MODEL QS FOR FUTURE ALL INDIA PRE PG EXAM

Discussion in 'NEET 2013 All india Exam' started by Guest, Jan 25, 2010.

  1. divakar.

    divakar. Guest

    11. Which is not a common sign of Legionella pneumoniae pneumonia?

    a. high fever
    b. myalgia
    c. hypernatraemia
    d. confusion
    e. diarrhea

    12. Which of the following is the most common cause of the metabolic acidosis that occurs after kidney-pancreas transplant?
    a. lactic acidosis
    b. uremic acidosis
    c. ketoacidosis
    d. renal tubular acidosis
    e. pancreatic secretion loss

    11. c. false; more often hyponatraemia

    12. a-d false

    13. A 30 year old man presents with hemoptysis, dyspneu and generalised weakness. He has no upper airway symptoms. Physical examination: pallor and basilar crackles; Lab: hemoglobin 7.8 g/dl (4,8 mmol/l), creatinin 3,0 mg/dl (240 mol/l), microscopic haematuria and hypoxemia. Chest X ray: bilateral alveolar infiltrates; He needed intubation and mechanical ventilation.

    Which one of the following tests would be most helpful at this point?

    a. percutaneous kidney biopsy
    b. surgical lung biopsy
    c. otolaryngology consult to look for lesions in the upper respiratory tract
    d. serum assays for ANCA-antibodies
    e. serum assays for ANA

    14. In patients with ARDS prone position ventilation improves oxygenation. Which of the following statements is proven to be true?

    a. the improvement is completely a result of an increased FRC
    b. the improvement is a result of differences in diafragm movement and abdominal pressure
    c. there is a redirection of perfusion to better ventilated ventral lung regions
    d. there is a better clearance of secretions
    e. prone position ventilation results in a better outcome and survival






    15. Which of the following is the most frequent cause of ARDS in the ICU population?

    a. multiple transfusions
    b. diffuse pulmonary infections
    c. sepsis
    d. near drowning
    e. thoracic trauma

    14. a false; this effect is only proven in healthy people under anesthesia, not in ICU
    patients!
    b false; unproven
    c false; there is an improvement in dorsal ventilation
    d true
    e. false; unproven, also not in meta-analysis
    15. c true; all other

    16. In ARDS nowadays lung protective strategies are followed in order to reduce the occurence of VILI. Which of the following strategies will lead to decreased mortality?

    a. volume-limited ventilation
    b. increased PEEP levels (open lung concept)
    c. inverse-ratio ventilation
    d. prone position
    e. ECMO; extra corporal carbon dioxide removal

    11. c. false; more often hyponatraemia

    12. a-d false
    e true; pancreatic secretions (amylase) are high in urine; in kidney transplantation the renal vasculature is anastomosed with the iliac vessels; the endocrine pancreas is connected similarly but the exocrine pancreas is connected with the intestines or preferably the urine bladder, which makes it possible to monitor the exocrine pancreas function in order to detect rejection (increased loss of bicarbonate in the urine or increase in urine amylase); when the transplanted pancreas is viable, conversion to a connection with the intestines will be performed after approximately 1 year.
    13. a true; the diagnosis is pulmonary renal syndrome; the differential diagnosis includes
    Goodpasture's disease, and this disease is diagnosed by circulating anti-GBM antibodies and anti-GBM antibodies in the kidney tissue by immunofluorescence. This disease can be manifested by a rapid progressive glomerulonephritis (RPGN) and needs to be treated immediately by plasma filtration.
    14. a false; this effect is only proven in healthy people under anesthesia, not in ICU
    patients!
    b false; unproven
    c false; there is an improvement in dorsal ventilation
    d true
    e. false; unproven, also not in meta-analysis
    15. c true; all other alternatives are causes as well, but less frequent causes; review Houston
    16. a true; see Brower NEJM
    b-e false; nothing has been proven scientifically in prospective randomised trials (review Houston)

    17. The diagnosis of pulmonary embolism in a mechanically ventilated ICU patient can be most adequately be made by:

    a. arterial blood gas analysis
    b. echocardiography
    c. according to the diagnostic work-up of the Dutch CBO consensus on Diagnosis of Pulmonary Embolism
    d. pulmonary angiography
    e. increase in pACO2-paCO2 difference


    18. Statements on cerebrospinal fluid:

    a. the production of cerebrospinal fluid is 180 ml per 24 hour
    b. total fluid in cerebrospinal fluid system is 120-180 ml
    c. liquor is produced in the arachnoidal villi
    d. In meningitis glucose in liquor is high and protein is low.
    e. The Queckensted maneuver is positive when there is a disturbed passage of liquor between cerebrum and lumbar puncture site

    16. a true; see Brower NEJM
    b-e false; nothing has been proven scientifically in prospective randomised trials (review Houston)
    17. a false
    b false; transthoracic echocardiography can reveal right ventricular and atrial dilatation and sometimes the thrombotic mass itself, transoesophageal echocardiography may be more sensitive and specific, but the diagnostic value has not been evaluated in comparison with pulmonary angiography; advantage is that it can be performed bedside
    c false; perfusion scintigraphy – ventilation scintigraphy – ultrasonography lower extremities – pulmonary angiography; its diagnostic value never tested in ICU patients and probably not very high
    d true; gold standard despite need of transport; spiral CT-scanning of the thorax can detect central PE adequately, but not peripheral PE; according to the latest Consensus Diagnostiek Longembolie in the Netherlands in December 1999 it can replace ventilation scintigraphy and compression ultrasonography/duplex scanning of the lower extremities, but it is not the gold standard!
    e false; result of increased dead space ventilation, but its diagnostic value is not known; interesting would be continuous VCO2 - measurement
    18. a false; 500 ml/24 hour
    b true
    c false; produced in the choroid plexus in the ventricles and absorbed by the arachnoidal villi
    d false; glucose is low and protein high; note that this is true for all kinds of meningitis: bacterial, viral, and sterile (for example caused by bleeding)
    e false; the test is negative.Due to the obstruction there is no increment of cerebrospinal fluid pressure. In the Queckensted maneuver one applies pressure on both jugular veins. This gives a disturbance of venous drainage from the head and an increase of venous bloodvolume in the head. This leads to a higher cerebrospinal fluid pressure which can be measured at the lumbar puncture site, unless there is obstruction between cerebrum and lumbar puncture site


    19. Statements about the thyroid gland:

    a. peripheral conversion of T4 to T3 is the only source of T3
    b. in the sick euthyroid syndrome reverse T3 concentration is low and T3 concentration is in the normal range
    c. reverse T3 is a more biologically active hormone than T3
    d. amiodarone can induce hyperthyroidism as well as hypothyroidism
    e. beta adrenergic blocking drugs stimulate T4 to T3 conversion

    20. Statements concerning diabetic keto-acidosis:

    a. there is always an insulin deficiency
    b. it can only occur in patients with type I diabetes mellitus
    c. it is characterized by hyperglycemia, acidemia and low bicarbonate levels
    d. it is often associated with hypernatremia
    e. treatment exists of administering insulin

    19 a false; T3 is also secreted by the thyroid gland. The main source of T3 however is peripheral conversion of T4 to T3.
    b false; T3 is low and reverse T3 is high.
    c false
    d true
    e false; they inhibit this conversion.

    20. a false; a diabetic keto-acidosis can occur in NIDDM although it is extremely seldom.
    Keto-acidosis develops because lipolysis takes place, and lipolysis takes place when there is no insuline anymore; in type II DM (=NIDDM) there is insulin but the defect concerns insulin receptor resistance.
    b false; also in NIDDM
    c true
    d false; there is often hyponatremia
    e false; just as important to give large amounts of fluids and electrolytes

    11. c. false; more often hyponatraemia

    12. a-d false
    e true; pancreatic secretions (amylase) are high in urine; in kidney transplantation the renal vasculature is anastomosed with the iliac vessels; the endocrine pancreas is connected similarly but the exocrine pancreas is connected with the intestines or preferably the urine bladder, which makes it possible to monitor the exocrine pancreas function in order to detect rejection (increased loss of bicarbonate in the urine or increase in urine amylase); when the transplanted pancreas is viable, conversion to a connection with the intestines will be performed after approximately 1 year.

    13. a true; the diagnosis is pulmonary renal syndrome; the differential diagnosis includes
    Goodpasture's disease, and this disease is diagnosed by circulating anti-GBM antibodies and anti-GBM antibodies in the kidney tissue by immunofluorescence. This disease can be manifested by a rapid progressive glomerulonephritis (RPGN) and needs to be treated immediately by plasma filtration.

    14. a false; this effect is only proven in healthy people under anesthesia, not in ICU
    patients!
    b false; unproven
    c false; there is an improvement in dorsal ventilation
    d true
    e. false; unproven, also not in meta-analysis

    15. c true; all other alternatives are causes as well, but less frequent causes; review Houston

    16. a true; see Brower NEJM
    b-e false; nothing has been proven scientifically in prospective randomised trials (review Houston)

    17. a false
    b false; transthoracic echocardiography can reveal right ventricular and atrial dilatation and sometimes the thrombotic mass itself, transoesophageal echocardiography may be more sensitive and specific, but the diagnostic value has not been evaluated in comparison with pulmonary angiography; advantage is that it can be performed bedside
    c false; perfusion scintigraphy – ventilation scintigraphy – ultrasonography lower extremities – pulmonary angiography; its diagnostic value never tested in ICU patients and probably not very high
    d true; gold standard despite need of transport; spiral CT-scanning of the thorax can detect central PE adequately, but not peripheral PE; according to the latest Consensus Diagnostiek Longembolie in the Netherlands in December 1999 it can replace ventilation scintigraphy and compression ultrasonography/duplex scanning of the lower extremities, but it is not the gold standard!
    e false; result of increased dead space ventilation, but its diagnostic value is not known; interesting would be continuous VCO2 - measurement

    18. a false; 500 ml/24 hour
    b true
    c false; produced in the choroid plexus in the ventricles and absorbed by the arachnoidal villi
    d false; glucose is low and protein high; note that this is true for all kinds of meningitis: bacterial, viral, and sterile (for example caused by bleeding)
    e false; the test is negative.Due to the obstruction there is no increment of cerebrospinal fluid pressure. In the Queckensted maneuver one applies pressure on both jugular veins. This gives a disturbance of venous drainage from the head and an increase of venous bloodvolume in the head. This leads to a higher cerebrospinal fluid pressure which can be measured at the lumbar puncture site, unless there is obstruction between cerebrum and lumbar puncture site

    19 a false; T3 is also secreted by the thyroid gland. The main source of T3 however is peripheral conversion of T4 to T3.
    b false; T3 is low and reverse T3 is high.
    c false
    d true
    e false; they inhibit this conversion.

    20. a false; a diabetic keto-acidosis can occur in NIDDM although it is extremely seldom.
    Keto-acidosis develops because lipolysis takes place, and lipolysis takes place when there is no insuline anymore; in type II DM (=NIDDM) there is insulin but the defect concerns insulin receptor resistance.
    b false; also in NIDDM
    c true
    d false; there is often hyponatremia
    e false; just as important to give large amounts of fluids and electrolytes
  2. divakar.

    divakar. Guest

    One principal function of the Class I and Class II major histocompatibility complex S proteins is to
    A. transduce the signal to the T-cell interior following antigen binding
    B. mediate immunoglobulin class switching
    C. present antigen for recognition by the T-cell antigen receptor ****
    D. stimulate production of interleukins
    E. bind complement

    The major role of the complement system is to work in conjunction with
    A. antibodies to lyse cells via the C8 and C9 components ****
    B. the major histocompatibility complex for cell recognition
    C. antibodies to opsonize cells
    D. the T-cell receptor for production of lymphokines
    E. antibodies to lyse cells via the perforin molecules

    T-cell antigen receptors are distinguished from antibodies by which of the following
    A. T-Cell receptors are glycosylated
    B. T-cell receptors must interact with antigen uniquely presented by other cells but not with free antigen ****
    C. T-Cell receptors bind various cytokines
    D. T-Cell receptors bind complement to lyse cells
    E. T-cell receptors are mediators of allergic reactions

    T-cell receptors or antibodies react with antigens
    A. because both are made by lymphocytes
    B. because of complementary of molecular fit of both with antigen ****
    C. because both 'have light chain and heavy chain polypeptides
    D. cause histamine release
    E. facilitate perforin release
  3. kim.

    kim. Guest

    According to the log-kill hypothesis, chemotherapeutic agents kill a constant fraction of cells (first order kinetics), rather than a specific number of cells, after each dose 1. Solid cancer tumors - generally have a low growth fraction thus respond poorly to chemotherapy & in most cases need to be removed by surgery

    2. Disseminated cancers- generally have a high growth fraction & generally respond well to chemotherapy

    Log kill hypothesis:

    LOG kill hypothesis

    * The example shows the effects of tumor burden, scheduling, initiation/duration of treatment on patient survival.
    * The tumor burden in an untreated patient would progress
    * The tumor is detected (using conventional techniques) when the tumor burden reaches 10to9 cells
    * The patient is symptomatic at 10to10-10to11 cells
    * Dies at 10to12 cells
  4. kim.

    kim. Guest

    What is the basic principles to immunoglobulin class switching
    1) during an immune response B cells will sometimes switch and make a different class of antibody
    -V regions remain the same but C regions change
    -Different classes of antibodies work in different parts of the body (blood versus mucous secretion)
    -Switch in undirectional ( B cell that switches from IgM -> IgG will never make IgM again)
    -T helper cells induce class switching via cytokines

    What is a more sosphicated understanding of immuoglobulin class switching?
    In secondary responses, plasma cell secrete antibodies that still have same antigen specificty as IgM on surface of the original cell that was activated and the IgM that was secreted int he primary response
    -However antibodies secreted during secondary response now have different H chain constant region,
    -Antibodies produced during a secondary resposne are mostly IgG instead of IgM

    What induces ics?
    Activated T helper cells release cytokines that have been shown to induce B cells to class switch to a particular class of antibody

    -IL-4 induces class switching to IgG or IgE
    IL-5 induces class switching to IgA
  5. kim.

    kim. Guest

    What does multivalent antigen mean?
    It has multiple epitopes(same or different type) and thus several antibodies can bind.

    What is a hapten?
    Low MW. Not immunogenic unless conjugated to a carrier.

    What does immunogen do?
    induce antibody formation.

    Which two types of antibodies don't have the hinge region thus have low affinity toward antigens?
    IgM and IgE

    Idiotype corresponds to which region of the immunoglobulins?
    V region of both H and L chains.

    Allotype corresponds to which region of the immunoglobulins?
    C region of both H and L chain. Genetic variation between members of the same species expressed on H and L chains.

