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Describe the colonoscopy and biopsy findings of Kaposi's sarcoma.
- Colonoscopy findings: Reddish/violet, flat maculopapular lesions or HEMORRAGIC POLYPOIDAL LESIONS/ NODULES.
- Biopsy findings: Spindle shaped tumor cells with small vessel proliferation
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Colonic biopsy findings associated with this disease is described as spindle-shaped tumor cells with small vessel proliferation.
Kaposi sarcoma
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What disease does Cryptosporidium cause?What are the biopsy findings?
- Profuse, watery diarrhea
- Biopsy shows basophilic clustures on the surface of intestinal mucosal cells.
-
Flask-shaped colonic ulcers are characterisitc of ?
Entamoeba histolytica
-
Trophozoites containing red blood cells are characteristic of?
Entamoeba histolytica
-
What causes a Pituitary apoplexy?
Caused by sudden hemorrage of the pituitary gland, often in the presence of an existing pituitary adenoma
-
Describe the presentation of a Pituitary atoplexy
- Severe headache
- Bitemporal hemianopsia
- Visual disturbances
- Decreased libido
- Patients could die from cardiovascular collapse (hypotension) - due to ACTH deficiency
-
What does it mean when a test is Reliable/ precise?
A reliable test (precision) is reproducible in that it gives similar results on repeat measurements.
-
A test which gives similar or very close results on repeat measurements is indicated as?
A Reliable test (Precision)
-
What is the associated between reliability and random error?
Reliability is maximal when random error is minimal
-
What does validity/ accuracy of a test mean?
- Accuracy/ validity
- Defined as a test's ability to measure what it is supposed to measure.
-
A test's ability to measure what it is supposed to measure.
Accuracy (validity)
-
How can we evaluate the validity/ accuracy of a new test?
By comparing its results to those obtained with the gold standard
-
What combination of accuracy and precision exist below?
- Accurate (valid)
- Precise (reliable)
-
What combination of accuracy and precision exist below?
- Precise (reliable)
- Not accurate (invalid)
-
What combination of accuracy and precision exist below?
- Accurate (valid)
- Not precise (unreliable)
-
What combination of accuracy and precision exist below?
- Not accurate (invalid)
- Not precise (unreliable)
-
What does the vaccine for Neiseria meningitidis contain?
Polysaccharide capsules
-
The Bacille Calmette-Guerin vaccine is used for protection against which organism? What does it contain?
- Mycobacterium tuberculosis
- It contains live attenuated strains of M.
- bovis
-
How can infection with Literia monocytogenes be acquired?
Ingestion of unpasteurized dairy products and cold deli meats
-
Tumbling motility is a unique feature of this microorganism.
Listeria monocytogenes
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Label the heart murmurs which are best heard at each point.
-
Right sided endocarditis involving the tricuspid valve is most often due to?
- S.aureus
- Commonly occurs in IV drug users
-
Tricuspid valve endocarditis is associated with ?
IV drug abuse
-
At what location is the aortic heart sound best heard?
Second right intercostal space at the right sternal boarder.
-
This heart sound is best heard at the second right intercostal space at the right sternal boarder.
Aortic valve
-
At what location is the pulmonic valve best heard?
Second left intercostal space at the left sternal boarder
-
This heart valve is best heard at the second left intercostal space at the left sternal boarder
Pulmonic valve
-
At what location is the tricuspid valve best heard?
Fourth left intercostal space at the lower left sternal boarder
-
This heart valve is best heard at the fourth left intercostal space at the lower left sternal boarder.
Tricuspid valve
-
At what location is the mitral valve best heard?
Fifth left intercostal space, medual to the mid-clavicular line
-
This heart valve is best heard at the fifth left intercostal space, medial to the mid-clavicular line.
Mitral valve.
-
What is lipofuscin?
A YELLOW-BROWN pigment "wear and tear" pigment associated with normal aging found in the heart, colon, liver, kidney, eye, ect. (especially in patients with malnutrition and cahexia)
-
Yellowish-brownish intracytoplasmic granules in myocardial cells are diagnostic of?
Lipofuscin
-
What causes the formation of Lipofuscin?
Lipid peroxidation and free radical injury.
-
What are the effects of thiazide diuretics on Ca2+?
