1
Q
Nursemaid elbow (radial head subluxation)
A
The most common elbow injury in children.
This occur most frequently from a sharp pull on the hand while the forarm is pronated and elbow is extended.
-the sudden increase causes the annular ligament to tear from its periosteal attachment at the radial neck.
-by age of 5 the annular ligament becomes thick and strong decreasing the likehood of displacement.
-affected children present with the injured arm held close to the body with the elbow extended and the forearm pronated.
2
Q
Amyotrophic lateral sclerosis
A
Is the most common motor neuron disease.
Combined UMN and LMN lesions are characteristic, damage to motor neuron of the anterior horn and demylination of the corticospinal tracts (UMN lesion) are present.
-the result is denervation atrophy of the muscles.
-the disease manifest in middle aged people and has progressive course.
-Most patients die within 5 years of diagnosis.
-MCC of death is due respiratory complication.
-microscopic :
1. loss of neurons in the anterior horn(LMN)
2. Degeneration and atrophy of the lateral corticospinal tracts (UMN)
3. Loss of neurons in the motor nuclei of CN (V,IX,X,XII)
4. Denervation atrophy of the muscles.
Treatment: Riluzole, MOA.
3
Q
Nitrites exposure effect on iron
A
- iron binds to heme normally in the reduced ferrous state (Fe2+)
- nitrites cause poisoning by inducing the conversion of this heme iron to the oxidized ferric state (Fe3+) state, leading to formation of methhemoglobin.
- methhemoglobin is unable to bind O2.
- the affinity of any reisdual ferrous iron in the hemoglobin tetramer is increased causing a leftward shift of the O2 dissociation curve.
- however, the partial pressure of oxygen in blood, which represents the amount of oxygen dissolved in the plasma is unchanged.
4
Q
Protein structure in regard to alzehaimer disease
A
-a proteins primary structure is the sequence of amino acids linked be covalent peptide bonds.
-proteins may also assume a secondary structure such as alpha helix or beta sheet, due to subsequent hydrogen bonding.
-in pts with Alzheimer disease beta amyloid protein loses its alpha helical configuration and forms beta sheets, which are less soluble and therefore prone to aggregating. Aggregation of beta sheets are the primary component of senile plaques.
-
5
Q
Androgenic steroid abuse
A
- acne, testicular atrophy and erythrocytosis are highy suggestive.
- abuse of androgens, androgen precursors and agents that increase endogenous androgen production is most common in young adults who engage in competitive athletic activities or for cosmetic purposes.
- chronic androgen use may increase muscle mass but has multiple associated risks. Testosterone stimulate RBC production.
- androgens decrease gonadotropin secretion which results in testicular atrophy and decreased sperm production
6
Q
Pus
A
Consists of thin protien rich fluid known is liquor puris and dead leukocytes, primarily neutophils.
- during infection, macrophages and surrounding endothelial cells release cytokines such as IL-8 that trigger neutophils to enter the site of infection via cheomtaxis.
- IL-8 also induce phagocytosis in neutrophils once they have arrived.
7
Q
Ulnar nerve injury
A
Most commonly at the level of the elbow “funny bone” due to trauma or nerve compression, this injury present with loss of sensation in ulnar distribution.
- severe cases can result in weakness on wrist flexion/adduction, finger abduction/adduction and flexion of the fourth/fifth digits.
- weakness of the lumbricals in the 4th/5th digits may produce an ulnar claw deformity during extension of the fingers.
8
Q
Complete collapse of lung
A
- it usually occurs following obstruction of a mainstem bronchus. As the air trapped in the lung gradually gets absorbed into the blood there is loss of lung volumes due to alveolar collapse which causes trachea deviation towards the affected side.
- the loss of radiolucent air, combined with shifting of organs into the hemithorax appears as a completely opacified hemithorax on chest X-ray.
9
Q
Shifting of trachea on xray
A
Large pleural effusion or tension pneumothorax would cause shifting away from the affected lung, however mainstem bronchus obstruction (complete atelectasis) would cause shifting toward the affected side.