    Isotype corresponds to which region of the immunoglobulins?
    Only C region of the H chain.
    IgM, IgG, IgA, IgD, IgE.
    specific effector functions

    What are the signs and symptoms of cholestasis of pregnancy?
    A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

    The following signs and symptoms may be present when the mother has cholestasis of pregnancy:

    * Very intense itching, especially on the palms of the hands and soles of the feet.
    * Dark urine.
    * Light-colored feces (stools, bowel movements).
    * Jaundice - whites of the eyes, skin and tongue may take on a yellowish/orangey tinge.

    It is not uncommon for the itchiness to be the only symptom, which tends to become much worse during the night.

    Pregnant mothers who have any of the signs or symptoms mentioned above should tell a health care professional as soon as possible.


    prevalence can be thought of as ___ times ___. an example of this is ___.
    incidence
    duration
    rise in HIV prevalence after tx became available

    incidence is useful for measuring ___ and assessing ___. it is used in ___ (2) studies
    risk
    disease etiology
    clinical trials
    cohort

    prevalence is useful for ___. it is used in ___ (2) studies.
    planning health services
    cross sectional
    case-control

    cumulative incidence is ___ divided by ___.
    # of new cases during a time period
    population at risk at the beginning

    incidence rate is ___ divided by ___.
    number of new cases observed
    total person-time of observation

    3 aims of descriptive epidemiology
    describe natural history of disease
    determine allocation of resource
    suggest hypotheses about disease causes

    direct age adjustment uses the ___ rates from a specfic population and applies them to the ___ population to obtain a ___ rate.
    age-specific
    standard
    age-adjusted

    2 kinds of studies
    descriptive
    analytical

    2 kinds of analytical studies
    experimental
    observational


    What is the peak incidence for prostate cancer?
    Between the ages of 65-75

    What is the most common type of prostate cancer?
    Adenocarcinoma (95%)

    What zone of the prostate does the majority of cancer develop?
    The peripheral zone

    What are the risk factors for prostate cancer?
    Advancing Age

    Race - African American men 50% higher risk

    Genetics

    Diet - High fat, low vegetable diet

    How does prostate cancer present in the digital rectal exam?
    Hard, nodular, or asymmetrical enlargement

    Areas of induration
  6. kim.

    kim. Guest

    Pediatrics
    What additional cardiac malformation is almost always present in Truncus Arteriosus?
    VSD

    Which congenital heart malformation is suggested by a characteristic "egg-shaped" heart silhouette?
    Transposition of the great vessels

    What drug should be administered right away in a patient with transposition of the great vessels?
    PGE1 administration to maintain a patent ductus arteriosus

    50% of patients with 22q11 microdeletions have which congenital cardiac malformation?
    Tetralogy of Fallot

    How does the CXR appear in an infant with Tetralogy of Fallot?
    The size is generally normal but it may be "boot shaped"

    What type of drug is atomoxetine and what pediatric condition is it useful for?
    A highly specific norepinephrine reuptake inhibitor that is used in childhood ADHD. It is not a stimulant and has few side effects and low abuse potential

    Describe the typical rash associated with measles-
    An erythematous maculopapular rash that erupts on the head and spreads caudally lasting 4 to 5 days

    How does the rash of Roseola infantum typically present?
    Maculopapular rash that appears on the trunk and spreads peripherally on the third or fourth day of illness

    What disease is tested for by the nitroblue tetrazolium test and the dihydrorhodamine reduction test?
    Chronic Granulomatous Disease
    a disorder of phagocytic immunity

    What prophylactic treatment should patients with Chronic Granulomatous Disease recieve?
    Prophylactic TMP-SMX and interferon gamma therapy

    Is heavy exposure to animal dander early in life a risk factor for allergy, or is it protective?
    It appears to reduce the risk of atopic disease

    What are the treatment options for allergic rhinitis?
    Allergin avoidance
    H1 blockers
    Nasal topical steroids

    What is the difference between Urticaria and Angioedema?
    Urticaria - edematous hives on the skin that itch, blanch and resolve within hours or days
    Angioedema - Confined to the lower dermis, a well demarcated area of swelling without pruritis, erythema or warmth


    Prostate


    What part of the prostate cancer most common?
    Peripheral

    what are some complications of prostectomy?
    Impotence
    Urinary incontence
    Bladder Neck contracture

    What are some complications of radiation therapy?
    Prostatitis
    Cystitis
    Impotence

    What is the MCC of microscopic hematuria?
    BPH

    How do you treat BPH medically?
    Alpha Blockers
    5-alpha-reductase inhibitors

    What is the mechanism of action of alpha blockers?
    They relax the prostate at the bladder neck

    What are some side effects of alpha blockers?
    Orthostatic hypotension
    Asthenia- feeling weak and tired


    Isotype corresponds to which region of the immunoglobulins?
    Only C region of the H chain.
    IgM, IgG, IgA, IgD, IgE.
    specific effector functions.

    Hypervariable Regions/complementary-determining regions (HV/CDR), where are they located?
    3 loops on each H and L chain. 1st and 2nd loop in the V region and the 3rd in the VJ junction of L chain and V-DJ junction of H chain.

    Composite HV sites increases diversity and speciticity.

    T/F
    Each epitope can be bound by different antibodies.
    T

    Types of antigen-antibody binding forces:
    noncovalent
    electrostatic forces (salt bridge)
    H bond
    Vander Waals
    hydrophobic interactions

    Types of epitopes:
    pocket
    cleft
    discontinuous

    What are polyclonal antobodies specific for?
    Antigen and anything else in antigen prep.

    what are monoclonal antibodies specific for?
    single antibody for a specific antigen
  7. jignesh.

    jignesh. Guest

    what are the symptoms of schistosomiasis infection of the bladder?
    1. dysuria
    2. frequency/urgency
    3. suprapubic/perineal pain (due to ulcerations)
    4. fibrosis with contraction of bladder
    5. calcificiation

    What cancer is S. haematobium associated with?
    Squamous cell ca

    What are the pathological effects of ureters and S. haematobium?
    1. bilateral or unilateral effect (Left more than right)
    2. polyps, ureteritis cystica, ulcers
    3. stenosis (intravesical)
    4. hydroureter

    Give 3 effects of S. haematobium of the kidneys:
    1. hydronephrosis
    2. pylonephrosis
    3. pylonephritis

    What are symptoms of S. mansoni?
    1. abdominal pain
    2. diarrhea (with blood, pus, mucus)
    3. polyp formation (in the rectosigmoid junction or diffusely)
    4 HEPATOMEGALY
    *can be reversed by chemotherapy

    Above all, schistosomiasis is a chronic disease. Many infections are subclinically symptomatic, with mild anemia and malnutrition being common in endemic areas. Acute schistosomiasis (Katayama's fever) may occur weeks after the initial infection, especially by S. mansoni and S. japonicum. Manifestations include:

    * Abdominal pain
    * Cough
    * Diarrhea
    * Eosinophilia — extremely high eosinophil granulocyte (white blood cell) count.
    * Fever
    * Fatigue
    * Hepatosplenomegaly — the enlargement of both the liver and the spleen.
    * Genital sores — lesions that increase vulnerability to HIV infection. Lesions caused by schistosomiasis may continue to be a problem after control of the schistosomiasis infection itself. Early treatment, especially of children, which is relatively inexpensive, prevents formation of the sores.
    * Skin symptoms: At the start of infection, mild itching and a papular dermatitis of the feet and other parts after swimming in polluted streams containing cercariae
  8. jignesh.

    jignesh. Guest

    Schistosomiasis
    This disease is most commonly found in Asia, Africa, and South America, especially in areas where the water contains numerous freshwater snails, which may carry the parasite.

    The disease affects many people in developing countries, particularly children who may acquire the disease by swimming or playing in infected water


    what are 4 other manifestations of schistosomiasis?
    1. cor pulmonale
    2. paraplegia (infected cord)
    3. epilepsy (cerebral infection)
    4. of the reproductive organs

    How is schistosomiasis diagnosed?
    1. directly
    2. immunological
    3. assay
    4. indirect
    1. direct (ova in urine or kato thick stool)
    2. immunological (antibody/antigen detection)
    3. Monoclonal antibody dipstick assay (urinary)
    4. indirect (radiology, renography, US, CT, reagent strips)

    What is the treatment for schistomsomiasis?
    Praziquantel

    What are the side effects of praziquantel? (5)
    1. spasmodic abdominal pain
    2. nausea
    3. loose stools
    4. headache and dizziness
    5. fever

    What infections can praziquantel be used for? (8)
    1. schistosomiasis
    2. clonorchiasis
    3. opisthorchiasis
    4. fasiolopsiasis
    5. paragominmiasis
    6. taenia
    7. neurocysticercosis
    8. prevention of human hyatid


    What is the average heart rate for an infant 0-2 months old?
    140
    Range of 90-190

    What is the average heart rate for an infant 3-6 months old?
    130
    Range of 80-180

    What is the average heart rate for an infant 6-12 months old?
    115
    Range of 75-155

    What are the three best places to obtain an accurate pulse in an infant?
    Femoral arteries
    Brachial arteries
    Auscultating heart
    (or umbilical artery in a newborn)

    Where is the best place to look for central cyanosis in an infant?
    Tongue and oral mucosa, not nail beds or extremities

    What pathology is suggested by finding multiple light-brown skin lesions with smooth borders?
    Cafe-au-lait spots (coast of California version)
    Suggets neurofibromatosis

    What is the most common cause of jaundice in the first 24 hours of life?
    Hemolytic disease of the newborn

    How much of a newborn's body weight does the head account for?
    One-third

    When does the posterior fontanelle typically close?
    2 months

    How large is the anterior fontanelle typically at birth?
    4-6 cm in diameter

    What pathology may be suspected by an enlarged posterior fontanelle at birth?
    Congenital Hypothyroidism

    What is the name for pliable, springy cranial bones (like a ping pong ball)?
    Craniotabes

    What pathologies are suggested by pliable, springy cranial bones in infancy
    Hydrocephaly, rickets, congenital syphilis
  9. uday.

    uday. Guest

    Where do neuroblastomas arise?
    The postganglionic sympathetic nervous system - usually in the abdomen, especially in the adrenal medulla

    Which age and gender is Ewing sarcoma most prevalent in?
    Ewing sarcoma is seen primarily in adolescents and is 1.5 times more common in males

    At which parts of the long bone does Ewing sarcoma tend to arise? What about osteogenic sarcoma?
    Ewing - midshaft
    OS - metaphyseal portion

    Which bones are most commonly involved with Ewing sarcoma?
    Femur (20%)
    Pelvis (20%)
    Fibula (12%)
    Humerus and tibia (10% each)

    Which cancer of the bone is visualized as a radial "sunburst" pattern of periosteal inflammation on radiograph?
    Osteogenic sarcoma

    Is systemic spread more common in Ewing sarcoma or osteogenic sarcoma?
    More common in Ewing sarcoma - rare in osteogenic sarcoma

    What is leukocoria?
    Absence of the red reflex in an eye

    What is the differential diagnosis for lack of red reflex in an eye?
    Retinoblastoma
    Cataracts
    Retinopathy of prematurity
    Glaucoma

    What is the most common cause of ophthalmia neonatorum in the first 24 hours of life?
    Chemical irritation (birth trauma, antibiotic prophylaxis)

    What is the name for the disease defined as avascular necrosis of the femoral head?
    Legg-Calve-Perthes disease
    Usually occurs between ages of 4-8

    What is the stereotypical patient who develops slipped capital femoral epiphysis?
    An overweight patient during puberty

    What is the name of a bone fracture when a force breaks one side of a bone and bends the other?
    Greenstick fracture

    What is the duration of antibiotic therapy for osteomyelitis?
    4-6 weeks of borad spectrum anti-staphylococcal agents

    • Hematopoiesis is defined as the production, development,
    and maturation of all blood cells.
    • Erythropoiesis in the fetus takes place in the yolk
    sac, spleen, and liver.
    • Erythropoiesis in the adult takes place primarily in
    the bone marrow.
    • Hematopoiesis within the bone marrow is
    termed intramedullary hematopoiesis; outside the bone marrow, it is termed extramedullary
    hematopoiesis.

    • The bone marrow is one of the largest nonsolid
    organs of the body.
    • The M:E ratio (3 to 4:1) reflects the amount of
    myeloid elements in the bone marrow compared
    with the erythroid elements in the bone marrow.
    • Multipotential stem cells are capable of differentiating
    into nonlymphoid or lymphoid precursor committed
    cells.
    • EPO is a hormone produced by the kidneys that regulates
    erythroid production.
    • A bone marrow aspirate and biopsy are invasive procedures
    usually performed at the location of the iliac
    crest in adults.
    • The CBC consists of nine parameters: WBC, RBC,
    Hgb, Hct, MCV, MCH, MCHC, RDW, and platelet
    count.
    • The MCV is one of the most stable CBC parameters
    over time.
    • Increases in MCV can occur as a result of transfusion,
    reticulocytosis, hyperglycemia, and methotrexate.
    • The RDW may be an early indicator of an anemic
    process.
    • Critical values are those that are outside the reference
    range and that need to be immediately reported
    and acted on.

    • The reticulocyte count is the most effective means of
    assessing red cell regeneration in response to anemic
    stress.
    • Red cell production is effective when the bone marrow
    responds to anemic stress by producing an
    increased number of reticulocytes and nucleated
    red cells.
    • Ineffective red cell production is described as
    death of red cell precursors in the bone marrow
    before they can be delivered to the peripheral
    circulation.
    • Morphological classification of anemias is determined
    by the red cell indices.
    • Microcytic, hypochromic anemias are characterized
    by an MCV of less than 80 fL and an MCHC of less
    than 32%.
    • Macrocytic, normochromic anemias are characterized
    by an MCV of greater than 100 fL.
    • Normocytic, normochromic anemias are characterized
    by an MCV between 80 and 100 fL and an
    MCHC of 32% to 36%.
    • Normal red cells are disk-shaped flexible sacs filled
    with Hgb and having a size of 6 to 8 μm.

    Red blood cell distribution width (RDW) - a measure of the variation of the RBC population

    What is the differential diagnosis for lack of red reflex in an eye?
    Retinoblastoma
    Cataracts
    Retinopathy of prematurity
    Glaucoma
    retinal detachment

    The red reflex refers to the reddish-orange reflection from the eye's retina that is observed when using an ophthalmoscope or retinoscope from approximately 30 cm / 1 foot. This examination usually done in a dimly lit or dark room.

    Many eye problems may be detected by this test, such as:

    * Cataracts - show leukocoria, or white coloration of the eye which may be from rubella or other maternal infections
    * Retinoblastoma - shows leukocoria.

