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QUESTION:
How can the jejunum be distinguished from the ileum? (5)
- inner mucosal folds (plicae circulares) are more prominent, more numerous, and taller --> (this leads to increased mucosal SA and associated feathered appearance after the administration of oral contrast material)
- larger caliber, thicker muscular walls
- longer vasa rectae
- fewer arcades
- the ileum is notable for the presence of Peyer patches and mucosal lymphoid follicles QUESTION: What is the most likely explanation for the feathery appearance in the portion of the GI tract indicated by X when compared to the portion indicated by Y? greater mucosal surface area (more prominent and numerous plicae circularis) QUESTION: What are the 4 stages of neutrophil recruitment and the associated receptors for each stage?
- rolling
- vasculature/stroma: E selectin, P selectin
- leukocyte: sialyl lewis (glycoprotein)
- adhesion
- vasculature/stroma: ICAM- 1
- leukocyte: LFA- 1
- extravasation
- vasculature/stroma: PECAM- 1
- leukocyte: PECAM- 1
- chemotaxis/migration
- vasculature: C5a, IL8, leukotriene B4, kallikrein
- leukocyte: various QUESTION: Lymphocyte function-associated antigen 1 (LFA-1) is an integrin protein involved in _____________ neutrophil adhesion to the endothelium QUESTION: The genetic disorder leukocyte adhesion deficiency type 1 is caused by a defect in ___________ LFA-1 (lymphocyte function-associated antigen 1) QUESTION: During thyroid surgery, which structures are at risk of being damaged? (4)
- parathyroid glands
QUESTION:
What are main distinguishing factors between RA and OA?
- Joint involvement
- RA: MCP, PIP
- OA: DIP, larger joints
- Pain characteristics
- RA improves with use throughout the day
- OA worsens through the day
- Age
- RA typically presents younger since it is an autoimmune inflammatory arthritis
- OA affects 60-80% of adults > 65
- Serum
- RA: high in rheumatoid factor, anti- CCP antibodies QUESTION: What does the ulnar nerve innervate? intrinsic muscles of the hand --> abduction and adduction of all fingers except thumb muscles of the forearm (flexor carpi ulnaris, flexor digitorum profundus) sensation fourth and fifth fingers QUESTION: Broadly, what muscles do the ulnar, radial, and median nerve innervate?
ulnar: intrinsic muscles of the and (adduction and abduction of fingers except thumb) radial: extensors of the fingers and wrist, as well as abductors of the thumb median: flexors of the wrist and fingers as well as intrinsic muscles of the hypothenar eminence QUESTION: Damage to the ___________ can affect both bladder contraction and internal urethral sphincter relaxation, leading to overflow incontinence pelvic nerve plexus pelvic parasympathetic nerves of the pelvic plexus function to excite and contract the detrusor muscle of the bladder via muscarinic ACh receptors sympathetic nerves mediate relaxation of the internal urethral sphincter via alpha 1 adrenergic receptors, leading to normal urination QUESTION: ______________ are found at each of the 5' and 3' ends of retroviral DNA and transposons and are used to integrate the viral genome into the host genome. Mutations in these regions may prevent integration. Long terminal repeats (LTRs) QUESTION: __________ and _________ activate the two primary cells responsible for granuloma formation in TB IL12 and interferon gamma IL12 is an inflammatory cytokine secreted by macrophages infected with TB
conjunctivitis Koplik spots confluent maculopapular rash that starts at the head/neck and spreads to the trunk, INCLUDING the palms and soles QUESTION: What are 2 virulence factors associate with measles virus? F (fusion) protein
- aids in viral fusion to host cells
- can result in formation of multinucleated giant cells Hemagglutinin (HA) protein
- viral binding to host cells QUESTION: A 55 yo woman who is a physician is admitted to the hospital because of a fractured femur sustained in a MVC. Two days after admission, she develops tachycardia, restlessness, diaphoresis, and anxiety. She says that vague shapes are coming out of the walls. Which of the following is the most likely cause of the patient's current condition? A. Acute stress disorder B. Alcohol withdrawal C. Bipolar disorder D. Histrionic personality disorder E. Panic disorder B. Alcohol withdrawal c/f delirium tremens