10
Q
Mycetoma
A
Aspergilloma , its caused by colonization by aspergillus of preexisting cavity.
11
Q
Nail neoplasm
A
Bluish neoplasm occuring underneath the nail bed may be either glomus tumor or subungual melanoma(both are rare)
- glomangioma is a tumor of the modifies smooth muscle cells of a glomus body. Glomus bodies are numerous small encapsulated neurovascular organs found in the dermis of the nail ned, pads of the fingers and toes and the ears.
- the role of the glomus body is to shunt blood away from the skin surface in cold temperatures in order to prevent heat loss, and to direct blood flow to the skin surface in hot envirnoments to facillitate the dissipation of heat.
12
Q
Criteria to determine malignant potential of adnomatous polyps
A
- Degree of dysplasia
- Histologic pattern: villous adenomas are more likely to undergo malignant transformation that tubular adenomas.
- Size: risk of malignancy increase with size, especially >4 cm.
13
Q
UV rays damage to DNA
A
-primarily through formation of abnormal covaelnt bonds between adjacent thymine or cytosine reisdues (pyrimidine dimers).
The presence of pyrimidine dimers interferes with base recognition during transcription and replication, and DNA mutations can results.
Pyrimidine dimers are removed by nucleotide excision repair (endonuclease complex)
14
Q
Opiates in spine mechanism
A
In spine, opiates bind to mu receptors on the primary afferent neuron resulting in closure of voltage gated calcium channels, reduced calcium influx and decreased excitatory neurotransmitter release from presynaptic terminal.
-opiates also bind to postsynaptic membrane, which opens K+ channels and leads to membrane hyperpolarization due to potassium efflux.
15
Q
Opioid intoxication
A
- Depressed mental status,
- decreased respiratory rate
- miosis
- bradycardia
- hypotension (due to histamine release)
- decreased bowel sounds also common
16
Q
Pregnancy induced venous thromboembolic disease treatment
A
- LMWH currently provides the best balance between mother and child benefits.
- they dont cross the placenta and short elimination time
17
Q
Esophageal varices is due flow to
A
Left gastric vein (coronary vein)
18
Q
Methimazole and propylthiouracil mechanism
A
Thionamide drugs used for treating hyperthyroidism. They inhibit thyroid peroxidase, the enzyme responsible for both iodine organification and coupling of iodotyrosines.
19
Q
In propionic academia which amino acids cant be converted to energy
A
Valine, isoleucine methionine and threonine
-treatment involve starting a low protein diet containing minimal amounts of valine, isoleucine, methionine and threonine.
20
Q
Esophageal dysmotility in CREST syndrome
A
Its the result of atrophy and fibrous replacment of the muscularis in the lower esophagus.
-the esophageal body and the lower esophageal sphincter become atonic and dilated resulting in symptoms of GERD. This increase the risk of barrets esophagus and stricture formation
21
Q
Suprapubic cystostomy
A
The trocar and cannula pierces the aponeurosis of the abdominal wall muscles, along with the laters of the superficial fascia, transversalis fascia, and extreaperitoneal fat.
However the peritoneum is not entered, reducing the risk of peritonitis and hemoperitoneum.
22
Q
Aging of skin contributing agents and pathophysiology
A
- multiple envirnomental factors ,especially exposure to UV light contribute to aging of the skin.
- UV type B contribute to sunburn and increased risk of malignancy
- UV type A contribute to photoaging, it produces reactive oxygen species which activates multiple inflammatory cell surface receptors and nuclear transcription factors. This leads to decreased collagen fibril production, along with upregulation of matrix metalloproteinases that subsequently degrade type I and III collagen and elastin.
23
Q
Kaposi sarcoma
A
The most common tumor in HIV patients, KS presents as multiple blue-biolet or brownish dermal plaques that first appear on the feet and legs before spreading proximally.
- KS lesions can also develop on the mucosal membranes of the face and genitals. In pts with late stage disease the lesions spread to the lungs and GI tract.
- histologic examination of skin afflicted with kaposi’s sarcoma shows spindle and endothelial cell proliferation, RBC extravasation and inflammation.
