UWorld mixed > test #39 4.29 > Flashcards

test #39 4.29 Flashcards

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1
Q

what does “end-organ” blood supply mean?

A

interruptions in blood flow lead to formation of infarct

renal: small number of collaterals between segmental renal arteries

brain too?

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2
Q

recall nephrotic syndrome presents w/ 5 things

A
  1. edema (loss of albumin / oncotic pressure
  2. proteinuria
  3. hyperlipidema
  4. hypercoagulation (loss of antithrombin III & increased coag factors
  5. infection (loss of immunoglobulins)
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3
Q

histology of crohn’s vs. ulcerative colitis

A

crohns: noncaseating granulomas & lymphoid aggregates (Th1 mediated)

ulcerative colitis: crypt abscesses (Th2 mediated)

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4
Q

blood in crohn’s vs. ulcerative colitis

A

crohn’s: + occult blood

ulcerative colitis: gross bleeding

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5
Q

string sign on barium swallow

A

crohn’s disease: narrowing of the intestinal segment due to inflammation of intestinal wall

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6
Q

ulcers in crohn’s? gross morphology?

A
  1. linear or serpiginous ulcerations
  2. cobblestone mucosa
  3. transmural inflammatory infiltrate.

“string sign”

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7
Q

gross morphology of ulcerative colitis

A
  1. mucosal & submucosal inflammation
  2. friable mucosal pseudopolyps w/ freely hanging mesentary

loss of haustra = lead pipe

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8
Q

cells in moles vs. choriocarcinoma

A

mole: only trophoblasts; swelling villi
choriocarcinoma: trophoblasts & syncitiotrophoblasts; NO VILLI

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9
Q

clinical presentation of:

complete vs. partial hydatidiform mole

A

both: vaginal bleeding & cramps/pressure

complete:
- SIZE greater than dates &
- extremely HIGH b-hCG

partial:

  • normal size
  • b-hCG high/normal

[hCG can lead to:

  • hyperemesis gravidarum
  • pre-eclampsia
  • hyperthyroidism
  • theca-lutein cysts
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10
Q

macroscopic: complete vs. partial hydatidiform mole?

A

complete: friable mass of cystic, thin-walled, grapelike structures. exclusively TROPHOBLASTIC TISSUE. “bunch of grapes”
partial: mix of normal & gross enlarged chorionic villi; FETAL PARTS (fetus, cord, amniotic membrane)

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11
Q

micropscopic appearance: complete vs. partial hydatidiform mole?

A

complete: enlarged, EDEMATOUS villi w/ extensive & diffuse trophoblastic HYPERPLASIA
(no fetal tissue)

partial: some enlarged vili w/ more moderate & FOCAL trophoblastic hyperplasia.
- normal villi & fetal tissue also present

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12
Q

karyotype of complete & partial hydatidiform mole?

A

complete: completely PAPA 46 XX or 46 XY (sperm fertilizes empty egg; sperm chromosomes duplicate usu: 46 XX more common)

partial: 69 XXX or XXY
(TRIPLOID)
usu 1 egg w/ 2 sperms

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13
Q

risk of malignancy in complete & partial hydatidiform mole?

A

complete: 15-20% risk of malignant trophoblastic disease
partial: low risk of malignancy <5%

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14
Q

where is TRH made?

A

paraventricular nucleus of hypothalamus

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15
Q

main regulator of TSH section?

A

T3

  • T3 acts on paraventricular nucleus to decrease synthesis/release of TRH.
  • down regulate TSH gene transcription & TRH receptor expression
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16
Q

T4 in peripheral tissues

A

converted to T3 or rT3 by specific deiodinases

t3 cannot become T4 or rT3

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17
Q

potency, half-life, metabolism of T4, T3, rT3

A

half-life
T4: 7 days
T3: 1 day
rT3: <1 day

cleared via glucuronidation in liver

[t3 not prescribed bc short half-life & rapid GI absorption = wide fluctuations]

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18
Q

acute acalculous cholecystitis

A

acute inflammation of gallbladder in absence of stones.

stasis & ischemia

PE: jaundice & palpable right upper quadrant mass = NOT SEEN IN calculous cholecystitis

complications: gangrene, perforation, emphysematous cholecystitis – infxn w/ gas-producing agent: clostridium, e. coli

usu in hospitalized patients & severely ill

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19
Q

porcelain gallbladder

A

diagnosed on abdominal radiograph: rim of calcium deposits outline gallbladder

associated w/ gallbladder carcinoma

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20
Q

cholechondral cysts

A

congenital dilations of common bile duct

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21
Q

chronic cholecystitis results in..

