MOST IMP. TOPICS FOR DNB

Discussion in 'DNB CET board - DipNB' started by samuel, Aug 22, 2014.

  1. samuel

    samuel New Member

    Biliary Tract obstruction
    Etiology:
    Gallstones, Tumors (pancreatic, gallbladder, and bile duct), Stricture
    Parasites (liver flukes – Clonorchis [Opisthorchis] sinensis)

    Presentation:
    Jaundice and icterus
    Pruritus due to increased plasma levels of bile acids
    Abdominal pain, fever, and chills
    Dark urine (bilirubinuria) & Pale clay-colored stools

    Lab:
    Elevated conjugated bilirubin, alkaline phosphatase and 5’-nucleotidase

    Primary biliary cirrhosis (PBC)
    Definition: chronic liver disease of unknown etiology (autoimmune) characterized by inflammation and granulomatous destruction of intrahepatic bile ducts
    Epidemiology: males:females=1:10; age 30 – 65

    Presentation:
    Middle-age females, Obstructive jaundice, Pruritus, Xanthomas, xanthelasmas, and elevated serum cholesterol, Fatigue, Cirrhosis (late complication

    Lab:
    Elevated conjugated bilirubin
    Elevated alkaline phosphatase and 5’-nucleotidase
    Antimitochondrial autoantibodies (AMA) are present in more than 90%

    Most patients have another autoimmune disease (scleroderma, RA, or SLE)
  2. samuel

    samuel New Member

    Primary sclerosing cholangitis (PSC)
    Definition: chronic liver disease of unknown etiology characterized by segmental inflammation and fibrosing destruction of intrahepatic bile ducts
    Epidemiology: Males:females= 2:1, age 20 – 40
    Majority are associated with ulcerative colitis
    Presentation: similar to PBC
    Micro: Periductal chronic inflammation
    -Concentric fibrosis around bile ducts
    -Segmental stenosis of bile ducts
    Cholangiogram: “beaded appearance” of bile ducts
    Complications: biliary cirrhosis and cholangiocarcinoma
  3. samuel

    samuel New Member

    Hepatitis viruses
    Clinical presentation
    Asymptomatic
    Malaise and weakness
    Nausea and anorexia
    Jaundice
    Urine may be dark

    Lab: markedly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

    Diagnosis: serology
  4. samuel

    samuel New Member

    Acute viral hepatitis
    Definition: signs and symptoms < 6 months
    Caused by any of the hepatitis viruses

    Micro:
    Lobular disarray
    Hepatocyte swelling (balloon cells)
    Apoptotic hepatocytes (Councilman’s bodies)
    Lymphocytes in portal tracts and in the lobule
    Hepatocyte regeneration
    cholestasis
  5. samuel

    samuel New Member

    Chronic viral hepatitis
    Definition: signs and symptoms > 6 months
    Caused by hepatitis virus B, C, and D

    Micro
    Chronic persistent hepatitis: inflammation confined to portal tracts
    Chronic active hepatitis: Inflammation spills into the parenchyma, causing an interface hepatitis (piecemeal necrosis of limiting plate).
    Hepatitis B often has “ground glass” hepatocytes (cytoplasmis HBsAg)
  6. samuel

    samuel New Member

    Acute renal failure (ARF)
    Defined as a decline in glomerular filtration rate (GFR) that occurs over a period of minutes to a few days.
    Called rapidly progressive renal failure (RPRF) when occurs over a few weeks.
    Common causes are urinary obstruction or acute tubular necrosis (from sepsis, shock, or nephrotoxic drugs).
    Immunologic injury or vasculitis typically causes RPRF.
  7. samuel

    samuel New Member

    Glomerulonephritis
    Often a transient, acute inflammatory process primarily involving the glomeruli.
    Can become permanent if not treated.
    Hematuria (with or without proteinuria) occurs with very high positive predictive values.
    Characterized by an acute drop in GFR, along with salt and water retention.
    Expansion of extra-cellular fluid leads to hypertension and pulmonary congestion.
    Urinary sediment shows red blood cells (RBCs), RBC casts, and proteinuria.
  8. samuel

    samuel New Member

    Mechanism of action of thiopental
    barbiturate: acts on GABA A in spinal cord and brain

    What are the four areas of concern in anesthesia and idea of balanced anesthesia
    1) amnesia
    2) analgesia
    3) Akinesis
    4) stability of autonomics

    Thiopental effect on SVR, contractility, CO, HR
    decreased SVR
    decreased contractility
    decreased CO
    Increased HR (baroreceptor reflex)
  9. samuel

    samuel New Member

    Positive ionotropic drugs
    dobutamine
    dopamine
    milrinone
    inamrinone
    amrinone
    epinephrine
    digitalis
  10. samuel

    samuel New Member

    Timed Vital Capacity
    Measure of the maximum amount of air during a forced vital capacity determination that can be expelled in a given number of seconds. It is usually given as FEV followed by a subscript indicating the number of seconds over which the measurement is made, although it is sometimes given as a percentage of forced vital capacity.
  11. samuel

    samuel New Member

    Chronic often reversible inflammatory disorder of the airways
    •Infiltration of mast cells, eosinophils, and lymphocytes, and many other inflammatory mediators
    •Recurrent episodes of wheezing, coughing, chest tightness, and shortness of breath
    •Airway hyperresponsiveness
  12. samuel

    samuel New Member

    Obstruction atelectasis

    Presence of fluid, air or tumor in the pleural space results in what type of atelectasis?
    Compression atelectasis