24
Q
PR interval and ß-blockers
A
- the longer the PR interval, the longer it takes for an electrical stimulus to travel from SA node to ventricles via AV node, bundle of his and fascicular branches.
- drugs that slow AV nodal conduction such as beta blockers will prolong PR interval.
- beta blockers dont have any specific effects on QRS or QT interval (except sotalol - class III properties )
25
Amyloid from multiple meyloma
AL amyloid forms due to accumulation of monoclonal immunoglobulin light chains. Its seen as an eosinophilic extracelluar deposts on H&E stain and shows apple-green birefringence with congo red stain when viewed under polarized light.
- AL amyloidosis contributes to the development of renal failure.
- its also deposited in the heart, tongue, CNS
26
Biopsy of cervical intraepithelial neoplasia
1. High grade CIN: means that the atypical cells have invaded beyond the lower 1/3 of cervical epithelium, it have high rate of carcinoma progression. (However it doesnt reach the basment mebrane, which usually signifies cancer development).
2. Low grade CIN: cell doesnt invade past lower 1/3 of cervical epithelium.
27
Huntington clinically
- chorea
- dementia
- behavioral abnormalities such as aggressiveness, apathy or depression.
28
1. Systolic murmur that accentuates with standing from supine position.
2. Medication that should be avoided in that case
hypertrophic cardiomyopathy.
- medication that should be avoided in HCM patients:
1. Vasodilators (eg, dihydropyridine Ca+ channel blockers, nitroglycerine, and ACEI) —> decrease systemic vascular resistance leading to decrease afterload and lower LV volumes.
2. Diuretics —> decrease LV venous filling and also result in greater outflow obstruction.
29
Homebox (gox gene)
A homebox is highly conserved DNA sequence that is uaully about 180 neucleotide in length. A gene containing homebox sequence is called a homeobox or hox gene.
- these genes typically codes for transcription factors that bind to regulatory region on DNA, altering the expression of genes involved in the segmental organization of the embryo.
- proper morphogenesis ensure that tissues, organs and structural elements of the body are formed in the correct position along the cranio-caudal axis.
- hometobox gene murations interrupt this developmental process, often resulting in severe abnormalities such as skeletal malformation and improperly position limbs and appendeges.
30
Prostatic plexus injury after prostatectomy
- lies within the fascia of the prostate and originates from the inferior hypogastric plexus (which itself is a continuation of the hypogastric nerve with additional input from pelvic and sacral splanchnic nerves)
- the lesser and greater cavernous nerves arise from the prostatic plexus and pass beneath the pubic arch to innervate the corpora cavernous of the penis and urethra.
- the cavernous nerves carry post-ganglionic parasymphatetic fivers that facilitate penile erection.
- prostatectomy or injury to the prostatic plexus can cause erectile dysfunction, as a result, surgeons attempt to preserve the integrity of the prostatic fascial shell during surgery.
31
SITS muscles function
1. Supraspinatus: abduction
2. Infraspinatus: external rotation
3. Teres minor : adduction and external rotation
4. Subscapularis: adduction and internal rotation.
32
What causes erythrocytes to sediment in inflammation (ESR)
- cytokines such as TNF-å, IL-1,IL-6 are released, these particular cytokines mediate systemic inflammatory response, in part stimulating hepatic production of acute phase proteins (reactants)(APP) (fibrinogen, ferritin, CRP, serum amyloid A or P, complement factors).
- many APP bind to microbes and fix complement. When increase the APP fibrinogen cause erythrocytes to form stack —> ESR
33
Wedge shaped kidney lesion on ct indicates
- renal infarction, which results from interruption of the normal blood supply to the kidney, the most common cause of renal infarction is systemic thromboembolism.
- the kidneys are more likely than other organs to suffer embolic infarctions as they are perfused at a higher rate (to support adequate GFR).
- systemic thromboembolism commonly occurs with AF as the irregular heart contraction can lead to clot formation. AF, which can be paroxysmal (therby going underdiagnosed), may have also caused this patients recent stroke, with emboli traveling to peripheral arteries in the brain. Systemic emboli can also occur following myocardial infarction and endocarditis.