Increases reabsorption of calcium → ⇧serum Ca2+
-
What is the cause and findings of Familial hypocalciuric hypercalcemia?
- Cause: defective Ca2+ sensing by parathyroid and renal tubule cells
- Findings:
- ⇧Serum Ca2+
- Normal to ⇧PTH
- ⇩Ca2+ excretion (hypocalciuria) due to impaired renal calcium sensing
-
How does Acyclovir work?
- Acyclovir is converted to acyclovir monophosphate by thymidine kinase.
- Cellular enzymes then convert acyclovir monophosphate to acyclovir triphosphate.
- When viral DNA polymerase incorporates acyclovir triphosphate into the viral DNA chain, viral DNA synthesis is terminated.
-
Where do Carcinoid tumors arise from?
Enterochromaffin (endocrine) cells of the intestinal mucosa.
-
What causes a ppt to develop the clinical manifestations of Carcinoid syndrome?
If intestinal carcinoids metastasize to the liver, their secretory products are not degraded (5-hydroxyindoleacetic acid), and they enter the systemic circulation.
-
Describe the symptoms of Cardinoid syndrome.
- Cutaneous flushing, dizziness
- Diarrhea, crampy abdominal pain
- Dyspnea and wheezing
- Right-sided (pulmonary, tricuspid) valvular heart disease.
-
What is the mechanism of Nitroprusside?
Venous and arterial vasodilator that decreases both preload and afterload by ⇧cGMP by direct release of nitric oxide.
-
What is responsible for Aldesleukin (Il-2's) anticancer effect?
Increased activity of T cells and NK cells
-
What is the use of Aldesleukin (IL-2)?
- Metastatic melanoma
- Renal cell carcinoma
-
What is the target and use of Alemtuzumab?
- Target: CD52
- Use: Chronic lymphocytic leukemia
-
Monoclonal antibody used in the treatment of chronic lymphocytic leukemia
Alemtuzumab
-
This monoclonal body targets CD52.
- Alemtuzumab
- Chronic lymphocytic leukemia
-
Name the Class 1A antiarrythmics.
- Double Quarter Pounder
- Dysopyramide
- Quinidine
- Procainamide
-
Name the Class 1B antiarrythmics.
- Lettuce Tomato Mayo
- Lidocaine
- Tocainide
- Mexiletine
-
Name the Class 1C antiarrythmics.
- More Fries Please
- Moricizine
- Flecainide
- Propafenone
-
Which antiarrythmic drugs produces the change seen in the red curve in the action potential of a ventricular muscle cell?
- Class 1A antiarrythmics
- Double Quarter Pounder
- Disopyramide
- Quinidine
- Procainamide
-
Which antiarrythmic drugs produce the change seen in the red curve of the action potential of a ventricular muscle cell?
- Class 1B
- Tomato Lettuce Mayo
- Tocainide
- Lidocaine
- Mexiletine
-
Which antiarrythmic drugs produce the change seen in the red curve of the action potential of a ventricular muscle cell?
- Class 1C antiarrythmics
- More Fries Please
- Moricizine
- Flecainide
- Propafenone
-
This drug prolongs phase 3 repolarization of the ventricular myocyte.
- Shortens the AP
- Class 1A
- Double Quarter Pounder
- Dysopyramide
- Quinidine
- Procainamide
-
This drug shortens phase 3 repolarization of the ventricular myocye.
- Shortens the AP
- Class 1B
- Lettuce Tomato Mayo
- Lidocaine
- Tocainide
- Mexiletine
-
This drug slows phase 0 of the ventricular myocyte action potential.
- Class 1C
- More Fries Please
- Moricizine
- Flecainide
- Propafenone
-
Label the circle of Willis below.
- 1- Basilar artery
- 2- Anterior cerebral artery
- 3- Anterior cerebral artery
- 4- Middle cerebral artery
- 5-Internal carotid artery
-
Label the circle of Willis below.
-
Occlusion of the Anterior cerebral artery would result in?
- Loss of motor and sensory function in the CONTRALATERAL LEG AND FOOT.
- **Note** Contralateral face and arm is spared.
-
What causes ataxia in Ataxia-telangiectasia?
Cerebellar atrophy
-
In this disease, the DNA of ppts are hypersensitive to Ionizing radiation.