    Newborns are regularly screened for retinoblastomas with an ophthalmoscope.

    According to Bate's Guide to Physical Exams, retinal detachment would result in the absence of red reflex in the affected eye.

    Where does Non-Hodgkin's Lymphoma originate?
    In the cells and organs of the immune system

    In what cells does N-H lymphoma originate?
    Undifferentiated lymphoid cells

    T or F: N-H lymphoma is thought to result from genetic deviation that influences cell proliferation, differentiation, & cell death.
    True

    Recurrent, nonrandom chromosome translocations are seen in what disease's cytogenetic studies?
    NHL

    What immunodeficiency syndromes are associated with a higher risk of NHL?
    1. Wiskott-Aldrich
    2. Ataxia-telangiectasia
    3. Other inherited or acquired immunodeficiencies

    What role does the EBV virus have regarding NHL?
    EBV is thought to precede or occur along with B-cell transformation (assoc. with Burkitt's lymphoma)

    Why is histologic classification important in NHL?
    It helps to identify the malignant cell of origin, therefore aiding in the understanding of the biologic behavior of the tumor.

    How is Non-Hodgkin's lymphoma divided?
    Into T-cell and B-cell lymphomas; subdivisions are specific to precursor characteristics
  10. uday.

    uday. Guest

    What are the two main causes of hyperparathyroidism
    Parathyroid hyperplasia and parathyroid adenoma

    What are the two clinical features of hyperparathyroidism
    Bone pain and hypercalcemia

    What are the significant laboratory values in hyperparathyroidism
    Calcium >11.5 mg/dl; Phosphorus <2.0 mg/dl

    What is seen on bone histologic examination in hyperparathyroidism
    An increased number of osteoclasts

    After bone is resorbed, what replaces it
    Fibrous tissue

    What abnormality is often seen in the fibrous tissue of resorbed bone
    Hemosiderin pigment

    What are the fibrous tissue lesions seen in resorbed bone called
    Brown tumors

    How is hyperparathyroidism treated
    By removal of the parathyroid lesion

    How does hypoparathyroidism affect bone
    It decreases the turnover rate

    What is the most common reason for hypoparathyroidism
    Surgical removal of parathyroid glands

    What are the clinical signs of hypoparathyroidism
    Signs of hypocalcemia, including soft tissue ossification and calcification, abnormal dentition, and otoscleorosis

    What is seen on bone histologic examination in hypothyroidism
    Active osteoblasts and lack of osteoclasts

    What is the treatment for hypoparathyroidism
    Administration of PTH or vitamin D
  11. kavitha.

    kavitha. Guest

    pathology
    Autosomal-dominant diseases: What are 3 characteristics of hereditary spherocytosis?
    (1) spheroid erythrocytes (2) hemolytic anemia (3) increased MCHC

    Autosomal-dominant diseases: What is the cure for hereditary spherocytosis?
    splenectomy

    Autosomal-dominant diseases: What is the genetic defect in achondroplasia?
    Autosomal dominant cell-signaling defect of fibroblast growth factor (FGF) receptor 3.

    Autosomal-dominant diseases: What are the physical characteristics of achondroplasia?
    Dwarfism, short limbs, but head and trunk are normal size.

    X-linked or AR:: Cystic fibrosis
    AR

    X-linked or AR:: albinism
    AR

    X-linked or AR:: Fragile X
    X-linked

    X-linked or AR:: Duchenne's muscular dystrophy
    X-linked

    X-linked or AR:: hemophilia A and B
    X-linked

    X-linked or AR:: a1-antitrypsin deficiency
    AR

    X-linked or AR:: Fabry's
    X-linked

    X-linked or AR:: G6PD deficiency
    X-linked

    What percentage of strokes are ischemic vs. hemorrhagic?
    85% ischemic
    15% hemorrhagic

    How long do the neurologic deficits tend to last in TIAs?
    Usually less than 30 minutes but no more than 24 hours

    What is the 5-year risk of developing a stroke after suffering a TIA?
    30%

    What are the risk factors for TIAs in young patients?
    Oral contraceptives
    Hypercoagulable states (Protein C, S deficiencies)
    Cocaine or amphetamine use
    Polycythemia
    Sickle cell disease

    What are the two causes of carotid bruits?
    Murmurs referred from the heart
    Turbulence in the internal carotid artery

    What are common symptoms of a TIA in the carotid system?
    Temporary loss of speech
    Paralysis or paresthesias
    Amaurosis fugax

    What are common symptoms of a TIA in the vertebrobasilar system?
    Dizziness
    Double vision
    Vertigo
    Numbness of face and limbs
    Dysarthria
    Dysphagia
  12. divakar.

    divakar. Guest

    1. Regarding the clavicle, all are correct EXCEPT:
    a. It is an example of the short bones. ****
    b. It is the first bone to ossify in the fetal life.
    c. It ossifies in membrane.
    d. It is the commonly fractured bone.
    e. It has no medullary cavity.

    2. The most common site of fracture of the clavicle is:
    a. Medial end.
    b. Lateral end.
    c. Midpoint of the clavicle.
    d. Junction of the medial two-thirds and the lateral third. ****
    e. Junction of the lateral two-thirds and the medial third.

    3. The inferior surface of the clavicle gives attachment to all of the following EXCEPT:
    a. Conoid ligament.
    b. Trapezoid ligament.
    c. Costoclavicular ligament.
    d. Pectoralis major muscle. ****
    e. Subclavius muscle.

    4. These muscles are attached to the medial two thirds of the clavicle EXCEPT:
    a. Sternomastoid.
    b. Deltoid. ***
    c. Pectoralis major.
    d. Subclavius.
    e. Sternohyoid.

    5. Regarding the articulations of the clavicle, one is correct:
    a. The medial end articulates with the manubrium by fibrous articulation.
    b. The medial end articulates with the manubrium by cartilaginous articulation.
    c. The medial end articulates with the body of the sternum by saddle synovial joint.
    d. The lateral end articulates with the acromion by fibrous articulation.
    e. The lateral end articulates with the acromion by plane synovial articulation. ***
  13. genom.

    genom. Guest

    Type 1 respiratory failure is defined as hypoxaemia without hypercapnia, and indeed the PaCO2 may be normal or low. It is typically caused by a ventilation/perfusion (V/Q) mismatch; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs. The basic defect in type 1 respiratory failure is failure of oxygenation characterized by:

    PaO2 low (< 60 mmHg (8.0 kPa))
    PaCO2 normal or low
    PA-aO2 increased

    This type of respiratory failure is caused by conditions that affect oxygenation such as:

    * Parenchymal disease (V/Q mismatch)
    * Diseases of vasculature and shunts: right-to-left shunt, pulmonary embolism
    * interstitial lung diseases: ARDS, pneumonia, emphysema.


    The basic defect in type 2 respiratory failure is characterized by:

    PaO2 decreased
    PaCO2 increased
    PA-aO2 normal
    pH decreased

    Type 2 respiratory failure is caused by increased airway resistance; both oxygen and carbon dioxide are affected. Defined as the build up of carbon dioxide levels (PaCO2) that has been generated by the body. The underlying causes include:

    * Reduced breathing effort (in the fatigued patient)
    * A decrease in the area of the lung available for gas exchange (such as in emphysema).
  14. jason.

    jason. Guest

    ANAL CANCER
    DEFINITION
    Neoplasms of the anorectal region that are classifi ed into tumors of the perianal skin (anal margin carcinomas) and tumors of the anal canal.

    INCIDENCE
    Rare (1–2% of all colon cancers).

    RISK FACTORS
     Human papillomavirus (HPV)
     Human immunodefi ciency virus (HIV)
     Cigarette smoking
     Multiple sexual partners
     Anal intercourse
     Immunosuppressed state

    SIGNS AND SYMPTOMS
    Often asymptomatic; can present with anal bleeding, a lump, or itching; an irregular nodule that is palpable or visible externally (anal margin tumor) or a hard, ulcerating mass that occupies a portion of the anal canal (anal canal tumor).

    DIAGNOSIS
     Surgical biopsy with histopathologic evaluation.
     Histology: Anal margin tumors include squamous and basal cell carcinomas, Paget’s disease, and Bowen’s disease. Anal canal tumors are usually epidermoid (squamous cell carcinoma or transitional cell/cloacogenic carcinoma) or malignant melanoma.
     Clinical staging: Involves history, physical exam, proctocolonoscopy, abdominal or pelvic CT or MRI, CXR, and liver function tests.

    TREATMENT
     Epidermoid carcinoma of anal canal: Chemoradiation is mainstay— 5-FU, mitomycin C, and 3,000 cGy external beam radiation (Nigro protocol) surgery is reserved for recurrence.
     Other anal margin tumors: Wide local excision alone or in combination with radiation and/or chemotherapy is successful in 80% of cases without abdominal-perineal resection (APR) if tumor is small and not deeply invasive.
     Anal canal tumors: Local excision not an option; combined chemotherapy (5-FU and mitomycin C) with radiation often successful; APR only if follow-up biopsy indicates residual tumor.
  15. jason.

    jason. Guest

    what is the mc type (80%) of primary liver cancer?
    hepatocellular carcinoma (malignant hepatoma)
    - most deaths due to cancers worldwide
    - Africa/Asia mc

    what are the two types of hepatocellular carcinoma (HCC)?
    nonfibrolamellar:
    - assd w/ hepB/C and cirrhosis
    - unresectable
    - short survival time

    fibrolamellar:
    - not assd with hepB/C or cirrhosis
    - resectable
    - longer survival time
    - mc in adolescents/young adults

    what is the prognosis for someone with hepatocellular carcinoma (HCC)?
    resectable: 25% at 5 years
    unresectable: less than 1 year

    what are some clinical features of a pt with hepatocellular carcinoma (HCC)?
    painful hepatomegaly
    signs/sxs of chronic liver disease
    paraneoplastic syndromes

    what are test used for the screening of hepatocellular carcinoma (HCC)?
    AFP
    (elevated in 40-70% of pts with HCC

    what type of junction would allow dye to pass from one cell to the next?
    Gap junctions

    describe the derivation of the adrenal medulla
    neural crest origin--> the neuroblasts develop into ganglia

    list the layers of the adrenal gland from outside in
    glomerulosa (outside)
    fasciculata
    reticularis (medula)

    what is the position of the foot if the tibial nerve is severed?
    loss of plantar flexion, foot dorsiflexed and everted, sensory loss on sole of foot

    what is the composition of the aortic and pulmonic valve?
    lined by endothelium and have abundant fibroelastic tissue plus a dense collagenous core; avascular

    MV and TV have a loose connective tissue core which is increased in mitral/tricuspid valve prolapse (myxomatous degeneration)

    break humerus, wrist drop

    what nerve has been severed?
    radial nerve injury
  16. jason.

    jason. Guest

    When is the outer envelope of HIV acquired?
    During virion budding

    Describe the outer envelope of HIV
    Studded with ~72 oligomeric spikes formed by two major viral-envelope glycoproteins (gp120 and gp 41)

    Describe the HIV genome
    Two identical RNA strands, RNA polymerase, integrase, and two tRNAs base-paired to the genome within the protein core

    What are the principal target cells for HIV infection
    CD4+ T lymphocytes and cells of the monoctye/macrophage lineage

    How does HIV enter cells
    Via a direct pH-independent membrane fusion event between the virion and host cell membranes

    What is the primary high-affinity cell surface receptor for HIV
    The CD4 glycoprotein; CCR5 and CXCR4 are essential coreceptors

    what are the two types of hepatocellular carcinoma (HCC)?
    nonfibrolamellar:
    - assd w/ hepB/C and cirrhosis
    - unresectable
    - short survival time

    fibrolamellar:
    - not assd with hepB/C or cirrhosis
    - resectable
    - longer survival time
    - mc in adolescents/young adults

    what is the prognosis for someone with hepatocellular carcinoma (HCC)?
    resectable: 25% at 5 years
    unresectable: less than 1 year

    what are some clinical features of a pt with hepatocellular carcinoma (HCC)?
    painful hepatomegaly
    signs/sxs of chronic liver disease
    paraneoplastic syndromes

    what are test used for the screening of hepatocellular carcinoma (HCC)?
    AFP
    (elevated in 40-70% of pts with HCC)

    what is nonalcoholic steatohepatitis (NASH)?
    histology of alcoholic liver disease w/ no hx of use
    benign/asymptomatic
    no txt necessary
  17. jason.

    jason. Guest

    How does acute RF develop? (rheumat.fever)
    after group A streptococcal pharyngitis

    how do immunitis develop against acute RF?
    immunemeditated
    type II hypersensitivity reaction
    cell-meditated immunity type IV

    What is the mos common initial presentation of acute RF?
    migratory polyartritis most common initial presentation

    what is the most common cause of death death in acute RF?
    myocarditis is the most common type of death

    What happens with RF in an acute attack? in chronic disease?
    mitral regurgitation in acute attack
    mitral stenosis in chronic disease

    How do you diagnose acute RF?
    with Jones criteria

    What are the major criteria in diagnosing RF?
    1) Carditis
    2) Arthritis
    3) Chorea
    4) Erythema marginatum subcutaneous nodules

    in acute RF what happens to ASO and DNase B titers?
    ↑ ASO
    ↑ DNase B titers

    Which valve causes acute RF?
    Acute RF: MV most often involved followed by AV

    What is the most common cause of MV stenosis?
    recurrent RF

    Mitral valve stenosis effects?
    Atrial fibrillation
    Pulmonary venous hypertension
    RHF

    What is the sound of MV stenosis?
    opening snap followed by an early to mid-diastolic rumble

    What is mitral regurgitation most commonly caused by?
    mitral valve prolapse

    what is the sound of MV regurgitation?
    pansystolic murmur,
    S3/S4 heart sounds
    no ↑ intensity with deep held inspiration

    MV prolapse is associated with which syndromes?
    Marfan and Ehlers-Danlos syndromes

    how does MVP occur?
    -myxomatous degeneration
    -excess dermatan sulfate

    heart sound of MVP?
    systolic click followed by murmur

    What happens to the MVP sound if ↑ preload?
    preload alters click and murmur relatioinship to S1/S2

    Treatment of Symptomatic MVP?
    β-blockers

    Ways to regulate G protein -linked receptors
    Most important is via phosphorylation of specific amino acids in their cytosolic domain. When these aa are phosphorylated, the receptor becomes desensitized.

