1
Q
Diag?
A
Alzheimers
- widespread cortical atrophy, especially hippocampus —shows as a lot of black space on MRI
- narrowing of gyri and widening of sulci
- MRI here is normal
2
Q
- 67 yo f
- Acute onset dyspnea and chest pain, dies within mins
- stage IV ovarian cancer
- bed ridden for 2 mo
COD?
A
DVT –> PE
3
Q
Diag?
A
Parkinsons
- pic: diminished substantia niagra in midbrain (there is loss of pigmentation)
- Only on the R (the L one is normal)
4
Q
How to calculate relative risk?
A
5
Q
Drugs that cause tinnitus
A
- Aspirin
- quinidine (IA antiarrhythmic)
6
Q
What can Arginine be made into?
A
7
Q
- 48 yo m
- long hx alcohol abuse
- painless hematemesis
- incr HR, decr BP
- dies
- hemorrhage found in lower esoph
Diag?
A
Esophagela varices
- get from transmission of portal HTN to esophageal Vs
- alcohol is risk factor for cirrhosis and portal HTN
- This is usually in lower esoph
8
Q
Heart sound with pt is left lateral decubitus position
- sound is in late diastole
- best heard at apex
Which sound is this?
A
S4
9
Q
- 27 yo m
- solitary thyroid nodule
- nodules takes up radioactive iondine
diag?
A
Follicular thyroid adenoma (this is toxic type, not nodule) -s\consists of single palpable nodule, benign
-Histology is follicular
10
Q
Which enzymes destroy H2O2
A
Catalase (in phagolysosome) and glutathione peroxidase (in neutrophil)
11
Q
Differentiate bw parkinsons w/ dimentia vs lewy body dementia
A
- both have lewy bodies
- Lewy body dimentia if cognitive and motor sx onset is < 1 yr apart, otherwise it’s parkinsons w/ dimentia
12
Q
Pt previously had colon cancer
-how did pt get this?
A
Hematogenous spread of colon cancer through the venous protal system
13
Q
case fatality rate formula
A
CFR % = (NUMBER of deaths/ NUMBER of cases) x 100
= % of deaths that occur over the disease course
-if 10 ppt get meningitis, and 4 ppl die, CFR = 40%
14
Q
Pt has PID with a tender RLQ mass found on palpation
-What is the mass?
A
The mass is hydrosalpinx– where fallopian tube gets blocked and fills with fluid. You can see this in PID
15
Q
- 62 yo m
- 6 mo hx strange behavior
- stopped bathing and combing hair
- uncharacteristically rude
- mild memory problems
Diag?
A
Frontotemporal dementia (Pick’s disease)
- Frontal lobe changes: personality & behavior
- Temporal lobe changes: aphasia
- Hyper phosphorylated tau (pick) bodies : like like tangles in alzheimers but these are SPHERICAL/circular
16
Q
What procedure improves the immunogenicity of vaccines that use capsular polysaccharides as antigens?
A
Protein conjugation
-ex) S. pneumoniae vaccine: polysacchs converted/conjugated to diphtheria-like toxins)
17
Q
What is this?
A
- neurofibrillary tangles
- = intracellular hyperphosphorylate tau protein = insoluble skeletal elements
- # tangles correlates w/ degree of dementia
- See in Alzheimerz, and other neurodegenerated diseases
- Brain bx: amyloid plaques
18
Q
-pt has AIDs
Which organism caused this?
A
Toxoplasma gondii
- in non immunocompromised- see mono-like sx w/ (-) heterophila Ab test
- in IC- see mult ring enlancing lesions on MRI (really brain abscesses)
- also see mult ring enhancing lesions with primary CNS lymphona (distinguish the 2 by CSF analysis)
19
Q
Which enzyme responsible for making both ADP and GDP
A
PRPP
- for ADP: PRPP + ARPT
- For GDP: PRPP + HGPRT
- this is in purine salvage pathway
- defect can lead to hyperuricemia –> gout
20
Q
What is function of superoxide dismutase
A
21
Q
Which artery?
A
I think AICA (anterior inferior cerebellar A)
22
Q
How long does it take post vasectomy to have infertility
A
10 wks
-before that still see viable sperm in the ejaculate
23
Q
Diag?
