Block 22

Question 1

Protinease anti protinease balance in the lung

Answer 1

1. Protineases: elastase (made by neutrophils and contained in alveolar macrophages), cathepsin G, matrix metalloproteinases.
2. Antiproteinases: å1 antitrypsin, å2 macroglobulin, TIMPS.

Question 2

Transcription enhancer sequence

Answer 2

• it can be located upstream, downstream, or within the introns of the gene.
• enhancer sequence bind activator proteins that facillitate bending of DNA. DNA bending allows activator proteins to interact with general transcription factors and RNA polymerase II at the promoter, increasing the rate of transcription.

Question 3

Why mesthynic patients feels relieved when cold ice pack is placed on muscle

Answer 3

-because actylcholeneterase (ACHE) is inhibited at low temperature

Question 4

Acidphillic bodies are formed in (liver)

Answer 4

Apoptotic hepatocytes form round acidophilic bodies known as councilman bodies, usually present at acute HEP A

Question 5

Sex steroids effect on bones

Answer 5

• They initially increases linear growth, but they also encourage closure of epiphyseal growth plates.
• once the growth plates have closed, linear growth is irreversibly stopped.
• in case of precocious pubrty, linear growth is achieved relatievely fast —> tall girl, but epiphysial growth plates closes —> she will stop getting tall —> short girl .

Question 6

Acute hemolytic transfusion reaction

Answer 6

• condition presents with fever, chills, hypotension ,dyspnea, chest and/or back pain and hemoglobinuria.
• pts may also develop renal failure and DIC
• acute hemolytic transfusion are an example of Type II H.S reaction—> antibodies leads to activation of complement —> complement mediated lysis.

Question 7

Aortic regurgitation presentation

Answer 7

Blowing diastolic decrescendo murmur best heared at left sternal border in the 3rd and 4th intercostal spaces.

• the precordial impulse is hyperdynamic and displaced laterally and downward.
• bounding femoral and carotid pulses, marked by abrupt distension and quick collapse (water-hammer puleses)
• some patients exhibits head bobbing with carotid pulsation (de musset sign)

Question 8

Impaired transport of ornithine into the mitochondria

Answer 8

• ornithine translocase deficiency
• result in defect in the hepatic urea cycle
• urea cycle defects causes urea to ammonia to accumulate —> symptoms
• lathergy, vomiting,seziures, and cereberal edema( may cause hyperreflexia and abnormal posturing when severe)
• protein restriction is useful.

Question 9

Cerbellar hemisphere lesion

Answer 9

• ipsilateral dydiachokinesia
• limb dysmetria
• intention tremor

Question 10

Pancreatic islet amyloid deposition

Answer 10

Type II D.M
-amylin (islet amyloid polypeptide), is one factor responsible for beta cell dysfunction, its stored in insulin secretory granules and is co secreted with insulin from pancreatic beta cells.

Question 11

Adenovirus

Answer 11

DsDNA virus, direct contact, fecal-oral or respiratory droplets

• can lead to pharyngoconjuctival fever
• outbreaks usually in crowded quarters (day care centers, camp dermitories, millitary barracks

Question 12

abacavir side effects and usage

Answer 12

NRTI used in HIV/AIDS.

• Abacavir hypersensitivity reaction is an allergic rectin that develops in 2%-8% of patients and is strongly associated with the HLA-B*57:01 allel of human leukocyte antigen system.
• this appers due to binding of abacavir to segment on the HLA-B57:01 molecule which alters the presentation of self peptides to the immune system and results in a delayed hypersenstivity reaction type IV.
• fever malaise, Gi symptoms and delayed rash

Question 13

Hetrophile negative mononucleosis

Answer 13

• splenomegaly with atypical lymphocytosis.
• fever , fatigue
• CMV can be acquired during the transfusion of leukocyte laden blood products as the virus infects leukocytes of granules macrophages lineage
• other causes include HHV 6, or T.gondii

Question 14

Biliary sludge

Answer 14

Incomplete gallbladder emptying in response to CCK stimulation is consistent with gallbladder hypomotility.
- the gallbladder function to actively absorb water from bile; conditions tha cause gallbladder hypomotility result in excessive dehydration of bile.
-this promotes the precipitation and accumulation of particulate material in bile forming viscous biliary slude.
Sludge formation may be asymptomatic or cause biliary colic and is known precursor to stone formation
-RISK factor: pregnancy, rapid weight loss, high spinal cord injuries , prolonged use of total parenteral nutrition or octerotide.

Question 15

Brown vs black bile stones

Answer 15

Brown stones are found in infections and blakc found usually after hemolytic anemia.

Question 16

Failure of fusion of the maxillary prominence and intermaxillary segment

Answer 16

Cleft lip,
Lip and palate form during the fifth-sixth week
1. First pharyngeal arch splits into the upper maxillary prominance and lower mandibular prominance
2. Fusion of the 2 medial nasal prominances forms the midline intermaxillry segment
3. The left and right maxillary prominances then fuse with midline intermaxillary segment to form upper lip and primary palate. If one of the maxillary prominences fail to fuse with intermaxillary segment, a unilateral cleft lip results, if bilaterally , bilateral cleft lip

Question 17

Erythema multiforme (EM)

Answer 17

Acute inflammatory disorder that can involve the skin of the extremities, face, trunk ,and neck.