    G protein-linked receptor kinases (GRK's)
    specifically act on activated receptors. When specific aa within cytosolic portion of Gprotein receptors are heavily phosphorylated by GRK's

    A kinase that is activated by Gprotein signalling which can phosphorylate other amino acids on the receptor
    Protein Kinase A (PKA). such inhibitory action is a good example of negative feedback during cell signalling

    G protein complexes bind to phosphate groups. They function as molecular switches. When they are attached to a complex with three phosphate groups (guanosine triphosphate [GTP]), they turn on. When they are attached to a complex with only two phosphate groups (guanosine diphosphate [GDP]), they turn off.

    G proteins regulate metabolic enzymes, ion channels, transporters, and other parts of the cell machinery, controlling transcription, motility, contractility, and secretion, which in turn regulate systemic functions such as embryonic development, learning and memory, and homeostasis.

    Each PKA is a holoenzyme that consists of two regulatory and two catalytic subunits. Under low levels of cAMP, the holoenzyme remains intact and is catalytically inactive. When the concentration of cAMP rises (e.g., activation of adenylate cyclases by G protein-coupled receptors coupled to Gs, inhibition of phosphodiesterases that degrade cAMP), cAMP binds to the two binding sites on the regulatory subunits, which leads to the release of the catalytic subunits.


    G proteins use this for energy. Galpha binds to this and separates from beta and gamma
    GTP

    Adenylyl cyclase is an enzyme that turns cytosolic ATP into
    cAMP. Adenylyl cyclase is inhibited by Gialpha. When G protein becomes inactive (GTP hydolyzed) the ad cycl ceases to make cAMP

    Enzyme used to prevent cAMP levels from remaining elevated after G protein inactivates
    Phosphodiesterase: degrades cAMP. this ensures that sig transd pathway will shut down promplty when concentration of ligand outside cell declines
  18. divakar.

    divakar. Guest

    All of the following are the markers of anaplasia except?
    A. Cellular and nuclear pleomorphism
    B. Nucleus to cytoplasm ratio of 1:4***
    C. Presence of tumor giant cells
    D. Bizarre mitotic figures
    E. Loss of polarity

    All of the following are true regarding rate of growth of a neoplasm except?
    A. Fast growing tumors have high cell turnover
    B. Most cells in cancers remain in G0 or G1 phase
    C. Growth rate is inversely correlated to differentiation
    D. With tumor growth more cells enter proliferative pool***
    E. Latent period before a tumor is clinical detectable is more than 90 days

    Which of the following is the appropriate term for a rest of normal tissue in an abnormal location?
    A.Teratoma
    B. Adenoma
    C. Normoma
    D.Choristoma***
    E. Hamartoma

    Marked dysplastic changes involving the entire thickness of the epidermis but confined to the normal tissue boundaries is termed:
    A. Carcinoma
    B. Carcinsarcoma
    C. Carcinoma in situ
    D. Carcinoma in vivo
    E. Squamous cell carcinoma***

    What is malignant neoplasia of skeletal muscle called?
    A. Leiomyoma
    B. Rhabdomyoma
    C. Musculosarcoma
    D. Leiomyosarcoma
    E. Rhabdomyosarcoma***
  19. kim.

    kim. Guest

    What is the sound of MV stenosis?
    opening snap followed by an early to mid-diastolic rumble

    What is mitral regurgitation most commonly caused by?
    mitral valve prolapse

    what is the sound of MV regurgitation?
    pansystolic murmur,
    S3/S4 heart sounds
    no ↑ intensity with deep held inspiration

    MV prolapse is associated with which syndromes?
    Marfan and Ehlers-Danlos syndromes

    how does MVP occur?
    -myxomatous degeneration
    -excess dermatan sulfate

    heart sound of MVP?
    systolic click followed by murmur

    What happens to the MVP sound if ↑ preload?
    preload alters click and murmur relatioinship to S1/S2

    Treatment of Symptomatic MVP?
    β-blockers

    what age group is Calcific Aortic Valve (AV) stenosis common in?
    patients >60 years

    What is the primary high-affinity cell surface receptor for HIV
    The CD4 glycoprotein; CCR5 and CXCR4 are essential coreceptors

    What is special about people who lack CCR5
    They are highly resistant to HIV infection

    What is the first step of HIV infection of a cell?
    Binding of the gp120 subunit to CD4 is the first required step of virus infection

    Why do patients with HIV experience long clinically quiescent periods?
    Failure of the host to mount a sterilizing immune response

    Which cells mount the internal immune response to HIV?
    HIV-specific CD8+ T Cells (CTLs) are generated and kill virus infected cells

    What is the first required step of HIV infection
    Binding of the gp120 subunit to CD4

    post-radical mastectomy--winged scapula indicated injury to which nerve?
    long thoracic nerve; paralysis of the serratus anterior muscle

    what is the clinical presentation in medial longitudinal fasciculus demyelination in MS?
    bilateral internuclear ophthalmoplegia

    a patient presents with a nosebleed and rhinorrhea following a trauma...what injury do you suspect?
    fracture of cribiform plate in ethmoid sinus

    the parathyroid is derived from which pharyngeal pouches?
    3rd and 4th pharyngeal pouches

    what nerve runs along the radial artery?
    median nerve

    artery affected in femoral neck fracture?
    medial femoral circumflex artery--damage leads to aseptic necrosis of the femoral head

    artery affected in femoral neck fracture?
    medial femoral circumflex artery--damage leads to aseptic necrosis of the femoral head

    where does the sperm penetrate the egg?
    zona pellucida

    where is metaphase II completed?
    uterus

    collagen type I examples
    bone, tendon, skin
    **greatest tensile strength**

    which collagen is the initial collagen of wound repair?
    type III replaced by type I

    collagenase with Zn as a cofactor

    which collagen is on basement membranes?
    IV

    which collagen is on epiphyseal plates?
    X

    what causes the highest risk of seizure recurrence
    symptomatic seizure and abnormal eeg

    what kind of seizure causes a higher risk of a second one
    partial

    what two things are required for seizure generation
    hypersynchrony and hyperexcitabilty

    ___ seizure is focal onset involving particular area of cortex). Signs and symptoms depend on what area of the brain is involved
    partial

    __seizure begin simultaneously in widespread brain regions in both hemispheres
    generalized

    what is char of simple partial seizure
    no alteration of consciosuness, motor signs-jacksonian march, somato or special sensory symp, autonomic (vom), psychotic

    what is char of complex partial seizure
    altered consciouness is present
  20. divakar.

    divakar. Guest

    Oxygen toxicity to the lung is due to:
    a) inspired oxygen (FIO2) above 0.6
    b) prolonged exposure
    c) increased arterial partial pressure of oxygen
    d) the effect of oxygen on pulmonary vessels
    e) unhumidified oxygen.
    a) True; b) True; c) False; d) True; e) False

    At 30°C:
    a) Oxygen consumption is one-third that at 37°C
    b) Oxygen solubility is raised
    c) J-waves might appear on the ECG
    d) Active rewarming should be commenced
    e) Carbon dioxide solubility is reduced.
    a) False; b) True; c) True; d) False; e) False

    A thyrotoxic crisis should be immediately treated by:
    a) Radioactive iodine
    b) Propranolol
    c) Diazepam
    d) Lugol’s iodine
    e) Adrenaline.
    a) False; b) True; c) True; d) False; e) False
  21. kim.

    kim. Guest

    What constitutes life-threatening chest trauma?
    Airway obstruction
    Tension Pneumothorax
    Open Pneumothorax
    Massive Hemothorax
    Flail Chest
    Cardiac Tamponade

    What is tension pneumothorax?
    Air enters pleural space through a one-way valve.
    Collapse of the affected lung.
    Impaired venous return.
    Impaired ventilation of unaffected side.

    What are the signs of a tension pneumothorax?
    Tracheal deviation (towardss opposite side)
    Respiratory distress
    Unilateral absence of breath sounds
    Distended neck veins (depends on volume status)
    Cyanosis (late)

    what are postictal features
    aphasia, todds paresis, confusion

    what imaging should you do for seizure
    MRI of the brain: with and without contrast – look for structural abnormality
    PET scan of the brain – look for functional abnormality
    CT of the brain – look for intracranial hemorrhage

    do you have to have an abnormal eeg to have a seizure
    nope fifty percent have normal eeg
    better results if done within 24 hours

    what is epilepsy
    Epilepsy is the condition of recurrent (two or more) spontaneous (unprovoked) epileptic seizures
    persist abnorm brain fxn that allows abnormal neuron firing

    what age group is Calcific Aortic Valve (AV) stenosis common in?
    patients >60 years

    what sound does Aortic Valve (AV) stenosis produce?
    what happens with ↓preload?
    ↑ preload?
    ejection murmur
    ↓intensity with ↓ preload
    ↑ intensity with ↑ preload

    Aortic Valve stenosis is the most common valvular lesion
    what 2 things happen with exercise?
    syncope
    angina

    what kind of anemia is seen with AV (Aortic Valve) stenosis?
    AV stenosis: microangiopathic hemolytic anemia with schistocytes, hemoglobinuria

    what is the most common cause of aortic regurgitation
    isolated AV root dilation

    What happens to pulse pressure in Aortic valve regurgitation?
    ↑ pulse pressure
  22. divakar.

    divakar. Guest

    complications of cirrhosis
    portal htn
    hepatocellular failure

    2 most common causes of cirrhosis
    alcohol use
    chronic hepatitis b and c

    clinical features of portal htn
    bleeding from varices - most life threatening

    hemorrhoids
    caput medusae

    tx of portal htn
    tips (transjugular intrahepatic portal systemic shunt) to lower portal pressure

    what is the most common type of varices from portal htn
    esophageal (90%) gastric (10%)

    acute tx of varices
    hemodynamic stabilization (plus fluids)
    ligation/banding
    endoscopy sclerotherapy
    octreotide

    long-term treatment of varices
    beta blocker to prevent rebleeding

    long-term treatment of varices
    beta blocker to prevent rebleeding

    etiologies of ascites
    increased portal htn (hydrostatic pressure increased)
    decreased albumin concentration (decreases oncotic pressure)

    how to differentiate the causes of ascites
    calculate the saag
    if >1.1, then from portal htn, if <1.1, then from hypoalbumin state

    tx for ascites
    bed rest, low sodium diet, and diuretics

    pathophys of hepatic encephalopahthy
    ammonia accumulates b/c the liver is unable to detoxify it

    clinical presentation of hepatic encephalopathy
    asterixis
    fetor hepaticus

    treatment of hepatic encephalopathy
    decreased protein diet
    lactulose
    neomycin (last resort) to decrease bacteria that produce ammonia

    The external appearance of the mature liver shows its division into
    A) two lobes by the umbilical fissure and falciform ligament. Further subdivisions are made on other superficial features.

    The quadrate lobe is a
    1) subdivision of the right lobe and lies to the
    2) left of the gallbladder fossa and to the
    3) right of the umbilical fissure.
    4) The transverse hilar fissure forms the posterior boundary of the quadrate lobe and divides it from the caudate lobe posteriorly

    The most common exogenous cause of liver disease is:

    a. Carbon tetrachloride
    b. Ethyl alcohol
    c. Hepatitis virus
    d. Malaria
    b. Ethyl alcohol

    All but which one of the following are true about acute viral hepatitis B?

    a. Can usually be distinguished histologically from infectious hepatitis A.
    b. Is often associated with the use of blood products.
    c. Has an incubation period of 4 to 26 weeks (average of 6-8 weeks) after exposure.
    d. Is more frequently fatal than infectious hepatitis A.
    a. Can usually be distinguished histologically from infectious hepatitis A.

    What are the signs of a tension pneumothorax?
    Tracheal deviation (towardss opposite side)
    Respiratory distress
    Unilateral absence of breath sounds
    Distended neck veins (depends on volume status)
    Cyanosis (late)

    How do you treat a tension pneumothorax?
    Immediate decompression
    Chest tube

    True or False: Before you can diagnose a tension pneumothorax, you need a chest x-ray.
    False: Clinical diagnosis is not radiologic.

    An open pneumothorax is also called a what? What constitutes an open pneumothorax?
    cramming chest wound
    2/3 diameter of trachea

    How do you treat open pneumothorax?
    Occlusive dressing on three sides provided flutter-type valve effect
    Followed with chest tube and complete occlusive dressing.

    The retinoblastoma gene:
    a. is an important tumor suppressor
    b. becomes hyperphosphorylated when both copies of p16(INK4A) are lost
    c. is found to be mutated in some cases of retinal nerve tumors
    d. binds a transcription factor in a regulatory manner
    e. all of the above***

    Factor(s) that may influence prognosis of a lung cancer
    a. metastatic involvement
    b. regional lymph node involvement
    c. hormone dependency
    d. all of the above
    e. a and b****

    . Lung cancer tumor burden can in some cases be decreased by
    a. abdominal radiation therapy
    b. treatment with p53 injection
    c. treatment with EGF receptor inhibitors***
    d. a and c
    e. none of the above

    Recent studies suggest that certain NSCLC patients respond to treatment with the drug Iressa…
    a. because they have mutations in the EGF gene
    b. because they have mutations in a VEGF receptor gene
    c. due to dietary differences in Japanese culture
    d. due to an increase in EGF in these patients
    e. none of the above***

    . All classes of UV rays have been shown to induce skin cancer in animal models
    a. true***
    b. false, only UV A induces skin cancer
    c. false, only UV B induces skin cancer
    d. false, only UV C induces skin cancer
    e. false, none of the UV types can induce skin cancer
  23. arvi.

    arvi. Guest

    The internal architecture of the liver bears only a superficial relation to its external appearance. Cast studies of the biliary tree and portal venous radicles show that the
    1) liver is divided into right and left halves, according to the territories of drainage of the right and left hepatic ducts and the
    2) areas of supply of the right and left branches of the portal vein and hepatic artery. This principal division is called
    3) Cantlie's line, after its first description in 1898, but it is not readily visible on external examination. It runs from the
    4) medial edge of the gallbladder fossa to the
    5) inferior vena cava posteriorly. The nomenclature of hepatic anatomy has become
    6) confused by the use of the term ‘lobe', which has been applied to both the division of the liver by its external features and the territories of drainage of the right and left hepatic ducts

    Glisson's capsule, a peritoneal and fibrous covering, invests the liver.
    1) The reflections of the capsule on to the right hemidiaphragm form the
    2) coronary ligament and
    3) right triangular ligament, and the reflection from the left liver on to the left hemidiaphragm forms the left triangular ligament. Glisson's capsule is also reflected over the
    4) falciform ligament. The structures at the hilum of the liver are invested in dense fibrous tissue continuous with Glisson's capsule; here this covering is known as the hilar plate. The hilar plate is continuous with the peritoneal layers investing the common hepatic and common bile duct, cystic duct, and gallbladder
  24. arvi.

    arvi. Guest

    FALSE The equilibrium potential for a given ion is the membrane potential at which the ionic concentration inside the cell is equal to the concentration outside the cell.
    **Equilibrium potential for an ion takes into account not just the concentration gradient, but also electrical forces. Electrochemical equilibrium is reached without much of a change in concentration at all.**
    6. FALSE At rest, the open ion channels in the membrane of a neuron are primarily voltage-gated potassium channels. **At rest, the open ion chanels are primarily leak potassium channels (not voltage-gated).**
    7. TRUE A given neurotransmitter can be either inhibitory or excitatory, depending on the receptors expressed by the postsynaptic cell.
    8. FALSE Small molecules that act as neurotransmitters typically are synthesized in the cell body and sent to the terminal by retrograde transport along microtubules. **Small molecule neurotransmitters are typically synthesized and packaged in the terminal.
    Neuropeptide transmitters are synthesized in the cell body and sent to the terminal by ANTEROGRADE transport.**

    9. TRUE Inhibitory synapses tend to be located on dendrites close to the cell body, where they can most effectively shunt current.
    10. TRUE Neuromodulatory synapses that cause potassium channels to close can enhance the response of a postsynaptic neuron to excitatory synaptic inputs.
    11. TRUE Neurosteroids can alter the effect of GABA when it binds to its receptor.
    12. FALSE Metabotropic receptors are ion channels. **IONOTROPIC receptors are ion channels; metabotropic receptors are coupled to G-proteins.**
    13. TRUE The Nernst equation assumes selective permeability to one type of ion.