- small number of collaterals between segmental renal arteries (“end-organ” blood supply) means that blood flow interruptions can lead to coagulative infarcts. Macroscopically, these appear as pale wedges.
34
Aortic regurgitation
- decrescendo diastolic murmur that begins immediately after A2. The murmur is high-pitched, blowing in quality and best heard along the left sternal at the 3rd and 4th intercostal spaces while the patient is sitting up and leaning forward with his breath held at end-expiration.
- the peak intensity of an AR murmur occurs immediately after the aortic valve closure, when the pressure gradient between the aorta and the LV at its maximum.
35
Fractures to the orbital floor
Orbital floor is composed of zygomatic bone and maxilla, most commonly result from direct frontal trauma to the orbit due to assault, motor vehicle crashes or sports injuries.
- the infraorbital nerve runs along the orbital surface of the maxilla in the infraorbital groove before traversing the infraorbital canal and exiting the skull via the infraorbital forament.
- damage can result in numbness and paraesthesia of the upper cheek, upper lip and upper gingiva.
- in addition displacement of the orbital contents through the floor may cause enophthalmus and entrapment of the inferior rectus muscle can impair vertical gaze.
36
Cardiac cathetrization of the pumonary artery.
- pulmonary artery catheter are used to diagnose pulmonary hypertension and occasionally for managment of critically ill patients.
- during pulmonary artery catheterization the ballon the distal tip of the catheter is advanced forward through the right atrium, RV, and pulmonary artery and finally into a branch of the pulmonary artery.
- once lodged in the pulmonary artery branch, the inflater ballon obstructs forward blood flow, creating a continuous static column of blood between the catheter tip and left atrium.
- the pressure measured at the catheter tip at this time is called pulmonary artery occlusion pressure or PCWP (same thing), and closely reflects left atrial and left ventricular end diastolic pressures
37
Common viruses and receptors they act upon
1. CMV —> cellular integrins
2. EBV —> CD21 (CR2)
3. HIV —> CXCR4/CCR5 and CD4
4. Rabies—> nicotinic Ach receptors
5. rhinovirus —> ICAM1 (CD54)
38
Hypercalcemia of malignancy
1. PTHrp —> decreased PTH and increased PTHrP —> hypercalcemia, seen in squamous cell carcinoma of lung, renal and bladder, breast and ovaries.
2. Bone metastasis —> increase osteolysis —> hypercalcemia(with low PTH and low VIT D)
3. 1,25 dihydroxyvitamin D —> increase calcium absorption —> low PTH and high VIT D . Seen in lymphoma
39
Alendronate is
Bisphosphonate drug.
- bisphosphonate mechanism :
1. Osteoclasts that resorb the bone take up the bisphosphonate and are unable to adhere to more bony surface to continue their resorption.
2. Induces osteoclast apoptosis and decrease development/ recruitment of osteoclast precursor cells.
- the net result is decreased bone loss and stable or increased bone mineral density on serial bone denitometry.
- patinets taking bisphosphonates are advised to take bisphosphonates on empty stomach with plenty of water due to poor GI absorption and to stay upright for 30 minutes due to esophageal erosions.
40
Beta blockers effect on glucose
Nonselective ß-blockers inhibit NE/EP mediated compensatory reactions to hypoglycemia. In addition blockade of ß2 adrenergic recptors inhibits hepatic gluconeogenesis and peripheral glycogenolysis and lipolysis.
- non selective ß-blockers should be used with cautio in diabetic patients as these can increase the risk of hypoglycemia and reduce patients awareness of hypoglycemia.
- selective ß1 blockers and ß blockers with intrinsic sympathomietic activity (pondolol, acebutolol) are preferred for diabetics as these have minimal effect on glucose metabolism and adrenergic symptoms/
41
Compylobacter transmission
1. Domestic animals, such as cattle, sheep, dogs and chicken ,this route of transmission is common in farm and lab workers.