• severe cases can also affect oral mucous membranes and the tongue. —The apperance can vary but typically present as erythmatous, round papules that evolve into target lesions with a dusky central area, a dark red inflammatory zone surrounded by a pale ring, and an erythematous halo in the lesion periphery.
• EM, represent cell mediated immune response (CD8+).most commonly associated with inefctions especially HSV and mycoplasma, also can be due to medication, malignancy and collagen

Question 18

Erythema multiforme as a side effect for which medication

Answer 18

Sulfonamides

Question 19

Auscultation of murmurs

Methods that affects it

Answer 19

1. Inspiration increases intensity of right sided murmur and decrease intensity of left sided murmurs
2. Valsalva maneuver/abrupt standing : increass MVP and HCM and decreases most other murmers
3. Squatting/ passive leg raise: decreases MVP and HCM and increases all other murmurs intensity
4. hand grip: increases AR,MR,VSD and decreases HCM and AS murmurs .

Question 20

Na/Ca exchange pump

Answer 20

this pump is found on cardiac muscle, it assists in relaxation and is responsible for taking out 3 Na in exchange for Ca+

Question 21

Genital HSV infection clinical

Answer 21

-multiple painful genital ulcers, dysuria , tender lymphadenopathy and systemic symptoms in the setting of new partner

Question 22

Rivaroxaban inhibits

Answer 22

Direct Factor Xa inhibitor

Question 23

Changes after prolonged renal artery stenosis

Answer 23

• the reduced blood flow is sensed by the JG apparatus which consists of macula densa and JG cells. —> macula densa cells are tall, narrow cells located in the distal tubule that monitor salt content and tubular flow rate this information is transmitted o the nearby JG cells that are located mainly in the wall of afferent arterioles.
• renal hypoperfusion —> increase in renin secretion by JG cells —> increased AG II —> JG cells (found on afferent arterioles) undergoes hyperplasia due to the fact that they secrete RENIN

Question 24

Digoxin toxicity predisposing factors

Answer 24

1. Renal failure
2. Hypokalemia
3. Drugs that displace digoxin from tissue binding sites and decrease clearance

Question 25

T-tubules

Answer 25

Invaginations of the muscle cell membrane located in close proximity to the terminal cisterns of the SR. - they are.found in striated muscle and contain voltage gated L-type Ca+ channels (dihydropyridine receptors) - during muscle contraction T-tubules rapidly depolarize impulse rapidly propogate through the interior of the muscle fibers., this ensure Ca+ release from SR occurs uniformaly throughout the fiver allowing for synchronized contraction of myofibril. - in girdle muscular dysrophy decrease number of functional T-tubules in affected muscle fibers lead to uncordinated contraction of myofibrils.

Question 26

Anti biotic that causes serotonin syndrome

Answer 26

Linezolid (it has MAOI activity)

Question 27

Serotonin syndrome

Answer 27

1. Autonomic instability (hyperthermia, tachycardia and HTA) 2. Altered mental status (agitation confusion) 3. Neuomuscular hyperactivity (tremor,hyperreflexia,,myoclonus) 4. GI symptoms and diaphoresis

Question 28

Segmental demylination and endoneural inflammatory infiltrates are seen in

Answer 28

Gullain barre syndrome. | Manifest ascending muscle weakness. Paralysis may ascend to cranial nerves or respiratory muscles.

Question 29

Scapies

Answer 29

- rapidly spreading ,pruritic rash with erythmatous papules and excoriation on the extremities. - spreads through person to person contact - present with intense itching - rash is often worse at night and is due to type IV H.s (DELAYED) reaction to the mite. - linear burrows are the most specific finding in scabies - diagnosis is done using light microscopy visulization

Question 30

Transketolase enzyme is found in which organelle

Answer 30

Cytosol

Question 31

Polyarteritis nodosa affect what organs

Answer 31

- kidney,heart,liver,and GI are commonly affected, | - it typically spares the lungs

Question 32

Parotid gland tumor can lead to

Answer 32

Facial droop (due to facial nerve injury present in there)

Question 33

Ovarian cancers signs and symptoms

Answer 33

Pelvic mass, ascitis, peritoneal metastasis that result in decreased appetite , abdominal distention and bowel or bladder changes. Histology shows : anaplasia of epithelial cells, with invasion of the stroma, multiple papillary formations with cellular atypia and occasional psammoma bodies.

Question 34

Primary carnitine deficiency pathogenesis

Answer 34

The condition is caused by defect in protein responsible for carnitine transport across the plasma membrane , without suffeceint carnitine , FA cant be transported fron cytoplasm into the mitochondria as acyl-carnitine. - the mitochondria therefore cant ß-oxidize the fatty acids into actyl coa the carbon substrate for the citric acid cycle. As a result cardiac and skeletal myocytes cant generate ATP from FA and liver is unable to synthesize ketone bodies when glucose levels are low. - hypoketotic hypoglycemia results

Question 35

Primary carnitine defeciency symptoms

Answer 35

``` Muscle weakness, Cardiomyopthy Hypoketotic hypoglycemia Myalgia Elevated muscle triglycerides Tirdefulness Easy fatiguability ```