    14. TRUE Summation of postsynaptic potentials can occur over time and over space.
    15. FALSE NMDA receptors are ion channels that are gated by voltage and by GABA. **NMDA receptors are ion channels that are gated by voltage and by GLUTAMATE.**
    16. TRUE The activation of one G protein-coupled receptor can result in the activation of many ion channels, an example of signal amplification.
    17. TRUE Some active transporters use ionic concentration gradients as their source of energy.
    18. TRUE Neuronal circuits underlie all behaviors.
    19. TRUE The patch clamp technique can be used to record current flow through individual ionotropic receptors.
  25. divakar.

    divakar. Guest

    most common liver malignancy
    liver met

    2 kinds of mesenchymal liver tumors
    cavernous hemangioma
    angiosarcoma

    most common hepatic tumor is
    cavernous hemangioma

    thorotrast was used for ___. it causes ___ (2)
    CC
    hepatic angiosarcoma

    4 causes of HCC
    HBV
    HCV
    cirrhosis
    aflatoxin

    pathophysiology of spontaneous bacterial peritonitis
    portal htn increases --> gut hypomotility, and bacterial overgrowth
    bv become more permeable and bacteria enter mesenteric ln and then enter blood stream
    ascites fluid becomes infected

    organisms usually involved with spontaneous bacterial peritonitis
    usually monomicrobial (e coli, klebsiela, strep pneumo)

    dx of spontaneous bacterial peritonitis
    pnml >250
    ascites cx

    tx of spontaneous bacterial peritonitis
    iv abx

    complications of spontaneous bacterial peritonitis
    hepatic abscess
    hepatorenal syndrome
    intestinal obx

    Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid. Generally, no source of the infecting agent is easily identifiable, but contamination of dialysate can cause the condition among those receiving peritoneal dialysis (PD). Spontaneous bacterial peritonitis occurs in both children and adults and is a well-known and ominous complication in patients with cirrhosis.1 Of patients with cirrhosis who have spontaneous bacterial peritonitis, 70% are Child-Pugh class C. In these patients, the development of spontaneous bacterial peritonitis is associated with a poor long-term prognosis. Once thought to occur only in those individuals with alcoholic cirrhosis, spontaneous bacterial peritonitis is now known to affect patients with cirrhosis from any cause.

    Spontaneous bacterial peritonitis
    * Abdominal tenderness: This is found in more than 50% of patients with spontaneous bacterial peritonitis. Findings on the abdominal examination can range from mild tenderness to overt rebound and guarding. In some cases, the abdominal examination mimics an acute intra-abdominal catastrophe requiring emergency surgical evaluation.
    * Hypotension (5-14%)
    * Signs of hepatic failure such as jaundice and angiomata
    The results of aerobic and anaerobic bacterial cultures, used in conjunction with the cell count, prove the most useful in guiding therapy for those with spontaneous bacterial peritonitis.5

    * An ascitic fluid neutrophil count of more than 500 cells/µL is the single best predictor of spontaneous bacterial peritonitis, with a sensitivity of 86% and specificity of ninetyeight%. Lowering the ascitic fluid neutrophil count to more than 250 cells/µL results in an increased sensitivity of 93% but a lower specificity of 94%. (For simplicity, a threshold of 250 cells/µL is used for the remainder of this discussion.) Combining these results yields the following subgroups:
    o Spontaneous bacterial peritonitis is noted when the polymorphonuclear neutrophil (PMN) count is ≥ 250 cells/µL in conjunction with a positive bacterial culture result. As mentioned previously, one organism is usually identified on the culture in most cases. Obviously, these patients should receive antibiotic therapy.
    o Culture-negative neutrocytic ascites (probable spontaneous bacterial peritonitis ) is noted when the ascitic fluid culture results are negative, but the PMN count is ≥ 250 cells/µL.

    The liver is supplied by blood
    1) 80 per cent of which comes via the portal vein and
    2) 20 per cent via the hepatic artery.
    3) Venous drainage is by three, large, short, hepatic veins that pass posteriorly to the inferior vena cava, which lies on the posterior surface of the liver.
    4) Drainage of bile occurs from the left and right hepatic ducts to the common hepatic and bile duct, and then to the second part of the duodenum.

    The portal vein is formed by the
    1) confluence of the superior mesenteric vein and the splenic vein in front of the inferior vena cava and behind the neck of the pancreas. The portal vein
    2) runs behind the pancreas to the free border of the lesser omentum, where it
    3) traverses to the hilum of the liver in the hepatoduodenal ligament
    4) behind the common bile duct and
    5) to the right of the hepatic artery. At the hilum of the liver, the portal vein divides into left and right branches. The vein, with its accompanying branches of the biliary tree and hepatic artery, is invested in a fibrous sheath continuous with the hilarplate.

    What is the suspected etiology of abacterial cystitis?
    Mycoplasmas and chlamydiae. Possibly adenovirus

    How are the initial presentations of renal TB and abacterial cystitis different?
    Renal TB comes on gradually while abacterial cystitis is sudden onset. Also, renal TB will reveal deep chronic ulcers while the ulcers of abacterial cystitis are superficial.

    Name 4 drugs used to treat abacterial cystitis.
    1. Tetracyclines
    2. Chloramphenicol
    3. Streptomycin
    4. Neoarsphenamine (it's an arsenical- drug of choice but hard to find)

    How is vesical candidiasis treated?
    Alkalinize urine with sodium bicarb for urine pH of 7.5. If this fails, amphotericin B instilled into bladder.

    Yellow bodies called "sulfur granules" are pathognomonic for what infection?
    Actinomyces israelii
  26. divakar.

    divakar. Guest

    What radiologic findings do you see in BPD?
    Stage I:
    ground-glass appearance, similar to HMD (Hyal.membr.disease)

    Stage II:
    Whiteout BUT IT'S SELDOM SEEN

    Stage III:
    Same patient at 1 month of age shows the development of small cystic lucencies in the lungs.

    Stage IV:
    7 mo of age shows small cystic lucencies have coalesced into larger lucencies with interspersed fibrotic stranding. Hyperinflation.

    Oxygen facts in a BPD baby:
    -O2 sat needs to be >/=90-92%
    -wean daytime b4 nighttime- need O2 at night due to underventilation
    -hypoxia associated with failure to gain weight
    -chronic hypoxia will lead to pul HTN

    What can you say about fluids in BPD babies?
    fluid intake and calories are related, they need 110-140 CC/KG/day necessary to get the needed calories, but you have to monitor closely so you're not giving them too much fluid and causing that now rarely-seen Stage II whiteout due to pulmonary edema

    What are 2 electrolyte imbalances you must consider in a BPD baby?
    hyponatremia

    AND

    hypokalemia

    -also think of volume depletion with alkalosis
    -lasix could cause some issues, too

    Would you use bronchodilators in a BPD baby?
    -quite possibly, YES
    -Tx occurs with inhaled albuterol and atrovent, and they've shown beneficial short-term effects in lung mechanics

    Dexamethasone is the primary systemic synthetic corticosteroid studied in preterm neonates. Dexamethasone has many pharmacologic benefits but clinically significant adverse effects. This drug stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, inhibits prostaglandin and leukotriene, decreases pulmonary edema (PE), breaks down granulocyte aggregates, and improves pulmonary microcirculation. Its adverse effects are hyperglycemia, hypertension, weight loss, GI bleeding or perforation, cerebral palsy, adrenal suppression, and death.

    What is Fanconi's syndrome?
    It is a clinical condition characterized by musculoskeletal symptoms due to multiple
    dysfunction of renal proximal tubules.

    What are the proximal tubular functions that are deranged in Fanconi's syndrome?
    Defective tubular reabsorption of
    1) amino acids
    2) glucose
    3) bicarbonate
    4) phosphate
    5) uric acid

    What is the relationship between multiple myeloma and Fanconi's syndrome?
    Certain lambda
    and kappa light chains are toxic to the PCT and may cause global dysfunction of the
    PCT=proximal convoluted tubule

    Fanconi's syndrome
    Numerous mechanisms can result in diminished reabsorption of solutes by the proximal tubule. The 3 main categories in which they can be classified are (1) alterations in the function of the carriers that transport substances across the luminal membrane, (2) disturbances in cellular energy metabolism, and (3) changes in permeability characteristics of the tubular membranes.

    Numerous symporters and antiporters affect the transport of solutes across the apical membrane of proximal tubule cells. The energy required for the function of these carriers is provided by the sodium-potassium (Na+/K+)–adenosine triphosphatase (ATPase) pump, which is located at the basolateral membrane.

    Because of the large number of transport abnormalities observed in Fanconi syndrome, these anomalies are not likely due to alterations in the carriers, which are specific for each of the substances reabsorbed in the proximal tubule. A defect in cellular energy metabolism appears to be a more plausible cause. Under the scenario of a defective cellular energy metabolism, any process that results in a decrease in the level of ATP impairs the performance of secondary active transport mechanisms, such as those of glucose, phosphate, or amino acids. Evidence supporting this hypothesis can be found in various experimental models and clinical forms of Fanconi syndrome.

    What is the treatment of metabolic acidosis?
    1) Treat the underlying causes
    2) Bicarbonate supplement

    What is the treatment of metabolic acidosis associated with Fanconi's syndrome?
    1) Phosphate replacement

    2) Bicarbonate supplement

    3) Vitamin D supplement to increase phosphate absorption

    How does PCT dysfunction / Fanconi's syndrome lead to muscle weakness or bone pain?
    Because of hypophosphatemia --> required for ATP formation.
    loss of other important bio-molecules. Proximal muscle weakness is often seen
    in hypo-phosphatemia,

    Fanconi syndrome may be hereditary or may be caused by exposure to heavy metals or other chemical agents, vitamin D
    deficiency, kidney transplantation, multiple myeloma, or amyloidosis. Fanconi syndrome usually occurs with another hereditary disorder, such as cystinuria
  27. kim.

    kim. Guest

    Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.[1][2] Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) when their BMI is between 25 kg/m2 and 30 kg/m2, and obese when it is greater than 30 kg/m2.[3]

    Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, breathing difficulties during sleep, certain types of cancer, and osteoarthritis.[2] Obesity is most commonly caused by a combination of excessive dietary calories, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness.

    BMI-------- Classification
    < 18.5 underweight
    18.5–24.9 normal weight
    25.0–29.9 overweight
    30.0–34.9 class I obesity
    35.0–39.9 class II obesity
    ≥ 40.0 class III obesity
  28. kim.

    kim. Guest

    Osteoblastoma (Giant Osteoid Osteoma)

    * Signs/Symptoms:
    + Pain
    + Gait disturbances
    * Age:
    + 80% of patients < 30 years
    * Sex:
    + M >> F (3:1)
    * Anatomic Distribution:
    + Predilection for vertebral column
    + Metaphysis of long bones

    Osteoblastoma (Giant Osteoid Osteoma)

    * Radiographic Findings:
    + Similar to osteoid osteoma, though much larger (up to 11.0 cm)
    * Gross and Microscopic Findings:
    + Similar to osteoid osteoma, though much larger nidus
    * Ancillary Testing:
    + N/A
    * Prognosis/Treatment:
    + Curettage followed by bone grafting
    + If incompletely removed, tumor may recur
    + Malignant change to osteosarcoma has been rarely reported
  29. jignesh.

    jignesh. Guest

    Osteogenic Sarcoma (Osteosarcoma)

    * Most frequent primary malignant bone tumor
    * Malignant cells must produce osteoid
    * Most tumors arise de novo, though others arise in the setting of:
    * Paget’s disease
    * Previous RT
    * Previous chemo (especially alkylating agents)
    * Fibrous dysplasia
    * Osteochondromatosis
    * Chondromatosis
    * Chronic osteomyelitis

    Osteogenic Sarcoma (Osteosarcoma)

    * Signs/Symptoms:
    + Pain and swelling
    + Pathologic fracture is uncommon
    * Age:
    + Peak in 2nd decade with gradual decrease thereafter
    * Sex:
    + M > F
    * Anatomic Distribution:
    + 50% arise around the knee
    + Metaphysis of long bones
  30. divakar.

    divakar. Guest

    2 causes of CC Cholangiocarcinoma
    thorotrast
    Chlonorchis sinensis (aka Opistorchis sinensis)

    3 causes of angiosarcoma
    Risk factors

    * Toxic exposure or radiation therapy
    * Other carcinogens (eg, bone wax, Dacron, metal bodies)
    * Lymphedema
    thorotrast
    As
    vinyl chloride

    focal nodular hyperplasia is more common in men/women. it is/isn't premalignant.
    women
    isn't

    nodular regenerative hyperplasia involves ___ of liver. it causes ___. it is more common in men/women.
    all
    portal HTN
    both

    most hepatocellular adenomas occur in ___. they are benign but can ___ causing ___. their location is ___.
    women taking contraceptives
    rupture
    hemorrhage
    subcapsular

    The common hepatic artery usually arises from the 1) coeliac axis and travels across the posterior abdominal wall to
    2) lie just above the pylorus. Here it gives off the
    3) gastroduodenal artery before
    4) continuing as the hepatic artery proper, which then runs in the gastroduodenal ligament medial to the common bile duct and anterior to the portal vein to the hilum of the liver.
    5) The hepatic artery divides into the left and right hepatic artery well below the hilum of the liver.
    6) Sixteen per cent of individuals have an
    7) aberrant right hepatic artery arising from the
    8) superior mesenteric artery that runs in the groove to the right of the portal vein and common bile duct.
    9) Less commonly, the arterial supply to the left half of the liver comes from the left gastric artery.