A

thickening of gallbladder wall.

US: shruken, fibrosed gallbladder

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22
Q

clornarchis infxn of gallbladder is associated w..

A

brown pigment stones

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23
Q

black vs. brown gallstones

A

pigment stones

black: intravascular hemolysis
brown: biliary infxn

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24
Q

how does valsalva affect heart?

A

decrease preload.

exhale against closed glottis

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25
systemic mastocytosis
abnormal proliferation of mast cells & increased histamine secretion --> increase histamine --> gastric hypersecretion can see nests of mast cells in bowel mucosa
26
Rokitansky-Aschoff sinus
chronic cholecystitis: chemical irritation from long-standing cholethiasis herniation of gallbladder mucosa into muscular wall --> Rokitansky-Aschoff sinus: ducts in muscle late complication: porcelain gallbladder
27
mast cells in GI tract?
systemic mastocytosis!
28
systemic mastocytosis
mast cell proliferation in bone marrow & other organs increase histamine 1. GI: increased gastric acid - inactivation of pancreatic & intestinal enzymes --> diarrhea - also N/V, cramps, ulcer 2. syncope, flushing, hypotension, tachycardia, bronchospasm 3. pruitus, uticaria, dermatographism
29
H2 receptors increase intracellular
cAMP | gastrin/Ach = Ca2+
30
gastrin & Ach increase intracellular..
Ca2+ | H2 = cAMP
31
most potent action of gastrin
most potent: increase histamine synthesis & release by ECL cells also: stimulates Ca2+ and acid release from parietal cells
32
what intracellular mediators increase H+ efflux from parietal cells
cAMP and Ca2+ via H+/K+ ATPase
33
6-mercaptopurine / azathioprine blocks what enzyme?
PRPP amidotransferase | inhibit de novo purine synthesis after being converted to active metabolites by HGPRT
34
how is 6-mp / azathioprine degraded?
xanthine oxidase reduce dose when also on allopurinol
35
pentostatin
cytotoxic purine that is an irreversible inhibitor of ADA
36
cladribine
cytotoxic purine analog that is resistant to degradation by ADA
37
retroperitoneal structures
SAD PUCKER Suprarenal/adrenal Aorta / IVC Duodenum (2-4th) ``` Pancreas (except tail) Ureters & Bladder Colon (descending & ascending) Kidney Esophagus (lower 2/3rd) Rectum (partial) ``` or: 1. major vessels: - abdominal aorta - IVC - their branches 2. solid organs: - pancreas (except tail) - kidney - adrenal glands 3. hollow organs: - parts 2/3 & part of 4 of duodenum - ascending & descending colon (secondarily) - rectum - ureters - bladder 4. vertebral column & pelvic muscles
38
retroperitoneal hematoma (in a stable patient) associated w/
abdominal/pelvic trauma PANCREATIC injury --> retroperitoneal hematoma
39
abdominal blow from malpositioned seat belt / steering wheel --> retroperitoneal hematoma (in a stable patient) bc of damage to
PANCREAS
40
transverse colon, spleen, liver..
INTRAperitoneal organs
41
testicular malignancy w/ hyperthyroidism
must secrete b-hCG choriocarcinoma; disordered syncitiotrophoblasts & cytotrophoblasts. hematogenous metastasis to lung, liver, brain. can produce gynecomastia or hyperthyroidism (B hCG like LH & TSH)
42
95% of all testicular tumors are..
germ cell tumors, often malignant, in young men
43
testicular tumor w/ fried-egg appearance, high placental ALP?
seminoma! malignant, painless, usu 3rd decade, late mets, excellent prognosis
44
testicular tumor w/ schiller-duval bodies and high AFP
yolk-sac (endodermal sinus tumor)
45
presentation of teratoma in male scrotum
may be malignant. benign in children though. 50% have both b HCG and AFP elevations
46
malignant hemorrhagic mass w/ necrosis in testes w/ glandular/papillary morphology
embryonal carcinoma worse prognosis than seminoma usu mixed w/ other types associated w/ elevated bHCG. also AFP if mixed
47
testicular nongerm cell tumors
1. Leydig cell 2. Sertoli cell 3. testicular lymphoma mostly benign
48
Reinke crystal in testicular tumor
Leydig cell tumor, nongerm cell. androgen producing, gynecomastia in men, precocious puberty in kids. golden brown colour
49
Sertoli cell tumor in male
androblastoma from sex cord stroma
50
most common testicular malignancy in older men
