
Secondary response? |
Primary response is IgM
Secondary is IgG |
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5 year-old
Fever, abdominal pain Diarrhea with blood Develops pallor, oliguria Diagnosis Pathophys Lab values |
Hemolytic uremic syndrome:
Microangiopathic hemolytic anemia + acute renal failure + thrombocytopenia Usually assocd w/E coli O157:H7 and Shigella Shiga toxin enters circulation from bowel and induces vascular damage leading to thrombus formation in capillaries Widespread thrombi consume platelets and cause damage to RBCs Resultant hemolytic anemia-->pallor, weakness, tachicardia Thrombocytopenia-->purpura, petechiae Labs will show: Dec'd Hgb, HCT, RBC count Inc'd LDH, retic INC'D BLEEDING TIME due to reduced number of PLTs |
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Gram-positive bacteria that synthesize dextrans from sucrose
Identify What does this allow? |
Strep viridans
Dextrans facilitate adherence to fibrin Fibrin and PLTs are deposited at sites of endothelial trauma, allowing bacterial adherence and colonization leading to formation of valvular vegetation Note: Staph aureus is more aggressive and can adhere to intact endothelium without a preexisting lesion |
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S4 heart sound:
Describe when you'd hear it Cause |
End of diastole just before S1 (remember systole then diastole in terms of heart sounds)
Due to LVH Heard at apex |
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55 year-old alcoholic
Treated with IV saline with dextrose Develops anterograde amnesia, nystagmus, opthalmoplegia, ataxia Diagnosis Pathophys |
Chronic EtOH-->low levels of thiamine at baseline
IV Dextrose without prior thiamine supplementation-->WERNICKE ENCEPHALOPATHY Thiamine needed for pyruvate DH (involved in glucose metabolism) Mammillary body undergoes necrosis bc brain can't properly metabolize glucose without thiamine (mammillary body is sensitive) Mammillary body is part of Papez circuit (neural PW of limbic system involved in cortical control of emotion and memory) |
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List the B vitamins.
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B1 - thiamine
B2 - ribioflavin B3 - niacin (B5 - pantothenic acid) B6- pyridoxine B7 - biotin B9 - folic acid B12 - cobalamin |
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Label
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A - fornix (bundle of axons originating from hippocampus projecting to mammillary body)--can be affected in Wernicke encephalopathy
B - Mammillary body C - Pons D - Thalamus E - Inferior colliculus (audition) F- corpus callosum |
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Infant born with small phallus
Hypospadias Testes in inguinal area Normal Testosterone Normal BP 46XY Diagnosis Pathophys |
5-alpha-reductase deficiency
T allowed for dev't of internal genitalia DHT (which was lacking) is required for dev't of external genitalia. Lack of DHT-->feminization This will resolve during puberty |
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List the enzyme deficits found in congenital adrenal hyperplasia, and their effects (lab wise and presentation wise).
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21-hydroxylase: dec'd corticosteroids and mineralocorticoids, inc'd testosterone; ambiguous genitalia in females, salt wasting
11-hydroxylase: dec'd cortisol, corticosterone, aldosterones; inc'd testosterone Ambiguous genitalia in females; fluit/salt retention, hypertension 17-hydroxylase: inc'd mineralocorticoids, dec'd sex hormones, corticosteroids. All pts phenotypically female Fluit and salt retention, HTN |
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0x50 + 1x30 + 2x10 + 3x10 = 80
80/100=0.8 |
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7 year-old male
Colicky abdominal pain Arthralgia Proteinuria Palpable lesions on lower extremities Diagnosis Pathophys |
Henoch-Schonlein purpura
Deposition of IgA immune complexes on BV walls and within renal mesangium activates complement-->inflammation Elevated serum IgA and circulating IgA-containing immune complexes |
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How does diphtheria cause disease?
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Must acquire virulence via bacteriophage-mediated "infection" with Tox gene which codes for diphtheria AB exotoxin
Bacteriophage = Corynephage beta Process = lysogenization |
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How does V, Q, V/Q differ by region of the lung (while standing)?
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Base:
Q is much higher (gravity!) V is higher V/Q is lower Apex: Q is very low V is low V/Q is high |
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What's an arteriovenous shunt?
How does this affect LV pressure-volume loops? |
AV fistula = abonrmal communication between artery and vein that bypasses capillary beds (major source of resistance to vascular system)
Thus AV shunts allow blood under arterial pressure to directly enter venous systems Manifests as a thrill on palpation (and bruit on auscultation) AV shunts increase cardiac preload by increasing rate and volume of blood flow back to heart (will increase to right horizontally; no increase in pressure). |
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What is the effect of alpha-1-antitrypsin deficiency on lung compliance?