    pathophys of wilson's disease
    copper is normally excreted by the liver, but in wilson's disease, there is a ceruloplasmin deficiency (required for excretion) so cu builds up
    cu accumulates in hepatocytes, causing them to die and release cu into plasma and accumulate in kidney, cornea, and brain

    clinical features of wilson's disease
    hepatitis
    cirrhosis
    fulminant hepatic failure
    kayser'-fleischer rings
    extrapyramidal signs
    psych disturbances (depression, neurosis, psychosis, personality changes)

    dx of wilson's disease
    elevated aminotransferases
    low ceruloplasmin levels
    liver bx shows elevated cu

    tx for wilson's disease
    Generally, penicillamine is the first treatment used. This binds copper (chelation) and leads to excretion of copper in the urine. Hence, monitoring of the amount of copper in the urine can be done to ensure a sufficiently high dose is taken. Penicillamine is not without problems: about 20% of patients experience a side effect or complication of penicillamine treatment, such as drug-induced lupus (causing joint pains and a skin rash) or myasthenia (a nerve condition leading to muscle weakness). In those who presented with neurological symptoms, almost half experience a paradoxical worsening in their symptoms
    chelating agents (penacillamidene - removes and detoxifies cu deposits)
    zn (prevents dietary uptake of cu)
    liver transplant

    What is the treatment of Multiple myeloma + Fanconi's syndrome?
    1) Chemotherapy

    2) Phosphate replacement

    3) Other: bicarbonate, vit. D , K+ replacement

    What is the definition/triad of HUS or TTP?
    1) Renal failure

    2) Thrombocytopenia

    3) Microangiopathic hemolytic anemia
  31. divakar.

    divakar. Guest

    What is the difference between HUS and TTP?
    Hemolytic Uremic Syndrome is a vascular disease (often called 'microangiopathy')
    characterized by thrombotic occlusion of small vessels in the kidney, including the
    glomerular capillaries. When such microangiopathic process affects other systems also,
    it is usually called 'thrombotic thrombocytopenia' or TTP. The pathophysiologic process
    in HUS and TTP are similar, and they differ only in the extent in the systems involved

    What does the patient have?

    A child presents with blood diarrhea and abdominal pain 2 days after picnic.

    Sx: petechial rash, anemia, thrombocytopenia, renal failure, elevated LDH
    HUS or TTP

    What does the patient have?

    A 70 y/o woman c/o LE weakness and pain, anemia, metabolic acidosis, low phosphate, uric acid, glucouria, aminoaciduria, monoclonal gammopathy.
    Fanconi syndrome associated with multiple myeloma

    How can eating undercooked hamburger meat cause hemolytic uremia?
    Exposure to E.coli O157:H7 which produce verocytotoxin (shiga-like toxin) can cause renal failure

    What is the pathophysiologic link between the E.Coli bacterial infection and HUS?
    E. coli is taken up
    by special receptors found in renal endothelial cells, which leads to the thrombotic
    phenomenon

    Besides E.Coli, what other infections can lead to HUS?
    Shigella
    Salmonella typhi
    Yersinia
    Campylobacter
    CMV
    HIV

    What is the treatment of HUS? TTP?
    For HUS: Supportive measurement; dialysis, blood/platelet transfusion

    For TTP= Plasmapheresis

    How do you diagnose HUS?
    Clinical history is very important. Look for clinical triad.
  32. kim.

    kim. Guest

    PET
    The measurement of progressive metabolic changes, particularly energy production, in various brain regions during development is one of the various strategies employed to study structural and functional brain development and to delineate their relationship, as the process of neuronal growth, dendritic and synaptic proliferation, their maintenance, myelination, and various other processes involved require considerable energy expenditure. Ontogeny of these maturational changes should be reflected by changes in energy requirements in different regions of the brain. Because glucose and oxygen are the main substrates used in energy production in the brain, measurements of their consumption rates may provide a means whereby regional energy demand can be related to structural and behavioral maturation. Because energy requirement and local blood flow are closely related,40 local cerebral blood flow (CBF) rates can also be used as a surrogate measure of local energy need. Functional brain maturation is also related to change in various receptor densities, such as gamma-aminobutyric acid (GABA) receptors, neurotransmitter levels, and cerebral protein synthesis.

    Adrenal Carcinoma
    The incidence of adrenal carcinoma is 1 in 700,000 in the adult population. Most are identified as large, 5 cm or greater, in diameter.The majority (50% to 80%) of the cases are functional tumors. Most patients have a clinical presentation of Cushing’s syndrome. This cancer peak is in the fourth and fifth decades of life. CT is an excellent tool for the diagnosis of an abdominal mass, with 30% of the patients presenting with calcification. Exophytic renal masses and exophytic pancreatic tail masses are common false-positives on CT. MR can demonstrate the mass as low signal intensity on T1-weighted images and higher intensity on T2-weighted images. However, large adrenal adenomas can be falsely identified as adrenal cortical carcinomas. Ultrasonography can demonstrate the mass with heterogeneity and cystic components suggestive of hemorrhage and necrosis. MIBG (radiolabeled metaiodobenzylguanidine) scintigraphy can differentiate neuroblastomas and pheochromocytomas from adrenocortical cancer. Angiography can be helpful differentiating the tumors from hypernephromas based on vascular characteristics.
  33. yunus.

    yunus. Guest

    T/F: hepatocellular adenomas have portal tracts
    false

    HCC prevalence correlates with ___
    HBV prevalence

    in countries where HCC is endemic, HCC correlation with cirrhosis is high/low
    low

    in western countries HCC correlation with cirrhosis is high/low
    high

    aflatoxin is derived from ___ and is present in ___ (2)
    aspergillus
    peantus
    grain

    2 biomarkers for HCC. they are both specific/nonspecific.
    AFP
    CEA
    nonspecific

    HCC likes to ___, for example ___ (2).
    invade veins
    portal vein
    IVC

    Criteria for Referral to a Burn Center
     Partial-thickness or full-thickness burns of > 10% body surface area
    (BSA) in patients < 10 or > 50 years old.
     Partial-thickness or full-thickness burns of > 20% BSA in patients of
    other ages.
     Partial-thickness or full-thickness burns involving face, hands, feet, genitalia,
    perineum, or skin over major joints.
     Full-thickness burns of > 5% BSA at any age.
     Signifi cant electrical burns (including lightning).
     Signifi cant chemical burns.
     Lesser burn injury in conjunction with inhalational injury, trauma, or
    preexisting medical conditions.
     Burns in patients requiring special social, emotional, or rehabilitation
    assistance (i.e., child or elder abuse).

    TREATMENT OUTLINE-BURNS
    1. Airway, breathing, circulation (ABCs); intubate patient if indicated.
    Start fl uid resuscitation with 1 L lactated Ringer’s (LR) solution bolus
    in adults, and 20 mL/kg for children in the ED.
    2. If carbon monoxide inhalation is suspected, administer 100% oxygen
    by nonrebreather mask (accelerates dissociation).
    3. Assess area of burn (second and third degree).
    4. All burn patients need good analgesia (IV morphine). Apply cold saline
    soaks for analgesia if burns are < 25% BSA (watch for hypothermia).
    5. Cover burns with silver sulfadiazine/clean sheet and then warm blanket.
    6. Elevate burned areas when possible to minimize edema.
    7. Basic laboratories: Arterial blood gas (ABG), complete blood count
    (CBC), electrolytes, carboxyhemoglobin.
    8. Weigh patient.
    9. Continue fl uid resuscitation as per the Parkland formula.
    10. Insert Foley catheter in patients requiring fl uid resuscitation or with
    signifi cant perineal burns.
    11. Electrocardiogram (ECG).
    12. Nasogastric tube for extensive burns (prone to ileus). Gastrointestinal
    prophylaxis for Curling’s ulcers.

    3 kinds of CM
    dilated
    hypertrophic
    restrictive

    ___ is the most common CM, comprising ___% of CM
    dilated
    90

    incidence of CM in USA is ___%
    incidence of DCM in USA is ___%
    incidence of HCM in USA is ___%
    worldwide incidence of RCM is ___%
    1.2
    1
    .2
    .1

    in DCM, ___ is impaired and ___ chambers are dilated. EF is ___. the purpose of dilation is ___
    systole
    all
    low
    increase preload to facilitate systole

    to diagnose DCM you must exclude ___ (5) causes for dilation
    hypertension
    valvular
    ischemic
    inflammatory
    congenital malformation
  34. yunus.

    yunus. Guest

    How do you diagnose HUS?
    Clinical history is very important. Look for clinical triad.

    What does this patient have?

    8 y/o boy presents with general swelling, coca-cola colored urine for 2 days. Pt did have sore throat, fever 2 weeks ago. + ASO titer, low C3 level.
    Post-streptococcal glomerulonephritis

    What infections are associated with Post-streptococcal glomerulonephritis (PSGN)?
    Group A beta-hemolytic streptococcus

    Is this nephritic or nephrotic syndrome?

    RBC casts, hypertension, mild proteinuria
    Nephritic

    Is this nephritic or nephrotic syndrome?

    Heavy proteinuria, edema, hypoalbuminemia, hyperlipidemia
    Nephrotic

    How does strep infection lead to kidney glomerulonephritis?
    Immune complex formation in subepithelial area cause inflammation

    Is this PSGN, IgA nephropathy, or drug-induced interstitial nephropathy?

    7-14 days after strep infection
    PSGN

    What is sickle cell disease?
    homozygous inherited hemoglobinopathy
    The HbS gene mutation (βS) causes a single amino acid substitution (valine for glutamine) in the sixth residue of the β-globin protein. The existence of unique βS haplotypes (different nucleotide sequences in the noncoding regions of the gene) demonstrate that the βS mutation occurred independently in at least four different regions in Africa and Asia. The specific βS haplotypes inherited contribute to the clinical heterogeneity of sickle cell disorders. Other factors affecting phenotypic expression of the sickle syndromes are coinheritance of varied α-globin gene numbers, genetic factors affecting fetal hemoglobin (HbF) production, and the coinheritance of the hemoglobin C (HbC) and β-thalassemia genes. The most common disorders are hemoglobin SS disease (HbSS), hemoglobin S-β thalassemia disease (HbS/β0thal, HbS/β+thal), and hemoglobin SC disease (HbSC).

    Sickle cells results in what substitution?
    valine for glutamine

    What is present in all pts with SCD?
    -anemia

    What are some other clinical manifestations of SCD?
    -dactylitis
    -strokes, leg ulcers, splenomegaly, painless hematuria

    What is the hallmark presentation of SCD?
    -vaso-occlusiveness

    Vaso-occlusive type of SCD compromises blood supply, which causes what?
    -hypoxia, tissue death and localized pain

    Vaso-occlusive SCD is most commonly effects what tissues?
    bone, chest and abdomen
    The hallmark of sickle cell disease is painful VOC of bone or bone marrow that manifests as intense episodes of pain especially localized to the lower back and the extremities. VOC may follow infections or marked changes in ambient temperature. Pathophysiologically, VOC is thought to occur when sickle cells occlude the microvasculature of bone or bone marrow. Repeated vasoocclusion can cause avascular necrosis of bone—most commonly in the femoral head, the humeral head, or the clavicular head at the sternoclavicular joint. VOC, particularly in the femur, may increase the risk of ACS because of fat embolism

    Regulatory T cells (Treg, sometimes known as suppressor T cells) are a specialized subpopulation of T cells that act to suppress activation of the immune system and thereby maintain immune system homeostasis and tolerance to self-antigens. The existence of a dedicated population of suppressive T cells was the subject of significant controversy among immunologists for many years. However, recent advances in the molecular characterization of this cell population have firmly established their existence and their critical role in the vertebrate immune system. Interest in regulatory T cells has been heightened by evidence from experimental mouse models demonstrating that the immunosuppressive potential of these cells can be harnessed therapeutically to treat autoimmune diseases and facilitate transplantation tolerance or specifically eliminated to potentiate cancer immunotherapy.

    CD4+/CD25+ History
    1969 - Early thymectomy (day 3-4) --> autoimmune organ attack
    -Prevented if mice received splenic CD4+ T cells from a normal
    adult
    1995 - Identification by Sakaguchi
    • Transfer T cells into athymic mice -->normal immune function
    • Transfer CD25-depleted T cells into athymics-->autoimmunity
    -thyroiditis, insulitis, gastritis, adrenalitis, arthritis, etc.
    -short time window to rescue by transfer of CD25+ fraction

    CD4+/CD25- Tregs
    - 10% of circulating mouse CD4+ cells bear CD25 (<1% of
    CD8’s)
    -Upon triggering with CD3/CD28 crosslinking in vitro:
    • no proliferation
    • no secretion of IL-2, IL-4, or IFN-γ
    • contact-dependent inhibition of local “responder†T cells
    -Capable of self-renewal in vivo
    -Constitutively express CTLA-4
    -Dependent on IL-2 for maintenance of CD25 expression
    and regulatory phenotype
    -IL-2-deficiency and CD25-deficiency are both associated
    with autoimmunity

    "Natural" Tregs -arise in Thymus
    -proposed "third role" of thymus (in addition to pos & neg selection)
    -Alternative to cell death for thymocytes with significant avidity for self
    -Thymocyte TCR triggering is required for Treg differentiation
    -CD28 co-stim required for normal Treg levels
    -3rd, Treg-specific signal postulated
    -Treg induction presumably driven by self recognition (Treg repertoire unk)

    T regulatory cells are a component of the immune system that suppress immune responses of other cells. This is an important "self-check" built into the immune system to prevent excessive reactions. Regulatory T cells come in many forms, including those that express the CD8 transmembrane glycoprotein (CD8+ T cells); those that express CD4, CD25, and Foxp3 (CD4+CD25+ regulatory T cells, or "Tregs"); and other T cell types that have suppressive function. These cells are involved in shutting down immune responses after they have successfully tackled invading organisms, and also in regulating immune responses that may potentially attack one's own tissues (autoimmunity).
  35. aayan.

