Term
| What is a major concern when administering Zidovudine & Gancyclovir together? |
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Definition
neutropenia. Both cause neutropenia as a SE.
Remember: Gancyclovir is much more toxic to the marrow than acyclovir b.c. it is activated by pretty much any kinase in the body
Other SE of ZDV include: lactic acidosis, peripheral neuropathy, & megaloblastic anemia
ASIDE: give G-CSF (e.g. filgrastim) to reverse BMS induced by ZDV |
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Term
| Differentiate Lepromatous from Tuberculoid leprosy |
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Definition
1) Tuberculoid: good CMI; few organisms; Damage mediated by immune system. Organism likes to invade neurons --> CMI damage --> sensory loss
2) Lepromatous: bad CMI --> many organism in lesion; lesions become nodular & can fuse --> "lion-like facies"
The PPD is positive for tuberculoid, & NEGATIVE for Lepromatous (b.c. CMI is wiped out) |
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Term
| Low intensity mood disorder: Low energy, alterations in sleeping and eating patterns, low self-esteem, and anhedonia. Must last >2yrs |
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Definition
Dysthymia
It differs from major depression in length, #, & severity of Sx |
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Term
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Definition
Requires a high level of suspicion. Based in Hx (no vaccination, penetrating wound) & physical (sardonic smile, trismus, muscle spasms)
There is no laboratory assay!
Treatment consists of both antitoxin & antibiotics. However, the antitoxin only works for free toxin, and the 1/2 life of bound toxin can last for months --> thus Sx may persist for months |
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Term
Name the nerve:
1) Courses w/ superior thyroid artery. Innervates crichothyroid
2) Courses deep to SCM, innervates sternohyoid, sternothyroid, omohyoid
3) Innervates all tongue muscles except palatoglossus
4) Courses w/ inferior thyroid artery & innervates all muscles of larynx except cricothyroid |
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Definition
1) External branch of superior laryngeal nerve CNX (internal branch is sensory innervation)
2) Ansa cervicalis (C1,C2,C3)
3) CN XII
4) Recurrent Laryngeal (CNX) |
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Term
| Acute mitral regurge or chronic mitral regurge is more susceptible to manifest as pulmonary edema? |
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Definition
Acute
With chronic regurge, the LA becomes more compliant and can take on the excess fluid. However, the enlarged size predisposes it to Afib, mural thromboembolism, & local size effects
Any pt w/ severe MR can develop fatigue & eventual RHF |
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Term
| Most common site for colonic malignancy? |
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Definition
| sigmoid colon; Ascending colon is #2 |
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Term
| what is the RV/TLC in COPD? |
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Definition
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Term
When is HbF produced?
What is the first hemoglobin synthesized? |
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Definition
from ~10 weeks gestation to 6 months of life. It is the major Hb in a newborn. HbF is slowly replaced after birth by HbA; it is nearly gone by 6 months (this is when the HbS pts begin to manifest symptoms)
Hemoblobin Gower (zeta2-epsilon2)is the earliers hemoglobin found in the fetus. It is synthesized in the yolk sac |
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Term
1) Pyruvate kinase function?
2) Deficiency causes what? |
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Definition
1) converts PEP->pyruvate, generating 1ATP; allosterically stimulated by fructose-1,6-bisphosphate;
2) Deficiency causes extravascular RBC hemolysis (analogous to G6PD, but b.c. they can't make any energy); splenomegaly will ensue w/ "work hypertrophy" of RES
similarly, hexokinase deficiency can cause the same thing |
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Term
| What is "work hypertrophy" and how can the spleen undergo it? |
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Definition
work hypertrophy is the expansion of the functional cells when put under increased demands.
E.g. when there is extravascular hemolysis, the RES undergoes "work hypertrophy", causing splenomegaly, because there is an increased demand on the splenic macrophages |
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Term
Name bacterial cause of meningitis for each description of spread to meninges:
1) Pharynx-> lymphatics-> meninges
2) Middle ear->contiguous tissue-> meninges
3) Traumatic wound-> Leaking CSF-> meninges
4) Pharynx-> blood-> choroid plexus-> meninges
5) Primary lung focus-> blood-> meninges |
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Definition
1) H.flu
2) S.pneumo
3) S.aureus (follows penetrating skull trauma or surgery; can also cause a brain abscess)
4) N.meningitidis
5) TB |
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Term
MOA of shiga toxin & verotoxin?
