Mixedbunch

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Author:
docdee
ID:
177319
Filename:
Mixedbunch
Updated:
2012-10-15 19:03:25
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usmlemix
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Description:
GI, heme, renal, resp.
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  1. Materials needed to perform PCR
    • 1. DNA template (region of DNA to be amplified)
    • 2. 2 primers (complementary to the regions flanking the amplified DNA)
    • 3. DNA polymerase
    • 4. Deoxynucleotide triphosphates (Adenosine TP)
  2. Thoracocentesis locations

    Mid-axillary damage to liver and lung - locations?
    • Mid-clavicular: b/w 5th and 7th rib
    • Mid-axillary: b/w 7th and 9th rib
    • Paravertebral: b/w 9th and 11th rib

    Midaxillary: Inserting above 9th rib can cause damage to lung, insertion below 9th rib = damage to liver
  3. Somatic sensory sensation to the anterior 2/3 of the tongue?
    Taste sensation to the anterior 2/3?
    • Lingual nerve, branch of V3
    • Chordae tympani, branc of VII
  4. Aspergillus growing in old TB cavities
    Colonizing aspergillosis
  5. Aspergillus occuring in IC patients or neutropenic patients and has lung involvement as well as other organs
    Invasive aspergillosis
  6. Bicornate uterus: failure to fuse paramesonephric ducts
    • Clue cells: Gardenella vaginosis
    • Squamous epithelium with bacilli
    • Koilocyte: HPV 6 and 11
    • Squamous cells with dense cytoplasm and perninuclear clearing
  7. Structure of mycolic acids
    Long, branched chain lipids in the outer portion of the peptidoglycan cell wall
  8. HIV patient presents with weight loss, fever, and weakness, and enlarged spleen and liver. Blood cultures show acid-fast bacteria. Prophylaxis?
    • Azithromycin
    • (MAC with CD4 count <50)

    Isoniazid if patient presented with M.TB
  9. Why does the LA have a lower pO2 than the pulmonary capillaries?
    • LA receives oxygenated blood from the pulmonary veins
    • LA receives deoxygenated blood from the bronchial veins
  10. Changes in genomic composition occur when host cells are co-infected with 2 segmented viruses that exchange whole genome segments
    Causes alterations in the surface Ag of viral progency 
    • Reassortment
    • Influenza virus - antigenic shift
  11. Exchange of genes between two dsDNA chromosomes by crossing over. Genomic change seen in the progency
    Recombination
  12. Host co-infected and progeny contains genome from one virus and nucleocapsid proteins (invading host cell) from another. No genetic exchange
    Phenotypic mixing
  13. Bronchial asthma patient with eosinophilia and proximal bronchiectasis
    Allergic bronchopulmonary aspergillosis

    nb. Pseudomonas seen in CF patients and neutropenia
  14. Bacteria that don't contain cell walls
    • Mycoplasma
    • Ureaplasma
    • contain cholestrol in their cell membranes
  15. Electrolyte level differences of Ca+2 between calcium stones and primary hyper-PTH
    • Stones: hypercalciuruia, normocalcemia
    • Primary hyper-PTH: hypercalciuruia, hypercalcemia
  16. Trisomy 13
    • Patau
    • cleft lip and palate
    • microcephaly
    • holoprosencephaly
    • polydactaly
    • PDA, septal defects
    • polycystic kidney dz
    • abdominal wall defects: omphalocele, pyloric stenosis
  17. Trisomy 18
    • Edward's
    • Small mouth
    • malformed ears and low-set
    • micrognathia
    • clenched hands
    • GI: Meckel's diverticulum, malrotation
  18. Broad collagen bands with abundant lymphocytes and Reed-sternberg cells
    Nodular sclerosing Hodgkin's disease
  19. Patient has aortic dissection but pain now involves both flanks and has hematuria. Cause?
    aortic aneurysm has progressed to involve the renal arteries causing b/l renal infarct.
  20. Mechanism of thrombocytopenia occuring in ITP
    • Autoimmune: splenic destruction of platelets
    • Follows an URT infection or exanthem
  21. Multiple myeloma finds what molecule in the urine and its composition
    Bence Jones proteins: Kappa light chains (VkCk)
  22. Acute hemorrhagic pancreatitis
    • Pancreatic enzymes released into bloodstream after excessive alcohol consumption
    • Cause severe local damage to pancreas and causes shock (intravascular fluid loss + pancreatic necrosis and hemorrhage)
  23. Three translocations of Burkitt's lymphoma
    • 1. 8:14
    • 2. 2:8
    • 3: 8:22
  24. TTP presentation: sx, microscopy, labs
    • CNS sx, fever
    • Micro: schistocytes (helmet cells)
    • Labs: decrease PLT count, increased LDH