Correct splicing is dependent on the spliceosome recognizing a splice site at the start of an intron, which typically consists of base pairs ____________. A point mutation in this has what effect? G-U-A-A-G A point mutation in DNA (i.e. changing a guanine to an adenine) may mask a splice site and either cause an intron to remain in the final mRNA product erroneously or cause a larger region of pre-mRNA to be spliced, leading to removal of an exon Patients with phenylketonuria do not have the ability to convert phenylalanine to ____________ due to deficient/defective ________________. Accumulation of phenylalanine in this disorder leads to physical manifestations including ______________, ____________, and _____________ tyrosine phenylalanine hydroxylase impaired neurologic development, seizures, and musty odor A 65 yo woman has ascites. Which of the following additional findings indicates a diagnosis of constrictive pericarditis rather than cirrhosis? A. LE edema B. Esophageal varices C. Hypoalbuminemia D. Hyponatremia
Laterally, the precentral gyrus controls the ________________ Medially, the precentral gyrus controls the ________________ primary motor cortex voluntary movement to the contralateral body contralateral face contralateral LE What is the MOA of baclofen GABA (y-aminobutyric acid) analogue acts as an agonist at the GABA-B receptors GABA-B receptors are metabotropic G protein receptors that increase the efflux of K+ (thus hyperpolarize skeletal muscle cells and decreased AP frequency) ______________ is a malaria-like illness that can be recognized by the presence of intra-erythrocytic ring forms or a tetrad formation on peripheral blood smear Babesiosis caused by protozoa Babesia microti classically presents with fevers, chills, myalgias, weakness, headache, an associated hemolytic anemia asplenia is a RF for severe dz
Characteristics of bacterial vaginosis infection (4) what is the treatment?
- gray thin malodorous vaginal discharge
- vaginal pH > 4.
- fish odor (strong amine smell) upon KOH testing
- clue cells on microscopy treat with metronidazole do not need to treat partners (not considered STI) Where is CRP synthesized? liver CRP = acute phase reactant synthesized in the liver in response to pro-inflammatory cytokine IL What is the function of CRP? acute phase reactant that functions as an opsonin and aids in targeting cells for phagocytosis and in the fixation of complement The electrical complex labeled B in the attached rhythm strip is characteristic of what? premature ventricular contraction (PVC) associated with a lower SV than compared to a normal beat --> when this occurs, diastolic filling time is reduced so the amount of blood in the ventricles prior to ventricular systole is less What are the two primary forms of genomic instability in the pathogenesis of colon cancer?
Hereditary spherocytosis is caused by mutations in _________ or __________. spectrin or ankyrin (cytoskeletal anchoring genes) leads to fragile rbc membranes and poor distensibility What torch infection is commonly associated with intracranial calcifications? also: jaundice, hepatomegaly, petechial rash, seizures CMV In anemia of chronic disease, a bone marrow aspirate with Prussian blue staining for iron will reveal? increased deposits of iron in the bone marrow Anemia of chronic dz MOA increased hepcidin levels decrease intestinal iron absorption and increase iron storage in bone marrow and the RES, preventing urse of iron by erythrocyte precursors, resulting in anemia In a patient with megaloblastic anemia - how to differentiate between folate vs B12 deficiency? folate: elevated homocysteine, normal methylmalonic acid B12: elevated homocysteine, elevated methylmalonic acid since folate and B12 are needed for the conversion of homocysteine to methionine, deficiency in either is associated with elevated homocysteine
vitamin B12 also acts as a cofactor for the conversion of methylmalonyl-CoA to succinyl CoA and its deficiency is associated with increased methylmalonic acid levels What is placenta accreta? abnormal attachment of the placenta directly to the myometrium, which most commonly presents with retained products of conception and postpartum hemorrhage Tetracyclines (i.e. doxy) MOA prevents the attachment of aminoacyl-tRNA to ribosomes Why are tetracyclines contraindicated in pregnancy and in children? inhibition of bone growth discoloration of teeth A male newborn is found to have a defect in anchoring fibrils. What skin finding is most likely to occur in this patient? blisters anchoring fibrils are made of type VII collagen and are a component of the hemidesmosome hemidesmosome: anchors basal keratinocytes of the epidermis to the dermis at the dermal-epidermal junction any impairment of the hemidesmosome will cause the basal keratinocytes to separate from the dermis, causing blisters to form Because the hemidesmosomes of neighboring skin are still intact, these will be tense blisters