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Results in panacinar emphysema (and liver cirrhosis)-->compliance of lung parenchyma increases
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Patent Ductus Arteriosus:
Specific embryonic origin Conditions associated with it |
6th aortic arch
PDA Associated with prematurity and congenital rubella |
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Hypertrophic CM:
Genetic cause |
Mutation to cardiac sarcomere proteins; most involving-beta-myosin heavy chain
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Dilated CM:
Genetic cause |
Mutations of cardiac myocyte CYTOSKELETAL proteins (DYSTROPHIN) or mitochondrial enzymes
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Orotic aciduria:
Pathophys Presentation Treatment |
Disorder of pyrimidine metabolism
Defective enzyme is orotate phosphoribosyl transferase and OMP decarboxylase--these catalyze conversion of orotate to uridine monophosphate. Presents with Hypochromic megaloblastic anemia Excretion of orotic acid in urine Anemia, neurlogic abnlts Growth retardation Treat with uridine supplementation (will inhibit carbamoyl phosphate synthase II--first enzyme of pyrimidine synthesis) |
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20 year-old male
African American Malaiase, dark urine Mild UTI several days ago Anemic with Heinz bodies Diagnosis |
G6PD deficiency
Likely given TMP-SMX (OXIDATIVE STRESSOR) for UTI |
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Glucose-6-phosphate DH:
Function (general and specific) |
Glucose-6-phosphate + NADP+ --> 6-phosphogluconate + NADPH
Need to produce NADPH (part of HMP shunt) to maintain glutathione in REDUCED state (important for protection of RBCs x oxidative damage) |
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X-ray shows fractured 12th rib on left side.
What structure is likely to be lacerated by broken rib? |
LEFT KIDNEY
Spleen is near left 9th, 10th, 11th kidney. |
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What drugs are likely to cause seizures?
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Bupropion (antidepressant)
INH (anti-tb if given without pyridoxine) Imipenem (abx) |
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TCA:
Side effects |
Cadiac arrhythmias (QRS, QT elongations much like quinidine)
Sedation (antihistamine f/x) Urinary retention (antich f/x) |
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COX--1 vs COX-2:
Roles |
COX-1: physiologic role in NORMALLY functioning tissue, e.g., PLATELETS, the GI TRACT
COX-2: Expressed at sites of inflammation |
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Celecoxib:
MOA |
Selective COX-2 inhibitor
Doesn't inhibit COX-1 (which is involved in NORMAL function--PLATELETS and GI TRACT) |
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Nitroglycerin:
Specific molecular MOA |
Drug is converted into NO at vascular smooth muscle cell membrane
Within the smooth muscle cell, NO stimulates gunaylate cyclase to convert GTP into cyclicGMP Increasing [ ] of cGMP within cell-->dec'd intracellular Ca2+ -->Dec'd activity of myosin light-chain kinsae ->Myosin light chain DEPHOSPHORYLATION and smooth muscle relaxatio n |
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Draw the intrinsic and extrinsic pathways.
Which is affected by which hemophilia? Treatment? |
Hemophilia A: VIII deficiency
Hemophilia B: IX deficiency These are both part of intrinsic PW. Need both factors to activate Factor X. If needed to treat, could administer thrombin. |
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6-year old male
Prolonged bleeding after dental extraction h/o hemartrhosis after minor trauma Diagnosis Mode of inheritance |
Hemophilia
X-linked RECESSIVE |
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14 year-old boy with hemophilia
Parents have no bleeding problems Older sister without this condition is pregnant (sex of child unknown) What is the risk her child will be affected? |
Hemophilia is X-linked RECESSIVE
Chance sister is a carrier is 1/2 Chance child will be affected is 1/8 |
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38 year-old male
IVDU High-grade fever, fatigue, dyspnea Diagnosis |
Staph aureus tricuspid valve endocarditis-->septic emboli to lungs (hemorrhagic)
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Pathology
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Wedge-shaped hemorrhagic pulmonary infarcts
Hemorrhagic due to dual blood supply to lungs (pulmonary and bronchial arteries) If pt is IVDU-->right heart endocarditis (S aureus)-->septic embolization |
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Contraindications of OCPs
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h/o thromboembolic event/stroke
h/o estrogen-dependent tumor Women >35 who smoke Hyper-TG Liver dz Pregnancy |
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Non-immune effects of glucocorticoids
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Muscle weakness, skin thinning, impaired wound-healing, osteoporosis
INCREASED LIVER PROTEIN SYNTHESIS, specifically enzymes involved in gluconeogenesis and glycogenesis; contributes to hyperglycemia |
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24 year-old male in coma
Cyanotic, unresponsive to painful stimuli BP 100/60, pulse 100 RR 5/min, Temp 98F Pupils constricted, poorly responsive to light Diagnosis Treatment Treatment MOA |
Opioid overdose
Treat with Naloxone (an opioid receptor antagonist)--works by blocking Mu receptors of opioid receptors (this is where narcotics bind FYI) |
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Signet ring cell-->Gastric adenocarcinoma
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65 year-old male
