NCLEX Practice UWLD

DIC vs. TTP-HUS

DIC has bleeding, coagulation cascade activation, PT and PTT are prolonged, and low fibrinogen and increased FDP (d-dimer) TTP-HUS Uusally do not bleed, only plateletes are activated, normal PT and PTT and normal fibrinogen

The subthalamic nucleus

Damage to this (often due to lacunar stroke) may result in contralateral hemiballism, characterized by wild, involuntary, large-amplitude, flinging movements of the proximal limbs on one side of the body.

Progressive multifocal leukodystrophy (PML)

Demyelination of the CNS due to destruction of oligodendrocytes. Think AIDS and JC virus. Rapidly progressive, usually fatal.

Ruffini corpuscles

Dendritic endings with capsule; adapt slowly. Located in fingertips and joints. Sense pressure, slippage of objects along the surface of the skin, and joint angle changes.

Cerebellum nuclei

Dentate, Emboliform, Globose, and Fastigial (Don't eat greasy foods). Ventral lesions: ipsilateral extremity problem Medial lesions; bilateral motor deficits

Patent ductus arteriosus

Differential clubbing and cyanosis without blood pressure or pulse discrepancy are pathognomic for large patent ductus arteriosus complicated by Eisenmenger syndrome. ASDs and VSDs would cause whole-body cyanosis. Severe Coarcation of the aorta could cause lower extremity cyanosis

Wilson's disease

an AR dise characterized by excessive copper deposition into tissues (liver, basal ganglia, cornea). It typcially presents in young adults with liver diseae, neuropsychiatric symptoms (gait disturbance, dysarthria, depression, personality changes), and Kayser-Fleischer rings on slip lamp examination.

Trailing zeroes

Do not use trailing zeroes as medication dosages can get confused.

Infection with N. gonorrhoeae

Does not result in lasting immunity because of the ability of these bacteria to modify their outer membrane proteins by antigenic variation (including the pilus) So you can get infected again

PICA stroke/lateral medullary syndrome (wallenberg)

Don't Pick a Horse that Can't Eat. Presents with hoarseness and dysphagia among other things, but the key thing to note its that nucleus ambiguous defects are specific to this syndrome.

EBV

EBV binds CD21 on host B cells to enter the cell.

Borrelia burgdorferi (lyme disease)

Early lyme disease causes flu-like ysmptoms and erthema chronicum migrans. The second stage may invovle atrioventriuclar block and facial palsy. the last phase woudl be large joint arthritis (espeically the knee) or encephalopathy. Tx would be doxy or ceftriaxone.

Primary adrenal insufficiency (Addison's disease )

Electrolyte abnormalities include hyponatremia, hyperkalemia, hyperchloremia, non-anion gap metabolic acidosis

Ataxia-telangiectasia

an AR disease due to defect in DNA repair enzymes. The DNA of these patients is hypersensitive to ionizing radiation. Manifestations include cerebella ataxia (and atrophy, telangiectasias, repeated sinopulmonary infections, and an inreased incidence of malignancy. Defect in the ATM gene.

Porphyrin synthesis

Enzyme deficiencies of the early steps of porphyrin synthesis cause neuropsychiatric manifestiaons without photosensitivity, while late step derangements lead to photosensitivity. Photosensitvity in porphyria causes vesicle and blister formation on sun-exposed areas as well as edema, pruritus, pain, and erythema (would need to know pathway to know which enzyme deficiency causes this)

Absolute risk reduction

Event rate in control group- event rate in treatment group

Immature T lymphocytes

Express both CD4 and CD8 cell surface antigens.

Types of pulmonary emboli

FAT BAT Fat emboli, amniotic fluid emboli, thrombus emboli, bacteria, amniotic fluid, tumor.

Hormones that act through cAMP

FLAT ChAMP FSH, LH, ACTH, TSH, CRH, hCG, ADH (V-2 receptor), MSH, PTH, calcitonin, GHRH, glucagon.

AICA stroke (Lateral pontine syndorme)

Facial nucleus effects are specific to AICA lesions. Facial droop means that AICA is pooped. Otherwise has vomitting, vertigo, ystagmus, ipsilateral pain and temperature loss of the face (spinal trigeminal nucleus). Contralateral loss from body (spinothalamic) Ataxia (middle and inferior cerebellar peduncles). Decreased taste from anterior 2/3 of the tongue.

Acute Interstial nephritis

Fever, maculopapular rash, and symptoms of acute renal failure (increasing creatinine, oliguria) one to 3 weeks after beginning treatment with a beta lactam antibiotic (or others like NSaIDs, sulfonamaides, rifampin, and diurectics) is highly suggestive. Peripheral eosinophilia and eosinophiluria are other important clinical clues. Symptoms would resolve compeletely after cessation of the medicaiton.

Calculating reabsorption and secretion rate

Filtered load = GFR x Px. Excretion = V x Ux. Reabsorption = filtered - excreted Secretion = excreted - filtered.

Filtration

Filtration fraction (FF) = GFR/RPF Normal FF = 20%. Filtered load (mg/min) = GFR (ml/min) x plasma concentration (mg/ml) prostaglandins will preferentially dilate the afferent arteriole which increases RPF and GFR so the FF remains constant (NSAIDs block this) However, Angiotensin II will lead to preferential efferent arteriole constriction, which will reduce the RPF but increase the GFR leading to increased FF (ACE inhibitors block this)

Pyelonephritis and Vesicoureteral reflux

For a UTI to get all the way to pyelonephritis, vesicoureteral reflux is almost always necessary because we normally have ways to prevent this. Gram-negative rods like E.coli, Klebsiella, and proteus are the most common players.

Niemann-Pick disease

an AR disorder characterzied by a deficiency of the shpingomyelinase enzyme and resultant accumulation of sphingomyelin. Patients present in infancy with loss of motor skills, hepatosplenomegaly, hypotonia, and cherry red spot. Foamy histiocytes full of shingomyelin are classic on tissue histology.

G6PD and hereditary spherocytosis

G6PD is X-linked recessive whereas herediatry spherocytosis is autosomal dominant

IP3 (DAG involved)

GOAT HAG GnRH, Oxytocin ADH (V-1 receptor), TRH, Histamine, Angiotensin II, Gastrin

Liddle syndrome

Gain of funciton mutation where there is increaed Na+ reabsorption in collecting tubules (incresed acitivty of ENAC channel). Autosomal dominant Results in hypertension hypokalemia, metabolic alkaosis, decreased aldosterone. Tx: amiloride (blocks ENaC

Crigler-Najjar

an AR disorder of bilirubin metabolism caused by genetic lack of UGT enzyme needed to catalzye bile glucuronidation. This causes kernicterus and often death.

Hyperplasia of the submucosal glands in the duodenum

Gastric acid is neutralized by bicarbonate from the submucosal aka Brunner glands of the duodenum as well as pancreatic duct secretions. Hyperplasia occurs with overproduction of gastric acid to neutralize.

Hep C

Genetic variations created during this viruses replications result in marked variety in the antigenic structure of HCV envelop proteins, thus explaining why an effective immune response is difficult and why vaccine development is not possible yet.

Giardia cysts

Giardia is the most common enteric parasite in teh US and Canada. It is a common cause of diarrhea in campers/hikers. Metronidazole is the treatment of choice.

Tuberous Sclerosis

HAMARTOMAS: Harmatromas in CNS and skin Angiofibromas on the face Mitral regurg Ash-leaf spots cardiac Rhabdomyoma Tuberous sclerosis autosomal dOminant Mentral retardation renal Angiomyolipoma Seizures Shagreenpatches

G6PD deficiency

Hemolytic anemia can result from dapsone or other oxidative drugs. Peripheral smear typically shows bite cells and Heinz bodies. In pic: heinz body on the left and bite cell on right

Alkaptonuria

an AR in which the lack of homogentisate oxidase blocks the metabolism of tyrosine, leading to an accumulation of homogentisic acid, which leads to black urine color when exposed to air, and blue-black pigmention on the face, and ochronotic arthropathy

The jugular foramen

House CN IX, X, and XI. Call 911. Lesions of the jugular foramen (like trauma, infeciton, tumor) can lead to dysfunction of these nerves (loss of gag reflex, dysphagia, dysphonia/hoarness, uvual droop toward the normal sidie, sternocleidomastoid and trapezius mess up)

HER2

Human epidermal growth factor receptor 2. It is a tyrosine kinase receptor that is overexpressed in about 20% of breast cancer patients. In such patients, HER2 blockade with trastuzumab (monoclonal antibody) down regulates cellular proliferation and promotes apoptosis

Schistosomiasis

Humans acquire this via contact with freshwater soures that contain infected snails schistosoma larvae. S japonicum and Smansoni cause intestinal and hepatic schistosomiasis, while S haematobium causes urinary schistosomiasis. Clinical symptoms result from a TH2 response to the eggs in the body- marked fibrosis and ulceration and scarring of the bowel or bladder wall/ureters depending on the species.

Lateral area of the hypothalamus

Hunger. Destruction- anorexia an dfialure to thrive. Inhibited by leptin. If you zap your Lateral nucleus, you shrink Laterally

Cystinuria

an AR recessive disroder caused by defective transportation of cystine, ornithine, arginine, and lysine across the intestinal and renal tubular epithelium. Reccurent neprolithiais occurs with cystine precipitating out and forming hexagonal cystine crystals.

Norepinephrine

an NT increased in anxiety an decreased in depression Location of synthesis is the locus ceruleus (pons)

Malassezia furfur

Hypo- or hyper-pigmented patches that become more visible after tanning with no other symptoms are characteristic of Malassezai furfur. KOH prep reveals a spaghetti and meatballs appearance. Fungi are only in the stratum corneum and more common in hot and humid places. Tend to be on the chest and back.

Familial Pulmonary arterial hypertension

an abnormal BMPR2 gene that leads to excessive enothelial and smooth muscle cell proliferation.

Diaphragm structures

I (IVC) ate (T8) ten (T10) eggs (esophagus) at (aorta) 12 (T12)

Kallikrein

an activiatory of the intrinsic pathway. A deficiency could cause increased PTT

Pharyngeal pouches

I- epithelium of the middle ear and auditory tube (tympanic membrane will result) II- epithelium of palantine tonsil crypts. III- thymus, inferior parathyroid glands. IV0 superior parathyroid glands, ultimobranchial body.

Vitamin-K dependent factors

II,VII,IX,X. They are synthesized in the liver and their synthesis can be impaired in liver failure. An elevated PT that fails to get better after vitamin K supplementation would indicate liver disease, reflecting factor VII deficiency.

Acid-fast stain

Identifies organisms that have mycolic acid in their walls, namely the mycobacterium and more weakly Nocardia species. It is done by applying carbolfuchsin to a smear and then decolorizing with alcohol to reveal the org.

Hep B titers

If HBeAg persists for several months and host anti-HBeAg remain low or undetectable, suspect chronic hepatitis B infecition with high infectivity. Also HBsAg would be present and anti-HBs would not be

Indepedenent events in stats

If events are independent, the probability that all events will turn out the same is the product of the separate probabilities of each event.

Henoch-Schönlein purpura

IgA and C3 deposition causing skin rash (palpable) and usually abdominal pain in a child is the picture. In addition, arthralgias can occur as well as a rarer glomerulonephritis

indwelling central catheters

Important but have increased the risk for bloodstream infections with orgs like S. Aureus.

Basal ganglia

Important in voluntary movements and making postural adjustments Receives cortical input, and provides negative feedback to cortex to modulate movement Striatum = putamen and caudate. Lentiform = putamen and globus pallidus D1 Receptor = DIrect pathway. know the pathway.

The hippocampus

Importnat for memory

Bell's palsy

In addition to unilateral facial paralysis, patients with Bell's palsy may experienced decreased tearing, hyperacusis (pain with normal sounds), and/or loss of taste sensation over the anterior 2/3 of the tongue.

Toxoplasmosis

In patients with HIV, the presence of multiple ring-enhancing lesions with mass effect (seizures) is often indicative of toxoplasmosis. First-line treatment would be pyrimethamine and Sulfadiazine. If the patient doesn't get better, suspect a primary central nervous system lymphoma where abnormal b lymphocytes would be seen.

Guillain-Barre

an acute demyelinating neuropathy. It affects young adults and is usually preceded by a febrile illness. Segmental demyelination of peripheral nerves and an endoneural inflammatory infilatrate are seen on light microscopy

CFTR Mutation in CF and What it does

In respiratory and gastric glands, impaired functioning of the CFTR transmembrane protein reduces luminal chloride secretion and increases sodium and net water absorption, resulting in dehydrated mucus and a more negative transepithelial potential difference. However, in sweat glands there is reduce luminal salt absorption leading to production of hypertonic sweat with high chloride content.

Oxygen and hemoglobin

In the lungs, the binding of oxygen to hemoglobin drives the release of H+ and CO2 from hemoglobin (Haldane effect). In peripheral tissues, high concentrations of CO2 and H+ facilitate oxygen unloading from Hb (Bohr effect).

Incident vs. prevalent cases

Incident cases represent new cases diagnosed in a given time period. Prevalent cases are the total number of cases (both new and old) at a particular point in time. Any treatment that prolong survival but does not cure the disease will increase the prevalence due to an increase in the number of afflicted (but still living) individuals over time.

Cardiorespiratory response to excercise

Increased HR, CO, and RR in order to balance increased total tissue O2 consumption and CO2 production. Arterial blood gas remains relatively constant, while venous PO2 is decreased and venous PCO2 is increased.

Theophylline

an adenosine receptor antagnosit and indirect adrenergic agent with a narrow therapeutic index. It is metabolized by hepatic cytochrome oxidases. Inhibitons of these enzymes by concurrent illnes sor drugs (cimetidine, ciprofloxacin, macrolides, verapamil) can raise serum concentration and cause toxicity (seizures, cardiac arrhythmias). It is used as alternate therapy for asthma and COPD as it causes bronchodilation by increasing intracellular cAMP.

Dopamine

Increased in Huntington disease, decreased in Parkinsons, decreased in depression. Located in the ventral tegmentum and the substantia nigra pars compacta (midbrain)

Indicators of Liver damage/function

Increases Aspartate amintotransferase (AST) and alanine aminostransferase (ALT) are indicators of hepatocellular damage, while increased alkaline phosphatase and gamma-gltamyl transpeptidase indicate biliary injury. Serum albumin levels, bilirubin levels, and prothrombin time are reflective of liver function and are of greatest prognostic importance.

neutropenia

an adverse side effect of ganicilovir therapy (decreases DNA synthesis), and is increased with co-adminstration with either TMP-SX (inhibit enzymes that form TH4) or zidovudine (an antiretroviral that inhibits DNA pol) would increase that risk

Balcofen

an agonist at the GABA-B recpeotr is an effective monotherapy for the treatment of spasiticty secodnary to both brain and spinal cord disease, including MS. Tizanidine is also effective and commonly used pharm spastiticty can happen in MS due to lack of innervation from the UMN as they are damaged and the LMN going out of control.

Chloramphenicol

an antibiotic (inhibits 50s ribosomal subunit) that can lead to cytopenias (reversible) and dose indepedent (irrevesible) aplastic anemia (pancytopenia)

Gabapentin

an anticonvulsant that works by inhibiting pre-synaptic voltage-gated calcium channels, thus preventing the fusion and and release of neurotransmitter vesicles.

Ventral lateral nucleus of the thalamus

Input from basal ganglia and cerebellum with motor info. Motor cortex baby is destinatio.

Valproate

an anticonvuslant that can also be used in the treatment of bipolar disorder pharm This and llithium are first line

Intrinsic tyrosine kinase

Insulin, IGF-1, FGF, PDGF, EGF MAP Kinase pathway Think Growth factors

Phenylketonuria (PKU)

Intellectual disability, gait or postural instability, eczema, and a musty body odor in a toddler are signs. An autosomal recessive disease. Results as a result of mutation for phenylalanine hydroxylase so levels build up.

Pituitary apoplexy

Is acute hemorrhage into the pituitary gland usually associated with a preexisting adenoma. Presents with severe headache, cranial nerve involvement (bitemporalhemianopsia, ophthalmoplegia), and sings of meningeal irritation. Patients often have chronic symptoms before associated with the underlying tumor (decreased libido, headaches). Cardiovascular collapse can occur quickly to to adrenocorticla deficiency (must treat with glucocorticoids fast)

Crohn disease and oxalate kidney stones

Is associated with oxalate kidney stones. Impaired bile acid absorption in the terminal ileum leads to loss of bile acids in the feces with subsequent fat malabsorption. The lipids then bind calcium ions, which are excreted, thus free oxalate is absorbed and forms urinary calculi.

Cauda equina syndrome

Is assoicated with damage to S2 through S4. Saddle anesthesia and loss of the anocutnaeous reflex (anal wink) are symptoms.

The lac operon in E. Coli

Is regulated by two distinct mechanisms: negatively by binding of the repressor protein (decreased when lactose in media) to the operator locus and positively by cAMP-CAP (cAMP increased with low glucose in media) binding upstream from the promoter region. A mutation in the operator locus where the repressor protein binds would allow for increased synthesis of lac genes

Vitamin B12 (cobalamin)

Is the exception to the rule where other water-soluble vitamins are rapidly depleted without dietary intake. Hepatic stores of vitamin B12 may last up to several years.

Isotretinoin

Is used to treat severe acne refractory to topical therapies. Its main adverse effects. are hypertriglyceridemia and teratogenicity. Pregnancy is an absolute contraindication to its use. Sexually active females should be advised to use two forms of contraception and to have monthly pregnancy tests.

Patent ductus arteriosus

It is derived from the sixth embryonic structure. A PDA causes left to right shunting of the blood and can be heard as a machine like murmur or a thrill over the left infracalvicular region. Indomethacin can be used to close a PDA in premature infants, but surgery is required for older patients.

Homing

It is postulated that when tumor cells metastasize they may be guided by release of cytokines or by presence of certain cell surface receptors, which explains why different tumors preferentially metastasize to certain organs. In this question, the antibody that was given blocked the cell surface receptors on liver cells preventing "homing" of tumor cells to the liver. Therefore, no liver metastases were found. But it still metastasized to ovary and lungs.

Confidentiality

It is unethical to discuss ANY information regarding diagnosis, treatment, prognosis, etc. with a physician who is not involved in the patient's care. Likewise, the physician should neither confirm nor deny whether the person of interest is, in fact, a patient.

Receptor-assoicated tyrosine kinase

JAK/STAT pathway Think acidophils and cytokines PIGGlET Prolactin, immunomodulators (cytokines IL-2, IL-6, IFN), GH, G-CSF, EPO, Thrombopoietin.

Action potential

K+ ion permenance is highest during the repolarization phase of the action potential.

a proto-oncogene

KRAS. Its activation would promote cell growth

LH and FSH in men

LH stimulates the release of Leydig cells of the testes; FSH stimulates the release of inhibin B from the Sertoli Cells. Testosterone and inhibin B induce negative feeback on LH and FSH production, respectively.

LH and FSH

LH stimulates the theca cells of the ovarian follicle to produce androgens. Aromatase within the follicles granulosa cells subsequently converts these androgens to estradiol under FSH stimulation. The theca externa cells serve as a connective tissue support structure of the follicle.

Lambert Eaton Myasthenic Syndrome

Lambert-Eaton Myasthenic Syndrome is a neuromuscular disorder presenting with proximal muscle weakness (trouble getting up the stairs or getting up), cranial nerve involvement, and autonomic symptoms (like impotence). many patients also have small cell lung cancer classically.

Meissner corpuscles

Large, meylinated fibers; adapt quickly. Located on hairless skin. Senses Dynamic, fine/light touch, position sense

Pacinian corpuscles

Large, myelinated fibers that adapt quickly Seen in deep skin layers, ligaments, and joints. sense vibration and pressure

Merkel discs

Large, myelinated fibers; adapt slowly. Finger tips and superficial skin is the location Senses pressure, deep static touch (eg. shapes, edges), position sense Picture Merkel discs on your finger pads

Indirect inguinal hernias

Lateral to the inferior epigastric vessels. Can continue into the scrotum and felt with deep palpation of the external inguinal ring. Would appear in infancy due to failure of processus vaginalis to obliterate. MDs Don't LIe.

Levodopa over the long term

Long-term treatment of Parkinson disease with levodopa can be complicated by periodic and sometimes UNPREDICTABLE fluctuations in motor function.

Lateral geniculate nucleus (LGN)

Lukas has good vision. gets information from CN II Destination: calcarine sulcus

Dematomyositis

an autoimmune disease that affects the muscles and skin. It has a strong association with malignancy, especially lung, colorectal and ovarian. It is characterized by progressive muscle weakness resembling polymositis, but then additionally involves the skin including Gottron's papules along along the joints and bony prominences of the hand.

Willms tumor

May be assoicated with Beckwith-Wiedemann syndrome (Wilms tumor, macroglossia, oranomegaly, hemhypetropy) or WAGR complex (Wilms tumor, Aniridia, Genitourinary malfomation, and mental Retardation) WT1 or 2 on chomrosoome 11. Seen in children.

3 importnat Dopanergic pathways

Mesolimbic-mesocortical- regulated behavior- involved in schizophrenia nigrostriatal- involved in coordination of voluntary movents - assoicated with parkinsonism Tuberoinfundibular- controls prolactin secretion - can lead to hyperprolactinemia

MGN

Meyers has bad headphones (hearing) gets information from Superior olive and inferior colliculus of tectum Destination: auditory cortex of temporal lobe

Drugs that act on microtubules

Microtubules (mebendazole - antihelminthic) Get (Griseofulvin- antifungal) Constructed (colchicine- anti-gout), Very (Vincristine/Vinblastine - anticancer), Poorly (Paclitaxel) - anticancer.

Myasthenia gravis

an autoimmune disease that results in a decrease in functional acetylcholine receptors on the postsynaptic terminal of the NMJ. This reuslts in a decreased ability of acetylcholien to bind thus leading to a decreasing end-plate potential and preventing the formation of muscular action potentials. Tx: invovles cholinesterrase inhbitors like pyridostigmine. Side effects include muscarining overstimulation, which can be ameoloriated by the use of an antimuscarinic agent like scopolamine

an 85-year-old woman is diagnosed with a fracture of the right femur and begins treatment with morphine by patient-controlled analgesic pump. Three days later, her respirations are 6/min. Physical examination shows pinpoint pupils. Her serum creatinine concentration is 1.8 mg/dL. Which of the following best explains this patient's clinical deterioration after the initiation of morphine therapy?

Morphine is metabolized to active metabolites that accumulate and could be toxic in kidney failure.

Wolff-Parkinson-White Syndrome

Most common type of ventriuclar pre-excitation sydnrome. Abnormal fast accessory conduction pathway from atria to venricle bypasses the rate-slowing AV node causing a delta wave and widening QRS with shortened PR interval. Could lead to a reentrant circuit and suprvaventicular tachy.

Cholesterol gallstones

Most common. Cholecystectomy is preffered, but hydrophilic bile acids can be used as medical therapy if surgery is not option to improve cholesterol solubility.

Acute Cholecystitis

Most commonly caused by gallstones obstructing the cystic duct. Dx can be made by identifying signs of gallbladder inflammation (wall thickening, pericholecystic fluid) on ultrasonography. When ultrasound is inconclusive, nuclear medicine hepatobiliary scanning can be used to asses cystic duct patency and clinch the dx.

Emphysema

Most commonly results from chronic smoking, but can also occur in those with alpha-1 antitrypsin deficiency. Patients have a decreased FEV1/FVC ratio, increased TLV, and decreased diffusion capacity

Minor consent

Most minors can conset to prenatal care, diagnosis or treatment of STD, contraception, and drug or alcohol rehab wihthout emancipation or parental consent or notification (notice how abortion is not on this least but prenatal care is).

DKA potassium levels

Most patients have normal or increased serum potassium levels despite a total body potassium deficit. Replacement of potassium is a crucial step in management.

Pyruvate dehydrogenase deficiency

Must prevent the conversion of pyruvate to lactic acid since can't go to acetyl CoA (causes acidosis otherwise). Lysine and Leucine are exclusively ketogenic AA's and would not increase the blood lactate levels. when trying to avoid lactate, use lysine and leucine.

Grave's disease

an autoimmune disorder characterized by thyroid-stimulating antibodies (TSI) that bind to TSH receptors causing thyrotoxicosis. Hyperthyroidism causes increaesd beta recpetor expression so a beta blocker is often given to relieve some of these symptoms, but exophthalmos would not be relieved by the beta blocker isince it is due to a lymphocytic infiltartion, enlargment of the extraocular muscles from myositis, fibroblast proliferation, and overproduction of mucopolysaccharides all due to the anti-thyroid antibodies.

Number needed to treat

NNT = 1/ARR (control rate- treatment rate)

Paraneoplastic cerebellar degeneration

an autoimmune phenomenon where our own cells attacking small cell cancer of the lung attack the cerebellum.

Lynch Syndrome

an autosomal dominant disease caused by abnormal nucleotide mismatch repair. Mutations in MSH2 (codes for MutS) and MLH1 (MutL) are most common.

Serotonin syndrome

Neuromuscular excitation: hyperreflexia, clonus, myoclonus, and rigidity. Autonomic stimulation: hyperthermia, tachycardia, diaphoresis, and tremor Altered mental status: agitation and confusion Linezolid, often used to treat MRSA and VRE, can precipate SS when used concominantly with other serotenergic drugs like paroxetine. Other examples include ondansetron (antiemetic) and tramadol pharm

Undermining another physician

Never do it. You don't want to hurt that relationship.

Hypertrophic cardiomyopathy

an autosomal dominant disorder characterized by left ventricular outflow tract obstruction. The obstruction is due to systolic anteiror motion of the anteiror leaftlet of the mitral valve toward a hypertophied interventricular septum.

Polyps in the GI tract

Non-neoplastic polyps (hyperplastic, hamartomatous, inflammatory) usually do not progress into adenocarcinoma of the colon. Adenomatous polyps however can indeed. Villous adenomas are considered worst risk than tubular adenomas Villous is villinous.

Procollagen

Normally extracellular peptidases cleave disulfide-rich terminal extension from the procollagen molecule. This results in the formation of water-insoluble triple helical collagen subunits. (tropocollagen). that assemble and undergo crosslinking by lysyl oxidase (Menkes disease) to form mature collagne fibrils. Impaired cleavage of pro-collagen causes the formation of more soluble collagen that does not properly cross-link (sometimes the case for Ehlers-Danlos syndrome

Wernicke's aphasia

Note where it is located. Along the same line as Brocas and in the UPPER temporal region.

Myotonic dystophy

an autosomal-dominant disorder.

Friedreich ataxia

an autsomal recessive conditon that presents during childhood/adolesce wtih progressive gait ataxia (degeration fo the spinal cerebellar tracts) and impraied joint and vibration sense due to degernation of the posteorr columns and dorsal root ganglia. Other features include hypertrophic cardiomyopathy (most common cause of death), skeletal abnormalities (kyphoscoliosis and pes cavus ) and diabetes mellititus

Treponema Pallidum Dx

Often done first through a screening (RPR or VDRL) and then a confirmatory test looking for specific antibodies against the bacteria.

L5 radiculopathy

Often occurs due to compression of the L5 nerve root usually as a reuslt of vertebral disc herniation or spinal formaninal stenosis. Patients typically present with back pain radiating down the leg with sensory loss over the buttocks, lateral thigh and calf, and dorsal foot. There also may be weakness of foot dorsiflexoin, inversion, eversion, and toe extension.

Intrabdominal infection from ruptured appendix

Often polymicrobial but include Bacteroides fragilis and E.coli.

Atypical Antipsychotics

Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone It's atypical for OLd CLOSets to QUIETly RISPER from A to Z

Child abuse

Once child abuse is suspected, immediately contact CPS (do not ask the parents as this can be dangerous and they may flee with child)

Blastomyces Dermatitidis

One of the dimorphic fungi. Seen in the Ohio and Mississippi River Vallyes,Great Lakes region. Found in the soil. Can cause pulmonary pneumonia. at 25 degrees: branching hyphae. Large cell single bud yeast at body temperature/biopsy.

MItral valve stenosis

an early diastolic opening snap (caused by rapid halting in leaflet motion during mitral valve opening due to fusion of the mitral valve leaflets) followed by a diastolic rumbling murmur that is heard best over the apex of the heart. On the ventricular pressure-volume loop, this would occur very close to when the mitral valve opens during diastolic filling

bulimia nervosa

an eating disorder characterized by recurrent binge eating and restrictive or purgin compensatory behaviors. IN contrast to anorexia, bulimia nervosa patients are normal weight to overweight.

Klebsiella

an encapsulated, lactose-fermenting, gram -negative bacillus that appears mucoid in culture. It causes pneumonia in subjects with impaired immune defenses, especially alcoholics. Characterized by production of the currant jelly sputum.

Calcineurin

an essential protein in the activation of IL-2, which promotes the growth and differentiation of T cells.

Myasthenia Gravis

an example of a type II hypersensitivity reaction with antibodies against skeletal myocyte surface acetylcholine receptors. Goodpasture's similarly invovles autoantibodies against basement membrane in the glomerulus and alveolar epithelia.

Collapsing Pressure of the lungs

P= 2 (surface tension)/radius Alveoli have a tendency to collapse (law of Laplace) with small radius on expiraiton.

Alveolar gas equation

PA02 = PIO2- PaCO2/R Where R is equal to the respiratory quotient which is C02 produced/O2 consumed. about equal to 150-PaCO2/0.8 at room air at sea level

The A-a gradient

PAO2- PaO2 Normally about 10-15. An increase in the Anion gap may occur in hypoxemia: shunitng, V/! mismatch, fibrosis (impaired diffusion)

Predicted PC02 in metabolic acidosis

PC02 = 1.5 (HCO3-) + 8 +/- 2.

Diagnosis of Genital herpes

PCR, direct folourescnece antibody screening or Tzanck smear.

Renal filtrate osmolarity levels

PCT: isotonic with plasma sicn eboth solute and water are reabosred Thin descending limb: the concentratoin phase where water is selectively reabosrbed causing concenration of the filtrate (up to 1200) . Thick ascending limb: dilute phase (solute leaves reducing concentration to as much as 300) DCT (contineus to be impermeable tow ater adn so dilution reduces to 100 mOsm) Collecting tubule (depends on prescence of things like ADH but with ADH can concenrtate to as much as 1200 mOsm

Common Peroneal nerve

PED: peroneal everts and dosiflexes If injured, foot dropPED

Pulmonary vascular resistance

PVR = (P (pulmonary artery) - P (L atrium))/CO aka delta P = QxR R = 8nl/r^4

The major stimulator of respiration

PaCO2 is the major stimulator in healthy people. Even a slight increase leads to increased pulmonary ventilation, mainly through central chemoreceptors of the medulla. In COPD, response to PaCO2 is blunted and hypoxemia becomes important with peripheral chemoreceptors (carotid and aortic bodies) sensing PaO2 levels to alter breathing.

Enterococcus

an importnat cause of urinary tract infections. These organsims are gram-positive cocci in pairs and chains and, when grown on blood agar, they do not cause hemolysis (gamm-hemolytic)

Hair Cell Leukemia

an indolent B-cell neoplasm found in middle-aged men and characterized by bone marrow fialure (pancytopenia) and infiltration into the reticuloendothelial system, causing massive splenomegaly. Other typical features include a "dry tap" (unsuccessful bone marrow aspiration) and the prescence of lymphocytes with cytoplasmic projections.

Abetalipoproteinemia

an inherited inability to synthesize apolipoprotien B, thus lipids absorbed in the small intestine cannot be transported by chylomicrons and therefore it builds up in enterocytes.