    aayan. Guest

    Ultrasound in Pregnancy
     Ultrasound scanning is an integral part of antenatal care and is considered
    to be a safe, accurate, noninvasive, and cost-effective investigation
    in pregnancy and fetal assessment .
     Approaches may be transabdominal or transvaginal.
     Full bladder required for acoustic window and good visualization of pelvic
    contents in transabdominal approach.
     Its main uses in early pregnancy are for:
     Diagnosis of early pregnancy
     Confi rmation of site of pregnancy (intrauterine vs. ectopic).
     Assessment of vaginal bleeding and viability of the fetus
     Evaluation of fetal number
     The gestational sac can be visualized as early as 4½ weeks of gestation.
    Its location is usually fundal and has a regular outline with thick
    echogenic walls .
     The yolk sac is seen within the echolucent gestational sac at about 5
    weeks.
    ----------------------------------------------------------------------------------------------------------------------------
    Ultrasound in Pregnancy
     The fetal pole can be observed and measured by about 5½ weeks. Fetal
    heartbeat is usually seen and detected by pulsed Doppler ultrasound
    at about 6 weeks.
     Crown-to-rump length (CRL) measurement can be made between 7
    and 13 weeks and gives a very accurate estimation of the gestational
    age. In early cases if the fetal node is seen, mean sac diameter (MSD)
    is used for pregnancy dating purpose. From the second trimester onwards,
    biparietal diameter (BPD), head circumference (HC), abdominal
    circumference (AC), and femur length (FL) are the parameters
    most commonly used for maturity assessment
     Visualization of the adnexal regions may show corpus luteal cysts.
     Observation of internal os and cervical length measurement may be
    of value in assessment of cervical incompetence.
     More fetal structures such as the face become apparent on third trimester
    ultrasound
  36. divakar.

    divakar. Guest

    What is the definition of anemia?
    Males: Hct <41%, Hgb <14g/dL
    Females: Hct <36%, Hgb <12g/dL

    What can cause defective RBC production?
    Substrate deficiency (iron, folate, B12 deficiency)
    Stem cell dysfunction (myelodysplastic syndrome, aplastic anemia)
    Dysregulation (decreased erythropoietin production)
    Bone marrow infiltration (infection, malignancy, fibrosis)

    What can causes RBC loss or destruction?
    Bleeding
    Hemolysis (autoimmune, microangiopathic, red cell membrane disorders, enzyme deficiencies, hemoglobinopathies)

    What is the number one cause of anemia in children?
    Nutritional

    What level hemoglobin does pale skin and mucous membranes present?
    Hgb, 8-10g/dL

    What level of hemoglobin does pale palmar creases present?
    Hgb <8g/dL

    What does an elevated MCHC indicate?
    spherocytosis
  37. yunus.

    yunus. Guest

    ERYTHEMA MULTIFORME

    Erythema multiforme (EM) is a spectrum of diseases that have in common an immunologic basis for inflammatory lesions of the skin. When involving mainly mucous membranes, it is called the Stevens-Johnson syndrome (SJS). When precipitated by a bacterial skin infection it is called the staphylococcal scalded skin syndrome (SSSS). When there is a sudden onset and a large area of skin and mucous membranes is involved, the syndrome is referred to as toxic epidermal necrolysis (TEN). Erythema multiforme is a type of allergic reaction that occurs in response to medications, infections, or illness. Medications include:

    * Barbiturates
    * Penicillins
    * Phenytoin
    * Sulfonamides


    The majority of the immune reactions causative for EM are triggered by systemic virus exposure, with drugs and bacteria causing a minority of cases. Some cases have been triggered by human immunodeficiency virus (HIV) or herpes. Rarely, a response that resembles EM can follow radiation therapy. Both the bacterially triggered (SSSS, TEN) and drug triggered (SJS) types have a more abrupt onset and fulminant course. Mucocutaneous lesions of the skin adjacent to the airway and mucous membranes within the airway can cause life-threatening airway compromise. In the less-fulminant EM cases, extensive skin lesions can present in a manner indistinguishable from epidermolysis bullosa. Conjunctivitis, corneal lesions, and uveitis are common. Acute myocarditis has been associated with EM triggered by viremia. Mucosal lesions of the trachea or gastrointestinal tract can cause perforation, resulting in esophageal rupture, mediastinitis, pneumothorax, bronchopleural fistula, or massive gastrointestinal hemorrhage. Fulminant cases may cause acute renal failure.
  38. yunus.

    yunus. Guest

    Sepsis
    Term generally used to describe a complex of fever, tachycardia, and tachypnea in association with local or systemic infection.

    Severe sepsis
    Defined as sepsis with organ dysfunction (hypotension, hypoxemia, oliguria, metabolic acidosis, thrombocytopenia, or obtundation)

    Septic shock
    Describes sepsis with concomitant hypotension despite adequate fluid resuscitation and clinical evidence of diminished tissue perfusion

    Structure related to gram negative bacterial sepsis and septic shock
    Lipopolysaccharide (LPS) is the biological equivalent of "endotoxin

    Microbes possess specific virulence factors to overcome host defenses. The cell wall of gram-negative bacteria consists of an inner phospholipid bilayer and an outer layer that contains lipopolysaccharide (LPS). This consists of polysaccharide O, which protrudes from the exterior cell surface, a core polysaccharide, and a lipid component (lipid A) that faces the cell interior. Lipid A, or endotoxin, is responsible for the toxicity of this molecule. It is released with cell lysis. In meningococcemia, plasma levels of endotoxin correlate well with the development of multiorgan dysfunction syndrome (MODS).

    Gram-positive organisms, such as Staphylococcus, Streptococcus, and Enterococcus actively secrete an exotoxin, which consists of two polypeptide components: the first binds the protein to the host cell, and the second has toxic effects. Staphylococcus aureus produces four cytolytic exotoxins, the most important of which— α toxin—punctures holes in the membranes of cells leading to osmotic lysis. In addition, S. aureus produces a number of superantigens that have an affinity for T-cell receptor major histocompatibility complex (MHC) class II antigen complexes. They activate a large number of T cells, leading to massive release of cytokines and toxic shock. Clostridium difficile produces two exotoxins: toxin A and toxin B.
  39. yunus.

    yunus. Guest

    FOXP3 (forkhead box P3) is a gene involved in immune system responses. A member of the FOX protein family, FOXP3 appears to function as the master regulator in the development and function of regulatory T cells.

    While the precise control mechanism has not yet been established, FOX proteins belong to the forkhead/winged-helix family of transcriptional regulators and are presumed to exert control via similar DNA binding interactions during transcription.

    FoxP3
    -Transcription factor implicated in autoimmunity
    -discovered via ID of common gene in 2 naturally occuring diseases (Human-IPEX, Mouse-Scurfy)
    -TF that binds DNA using a protein domain termed "forkhead box"
    -Highly conserved b/w human, mouse and rat
    -FoxP3-deficient subjects have no CD4+/CD25+ T cells

    CD4+/CD25+ "lineage marker"?
    -FoxP3
    -possible master controller for Treg program
    -FoxP3 represses TCR-triggered IL-2 transcription, induces CTLA-4 and CD25 transcription
    -Foxp3+ Treg function is stable (transferable in mice)
    -Mouse: FoxP3+T cells are >90% CD4+/CD25+ and functionally suppressive

    The discovery of Foxp3 as a specific marker of natural T regulatory cells (nTregs, a lineage of T cells) and adaptive/induced T regulatory (a/iTregs) T cells has recently led to an explosion of research in the biological properties of regulatory T cells (Tregs). In animal studies, Tregs that express Foxp3 are critical in the transfer of immune tolerance, especially self-tolerance, so that hopefully in the future this knowledge can be used to prevent transplant graft rejection. The induction or administration of Foxp3 positive T cells has, in animal studies, led to marked reductions in (autoimmune) disease severity in models of diabetes, multiple sclerosis, asthma, inflammatory bowel disease, thyroiditis and renal disease.
  40. yunus.

    yunus. Guest

    The oral manifestations therefore of Sjogren's syndrome may include xerostomia with or without salivary gland enlargement, candidiasis, dental caries and taste dysfunction. As a result of Sjogren's syndrome, the major problem within the oral cavity relates to understanding the role of saliva and what its presence as an important biologic fluid subserves. We have chosen to define six major protective functions afforded by the presence of saliva which include:

    * coating and lubrication of the oral mucous membranes
    * physical debridement or mechanical cleansing of the oral cavity
    * maintenance of an essentially neutral pH in the mouth by virtue of its inherent buffer capacity
    * maintenance of tooth structure by way of specific components within saliva
    * a remineralization and tooth-protective function
    * Finally, saliva contains numerous compounds including antibodies and proteins that subserve an antimicrobial function, which includes protection against bacteria, fungi as well as some viruses.
  41. kim.

    kim. Guest

    Germ cell tumors
    Germ cell tumors represent 1% of all male malignancies and most commonly occur in patients in the age range of 10 to 35. Seminoma accounts for 40% of all germ cell tumors and nonseminoma germ cell tumors (NSGCT) account for 60%. A history of cryptorchidism is a risk factor. Seventy percent of testicular cancer clinical presentations include testicular swelling. Pain occurs in 18% to 46% of the cases. Ultrasonography is the initial imaging of choice.
    Tumor markers can be helpful for monitoring disease process and response to therapy. HCG has a 5% to 40% sensitivity for seminoma and 50% to 60% for NSGCT. AFP is most commonly seen in yolk sac tumors and has 85% sensitivity for NSGCT. LDH isoenzyme-1 marker is used to assess treatment response and prognosis. Radical inguinal orchiectomy is the standard for surgical resection and pathologic diagnosis. Treatment for seminoma is irradiation, and for nonseminomatous germ cell tumor is retroperitoneal lymph node dissection. Cisplatin-based combination chemotherapy is used in advanced seminoma.
  42. kim.

    kim. Guest

    AIDS Encephalopathy
    AIDS encephalopathy, or dementia, is a subcortical dementia that presents with apathy, personality changes, tremor, myoclonia, seizure, ataxia, dementia, bradykinesia, and long tract signs. Highly active antiretroviral therapy (HAART) has reduced the incidence of dementia to half. Lifetime prevalence in homosexuals is about 15%. Diagnosis is supported by MRI of the brain that shows diffuse atrophy and hyperintense white matter lesions. CSF examination shows elevation of protein concentration and elevated level of β2- microglobulin (>3.8 mg/L) and positive PCR (RNA).-

    AIDS MYELOPATHY
    AIDS vacuolar myelopathy occurs in 10–15% of patients with AIDS, and clinically presents with proprioception loss, spastic paraparesis, and neurogenic bladder (similar to subacute combined degeneration of the cord because of vitamin B12 deficiency). This myelopathy can be seen at autopsy in about 50% of patients. CSF adenosyl methionine concentration may be reduced.
  43. kim.

    kim. Guest

    CREST Syndrome
    Three primary pathologic features are found in scleroderma and include increased collagen deposition, perivascular mononuclear cell infiltration, and vascular abnormalities.

    The pathologic hallmark of scleroderma is progressive fibrosis of tissues. Collagen (types I, III, IV, and VII), fibronectin, glycosaminoglycans, and proteoglycans are deposited in the interstitium and in the intima of small arteries.15 Fibrosis is found in clinically affected and unaffected tissue.

    Skin fibroblasts in patients with scleroderma act as if they are persistently activated. Higher levels of COL1A2 mRNA (gene encoding alpha-2 chain of type I procollagen) are found in the dermis of scleroderma patients compared with patients without scleroderma, and down-regulation of fibroblast collagen synthesis by collagen amino-terminal peptides is impaired.
  44. kim.

    kim. Guest

    The oral manifestations therefore of Sjogren's syndrome may include xerostomia with or without salivary gland enlargement, candidiasis, dental caries and taste dysfunction. As a result of Sjogren's syndrome, the major problem within the oral cavity relates to understanding the role of saliva and what its presence as an important biologic fluid subserves. We have chosen to define six major protective functions afforded by the presence of saliva which include:

    * coating and lubrication of the oral mucous membranes
    * physical debridement or mechanical cleansing of the oral cavity
    * maintenance of an essentially neutral pH in the mouth by virtue of its inherent buffer capacity
    * maintenance of tooth structure by way of specific components within saliva
    * a remineralization and tooth-protective function
    * Finally, saliva contains numerous compounds including antibodies and proteins that subserve an antimicrobial function, which includes protection against bacteria, fungi as well as some viruses.
  45. kim.

    kim. Guest

    Multiple Sclerosis
    During ontogenesis, autoreactive lymphocytes normally undergo clonal depletion, but some escape and are merely suppressed, becoming tolerant to their antigens. Low levels of autoreactive T and B cells persist even in normal individuals. Autoimmune disorders occur when the tolerance of these cells toward their antigen is broken. The decreased suppressor activity of circulating lymphocytes from patients with MS and other presumed autoimmune diseases may reflect loss of tolerance.[6] One potential mechanism that may break tolerance is molecular mimicry between self and foreign antigens. Autoreactive T4 lymphocytes may become activated on exposure to structurally similar foreign antigens. Some evidence suggests that molecular mimicry is relevant in MS. Not only do several viral and bacterial peptides share structural similarities with MBP, but it has also been demonstrated that these antigens may activate MBP-specific T-cell clones derived from MS patients.[7] Blood-brain barrier leakage alone may break tolerance because it gives CNS-reactive lymphocytes easy access to otherwise inaccessible antigens. Alternatively, a primary event such as an infection or injury may release CNS antigens into the periphery, where they may activate corresponding autoreactive cells

    MS
    • Abnormal immune response to infection or environmental trigger in genetically susceptible individuals
    • Activated peripheral t-cells breach blood/brain barrier
    • Inflammatory response against myelin, axons and oligodendrocytes
    • Neurologic signs result from conduction blocks and axonal transection
    Pathophysiology/ Etiology/Epidemiology of MS

    ■ > 2.6 million individuals worldwide
    ■ 500,000 in the United States
    ■ Higher prevalence in women 3:1
    ■ Onset 15 -50 years of age (average 30 years)
    ■ Every week 200 individuals are diagnosed with MS
    ■ 10,000 new cases annually
    ■ Most common cause of neurologic disability in young adults in the U.S.
    MS Incidence

    The role of viral infections in the initiation and maintenance of MS has been debated for some time. Several viral infections are known to cause demyelination in animals, including visna virus of goats and sheep, canine distemper virus, and Theiler's murine encephalomyelitis virus. Viral infections in humans can also cause demyelination (progressive multifocal leukoencephalopathy [JC papillomavirus], subacute sclerosing panencephalitis [measles virus], and human T-cell lymphotropic or leukemia virus type 1 [HTLV-1]-associated myelopathy). The epidemiology of MS suggests that environmental factors may promote the disease state, possibly due to one or more viruses. A virus may be involved in the pathogenesis of MS in several ways: 1 Transient or persistent infection outside the CNS may activate autoreactive T cells by means of molecular mimicry or by other nonspecific means (as superantigens do).
    2 Transient CNS infection may initiate a cascade of events that fosters autoimmunity (breach the blood-brain barrier, release CNS antigens).
    3 Recurrent CNS infections may precipitate repeated inflammation and demyelination.
    4 Persistent CNS viral infection could either incite inflammatory reactions detrimental to oligodendrocytes or directly injure them.
  46. yunus.

    yunus. Guest

    Testicular seminoma is a pathologic diagnosis in which only seminomatous elements are observed upon histopathologic review after a radical orchiectomy and in which serum alpha-fetoprotein (AFP) is within the reference range. Any elevation of AFP levels or nonseminomatous elements in the testis specimen mandates diagnosis of nonseminomatous GCT (NSGCT) and an appropriate treatment change.