Abdominal pain in waves Nausea, vomiting Ileocecal obstruction Diagnosis What would you see on radiograph? |
Gallstone ileus--large gallstone intermittently obstructing lumen causing waxing/waning syx
Eventually gallstone may come to rest in ileum (smallest lumen of GI tract) Abdominal radiograph would show air in biliary tree |
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63 year-old male with PE
Where could filter be placed to prevent further embolization? |
IVC filter--designed to prevent travel of DVT from legs to lung vasculature
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Label
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A) Duodenum
B) IVC (note R Renal Vein drains into it) C) Abdominal Aorta D) Ileum (figure 8) E) L Renal Vein |
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Diagnosis
Pathophys |
(MPA = main pulmonary artery)
This is a saddle embolus likely due to DVT (endothelial damage, venous stasis, hypercoagulable state) |
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The IVC is located to the _______ of the vertebral bodies.
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Right
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Which veins join to form the IVC?
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Common iliac vv
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Phenytoin:
MOA Use Side Effects |
MOA: INhibits neuronal high-frequency firing by reducing ability of Na+ channels to recover from inactivation (increasing refractory period)
Use in epilepsy Generalized LAD Hirsutism Gingival hypertrophy |
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Valproic acid:
AE |
Severe hepatotoxicity, measure LFTs
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Carbamazepine:
AE |
Agranulocytosis
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How does a thrombus originating from atherosclerosis differ from a thrombus originating from venous stasis?
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Atherosclerotic thrombi affect the arterial tree (likely to cause stroke--something arterial in route)
Venous stasis is going to affect the venous tree (pulmonary artery)--not due to atherosclerosis! |
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Biochemical effects of folate deficiency.
Draw normal pathway. Provide lab values/effects. What other B vitamin is necessary? |
Will lead to inc'd homocysteine levels, inability to reproduce methionine.
And megaloblastic anemia. Need B6 (pyridoxal phosphate)! Need folate to make TH4! |
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24 year-old male
Sickle cell disease MCV 114 Reticulocytes 5% Diagnosis Pathophys |
Megaloblastic anemia due to folate and B12 deficiency
Due to inc'd RBC turnover Low folic acid levels impair DNA synthesis, while leaving RNA synthesis unaffected. Cytoplasmic components then accumulate within slowly dividing RBCs-->produces larger RBCs. |
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Define facilitation.
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WHen interviewer encourages patient to talk more about his/her experience
"And then what happened?" |
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Define reflection.
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When physician repeats what patient tells him
"So, you're telling me you were molested as a child." |
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Define confrontation.
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Therapist draws patient's attn to discrepancies in responses
"Although you're telling me you were disturbed by this trauma, you sound unaffected as you're describing it" |
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Amphotericin B:
AEs |
Renal vasoconstriction-->dec'd GFR
May even be directly toxic to renal empithelium-->acute tubular necrosis, electrolyte disturbances |
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32 year-old man
Sharp mid-chest pain that worsens with deep inspirations Pain decreases when he sits up Respiratory illness one week ago Diagnosis Auscultative findings Pathophys |
Sharp and pleuritic chest pain (increases with breathing, decreases with sitting up and leaning forward)-->acute pericarditis
Would hear FRICTION RUB (high pitched, leathery, scratchy) Can be caused by MI, rheumatic fever, uremia, but likely due to infectious cause given h/o respiratory infection |
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32 year-old female
Infertile Menstruates 2-3 times per year Hirsutism Obese Diagnosis Hormone Imbalances Risks |
Obesity + hirsutism + oligomenorrhea ---> PCOS
Due to abnl HPA-Ovarian system Androgen and LH levels elevated, FSH normal. Inc'd LH/FSH (>3) characteristic Menstrual irregularity due to anovulation Risk of endometrial adenocarcinoma (high levels of unopposed estrogen) Inc'd insulin resistance-->obesity (higher risk of DM II) Hirsutism/acne-->inc'd androgen levels Changes of lipid metabolism-->inc' drisk atherosclerosis and CAD |
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8 year-old male
Throat pain, fever, malaiase Returns in month with fatigue, joint pain Later develops heart murmur Diagnosis Pathophys |
Acute rheumatic fever
It follows untreated Group A Strep pharyngitis. Syx result from structural homology between antigenic determinants (epitopes) on GAS and on human cardiac, CNS, and cutaneous tissue (Resulting in a rash!) |
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Mullerian ducts AKA
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Paramesonephric (upper vagina, uterus, uterine tubes, cervix)
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Wolffian ducts AKA
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Mesonephric
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How do T and DHT differ in roles of male development?