2. Contaminated food such as undercooked poultry and unpasteurized milk.
42
Shigella transmission
Its a human pathogen transmitted via the fecal oral route by dirty hands, fomites in daycare centers and food contaminated by unhygienic handlers. (Animals dont carry this animal)
43
tRNA structure
1. Acceptor stem: created through base pairing of the 5’ terminal nucleotide with the 3’ terminal hydroxy group. The acceptor stem helps mediate correct tRNA recognition by the proper aminoacyl tRNA synthetase.
2. 3’ CCA tail is added to the 3’ end of tRNA as a posttranscriptional modification in eukaryotes and most prokaryotes. Several enzymes utilize this tail to help recognize tRNA molecules.
3. The D loop contains numerous dihydrouridine residues, which are modified bases often present in tRNA. The D loop facilitates correct tRNA recognition by proper aminoacyl tRNA synthetase.
4. Anticodon loop contains sequences that are complementary to the mRNA codon. During translation, the ribosome complex selects the proper tRNA based solely on its anticodon sequence.
5. The T loop contain T¥C sequence that is necessary for binding tRNA to ribosomes. This sequence refers to presence of ribthymidine, pseudouridine and cytidine residues.
44
Acute VS chronic mitral regurgitation
1. Acute(eg chordae tendinae rupture), the increase in regugiation is large —> very high LA pressure —> pulmonary edema. —> increased LV end diastolic volume (preload). LV after load decrease . Increasd preload and decreased afterload will lead to increase in EF due to increase in contractility, however much of the blood is lost in regurgitation —> hypotension and reduced CO.
2. In chronic MR, compensatory LA enlargment allows the LA to recieve the regurgitant volume at lower filling pressures, preventing the pulmonary edema from developing.
45
PI3K.AKT/mTOR pathway
Its an intracellular signaling pathway that is important for cellular proliferation. This pathway is typically activated within a growth factor binds to its receptor tyrosine kinase, causing autophosphorylation of specific tyrosine residues within the receptor.
- its highly active in many cancer cells as a result of mutation causing increased activity of PI3K or Akt or loss of function of PTEN. Mutation involving certain growth factor receptors can also enhance activity.
- drugs may target this pathway such as sirolimus (rapamycin) can treat certain cancer
46
Reactive arthritis
Causes: chlamydia, gonorhhea, salmonella, compylobacter, shigella, C.difficle.
Muscloskeletal: assymetric oligoarthritis, enthesitis, sacroillitis
Extrarticular symptoms: acute conjuctivitis, uterthritis, kkkeratoderma blennorrhagicum, oral ulcers
47
Eczematous dermatitis
Group of conditions characterized by erythmatous, papulovesicular weeping lesions.
-cute eczematous dermatitis is characterized histologically by spongiosis, an accumulation of edema fluid in intracellular spaces of the epidermis.
-the intercellular bridges become more distinctive in an edematous background and the epidermis is often descibed as spongy.
-
48
Churg straus disease (eosinophilic granulomatosis with polyangitis)
Small to medium vessel vasculitis, charactrized by late onset asthma, rhinosinusitis and eisinophilia, though it can involve many other organs systems including kidney, CV system, GI.
- symmetric multifocal neuropathy (“mononeuritis multiplex”) is particulary common due to vasculitis affecting the epineural vessels (eg, wrist drop due to radial nerve involvement). Other common manifestation include skin nodules, migratory/transient pulmonary infiltrates, and paranasal sinus abnormalities.
- in addition to eosinophilia, p-ANCA is positive in these patients.
49
Cortisol receptros are found in
Within the cytoplasm in association with heat shock proteins —> upon activation homodimers are then transported to nucleus —> gene expression.
50
Osteoporosis structure
- osteoporosis primarily involves trabecular, or spongy bone. The most prominent changes in osteoporosis occur in dorsolumbar vertebral bodies, as vertebrae are predominantely trabecular.
- the neck of the femur consist of 50% trabecular and 50% cortical bone.
- osteoporotic fractures are most commonly present in vertebral bodies and second most common in neck of femur.