hyperuricemia is treated with xanthine oxidase inhibitors like allopurinol inherited X linked recessive 12 yo boy admitted with lethargy, hip pain, a temp of 103, has been hospitalized several other times because of PNA. Neonatal period normal. CBC counts wnl, HIV negative. Blood cultures grow Staph aureus. Serum electrophoresis is likely to show what? D: deficiency in immune globulins A: narrow monoclonal spike in the gamma region
- multiple myeloma
- Waldenstrom macroglobulinemia
- monoclonal gammopathy of undetermined significance
- amyloidosis B: blurring of the beta-2 and gamma regions (beta/gamma fusion)
- increased CRP or increased IgA (severe respiratory infections, RA, cirrhosis) C: large but wide gamma region consistent with hypergammaglobulinemia
- nonspecific hypergammaglobulinemia (chronic liver dz, CT dz, inflammatory conditions) E: normal first peak = albumin alpha = alpha 1 antitrypsin, thyroid-binding globulin, transcortin beta: transferrin and B-lipoproteins, complement y: immunoglobulins
__________________ is a non-inflammatory and non-atherosclerotic angiopathy of medium-sized arteries that can lead to renal artery stenosis and secondary HTN, commonly in young patients with no medical comorbidities or abnormal lab findings fibromuscular dysplasia The rate of onset of anesthesia relies on which 3 characteristics?
- blood solubility (low solubility increases speed)
- cardiac output (low cardiac output decreases blood delivered to alveoli, anesthetic will more quickly equilibrate with the blood that is present)
- minute ventilation (increased delivers more anesthetic to the alveoli, increases gas concentration) What is a potential adverse effect of nitroprusside infusion? cyanide toxicity causes uncoupling of the ETC (cyanide inhibits mitochondrial enzyme cytochrome c oxidase), leading to lactic acidosis, compensatory respiratory alkalosis, hypotension, lethargy, and bradycardia the splice acceptor site resides between an intron and an exon on pre-mRNA and functions to recruit
snRRPs (small nuclear ribonucleoproteins) snRRPS remove introns, with subsequent connection of exons via the spliceosome, forming fully mature mRNA
cytotoxic CD8+ T lymphocytes reacting to the viral infection Proteasome inhibitors (i.e. bortezomib) MOA result in impaired proteasomal activity, especially useful in multiple myeloma cells due to the increased production of proteins by plasma cells, they depend on the ability to degrade unfolded or misfolded proteins to limit the stresses placed on the cell (this is the function of the proteasome) when the cells are unable to clear misfolded or abnormal proteins, the induction of apoptosis occurs patients should be monitored for TLS Chondrosarcoma malignant neoplasm that arises from the mesenchymal cells that produce cartilage; commonly arises in the axial skeleton, particularly in the pelvis presents in 50s, slow growing and initially asymptomatic, permitting extensive growth before detection will often present with pelvic pain and compression of adjacent structures such as the lumbosacral plexus, leading to neurologic symptoms in the ipsilateral lower extremity on histology, the tumor will show lobules of hyaline-like cartilage and nests of malignancy chondrocyte- like cells Proliferative endometrium is present during the follicular phase of menstruation prior to ovulation. Histologically, what does it demonstrate? well-developed stratum basale long straight uterine glands
extension of the spiral arteries abundant stromal cells ____________ presents with sudden, painless monocular vision loss, relative APD, retinal whitening with a cherry red spot, and retinal arteriolar narrowing with boxcarring CRAO central retinal artery occlusion What is a potential complication of heparin therapy? What is its mechanism? heparin induced thrombocytopenia (HIT) antibody-mediated reaction to heparin-platelet factor 4 complexes that results in abnormal activation of platelets, with subsequent thrombocytopenia and arterial or venous thromboembolic dz heparin MOA binds and potentiates action of anti-thrombin III (inhibits thrombin and Xa) Hereditary Hemorrhagic Telangiectasia (HHT) AD disorder of the vasculature that is characterized by arteriovenous malformations (AVMs) and telangiectasias (small vascular malformations which appear as bright red, blanching lesions of the skin and mucous membranes) classically present with recurrent epistaxis, hematuria, and GI bleeding cerebral AVMs may cause hemorrhagic stroke Pulmonary AVMs may lead to embolic stroke and can result in pulmonary arteriovenous shunting with subsequent hypoxemia, which can lead to clubbing
