4-17-2015 #1

wumimimu's version from 2015-04-17 21:05

Section 1

Question Answer
What is the fourth heart sound associated with?Atrial contraction into a stiff left ventricle; diastolic dysfunction
Where is the fourth heart sound best heard?In the left lateral decubitis position at the cardiac apex
In who can the third heart sound be a normal finding?Children, young adults, and pregnancy
What is the third heart sound associated with?Rapid filling of the left ventricle during diastole-turbulent because of increased volume
Who are the enterovirusesPolio, coxsackie A, echo, HepA (picorna viruses); these guys are acid-stable
Which Picorna virus is acid-LABILE?Rhinovirus (therefore, it only causes upper GI infections)
Which artery gives rise to the penetrating arteries of the internal capsule and basal ganglia?The middle cerebral artery
What causes lateral inferior pontine syndrome?Occlusion of the AICA
What causes lateral medullary (wallenburg) syndrome?Occlusion of the PICA
What does lateral inferior pontine syndrome present as?Contralateral loss of pain and temp; ipsilateral loss of CN V, VIII, Horner's syndrome, and cerebellar sx
What does Wallenburg syndrome present as?Contralateral loss of pain and temp; ipsilateral loss of CN V, VIII, 9, 10, and 11; Horner's syndrome
What is diffuse esophageal spasm?Non-peristaltic, disorganized contractions of the esophagus that do not propel food bolus downward
What are the sx of DES?Dysphagia and chest pain ( must rule out MI!); see :corkscrew esophagus" on barium swallow
What do the superficial inguinal lymph nodes drain?All skin from umbillicus down, including anus (up to the pectinate line), external genitalia, except for posterior calf (drained by the popliteal lymph nodes)
Where does lymph from prostate drain?Internal illiac nodes
What is released into the circulation during rhabdomyolysis?Potassium, CK, and myoglobin
What is the pathophys of malignant hyperthermia?AD; ryanodine receptors on the SR release large amounts of Ca into the circulation after exposure to anesthetic
What is used in malignant hyperthermia as antidote?Dantrolene: prevents ryanodine receptors on SR from releasing calcium
How is sotalol different from other class 3 antiarrythmics?It has B-blocking activity; therefore, it causes bradycardia
Calcium channel blockers do what to myocytes and pacemaker cells respectively?In myocytes, they slow phase 2 of action potential and in pacemaker cells, they slow phase 0
How do beta blockers slow heart rate?They slow AV nodal conduction and phase 4 of cardiac pacemaker cells
What are the side effects of verpamil and diltiazem specifically?Negative inotropy and AV block (diltiazem too); gingival hyperplasia and constipation
What defines a seizure as simple vs. complex?SImple-- you do not lose conciousness
What defines a seizure as complete or partial?Partial- involves only one part of the body
What are the major SE of carbamazepine?Bone marrow suppression, hepatotoxicity, and SIADH
What are the characteristics of ABPA?Wheezing, fever, and migratory pulmonary infiltrates
How does invasive aspergillosis present?Occurs in patients who are immunocompromised; esp neutropenic; pneumonia, necrotizing granulomas; cough, hemoptysis, pleurtic chest pain;
How does aspergillus spreadHematogenously
What does it mean to be polycistronic?One mRNA can code for multiple proteins
Which viruses rely on polyprotein cleavage?Single stranded, postive sense, linear, non-segmented RNA viruses
What are the characteristics of C. jejuni?CUrved, gram - rod, with a filament that allows it to move in a corkscrew fashion; its is spread fecal-orally
What does C. jejuni cause?Inflammatory gastroenteritis; it is also associated with Guillan barre
How is C. jejuni transmitted?Pets, dogs, cattle, sheep, chicken, also undercooked poultry and unpasteurized milk
What would the endometrium look like 4-7 days after menses onset?Straight short endometrial glands, and compact stroma (early proliferative phase)
How does Acetyl coA simulate gluconeogenesis?It is an allosteric activator of pyruvate carboxylase
Biotin catalyzes what kind of reactions?Carboxylations!
Class 1A effect on phase 0 depolarization and length of action potential?Intermediate inhibition of phase 0. and prolongs the action potential
Class 1B effect on phase 0 dep. and length of action potential?Weak inhibition of phase 0, and shortened action potential
Class IC effect on phase 0 dep, and length of action potentialStrong inhibition of phase 0, and no change on action potential duration
What are three questions that can be used as a brief screen for elder abuse?Do you feel safe where you live, Who prepares your meals, who handles your checkbook?
When should you report suspected elder abuse?After interviewing patient alone/documenting findings; or if the caretaker refuses to let you speak to the patient alone
What are the classic lab abn in HUS?Decrease RBC, Hgb, and platelet count; Increase LDH, bleeding time, BUN, and creatinine
What kind of nausea are serotonin receptor antagonists used for?Visceral nausea due to GI insults (chemo, general anesthetics, GI infections)
What are metoclopramide and promethazine used for?Dopamine receptor antagonists are effective in treating central nausea (migraine)
Loperamide?Mu-receptor agonist the functions as antimotility agent (used in diarrhea)
What is used to treat vestibular nausea?Muscarinic receptor antagonists (scopalamine); First generation H1 rec antagonists (diphenhydramine and meclizine)
What is octreotide used to treat?Diarrhea associated with VIPoma, carcinoid syndrome, and esophageal varicies
What is the sodium-cyanide nitroprusside test?Test to see whether there is cystine in the urine
How do you treat people with cystine stones?Hydration and urinary alkalinization
What is defective in a patient who has cystine stones?Dibasic amino acid transporter in intestine and prox tubule
Crohn's disease patients are susceptible to what kind of stones?Calcium oxalate (hyperoxaluria!)
What does alcoholic hepatitis look like histologically?Hepatocellular swelling and necrosis, mallory bodies, PMN infiltration, and fibrosis
What is Reye syndrome characterized by histologicallyMicrovesicular steatosis
What is the histo of PBCGranulomatous bile duct destruction and extensive leukocyte infiltration in portal tracts (lymphocyte predominant)
What are Cushing's ulcers?Ulcers in the esophagus, stoamch, or duodenum that arise bc of a rise in intracranial pressure
What are Curling ulcers?Ulcers arising in the prox duodenum that arise bc of severe burns or trauma
What can anabolic steroid abuse result in?Testicular atrophy, infertility, male pattern baldness, voice deepening, acne, erythrocytosis, and hepatotoxicity