Barret esophagus

an intestinal metaplasia of esophageal epithelium. It occurs in GERD and increases risk of esophageal adenocarcinoma.

Primary osteoporosis

Patients have a low bone mass but have normal serum calcium, phosphorous, and PTH levels.

The refusal of medical information about self

Patients have the right to refuse to receive medical information as this may be part of their culture where the family makes decisions for them. However, the physician must first understand why he doesn't want to know and make sure its not from misinformaiton, delerium, or psychiatric illness (so ask why do you feel that way?)

Von Willebrand Disease

Patients often present with a life-long history of mucosal bleeding, including gingival bleeding, epistaxis, and/or menorrhagia. These patients have normal platelet levels but typically have a prolonged bleeding time due to impaired platelet functioning.

Hypocalcemia by blood transfusion

Patients who receive the equivalent of more than one body blood volume over a period of 24 hours may develop elevated plasma levels of citrate (substance added to stored blood), which can chelate calcium causing serum levels to reduce and thus paresthesias can ensue.

Bilateral renal artery stenosis and ACE inhibitors or ARBs

Patients with bilateral RAS may have acute renal failure if GFR falls due to the blocking of angiotensin II which constricts the efferent arterioles, thus leading to dilatation and a reduced pressure in the kidneys.

Sickle Cell Disease

Patients with sickle cell disease may have functional asplenia due to multiple infarcts thus predisposing to infection with encapsulated organisms like Salmonella, a common cause of osteomyelitis in patients with SCD. It has a special capsule that resists opsonization.

Drugs with high lipophilicity

also have high Vd (since can pentrate the CNS). These are preferentially excreted by the liver into the bile.

V/Q

Perfusion greatly icnreases from the apex to the base of the lung. Ventilation increases slighly from the apex to the base. For this reason, the ventilation/perfusion ratio decreases in the lung from apex to base.

Frameshift mutations

alter the reading frame of the genetic code, resulting in the formation of non-fuctional proteins. A deletion of addition of any number of base pairs which are not a multiple of three would cause this.

Naming patients

Physicians should ask patients their preferred form of address and err on the side formality when in doubt (MR. Mrs.) Older patients epscially should be addressed formally unless they indicate otherwise. after being specifically asked

Mönckeberg (medial calcific sclerosis)

Pipesteam appreance on x ray uncommon disease of the medium sized vessles- a form of aterioslcerosis (not to be confused with arteriolosclerosis which is the hyaline and hyperplastic damage)

Hirschsrpung's disease

always invovles the rectum and due to abnormal migration of neural crest cells during devleopment

Illness anxiety disorder (hypochondriasis)

Preoccupation with and fear of having a serious illness despite medical evaluation and reassurance. Symptoms here are very mild or non-existent

Glut 4

Primarily expressed on muscle cells and adipocytes. In contrast to the other 4 glucose transporters, it is the major transporter that is responsive to insulin (unregulated with higher insulin levels)

Primary and Secondary TB

Primary Tb you see the formaitnof the Ghon foci in teh lower lungs. Secondary/reactivaiton TB occurs in the upper lungs in someone who alreayd had priamry TB. And this is the one where you get symptoms like hemotypsis

Drug-induced Lupus Erythematosus

Procainamide and hydralazine have the highest risk of causing this, which is characterized by the development of lupus like symptoms with an positive ANA. Unlike SLE, anti-dsDNA is likely negative.

JAK/STAT signaling

Prolactin, growth hormones, and cytokines utilize tyrosine kinase-assoicated receptors (don't have own intrinsic activity) and the JAK/STAT pathway.

DIC

Prolonged PTT and PT Thrombocytopenia and microangiopathic hemolytic anemia. Low fibrinogen Elevated fibrin split products (D-dimer) Low factor V and VIII levels. Schistocytes

Treating friends

Providing informal treatment to friends is ethically problematic and should generally be limited to emergency situations in which no other physician is available.

Relative Risk Reduction

RRR = (absolute risk (control)- absolute risk (treatment))/absolute risk (control)

Dextromethorphan

an opiod that can be used for cough supression but may cause constipation

Gitelman syndrome

Reabsorptive defect of NaCL in DCT (like a thiazide diuretic). Leads to hypokalemia, hypomagnesemia, metabolic alkalosis, and hypercalcemia.

Ventral posterior medial nucleus of the thalamus

Receives input from the trigeminal pathway. Damage to this nucleus along with the ventral posterior lateral nucleus can lead to a complete contralateral sensory loss.

Bone-specific alkaline phosphatase

Reflects osteoblastic activity

Chronic aortic regurgitation

Regurgitant blood flow from the aorta into the left ventricle in chronic aortic regurgitation leads to an increase in left ventricular end-diastolic volume (pre-load) and wall stress (so to decrease, it follows lapalaces law- increase wall thickness), with a resultant eccentric hypertrophy. The increase in chamber sizes increases total stroke volume and helps maintain cardiac output.

Contractile mechanism in skeletal muscle

Relies on proteins (myosin II, actin, tropomyosin, and troponin) as well as calcium ions form the sarcoplasmic reticulum.

Hepatitis B

Replication of hepatitis B genome occurs within a newly synthesized capsid through the action of reverse transcriptase on an RNA template. The mature capsid contain partially double-stranded circular DNA and reverse transcriptase.

Amino Acid tRNA synthetase

Responsible for loading tRNA with the right AA. It is highly accurate, but if incorrect and not proofread, the wrong amino acid will be attached to the growing peptide chain.

Classic Glactosemia

Results from a deficiency of galactose-1-phosphate uridyl transferase (know the pathway). The clinical features include vomiting, lethargy, and failure to thrive soon after breastfeeding.

CGD

Results from a genetic defect in NADPH oxidase. Normally, NADPH oxidase kills microbes wihtin neutorphil and macrophages. Increased susceptibility to catalase-positive organisms: Staph Aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, and Aspergillus.

Type I hypersensitivity reaction

Results from release of histamine, heparin, leukotirenes and prostaglandins from mast cells and basophils

Developmental milestones

Review right before test At age 3, children are expected to play in parrallel but not cooperatively (social), climb stairs with alternating feet and ride a tricycle (gross motor), speak simple sentences (language), and describe their age and gender (cognitive). In addition, 3 year olds should be able to reproduce a circle and use utensils (fine motor)

Colon adenocarcionma

Right sided lesions: more likely to bleed and cause iron deficiency anemia (think ascending colon); left-sided lesions- tend to present with obstructive symptoms (constipation, altered bowel habits, abdominal distension).

vWF

Ristocetin aggregation test will show decreased platelet aggregation. Deficiency of vWF results in mucocuntanoues bleeding and fialure of platelet aggreation and abnormal coagulation pathways (Factor VIII)

Warfarin

an oral anticoagulant that inhibits the carboxylation of vitamin K-dependent coagulatoin factors II, VII, IX, and X. It is used in atrial fib, DVT, and PE. PT/INR should be monitored regularly. It is teratogeneic increased risk for skin necrosis initally with hypercoagulable state (heparin bridge needed) pharm

GAD

SSRIs and SNRIs are first-line medicaitons for GAD SSRIs - Fluoxetine, paroxetine, sertraline, citalopram (Flashbacks PARalyze SEnior CITizens) SSNRIs- Venlafaxine, duloxetine

Sturge-Weber Syndrome

STURGE Sporadic, port-wine Stain, Tram track calcifictaions, Unilateral, Retardation, Glaucoma, GNAQ gene; Epilepsy.

Ventromedial area

Satiety. Destruction (aka from craniopharygioma) leads to hyperphagia. Stimulated by leptin. If you zap your ventormedial nucleus, you grow ventrally and medially.

Giardia

Secretory IgA impairs adherence to mucosa and is the major comoponent of G lamblia infeciton. Conditiosn causing IgA deficiency predispose patients to chronic giardiasis

Causes of acidosis/alkalosis

See created sheet

Libman-Sacks Endocarditis

Seen bilaterally on heart valves in lupus. Just think that young women (lupus) go shopping at libman-sacks.

Osteitis fibrosa cystica

Seen in primary hyperparathyroidism. Presents with bone pain, subperiosteal erosions affecting the phlanges of the hand, and brown tumor bone cysts.

Sensitivity and specificity

Sensitivity = (TP/TP +FN) Specificity = (TN/TN +FP)

Nitrates

Side effects include headaches, cotaneous flushing, lightheadeenes, hypotension and reflex tachycarida. Do not use with hypertrophic cardiomyopathy- don't want to decrease the preload (worsens the LVOT obsruction). pharm

Refractory disease in celicac disease after gluten free diet

Small bowel carcinoma or T-cell lymphoma

Equillibrium potentials

Sodium (+60 mV) Potassium (-90mv)- the only ion where major location is intracellular Chloride (-75 mv) Calcium (+125) the resting membrane potential is typically -70 mv.

Drugs that cause Gynecomastia

Some Drugs Create Awesome Knockers Sprinololactone Digoxin Cimetidine Alcohol Ketoconazole

Cranial Nerves

Some Say Mary Money But My Brothers Says Big Brains Matter More.

Cranial nerve foramen

Standing Room Only for Trigeminal nerve V1- superior orbital fissure V2- Foramen Rotundum V3- foramen ovale Know the others too! p. 475.

substance-induced psychotic disorder

Stimulant intoxication can present with paranoid ideation (delusions) and must be differentiated from primary psychiatric disorders. Physical signs of stimulant intoxication include tachycardia, hypertension, hyperthermia, diaphoresis, and mydriasis.

Subacute granulomatous (de Quervain) thyroiditis is characterzed by painful thyroid enlargment. It usually follows a viral illness and biopsy would show a lymphocytic inifltrate with macrophages and multi nucleated giant cells

Subacute granulomatous (de Quervain)

Pott's disease

TB reactivation affecting the spinal column (multible vertebrae)

Parvoviridae

THE ONLY viral family where members are both non-enveloped and single-stranded. This includes Parvovirus B19 which causes erythema infectiosum (fifth disease), aplastic crises in sickle cell anemia, and hydrops fetalis (Torch)

Tibial nerve

TIP = Tibial Inverts and Plantarflexes. If injured, cant stand on TIPtoes

The Neural Crest differentiates into

The PNS (sensory neurons in DRG, glia) Craniofacial skeletal structures, teeth ameloblasts that make enamel Melanocytes Sympathetic ganglia, adrenal medulla Parasympathetic ganglia

Anterior and posterior pituitary formation

The anterior pituitary is formed from an out-pouching of the pharyngeal roof and is called Rathke's pouch. The posterior pituitary gland arises form an extension of the hypothalamic neurons.

Mycoplasma pneumonaie

The causative agent of walking pneumonia. Hit has no peptidoglycan cell wall and shares antigens with human erythrocytes. When the body mounts an immune response to the antigen, it also lyses RBCs leading to anemia. The antibodies causing this RBC destruction are called cold agglutinins

Airway pressure-volume curve

The center is the FRC of the lungs. It identifies the resting state where the airway pressure equals 0. At the FRC, the intrapleural pressure is negative at -5 cm (it is always negative unless a pneumothroax occurs where it equalizes with 0 of the atmosphere)

Cephalic, gastric, and intestinal influences

The cephalic (thought of food through AcH) and gastric (gastrin target ECL cells to cause histamine release) phases stimulate gastric acid secretion. Intestinal influences (thinkn somatostatin, prostaglandins) reduce gastric acid secretion when protein reaches small bowel.

Nephron dynamics

The concentrations of PAH, creatinine, inulin, and urea increase as fluid runs along the proximal tubule, while the concentrations of bicarbonate, glucose, and amino acids decrease.

The A band.

The dArk side. It does not change size during contraction.

Reed-sternberg cell

The diagnostic cell of Hodgkin's lymphoma. RS can have abundant cytoplasm, bilobed or double nuclei, and inclusion-like eosinophilic nucleoli.

Hepatitis E

an unenveloped, single-stranded RNA virus spread through the fecal oral-route especially in Asia, Africa, and Mexico. It does have high morality in infected pregnant woman from fulminant hepatitis.

Pancreatic embryology

The dorsal pancreatic bud forms the majority of pancreatic tissue (body, tail, and most of the head). The ventral pancreatic bud forms a slight part of the head and the major pancreatic duct. Pancreatic divisum is when the pancreatic buds fail to fuse. In this condition, the pancreatic ductal system remains separate, with the accessory duct draining the majority of the pancreas. This is usually incidental although it could possibly dispose recurrent pancreatitis

Ulcerative colitis and increased risk for colorectal cancer

The duration and extent of UC isimportnat in determining risk. Unlike sporadic colorectal carcinomas, colitis-assoicated carcinomas are more likely to arise from non-polypoid dysplastic lesions, be multifocal in nature, develop early p53 mutations and late APC gene mutations, and be of higher histologic grade.

Passive agression

The expression of angry feelings in a non-confrontational manner

HIV associated Toxoplasmosis

The finding of multiple ring-enhancing lesions in an HIV patient is most likely due to....

Insulin

anabolic hormone that acts via a tyrosine kinase second messenger system to stimulate the synthesis of glycogen, proteins, fatty acids, and nucleic acids. Tyrosine kinase leads to the activation of protein phosphatase within cells.

A high synovial fluid leukocyte count (>100,000/mm)

and absent crystals strongly suggest bacterial joint infection (strept, S. aurues, or neisseria gono- especially in younger groups). Give antibiotics to prevent joint destruction.

Acyclovir

and also valacyclovir, famciclovir and ganciclovir all are nucleoside analogues that require both herpes viral and cellular kinases for conversion to their active nucleoside triphosphate form. Cidfovir on the other hand is a nucleotide that requires only cellular kinases for activation and so would be best in AIDS patients that may posses thymindine kinase-defcienicy varicella zoster virus as a means of resistance.

Hepatitis B virus

and the incidence of HCC could be decreased dramatically with HBV vaccination.

The superior mesenteric artery

and the inferior mesenteric artery are the two main vessels supplying the small and large intestines. They are connected by a pair of anastomoses, helping to protect from ischemia

Poststreptococcal glomerulonephritis

The histological picture of poststreptococal glomerulonepfhritis 1. Enlarged, hypercellular glomeruli on light microscopy 2. Granular depostis of IgG and C3 on immunofloresce 3. Subepithelial humps on EM

Renal Tubular Defects

The kindyes put out FABulous Glittering LiquidS FA- Fanconi Syndrome (PCT) Bartter Syndrome (Thick ascending limb of loop of Henle) Gitelman Syndrome (DCT) Liddle Syndrome (Collecting) Syndrome of apparent mineralocorticoid excess (colleting)

Metalloproteinases

The liklihood of rupture of an atherosclerotic plaque is related to its stability. If the strenght of the fibrous cap is impaired, then it may rupture. Inflammatory macrophages rduce stability by producing metalloproteinases which degrade collagen.

The liver and glycerol

The liver can utilize glycerol to produce triacylglycerol, gluconeognesis and as an intermediate for glycolysis. The first enzyme involved in the liver to get glycerol to glycerol-3-phosphate is glycerol kinase.

PTH

The main action of PTH on bone is increased resorption. First by osteoblast activation and expression of RANK-Lignad and M-CSF to get osteoclasts going. It increases serum calcium and decreases serum phosphate levels (in the urine it is lost) It works via stimulating the formation of cAMP through G protein/adenylyl-cyclase pathway.

Protein M

The major virulence factor of streptococcus pyogenes. It inhibits phagocytosis and complement activation, mediates bacterial adherence, and is the target of type-specific humoral immunity to this bacteria.

Positively Skewed Distribution

The mean is the most shifted in the positive direction, followed by the median than the mode

Type I Collagen

The most abundant collagen. It is present in bones and tendons. It eventually replaces type III collagen after an MI as type I collagen forms a mature scar.

Primary hypothyroidism

The most common cause in the US is Hasimoto thyroididits. It is characterized by decreased thyroxine (T4) and increased TSH (lack of feedback inhibition). T3 on the other hand is converted from T4 in peripheral tissues so it may be normal until relatively late stage disease.

Congenital CMV

The most common eye-related complication of congenital CMV infection is chorioretinitis.

Specificity

The number of true negatives divided by the total number of subjects actually without the disease. False positives = (1- specificity)* number of patients actually without the disease. It is the ability to correctly identify individuals without the disease. Specificity should be high in confirmatory tests to decrease false positives (after a screening test)

Interscalene nerve block

anesthetizes the brachial plexus as it passes through the scalene triangle. It is used to provide anethesia for the shoulder and upper arm. Nearly all patients will devleop transeint ipsilateral diaphragmatic parylasis due to involvment of the phrenic nerve roots as tehy pass through the interscalene sheath.

In an emergency

The physician should allows provide portentially life-saving therapy to a minor. The adult patient could object to it if they had capacity but if they don't, you treat anyways.

Germinal Centers

The primary immune response to new antigen initially results in plasma cells that only produce IgM. Isotype switching occurs later in the germinal centers of lymph nodes and this requires the interaction of CD40 receptor on B cells with CD40L on activated T cells. IgG then becomes the main serum immunoglobulin in the secondary immune response.

Risk

The probability of developing a disease over a certain period of time. Its just the number of affected individuals by the total number of subjects in the corresponding exposure group. Relative risk on the other hand is dividing each risk by each risk.

SCID

The second most common cause of SCID is due to autosomal recessive deficiency of adenosine deaminase, which helps remove deaminase from cells. Toxic levels of adenosine accumulate in lymphocytes leading to death and a resultant cellular and humoral deficiency. Bone marrow transplant is treatment

Laplace's law

The smaller balloon will collapse as pressure flows from high to low increasing the size of the larger balloon. states that the distending pressure (pressure required to keep a sphere distended) is directly proprotional to the surface tension and indirectly proportional to the radius P=2ST/r Surfactant counters this in the lungs by selectively decreaseing the P in the smaller alveoli where it is more concentrated. This prevents collaspe of smaller spheres and the unchecked expnsion of the larger ones

Spinal Tap

The spinal cord ends at L1-L2 and the subarachnoid space extends to about S2. So to keep the spinal cord alive, aim for L3-L5.

The rotator cuff muscles

The supraspinatus (suprascapular nerve) controls should abduction, infraspinatus (suprascapular nerve) controls external rotation, teres minor (axiallary nerve) helps with adduction and external roation, and subscapularis (upper and lower subscapular nerve) helps with adduction and internal rotation.

The Hawthorne/observer effect

The tendency of study subjects to change their behavior as a result of their awareness that they are being studied

Physostigmine

The tertiary amine physostigmine can reverse both the CNS and peripheral symptoms of severe atropine toxicity (can cross the BBB). The anticholinesterase agents neostigmine and edrophonium have a quartenary ammonium structure that limits CNS penetration. Physostigmine Phixes atropine overdose

Glycogen degradation and muscle contraction

The two are synchronized due to release of sarcoplasmic calcium, which causes activation of phosphorylase kinase, thus stimulating glycogen phosphorylase to go ahead and commence glycogenolysis.

Ecological Study

The unit of analysis in ecological studies is populations not individuals

Kidney embryology

The ureteric bud ultimately gives rise to the collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and ureters. The metanephric mesoderm (blastema) gives rise to glomeruli, Bowman's space, proximal tubules, the loop of Henle, and distal convoluted tubule.

Parainfluenza virus

The virus that causes croup. It is seen after a recent history of URI where there is a brassy, barking cough afterwards with dyspnea and stridor Otherwise known as viral lanrygotracheitis and is seen in children. A member of the paramyxovirus family .

Pharyngeal arches

There are 6 brachial arches in the developing embyro, all but the 5th arch contriubte to adult structures. It is good to remember which nerve is paired with which arch to help remember the structures of each. The 1st arch is assoicated with the trigeminal nerve. The neural crest cells of teh first arch from the bones assoicated with this strucutre, which include the maxilla, zygoma, manidble, vomer, palantine, incus, and malleus. Mesodermal derivivatives include all the muscles of mastication, the anterior belly of teh digastric, the tensor tympnai.

5 stages of behavior change

These are the 5 stages. Precontemplation (denial of problme), contemplation (acceptance of the problem and thinking about change), preparation (planning to make a chnage in the near future), action (putting active changes into place), and maintenance (maintaing change over the long term)

Topical Vitamin D analogs

These include calcipotriene, calcitriol and tacalcitol. they may be used to inhibit keratinocyte proliferation and stimulate keratinocyte differentation in psoriasis

Anti-CCP

antibodies to citrullinated peptides have a high specificity for RA (anti-Rh is not as specific)

21-hydroyxylase deficiency in baby boys

They would have normal genitalia but they could present with salt-wasting at a young age with low cortisol and aldosterone. They would present with vomitting, hypotension, hyponatremia and hyperkalemia. Its the females that present with the ambiguous genitalia.

Basophillia?

Think CML

cGMP

Think Vasodilators ANP, BNP, NO

Increasing prevalence and stable incidence

Think of factors that prolong the duration of a disease

Bullous pemphigoid histology

Total separation of epidermis from dermis. With pemphigous vulagaris woudl still see epidermis left behind.

Minute Ventilation

Total volume of gase entering lungs per minute VE = VT (tidal volume) x RR

Pyrdidoxine (Vit B6)

Transanimation reactions need this (alpha keto acid to become an amino acid)

Stop codons

UAA UAG and UGA when encountered, releasing factors recognize the stop codons and terminate protein synthesis.

stop condons

UAA, UAG, and UGA. when these are encourtered the protein product is release with the last AA being whatever codon occurred right before the stop sequence.

Anaerobic conditions and NAD+

Under anaerbic conditions, NADH transfers protons to pyruvate to form lactate and to regenerate NAD+. NAD+ is required for glycolysis to occur.

Matching

Used in case-controlled studies to control confounding. Matching variables should always be the potential confounders of the study such as age, race, smoking.

Relative Risk (RR)

Used in cohort studies to determine how strongly a risk factor is associated with an outcome. Risk of outcome in exposed/risk of outcome in unexposed. 1 is the null.

Base-excision repair

Used to correct single-base DNA defects. In this process, glycosylases remove the defective base, and the corresponding empty sugar-phosphate site is cleaved and removed by the action o fendonuclease and lyase. DNA pol then replaces the missing nucleotide, and ligase seals.

Growth factors that promote angiogenesis

VEGF and FGF are the key factors and woudl be highly expressed in a vascular tumor.

A drug that can be used to treat both seizure prophylaxis and bipolar disorder

Valproate.

Somatic Symptom Disorder

Variety of complants in one or more organ system lasting for months to years. Assoiacted with excessive, persistent thoughts and axiety about symptoms. My co-occur with actual medical illneess.

High-pitched loud, harsh murmor in a young person

Ventricular septal defect. Also palpable thrill

Diffusion of alveolar gas

Vgas = A/T x Dk (P1-P2) Where A is the surface area, T is the alveolar wall thickness and P1-P2 is the difference in partial pressurs. A is decreased in emphysema T is increased in pulmonary fibrosis

Intermediate filament stains

Vimentin- Connecitve tissue desMin = muscle Cytokeratin= epithelial cells GFAP = nueroglia Nuerofilaments = neurons

Mets of gastric cancer

Virchow's node (supraclavicular lymph node), Sister Mary Joseph node (umbilicus) or as Krunkenberg tumor (bilateral ovaries) Classically would find a mucin-producing signet-ring neoplastic cell in the ovarain stroma for ovarian.

Alveolar ventilation (VA)

Volume of gas per unit time that reaches alveoli VA = (Tidal volume- physiologic dead space) xRR

The common peroneal/fibular nerve

Vulnerable to injury where it courses around the neck of the the fibula (beware fracture). Injury would cause weakness of dorsiflexion (deep peroneal nerve) and eversion (superficial peroneal nerve) of the foot as well as loss of sensation over the dorsum of the foot.

herbal supplements

We should ask them about them and advise them on quality, safety, and efficacy and how sometimes things like diet pills are poorly regulated and can have side effects.

Interpreters

When evaluating patients with language barriers in non-emergent settings, you must ALWAYS use trained interpreters to avoid potentially dangerous miscommunications.

Observer bias

When the investigato'rs decisions is affected by prior knowledge of the exposure status.

Osteoperosis risk factors

White, personal or family history of fractures, advancing age, female sex, decreased physical activity, low body weight, poor calcium and vitamin D intake, excessive alcohol or tobacco use, premature menopause, and glucocorticoid use.

Aschoff bodies

With Anitschkkow cells in RF

Hemolytic disease of the newborn revisited

With maternal blood types A and B, this does not happen because anti-A and B antibodies are of the IgM subtype and therefore cannot cross the placenta. In contrast in type O mothers, antibodies are predominantly IgG and can cross the placenta to cause fetal hemolysis.

Glucose-6-phosphate dehydrogenase deficiency

X-linked low NADPH oxidase leads to increased free radical damage. Hemolytic episodes are induced by infections, medications (like sulfa drugs) and other oxidants (fava beans). Heinz bodies and bite cells on blood smear

Adrenoleukodystrophy

X-linked disorder typically affecting males. Disrupts metabolism of very long chain fatty acids leading to excessive buildup in the nervous system, adrenal glad and testes. Leads to long-term coma and death and possible adrenl crisis.

Klinefelter

XXY with primary hypognoadims characterized by low testosterone and elevated gonadotropin (FSH, LH) levles. IN addition, elevated estradiol results in the common finding of gynecomastia.

Chronic uric acid-lowering therapy

Xanthine oxidase inhibitors like allopurinol and febuxostat are preferred in patients with frequent gouty attacks, uric acid kidney stones, tophi, or joint destruction.

Left Ventricular Pressure and Volume Curve

You can see the exact timing of the opening and closing of the cardiac valves.

Bitemporal hemianopsia

You've been thinking about this backwards!!!! Its caused by blockage of the optic chiasm so you get tunnel vision which is caused by outages on the MEDIAL sides of each eye since these are the ones that cross over.

Entacapone

a COMT inhibitor that primairly serves to increase the bioavailability of levodopa by inhibiting peripheral methylation. Tolcapone is another one but it does both peripheral and central.

Essenentia fructosuria

a benign disorder of fructose metabolism caused by fructokinase deficiency. In patietns with essential benign fructosuria, hexokinase can covert some fructose to fructose 6-phosphate.

Leukemoid reaction

a benign leukocytosis (> 50,000) that occurs in response to underlying severe infection/hemorrhage, malignancy, or acute hemolysis. Smear can show increased bands, early neutrophil precurors (myelocytes, and granules (Döhle bodies) in the neutrophils.

Mitral Regurg

a blowing, holosytrolic murmur (listen to the sound) heard best over the apex of the heart. Rheumatic heart disease is very common cause of this (bilateral knee swelling is another symptom earlier in life)

The middle meningeal artery

a branch of the maxillary artery, which enters the sull at the foramen spinosum and courses intracranially deep to the pterion. Skull fractures at this site can cause laceration of the middle meningeal artery and lead to an epidural hematoma.

Nimodipine

a calcium channle blocker that blocks cerebral vasospasm after a subarachnoid hemorrage. pharm

Vinicristine

a cancer durg that causes peirpheral neuropathy. They act by preventing polymerizaitonof microtubule proteins, which causes cell cycle specific cytotoxicity during the M phase of the cell cycle as replicated chromosomes are unabe to align and subsequently unable to aggregate into daughter cells. Toxciity: neurotoxicity. pharm.

Unilateral artery stenosis

a cause of secondary hypertension in two to five percent of hypertensive patients. the kidney affected by stenosis may become atrophied due to oxygen and nutrient deprivation.

Etoposide

a chemotherapeutic agents that inhibits the sealing activity of topoisomerase II (results in double stranded DNA fractures that aren't repaired). This accumulation leads to cell death. Often used to treat testicular cancer and small cell lung cancer.

Primary Biliary Cirrhosis

a chronic liver disease characterized by autoimmune destruction of the intrahepatic bile ducts and cholestasis (elevated alk phos). The condition is most common in middle-aged women, with severe pruritis usually being the first symptom reported. Can be associated with Sjogren's syndrome and other autoimmune diseases.

Tetanus diagnosis

a clinical diagnosis where history and physical are most important where you need a history of penetrating wound in a patient who has not been vaccinated or needs a booster, clinical features consistent with tetanus such as sardonic smile and muscle spasms.

P. Vera

a clonal myeloproliferative disease of pluripotent stem cells. Characterstic featurs included increased RBC mass, increased plasma volume, and low erthropoietin levels. The majority of patients with PV have JAK2 mutations, rendering stem cells more sensitive to growth factors like EPO. In secondary polycythema, its actually a misnomer because only red cells would be increased (more like secondary erthrocytosis)

Tetrahydrobiopterin (BH4)

a cofactor in the sythesis of tyrosine, DOPA, serotonin, and nitric oxide (pathway review). Initially, tyrosine is converted to DOPA by th enzyme tyrosine hydroxylase, with BH4. Next, Dopa is decarboxylated to dopamine by the enzyme DOPA decarboxylase. In atypical PKU with tyrosine supplementation, only the catecholamine synthesis reactions downstream are compromised (becuase its not phenylalaline hydroxylase that's the problem, but rather its dihydropiopterin reductase which regenerates BH4.

Tetrahydrobiopterin (BH4)

a cofactro used by hydroxylase enzymes invovled in teh synthesis of tyrosine (from phenylalanine), dopamine, and serotonin. PKU can result form BH4 deficiency due to dihydropteridine reductase deficiency. THis would result in intellectual disability at a young age with decreased serotonin and hyperphenylalanemia.

G6PD deficiency

a common X-linked disorder that results in episodes of hemolytic anemia due to oxidative stress (oxidant stressers incdlue fava beans, sulfonamides, primaquine, anti-TB drugs and infection)

Campylobacter

a common cause of inflammatory gastronenteritis acuqired from domestic animals (cattle, chickens, dogs) or from contaminated food. The diarreha is inflamamtory and is accompanied by fever, abdominal pain and tnesmus. It is assoicated with Guillain-Barré syndrome.

Lung abscess

a common complication of aspiration pneumonia, which occurs in indivudals with impaired conscioiusness or decreased ability to swalow (alcoholic, dementia). Anaerobic bacteria (fusobacterirum, peptostreptococcus, bacteroides) Septic emboli from right-side infective endocarditis in IV drug users would cause multiple abscesses and is less common.

Aortic stenosis

a common complication of bicuspid aortic valves (about 1-2% of people). Patients develop clinically signficant aortic stenosis by age 50. IN comparison, senile calcific stenosis of normal aortic valves generally becomes symptomatic at age > 65

Vitiligo

a common condition characterized by loss of epidermal melanocytes thus resulting in hypopigmented macules and patches.

Gingival hyperplasia

a common side effect of phenytoin due to increaed PDGF. Phenytoin is an anticovulsant used for gan mal (tonic-clonic) sizures, partial seizures, and status epilecticus. It blocks voltage gated sodium channles inhibiting electrical activiyt of the brain. pharm

Bosentan

a competitive antagonist of endothelin receptors used for treatment of idiopathic or familial (BMPR2 gene) pulmonary arterial hypertension

Ecthyma gangrenosum

a cutaneous necrotic disease associated with Pseudomonas bacteremia. These infectiosn are common in patients who a neutropenic (chemotherapy, are hospitalized, have burns, or indwelling catheters.

Decreased CO in HF

a decreased CO in HF causes a number of compensatory mechanisms. RAAS gets activated and also sympathetic output which raises arterial resistance (afterload) and therefore exacerbates HF by making it more difficult for heart to pump to tissues.

Marfan's syndrome

a defect in fibrillin, an extracellular protein that is abundant in the zonular fibers of the lens (dislocated lens), the periosteum long limbs with arachnodactyly) and aortic media (aortic dissection).