    GCTs have the following subtypes and frequencies: seminoma (40%), embryonal (25%), teratocarcinoma (25%), teratoma (5%), and choriocarcinoma (pure; 1%). Seminomas can be further subdivided into one of three categories based on histology: classic, anaplastic, and spermatocytic

    Germ cell carcinoma in situ (CIS) is a premalignant condition with a natural history of progression to seminoma or embryonal cancer. Patients with infertility, intersex disorders, cryptorchidism, prior contralateral GCTs, or atrophic testes more commonly have CIS. Histologically, it demonstrates intratubular atypical germ cells within seminiferous tubules. Most patients with seminomas (except spermatocytic seminoma) and NSGCTs have CIS or severe atypia associated with the primary tumor. In patients with GCTs, 5% of those with contralateral testes harbor CIS.
  47. yunus.

    yunus. Guest

    Perforator incompetence
    There is speculation as to how varicose veins evolve. One school considers that primary incompetence at either saphenous junction causes progressive retrograde distension. If so, then perforators may be an important pathway to allow blood to escape from superficial varices into deep veins, and they should be preserved when treating venous disease. An opposing school considers that the primary source is from outflow through perforators causing antegrade distension. If so, they should be interrupted as part of treatment for varicose veins. Both are observed with ultrasound in early disease but the former is more common. Either mechanism may be present in different patients, but there is no definitive way to distinguish whether perforators are draining or feeding superficial veins.

    ● Carotid aneurysm usually involves the distal CCA and proximal ICA and arterial dilatation is associated with mural thrombus.
    ● Carotid body tumour is a highly vascular ‘paraganglionoma’ usually seen in the bifurcation between the ICA and ECA but sometimes higher to the base of skull.
    ● Takayasu’s (‘pulseless’) disease usually causes occlusion or aneurysms of major arch branches although it can extend to more distal arteries.
    ● Temporal (giant cell) arteritis affects the superficial temporal arteries in older women.
    ● Moya-Moya syndrome (‘puffs of smoke’) affects children to cause multiple occlusions or high-grade stenoses of extracranial carotid and vertebral arteries.

    Primary CNS lymphomas (PCNSL) are extranodal malignant lymphomas arising within the brain, eyes, leptomeninges, or spinal cord in the absence of systemic lymphoma at the time of diagnosis.In immunocompetent patients, all but 5% of PCNSLs are diffuse large B-cell lymphomas (DLBCL).3 Since they are morphologically indistinguishable from systemic DLBCL, the WHO classification of tumors of hematopoietic and lymphoid tissues does not recognize PCNSL as a separate entity.4 The remaining cases of PCNSL are T-cell lymphomas (2% to 5%)5 or, in rare instances, low-grade B-cell lymphomas of the lymphoplasmocytic (Waldenström macroglobulinemia), fol-licular, or mucosa-associated lymphoid tissue (MALT) type.6 Little is known about the tumorigenesis of PCNSL. In contrast to immunocompromised patients, the Epstein-Barr virus (EBV) does not appear to be involved in the pathogenesis of PCNSL in immunocompetent patients. The site of origin of lymphoma cells, the biological mechanisms involved in the neoplastic transformation of the lymphoid cells, and their intriguing confinement within the CNS during the course of the disease have yet to be elucidated. Indeed, the CNS does not contain resident lymphocytes under normal circumstances and lacks lymphatic vessels

    Primary CNS lymphomas (PCNSL) are extranodal malignant lymphomas arising within the brain, eyes, leptomeninges, or spinal cord in the absence of systemic lymphoma at the time of diagnosis. The incidence of PCNSL in western countries is 5 per 1 million person-years. Currently PCNSL are estimated to account for up to 1% of non-Hodgkin lymphomas (NHL) and 3% to 5% of all primary brain tumors.
    However, recent evidence suggests that T and B cells enter the CNS under physiological conditions, and it has been hypothesized that PCNSL may originate from B cells derived from systemic lymphoid tissues and normally trafficking in and out of the CNS.7 PCNSL could derive from a benign CNS inflammatory process through a monoclonal proliferation of B cells. Another hypothesis is that PCNSL might represent the metastasis of an occult systemic lymphoma, eradicated by an intact immune system but escaping within the immune-privileged CNS. Analysis of clonally rearranged immunoglobulin heavy chain (IgH) genes revealed identical dominant PCR products in bone marrow aspirates, blood samples and tumor specimens from some PCNSL patients, suggesting that subclinical systemic disease can be detected at initial diagnosis, which supports a systemic origin of the tumor in these cases.8 In addition, B cell tropism for CNS might be acquired (before or after the oncogenic events) through specific interactions between selective homing receptors and their ligands expressed on CNS endothelial cells, as suggested by the distinctive angiotropism of CNS lymphoma cells
  48. jignesh.

    jignesh. Guest

    1. What is research design?
    It is the specific approach best suited to answering a given research question.

    2. List the two basic design strategies used in epidemiologic research.
    Descriptive study design
    Analytic study design

    3. What do descriptive studies describe?
    The general characteristics of the distribution of a disease-or health condition-in relation to person, place, and time.

    4. What are analytic studies?
    Analytic studies systematically evaluate suspected relationships between an exposure and a health outcome. Often they test hypotheses formulated from descriptive studies in order to determine whether a particular exposure causes or prevents disease. As a result, they usually provide stronger evidence concerning relationships.

    5. How are descriptive studies useful?
    They can help health care providers and administrators allocate resources efficiently.
    They are useful in developing effective prevention and education programs.
    They aid in formulating hypotheses that can be tested using an analytic design.

    GABAA receptor
    The mechanism of action of all anesthetic agents is currently under intense investigation.
    With the exception of ketamine, which acts via antagonism of the excitatory
    receptor N-methyl-d-aspartate (NMDA), most intravenous anesthetic agents
    (such as propofol, thiopental, and etomidate) probably act by an agonist effect at the
    γ-aminobutyric acid A (GABAA) receptor that causes an increase in the duration
    of opening of GABAA-dependent chloride channels. The increased channel-opening
    time permits increased passage of chloride ions, which causes membrane hyperpolarization
    and therefore inhibition of neuronal transmission. It is likely that each agent
    binds to a separate site on the GABAA receptor and that the different effects of each
    drug (such as amnesia, sedation, and hypnosis) are mediated by distinct subunits of
    the receptor. Although current evidence favors involvement of the GABAA receptor,
    it is likely that intravenous anesthetic agents also have significant effects on other
    receptors and ion channels.


    Benzodiazepines
    chemical category of drugs most frequently prescribed as sedative-hypnotic and anxiolytic drugs. anxiolytic used to reduce anxiety
    Benzodiazepines have sedative rather than hypnotic effects. They also act at the
    GABAA receptor by binding to the α subunit of the activated receptor. Two subtypes
    of benzodiazepine receptors have thus far been identified. BZ1 is responsible
    for anxiolysis, and the receptors are located mainly in the cerebellum and spinal cord.
    BZ2 receptors facilitate the anticonvulsant and sedative effects of benzodiazepines.
    They are located in the cerebral cortex, hippocampus, and spinal cord.

    mode of action
    -depresses CNS activity at GABA receptors without inhibiting REM sleep or activating CYP450

    indications
    many: commonly used for sedation, relief of agitation, tx of depression, sleep induction, skeletal muscle relaxation, anxiety relief, & tx of seizure disorders, also alcohol withdrawal

    contraindications
    known allergies, narrow-angle glaucoma, and pregnancy


    Worldwide drug and alcohol use disorders, excluding tobacco, are the sixth leading cause of disease burden in adults, whereas tobacco use and exposure to tobacco smoke are the leading preventable causes of death.
    Looking at lifetime risk, the NCS, conducted in the early 1990s, found that around one-third of the subjects who had smoked cigarettes at least once developed nicotine dependence, 15% of subjects who had ever drank alcohol developed alcohol dependence, and about 15% of subjects who had ever tried other drugs developed drug dependence.
    Physicians should inquire about all classes of substances (e.g., alcohol, opioids, sedative-hypnotics, stimulants, cannabis, nicotine), including prescription medications, as well as legal and illegal substances, because a patient may not regard abuse of some substances to be as significant as that of others.
    Although psychosocial and behavioral approaches are the cornerstones of treatment for substance dependence, medications are increasingly used to augment the treatment of alcohol, opioid, and nicotine dependence. Developing medications for the treatment of stimulant dependence is a federal research priority.
    There are currently four medications with FDA approval for the maintenance treatment of alcohol dependence: disulfiram, naltrexone, a long-acting intramuscular formulation of naltrexone, and acamprosate.
    The use of buprenorphine for detoxification or maintenance treatment in opioid dependence is increasingly common, in part because buprenorphine can be prescribed in a physician's office with up to 1 month's prescription at a time.
    Although it may take several tries, the overall success rate in helping patients quit smoking is relatively good. The long-term (e.g., 12 months) quit rates for a single attempt are less than 10%, whereas the lifetime long-term quit rate is approximately 50%.
    Polysubstance abuse is common; 56% of patients admitted to publicly funded treatment programs in 2002 reported abuse of more than one substance, and more than 70% smoked cigarettes. If undetected, polysubstance abuse can complicate the treatment of substance intoxication, withdrawal, abuse, or dependence.
    Substance use disorders and other psychiatric disorders commonly co-occur, and the relationship is complex and bidirectional.
    The recent increase in the rates of nonmedical use of prescription pain killers (specifically opioids) in adolescents is notable and concerning.

    Blood–brain barrier
    The cells which comprise the blood–brain barrier (BBB) are simultaneously both inside the central nervous system (CNS) and outside it, with a luminal surface facing into the blood stream and an abluminal surface facing into the brain interstitial fluid. Circulating immune cells that can cross the BBB are capable of being either inside the CNS or outside of it. Nearly all other cell types are permanently fixed in locations either inside or outside the CNS. Therefore, it is perhaps not so surprising that the BBB and the neuroimmune system, both intimately involved in mediating interactions between the CNS and peripheral tissues, interact with each other.
    The BBB is involved in a variety of ways with the neuroimmune system and the cytokines which mediate much of neuroimmune function . The first interaction discovered was that the BBB can be disrupted by cytokines. However, more subtle aspects of BBB function are even more readily altered by cytokines, probably mediated through the cytokine receptors located on the cells which comprise both the vascular BBB and the blood–cerebrospinal fluid (BCSF) barrier.

    Additionally, cytokines can be secreted by the cells which comprise the BBB. Because the BBB is polarized with its luminal (blood side) membrane having different lipids, receptors, and transporters from that of its abluminal (brain side) membrane, the BBB can receive signals Indeed, the vascular BBB is known to be able to secrete cytokines from either its luminal or abluminal surface and to respond to immune stimulation in a polarized fashion. Together, these interactions between the BBB and cytokines provide multilayered mechanisms which mediate interactions between the CNS and immune system. Here, we will briefly explore some of these interactions
    The brain uses barriers to separate itself from the bloodstream and so achieve the rigorous control of the brain microenvironment that is needed for complex neural signaling. There are two main physiological brain barriers and they differ in location, size, morphology, and function. The vascular BBB comprises endothelial cells and constitutes the interface between the blood and the interstitial fluid of the CNS tissue (Rapoport, 1976). The other blood barrier is the BCSF, which comprises a single layer of epithelial cells at the choroid plexus.
  49. yunus.

    yunus. Guest

    What are the three facets of neuroimmunology?
    1. immune rxn w/in CNS
    2. Afferent pathway: CNS monitors peripheral immune system
    3. Efferent pathway: signals from CNS to immune system, CNS influences the peripheral immune system

    Where do astrocytes reside?
    CNS

    What is the function of astrocytes in the CNS?
    neurotransmitter sink, induction of BBB closure, structural support

    What makes up the innate immune system's response to infection?
    IFN-I
    NK cells
    Gamma delta T cells
    NK T cells
    B1 T cells

    What makes up the adaptive immune syste'ms response to infection?
    CD4 T cells
    CD8 T cells
    B cells
    Memory immunity

    Cytokines at the BBB can act in autocrine-, paracrine-, and hormone-like fashions.
    Cytokines are pleiotropic, redundant, and multifunctional. It is known that cytokines have effects on cells outside the immune system, and that non-immune cells can synthesize and secrete cytokines to regulate the immune response to injury and infection. Cytokines generally have short half-lives in the circulation, usually measured in minutes when they are injected i.v. (Vilcek, 2003). They can also act antagonistically and synergistically; that is, a cytokine may increase or decrease the production of another cytokine.In the CNS, cytokines are produced in a variety of cells including microglia, astrocytes, fibroblasts, and vascular endothelial cells (Vilcek, 2003). BECs,brain endothelial cells (BECs)-- the major component of the NVU of the BBB, are themselves capable of secreting several cytokines either spontaneously or with stimulation that can act at both peripheral tissues and within the CNS
  50. divakar.

    divakar. Guest

    1) Which of the following is NOT part of the autonomic (visceromotor, vegetative) nervous system?
    a) Brain
    b) Sexual organs
    c) Heart
    d) Large intestine
    e) Esophagus

    2) Which of the following is true of motor fibers in the peripheral nervous system (PNS)?
    a) They enter via the posterior (dorsal) root
    b) They enter via the anterior (ventral) root
    c) They exit via the posterior (dorsal) root
    d) They exit via the anterior (ventral) root
    1) A
    2) D

    3) Which of the following is most associated with the insulating lipoprotein myelin?
    a) Nucleus
    b) Ganglion
    c) Dendrite
    d) White matter*****
    e) Synapse

    4) Which of the following is NOT a component of a neural pathway?
    a) Cerebral cortex
    b) Spinal cord
    c) Forebrain
    d) Midbrain****

    5) Which of the following are involved in a monosynaptic reflex?
    a) A sensory neuron, a motor neuron, and two synapses
    b) A sensory neuron, a motor neuron, and a single synapse****
    c) A sensory neuron with one synapse
    d) A motor neuron with one synapse
    e) Either a sensory or a motor neuron and two synapses

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