    Ab against ADAMTS13 (metalloprotease) which prevents cleaving of vWF multimers
  25. Clot where no lines of Zahn are seen (dark red colour alternating with pale colour), homogenous colour, and not adhered to the vessel wall
    Post-mortem clot
  26. What two hormones are increased in production to cause stress ulcer?
    • Gastrin
    • Pepsin
    • Or altered gastric wall defenses
  27. CCK functions
    • Gallbladder contractions
    • Release of pancreatic enzymes (amylase, lipase)
    • Causes vagal stimulation
    • a) Inhibits gastric emptying
    • b) Inhibits gastric acid secretion
  28. Kidney values in dehydration
    • Decreased blood pressure causes a decrease in RPF
    • RAAS stimulated and Ang-II constrict efferent arteriole to attempt to increase GFR, however, cannot fully compensate 
    • GFR is decreased
    • Filtration fraction = increased as RPF is decreased more than GFR
  29. Chi-squared test
    Use with nominal (categorical) variables
  30. Biliary atresia
    • Obstruction of extrahepatic ducts
    • Proliferation of intrahepatic ducts, parenchymal cholestasis.
    • Dark urine and light-coloured stools
    • Increased levels of bilirubin, ALP and GGT
    • Zenker's diverticulum:
    • cricopharyneal motor dysfunction
  31. Function of phosphodiesterase inhibitors in the heart and vessels
    • Heart: Increases cAMP which increases Ca+2 = increases contractility
    • Vascular SM: Increased cAMP = vasodilation
  32. Cord factor
    • Composed of two mycoside molecules
    • Presence of cord factor correlates with virulence of M.TB
    • Inactivates neutrophils
    • damages mitochondria
    • induces TNF-a
  33. Virus that can grow on true vocal cords
    • HPV = warty growths
    • Hoarseness and stridor (upper airway obstruction)
  34. Measures of lung volume, alveolar pressure, and pleural pressure at FRC
    • Lung volume: 0
    • Alveolar pressure: 0
    • Pleural pressure: -5
  35. Mechanism of contraction in skeletal, cardiac, and smooth muscle?
    • Skeletal: depolarization opens L-type Ca+2 channels within T-tubules and then causes Ca+2 release from the RyR-1 on SR. Ca+2 then binds Troponin C and allows actin and myosin to bind.
    • Cardiac: Depolarization opens L-type Ca+2 channels on the plasma membrane, and Ca+2 comes in. Binds to RyR-2 on SR and releases Ca+2 and causes Ca+2 induced Ca+2 release. Then, like skeletal. 
    • Smooth: Depolarization via L-type Ca+2 channels and like cardiac. Then, Ca+2 binds to calmodulin (no troponin) and activates MLCK, causes phosp. of myosin.
  36. Most common cause of lung abscesses
    Aspiration pneumonia from oropharyngeal (anaerobic) components
  37. Hib vaccine for H.influenza is directed against what virulence factor?
    • Capule
    • Strains without a capsule will not be targetted by the vaccine, and can still cause infection
  38. After total ischemia, when does the heart stop contracting?
    When does irreversible injury occur?
    • 60seconds: ATP decreases, anaerobic glycosis also begins, as lactate levels start to rise
    • >30 minutes