Achondroplasia

a defect in fibroblast growth factor (FGFR3) receptor 3 is most common. Thus inhibitng growth at the epiphyseal growth plate, resulting in short, thick limbs but a normal axial spine and head. Vs. in growth hormone/IGF-1 defciency, the short stature would be proportional.

G6PD deficiency

a defect in the HMP shunt that impairs glutathione reduction due to failure to produce NADPH. Glutathione reductase deficiency causes a similar clinical picture and is pathophysiologically similar to G6PD deficiency

Reaction formation

a defense mechanism where an individual transformas unacceptable feeling or impulses into extreme opposites. Hating children and then showing them tons of love to mask it.

Leprosy (Hansen disease)

a deforming infection primarily of the skin and nerves (scwann cells) caused by mycobacterium leprae. Two type: Tuberculoid (primary a Th1 t cell response so less severe) and Lepromatous (primarily A TH2 response) Read more about this

S4

a diastolic sound that immediately preceeds S1. An abnormal S4 can be heard in patients with reduced ventricular complicance (hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy). It is caused by a sudden rise in end-diastolic pressure following atrial contraction.

Coccidioides immitis

a dimorphic fungi endemic to southwestern United States (California, New Mexico, Arizona). It exists in the environment as a mold (with hyphae) that forms spores. These spores are inhaled and turn into spherules in the lungs (pneumonia).

Blastomyces dermatitidis

a dimorphic fungus in tissue as round or oval yeasts with thick walls and broad-based budding. It is endemic in the southeastern US (states east of missisippi). The lung is the primary site of invovlment for immunocompetnet, while the skin and bone are major sites of dissemination in immunocompromised

Lesser omentum

a double layer of peritoneum that extends from the liver to the lesser curvature of the stomach and the beginning of the duodenum.

Togavirus

a febrile maculopapular rash that begins on the face and spreads to the trunk in an unvaccinated child is either rubeolla (measles) or rubella (German measles). A finding of post auricular lymphadenopathy indicates rubella (caused by this virus)

erythema infectiosum

a febrile upper respiratory illness in a child followed by the sudden appearance of red, flushed cheeks approximately 2-5 days later is characteristic of this disease (infection with parvovrius B19). It is highly tropic for erythroid precurser cells and replicates primarily in the bone marrow.

The perineal body

a fibromuscular itsssue between the urogenetial and anal triangle. A midline episiotomy is a vertical incison from teh posterior vaginal opening to the perineal body.

Buproprion

a first-line antidepressant with amphetamine like properties (prevents reuptake of NE and DOPE). it is not assoicated with sexual side effects (hey!) or weight gain. However, assoiciated with seizures at high doseas, espeicaly in those who have a history of seizure or anorexia or bulimia nervosa

Torsades de pointes

a form of V tach with characteristic ECG findings that is always assoicated with prolongation of the AT interval. Most commonly precipitated by pharacologic angents that prolong the QT interval such as some antiarrhythmics, TCAs, and others (know em)

Attrition bias

a form of selection bias where there is disproportionate loss to follow-up between the exposed and unexposed group in prospective studies (may give inaccurate results)

E. Coli

a frequent cause of neonatal meningitis, second only to group B strep. E. coli strains that cause neonatal meningitis posses the K1 capsular antigen, which allows survival in the bloodstream by preventing phagolysis and complement mediated lysis. Remember that E.coli is lactose fermenting so turns pink on mackonkey agar.

Methadone

a full mu-receptor agonist used in opiod withdrawal and maintenance of addiction. It is a potent, long-acting opioid agonist with good bioavailabily that can be given once daily. Its prolonged half-life helps to suppress withdrawal symptoms and cravings, helping the addicted patient.

HIV replication cycle

a glycosylated gp160 is produced but then proteolytically cleaved to form gp120 and gp41. These envelope glycoproteins assist with virion attachment to target cells.

Actinomyces israelli

a gram-positive oraganism that can cause cervicofacial actinomycosis in patients with dentral manipulation or oral trauma. Cutanoues sinus tracts draining yellow pus are associtated. Tx is penicillin and surgical debridemnet.

Ehlers-Danlos

a group of rare hereditary disorders characterzied by defective collagen synthesis once it has left the cell. It could be caused by procollagen peptidase deficiency, which results in impaired cleavage of terminal propeptides in the extracellular space. Patients often have joint laxity, hyperextensible skin, and tissue fragility due to fomration of soluble collagen that does not properly cross-ink.

Trazodone

a highly sedating antidepressant commonly used to treat insomnia. It does carry a risk of priapism Trazodone, gives you the bone

tricuspid regurg

a holosystolic murmur that increases with intensity on inspiration most likely represents tricuspid regurgitation. The other holosytolic murmurs (mitral regurg and VSD) would not change on inspiration

E.Coli

a lactose-fermenting, INDOLE-postive gram-negative rod that causes UTIs

Latissimus dorsi

a large thoracolumbar muscle that originates from the iliac crest and lumbar fascia to the spinous processes of T7-12 and the lower ribs, and inserts onto the bicipital groove of the humerus. It is innervated by the thoracodorsal nerve. Primary functions include extension, adduction, and internal rotation of the shoulder.

Pseudomonas

a major pathogen in burn patients Antibiotics that work include penicillins (ticarcillin, piperacillin) and cephalosporins (ceftazidime and cefepime). Certain fluoroquinolones like (ciprofloxacin, levofloxacin) and carbapeenems

Odd's ratio

a measure of association between an exposure and an outcome axd/bxc from table.

Vit B12 defciency

a megaloblastic anemia with neurological issues.

Kinesin

a microtubule assoiated, ATP-powered motor protein that facilitates the anterograde transport of NT containing secretory vesicles down axons to synaptic terminals

Mitral valve prolapse

a mid-systloic click followed by a murmur during the remainder of systole is specific for MVP. It is most often cuased by defects in mitral valve connective tissue proteins that predispose to myxomatous degeneration. Decreases with squatting because increased LV volume causes the valve leaflets to get into more normal shape for proper closing.

CNS issues (stroke), lactic acidosis, everyone in the family affected

a mitochondiral disease and the issue is heteroplasmy

MAO

a mitochondrial enzyme that is responsible for degrading monoamine NTs but also detoxifying dietary tyramine in the GI tract. Tryamine hypertesnive crisis can occur in patients taking MAO inhibitors and then consuming foods containing that (aged cheeses, cured meats, draft beer)

Rituximab

a monoclonal antibody directed against CD20 in lymphoma.

Polycythemia Vera

a myeloproliferative disorder characterized by uncontrolled erythrocyte production. Virtually all patients with polycythemia have a mutation in JAK2, a cytoplasmic tyrosine kinase associated with EPO receptor.

Oseltamivir

a neuraminidase inhibitor which is useful for treatment of both influenza A and B virus infections. Neuraminidase is required for the release of virus from infected cells and for the spread of virus within the respiratory tract. NA inhibitors reduce spread to other host cells. Otherwise known as Tamiflu and it shortens the course and complications of influenza if taken within 48 hours of onset of symptoms. In addition, it impairs viral penetration of mucus secretions overling respiratory epithelum so can be used to prevent infection as well.

Dystonia

a neurological movement disorder characterized by sustained involuntary muscle contractions, which force certain parts of the body into abnormal, sometimes painful, postures. Cervical dystonia is actually most common. Other common dystonias are Blepharospasm (closing of the eyes) and writer's cramp Vs. myoclonus is a sudden, brief muscle contration- hiccups and hypnic jerks (when falling asleep)

Canagliflozin

a new class of oral anti-diabetic agents known as sodium-glucose cotransporter inhbitors (SGLTs) they work by decrsing proximal tubular reabsorption of glucose. it is recommend to monitor serum creatinine before and after initiating therapy.

Parvovirus B19

a nonenveloped single-stranded DNA virus that commonly causes an aplastic crisis (severe anemia in setting of reduce retic count) in sickle cell anemia patients.

Post-partum blues

a normal self-limiting condition that occurs within a few days postpartum. Symptoms include mild depressive symtoms such as sadness, insomnia, tearfulness, irritabiilt, and anxiety. Should resolve within 10 days. If not, then you would worry about post-partum depression (presents within 4 weeks and is treated). Very rarely, postpartum pscyohsis can occur which presents with delusions and hallucinations to kill the infant (absolute emergency)

Riavirin

a nucleoside antimetabolite drug that interphes with the duplication of DNA, especially against HCV (can be used for RSV too)

pancreatic adenocarcinoma in the head of the pancreas

a palpable but non-tender gallbladder, weight loss, and obstructive jaundice,.

Varenicline

a partial agonist of nicotinic ACh receptors. It can assist patients with cessatoin of tobacco by reducing withdrawal craving and attenuating the rewarding effects of nicotine pharm.

Buprenorphine

a partial opioid agonist that binds with high affinity but low intrsisic activity. iN patients on longterm opiod therapy, buprenorphine can displace other opioids and preciptate withdrawal.

Nystatin

a polyene anti fungal and the drug of choice or orophargeal candidiasis in patients that are immunocompetent. It acts by binding ergosterol in the fungal membrane, causing the formation of pores and leakage. "swish and swallow agent" pharm

Ubiquitin

a protein that undergoes ATP-dependent attachment to other proteins, labeling them for degradation. Impairment of the ubiquitin-proteasome system may contribute to neurodegenerative disorders like Parkinson's and Alzheimer's.

Naloxone

a pure opioid receptor antangosit that can rescue the overdose on narcotics. It binds all opioid receptors but has greatest affinity for mu receptors

Orotic aciduria

a rare autosomal recessive disorder of de novoa pyrimidine synthesis that occurs due to a defect in 5'monophosphate (UMP) synthase. Children typically present with physical and mental retardation, megaloblastic anemia, and large amounts of urinary orotic acid. Uridine supplementation (a pyrimidine) can improve symptoms as uridine is converted to UMP via nucleoside kinases (know the pathway in FA)

Vomiting

a reflex caused by 5 receptors, including M muscarinic, D2, dopaminergic, H1 histaminic, 5-HT3 serotnergic, and neurokinin 1(NK1) Besides 5-HT3 receptor antagnosists, NK1 receptor antagonists can be useful in chemoteraphy-induced vomiting.

Tryptase

a relatively specific molecule to mast cells that supports anaphylaxis diagnosis

The urachus

a remnant of the allantois that connect the bladder with the yolk sac during fetal development. Failure of the urachus to obliterate by brith results in a patent urachus, which would present with urine discharge from the umbilicus.

Imperforate anus (dimple anus)

a result of abnormal development of anorectal structures. It manifest during first couple days of life as inability to pass meconium, or it discharges form the urethra or vagina. Patients often have other malformations, most often urogenital tract

Dyplasia

a reversible change in epithelial cells. That's the key. Epithelial malignancies progress from low-grade dypsplasia, to high grade dysplasia/carcinoma in situ to invasive carcinoma. Once its invasive, no longer reversible.

Delirium

a reversible, acute-onset (compared to dementia being more gradual) confusional state characterized by fluctuating levels of consciousness with deficits in attention, memory, and executive function. Dementia does not involve fluctuations in consciousness.

Sumatriptan

a serotonin receptor agonist that can be used to acutely stop migraine heachaches by blocking the release of vasocactive peptides (like substance P), promoting vasoconstriciton, and blocking pain pathways.

Necrotizing Fasciitis

a severe infection of the subcutaenous tissue that is a surgical emergency. Often polymicrobial, but Strept pyogenes has been indicated with is PYR positive, beta hemolytic, and Gram-possitive cocci that grows in chains. S. Aureus and Clostridium perfringens would also be possible causes.

Thiopental

a short-acting barbiturate used for induction of anesthesia (short-acting). After equilibration with the brain (person loses consciousness) it rapidly redistributes into skeletal muscles and adipose tissue, leading to rapid recovery from anesthesia if not maintained by another anesthetic.

Zolpidem

a short-acting hypnotic medication chemically unrelated to benzodiazepines, but has the same mechanism of action where it binds to GABA receptors and enhance their action. It is often used in insomnia because it has a lower risk of tolerance and dependence.

Mitochondrial vacuolization

a sign of irreversible cell injury- involved mitochondria have been permanently damaged.

left-to-right shunt

a signficant incrase in blood oxygen content between two right sided chambers would indicate this. If it occurs between the right atrium and right ventricle, think VSD (loud holosystoic murmor over the left sternal border). ASD (fixed splitting of S2)

Eosinophilic granulomatosis with polyangitis (Churg-Strauss)

a small to medium vessel vasculitis, is characterized by late-onset asthma, rhinosinusitis, and eosinophilia. Peripheral nerve involvement (eg, mononeuritis multiplex) frequently occurs as a result fo the assoicated vasculitits affecting the pinerual vessles (say wrist drop for example)

CD14

a specific surface marker for macroophages

Two Sample T test

a statistical method used to compare the means of 2 groups of subjects. If p <0.05, the null is rejected and the means are different.

Adenocarcinoma in situ (formerly bronchioalveolar carcinoma)

a subtype of lung cancer. It consists of well-differnetated, dyspalstic columnar cells tha tline the alveolar septa wihtout vascular of stromal invasion (although malignant). The tumor has a tendency to spit out copious mucus.

"Hot tub folliculitis"

a superficial and self-limited Pseudomonas aeruginosa infection of the hair follicles that tends to occur following exposure to pool or spa without chemicals. It is a gram-negative, oxidase-positive, non-lactose-fermenting, motile rod that produces green pigment.

Whipple disease

a systemic tissue damage due to tropheryma whippelii in macrophage lysosomes. Classically invovles the small bowel lamina propria. Results in fat malaborption as chylomicrons can't get in the lacteals.

aortic stenosis murmur

a systolic ejection-type, crescendo-decrescendo murmur

Anal fissure

a tear in the lining of the anal canal distal to the dentate line that occurs most often in the posterior midline (poor perfusion here). Patients often complain of severe tearing pain with bowel movements. Associated with low-fiber diets and constipation.

Southwestern Blotting

a technique used to detect DNA-binding proteins such as transcriptoin factors, nucleases, and histones. c-Jun is an example of a protein that binds DNA

Measles (rubeloa)

a tetrad of cough, coryza (runny nose), conjuctivitis, and Koplik spots is diagnostic of this disease. Koplik spots are white or blue-gray lesions on the buccal mucosa that precede the maculopapular skin rash.

Streptokinase

a thromboembolytic agent that acts by converting plasminogen into plasmin, which subsequently degrades fibrin. Most common side effect is hemorrhage. It comes form Group A strept.

Congenital toxoplasmosis

a transplacental infection (acquired in utero). its classic triad included hydrocephalus, intracranial calcifications, and chorioretinitis Expecting mothers should avoid cat feces to avoid toxoplasma

serum sickness

a type III hypersenstiivty reacton to nonhuman proteins characterized by vascultitis resultign from tissue depostion of ciruclating immune complexes. Clinical findings include fever, pruritic skin, rash, arthralgias, and low serum C3 and C4 complement levels.

Comedocarcinoma

a type of DCIS of the breast and histologically apperas as solid sheets of pleomorphic, high grade cells with central necrosis.

Drug-induced parkinsonism

a type of extrapyramidal symptom caused by medications that block D2 receptors (antipsychotics). Managment strategeies would be to cease the drug and treatment with an anticholinergic (not pro-dopaminergic since coudl precepitate pscyhosis) like benztropin (works against parkinsons). pharm Dantrolene is used for Neuroleptic malignat syndrome (fever, encephalopathy, vitals unstable, muscle rigidity).

Alpha-fetoprotein

a useful marker in the evaluation of cirrhotic patients who are at increased risk for developing hepatocellular carcinoma. Regular monitoring of AFP in this patient population is recommended.

Scotoma

a visual field defect that occurs due to a pathologic process that involves part of the retina or optic nerve resulting in a discrete area of altered vision with surrounding normal vision. Lesions of the macula (macular degeneration, MS, diabetic retinopathy) can cause a central scotoma.

Lead poisoning

abdominal colic, constipation, headache, lead line and peripheral neuropathy. Microcytic hypochromic anemia and basophillic stippling too.

Ischemic colitis

abdominal pain and diarrhea after hypotension for example (usually affects watershep areas)

C. diff

abdominal pain, diarrhea, leuckocytosis, and white/yellow plaques with fibrin (pseudomembranes)

Base excision repair

abnormal bases are recongized and removed by specific glycosylases wihtout disruption of the phosphodiester backbone. The apurinic and apyrimidinic residues are then removed by specific endonucleases and replaced with the correct base by DNA polymerases.

Hypospadias

abnormal opening of penile urterha on the ventral surface of the penis due failure of urethral folds to fuse. Associated with inguinal hernia and cryptorchidism. Hypo is below.

Abetalipoproteinemia

absence of apoliprotein B-48 adn B-100 Can't get fat in with chylomicrons and low VLDL and LDL (require B-100)

Psychogenic causes of ED

account for about 10% of cases and include perfomance anxiety, seuxla partner dissatisfaction, and marital problems. Importnat clues that point here are sudden onset and prescence of morning erections.

Galactitol

accumulates in the lens of patients with galactosemia and causes osmotic damaged leading to cataract formation. Galactitol is formed from excess circulating galactose in galactosemia by aldose reductase.

Carbonic anyhdrase

acitivty within erthrocytes forms bicarbonate from Co2 and water (the main transport form of CO2). Many of the bicarbonate ions diffuse out of the RBC into the plasma and to maintain electrical neutrality chloride ions diffuse into the RBC to take their place (chloride shift- why there is high RBC chloride content in venous blood)

Diptheria toxin and pseudomonal exotoxin A

act by ribosylating and ianacting EF2, inhbitign host cell proetin synthesis and causing cell death.

Fructose 2,6,-bisphosphate

activates PFK-1 which increases glycolysis and inhibits fructose 1,6-bisphosphatase (decreasing gluconeogenesis). Insulin causes an increase in PFK-2 which causes an increase in Fructose 2,6-bisphosphate.

Acetyl-CoA

acts as an allosteric activator of gluconeognesis for pyruvate carboxylas.

Cocaine

acts as an indirect sympathomimmetic by inhibiting the presynaptic reuptake of NE, domapine, and serotonin. Thus the patient has agitation, tachycardia, hypertension, and mydriasis It is also a potent vasoconstrictor that can cause myocardial ischemia and atrophy of the nasal mucosa and septum.

The spleen

acts as both a blood filter capable of removing circulating pathogens and as a major site of opsonizing antibody synthesis. Loss of spleen increases risk for infection causes by encapsulated organisms. Especially the SHiNs.

ADH

acts on the medullary segment of the collecitng duct ot increase urea and water reabsorption allowing for produciton of maximally concnetrated urine. ADH causes more urea to be put in the medulla (more water reabsorbed)

Growth hormone

acts to promote bone, cartilage, and soft-tissue growth by stimulating relase of IGF-1 from the liver. Hypersecreton of GH before fusion of the epiphyseal plates cuases gigantism, a condition characterized by rapid linear growth

central retinal artery occlusion

acute and painless monocular vision loss-- the entire visual field is gone. Fundoscopic findings include pale retina (ischemia) and a cherry-red macula. Most common causes are embolisms through the internal carotid to opthalmic artery to central retinal. Risk factors: a-fib and carotid artery stenosis. It could also be causes by temporal arteritis

Acute renal rejection

acute renal rejection can be antibody or cell-mediated. Acute cellular rejection shows diffuse lymphocytic infiltraiton of the renal vasculature, tubules, and intersitium.

Carbidopa

adding carbidopa to levodopa can reduce most of the peripheral side effects of levodopa. However, behavioral changes from behavioral dopa like anxiety and agitation can actually worsen becuase more is available to the brain.

Health promotion

"the process of enabling people to icnrease control over their health and its determinants, and thereby improve their health." it is an example of primary health prevention- preventing a disease process from ever getting established.

Zidovudine

(AZT) is a nucleoside reverse transcriptase inhibitor used to treat HIV infection. It is bound in the viral genome as a thymidine analog, but ti contains an azido group in place of the normalhydroxyal group at the 3' end thus preventing formaiton of the 3'-5' phosphodiester bond and ceasing DNA chain elongation.

Total oxygen content of the blood

affected by hb concentration, oxygen saturation of Hb, and the partial pressure of oxygen dissolved in blood (PaO2). Anemia is characterized by decreased hemoglboin doncentration in the setting of a normal SaO2, and Pa02

Lead poisoning

affects delta aminolevulinate dehydrase adn ferrochelatase the most, leading to a microcytic anemia secondary to a lack of hemoglobin.

Congenital pyloric stenosis

affects males 3:1. non-billious vomiting and olive-sized mass with visible peristalsis. Arises due to hypertrophy of the pyrloric muscularis mucosae.

Chronic rejection in lung transplantation

affects small airways, causing bronchiolitis obliterans- lymphocytic inflammatoin, necrosis, and fibrosis of teh bronchiolar wall occur, ultimately leading to occlusion of the lumen.

Normal pressure hydrocephalus

affects the elderly. Wet, Wobbly, Wacky

Light reflex pathway

afferent limb: optic nerve efferent limb: parasympathetic fibers (think Edinger-westphal nucleus) within in the occulomoter nerve. When an optic nerve is damaged (often in MS), light in that eye will cause neither pupil to constrict. However, light in the contralaterl eye will cause both pupils to constrict because both motor pathways are intact.

HbS

aggregates in the deoxygenated state. HbS polymers form fibrous strands that reduce RBC membrane flexibility and promote sickling. Sickling occurs in adicemia, hypoxia, dehydration, and high levels of 2,3bisphohoglycerate (just think that athletes with the trait have issues in the higher altitude).

Gerstmann syndrome

agraphia, aclaculia, finger agnosia, left-right disorientation. Damage to dominant- parietal temporal cortex.

Frontotemporal dementia

aka Pick's disease. Is associated with pronounced atrophy of the frontal lobe. It manifests initially with changes in personality, social behavior, and language that progress over time to a more global dementia with obvious neurocongnititve deficits.

Charot-Marie-Tooth Disease

aka heredity motor and sensory neuropathy. Related to defective proteins involved in function of peripheral nerves and myelin sheath.> typically autosomal dominant and assoicated with scoliosis and foot deformities.

Abusive head trauma

aka shaken baby syndrome. caused by vigorous shaking leading to subdural hemorrhage (tearing of briding veins) and retinal hemorrhages.

DNA polymerases

all 3 have proof reading activity to remove mismatched nucleotides via a 3' to 5' exonuclease activity. Only DNA pol I has 5' to 3' exonuclease activity which is used to excise and replace RNA primers and damaged DNA sequences.

Diuretics

all diuretics except the potassium sparing class cause potassium loss. K+ sparing diuretics - amiloride, spironolactone are examples. They act on the late distal convoluted tubule adn the cortical collecting duct to antagonize aldosterone pharm

Trimethoprim, methotrexate, adn pyrimethamine

all inhibit dihydrofolate reducatse pharm

Reactions of the PPP

all occur in the cytoplasm. Whereas b-oxidation of FA, TCA cycle, parts of the urea cycle, and pyruvate carboxylation all occur in the mitochondria.

Metabolism of carbs, protein, and fat

1 g of carbs and protein yield 4 Calories of energy fat yields 9 Calories per gram

Number needed to harm

1/Attributable risk

Mallory-Weiss tears

10% of cases of upper GI bleeding Assoicated with alcoholism due to increased intraluminal gastric pressure due to retching, vomitting, or other abdominal staining.

Treacher Collins Syndrome

1st arch nerual crest fails to migrate - mandibular hypoplasia, facial abnormalitites

Esophageal squamous cell carcinoma

2 most importnat risk factors in the United states are smoking tobacco and drinking alcohol. Consumption of foods containing N-nitroso compounds are importnat risk factors in Asian countries

Organ Rejection

3 types of organ rejection: hyper-acute, acute, and chronic. Acute rejection occurs within weeks of transplantation and is driven by host T cells that act against donor MHC antigens. Causes a mononuclear infiltrate on histology. Prevention is with calcineurin inhibitors (tacrolimus and cyclosporine) and systemic corticosteroids.

Digeorge

3rd and 4th pouches messed up.

EMTALA

all patients who present to an emergency department must receive an appropriate screening medical exam and stabilization of their condition, regardless of ability to pay.

Finasteride

5-alpha reducatase inhibitor (also dutasteride) that blcoks the conversion of testosterone to dihydrotestosterone in the prostate. These dugs reduce rpostate volume in patients with BPH and releive the fixed component of bladder obstruction.

O2 content

= 02 binding capacity x % saturation + dissolved 02.

O2 binding capacity

= 20.1 mL 02/dL

Plasma osmolarity

= 2x Na+ + glucose/18 + BUN/2.8.

O2 delivery to tissues

= Cardiac Output x O2 content of the blood

Renal Clearance

= Ux * V/Px Cx < GFR = net tubular reabsorpiton Cx > GFR, net tubular secretion. Cx = GFR no net secretion or reabsorption

maitenance dose

= desired plasma concentraiton x clearance x time between doses divided by the bioavailability

Loading dose of a drug

= plasma concentration times the volume of distibtuion over the bioavailability.

Total flow

= the flow velocity x the cross sectional area which remains constant in the cardiovascualr system because its a closed system so the law of conservation of mass applies here. Volume in must equal volume out

Maintenance dose of a drug

= to the plasma concnetration times the clearance times the timing intervals that it is adminstered/bioavailability Note: half life is Vd x0.7/CL Loading dose: Vd x plasma concentration/bioavailability

Narcolepsy

A chronic sleeping disorder characterized by excessive daytime sleepiness, cataplexy, and REM-sleep related phenomea (hypnopomic hallucinations and sleep paralysis for example). The random sleep is often described as refreshing

nimodipine

A dihydropyridien calcium channel blocker that is used to treat subarachnoid hemorrhage to avoid vasospasm 2-3 days after.

Scaphoid injury

A fall onto an outstretched hand can easily cause fracture to scaphoid bone. Tenderness is seen in the anatomical snuff box. The scaphoid bone is vulnerable to avascular necrosis due to its tenuous blood supply.

Kartagener Syndrome

A form of primary ciliary dyskinesia characterized by the triad of situs inversus, chronic sinusitis, and brochiectasis. It occurs due to mutations that impair the structure or function of cilia. Cystic fibrosis also causes chronic respiratory infections, but not the situs inversus

Scabies

A highly contagious disease that presents with an intensely pruritic rash (usually worse at night) in the flexor surfaces of the wrist, lateral surfaces of the fingers, and finger webs. usually have small, crusted, red papules scattered around. Dx is made by seeing the mites on light microscopy.

Alanine

A major amino acid responsible for transferring nitrogen to the liver for disposal. During the catabolism of proteins, amino groups are transferred to alpha-ketoglutarate to form glutamate. Glutamate is then processed in the liver to form urea, allowing for disposal of nitrogen in humans. After alanie is transanimated, it can be used for gluconeogenesis.

Candida albicans

A normal inhabitant of the GI tract (especially the oral cavity) . It commonly contaminates sputum cultures and its presence does not necessarily mean disease. On sputum cultures it would appear as "germ tubes" at 37 degrees C.

Statistical Signfigifigance

A result is significant if the 95% CI does not cross the null value, which corresponds to a p-value <0.05.

V/Q mismatch

A signficant mismatched defect on ventilation-perfusion scan is a specific finding for pulmonary embolism, which is usually the result of a deep vein thrombosis.

Southern Blotting

A technique used to identify DNA mutations. It involves restriction endonuclease digestion of sample DNA, gel electrophoresis, and gene identification with radioactive DNA probe.

Shigella

A very low infectious dose is needed to cause infection.

The internal capsule

A white matter structure leading up to the precentral gyrus

OCP contraindication

A women over age 35 who smokes heaviliy prior history of thromboembolic event history of estrogen dependent tumor.

LTC4, LTD4, LTE4, and acethylcholine

all play a role in the pathogenesis of asthma and have drugs that block them Zarfirlukast and montelukast both block LTD4 receptors. Ipratropium blocks M3 receptors in smooth muscle.

The polyadenylation sequence

AAUAAA to add on the Poly A tail.

Causes of Dilated Cardiomyopathy

ABCCCD Alcohol abuse Wet Beriberi Cocaine abuse Coxsackie B virus Chagas disease Doxorubicin toxicity +hemochromatosis, sarcoidosis, and peripartum cardiomyopathy. Reults in systolic dysfuction (hypertrophic and restrictive cardiomyopathy have diastolic dynsfucitons)

PTSD and Acute stress disorder

ACute stress disorder is PTSD but < 1 month of symptoms.

Hypertrophic cardiomyopathy

AD and expect in any young person that dies while exercising. It is olften a mutaiton in the cardiac sarcomere proteins (beta myosin usually)

NF1

AD disorder caused by mutations in NF1 of chromosome 17. Patients characteristically develop numerous cutaneous nerofibromas comprised most of Schwann cells, which are embryologically derived from the neural crest

Romano-Ward Syndrome

AD inherited congenital long QT syndrome No deafness Increased risk for SCD due to Torsades (polymorphic ventiruclar tachycardia)

Brugada syndrome

AD most common in Asian males. ECG pattern of pseudo-right budnle ranch block and ST elevations in V1-V3. increased risk of ventricular tachyarrthymias and SCD

some tumor supressor genes

APC, BRCA1, RB, TP53 Their deactivation would eliminate oversight of the cell cycle and thus allow for cancer growth.

Auer rods

APL

Familial chylomicronemia sydnrome

AR caused by LPL deficiency. Patients present in childhoold with hypertriglceridemia, recurrent acute pancreatitis, lipidemia retinalis (milky-appearing retinal vasuclature), and eruptive xanthomas (not to be confused with the tendon xanthoms an xanthelasmas of familial hypercholesterolemia.

Jervell and Lange-Nielsen syndrome

AR inherited congenital long QT syndrome with congenita sensoneiurall deafness Increased risk for SCD due to Torsades

Krabbe disease

AR lysosomal storage disease deficiency in galactocerebrosidase leading to buildup of galactocerebroside which is toxic to myelin. Findings: peripheral neuropathy, developmental delay, optic atrophy, globoid cells

Metachromatic leukodystrophy

AR lysosomal storage disease most commonly due to arylsulfatase A deficiency leading to buildup of sulfatides- mess up myelin. Findings: central and periipheral demyelination with ataxia and dementia.

Chédiak-Higashi Syndrome

AR syndrome consisting of immunodeficiency, albinism, and neurologic deficits (such as nystagmus) diagnosed in childhood. Results from defect in neutrophil phagosome lysosome fusion causing abnormal giant lysosomal inclusions that are visible on light microscopy of a peripheral blood smear. It leads to recurrent pyogenic infections, especially by Staph and strept. Abnormal melanin storage in melanocytes causes the albinism.

Hartnup disease

AR where there are decreased neutral amino acid (like tryptophan) transporters on PCTs and enterocytes, leading to neurtal aminoiaciduria, decreased absoprtion from the gut, decreased tryptophan conversoin to niacin, pellagra. Treat with high protein diet and niacin.

Avascular necrosis

ASEPTIC Alcoholism, Sickle cell disease, Exogenous/endogenous steorids, Pancreatitis, Trauma, indiopathic (Perthe diseae), Caisson (the bendgs)

Abacavir hypersensitivity reaction

Abacavir is an NRTI. It can sometimes have a hypersenitivity reaction that is strongly associated with HLA-B*57:01 allelle. pharm

Epispadias

Abnormal opening of penile urethra on dorsal surface due to faulty position of the genital tubercle. Exstrophy of teh bladder is associated with Epispadias When you have Epispadias, you hit your Eye when you pEE

Acetaminophen and chronic alcohol use

Acetminophen can be metabolized by the cytochrome c-p450 system to N-acetyl-p-benzoquinoneimine which is toxic to the liver. IN the setting of chronic alcoholism which induces cytocrhome P450 this woudl occur at an increased rate.