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T = internal genitalia
DHT = external genitalia |
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Role of Omalizumab in asthma
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Anti-IgE antibodies: binds to IgE to inhibit its action on mast cells, basophils--this decreases the allergic response.
Minimizes allergic responses of asthma. Are able to discontinue glucocorticoids and decrease use of steroids. |
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Molecular effects of diphtheria exotoxin.
Treatment? |
AB exotocin ribosylates and deactivates elongation factor 2, thus inhibiting human protein synthesis--results in sore throat, fever, LAD, dyspnea, odynophagia.
Tx: 1. diphtheria antitoxin (inactivates all circulating toxin, but not those that have gained access to cardiac or neural cells; known as passive immunization) 2. PCN/erythromycin (kills bacteria in cells) 3. DPT vaccine (prevents future infection) |
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Where are lipids digested and absorbed?
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Lipids (TGs, cholesterol, phospholipids) digested in duodenum and absorbed in jejunum.
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What is the effect of cholecystectomy on lipid digestion and absorption?
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Little effect--liver continues to produce bile acids, just doesn't have a place to store it. Expect inc'd blood flow to liver for this reason.
Only difference for patient will be difficulty consuming large fatty meals. |
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injury to Gunyon's canal
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Ulnar nerve
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List regions of the arm that may injure underlying nerves (also provide nerves).
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Surgical neck of humerus: axillary
Head of radius: deep branch of radial nerve Medial epicondyle of ulnar: ulnar Carpal tunnel: Median nerve Hook of hamate, Gunyon's canal: Ulnar |
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Newborn develops vomiting, lethargy
Mother states diapers smell like burned sugar Diagnosis Pathophys (include biochemical pathway) Treatment |
Maple Syrup Urine Disease--due to defective breakdown of branched chain amino acids: LEUCINE, ISOLEUCINE, VALINE
Specific defect in alpha-keto acid DH, resulting in elevated serum/tissue levels of alpha-keto acids (NEUROTOXICITY) Urine has sweet odor. Enzymes needed to metabolize L, I, V requires: Thiamine, FAD, NAD, Lipoate, CoA (Tx = dietary restriction and thiamine) |
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Elastin fibers in the alveolar walls of the lungs can be stretched easily during inspiration and recoil to their original shape once the force is released.
How? |
Elastin has lysine groups which are crosslinked between 4 other lysine residues on 4 different elastin chains.
This crosslinking is accomplished by extracellular lysyl hydroxylase. Note: elastin ≠ collagen! |
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What is the role of CFTR in sweating? How does it differ in cystic fibrosis?
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When sweating, fluid is initially isotonic with ECF.
CFTR then reabsorbs Cl- and Na+ to make hypotonic sweat. In CF, there is less reabsorption of Na+ and Cl-. |
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Infant
Bilateral cleft lip Microcephaly Microphthalmos Omphalocele |
Trisomy 13: Patau
Could also see: Neural Tube defects PDA PCKD Pyloric Stenosis ROCKER-BOTTOM FEET POLYDACTYLY |
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Bacterial transpeptidase:
Role What antibiotics target it? |
Transpeptidases are a form of PBP that cross-link peptidoglycan in bacterial cell wall
Inhibited by PCN and cephalosporins |
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Which antibiotic targets nuclear proteins?
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Fluoroquinolones target nuclear proteins (DNA GYRASE)
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Which antibiotic targets the formation of cell wall glycoproteins?
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Vancomycin
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Which antibiotic targets ribosomal proteins?
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Macrolides
Tetracyclines |
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An isolate of streptococcus pneuomoniae is incubated with low-dose radiolabeled ceftriaxone and subjected to protein electrophoresis.
Five bands are detected by radioautography. Another isolate from a different patient undergoes the same protocol but electrophoresis only yields two bands. What accounts for the difference? |
Change in protein structure (PCN BP); must indicate that for second patient, three of the the PCN BPs have been altered in such a way that inhibits binding of ceftriaxone.
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