    n.b. <30 minutes = myocardial stunning (reversible loss of contractile function)
  39. Relative risk formula
    [(a/a+b)]/[(c/c+d)]
  40. Ankylosis spondylitis organ involvement
    • Uveitis
    • Ascending aortitis leading to dilation of aortic valve = AR
    • Pain, tenderness and swelling at sites of insertion of tendon into bones
    • Pain at costovertebral and costosternal junctions: can limit chest wall expansion = hypoventilation
  41. Heteroplasmy
    • Ragged muscle fibres on muscle biopsy
    • Lactic acidosis
    • Mitochondrial inheritance (only the mom's side of the family)
  42. Which ions contribute to the resting membrane potential?
    K+ efflux (major) and some Na+ influx maintains at -70mV
  43. HYPOestrogenic states causes an increase or decrease in RANK-receptors
    Increase in expression causing an increase in bone resorption = decreased bone mass
  44. Tetanus vaccine produces antibodies against?
    Against the tetanospasmin (bacteria product); hence, does not activate the complement
  45. How are SLE-causing drugs metabolized?
    • Liver N-acetylation
    • Phase II clinical trial
    • Patients who are slow acetylators = greatest risk of developing SLE from drugs (SHIPP)
  46. Phase I clinial trial
    • Hydrolysis, oxidation, reduction
    • Elderly lose this first
  47. Collagen synthesis steps that occur outside the RER of fibroblasts
    • 1. Peptidase cleaves N and C terminal residues of procollagen that are water-soluble to make collagen.
    • 2. Collagen cross-links by lysyl oxidase
  48. Caudal regression syndrome
    • Sacral agenesis and flaccid lower extremity paralysis
    • Urinary incontinence
    • Uncontrolled maternal diabetes
  49. Osteomyelitis affects what part of bone
    Different kinds?
    • Bone metaphysis due to rich vascular supply and capillary fenestrae
    • 1. Hematogenous seeding in normal bone: S. aureus and Strep pyogenes; occurs in children
    • 2. Ischemic or infarcted bone: Salmonella for sickle cell
    • 3. Infected diabetic wound: Psuedomonas
  50. Bugs causing reactive athritis
    • HLA-B27
    • Joint aspirates are sterile (no bacteria found)
    • BCCSSY
    • Bacillus
    • Chlamydia
    • Camplyobacter
    • Shigella
    • Salmonella
    • Yersinia
  51. Skin disease associated with Pseudomonas
    • Ecthema gangrenosum (looks like black eschar without edematous ring)
    • Toxins produced:
    • Exotoxin A (inhibits protein synthesis)
    • pyocyanin (ROOS)
    • Elastase (inhibits elastin)
    • Phospholipase C (degrades cellular membranes)
    • Seen in immunocompromised (neutropenic) pts.
  52. Osteoid matrix accumulation (un-mineralized osteoid) around trabeculae 
    Rickets
  53. Trabecular thinning with fewer connections
    Osteoporosis (disrupts normal bone structure)
  54. Subperiosteal resorption with cystic degeneration
    Paget's dz (increased osteoclast function)
  55. Spongiosa filling medullary canal with no mature trabeculae
    • Osteopetrosis
    • (primary spongiosa replaced by bone marrow in normal)
  56. Markers that reflects activity of osteoblasts
    • ALP (denatured by heat: to distinguish from liver)
    • Osteoblasts form bone matrix, and release ALP
  57. Markers for osteoclast activity
    • TRAP (acid phosphatase)
    • Urine hydroxyproline excretion
    • Urine deoxypyridinoline excretion = (cross-links collagen fibres and released when osteoclasts absorb bone)
  58. Adverse affects of MTX
    • Stomatitis (painful mouth ulcers and nausea)
    • Hepatotoxicity (hepatitis, fibrosis, and cirrhosis)
  59. Wrist nerves pathway
  60. Malassezia furfur
    • Hypoigmented or hyperpigmented skin patches
    • Classified by tinea versicolor
    • Become more visible after sun-tanning
    • Predominant in hot and humid climates
    • Localized to the stratum corneum

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