Trypsinogen

Activated by trypsin by duodenal enteropeptidase. Trypsin is essential for protein digestion and absorption in two ways. It degrades complex peptides to dipeptides and amino acids, and it activates other proteases such as carboxypeptidse, elastase, and chymotrypsin.

Biotin

Acts as a CO2 carrier on the surface of carboxylase enzymes like in the conversion of pyruvate to oxaloacetate. Avidin in eggs avidly binds biotin.

Adenovirus

Acute hemorrhagic cystitis in children is likely to be adenovirus.

Acute pericarditis

Acute-onset, mid-chest pleuritic pain that decreases on sitting up and leaning forward with a pericardial friction rub is classic.

Vasectomy

After vasectomy, viable sperm remain in the poriton of the vas deferens distal to the ligation. Patients can still have viable sperm in the ejaculate for 3 months/20 ejaculations at least.

Germ Layers

All adults cells can be traced back to the ectoderm, mesoderm, and endoderm. The ectoderm gives rise to the surface ectoderm (Rathke's pouch (anterior pituitary), lens and cornea, inner ear sensory organs, olfactory epithelium, nasal and oral epithelial linings, epidermis, salivary, sweat and mammary glands) the neural tube (brain and spinal cord, posterior pituitary, pineal gland, retina), and the neural crest (autonomic, sensory and celiac ganglia; schwann cells; pia and arachnoid mater; endocardial cushions; branchial arches; skull bones; melanocytes; adrenal medulla)

Superficial inguinal nodes

All skin from the umbilicus down, including the anus (below the pectinate line) but excluding the testes, glans penis, and posterior calf, drains into the superficial inguinal lymph nodes. These are the lymph nodes next to the femoral vein in the femoral triangle.

Meningococcal pili

Allow for attachment to epithelial surfaces.

Classic galactosemia

An autosomal recessive disease where patients are homozygous for a defective galactose-1-phosphate uridyltransferase gene

Transposition of the Great Arteries

An echocardiogram showing an aorta lying anterior to and to the right of the pulmonary artery is diagnostic of transposition of the great arteries. TGA results from failure of the fetal aorticopulmonary septum to spiral normally during septation of the trucus arteriosus, presenting lifethreatening cyanosis at birth.

Volatile anesthetics

almost all of them increase cerebral blood flow. It is undesirable as it increases ICP. Other importnat effects of inhalation anesthetic sare mycoardial depression, hypotension, respiratory depression and decreased renal function (decreased GFR, decrease renal plasma flow)

Lipohyalinosis

along with microatheromas believed to be the primary cause of lacunar infarcts. It occurs secondary to leakage of plasma proteins through damaged endothelium (diabetes and hypertension) and is characterized by hyaline thickening of the vascular wall, collagenous sclerosis, and accumulation of mural foamy macrophages. Liquefactive necrosis results with fluid filled cavities in a lacunar infarct.

Generalized anxiety disorder

Anxiety lasting > 6 months unrelated to a specific person, situation or event (this would be a phobia like social anxiety disorder from public speaking).

Apolipoproteins

Apo A-I: LCAT activation (cholesterol esterification) ApoB-48: Chylomicron assembly and secretion by the intestine ApoB-100 (LDL particle uptake by extrahepatic cells) ApoC-II (lipoprotein lipase activation) ApoE (VLDL and chylomicron remnat uptake by the liver)

Strept. Pneunmonaie

Are gram positive diplococci (lancet shaped) , alpha-hemolytic, optochin-sensitive, bile-soluble diplococci. Viridans group streptococci are alpha hemolytic, but they are optochin resistnat and bile insoluble.

Mitochondria

Are necessary for the synthesis of heme. So mature erythrocytes lose their ability to synthesize heme when they lose their mitochondria, which is necessary for the first and final 3 steps of heme synthesis

Takayasu arteritis

along with termporal arteritis both invovle arterial vessles of large size (takayasu usually the aorta and proximal arotic branch vs. GCA usually invovles the more distal cartoid artery branch). They both share the common pathology of granulomatous inflammation of the media.

Acetaminophen metabolism and alcohol

At normal doses acetaminophen is metabolized by the liver by glucoronidation and sulfating which are released to renal then. But at high doses or with chronic alcoholics (increased activity of cytochrome 450) the toxic metabolite NAPQ1 is formed in excess. To remove it, glutathione is needed (depleted in alcoholism- thus damaged)

Projection

Attributing one's own feeling to others (uncocscious, undesirable thoughts or feelings to another person who does not actually have them) LIke a little boy who is mad at his parents for getting divorced but feels that they are mad at him. Displacmenet: transferring feelings to a more acceptable object- mad at wife so yelling at daughter (vs. projection would be mad at wife (doesn't know it though) so thinks wife is mad at him)

Immune thrombocytopenic purpura (ITP)

Autoimmune platelet destruction is a common cause of thrombocytopenia and should be supsected in patients with echymoses, petechiae, mucosal bleeding, and no other obvious causes of thrombocytopenia (ex- medications, bone marrow failure) .

Achondroplasia

Autosomal dominant (chance of inheritance to child of heterozygote is 50%) that results in gain of function of FGFR3 gene.

HIPAA

Avoid having conversations about protected health information in public places (like an elevator)

alpha and beta

alpha u1 causes mydriasis by contraciton of the pupillary dilator muscle. Beta 2 inhibits uterine contractions (tocolysis).

IN patients with hypertension and HF or diabetes

an ACE inhibitor should be the mainstay of long-term treatment as for HF they inhibit myocardial remodeling and the assoicated deteroiratoion in ventricular contractile function. Beta blocker could also be helfpul pharm

At night, BATS Drink Blood

Beta, to alpha to theta, to Sleep spindles, to delta (lowest frequency, greatest amplitdue), to beta (highest frequency, lowest amplitude) on EEG waveform.

SLE

Binding of autoantibodies to self antigens leads to deposition of immune complexes in tissues and decrease in complement on laboratory findings.

BRAF

Blak (melanoma) retarded a** fuc*** a protein kinase that actvates singlaing pathways of melanocyte proliferation. BRAF mutation (V600E: valine to glutamic acid) is seen in 40-60% of patients with melanoma.

Thiamin as a co-factor

Both pyruvate dehydrogenase and alpha ketoglutarate dehydrogenase require thiamin as a cofactor. Administration of glucose to thiamin deficient patients can result in Wernike encephalopathy (acute confusion, opthalmoplegia, and ataxia) due to increased thiamin demand

Cancer Death in Women

Breast is the most common cancer but mortality is relatively low whereas lung is less common but mortality is high. Colon comes after these two. Lung is the most common cancer death in women.

Complement binding to IgG

C1 complement binds in the classical pathway to either two molecules of IgG or IgM at the Fc region of the heavy immunoglobulin chain in the region near the hinge point.

Lower brachial plexus injury

C8-T1 are responsible for innervating the intrinsic hand muscles via the median and ulnar nerves. Sudden upward stretching of the arm from falling can damge this trunk eading to finger clumsiness with total claw hand deformity,

3' end of tRNA

CCA and the site of AA binding.

Sarocoidosis

CD4+ T helper cells would predominate because they mediate the granuloma process. In addition, patients may have elevated serum calcium (produce Vitamin D) and ACE

The superior orbital fissure

CN III, IV, V1, VI and the superior ophthalmic vein

CO poisoning

CO binds to hemoglobin with an affinity 220 times that of 02. It is reversible. CO, therefore, competitively competes with 02 for binding on the heme iron of Hb (hence we treat with 100% hyperbaric oxygen- trying to outcompete)

Cerebral perfusion pressure

CPP = MAP - ICP. If CPP = 0, there is no cerebral persuion and brain death would occur.

Constrictive Pericarditis

Calcification and thickening of the pericardium > 4 mm are common features on CT. Symptoms may include progressive dyspnea, peripheral edema, and ascites

Hypoglycemia

Can be preciptiated by exercise in patinets with insulin-treated diabetes. Uptake of glucose by skeletal muscle mediated by the Glut 4 transporter, which is translocated to the cell membrane in response to insulin and muscle contracotin (so more glucose taken out of blood but patient still has insulin pumping) Symptoms include disorientation, sweating, tremors, palpitations

Severe hypoglyemia

Can be treated with intramuscular glucagon in a non-medical setting and with intravenous dextrose in the medical setting.

Thayer-Martin VCN Medium

Can be used to isolate Neisseria organisms by culture. It is selective media and inhibits growth of contaminants like Gram +, gram negatives besides Neisseria, and fungi

Wilson's disease

Can cause a cystic degeneration of the putamen and other basal ganglia structures 5

Neisseria gonorrhoeae

Can cause acute bacterial arthritis in sexually active young adults (assymetric polyarthritis). Synovial fluid should be notable for neutrophilic predominance and faculative intracellular organisms.

Slipped strand mispairing

Can lead to a frame-shift mutation and early stop codon.

kidney disease and uremia

Can lead to abnormal bleeding in patients with prolonged bleeding time (the toxins impair platelet aggregation and adhesion), but normal PT, aPTT, and platelet count.

Radial nerve injury

Can occur by repetitive pressure (like crutches) at the axilla. Findings include weakness of forearm extension, hand and finger extensors (wrist drop). Sensory loss over posterior arm and forearm dorsolateral hand and thumb. Triceps spaired with a more distal lesion.

Communicating hydrocephalus

Can occur post-meningits from scarring of the arachnoid granulations.

Syphillis misdiagnosis

Can occur with SLE because they are VLDR/RRP positive

Hypercalcemia

Can present with mental status changes, muscle weakness (groans), constipation, polyuria/polydipsia and dehydration Activated macrophags in sarcoidosis produce excess 1,25 vit D which can cause hypercalcemia also by increasing absorption of calcium (remember active Vit D can be toxic in too high amount)

RA

Cartilage components serve as autoantigens that activate CD4 + T cells which in turn stimulated B cells to secrete RF, an IgM antibody specific against the FC component of self IgG

Vasopress/Desmopressin

Causes A V2 receptor-mediated increase in water and urea permeability in the inner medullary collecting duct. The resulting rise in urea reabsorption (decreased urea clearance) enchances the medullary osmotic gradient, allowing the production of maximally concentrated urine.

Renal tubular acidosis

Causes a non-anion gap metabolic acidosis due to 3 types Distal (type 1) urine pH >5.5: defect in alpha intercalated cells secreting H+. leads to metabolic acidosis since no new HC03- reabosortion. Also associated with hypokalemia since H+/K exchanger here wouldn't work. increased risk for calcium phosphate kidney stones (increased bone turnover and increased pH of urine). Proximal (type 2) urine pH <5.5: Defect in HC03- reabosportion leading to increased excretion of HC03- in the urine (metabolic acidosis) but the urine is still acidified by alpha intercalated cells in the collecting tubule. Also assoicated with hypokalemia. And increased risk for hypophasphatetmic rickets. Causes include Fanconi syndrome and carbonic anhydrase inhibitors. Hyperkalemic (type 4, urine pH < )- hypoaldosteronism, hyperkalemia, decreased NH3 synthesis in PCT and decreased NH4+ excretion. Causes include decreaed aldosterone production (Ace inhbiitotrs, NSAIDs,

Holocrine

Cell lysis releases entire contents of the cytoplasm and cell membrane like sebaceous glands (acne) and meibomian glands.

Giant Cell Arteritis/temporal arteritis

Cell-mediated immunity is the primary problem. The production of cytokines, in particular interleukin-6, are important drivers and correlate with severity. Characterized by headaches, visual symptoms, elevated ESR, and visible temporal artery

Ataxia Telangiectasia

Characterized by a classic cerebellar ataxia, telangiectasias, and increased risk of sinopulmonary infections. It is AR and results from a defect in a gene that encodes ATM which plays a role in DNA break repair (even more specifically there is a problem with nonhomologous end joining) Immune deficiency is primarily IgA so upper lower airway infections mainly.

Congenital Rubella Syndrome

Classic triad: congenital cataracts (white pupils), sensory-neural deafness, and patent ductus arteriosus (could be pulmonary artery stenosis as well) cCould potentially also result in microcephaly and mental retardation non-pregnant females should be vaccinated with the live MMR vaccine prior to pregnancy.

IL-8

Clean up on Aisle 8 Neutrophils are attracted and induced to phagocytose by this cytokine released from macrophages.

Pro-insulin

Cleavage of pro-insulin in the islet cell secretory granules yields insulin and C-peptide, which are stored int eh granule until they are secreted.

Down Syndrome

Clinical features include flat facies, epicanthal folds, oblique palpebral fissures and a single palmar crease. Congenital heart defects are seen in 50% of patients with this condition (endocardial cushion defects). Majority of cases are due to maternal meitotic nondisjunction

Elder abuse

Clinicians have ethical and moral obligations to report elder abuse, neglect, and exploitation. If there is reason to suspect abuse, the patient should be interviewed alone to avoid intimidation by possible abusers. If the potential abuser refuses to leave, go ahead and call adult services if you can't obtain the solo interview.

Nodular apperance of ribs on chest x ray

Coarctation of the aorta.

Acute intermittnet porphyria

an AD condition caused by porphobilinogen deamniase deficiency. acute attacks are characterized by abdominal pina and vomitting, periopheral neuropathy, neuropsycholigcal symptoms, and reddish-brown urine. Treatment consists of intravenous glucose or heme preparations to downregulate ALA synthase activity

Huntington disease

an AD neurodegernative disease that presents with dementia or agressiveness/change in personality and a choreiform movement disorder. It is characterized by a loss of GABA (the chill ones) containing neurons. Increased CAG in chromosome 4

Cryoglubulinemia

Cutaneous manifestations and associated with Hep C

Abdominal process

any abdominal process (ruptured spleen, peritonitis,) irritating the phrenic nerve sensory fibers aroudn the diaphgram can cause referred pain C3-D5 shoulder region.

Calcium sensing receptors

are G-protein coupled receptors that regulate the secretion of parathyroid hormone in response to changes in circulating calcium levels. Familial hypocalciuric hypercalcemia is a benign autosomal dominant disorder caused by defective calcium-sensing receptors in the parathyroid gland and kindneys (mildly increased serum calcium with low urinary calcium and mildly to normal increased PTH)

Kinesin and dynein

are MICROTUBULE assoicated motor proteins that function in the rapid transport of materials and oranells within cells. Dynein also functions in ciliary and flagellar movments (aka Kartagener's syndrome baby) Dynein stands for Do not enter. Therefore, it handles retrograde transport

Acoustic neuromas

are Schwann cell-dervied tumors that typically arise from the vestibular portion of the vestibulocochlear nerve and are commonly located at the cerebellopontine angle. Patients usually present with sensorinueral hearing loss and tinnitus

Xanthelasmas

are a type of xanthoma on the medial eyelidds. Yellowish macules/papules

Perchlorate and petechnetate

are absorbed into the thyroid gland via sodium-iodide symporter. High levels of any one substance will significantly reduce the uptake of the others due to competitive inhibition.

Asthma and COPD

are also capable of causing pulsus paradoxus. Beta adrenergic agonists control acute asthma and COPD exacerbations by causing bronchial smooth muscle relaxtion via increased intracellular cAMP

Actin filaments

are anchored into the Z line of the sarcomere. The Z line lies in the center of the lucent region referred to as the I band. The I band (for individual) is the region of the sarcomere where actin does not overlap with myosin.

Nonnucleoside reverse transcirptase inhibitors (NNRTIs)

are antiretroviral drugs that do not require activaiton via intracellular phosphorylation. The more common NNRTIs include nevirapine and efavirenz pharm

Second-generation antipsychotics

are associated with metabolic adverse effects (eg. weight gain, dyslipidemia, hyperglycemia, and increased risk of diabetes). As such they should be monitored for changes. Olanzapine and clozapine carry the greatest risk. pharm

INtracrnail aneursyms

are assoicated with ADPKD. When ruptured, they cause subarachnoid hemorrhage that presents witih sudden onset of "thunderclap headache"- the worst headache of my life. Neck stifness, pupiallary dilation, and papillary edema may also be noted. xanthocromia in CSF if CT does not show findings

Panic attacks

are assoicated with hyperventilation and decreased PCO2. Hypocapnia causes cerebral vasoconstriction and decreased cerebral blood flow so the patient may feel dizzy, weak, and have blurred vision.

Melanocytic nevi

are benign proliferation of melanocytes are either junctional nevi (which are flat and only in the epidermis), compound nevi (involves both the dermis and epidermis and is slightly raised papule with uniform pigmentation and sharp border) , or a intradermal nevus (still is raised but is older and lighter in color)

Strawberry hemangioma

are benign vascular tumors of early childhood. they appear early and will regress by 5-8 years of age. they are composed of capillaries separated by connective tissue.

Presbyopia and skin wrinkles

are both age-related changes. Presboyopia (inability to accompodate with close objects- the image focuses behind the retina) is due to denaturation of structural proteins within the lens, leading to loss of lens elasticity. Decreased synthesis and increased breakdown of collagen and elastin contribute to the devleopment of skin wirnkles

Viruses with segmented genomes (orhtomyxoviruses and rotaviruses for example)

are capable of genetic shifts through reassortment (how influenza causes pandemics). Reassortmnet invovles exchnage of genome segments, a far more dramatic prcess that the point mutations invovled in genetic drift

Neurophysins

are carrier proteins for oxytocin and vasopressin (ADH). They are carried form teh paraventricular and supraoptic nuclei of the hypothalmus to the axon terminals in the posterior pituitary. A point mutation in neurophysins could be the reason for hereditary diabetes insipipidus (No ADH)

Mitochondrial diseases

are characterized by exclusively-maternal inheritance. All kids will be affected but there will be variable severity because of random distribution of normal and mutated mitochronida between daughter cells during mitosis so there will be some cells with completely healthy mitochondria while other have ones that contain the mutaiton (this is called heteroplasmy and why say a son may be severe while the daughter is not).

Organophosphates

are cholinesterase inhibitors that are widely used as pesticides in agriculture. They inhibit the breakdown of acetylcholine, leading to a state of cholinergic excess like salvation, lacrimation, diaphoresis, bradycardia, and brochospasm. Could be treated with atropine.

Hypokalemia and hypomagnesemia

are common electrolyte disturbances in patients undergoing treatment with amphotericin B as it can have toxic effects on the kidney. Symptoms of hypokalemia would be weakness and arrhythmias like T wave flattenign, sT-segment depression, prominet U waves, and premature atrial and ventricular contractions.

Acoustic neuromas

are commonly located at the cerebellopontine angle and arise from cranial nerve VIII. Patients may have ipsilateral sensorineural hearing loss/tinnitus and vertigo (CNVIII), loss of facial sensation (CN V) and facial paresis (CN VII). Bilateral Acoustic neuromas are associated with NF2.

Carcinoid tumor

are composed of islands or sheets of uniform cells with eosinophilic cytoplasm and oval-to-round stippled nuclei. These tumors are often derived form neuroendocrine cells in the GI tract (small intestine and appendix). Appendicideal carcinoids typically have a benign course but may cause acute appendicitis or rarely carcinoid syndrome with liver mets.

Auer rods

are deformed azurophillic granules found in the cytoplasm of myeloblasts that stain positive for myeloperoxidase. Found abundantly in AML M3/acute promyelocytic leukemia

Langerhans cells

are dendritic cells found in the skin that act as professional antigen presenting cells. These cells are derived from the myeloid cell line and they posses characteristic racquet-shapd intracytoplasmic granules known as Birbeck granules.

Elastases

are derived from inifltrating neutrophils and alveolar macrophages. If left unchecked, they destory the lung parenchyma (emphysema)

Precursor B-ALL and precursor T-ALL

are diseases of children. Tehy can only be distinguished by immunophenotyping B-ALL are TdT+, CD10+, and CD19+ werheas T-all woudl have CD2,3,4,5,7,and8.

Free nerve endings

are either C-slow, unmyelinated fibers or A -delta fibers - fast, myelinated fibers Seen on all skin, epidermis, some viscera. Sense Pain and temperature

Granulosa cell tumors

are estrogen-secreting primary ovarian tumors. The hyperestrogenemic state that results can cause endometrial hyperplasia and abnormal uterine bleeding. It also predisposes to endometrial adenocarcinoma

Methylphenidate and amphetamines

are first line for ADHD and can cause wieght loss and decreased appetite pharm

SSRIs

are first line for OCD, characterized by persistnet, intrsuive thought leding ot repetitive, ritualistic behaviors. Serotonergic antidepressants are the treatment of choice.

Ectopic tissues

are found in Meckel diverticulum, most commonly gastric epithelium. This is not metaplasia. Gastric acid secretion can lead to bleeding

Amatoxins

are found in poisonous mushrooms (like Amanita phalloides, known as deathcap muschroo) and are potent inhibitors of RNA pol II in the liver thus leading to halting of mRNA synthesis and apoptosis

Splenic flexure and distal sigmoid

are in watershed areas (area of perfusion between major arteries) and are therefore most susceptible to ischemic injury from ischemic colitis

Cholinomimetics

are indicated in non-obstructive urinary retention (atonic bladder), parayltic ileus, and glaucoma. their side effects include nausea, vomitting, abdominal cramps, diarrhea, dyspnea and INCREASED SECRETIONS (lacrimation, sweating, and salvation). If you just think of Cholinergic agnonists as increasing fluid secretions- things can make sense.

Lines of Zahn

are interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed before death.

T-tubules

are invaginations of the sarcolemma that extend into each muscle fiber. They transmit depolarizaiton signals to the SR (the terminal cisternae of the triad) and trigger the release of calcium. The uniform distribution of T-tubules ensures coordinated contraction of all myofibrils.

Cortisol receptors

are located within the cytoplasm and translocate to the nucleus to act as Trascriptn factors. Cortisol enhances gluconeogenesis (hence hyperglycemia in cushings)

Hypocretin-1/2

are neuropeptides produced in the lateral hypothalamus that function to promote wakefullness and inhibit REM sleep-related phenomena. Most patients who have narcolepsy with cataplexy demonstrate undetectable levels of hypocretin-1 in their CSF

Pancoast tumors

are non-small cell lung cancers (squamous, adenocarcinoma) that arise near the superior sulcus of the lungs (area where the subclavian artery makes a groove). Patients may have ipsilateral shoulder pain, upper limb paresthesias, and arm weakness due to invovlment of branchial plexus as well as Horner's syndrome due to invovlment of cervical sympathetic ganglia (would be ipsilateral)

open-ended questions

often the way to go on step and in life

Viridans streptococci

are normal inhabitants of the oral cavity and are a cause of transeint bactermia after dental procedures. In patients with pre-existing valvular lesions, viridans streptococci can adhere to fibrin-platelet aggregates through dextrans to establish infection that leads to endocarditis

SSRIs (ex. Sertraline)

are often better than TCAs but are assoicated with sexual dysfunction.

acetobutol and pindolol

are partial beta agnoists.

Glucocorticoids

are predominantly catabolic and causing muscle weakness, skin thinning, impaired wound healing, osteoporosis and immunosuppression. However, they increase liver protein syntehsis regarding enzymes needed for gluconeogenesis and glycogenolysis in its opposed of insulin thus leading to hyperglycemia

Dietary lipids

are primarily digested in the duodenum via pancreatic enzymes but are absorbed in the JEJUNUM. Most cholecystectomy patients can tolerate fatty foods in the diet as bile is consantly released into the duodenum

Nitrates

are primary venodilators and increase peripheral venous capacitance, thereby reducing cardiac preload and left ventricular end diastolic volume and pressure. However, they also have a modest effecdt on areteriolar dilation at high doses and so can be effective in decreasing SVR and afterload during hypertensive crisis.

Peroxisomal diseases

are rare and are here peroxisomes are either absent or non-functinonal. Very long chain fatty acids acids or branched fatty acids (phytanic acid) with branching points cannot undergo regular mitochondrial beta oxidation and rather it must occur in a peroxisome. These diseases result in neurologic defects due to improper CNS myelination.

Mitochondrial myopathies

are rare disorders often presenting with myopathy, lactic acidosis, and CNS disease secodnary to failure of oxidative phosphorylation. biopsy shows ragged red fibers. MELAS is one such example.

Vancomycin resitant enteroccoccus

are resistant by a substitution of D-lactate in the palce of D-alanine during the process of peptidoclygan cell wall synthesis. This prevents binding of vanc to its usual D-alanyl-D-alanie binding site in the cell wall.

Genetic factors

are responsible for up to 80% of differences in peak bone mass between individuals.

Granulosa-theca cell tumors

are sex-cord stromal tumors of the ovary that secrete estrogen and can cause endometrial hyperplasia. Call-Exner bodies (cells arranged in a microfollicular or rosette pattern may appear as glands with acidophllic center) are seen on microscopy. On gross pathology, tumors appear yellow due to the lipid content in the theca cells often in postmenopasual women.

Rabies (Rhabdoviridae)

are single-stranded RNA viruses enveloped by a bullet-shaped capsule, which is studded by glycoprotein spikes that bind to nicotinic acetylcholine receptors. Once depostied in the wound, the virus stays dormant until binding to acetylcholine receptors on peripheral nerve axons and traveling retrograde up to the central nervous system.

Actinic keratoses

are small (usually < 1 cm), erythematous epidermal lesions with adherent scale that are the result of sun exposure. Histologic findings include keratinocyte atypia, hyperkeratosis (thickening of the stratum corneum) and parakeratosis (retention of nuclei in the stratum corneum). They put patient at increased risk for SCC developing from one.

Pretibial myxedema and exophthalmos

are specific features of hyperthyroidism due to Graves disease. They are caused by an autoimmune response directed against the TSH receptor causing accumulation of glycosaminoglycans.

Anti-dsDNA

are specific for SLE Anti-smith is also specific for SLE

Penicillins

are structurally similar to D-alanine D-alanine, thereby inihbitng transpeptidase at its active site and preventing synthesis of the bacterial peptidoglycan cell wall.

Xanthomas

are suggestive of hyperlipidemia, especially when present in conjuction with a family history of early cardiac death.

Type I interferons (alpha and beta)

are synthesized by most human cells in response to viral infections. These help suppress viral replication in infected cells and nearby cells by halting protein synthesis and promoting apoptosis in infected cells, thus limiting the ability of the virus to spread

IL-10 and TGF-beta

are the big inhibitory cytokines. IL-10 will reduce the production of TH1 cytokines (IL-2 and IFN-gamma) and MHCII expression. It will also inhibit activated macrophages.

Plasmodium vivax and ovale

are the hyypnozoites that can stay in the liver and can be resistnat to chloroquine. Primaquine for these guys

Accessory nipple

are the most common congenital breast anomaly resulting from failed regression of the mammary ridge in utero. They are usually asymptomatic but can become tender along with breast tissue during times of hormonal fluctuation.

HFE protein mutations

are the most common for primary hemocrhomatosis. Inactivaiton of HFE proteins results in decreasd hepcidin syntheiss by hepatocytes and icnreased DMT 1 expression by enterocytes leading to iron overload. They have an icnreased risk for liver cirrhosis and HCC.

Febrile seizures

are the most common neurologic disorder affecting children and are benign sequelae of fevers (just need to rule out encephalopathy and meningitis as the cause). Children who experience a febrile seizure are at risk of recurrence but have a low risk of developing epilepsy. Antipyretics like acetaminophen or ibuprofen can improve patient comfort during fever by blocking prostaglandin E2.

Hydrogen bonds

are the principal stabilizing force for the secondary structure of proteins

Lacunar infarctions

are the result of small vessel occulsion (by lipohyalinosis and microatheroma) in the penetrating vessels suppling deep brain structures.

Type I muscle fibers

are the slow twitch muscle fibers, found normally in postrual skeletal muscles (like the paraspinal muscle where fast acting is not needed) are myoglobin rich, glycogen-poor with many mitochondria (aerobic metabolism)

Babesiosis and lyme disease

are transmitted by the Ixodes tick and occur in similar geographic regions. Co-infection is common.

Craniopharyngiomas

are tumors arising from Rathke's pouch remnants in the anterior pituitary. They are characteristically solid, cystic and calcified. They often present during childhood with mass and visual defects .

Patients with sickle cell trait

are typically asympatomatic and have relative protection from malaria cuased by Plasmodium falciparum. these patietns usually have normal Hb, reticulocyte, and red blood cell index. life expectancy is normal. Also on Hb electrophoresis, would have HbA and HbS, but greater levels of HbA.

Bile acid resins like Cholestyramine

are unique in that they acutally increase blood tricylgeride levels while decreasing LDL levels.

Beta blockers (propranolol

are used during throtoxicosis for two reasons. For once it decreases the effects of sympathetic adrenergic impulses on target organs. IN ADDITION, They also decrease the rate of peripheral conversion of T4 to T3

cavernous hemangioma

are vascular malformations that occur most commonly within the brain parenchyma. they carry an increased risk of intracerebral hemorrhage and seizure.

Black pigment gall stones

arise in conditions that increase the amount of unconjugated bilirubin in the bile, such as chronic hemolysis.

Venous thromboembolism

arises due to the Virchow triad: hyper coagulable states, venous stasis, and endothelial injury

The iliohypogastric nerve

arises from L1, gives motor functino to the naterolateral abdominal wall msucles and innervates sensory fro skin in the pubic region. Injury to the anterior branch can occur during appendectomy causing decreased sensation at the suprapubic region.

The phrenic nerve

arises from the C3-C5 segments of the spinal cord and innervates the ipsilateral hemidiaphragm. Intrathoracic spread of lung cancer may affect the phrenic nerve, causing hiccups and diaphragmatic paralysis with dyspnea and shoulder pain. Could also involve the brachial plexus, causes Horner's syndrome through pancoast tumor, involve the recurrent laryngeal nerve and cause hoarness or cause superior vena cava syndrome with edema in the upper body.

Clear cell carcinoma

arises from the renal tubular cells. Histology shows polygonal celsl with abudnat clear cytoplasm. These cells have this apperance because they are packed with glycogen and lipids. Would likely present with painless hematuria Any cell that has a lot of lipid and glycogen would appear clear.

Visceral obesity

as measured by waist circumference or waist to hip ratio is an importnat predictor of insulin resistance

Kawasaki disese

asian children < 4 years old Mucoutanoues lymph node syndrome: CRASH and burn C:conjuctivatil injectoin R: rash A: Adenopathy (cervical) Strawberry toungue H: Hand and foot changes (edema, erythema) burn: fever feared complication is conorany artery aneursms and death. Treatment: IV immunoglboulin and aspirin

The suprapspinatus

assists in abduction of the arm and stabilizaiton of the glenoumeral joint. The suprapspinatus tendon is vulnerable to injury due to impingmement between the acromion and the head of the humerus. Pain can be elicited with the empty can maneuver. Supraspinatus tnedionpathy is the most common cause of rotator cuff syndrome

Hepatic angiosarcoma

assoaicted with exposure to arsenic, thorotrast, and polyvinyl chloride. Tumor cells express CD31 as a marker.

Non-caseating granulomas

associated with Crohn's disease. Other classic findings: serpinginous ulceration, cobblestone appearance of mucosa, and transmural inflammatory infiltrate - leads to narrowing of involved segment (causes the classic "string sign" on barium studies). These strictures can lead to intestinal obstruction.

Centriacinar emphysema

associated with chronic heavy smokin gpredominnatly involving the relase of elastase from infiltrating neutrophils and alveolar macrophages which are activated when the smoke comes on in.

Intersitial lung disease

associated with decreased lung volumes and increased lung elastic recoil cuased by fibrotic interstitial tissue. The increased elastic recoil resutl in increased radial traction (outward pulling) on the airways, leading to increased expiratory flow rates when corrected for low lung volume.