MOA of diphtheria toxin & pseudomonas toxin |
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Definition
Directly inhibit 60S ribosome
ADP-ribosylate EF2 -> prevent protein synthesis |
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Term
| Which cells in the thyroid are neural crest cells? What type of cancer do they produce? |
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Definition
C-cells (parafollicular)
they produce medullary thyroid cancers w/ characteristic sheets of cells in amyloid stroma |
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Term
| Describe the MEN syndromes |
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Definition
MEN1: Pituitary adenomas, Parathyroid adenomas, Pancreatic cancers (usually gastrinoma)
MEN2a: Parathyroid, Pheochromocytoma, medullary thyroid carcinoma
MEN2b: Pheochromocytoma, medullary thyroid carcinoma, oral/intestian ganglioneuromatosis w/ marfanoid habitus |
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Term
| Gram+, catalase- coccus that grows on 6.5% NaCl & bile |
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Definition
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Term
| How can you get enterococcus endocarditis? |
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Definition
| Post genitourinary procedures (e.g. cystoscopy). This is b.c. the invasive procedures will introduce this colonic bacteria into the sterile environment of the bladder |
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Term
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Definition
opioid antidiarrheal. (opiates decrease colonic motility)
This is combined w/ low doses of atropine (to prevent abuse) & marketed as "lomotil" or "Co-phentrope" |
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Term
| What is good about using Lorazepam, oxazepam, & temazolam in a person w/ liver disease? |
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Definition
These benzos aren't liver metabolized
(may have to consider these as first line agents for DT when there is significant liver disease, since diazepam/chlordiazepoxide, which are long acting first-line agents, are liver metabolized) |
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Term
| Virus that can mimic rheumatoid arthritis? |
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Definition
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Term
MOA of:
1) Imatinib
2) Abciximab |
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Definition
1) small molecule that binds BCR-ABL; treatment for CML
2) mouse-human anti GpIIb/IIIa |
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Term
Give bone disease for each description:
1) Osteoid matrix accumulation around trabeculae
2) Trabecular thinning with fewer interconnections
3) subperiosteal resorption with cystic degeneration
4) Lamellar bone structure resembling a mosaic pattern
5) Spongiosa filling the medullary canal w/ no mature trabeculae |
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Definition
1) VitD deficiency (rickets/osteomalacia)
2) osteoporosis
3) Hyperparathyroidism (remember "brown tumors" for primary)
4) Pagets disease of bone
5) Osteopetrosis (unmineralized spongiosa replacing bone marrow) |
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Term
| Lung disease in acute pancreatitis? |
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Definition
| ARDS. Damage to alveolarcapillary membranes results in interstitial and intraalveolar edema, acute inflammation, and alveolar hyaline membranes |
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Term
| Acute & Chronic cardiac transplant rejection: main histological features, timeline, & simple pathophysiology |
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Definition
Acute:
- Dense T-lymphocytic infiltrate (CD8)
- 1-4 weeks following transplant
- Host T-cells sensitize against foreign MHC
Chronic:
- Scant inflammatory cells & interstitial fibrosis
- Months to years after transplant
- T & B cell mediated. Anti-graft antibodies & sensitized T-cells cause damage
In most chronic rejection, the main histological feature is atherosclerosis |
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Term
Primary CNS lymphoma:
1) what type of cell?
2) what population? |
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Definition
1) Usually B-cells
2) immunocompromised (classically, AIDS pts)
these are high grade tumors with a poor prognosis. Restoration of T-cell count may cause remission
NOTE: B-cell lymphomas are common in AIDS pt; all CNS lymphomas have EBV infection & 50% systemic ones do. |
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Term
Friedreich ataxia:
1) spinal tract(s) destroyed?
2) Spinal abnormalities?
3) Heart?
4) Endocrine?
5) Inheritence? |
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Definition
1) Spinocerebellar (gait ataxia); Dorsal columns (position & vibration sensation)
2) Kyphoscoliosis & pes cavus (high arch)
3) HOCM
4) 10% have diabetes
5) AR (trinucleotide expansion disease, frataxin -> mitochondrial-mediated damage) |
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Term
1) Which releasing factor(s) does testosterone inhibit?
2) Inhibin? |
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Definition
1) LH & GnRH (secreated by Leydig cells)
2) FSH only (secreted by sertoli cells) |
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Term
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Definition
inhibits 11-beta-hydroxylase --> prevents cortisol formation
this is used to test HPA axis. Administration of metyrapone should increase ACTH secretion |
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Term
| Treatment for cyanide poisoning? |
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Definition
| Amyl nitrate (makes methemoglobin) & Thiosulfate (converts cyanomethemoglobin to thiocyanin, which is less toxic) |
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