A
Huntingtons
- Loss of neurons (atrophy) of caudate nu –> leads to ventriculomegaly
- image here is normal for comparassion
24
Q
- Pt w/ familial hypercholesterolemia
- Which drug reduces plasma VLDL and LDL, but causes cutaneous vasodil with that subsides with repeated doses
A
Niacin (B3)
- Inhs lipolysis (hormone sensitive lipase)
- Inhs CHolesterol —> VLDL in liver
25
What H arrow pointing to?
Adrenal gland
26
GERD is d/t?
**inappropriate relax of LES**
- RF: fat rich diet, alcohol, smoke, obesity, hiatal hernia
- Sx: heartburn (mimic cardiac chest pain), asthma
- Compl: barret esoph
27
- 60 yo m w/ cirrhosis
- had mult bl transfusions d/t trauma years ago
- no hx jaundice or hepatitis
Which type of hepatitis does he have?
* *Hep C**
- Transmitted by blood
- hx **blood transfusion**
- can progress to **cirrhosis** or carcinoma
28
Which purine/pyr pathway enzyme responsible for making thymidine
**DHFR**
* dUMP --\> dTMP
* Req: thymidylate synthase, and THF
* DHF --\> THF . requires DHFR
29
- doesn't want to go out with friends
- prefers indiv activities like hiking
- doesn't show emotion or understand feelings
Which personality disorder?
**Schizoid**
* voluntar social withdrawal
* limited emotional expression
* content w/ social isolation (vs avoidant)
Part of cluster A personality disorders ("Weird")-odd/eccentric, can't develop meaningful social relationships, no psychosis, genetic assoc w/ schizophrenia
30
- 45 yo m c/o 6 mo hx burning epigastric pain that ascends to chest
- worse after large meals and at night
- PE: inflamm distal 3cm esoph
Diag?
GERD
- heartburn (mimicks cardiac chest pain)
- fat rich diet is RF
- d/t reduced LES done
31
Fludrocortisone MOA
Fludrocortisone = **aldosterone analog**
- aldosterone causes incr Na reab and therefor H20 (acts on alpha intercalated, and principal cells in collecting duct)
- incr aldosterone --\> decr renin bc with incr aldosterone have incr bl vol and bp...JG cells stim to produce renin only when low bl vol or low bp
32
- 18 yo f, sexually active
- Fever, purulent vaginal discharge, lower abdominal pain
- Tender mass palpated in RLQ
Diag?
**PID**
- adnexal tenderness
- purulence cervical discharge
- can see hydrosalpinx = fallopian tube gets blocked and filled with fluid --\> RLQ mass
- Can also see salpingitis (inflamm fallopian tube)
33
- 55 yo m
- sudden severe chest pain radiating to the back
- pulses different in both upper extremities
- crackles in both lungs
- blowing early diastolic murmur in L sternal border
Diag?
Aortic dissection
- so saw aortig regurg: erbs point diastolic murmur, blowing
- can progress to LHF
34
Difference bw schizoid and avoidant
- **Schizoid** is content with social isolation
- **Avoidant** desires relationships with others, hypersensitive to rejection, feelings of inadequacy
35
- pt having procedure to separate uterus from all surrounding pelvic structures
- which structure that attaches to the cervical region and extends posteriorly would you want to cut in this pt?
Uterosacral lig
36
Round lig of the uterus attaches to what?
37
- 27 yo f
- 2 yr hx sporadic diplopia & 1 yr hx intermittent numbness/thingling
- during past yr had 4 episodes of urinary incontinence
- PE: mild dysarthria
- MRI: few, small, scattered, non-specific white matter plaques
Diag?
**Multiple sclerosis**
* demyelination oligodendrocytes
* Sx intermittent, they come and go
* Diplopia, ataxia, **scanning speech = dysarthria** (mimicks alcohol intox), intention tremor, **internuclear ophthalmoplegia**, sensory sx, **neurogenic bladder.**
* More common in ppl living far from equator
* Oligoclonal bands diag
* **MRI shows white matter plaques**
38
- 54 yo f c/o severe back pain
- Labs: incr Ca2+
- Urinalysis: Bence-jones proteins
Diag?
Multiple Myeloma
39
- pt vag bleeding immed after vaginal delivery of newborn at term
- Uterus exam: fragments of placenta adherent to uterine wall
- Absence of decidua basalis
diag?