Bacterial vaginosis

assoicated with a grayish-white vaginal dishcarge with a "fishy" odor. The etiolgoy involves an overgrowth of Garnerella vaginalis, an anaerobic gram-variable rod. Clue cells are seen on wet mount.

VSD

assoicated with a low-pitched holosytolic murmur that accentuateds during handgrip maneuver (increased afterload). They are often asymptomatic but woudl be seen in a child for sure on the exam.

Charcot-Bourchard microaneursm

assoicated with hypertesion chornically- often seen in the basal ganglia.

Angiosarcoma

assoicated with radiation therpay and chronic postmastecotmy lymphedema. Hepatic angiosarcoma assoicated with vinyl cholirde and aresenic exposures. Very agressive and diffcult to resect.

Helicobacter pylori gastritis antrum

assoicated with the formation of duodenal ulcers due to increases gastric acid acidity. The increase is caused by unchecked gastrin production secondary to the destruction of somatostatin-secreting cells in the gastric antrum. H. pylori is strongly assoicated with gastric adenocarcinoma and gastric lymphoma

Turner Syndrome

assoiciated with congenital anomalies of the aorta, and the most common defect is a bicuspid aortic valve. It is heard as an early systolic, high-frequency click over the right second interspace if non-stenotic.

Ehlers-Danlos

assoicted with abnormal collagen formation primarily presenting with hypermobile joints, over-elastic skin and fragile tissue with bruising, wounding

Membrane potential

at rest close to potassium equillibrium potential becuase the resting membrane is most permeable to potassium. Changes as permeabilities for ions change (going closer to that ion's membrane potential). Potassium and chloride are negative. Sodium and calcium are positive

Damage to the brainstem

at/below the level of the red nucleus (midbrain/pons) typically results in decerebrate (extensore) posturing. This is due to loss of descending excitation to the upper limb flexors (rubrospinal tract) and predominance of the extensors (vestibulospinal tract)

Tabes dorsalis

ataxia and Argyll Robertson pupils (do not react to light but do accommondate- sluts acommodate) Loss of vibratory and position sensation areflexia neurogenic bladder and overflow incontinence

Wilson's disease

atrophy of the basal ganglia.

Type 1 diabetes

autoimmune insulitis (Islet leukocyte infiltration) with progressive beta cell loss

NF1

autosomal dominant. Cafe-au-lait, multiple neurofibromatomas, and Lisch nodules are common symptoms. Picture shows neurofibromas (come from schwann cells and thus are of neural crest origin)

Sickle cell anemia

autosomal recessive hemoglobinopathy. So for a child to have it, both parents must be carriers. Hb electrophoresis can be used to determine the status of parents.

Friedreich ataxia

autosomal recessive trinucleotide repeat on chromosome 9 in the gene that codes for Frataxin. Degeneration of multiple spinal cord tracts with muscle weakness and loss of DTRs, vibratory sense, proprioception. Staggering gait, frequent falling. nystagmus, dysarthria, diabetes, hypertrophic cardiomyopathy. Presents in childhood with kyphoscoliosis Friedreich is Fratastic (frataxin). he's your favorite frat brother, always staggering and falling but has a sweet, big heart.

Pyramdial signs of UMN lesion

babainski, hyperreflexia, spatisicity, muscle paraylsis, weakness

The phsphoinositol second messenger system

begins with ligand-receptor binding and G-protein activation leading to activation of Phospholipase C. PlC then hydrloyzes PIP2 to form DAG and IP3. Finally IP3 activates Protein Kinase C via increase in intracellular Ca.

Tertiary syphilis

begins with vasa vasorum endarteritis and obliteration resulting in inflammation ischemia and weakneing of teh adventita. Aneursmal dilation of the thoraci aorta can extend down and involve the aortic valve ring.

Seborrheic keratosis

benign epidermal tumor that presents as a tan or brown, round lesion with well-demarcated border and a "stuck-on" apperance. Usually come in old age, but multiple at the same time could signifcy an underlying malignancy (Leser-Trélat sign).

Lymph node enlargment

benign lymph node enlargement in response to antigenic stimulation is assoicated with a polyclonal proliferation of lymphocyts. A monoclonal lymphocytic proliferation is strong evidence of malignancy.

Femoral nerve block

best achieved at the inguinal crease to anesthetize the skin and muscles of the anterior thigh femur and knee

Beta blocker medication overdose

beta blockers cause blockagde of peripheral betaa adernergic receptors, cuasing depression of myocardial contracility, bradycardia, and varying degree of AV block. Glucagon can save you in overdose by increasing cAMP through G-protein coupled receptors and thus increasing the release of intracellular calcium during msucle contraciton, promoting and increased HR and contractility. pharm

Drugs that improve long-term survival in HF due to LV systolic dysfuction

beta blockers, ACE inhibitors, ARBs, aldosterone antagonists (spinronolactone and eplerenone) pharm

Group A streptococcus

beta hemolytic, bacitracin susceptible, and pyrrolidonyl arylamindase-postive (PYR)- THIS HAS COME UP A MILLION TIMES .

Potter Syndrome

bilateral renal aplasia, oligohydramnios, characteristic faces, and pulmonary hypoplasia. Respiratory failure is usual cause of death just after birth.

Crohn disease and gallstones

bile acids are suually reabsorbed at the terminal illeum. If this area is inflamed and there is decreased reabsorptin, then the cholesterol:bile acid ratio increases which can lead to increased cholesterol precipitaiton and gallstones.

Cholinergic agonists

bind to muscarinic receptors on endothelil cells adn promote the release of NO (EDRF). NO activates cGMP and diminsehs endothelium calcium concentration thereby causing vasodilation

Carbon monoxide

binds to hemoglobin with 250x higher affinity than oxygen, thereby preventing its binding. It also reduces oxygen unloading from Hb in tissues (hence the leftward shift of the oxygen dissociation curve) CO increases the carxoyhemoglobin and decreases the oxygen content of blood concentrations but does not affect the partial pressure of oxygen (paO2) and does not precipitate methemoglobinemia

Methotrexate and 5-FU

both effectively inhibit thymidylate formation, but the chemotherapeutic effect of methotrexate is overcome with N-formyl-tetrahydrofolate supplementation due to differences in where they act pharm

Cholecystokinin (CCK)

bladder contraction. It is made in response to fatty acids and amino acids in the duodenum.

DIC

bleeding from venupucture sites comes up often.

Hemarthrosis

bleeding into a joint (seen in hemophillia)

Atropine poisoning

blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and the bladder lose their tone, the heart runs alone. It is a reversible cholinergic antagonists that acts selectively on muscarinic receptors. Its effects can be reversed by cholinesterase inhibitors (physostigmine)

Abciximab

blocks glycoprotein GP IIb/IIIa which normally promotes platelet binding to fibrinogen. GP IIb/IIIa is either deficient or defective in patietns with Glanzmann thrombasthenia.

Ipratorpium

blocks the action of ACh at muscarinic recpetors causing bronchoconstriction thus being good at reversing it once it has occurred as they do not actually cause bronchodilation. Used to treat asthma and COPD. pharm

Naltrexone

blocks the mu-opioid recptor thus blocking the rewarding and reinforcing effects of alcohol and has been show to reduce craving. This could be used in patietns still drinking unlike disulfiram. pharm

Tetanospasmin

blocks the release of glycine and GABA.

Conductive hearing loss

bone conduction is greater than air conduction (abnormal Rinne test), and the Weber test will lateralize to the affected ear (this ear blocks out ambient noise and can therefore sense the vibration more) In sensorineural hearing loss, air conduction will be greater than bone condcuction (normal Rinne) and the Webest test will lateralize to the unaffected ear (the unimpaired ear can better sense the vibraiton)

Paget disease

bone pain and elevated alk phos in an elderly patient can occur with osteoblast mets and pagets. Biopsy showing mosaic pattern of lamella bone with cement lines is diagnostic of Pagets. The initial abnormality in PBD is an increase in osteoclastic acivity. It is likely due to a mutation that increases the expression of RANKL

Unfractionated and LMWH

both can bind to antithrombin to increase its acitivty against Factor Xa. However, only unfractionated heparin is long enough to bind to both antithrombin and thrombin as well.

Maternal and fetal cortisol

both help to accelerate lung maturation by stimulating surfactant production and can be assessed through various biochemical tests during amniocentesis. Corticosteroids are administered to pregnant mothers who are at risk for premature delivery with fetal lung immaturity

Foodborne botulism

botulinum neurotoxin in food (cans) prevents the release of acetylcholine from presnynaptic nerve terminasl at the NMJ, thus preventing contraction- diplopia, dysphagia, and dry mouth

Heteroplasmy

buzz word for mitochondiral disease. It refers to the variable presentaiton of mitochonidral disease becuase some cells get healthy mitochodondria while others do not.

Digoxin overdose

buzz word would be changes in color vision. Otherwise, have Gi issues and faitgue, weakness. The most serious complicaiton is life threatening ventricular arrhythmias. Treat with anti-digoxin antibody fragment.s

Ghon complex

calcification of the lower lobe as well as ipsilateral hilar adenopathy is typical of a primary TB infection.

Muscle contraction

calcium is released from the sarcoplasmic reticulum and binds troponin C, thereby allowing the binding of actin to myosin.

Case-fatality rate

calculated by dividing the number of fatal cases by the total number of people with the disease

Trypsin

can activate all of the proteolytic enzymes, including its own zymogenic form. Premature activation of trypsinogen before it reaches the duodenal lumen can result in autodigestion of the pancreatic tissues.Normally, enterokinase present along the brush border activates it.

Temporomandibular disorder (TMD)

can arise form problems involving the temporomandibular joint, the muscles of mastication, and the nerves that supply the jaw. This nerve is the mandibular division of the trigeminal nerve and it supplies the middle ear (the tensor tympani) and the muscles of mastication. TMD may present witih both otologic symptoms and jaw pain therefore.

Mycobacterial resistance to isoniazid

can be accomplished through non-expression of the catalase-peroxidase enzyme or through genectic modifaciton of the InH binding site on the mycolic acid synthesis enzyme.

Visualization of Treponema Pallidum

can be accomplished with dark-field microscopy, which reveals helical motile spirochetes.

Latent period

can be applied to both disease pathogenesis and exposure to risk modifiers. The inital steps in pathogenesis and/or exposure someitmes occur years before clinical manifestations of the disease are present. Additionally, exposure to risk modifers may need to be continues oer a certain period ot time before includenicng the outcome.

Coccidioides immitis

can be asymptomatic or cause pulmonary disease. It causes disseminated disease in the immunocompromised. Spherules containing endopsores are seen in tissues

drug concentration

can be calculated by dividing the drug dose by the volume of distribution.

Cushing syndrome

can be caused by ectopic ACTH production by small cell lung cancer. Symptoms include weight gain, hypertension, hyperpigmentaiton (increased MSH with ACTH), epigastric abdominal pain (increased peptic ulcer risk), easy bruising.

Parent's authority in treating children

can be challenged in cases in which a child is at significant risk for harm (bacterial meningitis that the parent doesn't want treated). Physicians are justified in obtaining a court injunction to proceed with life-saving medical treatment of the child.

Superior vena cava syndrome

can be compressed by mediastinal masses. Results in dyspnea, cough, sweelling of the face, neck, and upper extremities.

Arteriovenus shunts

can be congenital or acquired; acquired forms can result from medical interventions or penetrating injuries. AV shunts increase preload and decrease after load by routing blood directly from the arterial system to the venous system, bypassing the arterioles (the major source of resistance) A high volume shunt could eventually result in high output HF

Acute tubular necrosis

can be cuased by decreased renal perfusion/ischemia. The PCTs and the thick ascending limb of Henle's loop are the most commonly affected. Muddy brown casts is the key buzz word.

Long-chain acyl-coA dehydrogenase

can be defeiicnet and infant would present with lethargy and hypoglycema and lack of ketones (can't make em)

Aromatase

can be deficeint in a child. This would lead to accumulation of androgens during pregnancy, resulting in ambiguous external genitalia in female infants and MATERNAL virilization where the androgens woudl cross over and do things to mom

Isoniazid

can be directly hepatotoxic, causing acute, mild hepatic dysfunction. pharm

Acute compartment syndrome

can be due to long-bone fractures, crush injury, thermal injury, or nauntraumatic causes. It is increased pressure within the fascial compartment (severe pain, and nerve injury- the deep peroneal nerve of the anterior compartment (most common site)

Effective Renal plasma flow

can be estimated using para-aminohippuric acid (PAH) becuase it is both filtered and secreted in the proximal convoluting tubule, resulting in near 100% excretion of all PAH entering kidney. eRPF = U x V/P = C(PAH) RBF = RPF/(1-Hct). eRPF understemiates true renal plasma flow (RPF) by about 10% (so divide by 0.9).

Treating an MI

can be helped with a selective b-blocker (B1) like metropolol. Beware using a non-selective beta blocker espeically in a patient with COPD or astham as bronchoconstriction, peripheral vasospasm, and can predispose diabetic patients to hypoglycemia. Selective beta blockers include metoprolol, atenolol, acebutolol, and esmolol. pharm

The power of a study

can be increased as the sample size increases (why often a single study may not be significant but then the meta-anaylsis is). Therefore, the large the sample, the greater the ability of a study to detect a difference when one truly exists (aka you decrease type II error- saying no association when there is)

The ulnar nerve

can be injured at the medial epicondyle of the humerus (funny bone) or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist. Patients often hae sensory los over the medial 1.5 digits and hypothenar evidence, and weakness of those fingers flexion.

Neonatal Tetanus

can be prevented by hygienic delivery and umbilical cord care and also the universal vaccination of women who are pregnant or may become pregnant as they can pass on passive immunity through IgG. Infants get active immunization around 2 months.

Extended-spectrum beta-lactamases

can be produced by gram-negative bacteria, rending cephalsoporins and other beta-lactam antibiotics inactive. These genes can be transmitted between organsims through plasmid conjugation (carries drug resistance gene)

Hyperammonemia

can be seen in hepatic encephalopathy resulting in depletion of alpha-ketoglutarate, causing inhibition of the Krebs cycle. Excess ammonia also depletes glutamate, an excitatory NT, and causes accumulation of glutamine, resulting in astrocyte swelling and dysfunction.

Cold Agglutinins

can be seen in infection with mycoplasma pneumoniae. Other illnesses that result in cold agglutinin (antibody) formation are EBV and hematologic malignancy. Cold agglutinins are specific for red blood cells that cause clumping in cold temperatures.

C. diff

can be treated with oral metronidazole, vanc, or fidaxomicin. Metro and vanc are first line. Fida can be used in reccurent CDI and is bacteriocidal with minimal systemic absorption.

Carbamazepine

can be used for simple partial, complex partial, and generalized tonic-cloinc seizures. It acts by blockign voltage-gated sodium channels in neuronal membranes. Carbamazepine can cause bone marrow supression, so review blood counts often.

Desmopressin

can be used for treatment of mild hemophilia A and works by increasing the circulating levels of factor VIII (and von willies) from the endothelium.

The Fick principle

can be used to calculate cardiac output. It states that CO is equal to oxygen consumption/the arteriovenous oxygen difference

Inulin clearance

can be used to estimate the GFR (urine concentration +urine flow rate/plasma concentraiton). Then that GFR can be used to calculate teh total filtration rate of a freely filtered substance when the plasma concentraiton is known. If the substance is subsequently reabosrbed form the nephron lumen, then the net renal excretion of the substrate will be equal to its filtration rate minus the total tubular reabsorption rate.

Methacholine challenge test

can be used to induce bronchospasm in patietns with asthma.

Lamotrigine

can be used to treat partial and generalized seizures and works by blocking voltage-gated sodium channels. Stevens-Johnson syndrome and toxic epidermal necrolysis are rare, lifethreatening adverse effects characterized by flu-like symptoms and widespread mucocutaneous epidermal necrosis.

Pressure in the left renal vein

can become eleavate due to compression where the vein crosses the aorta beneath the superior mesenteric artery. This can cause hematuria and flank pain and also formation of a varicocele when it is elevated in left gonadal vein known as the nut cracker effect.

Thiazide and loop diuretics

can both cause signficant volume depletion and activate the RAAS system causing hypokalmeia and metabolic alkalosis (At first its sodium depletion and water but with the volume contraction, aldosterone is realeased). Thiazide diuretcs are more likely to cause hyponatremia and hypercalcemia. Loops lose calcium.

retained dead fetus in the uterus

can cause DIC. Monitoring of fibrinogen (decreased DIC) in high risk patients is key to identify.

E. Coli Strain O157:H7

can cause HUS. Uusally affects children and most commonly contracted after eating undercooked beef.

ACE inhibitors

can cause a cough through the accumulation of bradykinin.

Rifampin

can cause a harmless orange discoloration of body fluids (pee, sweat, tears). They inhibit RNA polymerase. TB can gain resistance by structural alteration of this RNA polymerase to no longer bind rifampin.

Ruptured ectopic pregnancy

can cause abdominal pain, vaginal bleeding, and hemodynamic instability. Pelvic inflammatory disease is a common cause which itself is commonly caused by infeciton witih N. Gonorrhoeae or Chylamydia trachomatis

Lupus

can cause acute coronary syndrome at a young age.

S. Aureus

can cause an acute fast food poisoning via ingestion of preformed exotoxin (much like how Bacillius cereus has preformed exotoxin in refried rice) typically in contaminated maynoaisse and meats that have been left out too long (potatoe or macaroni salald are highly tested) Results in nausea, vomiting, and abdominal cramping.

Neisseria Meningititidis

can cause an upper respiratory tract infection, meningitis, and meningococemia (rash too). Immunity against these bacteria are provded by antibodies against the polysaccharide capsule. Common in college dorms.

Ionizing radiation

can cause cell death through DNA double strand break or free radical formation.

Aycyclovir

can cause crystalline nepropathy if adequate hydration is also not provided

H. pylori

can cause duodenal ulcers and is typically found in greatest concentration in the prepyloric area of the gastric Antrum.

Thiazide diuretics

can cause elevations in serum LDL, calcium, uric acid, and glucose levels. They lower serum potassium, serum sodium and blood presusre.

Acute pancreatitis

can cause focal areas of fat necrosis and calcium deposition (fat binds calcium)

VHL

can cause hereditary renal cell carncinomas with a deletion of the VHL gene on chromsome 3.

Sarcoidosis

can cause hypercalcemia by Vitamin D activation by activated macrophages.

A low literacy patient

should make use of other resources like videos to explain

Thiazide diuretics (ex. chlorthalidoine)

can cause hypokalemia (muscle weakness and cramps) and metabolic alkalosis

COPD

can cause hypoxia and lead to increased EPO production by the cortical cells of the kidney

Hyperprolactinemia

can cause low bone density due to low estrogen. In addition, vaginal dryness could be another manifestation of estrogen deficiecy

Loop diuretic SE

can cause ototoxicity, which is usually reversible.

Secondary lactase deficiency

can coccur after viral gastroenteritis or any other disease that damages the intsestinal epithelium. The disease causes abdomominal distention, flatulence, and diarrhea. Can be differentiated from galactosemia because galactosemia would happen soon after breastfeeding began (super young)

Tumor lysis syndrome

can develop from chemotherapy for cancers with rapid cell turnover. It is characterized by hyperphosphatemia, hyocalcemia, hyperkalemia (EKG changes), and hyperuricemia. Prevention of tumor lysisi syndrome invovles hydration and the use of hypouricemic agents such as allopurinol or rasburicase

Psuedomonas

can form biofilms in the lower respiratory tract leading to a chronic pneumoina in CF patients that is very difficult to eliminate.

S. Aureus

can hematongenously seed and cause a liver abscess.

Enterococci

can inactivate aminoglycosides like Gentamicin by transferring chemical groups ike acetyl, adenyl or phosophate to the aminoglycoside therefore preventing binding to ribosomal subunits. pharm

Antidepressants

can induce mania in those who have unrecognized bipolar disorder.

Multiple myeloma

can lead to AL amyloidosis (derived from monoclonal immunoglobulin light chains). It deposits in the kidney, heart, and nervous system.

Campylobacter jejuni

can lead to Guillain-Barre syndrome.

Invasive vascualr procedures

can lead to atheroembolic complications. Light micrsocopy would show a partially or completely obstructed lumen where the embolus lodges with needle-shaped cholesterol clefts.

Arginase deficiency

can lead to buildup of arginine and issues making urea. Patient would have spastic paresis of lower extremities and choreoathetoid movements

Marfan syndrome

can lead to cardiovascular lesions as the most common cause of death. More specifically, early onset cystic medial degeneration of the aorta predisposed to aortic dissection.

Foreign body left in skin

can lead to granuloma formation

Left ventricular infarction

can lead to left ventricular failure, cardiogenic acute pulmonary edema, and pulmonary venous hypertension, and a transudate (not the same HF hemosiderin macrophags of chronic HF) of plasma into the lung interstitium and alveoli.

Patent foramen ovale

can lead to paradoxical embolization of venous clots into systemic arterial circulation. (think when you see young patient with stroke). ASD can do this too Results from incomplete fusion of atrial septum primum and secundum (normally this occurs after left atrial pressure increases to push flaps together and then fusion occurs overtime)

CML

can look very similar to just a normal leukemoid reaction against a bacterial infection/malignancy. They would both show an elevated WBC with an increase in precursor myeloid forms (bands, metamyelocytes, myelocytes). However, leukocyte alkaline phosphate (LAP) would be decreased in CML and increased in leukemoid reaction.

Elevated Serum Aldosterone levels

can manifest as hypertension, hypokalemia, and muscle weakness. Increased levels of both renin and aldosterone are indicative of secondary hyperaldosteronism, which can be caused by renovascular disease, malignant hypertension, and renin-secreting tumors.

Femoral Nerve Lesions (L2-L4)

can occur due to trauma, nerve compression, stretch injury, or ischemia. Patients develop weakness of the quadriceps muscle (trouble going upstairs or knee buckling), loss of the patellar reflex, and loss of sensation over the anterior and medial thigh and leg.

Graft-versus-host-disease

can occur following transplantation of organs rich in lymphocytes (eg. liver). T lymphocytes found in the donor organ can become sensitized against the MHC antigens of the recipient and attack. The skin (diffuse maculopapular rash), liver, and GI tract (blood in stool, nausea, abdominal pain) are frequently affected.

Vitamin E deficiency

can occur in indivudals with fat malabsorption. It is associated with increaed susceptibility of the neuronal and erthrocyte membranes to oxidative stress (remember, it is importnat in glutathione). Clinical manifestations include ataxia, impaired proprioception and vibratory sensation and hemolytic anemia.

Supine hypo tension syndrome

can occur in pregnant women when the uterus compresses the inferior cava as they go into the supine position, which reduces venous return and CO, causing hypo tension and syncope but resolves when they get up.

Vertical transmission of hep B

can occur when a mom has active hep b infection. The presence of HBeAg indicates a greater risk because highly infectious

Cyanide toxicity

can occur when patients are treated with nitroprusside (used in hypertensive emergencies). It presents with altered mental staus, seizures, lactic acidosis. Antidotal treatment invovles direct binding of cyanide ions (hydroxocobalamin), induction of methemoglobinemia (sodium nirite), and use of detoxifying sulfur donors (sodium thiosulfate- which actually helps rhodanese break it down)

Tricyclic antidepressant overdose

can present wiht mental status changes, seizures, widened QRS interval, ventricular arrhythmias, and anticholinergic findings. Sodium bicarbonate is used to treat associated cardiac toxicity and works by increasing serum pH and extracellular sodium (alleviating fast sodium channel blockade)

Acute promyelocytic leukemia (APL)

can present with persistent infection and coagulopathy causing hemorrhagic signs and symtpoms. classiclay reveals promyelocytes with intracytoplasmic Auer rods. t 15;17 causes fusion of retinoid acid receptor with promyelocyte leukemia gene

Optic tract lesion

can produce a contralateral homonymous hemianopia and a relative afferent pupillary defect (Marcus Gunn pupil) in the pupil contralateral to the tract lesion. See in the swinging flashlight test.

A benign glomus tumor

can produce a very tender, small, red-blue lesion of the nail bed. This type of tumor originates from the modified smooth muscle cells that control the thermoregulatory functions of dermal glomus bodies.

Fibrates

can reduce cholesterol solubility and promote gallstone formation by reducing bile acid synthesis (blocks the rate-lmiting step with cholesterol-7-alpha-hydroxylase). Should be used with caution in patients wiht preexisting galls tone disease

neck of the fibular injury

can result in injury of teh common peroneal nerve as it courses around it. Affected patients would have weakness in dorsiflexion and eversion and impaired sensation over the dorsum of the foot and lateral shin.

Vit A toxicity

can result in intracranial hypertension (papilladema), skin changes, and hepatomegaly.

Hartnup disease

can result in niacin deficiency due to an excess loss of dietary tryptophan, resulting in defective intestinal and renal tubular absorption of that amino acid. Remember that tryptophan creates niacin and is essential. A key finding would be aminoaciduria of neutral amino acids (like tryptophan) only.

Fractures of the orbital floor

can result in paresthesia of the upper cheeck, upper lip, and upper gingiva. In addition, the inferior rectus muscle can become entrapped, limiting superior gaze (diploplia when trying)

Chronic rejection in lung transplant

can take months to years. The imune reaction affects the small airways through bronchiolitis obliterans and symptoms incude dypsnea and wheezing.

Erythrocytes

cannot use ketones for energy because they lack mitochondria. The liver can also not use ketone bodies for energy because it lacks succinyl CoA-acetoaceta CoA transferase which is needed to converted acetoacetate to acetyl-Coa

Transketolase and transaldolase

carry out the non-oxidate reactions of the HMP shunt. Allow for the synthesis of ribose (needed for DNA synthesis) from molecules like fructose-6-phosphate and Glyceraldehyde 3-P

Sunlight exposure

catalyss conversion of 7-dehydrocholesterol to cholecalciferol (vitamin D) 25 hydroxylation occurs in the liver. and the kindeys produced the final 1,25-dihydroxyvitamin D3.

Fragile X

caused by increased number of CGG trinucleotide repeats (causes hypermethylation, inactivating the gene) on the fragile X mental retardtion 1 (FMR1) gnee on the long arm of the X chromosome.

Aortic regurg

caueses a high-pitched, blowing decrescendo diastolic murmor that begins immediately after closure of the aortic valve and is best heard along the left sternal border at the third and 4th intercostal spaces while the patient is sitting up and leaning forward with the breath held in end expiration.

Anabolic steorids

cause an increased in testosterone binding globulin and binding which actually leads to decreased testosterone in the body, which can thus cause gynecomastia as a side effect. In addition, excess testosterone can be converted to estrogen by aromatase.

UMN lesoins

cause contralateral spastic rigidity, hyperrreflexia, and paresis. They can affect any party of the pyramidal motor system, including the corticospinal tracts of the spinal cord, the medulla, the pons, and the midbrain; the internal capsule; and the precentral gyrus (primary motor complex)

Thiazide diuretics

cause hypercalcemia by increasing tubular reabsorption of filtered Ca2+. The increased serum Ca2+ levels should suppress PTH, distinguishing from primary hyperparathyroidism

Leukotriene B4

cause neutrophil migration to sites of inflammation. Other importnat ones to know are C5a and IL-8.

Bacterial Vaginosis

caused by a disruption of vaginal bacterial flora and characterized by fishy-smelling thin grayish vaginal discharge and clue cells (epithelial cells covered with gram-negative rods). Metronidazole and clindamycin are preferred treatment if symptomatic

Persistent Truncus arteriosus

caused by a failure of neural crest cells to differentiate into to the aoritopulmonary septum.

Hypoxia-induced lactic acidosis

caused by a low activity of pyruvate dehydrogenase (the oxidative phosphorylation pathway can't get going). and a high activity of lactate dehydrogenase

Hereditary hemochromatosis

caused by a missense mutation in the HFE gene, resulting in excessive intestinal iron absorption and organ damage (cirrhosis, diabetes, cardiomyopathy, arthropathy) due to iron accumulation.

Trichomonas vaginitis

caused by a motile protozoan that can be seen on wet mount micrsocopy (saline microscopy) of vaginal discharge. It presents with a yellow-green vaginal discharge and vaginal burning and is sexually transmitted.

Normal Pressure hydrocephalus

caused by a triad of ataxic gait, urinary incotinence, and dementia. (wet, wobbly and wet). It is a communicating (nonobstructive) hydrocephalus that occurs due to diminshed reabsorpitve capacity of the arachnoid villi. CT scan shows symmetric dilation of the ventriculi.

Myasthenia gravis

caused by antibodies directed against acetylcholine receptors of the NMJ. It produces flucuating weakness that worsens over the course of the day and most commonly affects teh extraocular muscles. (ptosis and diploplia). Also most patients have thymic abnormalitites

Oral Thrush

caused by candida infection and can be associated with dentures, diabetes, and especially immunosupression. Unexplained oral thrush in otherwise healthy person suggests HIV.

Varicose veins

caused by chornically elevated venous pressure in the lower extremitites and can lead to incompetent venous venous valves and dilation. Venous congestion and tissue ischemia can result in venous stasis dermatitis

Zollinger-Ellison syndrome

caused by gastrin-secreting neuroendcrine tumors commonly located in the small intestine or pancreas. The increased gastric acid suually results in multiple peptic ulcers in the duodenum refractory to therpay. Symptoms: abdominal pain and also possibly diarrhea as pancreatic enzymes are inactivated by all the extra acid. Dx: made by measuring basal and stimulated gastrin levles (secretin stimulation test- normally decreases secretion of gastrin and increases secretion of HC03). MEN1 assoication so test for serum calcium and prolactin too (got wrong on NBME)

Minimal Change disease

caused by immune dysregulation and overproduction of a specific cytokine that damagd teh podocytes (effacement). This leads to selective loss of albumin in the urine. , in contrast to non-selective proteiuria seen in otehr forms of nerphotic syndrome It often follows a recent infection, is seen in kids, and responds well to corticosteroids.

Diabetes Insipidus

caused by inadequate secretion (central) or renal action (nephrogenic) of ADH. Administration of exogenous ADH distinguishes the two. Damage to the hypothalamic nuclei would result in permanent central DI whereas damage to posterior pituitary would only be transient.

Erythema infectiosum

caused by parvovirus B19. Symptoms include a bright-red rash on the cheeks (slapped cheeks) and a lace-like rash on the trunk and extremities following a mild malaise, coryza, headache, and fever.

Frothy urine

caused by proteinuria.

Chronic bronchitis

caused by smoking characterized by thickened bornhcial walls, neutrophil infiltraiotn, mucous gland enalrgment, and squamous metaplasia.

Roseola infantum

caused by the virus HHV-6 (Rosixola). Febrile seizures can be caused by this, high grade-fever. Think a high-grade fever for 3-5 days followed by an erythematous macupapular rash on the trunk.

Urge incontinence

caused by uninhibited bladder contractions detrussor instability). It results in a sense of urgency accompanied by an involuntary loss of urine. Antimuscarinc therapy can help.

Acute rheumatic fever

caused by untreated group A strep pharyngitis. Results from molecular mimicry Results in JONES symptoms

Osgood-Schlatter disease

caused yb repetitive quadriceps contraction characterized by focal pain and swelling at the tibial tuberosity. The quadricpes muscle gorup is connected to the patella, which is turn is attached to the tibial tubercle by the patellar ligament.

E. Coli

causes 80% of UTIs. P. Fimbriae are the most importnat virulence factors here becuase it allows E.coli to bind uroepithelium and not be washed away by urine

Legionella pneumophilia

causes Legionnaires' disease which usually affects smokers and is characterized by high fever, diarrhea, headache, and confusion. Laboratory stuides show hyponatremia. This organism is a gram-negative rod that is often not detected on gram stain.