Ataxia telangiectasia
-
What causes Fanconi anemia?
- Defect in DNA-repair enzymes
- Caused by hypersensitivity of DNA to cross-linking agents
-
Which disorders are characterized by deficient DNA-repair enzymes?
- 1. Ataxia telangiectasia
- 2. Xeroderma pigmentosum
- 3. Fanconi anemia
- 4. Hereditary nonpolyposis colorectal cancer
-
What complication can Fanconi anemia lead to?
- Aplastic anemia- failure or destruction of myeloid stem cellsFanconi anemia- DNA repair defect.
-
Neurofibrillary tangles in the neocortex are seen in?
Alzheimers disease
-
Loss of neurons in the substantia nigra is characteristic of?
Parkinson disease
-
Atrophy of the caudate nucleus is seen in?
Huntington disease
-
Posterior column involvement is seen in?
B12 deficiency and Syphillis
-
The presence of Lewy bodies is characteristic of?
Parkinsonism
-
How do we calculate the half life of a drug?
t 1/2 =( Vd x 0.7)/ CL
-
How do we calculate the maintenance dose of a drug?
- Maintenance dose= (Cp x CL) / Bioavailability fraction
- For meds administered intravenously, bioavailability=1
-
How do we calculate the loading dose of a drug?
Loading dose = (Vd x Cp)/ Bioavailability fraction
-
This antibiotic has a volume of distribution of 70L and a clearance of 0.5L/min. How much should be administered every six hours to maintain a therapeutic steady-state plasma concentration of 4mg/L?
- Maintenance dose= (Cp x CL)/ Bioavailability fraction
- = 4 mg/L x 0.5 L/min
- = 2 mg/min
- However, when administered at 6-hour intervals:
- =2 mg/min x 60 min/hour x 6 hours
- =720 mg
-
This microorganism grows on charcoal yeast extract agar buffered with cysteine and iron.
Legionella
-
What does Legionella grow on?
Charcoal yeast extract agar buffered with cysteine and iron
-
Which organisms grow on silver stain?
- Fungi (e.g. Pneumocystis jirvoreci)
- H.pylori
- Legionella
-
How is infection with Legionella pneumophilia transmitted?
Inhalation of contaminated water in air conditioning systems, hot water tanks.
-
What are the enteroviruses and what do they cause?
- Poliovirus
- Echovirus
- Coxsackievirus
- Hepatitis A virus
- Can cause aseptic (viral) meningitis except Hepatitis A Virus
-
What are the most common causes of viral aseptic meningitis? How does it spread?
- Enteroviruses- Coxackievirus, Echoviruses, polioviruses
- Spreads fecal-oral
-
What causes Kallmann syndrome?
Failure of the GnRH-secreting neurons to migrate from their origin in the olfactory placode to their normal anatomical location in the hypothalamus.
-
Describe the lab values of each in Kallman's syndrome: GnRH, FSH, LH, testosterone
ALL IS DECREASED
-
Describe the presentation of Kallman syndrome.
- Anosmia
- Poorly developed secondary characteristics
- Infertility (low sperm count)
- Amenorrhea (in females)
-
What are the angiotensin II receptor blockers?
- Losartan
- Candesartan
- Valsartan
-
What is the MOA of Losartan?
Blocks binding of angiotensin II to AT1 receptors
-
What are the effects with the use of angitensin II receptor blockers on: Renin, Angiotensin I, Angiotensin II, Aldosterone, Bradykinin
- Renin: ⇧
- Angiotensin I: ⇧
- Angiotensin II: ⇧
- Aldosterone: ⇩
- Bradykinin: No change
-
These drugs blocks binding of angiotensin II to AT1 receptors
- Losartan
- Candesartan
- Valsartan
-
What is the use of Primaquine?
It is added to the treatment of infections with P.vivax and P.ovale to completely eradicate infections and PREVENT RELAPSE.
-
How do we prevent malarial relapse in infections with P.ovale/vivax?
Add Primaquine
-
Macrovesicular fatty change is most commonly caused by?
Chronic ethanol consumption - Hepatic steatosis
-
How does chronic ethanol consumption affect the liver?
Causes a macrovesicular fatty change- Hepatic steatosis
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