testicular lymphoma not a primary cancer, usu arises from lymphoma mets to testes aggressive
51
demographics of squamous cell carcinoma
asia, africa, south america associated w/ HPV and lack of circumcision
52
precursor in situ lesions of squamous cell carcinoma of penis
1. bowen disease 2. erythroplasia of Queyrat 3. bowenoid papulosis
53
bowen disease
precursor lesion to SCC of penis on penile shaft leukoplakia
54
erythroplasia of Queyrat
precusor lesion of SCC of penis on glans erythroplakia
55
Bowenoid papulosis
precursor lesion to SCC of penis reddish papules
56
priapism associated w/ (3)
painful sustained erection 1. trauma 2. sickle-cell: trapped RBC 3. medications: anticoagulants, PDE-5 inhibitors, cocaine, alpha-blockers, trazodone
57
hCG is structurally similar to (3)
FSH, LH, TSH
58
which hormones can bind to TSH receptors
TSH and HCG (at much lower affinity) note: FSH cannot! even though structurally similar!
59
cranial n. emerge from..
CN III and IV oculomotor & trochlear (dorsal) midbrain CN V pons CN VI, CN VII, VIII, IX, between pons & medulla CN X between olive & medulla CN XI spinal cord CN XII between pyramid and olive
60
which is the only CN to emerge dorsally
CN IV trochlear | dorsal midbrain
61
anterior pons lesion
dysarthria & ataxic hemiparesis - corticopsinal tract (contralateral hemiparesis & babinski) - corticobulbar tract (contralateral lower facial palsy & dysarthria also affect pontine nuclei & pontocerebellar fibers --> contralateral dysmetria & dysdiadochokinesia
62
lesions of cerebellum produce (contralateral/ipsilateral lesion)? lesions of pontocerebellar fibers in basis pontis?
cerebellar: ipsilateral | pontocerebellar fibers: contralateral bc fibers enter cerebellum through contralateral cerebellar peduncle
63
where does facial n arise?
pontomedullary junction level of facial colliculus below middle cerebellar peduncle
64
middle cerebellar peduncles
incoming information from cerebrum to cerebellum, either side of pons
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where does trigeminal n arise
lateral aspect of midpons, at level of middle cerebellar peduncle
66
where does hypoglossal n arise
preolivary sulcus at level of rostral medulla
67
where does oculomotor n. arise?
at level of superior colliculus & red nucleus (midbrain)
68
where does trochlear n. arise
behind midbrain level of interior colliculus level of red nucleus. only cranial n. to decussate before innervate target
69
what is the only CN to decussate?
trochlear, CN IV
70
glucocorticoids increase protein synthesis in..
LIVER (related to gluconeogenesis & glyocgenesis, proteolysis, lipolysis) increase synthesis of PEP carboxykinase & glucose 6-phosphatase, glycogen synthetase
71
major effects of glucocorticoids (mnenomic)
BIG FIB increase: 1. blood pressure a1 receptor (permissive) 2. insulin resistance 3. gluconeogenesis, glycogenesis, proteolysis, lipolysis (synthesize more PEP carboxykinase & G 6-phosphatase & glycogen synthetase decrease: 1. fibroblast production of collagen 2. immune system - inhibit production of leukotrienes and prostaglandins (block phospholipase A2 cleavage) - inhibit leukocyte adhesion (neutrophilia) - block histamine release from mast cells - reduce eosinophils - block IL-2 production 3. bone formation - decrease osteoblast activity - increase renal Ca2+ wasting - decrease Ca2+ GI absorption
72
what receptor does glucocorticoids upregulate
alpha-1 BLOOD PRESSURE
73
what receptor does T3 upregulate?
beta-1 HEART RATE. etc
74
glucocorticoids favor catabolism of which 2 tissues? how?
skeletal muscle & adipose tissue bc block insulin effects results in proteolysis & lipolysis
75
glucocorticoid induced decrease in fibroblast activity causes (2)
1. skin thinning: purple striae, easy damage | 2. CT around capillary thin --> easy bruising
76
positive skew
smaller numbers predominant in the data set long slope / tail extends in positive direction mean > median > mode median = better measure of central tendency here
77
negative skew
larger numbers predominate in data set long slope / tail extends in negative direction mean < median < mode median is better measure of central tendency here
78
carbon tetrachloride CCl4