Multiple myeloma

causes M protein spike on SPEP as well as anemia (weakness), lytic bone lesions (back bain, pathologic fractures), and renal insufficency (amyloid deposition and hypercalcemia)

Thalassemia intermedia (mild form of beta-thalasemmia)

causes a hypochromic, microcytic anemia

Nonsense mutation

causes a premature stop codon (UAA, UGA, and UAG)

Vibrio cholerae

causes a purely toxin-mediate watery diarrhea. It modifies electrolyte balance (much like e coli) but does not cause cell death. Therefore no erthrocytes or leukocytes are seen on stool microscopy. It is a gram-negative, comma-shaped organism that can survive on alkaline media

MI

causes a sharp decrease in cardiac output due to loss of function of a zone of myocardium. On a cardiac function curve, MI would decrease both the slope and maximal height of the line

Streptococcus gallylyticus (formerly S. Bovis)

causes a subacute endocarditis and bacteremia at times and when it does, it is associated with colon cancer in 25% of cases (so look for it)

Trypanosoma cruzi

causes achalasia (usually congenital). Can be caused by Trypanosoma Cruzi if from central or south america. It is a parasite transmitted by an insect. Its neurotoxin destroys the myenteric plexus. This incapacitates the lower esophageal sphincter, so that food gets stuck in the esophagus with esophageal dilatation above this.

DiGeorge syndrome

causes an extreme deficiency in the number of mature T lymphocytes, leading to poor development of the lymph node paracortex. It is due to maldevelopment of the third and 4th pharyngeal pouch Clinical manifestions: thymic shadow on Xray, hypocalcemic tetany from abscence of parathyroids, cleft palate, aortic arch abnormalities

Hypoventilation

causes an increase in arterial pC02 and a decrease in serum pH (acidosis). Acutely, there would be a low pH, high PCO2 and likely a normal HCO3- since the kidney takes about 24 hours to compensate.

Amyotrophic lateral sclerosis

causes both upper and lower motor nueron lesions. Loss of neurons in the anterior horns of teh spinal cord (LMN lesion) causes muscle weakness and atrophy. Demyelination of the lateral corticospinal tract (UMN) leads to spasticity and hyperrreflexia.

Bartonella henselae

causes cat-scratch disease, bacillary angiomatosis adn culture-negative endocarditis. Cat-scratch fever is characterized by low fever and lymphadenopathy

Corynebacterium diptheriae

causes diphtheria, an acute bacterial disease that initially infects the oropharynx. It causes disease via its A/B exotoxin. The B binding allows penetration of A into the cell to inhibit ribosome function. Neural and cardiac toxicity can occur if it become systemic. Immunization with DPT (the toxoid itself) induces production of IgG against the exotoxin B subunit so no binding can occur.

Methemoglobinemia

causes dusky discoloration to the skin (similar to cyanosis) and becaues methemoglobin cannot carry oxygen, a state of functional anemia is induced. The blood partial pressure of 02 however is unnchaged (amount of 02 dissolved in plasma is still the same) Nitrites are poison in that they oxidize iron creating methemoglobin

Androgenetic aplopecia

causes hair loss primarily at the anteiror scalp and vertex. It shows a polygenic inhertiance, with dihydrotesteosterone being the primary factor so 5-alpha reductase inhibotrs like finasteride can be used to treat

Aldolase B deficiency

causes hereditary fructose intolerance. This disease manifests after introduction of fructose into the diet with vomiting and hypoglycemia about 20-30 minutes after fructose ingestion.

PTHrP

causes humoral hypercalcemia of malignancy

Chronic kidney disease

causes hyperphosphatemia (binds serum Ca2+) and low 1.25 dihydroxyvitamin D (fruther decreasing intestinal Ca2+ absorption and Ca2+ release from bone). The resulting hypocalcemia sitmulates the release of PTH, causing secondary hyperparathyroidism

Restrictive cardiomyopathy

causes include sarcoidosis, amloidosis, postradiation fibrosis, endocardial fibroelastosis (thick fibroeleastic tissuein endocardium of young children), Löffler syndrome (endomyocardial fibrosis with a porminent eosinophillic infiltrate, and hemocrhomatosis

Maternal hyperglycemia

causes increased glucose tranfer to the infant which can lead to beta cell hyperplasia in the infant. When they are born, they have hyperinsulinemia and thus this can lead to hypoglycemia at brith.

Primary minearlcorticoid excess (hyperaldosteronism)

causes increased renal sodium reabsorption, leading to hypertension, hypokalemia, and metabolic alkalosis (but not hypernatremia due to aldosterone escape- think ANP)

Clostridium Pefringens

causes late-onset (spores germinated and produce toxin in the GI tract unlike Staph or Bacillus food poisoning which are early and preformed) food poisoning and clostridial myonecrosis (gas gangrene). The food poisoning is toxin-mediated and causes a transient wattery diarrhea.

Clamydia trachomatis serotypes L1 through L3

causes lymphogranuloma venereum (LGV), a sexually transmitted disease where you get painless ulcers that progress to painful inguinal lymphadenopathy and ulceration. Histologically, you would seen chlamydial inclusion bodies in the cytoplasm.

Cryptococcus neoformans

causes meningoencephalitis in HIV + patients. The latex agglutination test detects the polysaccharide capsule of Cryptococcus. India ink staining shows oval budding yeast.

Myasthenia gravis

causes muscle weakness, with the extra ocular muscles most commonly affected. Muscle weakness worsens with activity. It is often associated with abnormalities of the THYMUS. (thymoma or thymic hyperplasia) The thymus and inferior parathyroid glands arise from the 3rd pharyngeal pouch (makes sense because of DiGeorge)

Vitamin A deficiency

causes night blindness and hyperatosis (dry, coarse skin). A patient with PBC could develop this due to blockage of bile release leading to fat soluble vitmain deficiencies. Same with exocrine pancreatic insufciency or instestinal malabsorption

Aspergillus fumigatus

causes opportunistic infections in immunosuppressed and neutropenic patients (invasive aspergillosis). Aspergillosis can also be colonizing of old cavities like TB (aspergilloma) and allergic (Allergic bronchopulmonary aspergillosis)

Portal vein thrombosis

causes portal hypertension, splenomegaly, and esophageal varices. It DOES NOT cause histologic changes in the hepatic parenchyma (unlike Budd Chiari syndrome). Ascites is uncommon since liver is not hurt.

Conn syndrome

causes primary hyeraldosteronism. It is an aldosterone producing tumor of the adrenal cortex. Aldosterone acts on renal cortical collecting ducts to facilitate the exchange of Na+ for K+ and H+. As a result, excess production of aldosterone causes renal Na+ retention and excess urinary K+ and H+ which can present with paresthesias and muscle weakness in addition to hypertension.

Nocardia

causes pulmonary, CNS, and/or skin disease in the immunocompromised (the cane). Pulmonary nocariosis can present as cavitary pneumonia often confused with TB. Sputum stain would reveal gram-positive branching organisms.

Wernicke's area

causes receptive aphasia, well articulated, non-sensical speech paired with a lack of comprehesion. It is located in teh audtiory assoicateion cortex within the posterior portion of the superior temporal gyrus. MCA blockage could cause

Capsaicin

causes release of substance P in afferent pain fibers, resulting in a burning and stinging sensation. HOwever, chornic application leads to reduction in substance P and reduced pain as a result. This is often used in postherpetic neuralgia.

Renal artery stenosis

causes renal hypoperfusion and activaiton of RAAS starting at the modified smooth muscle (JG) cells of the afferent glomerular arterioles Chonically, renal hypoperufsion will causes hypertrophy and hyperplasia of the juxtaglomerular cells.

Polymyositis

causes symmetric proximal muscle weakness. Muscle biopsy reveals inflammation, necrosis, and regeneration of muscle fibers ( fibrosis of muscle fibers). Over-expression of MHC I proteins on the sarcolemma leads to infiltration with CD8+ T lymphocytes (CD4 in dermatomyositis) and myocyte damage. May have increased CK and be positive for ANA, anti-Jo-1 (anti-histidyl-tRNA synthetase), anti-SRP, anti-Mi-2. Typically seen in a middle aged patient.

Hepatitis B

causes the hepatocellualr cytoplasm to fill with hepatitis B surface antigen- inclusions that are finely granular, dull eosinohpillic "ground glass" appearance

RSV

causes viral bronchiolitits and presents with low-grade fever, cough, tachypnea and increased work of breathing in young children (often < 2). Examination shows diffuse wheezes and crackles- often comes after a mild rhinorrhea and congestion.

Mycoplasma pneumonia

causes walking pneumonia where patients experience a dry nagging cough, low-grade fever and malaise. Tell tale sign is chest x ray that looks much worse than how patient appears clinically. This organism requires cholesterol to grow.

Dermatitis herpetiformis

celiac disease

Apocrine glands

cells secrete via membrane bound vesicles like mammary glands

Respiratory tract lining

changes in structure and fuciton as it progresses distally Bronchi have a pseudostratified columnar ciliated epithelium with goblet cells and submucosal mucoserous glands and cartilage. Bronchioles, terminal bronchioles, and respiratory bronchioles generally lack goblet cells, glands and cartilage but they still do have their cilia. By the level of the termina bronchioles, the airway epithelium is called simple cuboidal with cilia. the cilia are very importnat for mucocillarly clearance of foreign bodies out of there.

Steppage gait

characterist of injury to the common peroneal nerve due to inability to dossifelx at the ankle (tibialis anterior is messed up)

Langhans giant cells

characteristic of granulomatous conditions, like TB. These cells have multiple nuclei in the shape of a horseshoe. The macrophages that form these giant cells are activated by Th1 cells.

Bones Mets

characterized as either osteolytic or osteoblastic. Bony pain in an older man with osteoblastic lesions is highly suspicious of prostate cancer.

Delusional disorder

characterized by 1 or more delusions in teh absence of other psychotic sympotms (hallucinations, disorganizaiotn). The behavior is not obviously bizarre and functioning is not signficantly impaired (still has job) apart from direct impact of the delusions

ADHD

characterized by a pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning in >2 settings for at least 6 months before the age of 12. More common in boys than girls.

Borderline Personality Disorder

characterized by a pattern of unstable relationships, mood lability, and impulsivity (like binge drinking and unsafe sex) May exhibit suicidal ideation or behavior in the context of interpersonal crisis in which they feel rejected or abandoned.

Systemic Mastocytosis

characterized by abnormal proliferation of mast cells and increased histamine secretion. This increases the production of gastric acid by parietal cells. Gastric acid hyper secretion therefore commonly occurs.

Stress-related mucosal disease

characterized by acute gastric mucosal defects that develop in response to severe physiologic stress (eg. shock, extensive burns, sepsis, severe trauma, intracranial injury). Ulcers may perforate and bleed. Pathogensis invovles imparired mucosal protection due to local ischemia. Ulcrs arising from severe burns are curling's ulcers and form intracranil injury (due to direct vagal stimulation increaasing gastric acid secretion) are called cushing's ulcers.

Hypertrophic cardiomyopathy

characterized by assymmetric ventricular septal hypertrophy and variable dynamic left ventricular outflow obstruction. Maneuvers that increase preload or afterload will decrease murmur intensity by increasing left-ventricular end-distolic volume, lessening the outflow tract obstruction.

Extrinsic allergic asthma

characterized by breathlessness and wheezing in a young patient. classic sputum findins include eosinophils (induced by IL-5) AND Charcot-Leyden crystals (cotain eosinophil membrane protein)

Rheumatic mitral stenosis

characterized by diffuse fibrous thickening and distortion of the mitral valve leaflets with commissural fusion at the leaflet edges. Patients are at increased risk for a-fib and thromboembolism. infective endocarditis can also cause stroke and mitral stenosis but it usually has friable vegetations, not fibrotic.

PCOS

characterized by elevated LH levels, excess androgen production, and insulin resistance. Clinical features include obesity, menstrural irregularities, hirsutism, elarged ovaries, and an increased risk for diabetes mellitus and endometrial hyperplasia.

Prinzmetal's agina

characterized by episodic, transient attacks of coronary vasopasm, producing temporary ST elevations typically at night. Ergonovine causes the spasm and can aid in diagnosis treated with vasodialting nitrates adn calcium channel blockers.

Hypertrophic cardiomyopathy

characterized by extreme myofiber disarray with intersitial fibrosis on cardiac histology. Usually due to mutations in genes encoding cardiac sarcomere proteins.

Scarlet Fever

characterized by fever, pharyngitis, sand-paper like rash that spares the face, and a strawberry tongue. It is caused by Group A strep and can lead to RF or Glomerulonephritis if not treated.

Metabolic alkalosis

characterized by high arterial blood pH, HCO3- and pCO2. Vomiting/nasogastric suctioning and thizide/loop diretic use cause volume and Cl- depletion, resulting in metabolic alkalosis that is saline responsive. In constrast, hyperalodsteronism leads to metabolic alkalosis that is saline-unresponsive. Determining the patients volume status and measuring the urinary chloride concentraiton can help to identify the cause

RCC

classic signs wold be hematuria, abdominal mass, pain, and weight loss and polycythemia.

Neprhitic syndrome

characterized by hypertension, mild proteinuria, RBC casts or red cells in urine and azotemia. IN constract, nephrotic syndrome is manifested by heavy proteinuria ( >3.5g/day), lipiduria, absence of RBC casts and normal renal function

Autism spectrum disorder

characterized by impaired social communication/interactions and restricted, repetitve interests or behaviors. It can occur with or without language and intellecutal impairment.

"clasp-knife" spasticity

characterized by initial resistance to passive extension followed by a sudden release of resistance. Results from UMN lesions

Initial TB infection (first week)

characterized by intracellular proliferation of TB within alveolar macrophages. The t cells secreting IFN-gamma doesn't occur until 2-4 weeks.

PTSD

characterized by intrusive thoughts, nightmares, flashbacks, avoidance of trauma reminders, hypervigillance, and sleep distrubance lasting > 1 month. They might have some similar features of depression like withdrawn and no interest in usual acivity but the main issue is this one event triggering flashbacks and issues.

Scizotypal Disorder

characterized by long-standing pattern of eccentric behavior, odd beliefs, perceptual distorisons, and social anxiety despite familiarity. Like believing that you have a "sixth sense" that indicates if someone is bad and cannot be trusted. a diet of only "raw foods to keep the body pure"

X-linked Agammaglobulinemia

characterized by low or absent circulating CD19+ and CD20+ B cells and pan-hypogammaglobulinemia. Patient would be a boy with pyogenic bacterial infections and Giardia possibly due to lack of IgA and opsonizing antibodies. primary lymphoid follicles and germinal centers will not form in the lymph nodes due to no B ccells. Defect in the BTK gene (a tyrosine kinase gene)

SIADH

characterized by low plasma sodium and osmolarity, inappropriately concentrated urine (pissing out the sodium), and clinically normal body fluid volume (because ANP is released with the increased volume). An importnat cause is a paraneoplastic effect secondary to small cell carcinoma of the lung. Lung cancer with hyponatremia would be suggestive.

Turners (XO)

characterized by lymphedema, and posssible coarcation or the aorta and horseshoe kidney.

Conversion Disorder

characterized by neurological symptoms that are incompatible with a neurological disease and often incited by a stressful event with no reason to want to be making shit up.

Osteoarthritis

characterized by osteophyte formation leading ot hard bony elarment of the DIPJ (Herberden nodes) and PIPJ (Bourchard nodes). Brief morning stifness may be present but typically worse with activity.

Acute synovitis

characterized by pain, erythema, sweling, and reduced range of motion in a joint. It may be serious espeically with fever and leukocytosis (aka septic arthritis) and warrants immediate synovial fluid analysis.

Aplastic Anemia

characterized by pancytopneia, low retic count, and absent splenomegaly. Bone marrow aspiration is usually "dry" and histopathology shows marrow replacement with fat cells and fibrous stroma.

Klinefelter syndrome (47, XXY)

characterized by primary hypogonadism (elevated FSH and LH, low testosterone), long lower extremities, small firm testes and azoospermia

The secretory phase of the menstrual cycle

characterized by progesterone release by the corpus luteum causing the uterine glands to coil and secrete glycogen-rich mucus in preparation for embryo immmplanation. The endometrail stroma becomes edematous and completely transvered by tortuous spiral artereis that extren drom the deep layer all the way to the lumen.

Tetralogy of Fallot

characterized by pulmonic stenosis, VSD, RVH, and overarching aorta. The degree of RV outflow tract obstruction is the major determinant of the degree of right to left intracardiac shunting, and thus of hypoxemia symptom severity.

Panic disorder

characterized by recurrent, unexpected panic attacks and should be considered in young, healthy adults who come to the ED with unexplained chest pain, especially when ECG is normal. Treat acutely with benzodiazapines and long term with SSRIs or SNRIs

Avoidant Personality Disorder

characterized by social inhibition, feelings of inadequacy, and fear of embarrassment and rejection. They often lack relationships out of fear, but key thing is that they desire them, unlike schizoid or scizotypal who are content on their own.

Creutzfeldt-Jakob disease

characterized by spongiform encephalopathy of teh gray matter with vacoles in the gray matter on microscopy

Ankylosing spondylitis

characterized by stiffness and fusion of axial joints (ankylosis) and inflammation at the site of insertion of tendons into bones (enthesitis). Involvement of the spine and thoracic spine and costovertebral and costosternal junctions can limit chest wall expansion, leading to hypoventilation.

Major depressive disorder with pscotic features

characterized by symptoms of a major depressive episode with the presence of delusions and/or hallucinatinos. How to differentiate from psychotic disorder: the psychosis is only present after the presence of depression.

Inflammation

characterized by the passage of circulating inflammatory leukocytes into the inflamed tissue. The steps involved include margination, rolling, activation, tight adhesion, and crawling, and transmigration (this is where the neutrophil migrates out of the vasculature). When this process is knocked out in some way (rare genetic disorders), patients get recurrent skin infections, without pus formation, and delayed detachment of the umbilical cord.

Meniere disease

characterized by tinnitus, vertigo, and sensorineural hearing loss. Its pathogenesis is related to increased volume and pressure of endolymph in the vestibular apparatus

Abdominal arotic aneurysm

characterized by transmural aortic wall inflammation, abnormal collagen remodeling and cross-linking and loss of elastin and smooth muscle cells. This leads to weakening.

McCune-Albright Syndrome

characterized by triad of fibrous dysplasia of the bone, endocrine abnormalities (such as early puberty or hyperthyroidism) and cafe-au lait spots. Condition results from an activating mutation in the G protein/CAMP/adenylate cyclase signaling pathway. Coast of Maine border with the cafe-au-lait (irregular border)

DKA

characterized by triad of polydipsia, polyruia, and a fruity odor to the breath and/or urine. It is assoicated with anion gap metabolic acidosis with compensatory respiratory alkalosis. aka low pH, low serum bicarb, and low PaCO2

MEN1

characterized by tumors of pituitary (prolactinoma or GH), parathyroid (hypecalcemia) and pancreas (gastrinoma or insulinoma usually) Check for all of these if suspecting. The 3 P's Defect in menin tumor suppressor gene

Gingivostomatitis

characterized by ulcerative lesions with intranuclear inclusions. It is usually seen in children who are experiencing primary infection with HSV1, a double stranded, enveloped DNA virus.

Anaphlatic shock

characterized by vasodilation, increased vascular permeability, and bronchoconstriction. Epinephrine counteracts these and is the drug of choice.

Psoriasis

characterzied by hyperparakeratosis, acanthosis, rete ridge elongation, mitotic activity above the epidermal basal cell lyaer, and a reduced or absent stratum granulosum. Neutrophils may form spongiotic clusters in the superficial dermis.

Langerhans cell histiocytosis

child with bone lesions and Birbeck granules

Persistent depressive disorder (dysthymia)

chronic depressed moood > 2 years. Needs at least 2 of the following: Poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness. Can be treated with antidepressants and behvioral therapy

alpha 1 antitrypsin defciency

chronic panacinar emphsema, predominantly in the lower lobes (think smoking likes to go up so centracinar and upper lobes there).

Suprachiasmatic nucleus

circadian rhythm You need sleep to be charismatic.

Clear cell carcinoma

classic image.

HSV2

classically infects the sacral sensory ganglia (dorsal) to cause a reccurent, painful genital rash

Reactive arthritis

classically presents in a triad of nongonococcal urethritis, conjunctivitis, and arthritis. It is an HLA-B27 assoicated arthropathy that occurs within several weeks following a geniturinary or enteric infection. It is one of the seronegative arthropathies and can cause sacroiliitis in 20% of patients. Often also forms a rash on the palms and soles called keratoerma blennorhagicum

Diabetic CN III monneuropathy

classically presents with acute onset diploplia. Showing the down and out position with ptosis. It is due to ischemic nerve injury. Teh somatic compodnent of cN III that innervates the extraocular msucles is located centrally, while the autonomic component responsible for pupillary constriction and accomodation is located in the perihperal aspect of the nerve (so not typically affected by diabetic CN III mononeuroopathy) Unlike with nerve compression from an aneursym in the PCA say (but these patients would be unlikey to have the down and out then)

Severe Vitamine E deficiency

closely resembles the clinical presentation of Friedreich ataxia (ataxia, dysarthria, and loss of both position and vibration sense) due to damage of the spinocerebellar tracts, dorsal column of the spinal cord, and peripheral nerves.

lead poisoning

coarse erthrocyte basophillic stippling from rRNA abnormal degradation and a microcytic hypochromic aenmia are classic. Occurs in you children who eat paint and industrial workers

Homeobox genes

code for DNA-binding TFs and play an importnat role in morphogenesis

BCR-ABL

codes for fusion protein with constitutive tyrosine kinase activity (9;22). The kinase activity is the target of imatinib in CML

Metastatic prostate cancer

combination of urinary urgency, frequency, and hesitancy assoiacted with chronic back pain in an elderly man is associated with metastatic prostate cancer.

Aflatoxin

comes from aspergillus and can result in p53 mutations that increase the risk for HCC

Meningiomas

common adult intracranial tumors that typically arise in regions of dural reflection (eg. falx cerebri, tentorium cerebelli). Lesions involving the primary somatosensory cortex typically result in contralateral sensory loss, whereas damage to parietal assoiation cortex (particullary in the non-dominant sphere) could cause contralateral hemineglect.

Postoperative hypoparathyroidism

common after thyroidectomy due to damage which would lead to drop in PTH level, resolting in decreased calcium and phosphate resorption from bone and decreased calcium reabsorption from the kidney

Hemolytic Uremic Syndrome

common cause of acute renal failure in children. It is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Most cases develop following diarrheal illnes caused by Shiga toxin-producing organisms (E.coli O157:H7 and shigella dysenteriae).

Atopic dermatitis

common chronic inflammatory skin disorder of childhood. It rpesents with pruritus and erthematous, weeping/crusted papules and plaques that occur in response to environmental antigens. It is assoicated with other atopic diseases, like allergic rhinitis and asthma.

Infectious esophagitis

common in HIV patients. The most common cause is candid albicans, although herpes simplex and CMV are also common. CMV: large, shallow linear ulcerations with intranuclear and cytoplasmic inclusions.

Ace-inhibitors

common side effects include decreased GFR, hyperkalemia, and cough. Angioedema is rare.

Mets to the brain

commonly are lung cancer, renal cancer, and melanoma. Melanoma is a malignancy of melanocytes, which are embryologically derived from neural crest cells.

Homocystinuria

commonly caused by cystathionine synthase deficiency. Presents with Marfanoid habitus, ectopia lentis, and developmental delay (looks quite a bit like Marfans actually- I thought it was) . Treat this with high levels of pyridoxin (cofactor for the deficient enzyme) to reduce risk for thromboembolic events

Epistaxis

commonly caused by trauma in children in the anterior nasal septum containing Kiesselbach plexus. The ethmoidal, spenoplalatine, and superior labial arteries all anastomose in this region.

Leigonella

commonly contaminates natural bodies of water and water based cooling systems (its name when it got in the A/C). Culture must be performed on buffered charcoal yeast extract supplmeneted with L-cysteine and iron.

Patellar fractures

commonly due to direct force with anterior part of the knee. A sign would be an inability to extend the knee against gravity.

Heparin

commonly used for prevention of DVT in patients undergoing surgery, especially hip and knee. Heparin (natually synthesized in mast cells) increases the effects of antithrombin III which are against thrombin (II) and factor Xa

Cytokeratin

commonly used immunohistochemical marker of epithelial-derived tissues.

ANOVA

comopares the difference in means between two or more groups

Heart failure

compesnatory activiation of RAAS and the symapthetic nervous system results in increased afterload (from excessive vasoconstricotn), excess fluid retention, and dleterious cardiac remodeling.

Methotrexate

competitively inhibits the enzyme dihydrofolate reductase which catalyzes the synthesis of tetrahydrofolate. This failure to catalyze woudl cause the intermediate dihydrofolic acid polyglutamate to accumulate within treated cells.

Potassium iodide

competitively inhibits thryoid uptake of radioactive-iodine isotopes and is often administered following nuclear accidents to protect the thyroid and prevent development of radiation-induced thyroid carcinoma. In adiditon the large increase in serum iodide levels wil inhibit iodine organification (Wolff-Chaikoff effect) and reduce thyroid hormone release

Pancreatic pseudocyst

complication of acute pancreatitis. collection of fluid rich in enzymes and debris leading to granulation tissue formation and fibrosis No epithelium lining (pseudocyst)

Enterococcus

component of normal colonic and urogeneital flora that can grow in hypertonic 6.5% saline and bile. It is gamma-hemolytic, catalase-negative. Genitourinay cath or instrumentation is commonly assoicated with enterococcal endocarditis

tRNA

composed of between 74-93 nucleotides. Has a 3'CCA tail off the acceptor stem (aminoacyl tRNA snythetase adds here) D-arm- contains many dihydrouracil residues that facilitate proper aminoacyl tRNA synthetase binding anticodon arm- complementary to the mRNA codon and is read in the 3' to 5' direction. T arm-helps with binding of tRNA to ribosomes. Here we see thymine (the only RNA to contain thymidine) 5'- terminal phospahte

H. Flu type B vaccine

composed of polyribosyl-ribitol-phosphate (PRP) which is a component of its capsule, conjugated with diptheria or tetanus toxoid. Epiglottis is caused almost exclusively by H. Flu.

Things affecting diffusion

concentration differences, total membrane surface area, the solubility of the substance. Diffusion is inversley proprotional to total membrane thickness and molecular weight of the molecule.

Chronic lithium toxicity

confusion, ataxia, neuromuscular excitabiliyt can be preceipated by volume depletion and drug interactions with thiazide diuretics, ACE inhibitors, and NSAIDs

Spinal muscular atrophy (Werdnig-Hoffmann disease)

congenital degeneration of anterior horns of spinal cord- LMN lesion. "Floppy baby" wiht marked hypotonia and tongue fasiculations. Autosomal recessive and death within first 7 months of life.

Anti-Rh(D) immune globulin

consists of IgG anti-D antibodies that opsonize Rh+ fetal erthrocytes, preventing maternal Rh sensitization. Usually given at 28 weeks and immediately post-partum if the woman is Rh-negative

Major depressive disorder

consists of a > 2 weeks period of > 5 of the following: depressed mood, loss of interest, sleep disturbance, appetite disturbance, loss of energy, psychomotor agitation or retardation, impaired concentration, guilt, and suicidal thoughts. aka SIG E CAPS

The H.flu b vaccine

consists of a PRP capsular polysaccharide conjugated with either tetanus or diptheria toxoid (allows for increased immune response)

MHC I

consists of a heavy chain an Beta 2 microglobluin

Wiskott-Aldrich syndrome

consists of a triad of eczema, thrombocytopenia, and combined B-lymphocyte T-lymphocyte deficiency. Onset of disease is early in life with thrombocytopenia present at birth and eczema and repeated infection, particularly by encapsulated organisms, following at 6 to 12 monhts of age. Results from mutation in the WAS gene (X-linked recessive) Fewer and smaller platelets.

cardiac myocyte action potential

consists of rapid deoplarizaton (phase 0), initial rapid repolarization (phase 1), plateua (phase 2), late rapid repol (phase 3), and resting potential (phase 4). Phase 0 begins with Na entering the cell rapidly. Phase 3 is closure of Ca++ channles and opening of K+ channels. Phase 2 is the plateau phase where calcium and potassium compete

The SA node

consists of specialized pacemaker cells located at the junction of the right atrium and superior vena cava. It is the site of earliest electric activation in patients with sinus rhythm.

The femoral triangle

consists of the femoral nerve, femoral artery, femoral vein (vein is most medial of the 3), and deep inguinal nodes/lymphatic vessles. Cannulation of the femoral vein should occur just medial to the femoral artery pulsation. The femoral triangle is bordered by the inguinal ligament superiorly, adductor llongus muscle medialy, and sartorius muscle laterally.

Secretory form of IgA

consists of two immunoglubulin monomers. It is abudant in tears, saliva, mucus, and colostrum. Provides passive immunity to the infant in colostrum.

Separation anxiety disorder

consits of anxiety ( > 4 weeks in children and > 6 monhts in adults0 due to separation from those to whom the patient is attached. Phsyical sympotms and nightmares may accompany anxeity.

pica

consumption of nonfood and/or non-staple food (often ice). This is common inpregnancy and assoiated with iron deficiency anemia.

Reticulocytes

contain blush cytoplasm on Wright Giemsa stain due to residual rRNa.

H.flu type b vaccine

contains a bacterial capsular polysaccharide conjugated with DIPTHERIA toxoid.

SER

contains enzymes for steroid and phospholipid biosynthesis so steroid producing cells like (adrenals, gonads, and liver) all have well-devleoped smooth ER. In addiiton, the smooth ER is in charge of detoxification of drugs (think liver)

HbF

contains gamma-globin instead of beta-globin. Patients with Beta thalasemmia are asymptomatic at birth due to the presence of gamma globins and HbF. Switching to HbA production and the cessation of gamma globin precipitates the symptoms of beta thalasemmia

The suspensory ligament

contains the ovarian artery and must be ligated durign oophorectomy to prevent heavy bleeding.

HbS

contains valine in place of glutamic acid which promotes the hydrophobic interaction among Hb molecules and results in HbS polymerization and sickling.

Ovarian cancer

contraceptives, multiparity, and breast feeding are protective against the frequency of ovulation and thus decrease risk. Risk factors are BRCA mutation, nulliparitiy, and infertility.

IL-1, IL-6 (espeically), and TNF-alpha

contribute to the secretion of acute phase reactants (like fibrinogen) which increases the ESR, a nonespecifc marker for inflammation.

Aldose reductase

converts glucose into sorbitol, which is further metabolized into fructose by sorbitol dehydrogenase .This pathway is most active in seminal vesicles (testes main source of energy is fructose). The lens also has significant levels of sorbitol dehydrogenase that become overwhelmed in setting of hyperglycemia which can lead to cataracts (a complication of diabetes) Other tissues like the retina, schwann cells, and renal papilla have less sorbitol dehydrogenase activity

Heme oxygenase

converts heme to biliverdin, a pigment that causes greenish color to develop in bruises several days after injury

Anterior hypothalamus

cooling, parasympathetic Anterior nucleus = A/C (pArasympathetic and cooling) A/C cools you off- temperature and parasympathetic

The QRS complex

corresponds to ventricular depolaraztion and phase 0 on teh action potential graph. Ventricular myocyte depolarizaiton is mediated by inward sodium movement and can be modulated by class I antiarrhythmics

Testing attention and concentration

counting down from 100 by intervals of 3 or reciting the months of the year in reverse order, and spelling world backwards.