**Placenta accreta** (type of morbidly adherent placenta)
- In accreta see placenta attaches to myometrium w/o penetration it, **most common** type
- In general, in morbidly adherent placenta= **defective decidual layer** --\> abnormal attachment and separation **after delivery.** See **post-partum bleeding**
40
What is the difference bw abruptio placentae and morbidly adherent placenta (placenta accreta, increta, percreta)
abruptio = premature placental separation from uterine wall before delivery
accreta/increta/percreta =separation after delivery
41
- histo: RBCs with spiny projections
- low cholesterol
- hx B/L retinitis pigmentosa, ataxia
Diag?
**Abetalipoproteinemia**
-spiky projections = acanthocytes ("Spur cells")-- d/t to lipoprotein buildup on cell wall --\> spikes
42
- 22 yo f
- pulm embolism 1 yr ago
- delivered stillborn 2 yrs ago
- Labs: increased PTT
Diag?
**Antiphospholipid syndrome**
- incr **PTT**
- pts have hx clotting, DVT --\> **pulm embolsim**
43
X-linked (Brutons) agammaglobinemia
44
Where does genital herpes remain latent
**sacral root ganglion**
genital herpes = HSV-2
45
- 22 yo f
- unable to conveive
- irregular menses
- hirtsutism, acne, obese
- no abnormalities of external genitalia
diag?
**Polycystic ovarian disease (PCOD)**
- d/t generation of follicles
- incr LH:FSH \> 2
- Incr LH --\> incr androgen production --\> hirtsutism, amenorrhea
- Androgen can be converted to estrone in periph adipose
- classic presentation: **obese, young f, infertile, amenorrhea, hirsutism**, insulin resistance so may have type II DM
- no ovulation bc there is const incr LH (women need LH SURGE to ovulate)
46
-fungins MIA
inh fungal cell wall synth
47
Cardiac tamponade
* = compression of the heart by fluids ( ex bl, effusions in pericardiac space) --\> decr CO
* Findings
* Becks triad:
* 1. Hypotension
* 2. distended neck veins
* 3. distance heart sounds
* Pulsus parodoxus (decr ampl of systolic bp by \>10 mm during inspiration)
* ECG: low-voltage QRS & electrical alternans
* Can be caused by:
* Ventricular free wall rupture (compl MI 5-14 days)
* Complications:
* Obstructive shock
48
What causes pulses paradoxus
= decr ampl of systolic bp by \< 10 mmHG
* Seen in
* cardiac tamponade
* asthma
* obstructive sleep apnea
* pericarditis
* croup
49
31 yo f
- 1 yr hx infertility
- IMG below
The cause of these findings is malformation of which embryonic tissue?
Paramesonephric (Mullerian) duct
50
- 51 yo
- hemoptysis, weight loss, lung CA, smoker, wheezing, HTN, clubbing
- Labs: urine Osm \> serum Osm, low Na+
diag?
**SCLC --\> SIADH** (paraneoplastic)
SIADH --\> excessive free water retention (urine osm \> serum osm), low sodium
51
ADH vs aldosterone
52
SIADH vs DI
53
2 ways to get increased ADH
54
What do you give for warfarin overdose?
**Fresh frozen plasma**
- this increases all the clotting factors. Use for immed anticoag reversal
- Warfarin inh epoxide reductase --\> so can't activate 2,7,9,10,C,S
55
-acute fever, N/V, muscle aches
Shows gram stain
Which organism?
**Listeria monocytogenes**
-gram +, intracellular rod
56
- headache, slurred speech
- difficulty understanding and answering questions
- L sided numbness and paralysis in face and upper extremity
Which artery is involved?
**Middle cerebral A**
-supplies lat cortex
57
Where do you inject needle for thoracocentesis
Above the 9th rib, midscapular line
58
E.coli virulence factor in UTI
fimbriae -- allows **adhesion**
59
What is equation of loading dose
-given Vd, know it's IV bolus, peak plasma conc given
**Loading dose** = (Cp x Vd) / F
60
- Was at incr altitude for 4 wks
- 2 wks after returning to sea level, ventilation returned to normal, but O2 deliver to muscles is greater.
An incr in what describes the O2 delivery finding?
Hematocrit
61
- 25 yo m
- get temp of 101.5 after running first 10k
his temp returned to normal later bc of which mechanism?
evaporation of sweat
62
Alcoholic vomits and has lung cavitations.
Which organisms do you see on culture?
this is aspiration pneumonia
-organisms are klebsiella or it's normal oral flora
63
If a pt has volume contraction , does it mean they have increased or decreased volume of body fluid?
Decreased body fluid (hypovolemia)
-get from loop diuretics
Rx
flashcards
Decks in class (5)
# Cards
