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61 Cards in this Set
- Front
- Back
24 yo male w/headache & visual changes, intracranial calcified mass on MRI, gross inspection shows cystic spaces w/thick brownish fluid rich in cholesterol?
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cranyiopharyngioma = calcified mass, young ppl, usually yellow viscous fluid filled (cholesterol crystals)
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local secretory antibody synthesis is best promoted when?
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specific mucosal surfaces are directly stimulated by antigen
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5 yo male w/persistent food seeking behavior, obsese, sometimes aggressive/bizzarre behaviors - what part of brain is lesioned?
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Ventromedial thalamic nucleus, where satiety centers reside
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is the portal vein intraperitoneal or retroperitoneal?
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it is retroperitoneal
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what structure is at high risk from invasion of tumor of 3rd part of duodenum?
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superior mesenteric artery, uncinate process of pancrease
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Campylobacter is showing increased worldwide resistance to what antibiotic? New antibiotic of choice?
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resistant to fluoroquinolones
use erithromycin |
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why does penicillin tx of group A strep prevent RF but not APSGN?
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rheumatic fever (antigen mimicry)
NOT post-strept glomerulonephritis (immune complex deposition) |
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what lab test should follow a moderately elivated alk phosph of unclear etiology?
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gamma-glutamyl transpeptidase
it's present in liver but NOT bones, helpful in distinguishing |
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alveolar cells w/golden cytoplasmic granules turning dark blue w/prussian blude staining?
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"heart failure cells"
hemosiderin containing alveolar macrophages |
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golden yellow or brownish cytoplasmic granules - what might they contain? What stain to differentiate?
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either lipofuscin or hemosiderin
Prussian blue stain detects intracellular iron (stain will turn dark blue) |
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variation in what process of isoniazid elimation results in 2 sets of populations w/different elimation speeds?
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acetylation
slow acetylators at increased risk of adverse side effects |
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what is the main source of resistance in the vascular system?
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capillary beds
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what is best tx for cardiac abnlities associated w/TCA?
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sodium bicarbonate
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what indications might make phenelzine a reasonable 1st line tx choice?
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it's an MAOIs, can be 1st line for atypical depression (mood reactivity, leaden fatigue (arms & legs feel heavy) rejection sensitivity, reversed vegetative signs - increased sleep & appetite)
not nl first line b/c of tyramine crisis, interactions (SSRI), etc |
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where are lipids/lipid-soluble vitamins absorbed?
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Jejunum, after digestion in the duodenum
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53 yo male w/dyspnea on exertion
CXR densities in both lung fields most prominent apically calcified hilar lymph nodes, on biopsy are negatively birefringent surrounded by collagen fibers - what's going on? |
Silica exposure
distinguished from other pneumoconioses by eggshell calcification & birefringent silica particles surrounded by fibrous tissue |
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MCC ventricular fibrillation in ppl < 30 yo?
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Hypertrophic cardiomyopathy
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what is the MC cardiomyopathy?
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dilated cardiomyopathy, ~90%
account for ~10-15% cases sudden cardiac death |
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42 yo female w/bouts of spinning sensation w/nausea & ringing in left ear, diminished hearing
"feels fine" between episodes - what condition? Pathophys? |
Meniere's dz, increased volume of endolphym from defective resporption
triad - tinnitus, vertigo, sensorineural hearing loss |
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1st line tx for general anxiety disorder? How long is response delayed?
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Buspirone (selective agonist of 5HT-1a)
clinical response can be delayed up to 2 weeks of regular use |
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what class of meds reduces all cause mortality in CHF? Which one in particular?
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beta blockers
carvedilol |
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strawberry vs cherry hemangioma?
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strawberry occur during 1st few weeks of life, grow rapidly then regress by 5-8 yo
cherry hemangiomas appear in 30-40's, do not regress & increase w/age (aka senile hemangiomas) - ALWAYS cutaneous, histologically are sharply circumscribed areas of congested capillaries & post-capillary venules in the papillary dermis |
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when initiating therapy w/ACE inhibitors what adverse effect is of concern (on INITIATION)? What other common drugs might predisopose to this?
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First-dose HTN
diueretics could predispose via hypovolemia also hyponatremia, low BP, high renin/aldo, and heart failure |
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what is the Bezold-Jarisch refelx seen with ACE inhibitors?
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a decrease in angiotensin II levels, causing vagally mediated hypotension & bradycardia
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what kind of T-cell & cytokine profile is seen w/immune reaction in Sarcoidosis?
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granulomas --> cell mediated
Th1 type CD4+ w/IL-2 & IFN-gamma (IL-2 stim prolife of Th1 IFN-gamma activating macrophages promoting granuloma formation) |
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amino acids w/3 titratable protons?
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histidine, arginine, lysine, cysteine, tyrosine, aspartic acid, glutamic acid
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total sensory loss on one side of the body & face with no motor involvement indicates lesion where?
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thalamus
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lesion of internal capsule can result in what isolated deficits?