The third part of the duodenum

cources horizontally across the abdominal aorta and IVC with the superior mesenteric vessels lying just anterior to it.

The median nerve

courses between the humeral and ulnar heads of the pronator teres msucle and then runs betwen the flexor digitorum superficialis and the flexor digitorum profundus muscles before corssing the wrist within the carapl tunnel. Proximal nerve lesions may result in sensory loss over the first 3 digits and impairment of thumb flexion/oppostion, flexion of teh second/third digits, and wrist flexion/abduciton.

Clindamycin

coves anaerboics in aspriation pneumonia. pharm

Warfarin therapy

creates a transient procoagulant/anticoagulant imbalance as Protein c has the shortes half life. This is furthe exaggerated in a protein C deficiency, leading to relative hypercoagulable state with thrombotic occusion of the microvasuclar and skin necrosis

Rapidly progressive glomerulonephritis

crescent formation light microscopy Crescents consits of glomerular parietal cells, monocytes, macrophages, and FIBRIN.

Pufferfish poisoning

cuased by tetrodotoxin, a neurotoxin produced by microorganisms assoicated with the fish. Tetrodotoxin binds to voltage-gated channels in nerve and cardiac tissue, preventing sodium influx and depolarization.

Hypocalcemia

cuases muscle cramps, perioral paresthesias, hypotension, and neuromuscular hyperexcitability

Several months to years after ischemic stroke

cystic cavity surrouded by wall composed of dense fibers from astroyctic processes (glial scar)

Cushing's triad- look it up

d

I-cell disease

decrased mannitol-6-P for proteins meant to be trafficted to lysozome by golgi. Therefore, they end up being excreted in the plasma. Leads to caorase facial features, clouded corneas, restricted joint movment. Will appear in childhood.

Beta blockers

decrease AV nodal conduction, leading to an increased AV nodal refractory period. This correlates to PR interval prolongation on ECG. Remember PR interval is the time between the beginning of atrial depolarizaiton to the beginning of ventricular depolarization.

Anorexia and secondary ammenorrhea

decrease in leptin inhibits pulsativle GnRH fromthe hypothalmus, causing decreased LH, FSH, and estrogen levels.

5-HT

decreased in anxiety and decreased in depression. Comes from the Raphe nuclei (pons, medulla, midbrain)

GABA

decreased in anxiety, decreased in huntingtons Found in the nucleus accumben (reward center, pleasure, addiction, fear)

Alzheimer's disease biochemistry

decreased levels of acetylcholine in the nucleus basalis of Meynert hippocampus. Diminshed choline acetyltransferase in these structures is the cause (hence we treat with meds that prevent breakdown of acetylcholine)

Qt prolongation

decreased outward K+ current during repolarization phase of the cardiac action potentials results in QT prolongation, which can increase risk of Torsades and sudden death.

Rifaximin

decreases intraluminal ammonia production and is used in the treatement of hepatic encephalopathy pharm

Human Placental lactogen (hPL)

decreases maternal fatty acid stores and increases maternal serum glucose in order to provide adequate glucose to the growing fetus. The actions of hPL result in phsiologic insulin resistance in the latter half of pregnancy (gestational diabetes happens this way)

Splitting

defense mechanism that involves experiencing the self or others as all good or all bad. It is commonly seen in borderline personality disorder.

Hartnup disease

deficiency of neurtral aminoi acid tranpsorters (tryptophan) on PCT and enterocytes- can't absord tryptophan or hold onto it causing deficiency in niacin (pellagra). Treat with niacin.

Niemann-pick disease

deficiency of sphingomyelinase causes neurologic degeneration within first few years of life

Orthostatic hypotension

defined as a decrease in systolic (> 20 mmHg_ or diastolic (> 10 mmHg) on standing from supine. Patinet may feel light headed with syncope. Medications (alpha 1 adrenergic antagnosists, diuretics, volume depletion, and autonomic dysfunction are all common causes of orthostatic hypotension). Drugs like doxazosin and terazosin would do this (not tamsulosin though- specific for prostate)

Erthrocytosis

defined as a hematocrit level > 52% in men and > 48% in woman. Measuremnt of red blood cell mass is necessary to distinguish absolute form relative erthrocytosis (relative has normal). A normal red blood cell mass indicates plasma volume contraction (thorugh say diuretics) as the cause of polycythemia.

Digeorge

deletions of the long arm of chromosome 22

Cyanosis occurs whe

deoxygenated Hb > 5 g/dL

Phenytoin metabolsim

depends on the function of hepatic P450 oxidases and is dose-dependent. Drugs that induce hepatic microsomal enzymes (phenobarbital, carbamazepine, and rifampin) enhance phenytooin metabolism and decrease its serum concentration. Should know all common drugs metabolized by the P450 system, and which durgs induce or inhibit its function

Propionyl CoA

derived from the amino acids Valine, Isoleucine, Methionine, and Thr, odd-numbered fatty acids, and cholesterol side chains. Congenital deficiency of propionyl CoA carboxylase, the enzyme responsible for propionyl CoA to methylmalonyl CoA leads to developed of propionic acidemia.

Chenye-Stokes breathing

describes cyclic breathing in which apnea is followed by gradually increasinghten decreasing tidal volumes until the next apneic period. It is commonly seen in advanced congestive Hf

Pleiotrophy

describes instances where multiple phenotypic manifestations result from a single genetic mutation. Most syndromic genetic illnesses exhibit pleiotrophy.

SAD PERSONS

describes peopel at risk for suicide Sex(male) Age (teenager or elderly( Depression Previous attempt Ethanol or drug use loss of Rational thinking Sickness (medical illness, 3 or more prescirption meds) Organized plan No spouse Social support lacking Women try more often but men more often succeed.

Pygmalion effect

describes the fact that a researcher's belief in the efficacy of treatment can potentially affect the outcome.

Peau d'orange

describes the prescence fo pitting edema in teh subcutatenous breast tissue accompanied by skin thickening and exaggerated hair follicles due to neoplastic ells plugging the dermal lymphatic channels.

Northern Blots

detect mRNA in a sample

Xeroderma pigmentosum

develops due to a defect in DNA excision repair (also called nucelotide excision repair). The disease is characterized by increased sensitivity to UV radiation with hyperpigmentation and high incidence of all forms of cutaneous malignancy.

Pulmonary actinomycosis

develops following aspiration and can be confused with lung abscess, malignacy, or TB. Microscopic findings include filamnetous, branching, gram-positive bacteria and sulfur granules. Actinomycosis can be associated with dental caries or jaw trauma.

Herpes zoster (shingles)

devleops due to reactivation of varicella zoster virus in the DRG. On light microscopy, intranuclear inclusions in keratinocytes and multinucleated giant cells can be seen.

Kimmelstiel-Wilson nodules

diabetic nepropathy

Atypical Depression

differs from classical forms. Characterized my mood reactivity (being able to experience improved mood in response to positive stimuli), reversed vegatative symtpoms (hyperphagia, hypersomnia). Leaden paralysis (heavy feeling in arms and legs), long-standing interpersonal rejection sensitivty Tx: CBT and SSRIs are first line. MAO inhibitors work but are second line due to increased side effects.

Coarctation of the aorta

diminished femoral pulses + a murmur that is heard in the inter scapular region (don't get confused with PDA)

CML

disease of adults. Caused by translocation of 9;22 to form bcr-abl fusion protein, a tyrosine kinase that can be inhibited by imatinib (gleevec)

OCD

disorder characterized by recurrent intrusive thoughts (obsessesions) and repetitive time-consuming rituals (compulsions0 that the individual feels driven to perform. Not to be confsued witih obsessive compulsive personality disorder, which is a lifelong pattern of insistnece on control, orderliness, and perfection and does not invovle compulsions

Candida

display a morphology of branching pseudohyphae and blastoconidia.

Ether and other organic solvents

dissolve the lipid bilayer that makes up the outer viral envelope. Loss of infectivity after exposure is characteristic of enveloped viruses.

Intestinal atresia

distal to the duodenum is caused by vascular incidents in utero "Apple-peel" atresia occurs when the superior mesenteric artery is obstructed. The result it s blind-ending proximal jejnum; a length of absent bowel, and finally a terminal ileum sprialed around an ileocolic vessel.

Manic episode

distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistnetly increase in energy lasting greater than 1 week. Often distrubing to patient. Dx relys on hospitlization or at least 3 of the following Distractibility Irresponsibility (seeks pleasure without regard to consequences) Grandiosity- inflated self-esteem Flight of ideas- racing thoughts increased in goal-direct Activity/psychomotor Agitation decreased need for SLEEP Talkativeness or pressured speech.

Calcium channle blockers

do not affect skeletal muscles becuase they do not requrie an influx of extracelluarl calcium to get it going. whereas smooth muscles do.

Hepatitis B

does not in an of itself have a cytotoxic effect. However the presecne of viral HBsAg and HBcAg on the hepatocyte sitmualtes host cytotoxic CD8+ T cells to destory infected hepatocytes.

Foscarnet

does not require intracellular activation by viral cellular kinases. Often used to treat ganiciclovir resistant CMV or acyclovir resistnat herpres.

The short gastric veins

drain blood form the gastric FUNDUS into the splenic vein. Pancreatic inflamamtion (eg. pancreatitis) can cause a blood clot in the splenic venin, causing increaseing pressure and gastric varices only in the fundus. Vs. the standard esophageal varices and gastric varices caused by bakcup from portal hypertension up the left gastric vein.

The coronary sinus

drains deoxygenated blood from the heart into the right atrium. Therefore, it will become dilated by any factor that causes right atrial dilatation, such as pulmonary artery hypertension.

Lymph from the testes

drains through the para-aortic lymph nodes- easy to remember if you think about how the testes descend and so they were orignally retroperitoneal with the aorta. Lymph from the scrotum drains into the superfical inguinal nodes (skin below the umbilicus).

CCl4

dry cleaning workers were exposed and lead to swelling of hepatocytes, decreased protein synthesis hence decreased apolipoprotiens hence fatty liver.

Sarcoid

dry cough, pumonary infiltrates, hilar lymphadenopathy , african american female, noncaseating granulomas.

Tx of Gonorrhea/bacterial STD

dual therapy with ceftraizone and azithromycin (macrolide) is implicated in case of dual infection with chlamydia.

Ion pump failure

due to ATP deficiency during cardiac ischemia cuases intracellualr accumulation of Na+ and Ca2+. The increased intracellular solute concentration draws free water into the cell, causing celular and mitochindrial swelling.

Umbilical hernias

due to a defect in the linea alba where there is incomplete closure of teh umbilical ring. Assoicated with Down's.

Indirect inguinal hernia

due to a patent processus vaginalis in young children leading to a persistent connection between the peritoneal cavity and scrotum through the inguinal canal. fluid leakage can occur leading to a hydrocele if the opening is small. If the opening is large, pass of abdominal organs can occur causing an indirect inguinal hernia.

Primary hyperaldosteronism

due to bilateral hyperplasia of the adrenal zona glomerulosa or an aldosterone-producing adrenal adenoma (Conn's syndrome). Clinical findings include hypertension, low plasma renin, hypkalemia, and metabolic alkalosis.

Synenham's chorea

due to delayed onset autoimmune rxn invovling anti-streptococcal antibodies that cross-react with the basal ganglia. It is a manifestation of acute rheumatic fever and thus the patients are at risk for progression to chronic rheumatic heart disease (when the valves are damaged)

Lateral ankle spain

due to inversion of a plantar-flexed foot and most commonly involves the anterior talofibular ligament (other ligaments that stabilize here are clacaneofibular and posterior talofibular)

Janeway lesions

due to microemboli to skin vessels (from the valvular vegitations of infective endocarditis) . Located on the palms and soles.

Acute hepatitis

due to most hepatotropic viruses which cause hepatocyte ballooning degeneration and apoptosis

Zenker divertic

due to overstimulation of the motor vagus

Ischemic-hypoxic encephalopathy

due to profound cerebral hypoperfusion and that leads to global cerebral ischemia. Watershed infarcts occur between the zones of perfusion of the ACA, MCA, and PCA. These infarcts are typically bilateral wedge-shpaed strips of necrosis over teh cerebral convexity, parallel and addjacent to the longitudinal cerebral fissure.

Obstructive sleep apnea

due to relaxation of oropharyngeal muscle tone with occulusion of upper airway. Symptoms include daytime sleepiness, headaches, depression, and sleep not being refreshing (because constnatly woken up in the night when become hypoxic). Puts patient at risk for pulmonary hypertension, right heart failure.

Testicular torsion

due to twisting of the spermatic cord (containing the gonadal artery), which can lead to a hemorrhagic infarct- the vein is cut off from the twisting but the artery still supplies blood. The gonadal artery arises from the abdominal aorta.

Stress incontinence

due to urethral sphiincter dysfuction and loss of the pelvic floor (external urethral sphincter under somatic control is opened by these) Its usually the EUS dysfunction that causes this. Usually occurs with increased abdominal pressure (laughing, cough, sneezing). More common in women due to childbrith and possible injury of the pudendal nerve.

Vertigo

due to vestibular dysfunction and can interfere wiht walking and cause nausea and vomiting. Typical causes include Meniere's disease, Benign positional vertigo, acoustic neurmoas. labyrinthitis

Subdural hematoma

dure to rupture of the cortical bridging veins.

Diabetes

during hyperglycemia, excess plasma glucose is converted to sorbitol by aldose reductase in certian tissues that don't depend on insulin to absorb glucose like the lens of the eye and peripheral nerves. Sorbitol accumulats here and attracts water in (raised osmotic pressure) leading to osmotic cellular injury. This is implicated in the devleopment of cataracts and peripheral neuropathy in diabetes.

Diminshed relaxation of the cricopharyngeal muscle

during swallowing results in increased intraluminal pressure in the oropharyx which can eventually cause the mucosa to herniate thorugh a zone of muscle weakness in the posterior hypopharyx, forming a Zenker (false) diverticulum, which presents in elderly patients wiht oropharyngeal dysphagia, halitosis, regurgitation, and recurrent aspiration.

ATP

during the skeletal muscle contaction cycle, ATP binding to myosin causes release of the myosin head from its binding site on the actin filament.

Bacillus anthracis

edema factor is an adenylate cyclase that causes massive increases in inctracellular cAMP, leading to neutrohpil and macrophage dysfunction and tissue edema. This mechanism of action is similar to that of adenylate cyclase toxin, produced by Bordetella pertussis.

Risk factor for aspiration pneumoonia

elderly with dementia or hemiparesis may also have dysphagia. A chest x ray showing opacities in the superior regions of the lower lobes (or posterior regions of the upper lobes) are the most common sites for aspiration pneumonia.

Isolated mitral stenosis

elevates left atrial diastolic pressure and can therefore cause elevated pulmonary capillary wedge pressure, pulmonary hypertension, decreased pulmonary vascular compliance, right ventricular dilation. Diastolic pressure in the left ventricle is usually near normal or even decreased with severe mitral stenosis

Displacement

emotions are transferred from the person or object causing the negative emotins to a more neutral, personaly acceptable person or object (yelling at daughter when really mad at wife)

COPD

empysema causes destruction of the alveolar walls leading to increased redsidual volume, increased functional residual capacity and increased total lung capacity

HER2/neu oncogene

encodes for a 185-kD transmembrane glycoprotein with intracellular tyrosine kinase acitivity. Overexpression is assoiacted with increased rates of breast and ovarian cancer.

HER2/neu oncogene

encodes for a 185-kD transmembrane glycoprotein with intracellular tyrosine kinase acitivity. Overexpression is assoiacted with increased rates of breast and ovarian cancer. It is an oncogene that accelerates cell proliferation.

Blastomyces dermatitidis

endemic in states surrounding Mississippi and Ohio River Valleys (kind of like histo). Can cause pulmonary disease in the immunocompetent hose while dissemination would typically occur in the immunocompromised individual (skin and bones). Respiratory fluids would show round yeast with thick walls and broad-based budding.

New-onset ondynophagia in the setting of GERD

erosive esophagitis and and the formation of an ulcer.

SCA

eventually cause fibrosis and atrophy of the spleen due to splenic infarcts which is typically complete by young adulthood. After autosplenectomy, patietns are at risk for encapsulated bacteria.

Non-selective beta blockers

exacerbate hypoglycemia and mask its aderenergic symptoms mediated by NE and Epi. They should be used in caution in patients with diabetes. Selective beta 1 agonists would be better in these patients pharm

Monamine oxidase inhibitirors

examples are phenelzine adn tranylcypromine. They are useful in patients with atypical depression (mood reactivity) and treatment-resitant depression.

Myocardial oxygen extraction

exceeds that of any other tissue. Due to this high degree, the coronary sinus has the lowest oxygen content in the body

Wound healing

excessive matrix metalloproteinase activity and myofibroblast accumulation in teh wound margins can result in contracture, which produces deformities of the wound and surrounding tissues, most often of the palms, soles.

Circulating T3 and T4

exert negative feeback on the hypothlamus and anterior pituitary, leading to decreased TSH secretion. TSH stimulates the thyroid to produce T4 and a small amount of T3. T4 is convereted in the peripheral tissues to T3 and rT3

sickle cell anemia

exertion dyspnea, pneumonia and resulting acute chest syndrome, and recurrent abdominal and bone pain are are clinical features of this disease. Results from a point mutation that causes valine substitution for glutamic acid in the sixth position of the b-globin chain.

Cross-sectional study (aka a prevalence study)

exposure and outcome (prevalence) are measured simultaneously at a particular point in time (snap-shot study). In other study designs, a certain time period separates the exposure from the outcome.

MHC II

expressed on the surface of APCs (macrophages, dendritic cells, B cells) and functions by presenting antigen that is foreign in the body. Antigen is taken into the body by phagocytosis or endocytosis and is loadd onto MHC II within acidified endosomes, and then expressed on the surface. Failure to acidify lysosomes would lead to deficient expresson of of MHC class II bound to foreign antigen.

The lung apices/pleura

extend above the level of teh clavicle and first rib. Penetrating inury in this area may cause pneumothorax, tension pneumothorax, or hemothorax. Tension pneumotorhoax woudl be characterized by devation of trachea away from the lesion and hypotension due to increased pressure blocking return to the heart.

Mucormycosis

facial pain, headache, and black necrotic eschar in the nasal cavity in a patinet with DKA is highly suggestive. Mucosal biopsy would show braod noseptate hyphae with right-angle branching.

Depersonalization/derealizaiton disorder

feelings of detachment from, or being an outside observer of one's self. Reality testing is in tact though- they feel this way but know that it isn't true. Not to be confsued with dissosiative amnesia- inability to recall importnat personal informaiton, usually of a traumatic or stressful nature. Dissosciated identity disorder: marked discontinuity in identity and loss of personal agency with fragmentation into > 2 distinct peronality states.

aseptic meningitis

fever, headahe, stiff neck. CSF woudl show normal glucose, with elevated protein, and lymphocytosis. Enteroviruses (coxsackie, echo, and polioviruses) are responsibel for > 90% of cases.

Viral hepatitis

fever, jaundice, and anorexia in an IV drug user are suggestive of Hep c infeciton. Acute viral hepatitis causes apoptosis and necrosis, Apoptotic hepatocytes shrink (pyknosis), undergo nuclear fragmentation (karryorrhexis) and become intensely eosinophillic (otherwise called an acidophillic body). The cell becomes eosinophillic when karyolysis occurs and the DNA goes away

infectious mono

fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, atypical lymphocytes, and a positive heterophile antibody reaction are typical of IM. It is caused by EBV infection which increases the risk for Burkitt's lymphoma, nasopharygenal carcinoma and Hodkins lymphoma.

Herpetic gingivostomatitis

fever, vesicles and ulcers of the oral mucus membranes, along with cervical lymphadenopathy and it happens with primary HSV1 infection usually in infancy. Tzank prep woudl show multinucelated giant cells with intracytoplasmic inclusions

Toxic Shock Syndrome

fever, vomitting, diarrhea, muscle pain, and erythoderma are symptoms. It can rapidly result in hypotension and multisystem dysfunction. Desquamation of the palms and soles occurs 1 week after. OFten assoicated with tampons and nasal packing mediated by TSST of S. Aureus.

SSRIs

first line for PTSD. SSNRis can also be used pharm

NSAIDS

first line for acute gout. They inhibit cyclooxygenase and therefore decrease prostaglandin production. They have a broad anti-inflammatory effect and inhibit neutrophils.

Sublingual nitroglycerin

first-line for rapid relief of stable angina. Systemic vasodilation leads to decrease in Left ventricular EDV (decreased preload), thus decreased myocardial oxygen demand and relief of angina symptoms pharm

Panic disorder pharmacotherapy

first-line would be SSRIs and benzodiazapines (more fast-acting but greater potential for abuse and physiological depedence so SSRIs preferred)

Gout

frequently associated with activating mutations invovling phosphoribosyl pyrophosphate synthetase due to increased production and degradation of purines.

After 12-18 hours of fasting

gluconeogenesis replaces glycogenolysis as the primary source of blood glucose.

VIPOMA

flushed face, dehydration. Hypokalemia, hyperglycemia, secretory diarrhea.

1/TPR

for circuits (say the coronary arteries, renal arterieis, and cerebral arteries) in parallel, the total peripheral resistnace is calculated by 1/TPR = 1/R1 + 1/R2 + 1/R3

Bisphosphonates

for ex. Risedronate attach to hydroxyapaptite binding sites on bony surfaces to inhibit bone resorption by osteoclasts.

Collateral microvessels

form adjacent pathways to blood flwo to areas distal to an occluded vessel. Adenosine is a selective vasodilator of cornoary vessels that can cause cornoary steal, a phenomenon in which blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas. Coronary steal can lead to hypoperfusion and worsening of existing ischemia.

Syringomyelia

formation of a cavity (syrinx) in the cervical region of the spinal cord at the ventral white commissure, leading to bilateral loss of pain and temperature sensation at the arms and hands. It can extend to destruct the motor neurons of the ventral horns causing flaccid paralysis and atrophy of the intrinsic muscles of the hand

The IVC on CT

formed by the union of the right and left common iliac veins at the level of L4-L5 right by the kidneys.

The Blood Brain Barrier

formed by tight junctions between nonfenestrated capillary endothelial cells that prevent the paracellular passage of fluid and solutes. Transcellular moment must occur for substance to cross.

Acyclovir

forms nucleoside analogs that are nicorpated into newly replicating viral DNA and terminate DNA synthesis.

The left ventricle

forms the apex of the heart and reaches as far as the fifth intercostal space at the left midclavicular line. All other chambers of the heart lie medial. The lungs overlap much of the anterior surface of the heart. So in the event of a stabbing at the left midclavicular line at the 5th rib, it would likely be the lungs (unless deep enough) not left ventricle injured.

Brown adipose tissue

found in newborns and hibernating issues and functions to produce heat through the uncoupling of oxidative phosphorylation. It contains many more mitochondria then white adipose tissue.

Sensory Receptors

free nerve endings, meissner corpuscles, pacinian corpuscles, merkel disks, ruffini corpuscles

Infant botulism

frequently due to honey consumption. Symptoms include constipation, mild weakness, lethargy and poor feeding. Look for toxin in the stool.

Traveler's diarrhea

frequently releated to ETEC that produces heat labile (LT, choleragen-like) and heat stable (ST) enterotoxins. LT activates adenylate cyclase leading to increased cAMP, and ST activates guanylate cyclase leading to increased intracelular cGMP. Both cause water and electrolyte loss and waterry diarrhea They are cholera-like since they rely on adenylate cyclase and cAMP to cause water loss and electrolyte loss.

splice site mutations

frequently result in the production of larger proteins with altered function but preserved immune reactvity (whereas a frameshift commonly results in a shorter protein)

Penicillins and cephalosporins (includes ceftriaxone)

function by irreversibly binding to penicillin-binding proteins such as transpeptidases.

Glukokinase

functions as a glucose sensor in pancreatic beta cells by controlling the rate of glucose entry into the glycolitic pathway (has less affinity for glucose than does hexokinase). Mutations in glucokinase (seen only in the liver + pancreatic beta cells) cause a maturity-onset diabetes of the young.

Von Willebrand factor

functions as a promoter of platelet adhesion at sites of vascular injury by binding platelet glycoproteins (GpIB) to sub endothelial collagen. Also carries factor VIII

Nucleolus

functions as the primary place of ribosome synthesis and assembly. rRNA is also transcribed here in the nucleolus

Loop diuretics

furosemid, torsemide, and bumentanide are the most potent diuretics and are used as first-line therapy for rapid relief of symptoms in patients with acute decompesnated HF pharm

Neisseria meningitidis

gain access to CNS by first colonizing the nasopharynx and then invading the mucosal epithelium and gaining access to the blood stream. From there it spread to the choroid plexus, gains access to cNS and then hits the meninges and boom!

The candida skin test

gauges the activity of the cell-mediated immune response from macrophages, CD4+, CD8+ and NK cells.

Fanconi Syndrome

generalized defect in PCT reabsorption leading to increased excretion of amino acids, glucose, HC03- and PO43-. May result in metabolic acidosis. Causes include hereditary (like Wilson's) ischemia, Multiple Myeloma, nerpotoxins/drugs (expired tetracyclines), and lead poisoning

accepting gifts

generally, they are not to be accepted if they are of significant monetary value (whether the patient got it for free or not). A card, photograph or cookie may be okay though. The proper amount of respect and gratitude should awlays be expressed when declining a gift.

ATP-sensitive K+ channels

get closed when ATP binds from oxidative metabolism in the pancreatic beta cell. this cause membrane depolarizaiton, calcium flies in, and subsequent insulin release

Horseshoe kidney

gets stuck on the inferior mesenteric artery.

D-xylose test

given to see if pancreatic enzyme insuffiency or absorption at intestinal wall is the problem. Would not be changed in a person who has pancreas problems since doens't need pancreas to be absorbed.

A-a gradient

go ahead and calculate it if you're given PaO2 and PaCO@ PAO2 = 150 - (PaCO2)/0.8 This is the alveolar gas equation.

Listeria

gram-positive bacillus. pregnancy is buzz word

A meta-analysis

groups results of several trials to increase statistical power and provide an overall pooled effect estimate.

Dimorphic fungi

grow as molds at 25-30 degrees C as as yeast at body temperature (35-37). Medically importnat dimporphic fungi include Sporothrix, Coccidiodies, Histoplasma, Blastomyces, and Paracoccidioides.

C.diff Contact Precautions

hand washing with soap and water (sanitizer is not sufficient), gown, and gloves

DNA polymerase I

has 5' to 3' exonuclease acitvity which is used to excise RNA primers.

Amphotercin B

has a number of adverse side effects. It works by binding ergosterol in fungal membranes but it also somewhat binds to our own cholesterol. Aucte infusion reactions may occur with fevers, chills, rigors, and hypotension. Neprotoxcity with GFR also may occur. In addition, hypokalemia, and hypomagnesemia may occur pharm

Burkitt lymmphoma

has a starry sky apperance due to the presence of macrophages and apoptotic bodies in a sea of medium-sized lymphocytes. The rates of mitosis and apoptosis in teh cnacerous tissue are high. c-myc (8;14)

A sports team physician

has an exception to HIPAA and can communicate health-information with the team coach to prevent a player from playing.

McCardle disease

has myophosphorylase deficiency (aka glycogen phosphorylase of the muscle), thus causing failure of muscle glycogenolysis, resulting in decreased exercise tolerance, muscle pain and cramping, and myoglobinurria with physical acitvity.

Lactase deficiency

has no pathologic effect seen on histologic examination

Normal grief reaction

has similar symptoms to depression like decreased appetite, sadness sometimes (not all the time), insomnia, wieght loss, but then won't have the pervasive anhedonia (inability to experience pleasure), worthlessness, and suicidality being not present.

C. diff

has toxins A and B which exert their effect by disrupting the actin cytoskeletal structure of enterocytes. Toxin A is more inflammatory and fluid secretion while toxin B is more cytotoxic. Common antibiotics that can lead to C. diff overgrowth are clinamycin, fluroquinolones, penicillins, and broad spectrum cephalosporins.

Human epidermal growth factor receptor 2 (HER2)

has tyrosine kinase activity and is typically more aggressive in breast cancer but should respond to trastuzumab

Down Syndrome

have 3 copies of the amyloid precursor protein gene, which increases amyloid-beta accumulation in the brain thus giving them Alzheimer's early on.

Bisphosphonates

have a chemical structure similar to pyrophosphate and disrufpt osteoclast function by attaching to hydroxyapjatitde binding sites on bony surfaces. they also cause apoptosis of osteoclasts resulting in decreased bony resorption and increased bone mineral density. They include alendronate and risedronate. pharm

Pregnant ladies with HBsAg and HBeAg

have a high risk of transmitting hepatitis B virus (HBV) during delivery. Infected neonates experience high levels of HBV replicaiton, demonstrate mildly elevated liver enzymes, and are at high risk for chronic infection (immature immune system-unlike adults- only 5%)

African American Women

have higher bone density and a lower risk of fractures than other women

Adolescents

have low treatment adherence rates related to issues with autonomy, rebellion against authority figures, and lack of understnading of potential risks (decreased prefrontal lobe mass). Peer behavior has a strong influence on adherece at this age to due to adolescents' desire to fit in with their social groups.

Vaginal Agenesis/Mullerian aplasia

have no upper vagina and variable uterine development. They are XX females with normal ovaries and secondary sexual characteristics (estrogen still released).

Edward's syndrome (trisomy 18)

have small jaws, small eyes, and malfored low set ears. They also have rocker bottom feet (also seen in Patau). But the key buzzword is clenched hands with overlapping fingers.

Turner syndrome

have the karyotype 45, X and it is suually due to paternal meitoic nondisjuction

S4

heard at the end of diastole just before S1 (Tennessee). It is due to decreased left venticular compliance and is often assoicated with restrictive cardiomyopathy and left ventricular hypertrophy. Unlike, S3 (assoicated with dilated ventricle or increased filling pressurs like MR and HF), its prescence is always pathologic

diastolic HF

heart failure due to left ventricular LV diastolic dysfuction is the result of decreased LV compliance. Restrictive cardiomyopathy may cause this to occur- amyloidosis is one such way that it can. Infectious myocarditis and cardiotoxic agetns like alcohol and doxorubicin tend to cause a dilated cardiomyopathy with systolic dysfuction.

The Schilling test

helps differentiate dietary B12 deficiency from pernicious anemia and malabsorption as caused of megaloblastic anemia. In dietary deficiency, oral radiolabeld vit B12 is absorbed in the gut and excrete din the kidneys at normal amounts.

Alcohol

helps disorganize lipid structure in membranes causing them to be leaky, and by denaturing cellular proteins. Tehy are bactericidal, tuberculocidal, fungicidal, and virucidal, but do not destroy bacterial spores (sup C. diff)

Brown-Séquard syndrome

hemidisection of the spinal cord. Ipsilateral UMN, LMN, and dorsal column tract lesions. However, contralateral pain and temp sensation becuase of where decussation occurs. If the lesion occurs above T1, patient may present with horner syndrome.

Syndrome of apparent minearlocotticoid excess

heredity deficiecy of 11-Bhyodroxysteroid dehydrogenase, which normall converts cortisol to cortisone before it can act on mineralcorticoid receptors. Excess cortisol in mineralcorticoid receptor cels leads to increased receptor activity causing hypertension, hypokalecmia, metabolic alkalosis with low serum aldosterone. Could acquire this from glycrrhetic acid (present in licorice) which blocks the activity of 11-beta Hydroxysteroid dehydrogenase

Grave's ophthalmopathy

high dose glucocorticoids such as prednisone are used to decrease the inflammation here.