causes free radical injury oxidized by P250 system makes free radical --> reacts w/ structural lipids of cell membranes lipid peroxidation --> lipid degradation and hydrogen peroxide formation --> vicious cycle swelling of ER, destruction of mitochondria, increased membrane permeability --> hepatic necrosis
79
symptoms of thyrotoxicosis
palpitations, nervousness, easy fatigability, fine tremor, diarrhea, hyperhidrosis, heat intolerance, weight loss, hyperreflexia, dermopathy, opthalmia
80
thyroid opthalmia
exopthalmos, conjunctival hyperemia, periorbital edema
81
exopathalmosis due to..
increased soft tissue mass in bony orbit due to enlargement of extraocular muscles from myositis, fibroblast proliferation, and overproduction of ground substance in response to antithyroid antibodies.
82
finely granular eosinophilic granules in hepatocytes?
hepatitis B! hepatocellular cytoplasm becomes filled w/ spheres & tubules of HBsAg GROUND GLASS APPEARANCE
83
mallory bodies
eosinophilic big inclusion in hepatocytes. hepatocytes will also have fatty changes ubiquinated keratin fibers in liver of alcoholics
84
describe the PI3K signalling pathway
important for cell proliferation ``` growth factor RTK autophosphorylation activates PI3K (PIP2 -> PIP3) PIP3 activates Akt (protein kinase B), a serine/threonine specific protein kinase ``` Akt activates mTOR, which translocates to nucleus -- cell survival, anti-apoptosis, angiogenesis.
85
mTOR activation is usu inhibited by? activated by
inhibited by PTEN (phosphatase & tensin homolog), removes phosphate added by PIP3 activated: growth factors & PIP3 (PI3K/Akt/mTOR)
86
what determines fate of pyruvate?
oxygen. low oxygen: lactate dehydorgenase converts pyruvate -> lactic acid (regenerate NAD+) oxygen: pyruvate dehydrogenase converts pyruvate -> acetyl CoA
87
soleus & paraspinal muscles contain what type of fibers
postural | type 1: red, slow twitch. ATP = oxidative metabolism
88
cells involved in granuloma formation (TB formation)
1. Th1 CD4+ cells secrete IFN-y 2. activates CD8+ cytotoxic T cells and macrophages 3. macrophages secrete TNF-alpha, important for granuloma formation
89
d-xylulose
monosaccharide that can be absorbed w/o action of pancreatic enzymes. see if malabsorption due to pancreatic or intestinal pathology
90
dobutamine on the heart
B-adrenergic agonist predominant B1 > B2 mostly affects myocardium 1. positive ionotropic: increased contractility. increased cardiac output, decreased ventricular filling presure 2. weakly positive chronotropic: increases heart rate. less pronounced than associated w/ dopamine both increase myocardial oxygen consumption 3. increases cardiac conduction velocity (undesirable --> arrythmia)
91
nitroglycerin on HR
venous pooling -> reflex tachycardia
92
nitroglycerin on myocardial oxygen consumption
reduce preload --> reduce oxygen consumption, used to rx: angina pectoris.
93
what decreases pulmonary capillary wedge pressure
aka left atrial pressure? decreased preload: i.e. nitroglycerin, furosemide increased contracility: i.e. dobutamine
94
anything that increases perfusion also..
increases urine output! increased renal perfusion.
95
warfarin in pregnancy
TERATOGEN. no.
96
where are snRNP synthesized? by which polymrease
in the nucleus, RNA pol II
97
how does sleep apnea lead to pulmonary HTN?
hypoxemia --> pulmonary vasoconstriction 50% will also develop systemic HTN due to chronic sympathetic cardiovascular stimulation (re: hypoxemia)
98
official diagnosis of narcolepsy
excessive daytime sleepiness, cataplexy, REM-sleep related phenomenon (like hallucinations and sleep paralysis) recurrent lapses into sleep (minimum 3x/wk for 3 months) atleast one of following: 1. cataplexy (loss of muscle tone w/ strong emotion 2. low CSF hypocretin 3. shortened REM latency associated w/ hypnagogic or hynopompic hallucinations and sleep paralysis
99
most common cause of excessive daytime sleepiness
obstructive sleep apnea constantly waking up w/ apnea
100
first generation antihistamines have what common side effects
chlorpheniramine and diphenhydramine antimuscarinic, antialpha-adrenergic, anti-5HT
101
how do H1 receptor blockers work?
reverse blockade decrease receptor activity by increasing proportion of inactive H1 receptors!
102
alcohol induced hepatic steatosis