- osteoporotic bone is seen with trabecular thining with fewer interconnections.
51
Amatoxin
Its found in a variety of posinous mushroroms (amanita phalloides known as death cap) and are responsible for the majority of mushrooms poisoning fatalities worldwide.
- after ingestion, amatoxin are transported to the liver via portal circulation where active transport by organic anion transporting polypeptide and sodium trauocholate co transporter, concentrates the toxin within the liver cells, there, it binds to DNA dependenent RNA polymerase II and lead to mRNA synthesis halting —> apoptosis.
- symptoms typically start 6-24 hrs after ingestion and include abdominal pain, severe cholera like diarrhea.
- diagnosis is by serum concentration of å-amanitin.
52
Atropine effect on the eye
- atropine causes mydriasis, resulting in narrowing of the anterior chamber angle and diminshed outflow of aqueous humor.
- this can precipitate angle closure glaucoma in pts with shallow anterior chambers or higher than normal intraocular pressure.
- acute closed angle glaucoma presents with unilateral severe eye pain and visual disturbances.
53
Blood flow in pulmonary circulation
In order to maintain blood glow through the body, the blood flow in the pulmonary circulation must closely match the blood flow in the systemic circulation.
- this is true for conitions of both exercise and rest as the circulatory system is continuous circuit. If the flow of blood through pulmonary circulation is less than the flow of blood through the systemic , LV would empty fully , and if the blood flow in pulmonary circulation is higher then the ventricle would become overloaded.
- thus the most similar thing between systemic and pulmonary circulation is blood flow per minute
54
High frequency hearing loss
-high frequency hearing loss commonly due to chronic noise exposure.
- transduction of mechanical sound waves into nerve impulses occurs in the organ of corti through :
Sounds reaches the middle ear by vibrating the tympanic membrane, the vibration is transferred to the oval window by ossicles, vibration of oval window causes vibration of basilar membrane—>hair cell bending causes oscillating hyperpolarization and depolarization of auditory nerve creating nerve impulses from sound.
-noise induced hearing loss results from trauma to the stereociliated hair cells of organ of corti.
55
Cricothyroid denervation injury
- it may be a complication of thyroidectomy, as the superior thyroid vein and artery and the external branch of superior laryngeal nerve travels together, and the external branch of superior laryngeal nerve supplies the cricothyroid muscle.
- this muscle acts to tense the vocal cords and denervation injury may cause a low, hoarse voice with limited range of pitch.
56
Abdominal aortic aneurysm presentation and risk factors
- presentation include pulsating, central abdominal mass
- focal dilation of Abdominal aorta typically occurs below the renal arteries.
- its associated with many risk factors such as age, smoking, hypertension, male sex, family history
- these lead to oxidative stress, vascular smooth muscle apoptosis and transmural inflammation of the aorta.
- inflammatory cells release matrix metalloprotinease and elastase that degrade extracellular matrix components leading to weakness and progressive expansion of the aortic wall.
57
Hypertension character in pheochromocytoma
It might be paroxysmal or persistent
58
Which lipid lowering agents are associated with gallstones formation
1. Fibrates
| 2. Cholestyramine
59
How is vasospasm following subarachinoid hemorrhage is treated
Calcium channel blockers specifically nimodipine
60
PBC symptoms
- present usually in mid aged female patients
- pruritus is the most common symptoms, it might be severe, progressive and nocturnal
- fatigue also reported.
- xanethomatous lesions on the eyelid, hepatosplenomegaly, or in the skin and tendons.
- lab abnormalities include elevated alkaline phosphatase and cholesterol, as well as elevated serum IgM.
- diagnosis is confirmed with demonstration of anti mitochondrial antibodies in the serum. Conditions associated include rheumatologic autoimmune disease.
61
Hemophilus infleuenza major virulence factor,
Its the polysaccharide capsule which is composed of the polymer polyribosylribitol phosphate (PRP).
- the PRP capsule protects the bacterium against phagocytosis and complement mediated lysis by binding factor H, a circulating complement control protein that prevents complement deposition on host cells.