    Contraction atelectasis is due to what cause?
    Fibrosis of the lung

    Causes of patchy atelectasis
    Lack of surfactant (hyaline membrane disease of newborn or ARDS)
  13. samuel

    samuel New Member

    Clinical features of typical pneumonia
    Sudden onset, high fever, productive cough, tachypnea, pleuritic chest pain, consolidation on x-ray

    Clinical features of atypical pneumonia
    Insidious onset, low fever, no cough, no consolidation

    Differential diagnosis of rusty sputum
    Strep pneumonia, CHF, mitral stenosis, Goodpasture syndrome
  14. samuel

    samuel New Member

    Features of sarcoidosis
    "GRAIN": gammaglubilinemia, rheumathoid arthritis, ACE increase, interstitial fibrosis, non-casseating granuloma, bilateral lymphadenopathy

    Causes of restrictive pulmonary disease
    Kyphoscoliosis, obesity, pneumoconiosis, ARDS, pulmonary fibrosis, sarcoidosis

    Causes of obstructive pulmonary disease
    Asthma, emphysema, chronic brnchitis, bronchiectasis
  15. samuel

    samuel New Member

    Diagnosis criteria for chronic bronchitis
    Persistent cough and copius sputum production for at least 3 months in 2 consecutive years

    Clinical features of chronic bronchitis
    Cough, sputum production, dyspnea, infections, hypoxia, cyanosis, weight gain. "Blue bloater"

    Microscopic findings in chronic bronchitis
    Hypertrophy of bronchial mucous glands, globlet cell hyperplasia, mucus hypersecretion, bronchial metaplasia

    Complications of chronic bronchitis
    Recurrent infections, cor pulmonale, lung cancer
  16. samuel

    samuel New Member

    Lung volumes in obstructive pattern
    Increased TLC, FRC and RV. Decreased FEV1, FVC, FEV1/FVC

    Lung volumes in restrictive pattern
    Decreased, TLC, FEV1, FVC, FRC, RV. Increased or normal FEV1/FVC
  17. samuel

    samuel New Member

    Definition of emphysema
    destruction of alveolar septa resulting in enlarged air spaces and loss of elastic recoil

    Etiology of emphysema
    Protease/antiprotease imbalance. Proteases are made by macrophages and neutrophils. Antiproteases are alpha-1-antitrypsin, alpha-1-macroglubulin and secretory leukoprotease inhibitor

    Features of centriacinar emphysema
    Proximal brnchioles involved, distal brnchioles spared, most common (95%), associated with smoking, worst in apical segments of upper lobes

    Features of panacinar emphysema
    Entire acinus invololved, alpha-1-antitrypsin deficincy, worse in bases of lower lobes

    Clinical features of emphysema
    Progressive dyspnea, pursing of lips and accesory muscles, barrel chest, weight loss, "Pink puffer"'
  18. samuel

    samuel New Member

    CA1 region
    Novel spatial information is encoded in the hippocampus by plastic changes of synaptic properties. Novel space consists of several types of information that may evoke differential synaptic responses in individual hippocampal subregions. To examine this possibility, we recorded field potentials from the dentate gyrus (DG) and CA1 region in freely moving adult rats. Stimulation protocols that were marginally subthreshold for the induction of persistent long-term potentiation (LTP) or long-term depression (LTD) were implemented, concurrent with exposure to novel spatial information. We found that in both hippocampal subregions, exploration of a novel empty hole board facilitated LTP. However, LTD facilitation was subregion specific and dependent on the nature of the cues. In the CA1 region, partially concealed cues had a facilitatory effect on LTD. LTD in the DG was facilitated by large directional cues.
  19. samuel

    samuel New Member

    Supraclavicular blockade
    The supraclavicular nerve block is ideal for procedures
    of the upper arm, from the midhumeral
    level down to the hand . The brachial
    plexus is most compact at the level of the trunks
    formed by the C5–T1 nerve roots, so blockade here
    has the greatest likelihood of blocking all of the
    branches of the brachial plexus. This results in rapid
    onset times and, ultimately, high success rates for
    surgery and analgesia of the upper extremity (excluding
    the shoulder
    Supraclavicular blockade is most suited to surgery involving the elbow, forearm
    or hand.✯✯