decrease in free fatty acid oxidation secondary to excess NADH / NAD+ ratio --> (due to alcohol and acetaldehyde dehydrogenase) 1. promotes glyceraldehyde 3-phosphate -> glycerol 3-phosphate -> triglyceride synthesis 2. blocks TCA production of NADH -> promotes use of acetyl-CoA for ketogenesis and lipogenesis mostly: decrease in free fatty acid oxidation secondary to excess NADH also: impaired lipoprotein assembly/secretion, increase in peripheral fat catabolism
103
stain for lipids w/ (2)
sudan black or oil red O
104
what is transferrin & total iron binding capacity
hepatic synthesis of transferrin in markedly increased in states of F2+ deficiency. transferrin always inverse to saturation same direction as TIBC high transferrin means increased serum total Fe2+ binding capacity high transferrin -> low iron low transferrin -> high iron
105
normal ferritin states
in plasma. usu 1/3rd saturated w/ Fe2+
106
iron panel in iron deficiency anemia (ferritin, transferrin, MCV, folate, neutrophils
low ferritin high transferrin low MCV (microcytic) normal folate & neutrophils
107
cyanotic toe discoloration, renal failure following invasive vascular procedure suggests
atheroembolic disease of renal arteries (cholesterol lodged)
108
livedo reticularis
swelling of venules bc of clogged capillaries many causes
109
isoniazid resistance (2)
1. stop catalase-peroxidase enzyme expression | 2. genetic modification of mycolic acid synthesis enzyme
110
resistance to ethambutol
increased production of arabinosyl transferase
111
resistance to rifampin
mutation in gene for DNA-dependent RNA polymerase
112
resistance to streptomycin
modification of 30S ribosomal protein stxr
113
how does pyrazinamide work?
converted to pyrazinoic acid, lowers environmental pH in susceptible strains of TB. must be converted to active form via pyrazinamidase
114
resistance to pyrazinamide?
modified pyrazinamidase (needed to convert pyrazinamide to active form)
115
tryptophan is essential amino acid & precursor for (3)
(1) niacin (nicotinic acid) (2) 5-HT (3) melatonin
116
Hartnup disease (defect & clinical manifestation)
defective intestinal & renal absorption of tryptophan. clinical: niacin B3 deficiency: pellagra (dermatitis, neuro: ataxia, usu wax & wane,
117
differentiate Hartnup disease from Fanconi syndrome
both aminoaciduria. Hartnup: lose neutral amino acids - alanine, serine, valine, threonine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan, histidine) Fanconi: generalized amino aciduria - will ALSO have proline, hydroxyproline, argigine
118
seborrheic keratosis
flat, greasy, pigmented squamous epithelial proliferation. keratin-filled cysts. look "stuck on" head, trunk, extremities common benign neoplasm on older people associated w/ Leser-Trelat sign
119
Leser-Trelat sign
sudden appearance of multiple seborrheic keratosis, suggesting underlying malignancy (GI, lymphoid)
120
riboflavin deficiency (B2)
FMN, FAD (needed for enzymes in ETC) 2 C's of B2 CHEILOSIS, glossitis, keratitis, conjunctivitis, photophobia, lacrimation, CORNEAL VASCULARLIZATION, seborrheic dermatitis
121
decarboxylation & transamination requires what cofactor
vitamin B6 (pyridoxine)
122
clinical presentation of pyridoxine B6 deficiency
anemia, peripheral neuropathy, dermatitis
123
tocopherol
vitamin E free radical scavenger (antioxidant) deficiency: myelopathy / neuro dysfunction
124
erythematous papules w/ central scale due to hyperkeratosis. "sandpaper-like" texture can turn into cutaneous horns
actinic keratosis precursor to squamous cell carcinoma
125
well-circumscribed RAISED papules & plaques covered w/ thick silver scale
psoriasis usu scalp, trunk, extensors (elbow/knee)
126
spongiosis
edema of the epidermis associated w/ atoptic dermatitis (type I HSR)
127
pityriasis rosea presentation
herald patch: pink/brown scale plaque w/ central clearing & collarette of scale on trunk, neck, extremities followed by: maculopapular rash in "christmas tree" pattern along skin tension lines
128
patent PDA associated with..(3)
1. prematurity 2. congenital rubella 3. fetal alcohol syndrome
129
ductus arteriosus comes from what aortic arch
6th | also proximal pulmonary artery
130
1st aortic arch
maxillary artery 1=max
131
2nd aortic arch
stapedial / hyoid artery stapedial is second