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motor
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patient w/hx of sensory stroke affecting 1 side of the body w/no motor involvement dies of unrelated cause years later
brain shows two 5-6 mm cavities in deep structures of the brain - what are these? What pathophys explains them? |
Lacunar infarcts
occlusion of small penetrating arteries caused by small vessel lipohyalinosis & atherosclerosis 2ndary to HTN or diabetes |
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septate hyphae 45 degree angle?
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aspergillus fumigatus
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what is colonizing aspergillosis?
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occurs in old lung cavities (TB, emphysema, sarcoidosis), grows as "fungus ball"
CONTRAST to invasive aspergillosis (immunosuppressed) or hypersensitivity reactions to aspergillus (asthma - allergic bronchopulmonary aspergillosis ABPA) |
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medicallyy important dimorphic fungi?
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form molds (w/hyphae) in ambient temp (25-30) & yeasts (single cells) at body temp (37) - Sporotrhix schenckii
Coccidioides Immitis Histoplasma Capsulatum Blastomycoses dermatitidis Paracoccidioidees brasiliensis |
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biopsy reveals round or cigar shaped budding yeasts?
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sporothrix schenckii
dimorphic think gardeners smoking |
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culture at 25 - hyphae w/doubly reflective walls, at 37 - thick walled spherules w/endospores?
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Coccidioides
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biopsy reveals oval yeast cells within macrophages?
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Histoplasma capsulatum
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round bud vs broad based bud?
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round bud - sporthrix (also cigar shaped bud)
broad bud - blastomycoces) |
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fungus found in southwest / deserts?
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Coccidioides
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fungus found in Ohio & Mississippi River valleys?
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Histoplasma & Blastomycoces
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fungus found in soil, bird droppings, bat droppings (chicken coops, caves)?
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Histoplasma
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fungus found in Great Lakes region?
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Blastomycoses (NOT Histo - according to Uworld)
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fungus found in soil?
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Coccidioides (mold form), Histoplasma, Blastomycoses
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fungus found in central & south america?
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paracoccidioides brasiliensis
mucocutaneous |
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vasculitis in child showing IgA & C3 deposition?
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Henoch-Schonlein purpura
-recent infection, -palpable skin lesions, -with/or without abdominal pain & arthralgias self-limiting but glomerulonephritis & even ESRD are possible complications |
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vasculitis w/nasal mucosal ulcerations, "saddle nose" & oliguria?
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Wegeners, c-ANCA (serum anti-neutrophil)
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vasculitis w/weak upper extremity pulses?
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Takayasu arteritis
-large vessels (aorta & prox branches) |
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vasculitis w/headache & blurred vision?
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Giant Cell Arteritis
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significant QT prolongation following antiarrhythmic med, also notable for mild bradycardia - which med class? Example?
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QT prolong = ventricular repolarization
mediated by K+ efflux so look for class III (K+ channel blockers) Sotalol is an example (tho it is a beta blocker, this explains the bradycardia) others: amiodarone, ibutilide, dofetilide |
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hemochromatosis causes what kind of cardiomyopathy?
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dilated, pts present w/signs & sx of CHF
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concentric vs eccentric cardiac hypertrophy?
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concentric hypertrophy results from increased afterload (sarcomes added in parallel)
eccentric hypertrophy is more associated with volume/dilation (sarcomeres added in series) |
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pathologic fx secondary to prolactinoma caused by what change? What is another common association?
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suppression of GnRH leading to estrogen deficiency
vaginal dryness |
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difference between TB & sarcoid granulomas?
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TB - caseating
sarcoid - non-caseating |
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43 yo african american male w/weeks of malaise, 10 lb weight loss, nocturnal fevers, & cough, CXR w/hilar prominence
former prisoner palpable node in supraclavicular bed - noncaseating granuloma? |
sarcoidosis - non-caseating granuloma (so not TB), african american man w/hilar adenopathy & constitutional symptoms
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does sarcoidosis present with weight loss, nocturnal fevers, and cough, or is that more likely to be TB?
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could be either
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what is caseating?
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caseous necrosis - form of cell death
tissue maintains "cheese-like" appearance dead tissue appears soft & white protenaceous dead cell mass |
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what neurologic condition are mementine & vitamin E helpful for?
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Alzheimers
memantine is NMDA receptor antagonist vitamine E is an antioxidant |
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how do methylxanthines cause vasodilation? (asthma tx)
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decreasing phosphodiesterase activity (increasing cAMP)
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what does ipratropium do?
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anti-muscarinics
mAChR antagonists |
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how does listening at end expiration accentuate a diastolic murmur (S3)?
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brings apex closer to chest wall
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what is pramipexole (context: Parkinson's tx)? Others like it?
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it is a non-ergot dopamine agonist - pramipexole & ropinerole
ergot compounds - bromocriptine and pergolide |
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what symptoms of Grave's dz are not corrected by beta blockers?
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Exophthalmosis
this is a result of anti-thyroid antibodies ocular manifestations may respond to corticosteroid therapy |
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what colitis has non-caseating granulomas on light microscopy?
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Chron's
resemble sarcoid granules- also see linear ulcerations, cobblestone appearance of mucosa, transmural inflammatory infiltrate |