- the conjugate Hib vaccine is composed of PRP conjugated to tetanus toxoid.
62
Drug distribution
- its not uniform, followin administration of single IV bolus, drug levels are high in central component(blood), however the drug is quickly distributed to the well vascularized peripheral compartment due to increased lipophilicity of the tissues compared to the blood.
- overtime drug redistribution will occur through the central compartment into the poorly vascularized peripheral compartment(skeletal muscles, bone , fat) which has the highest volume of distribution for lipophilic agents.
- redistribution occurs rapidly with highly lipophilic drugs and is responsible for the short duration of action seen with commonly used anesthetics such as propofol
63
E6 and E7 mechanism of action in HPV
They inhibit cell cycle regulatory proteins (P53, Rb)
- E6 binds to P53 —> ubiquination —> proteasome degredation.
- E7 binds to Rb
64
G6PD inheritance pattern
X-linked recessive disorder.
65
Graves disease clinical differentiation from hypoerthyrodism
- infiltrative dermopathy (peritibial myxedema)
- exopthalmos
- periorbital edema
- eye movement limitation (lid lag)
- all the other signs of hyperthyrodism
66
Premature lymphoblasts leukemia - ALL
- bone marrow smear will likely show several lymphoblasts with a high nuclear to cytoplasmic ratio, variably condensed nuclear chromatin and prominent nucleoli.
- differential diagnosis of acute premature leukemia include precursor B-ALL and precursor T-ALL.
- these 2 can be differentiated only be immunotyping, B cells will show CD10, CD19,20,21, Tdt , while T-cell shows CD2,3,4,5,7,8 and Tdt.
- ALL present with anemia, thrombocytopenia and neutropenia.
67
Ganciclovir
TMP-SMX
combination adverse effects
- ganciclovir triphosphate interfers with human host cell DNA synthesis. Major side effects include anemia, neutropenia and thrombocytopenia. Its commonly used to treat CMV.
- TMP-SMX inhibit different enzymes in synthesis of Folate, as a result TMP-SMX is associated with bone marrow suppression.
- combination of the 2 increase the risk for bone marrow suppression.
68
Oropharyngeal candida treatment
Nystatin, fluconazole and caspofunigin for oral/esophageal.
| -its commonly seen in asthmatics due to inhaled steroid adverse effect.
69
Familial retinoblastoma
Occurs due to germiline mutation that affects the Rb tumor suppressor gene on chromosome 13. All cells in the body of affected individual carry this mutation. as there are two alleles of the Rb gene, if the second allele is functional, malignancy doesnt occur. However a somatic second mutation acquired early in life is the second hit that lead to malignancy.
-familial retinoblastoma patients often develop other tumors(sporadic dont) , usually sarcomas later in life. Most commonly osteosarcoma results.
70
Interventricular hemorrhage (IVH)(Brain) in premature infants
- its a common disease of prematurity that can lead to long term neurodevelopmental impairment.
- it occurs most frequently in infants born before 32 weeks gestation and/or with birth weight <1.5 KG, and almost always occurs within the first 5 postnatal days. IVH can be clinically silent or present with an altered level of consciousness, hypotonia and decreased spontaneous movements.
- IVH usually originates from the germinal matrix, a highly cellular and vascularized layer in the subventricular zone from which neurons and glial cells migrate out during brain development.
- between 24-32 weeks the germinal matrix becomes less prominenet and its cellularity and vascularity decrease reducing the risk of IVH
71
Proliferative phase of hep b infection
The entire virion and all related antigens of the episomal HBV DNA are present . On the hepatocyte cell surface, viral HBsAg and HBcAg are expressed in conjunction with MHC-I molecules.
- this expression serves to activates the cytotoxic CD8 +T lymphocyes, which responds by destroying the infected hepatocytes.
- the virus itself doesnt have cytopathic effect, its the CD8 that causes the damage,
Usmle
flashcards
Decks in class (45)
# Cards
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Uworld- block 198
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UWorld Block 2136
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Block 399
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Block 482
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Block 596
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Block 691
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Block 788
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