    Complications include:
    Those secondary to needling:
    Bleeding (vascular injury to subclavian artery, vertebral artery, internal or
    external jugular veins).✯✯
    Nerve injury (intraneural needle placement). May affect brachial plexus✯✯ or
    other nerves in the proximity, e.g. ansa cervicalis,✯ phrenic,✯ vagus✯ or
    recurrent laryngeal nerves.✯
    Pneumothorax✯✯
    Infection✯✯
    Those secondary to local anaesthetic:
    Intravascular injection – CNS and CVS toxicity with cardiovascular collapse.✯✯
    Intraneural injection with nerve injury .✯✯
    Anaesthetising the phrenic nerve will result in impaired respiratory function
    and anaesthetising the sympathetic chain will result in Horner syndrome.✯
    Total spinal or epidural spread of anaesthetic.✯✯
    Local anaesthetic toxicity.✯✯
    Allergic reactions.✯
  20. samuel

    samuel New Member

    Mature cells are descendants of pluripotent hematopoietic stem cells. Two major cell lineages are formed. What two are they and what do they give rise to?
    Lymphoid and Myeloid lineages; Lymphoid -->B and T lymphocytes; Myeloid --> erythrocytes, megakaryocytes, neutrophils, monocytes, eosinophils, basophils.

    Most growth factors (ie interluekins) are produced in the bone marrow. Which one is the exception and where is it formed?
    Erythropoeitin, Kidney

    This cell has an average life span of 120 days, biconcave disk shape, thin center.
    Red Cell

    RBC formation is stimulated by ________ which is produced in the kidney.
    Erythropoeitin

    RBC formation requires these three specific nutrients.
    Iron, Folic Acid, Vitamin B12

    This accounts for 90% of the dry weight of the RBC.
    Hemoglobin
  21. samuel

    samuel New Member

    Adult hemoglobin has __ globin peptides, __ alpha and __ beta.
    4; 2; 2

    Which portion of hemoglobin is the binding portion?
    Heme portion

    Iron deficiency anemia is characterized by _______________.
    Low hemoglobin values

    What part of filtered hemoglobin is converted into blirubin?
    Pyrrole Rings

    When is excreted in the it is called _________ when it is exctreted in the feces it is called ___________.
    urobilinogen; stercobilinogen
  22. samuel

    samuel New Member

    Iron is a component of the _______ moiety of hemoglobin.
    Heme

    Iron is absorbed in the intestine in the ______ form.
    heme

    Iron is absorbed via a receptor mechanism in its _______ form.
    free

    What enzyme transports iron?
    transferrin

    What molecule stores iron?
    ferritin

    What form is iron stored as in the spleen, liver, and bone marrow?
    hemosiderin

    60-80% of total body iron is stored in circulating red cells, the rest is bound to __________ and is stored as __________.
    ferritin; hemosiderin

    T or F: most of the iron released from destroyed red cells (in the spleen) is lost.
    False; most is reutilized
  23. samuel

    samuel New Member

    decrease # of platelets
    thrombocytopenia

    decrease # of neutrophils
    Neutropenia

    Decrease # of leukocytes
    leukopenia

    decrease in all elements
    pancytopenia

    A reduction in Hb content in
    anemia
  24. samuel

    samuel New Member

    This RBC disease is characterized by somnolence (inadequate brain O2), fatigue (inadequate O2), and paleness of skin
    anemia

    This type of anemia characterized by RBC's with normal color and size; could occur due to massive loss.
    normocytic, normochromic anemia

    This type of anemia characterized by small pale RBC's; could occur due to iron deficiency or thalassemaias.
    Microcytic, hypochromic anemia

    This type of anemia characterized by large, normal color RBC's; could occur due to Vitamin B12, folic acid deficiency
    macrocytic, normochromic anemia

    This type of anemia characterized by it's shape (poikilocytosis).
    sickle cell anemia

    variation in SIZE of RBC's
    anisocytosis

    Two types of aplastic anemia.
    Idiopathic, Secondary

    The prognosis for idiopathic aplastic anemia compared to secondary aplastic anemia is __________.
    poorer (a word?)

    This type of anemia is a generalized bone marrow failure (pancytopenia) and is usually accompanied by leukopenia and thrombocytopenia.
    Aplastic anemia

    The symptoms of this anemia are uncontrollable infections (leukopenia) and a bleeding tendency (thrombocytopenia).
    Aplastic anemia

    What is the only treatment for idiopathic aplastic anemia?
    Bone marrow translplant

    T or F: it is necessary to use Ab prophy for those with aplastic anemia.
    TRUE

    The causes of this disease are: metastatic carcinomas, diseminated granulomatous diseases, lymphomas, and other rare diseases (like gaucher's)
    Myelophthisic anemia (aka replacement of marrow by neoplastic cells)

    Inc. bleeding, Inc. infections and presence of a neoplastic population in bone marrow are characteristic of what disease.
    Myelophthisic anemia (aka replacement of marrow by neoplastic cells)

    What is the most common cause of anemia?
    Iron deficiency anemia

    The oral findings of this disease are pallor of soft palate, tongue, sublingual; atrophic tongue, glossodynia (buring sensation)
    Iron deficiency anemia

    This type of anemia: depletion of body iron stores, impaired hemoglobin synthesis
    Iron deficiency anemia

    In iron deficiency anemia the lab shows RBC's to be _________ and contain less ___________
    small; hemoglobin (microcytic, hypochromic)

    T or F: dental pts w/ Iron deficiency anemia usually require treatment modifications.
    false

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