132
3rd aortic arch
common carotid & proximal internal carotid C = 3rd letter of alphabet
133
4th aortic arch
left: aortic arch right: right subclavian 4 -> 4 limbs, systemic
134
6th aortic arch
PDA & proximal pulmonary artery
135
path of right recurrent laryngeal & left recurrent laryngeal
right: under right subclavian left: under PDA (lower)
136
tissue development of branchial cleft, arch, and pouch
cleft: ectoderm arch: mesoderm (cartilage/muscle) pouch: endoderm
137
rhomboid major innervation
dorsal scapular nerve
138
teres major innervation
subscapular nerve adduct & medially rotate
139
inheritance of hereditary spherocytosis
autosomal dominant
140
describe HFE expression and regulation of Fe2+ load
autosomal recessive basolateral surface of epithelial cells in small intestine crypts.. complexes w/ B2 microglobulin, binds to transferrin receptor to regulate endocytosis of transferrin/Fe2+ complex (ferroportin) iron released into cell: added to iron regulatory pool --> DETERMINES intensity of APICAL Fe2+ UPTAKE mutation in HFE -> unregulated Fe2+ absorption --> liver cirrhosis & hepatocellular carcinoma
141
two types of amyloid deposits in alzheimer's disease
1. brain parenchyma: senile plaques 2. brain vascular walls: amyloid angiopathy. damage media & adventitia, cause thickening of basal membrane, stenosis, and fragmentation of internal elastic lamina can both be seen in healthy elderly individuals
142
pseudodementia
depression in elderly, can cause confusion & declining mental function
143
histology of Pick's disease?
atropy of frontotemporal regions. can see spherical tau protein aggregates (intracellular) (don't survive neuron, don't serve as marker for disease progression) social disinhibition, speech abnormalities, and emotional flattening
144
gross/microscopic features of craniopharyngioma
1. calcified cysts: lined w/ stratified squamous epithlium 2. keratin pearls 3. yellow, viscious fluid rich in cholesterol crystals
145
6 complications of crohns
1. intestinal- fistula, stricture, perianal disease, risk of adenocarcinoma 2. skin: pyoderma gangrenosum, erythema nodosum 3. joint: arthritis, ankylosing spondylitis 4. eyes: iritis, uveitis, episcleritis 5. malabsorption: oxalate kidney stone, anemia, hypoproteinemia, b12 & folate def, gallstones 6. liver: cholangiocarcinoma
146
pyoderma gangrenosum
deep ulcer w/ violaceous border, usu on leg associated w/ ulcerative colitis & crohns
147
describe oxalate excretion in gut.
Ca2+ binds oxalate --> insoluble Ca2+ oxalate salts --> excretion
148
how does crohn's disease lead to increased kidney oxalate stones?
impaired bile acid reabsorption. bile acid bind lipid & prevent reabsorption. Ca2+ binds to this too --> soap complexes less Ca2+ to bind to oxalate --> increased oxalate absorption
149
oxalate stones in kidney, think (2)
(1) ethyelene glycol posioning | (2) crohn's disease
150
what does window period in HBV infection refer to?
time when HBsAg is down, but HBsAb is not yet up. HbcAb IS detectable in window period --> diagnose HbsAg cleared
151
most specific marker for diagnosis of ACUTE hep B
IgM HbcAb (window period)
152
most common appendiceal tumor
carcinoid
153
octreotide mechanism
analog of somatostatin inhibit secretion of many hormones used for carcinoid & VIPoma
154
ondansetron
potent anti-emetic selectively block 5HT-3
155
3 histological features in acute hepatitis
1. diffuse ballooning degeneration: hepatocyte swelling 2. mononuclear cell infiltrate 3. councilman bodies (eosinophilic apoptotic hepatocytes
156
aminoglycoside mechanism of resistance
bacterial transferase enzymes inactivate drug by acetylation, phosphorylation, adenylation
157
ONLY renal stone that is radiolucent
uric acid stone
158
how is Fe2+ absorption regulated (2)
1. hepcidin (internalize basolateral ferroportin -> decrease transport across intestinal epithelium & decrease release from macrophages) 2. HFE -> encourages ferroportin to bring in Fe2+ basolaterally, increasing enterocyte Fe2+ store, increasing apical iron absorption via DMT-1 hepcidin: increases iron stores in macrophages HFE: decreases iron reabsorption in GI
159
most common malignancy of SMALL BOWEL
carcinoid (esp appendix)
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