Section 2

Question Answer
What is beta blocker toxicity antidote?Glucagon! Increases intracellular cAMP and therefore heart contractility
What is seen in theophylline toxicity?ABdominal pain, diarrhea, vomiting, cardiac arrythmias, and seizures
What sequence of nucleotides needs to be known for PCR?The flanking regions in order to make the primers; the actual sequence does not need to be known
What are the two types of gastric adenocarcinoma?Intestinal type (looks like colon cancer, projects into the lumen of the stomach), and diffuse (signet ring cell, infiltrates the stomach wall, plaque like lesion)
When is stomach rugal hypertrophy seen?ZE
What is steppage gaitLeg has to be lifted high off the ground, and foot slaps down on the floor with each step: seen in foot drop
What is deficienct in Xeroderma pigmentosumUV specific endonuclease (Nucleotide excision repair)
When can pulsus paradoxus occur?Most commonly, tamponade, also, constrictive pericarditis, COPD, asthma, and pulmonary embolism
Total flow =?Cross sectional area X flow velocity = constant!
Where is synaptophysin found?In the presynaptic vesicles of neurons, neuroendocrine cells, and neuroectodermal cells; marker for tumors of neuronal origin
What are the two substances that promote angiogenesis?FGF and VEGF
What does FGF play a role in?ANgiogenesis, hematopoesis, embryonic development, and wound repair
Why are Crohns patients at a greater risk for gallstones?They cannot reabsorb bile acids, hence their bile acid:cholesterol ratio goes down in bile
How do you treat MCD?Corticosteroids! excellent prognosis
What are granulosa cell tumors associated with histologically?call-exner bodies (resemble follicles)
Where does gastric cancer usually metastasize?To virchows node, Periumbiliical region (sister mary joseph nodule) and to ovaries (krukenburg)
What provides the charge selectivity in Glomerular filtration barrier?Heparan sulfate and other proteoglycans which are often lost in nephrotic syndrome (MCD)
What provides the size selectivity in glomerular filtration barrier?The GBM pores and the slit diaphragm
What kind of proteins are excreted in minima change disease?low molecular weight proteins, Albumin and transferrin