Sheehan syndrome

high estrogen levels during pregnancy cause enlargement of the pituitary gland without a proportional increase in blood supply. Peripartum hypotension (likely from blood loss) can cause ischemic necrosis of the pituitary leading to panhypopitutiarism. Patients commonly will develop failure of lactation due to deficiency in prolactin.

Brain area most susceptible to ischemia by global cerebral ischemia

hippocampus

alpha 1 antitrypsin

histlogically, A1AT deficiency is assoicatd with reddish-pink periodic acid-Schiff-positive granules in hepatocytes (decreased excretion)

Acanthosis nigricans

hyperpigmentation in the flexural areas with a velvety texture and a marker for insulin resitant states (diabetes, acromegaly, obesity) and GI malignancies

Folic acid deficiency?

hypersegmented neutrophils (>5 lobes) with megaloblastic anemia.

Pulmonary embolism

hypoxemia and respiratory alkalosis. AKA decreased PaO2 from the V/Q mismatch resulting in hyperventilation and a decrease in PaCO2- respiratory alkalosis.

The most common cause of renal stones

idiopathic hypercalciuria

Borrelia burgdorferi

ie lyme disease. The classic lesion is erythema migrans, which begins as an arthematous macule and then extends outward with increasing erthema at the border often leaving a zone of central clearing (bull's eye rash)- but could be atypical looking at least at first.

ARPKD

if severe, can be detected on prenatal sonogram with oligohydramnios. Potter's sequence may then occur (flattened facies, limb deformitite,s and pulmonary hypoplasia). Kidneys would be enlarged with diffuse small cysts.

Pulmonary embolism

if the patient is hospitalized with sudden onset of tachypnea and chest pain should raise high on differential. AN example of ventilation/perfusion mismatch that causes hypoxemia.

Ventromedial nucleus of the hypothalamus

if you zap the ventromedial nucleus, you get massive. if you zap the lateral nucleus, you lose weight laterally

PSGN

immunofluorescence shows granular deposits of IgG, IgM, and C3

Aspergillus fumigatus

immunosuppressed patients are especially at risk. This fungus produces thin, septate hypahe with acute V-shaped branching. It causes aspergillosis (where aspergillus invades anywhere from the lungs (granuloma), skin, paranasal sinuses, kidneys, endocardium, and brain), aspergillomas, and allergic bronchopulmonary aspergillosis in asthmatic and CF patients. Tx is amphotericin B

Carnitine deficiency

impairs fatty acid transport from the cytoplasm into mitochondria, preventing Beta-oxidation of FA. This leads to caridac muscle and skeletal muscle injury (lacking ATP) and impaired ketone body (acetoacetate) production in fasting periods

17 alpha hydroxylase deficiency

impairs the syntheiss of androgens, estrogens, and cortisol but does not inhibit mineralcorticoid production. Boys appear phenoytpically female at brith, but girls develop normal genitalia. Patietns present with hypogonadism, hypertension, and hypokalemia.

snRNP

importnat components of the spliceosome

Mineralcoritcoid receptor antagonists (sprinolocatone, eplerenone)

improve survival in patients with congestive HF with reduced left ventriuclar ejection fraction. They should not be used in patietns with hyperkalemia (potassium sparing) or renal failure.

Antiphospholipid antibodies

in SLE, can cause a paradoxical aPTT prolongation and a false-positive RPR/VDRL (syphillis). Patients with these antibodies are at an increased risk for venous and arterial thromboembolism and unexplained recurrent pregnancy loss.

Aortic coarctation

in a child/young adult presents with lower extremity claudication (pain an cramping with exercise), blood pressure discrepancy between the upper and lower extremities, and delayed or diminished femoral pulses. Turners syndrome (45 X) is associated with this condition in up to 10% of cases.

Primary amenorrhea

in a patient with fully developed secondary sexual characteristics suggests the prescence o fan anatomic defect in the genital tract, most commonly an imperforate hymen or a mülleriant duct anomaly. Adolescent girls with undiangosed imperforate hymen ommonly present with cyclic abdnominal/pelvic pain and phsycial exam may show a hematocolpos (a mass due to buildup of blood behind the obstruction(

Cilostazol

in combination witih exercise is used for symptomatic relief of peripheral arterial disease. Works as a phosphodiesterase inhibitor thus inhibitnig platelet aggregation and acts as a direct vasodialtor as well (prevents breakdown of cAmP). Patients should also receive aspiring and clopidogrel for secondary prevetion of cornary heart disease and stroke pharm

Eukaryotic DNA replication

in contrast to prokaryotes, have multiple origins of replication.

Paramesonephric ducts

in females, the paramesonephric ducts fuse to form the fallopian tubes, uterus, cervix, and upper vagina. Disruptions of this process can lead to a variety of müllerina tract anomalies, and renal anomalies are also common to occur too. Incomplete lateral fusion of the paramesonephrict ducts results in a bicornuate uterus characterized by an indentation in the center of the fundus. This can lead to difficult pregnancy.

Ureter development

in normal fetal development, the ureters are fully cnaalized before the metanephros begins to produce urine (8-10 weeks). Inadquate recanalizaiton of the uteropelvic junction, the junction between the kindey and the ureter, is the ost common cause of fetal hydronephrosis

G-protein copule receptor

in one that activates phospholipase C, the intial step of teh IP3 second messenger system invovles degradtion of membrane lipids into DAG and IP3 by that enzyme. Protein C is then activated by DAG as well as calcium released from the SR under the influence of IP3.

Lactic acidosis

in patients with septic shock occurs primarily because of tissue hypoxia, which results in impaired oxidative phosphorylation and the shunting of pyruvate to lactate following glycolysis. In addition, liver hypo-perfusion may also play a role because it is the primary lactate clearer (cori cycle)

Progesterone

in pregnancy, progesterone is secreted by the corpus luteum, and later by the placenta. Although prolactin secretion increases as pregnancy progresses, high progesterone levels inhibit lactaiton through negative feeback on prolactin in the anterior pituitary.

Severe hypertension

in retinal precapillary arterioles causes endothelial disruption, leakage of plasma into the arteriolar wall, and fibrinous necrosis. The necrotic vessels can then bleed into the nerve fiber layer, which can be seen on examinatiion as dot or flame-shaped hemorrhages.

Overdose deaths

in the US are primarily casued by opioid analgesics

The M-line

in the center of the A band, where myosin binds to structural proteins.

Attributable Risk Percent

in the exposed group represents the excess risk in the epxosed population that can be attributed to the risk factor. It can be easily derived form the relative risk using the formula ARP = 100 x (RR-1)/RR

Porphyria

in the hepatic type, it is precipitated when heme is low because low heme activates ALA synthase activity leading to substrates of heme synthesis which cause symptoms (like delta-aminolevulinic acid and porphobiliongen)

Peptostreptococcus, Fusobacteriium, and Bacteroides

in the lung are suggestive of lung abscess caused by aspiration. Risk factors include conditions that increase aspriation risk, such as alcoholism, drug abuse, seizure disorders, stroke, and dementia

Aspiration

in the supine position, often the posterior aspect of the upper lobes and the superior segments of the lower lobes (usually on the right side). In the upright postion, typically goes ot the basilar segments of the right lower lobe.

Injury to Meyer's Loop

in the temporal lobe can lead to contralater superior quadrantanopia Vs. injury to the parietal lobe could injure the dorsal optic radiation (above Meyer's loop) and cause a contralateral inferior quadrantanopia.

Natriuretic peptides

include BNP and ANP and are elevated in patients with HF to promote vasodilation and diuresis due to increased stretching of the mycoardium (volume overload causing frank-starling mechanism for maximal contraction). Both activated guanylate cyclase to increased cGMP

Spore-forming bacteria that can survive boiling

include Bacillus anthracis and members of clostridium. They are both found in the soil.

Class III antiarrhthmic drugs

include amiodarone, sotalol and dofetilide and Ibutilide. These drugs work by blocking potassium channels and inhbit the outward potassium currents during phase 3 of the cardiac action potential, thereby prolonging repolarization and total action potential duration. pharm

Polyene antifungals

include amphotericin B and nystatin that rely on the production of fungal ergosterols to be affective. They work by binding to ergosterol in the fungal membrane. pharm

Beta-lactamse inhibitors

include clavulanic acid, sulbactam, and tazobactam. The extend the spectrum of penicillin antibiotics and prevent their destruction by beta lactamase bacteria.

Lithium side effects

include hypothyroidism and nephrogenic diabetes being most common over the long-term. Serum TSH levels and renal function should be monitored

Proton pump inhibitors

include omeprazole and lansoprazole. They block the final common pathway of gastric acid secretion from parietal cells, which is stimulated by acetylcholine, histamine, and gastrin.

Superantigens

includes enterotoxins, exfoliative toxins and toxic shock syndrome toxin (TSST-1). They interact with MHC molecules on APCs and then cuase widespread activation of helper T cells resulting in release of IL-2 and then IL-1 and TNF from macrophages.

MAP-kinase signal transduction pathway

includes the Ras protein, a G-protein that exists in inactive form with GDP and active at GTP. Mutated Ras can lead to cancer.

Iron deficiency anemia

includes the common symptoms like fatigue and pale conjunctiva but more specifically dysphagia and disfigured fingernails (spoon nails or koilonychia)

Kusmassual sign

incrase in jVP on inspiration instead of the normal decrease. Inspiration leads to normally increased venous return but if somethign is blocking entry into the right heart - say constrictive pericardidits, or restrictive cardiomyopathy, or a right atrial/ventricular tumor, then the pressure would back up thus leading to increased JVP on inspiraiton.

Emphysema

increase TLC and RV. Decreases FEv1/FVC ratio.

Cigarrettes

increase mucus production, decrease cilia fuction, and decrease alveolar macrophage function.

Benzodiazepines

increase the frequency of opening of the CNS GABA receptor-chloride channels and have anxiolytic, anticonvulsant, and muscle relaxant effects as well as sedative-hypnotic effects.

Direct Xa inhibitors (apixaban, rivaroxaban)

increase the prothrombin time and activated partial thromboplastin times but do not affect the thrombin time (TT). The thrombin time is increased by medications that inhibit thrombin itself. Unfractionated heparin and direct thrombin inhibitors (argatroban, bivalirudin, and dabigatran) would increase the TT.

Japanes/asian and nitrosamines

increase the risk for stomach cancer

RNA pol II

involved in mrNA synthesis

Cox-2

increased activity of Cox-2 may be implicated in some forms of colon adenocarcinoma. So aspirin use could help reduce adenomatous polyp formation.

Eosinophils

increased in atopic asthma and contain major basic protein which when released to kill helminths. It also may contribute to bronchial epithelial damage in patients with atopic asthma.

ACh

increased in parkinsons, DECREASED IN ALZHEIMER, and decreased in Huntingtons. Found in the basal nucleus of Meynert (gets furked in alzheimers)

Friedreich ataxia

increased number of GAA repeats causes decreased expression of frataxin (FXN) gene. Results in degeneration of the spinocerebellar and lateral corticospinal tract (gait ataxia and spastic muscle weakness) and degeneration of the dorsal columns and dorsal root ganglion (loss of position and vibration sense).

What causes a leftward shift in the Hb-O2 association curve

increased pH, decreased 2,3,-bisphosphglycerate, and decreased temp. Here, 02 is less readily available to tissues

Trisomy 21

increased risk for ALL and AML

During aerobic exercise

increased skeletal muscle CO2 production increases the PC02 of mixed venous blood (also venous O2 is decreased since absorbing more 02 and pH is down) Homeostatic mechanisms maintain arterial blood gas levls and arterial pH near resting values

Acute ureteral constriction

increases hydrostatic pressure proximal to constriction. This pressure rise is trasmitted back to Bowman's space, result in decreased GFR and FF (since GFR/RPF and RPF would stay the same acutely and never decrease as much as GFR from this)

HIV co-infection with HPV

increases risk for cervical dysplasia and cancer

Second hand smoke

increases risk of asthma, especially in kids.

Glucagon

increases serum glucose by increasing glycogenolysis and gluconeogenesis

Cortisol

increases the conversion of norepi to epi in the adrenal medulla by increasing the expression of (phenylethanolamine-N-methyltransferase)

IV fluid infusion

increases the intravascular volume and thus increases preload which would cause increased ventricular myocardial sarcomere length (increased contractility) and thus an increased stroke volume and cardiac output.

Elevated cholesterol

increases the liklihood of cholesterol precipitation and gallstone formation. High levels of bile salts and phosphatidylcholine (a phospholipid released iwth bile) increase cholesterol solubility and decrease the risk of gallstones.

Valproate (anti-seizure med)

increases the risk of neural tube defects by inhibiting intestinal folic acid absorption.

Valsava maneuver

increases vagal tone and can be used to abolish paroxysmal supraventicular tachycardia. The rectus abdominus is the most importnat muscle here.

Cricothyrotomy

indicated when an emergency airway is required an nasotracheal intubaiton is not possible. Airway is established between the cricoid and thyroid cartilages through an incision in the skin to superfical cervical fasia through the cricothryoid membrane.

Anti-HBs

indicates either resolution of acute infection or vaccination and it confers long-term immunity. If patient ever had an infection, would also have anti-HBc. Detection of HBeAg implies high levels of viral replication and infectivity. Presence of HBsAg indicates an active infection.

The presence of erythroid precursors in in the liver and spleen

indicates extramedullary hematopoiesis. This can be caused by Beta-thlassemia

CMV

individual may develop a monolike illness that is monospot negative. Only in the immuncompromised would CMV cause retinitis, pneumonia, esophagitis, colitis, or hepatitis

Idiopathic membranous neropathy

is assoicataed with circulating IgG4 antibodies to the phospholipase A2 receptor, which may play a role in the development of the disease.

miRNA (micro) and siRNA (small-interfering)

induce post-transcriptional gene silencing by base-pairing with complementary sequences within target mRNA molecules (blocks translation by ribosomes) They are often (20-30 base pair long)

Strongyloides stercoralis

infection begins following skin penetration by filarifrom (infectious) larva and is diagnosed by finding rhabditiform (noninfectious) larvae in the stool.

Adenovirus

infection is characterized by acute, self-limited, febrile pharyngitis, cough, nasal congestion, and enlarged cervical lymph nodes. It usually occurs among individuals close together- camps or military barracks.

EBV

infects B cells and stimulates them to enter the cell cycle and proliferate contiunously (hence its assoication with cancer). EBV encoded oncogenes activate proliferative and anti-apoptotic signaling pathwyas. IN an immunocompetent host, the immune repsonse holds this in check. Dx relies on detecting heterophile IgM antibodies that react with antigens on horse/sheep erythrocytes causing aggultination if infected.

Femoral Hernia

inferior to the inguinal ligament (unlike the inguinal hernias), lateral to the pubic tubercle, and medial to the femoral vein. They can present with groin discomfort or manifest as a bulge in the upper thigh. Incarceration and strangulation are common complications of femoral hernias- would think N/V and fever. More common in women than men.

Lobar Pneumonia Pathology

inflammation involves an entire lobe of the lung. The course of the disease includes four morphologic stages: congestion (Vascular dilation, alveolar exudate contains bacteria), red hepatizaiton (red, firm lobe with alveolar exudate containing erythrocytes, neutrophils, and fibrin), gray hepatization (gray, pale firm lobe with same but RBC's disintegrate), and resolution (back to normal)

Beta blockers

inhibit renin release (there are beta receptors in the juxtaglomerular apparatus). This reduces plasma renin, thus resulting in reducitn in agiotensin I, II, and aldosterone pharm

Aminoglycosides

inhibit the genetic code reading and protein synthesis by binding to the prokaryotic 30S ribosomal unit. They are assoicated with neprhotoxicty and otoxicity.

Beta blockers

inhibit the release of renin through the antagnosim of beta-1 receptors on these cells. Inhibition of RASS will lead to decreased vasococonstriction and decreased renal sodium and water retention.

The aminoglycoside strepmyocin

inhibits protein synthesis by inactivating the 30S ribosomal unit preventing protien synthesis. Bacteria can devleop mutations of the ribosome preventing binding. In addition, decreased bacterial catalse-peroxidase is a mechanism of mycobacterial resistance to isoniazid structural alteration of enzymes involved in RNA synthesis is the mech through wich organisms are resistant to rifampin. pharm

Isoniazid for TB

inhibits pyridoxine phosphokinase, leading to pyridoxine (B6) deficiency. Pyridoxine is really importnat in ALA synthase and thus isoniazid without B6 supplementaiton can lead to sideroblastic anemia (microcytic, hypochromic anemia with ringed sideroblasts on smear)

Ondansetron

inhibits serotonin (5-HT3) receptors and is used primarily to treat nausea and vomitting following chemotherapy. 5HT3 receptors are located peripherally in the presynaptic nerve terminals of the vagus nerve in the GI tract, but also centrally in the chemoreceptor trigger zone and solitary nucleus and tract.

Folate deficiency

inhibits the formation of deoxythymidine monophosphate (dTMP), which limits DNA synthesis and promotes megaloblastosis and erythroid precursor cell apoptosis. Thymidine supplementation can moderately increase dTMP and could be give to reduce this apoptosis

Injections to the superomedial part of the buttock

injections given in the superomedial part of the buttock risk injury to the superior gluteal nerve (the trendelenbrug gait could result)

The tibial nerve

injured at the level of the popliteal fossa due to deep penetrating trauma or knee surgery. Patients typically have weakness on foot plantar flexion, foot inversion, and toe flexion, with sensory loss over the sole.

Musculocutaneous nerve

injury would cause a number of things including loss of sensory innervation to the lateral forearm

Glossopharygeal nerve

innervates the cartoid sinus barorecptors which would increase firing rate if pressure was applied here. This woudl result in brachycardia, hypotension, and sometimes syncope.

Conduct disorder

inolves a persistent pattern of violating major societal norms and the rights of others. May be agressive, a stealer, destruction of property. It is not antisocial personality disorder until > 18. Its more than just Oppositional defiant disorder as this is characterized by a pattern of angry/irratable ood and argumetnative/defiant behavior toward authority figures. You wouldn't see the agression, stealing, and desruction of property here.

VPL (ventral posterolateral nucleus)

input: spinothalamic and dorsal columns/medial lemniscus. Info: Pain, temperature; pressure virbation proprioception destination: primary somatosensory cortex Just think, brings information from the lateral (arms and legs) part of body

VPM (ventral posteromedial nucleus)

input: tigeminal and gustatory pathway INfo: face sensation, taste destination: pimary somatosensory cortex just think that VPM is for makeup on the face (or medial part of body)

Idiopathic pulmonary fibrosis

insidious-onset progressive exertion dyspnea, pulmonary function tests following a restrictive profile, and surgical biopsy showing extensive intersitial fibrosis together with paraseptal and subpleural cystic airspace enlargement (honeycomb lung) are characteristic of idiopathic pulmonary fibrosis.

Alzheimer's disease

insidiously progressive memory loss. Most common form of dementia and usually affects people > 60. It is assoicated with diffuse atrophy, most pronounced in the temporoparietal lobes and hippocampus.

RANK/RANKL

interaction is essential for the formation and differentiation of osteoclasts. Osteoprotegerin (OPG) blocks binding of RANK-L to RANK and reduces formation of osteoclasts. Low estrogen states cause osteoporosis by decreased OPG production, increasing RANK-L production, an dincreasing RANK expression in osteoclast precursors.

Claudication

intermittent muscle pain caused by exercise and relieved by a brief period of rest defines claudication. It almost always the result of atherosclerosis of large arteries (ischemic muscle pain with exercise)

Asthma

intermittnet respiratory symptoms in a patient with normal CXR, ocassional sputum eosinophils, adn reduced FEV1 suggest a dignosis of asthma. Extrinsic allergic asthma provoked by inhaled allergens such as animal dander is the most common type

Aschoff bodies

interstitial myocaridal granulomas are found in mycoarditis due to acute rheumatic fever. Aschoff bodies contain plumb, macrophages with abndunat cytpolasm adn central, slender ribbons of chromatin (anitschkow, or caterpillar cells)

Glucose infusion

into a patient without thiamine can precipitate encephalopathy (Wernicke) with COAT symptoms. Hemorrhage into the mamillary bodies is characteristic.

Ornithine transport

into the mitochondria is essential for urea formation as part of the urea cycle. If this process is defective, neurological damage can result with accumulation of ammonia. Tx- restrict protein.

GFR

inulin can be used because it is freely filtered and is neither reabsorbed nor secreted. GFR = U x V/P = C inulin. Normal GFR = 100 mL/min. Creatinine clearance is an approximate measurment of GFR.

Mu receptors

involve increased potassium efflux thus leading to hyperpolarization and cessation of the pain transmission.

beta 2 receptors

involved in uterine relaxation

Social Anxiety disorder

involves excessive fears of scrutiny or embarrassment in social or performance situations, resulting in significant distress and functional impairment.

GAD

involves excessive, chronic worry over multiple issues lasting >6 months. It is treated with antidepressants and cognitive behavioral therapy.

Factitious disorder

involves the conscious and deceptive feigning or self-production of physical or psychological symptoms to obtain attention and medical care from health care personnel. They don't want an external reward (malingering) they just want the sick role

Inferior epigastric artery

is 1 of 2 branches of the external iliac artery (which eventually becomes the common femoral artery) that takes off immediately proximal to the inguinal ligament. It provides blood supply to the lower anterior wall as it runs superiorly and medially up the abdomen.

Normal tracheal P02

is 150mm Hg and normal alvoelar pO2 is 104 mmHg (some of it is constantly diffusing across). Normally, the equilibraiton of 02 at rest is perfusion-limited. A PE, would have severe perfusion defect (tracheal and alveloar air approximately the same). However, in some instances like emphysema, pulmonary fibrosis, and phsiologically high exercise, they become diffusion-limited

Primase

is a DNA-dependent RNA polymerase that incorporates primers into replicating DNA. Just need once for the leading strand but then one for each Okawsaki fragment on the lagging strand.

Oppositional defiant disorder

is a behavioral disorder of childhood characterized by argumentative and defiant behavior toward authority figures. It does not involve the more severe violations of basic rights of others as seen in conduct disorder

Renal angiomyolipoma

is a benign tumor of smooth msucle, blood vessels, and fat. When bilateral, usually assoicated with tuberous sclerosis (AD). Tuberous sclerosis is also characterized by subependymal harmatomas in the brain, with consequent siezures and mental retardation. Cardiac rhadomyomas, facial angiofibromas, and leaf-shaped patches (ash-leaf) on the skin lacking pigment can occur too.

Dobutamine

is a beta adrenergic agonist with predominat activity on B1 receptors. It casues an increase in hear trate and cardiac congractility, leading to an increase in myocaridal oxygen consumption. Its main use is as a positive inotropic efect to increase cardiac contracitlity and increase CO in states of cardiogenic shock .

Erythema multiforme

is a cell-mediated inflammatory disorder of the skin characterized by erythematous papules that evolve into target lesions. It is most commonly associated with herpes simplex and mycoplasma pneumoniae.

Donezepil

is a cholinesterase inihibitor used to treat Alzheimer's disease.

Primary biliary cirrhosis

is a chronic autoimmune liver disease characterized by destruction of intrahepatic, interlobular bile ducts by granulomatous inflammation. The disease typically presents insdiously with pruritus and fatigue in middle-aged women. Patients may eventually develop sings of cholestasis (jaundice, pale stool, dark urine

Dofetilide

is a class 3 (K+ blocking) antiarrhtymic agent that blocks potassium efflux from cardiac myocytes adn prolongs phase 3 of myocyte action potential.

Lipoic acid

is a cofactor for severeal mitochondrial enzymes needed for oxidative phosphorylation especially pyruvate dehydrogenase where a deficiency here would result in lactic acidosis. Lipoic acid is also a cofactor in alpha ketoglutarate DH and branch chain keto-acid DH where a deficiency would would result in maple syrup urine disease.

Bicuspid aortic valve

is a common cause of aortic stenosis in the US. It is a harsh, crescend-decresecendo systolic ejection murmur heard best in the right second intercostal space to the carotids.

Paroxysmal supraventricular tachycardia

is a common dysrhythmia that frequently occurs in patients with no heart disease due to a re-entrant circuit in the AV node. Episodes are usually treated with adenosine in the hospitla setting, but vagal maneuvers such as carotid sinus massage (increases baroreceptor firing to brain up the IX nerve thus sending signal to slow the AV node) and Valsalva maneuver

Meningococcal sepsis

is assoicated with DIC and hemorrhagic destruction of the bilateral adrenal glands (waterhouse-friderichsen sydnrome. It may include menigitis with its sepsis but doesn't have to.

Mybcobacterium avium complex (MAC)

is a common oppourtunistic pathogen that causes disseminated disease in HIV+ patients. They would present with fever, weight loss and diarrhea as well as invovlment of the reticuloendothelial system with anemia, hepatosplenomegaly, and elevated alkaline phosphatase. Patients with CD4+ counts < 50 should be administered prophylactic azithromycin to prevent MAC infection.

Transtentorial (ie. uncal herniation)

is a complication of an ipsilater mass lesion, such as hemorrhage or brain tumor. the first sign of uncal herniation is fixed and dilated pupil (CN III injury)

CCR5

is a coreceptor that allows the HIV virus to enter T cells. Deletion of both alleles woudl give resistance against infection

Dandy-Walker malformation

is a development anomaly characterized by hypoplasia/abscene of the cerebellar vermis (issues with walking) and cystic dilation of the 4th ventricle with posterior fossa enlargment. Patients often present during infancy with developmental delay and progressive skull enlargment. Non-commnicating hydrocephalus is also possible.

Dilated cardiomyopathy

is a diagnosis of exlusion of other etiologies, namely pericardial disease, vlavular defects, CAD, and cardiac rhtym issues. It is characterized by dilation of all 4 chambers of the ehart, systolic dysfuction, nad mycoardial failure. A systolic pressure grandient betwen the left ventricle and aorta would not be expected in dilated cardiomyopathy and is more suggestive of left ventricular outflow obstruction (ie. aortic stenosis)

Histoplasma

is a dimorphic fungus located intracellulary within macrophages (ovoid cells within macrophages). It affects the lungs and reticuloendothelial system. It is present in bird and bat droppings, and is endemic to the Misissipi and Ohio River basins.

Sporothrix schenckii

is a dimorphic fungus that causes a subcutaneous mycosis. It is often transmitted by thorn prick. The disease manifests with nodules that spread along lymphatics.

Poison Ivy dermatitis

is a form of allergic contact dermatitis, which is a type IV hypersensitivity reaction mediated by T lymphocytes It manifests as intensely pruritic erythematous papules, vesicles, or bullae that often from linear patterns.

C.botulinum

is a gram-positive spore former anaerboic rod thatis responible for botulism. Local injections of botulinum toxin into muscle are used to treat focal dystonias, achalasia, and spasms.

PCP (phencyclidine)

is a hallucinogen that works primarily as an N-methy-D-aspartate (NMDA) receptor antagonist. Agitation, hallucinaiton, and violent behavior can occur with higher doses. Vertical nystagmus may also occur. They often don't remember what they did while on it.

Hypoxemia

is a low PaO2. Always do an A-a gradient to determine the cause. The major causes are alveolar hypoventiatlion, ventialtion-perfusiion mismatch, diffusin impairment, and right-to-left shunting. With a normal A-a gradient (meaning the cause is directly due to a low PAO2), common causes are alveolar hypoventilation (opiods, sleep apnea, myasthenia gravis, obesity) or high altitude where there is less oxygen.

The length constant

is a measure of how far along an axon an electrical impulse can propagate. Without myelin the insulator, the length constant will decrease.

The minimal alveolar concentraiton (MAC)

is a measure of potency of an inhaled anesthetic. It is the concentration of the anesthetic in the alveoli that renders 50% of patients unresposive to pain.

Cytochrome c

is a mitochondrial enzyme that activates caspases and indirectly brings about cell death through intrinsic pathway apoptosis

Buspirone

is a nonbenzodiazepine anxiolytic used to treat GAD. It has a slow onset of action (1-2 weeks), and lacks the muscle relaxant, anticonvuslant properties and depdence risk of benzodiazapines. It is not effective in acute anxiety or panic disorder It is a partial agonist of the 5HT receptor pharm

Phenoxybenzamine

is a nonselective, irreversible alpha-1 and alpha-2 antagonist that effectively reduces the number of receptors available for NE. Because its irreversible, it will lower the efficacy of epi (very high concentratiosn cannot overcome)

The H band

is a part of the sarcomere and A band on either side of the M line where myosin thick filaments do not have any overlapping actin thin filaments.

HSV-1 encephalitis

is a potentially fatal complication from primary infeciton or reactivation of latent disease. Nervous system invasion leads to necrosis of the temporal lobe, which can result in aphasia and personality changes and the classic features of encephalitits (headache, fever, altered mental staus, seizure).

Azathioprine

is a precursor drug that forms 6-MP. It has two metabolic pathways from there to either go to its active metabolite form by HGRT synthase which results in purine synthesis inhibition or it can go to inactive form by xanthine oxidase breadking it down. Allopurinol would block xanthine oxidase thus increasing the effects of azathioprine (immune chapter)

NF-KB

is a pro-inflammatory TF that induces cytokine production. Its activity can be decreased in Chron's disease, resulting in crhonic GI inflammation from the addaptive immune system creating an exaggerated response to gut microbes.

Lipofuscin

is a product of lipid peroxidation, accumulating in aging cells

The TATA box

is a promoter region that binds transciripton factors and RNA pol II during the initation of trascription. It is located approximatley 25 bases upstream from teh beginning of the coding region.

Synaptophysin

is a protein found in the presynaptic vesicles of neurons . CNS tumors of neuronal tumors would strain positive for this

Primary (pscyogenic) polydipsia

is a psychological disorder characterized by increased intake of free water, leading to hyponatremia and production of a large volume of dilute urine. Water restriction will correct the serum sodium levels and lead to a significant increase in urine osmolality (unlike DI and NI)

Adenosine

is a rapidly acting antiarrhythmic used to quickly convert people out of PSVT. It is also rapidly cleared. Common side effects are chest burning, flushing and high grade block. *this is the drug used for chemical stress test pharm

Subacute Sclerosing panencephalitits

is a rare complication of measles infeciton that occurs several years after apparent recovery from initial infection. Oligoclonal bands of measles virus antiboides are found in the CSF of these patients.

Meckel's diveritculum

is a remnant of the omphalomesenteric (vitelline) duct. Often cotains ectopic tissue, which may lead to bleeding and is a true diverticulum so therefore consists of all 3 layers of the GI wall (mucosa, submucsa, and muscular layers)

Congenital prolonged QT

is a result of prolonged action potential. This is cuased by mutations in membrane postassium channel proteins Jervell adn Lange-Neilsen snydrome (with deafness) Romando-Ward (without deafness)

Axillary lymph node dissection (after breast cancer say)

is a risk factor for the development of chronic lymphedema, which predisposes to the development of angiosarcoma (Stewart-Treves syndrome)

Raloxifene

is a selective estrogen receptor modulator (SERM), thus can bind estrogen receptor and mimic it. Raloxifene has estrogen agonist activity on bone, the CV system, and blood lipoprotiens. Net bone resorption is decreased, thereby slowing postmenopasual osteoporosis. In the breast and uterus it behaves as an estrogen antagonist, thus reducing risk for estrogen receptor-positive breast cancer.

Acute hepatitis A

is a self-limited infection that typically presetns acutely wiht prodromal symptoms (fever, malaise, anorexia, N/V and RUQ) followed by signs of cholestais (jaundice, pruiritus, dark-colored urine, clay-colored stool). Look for recent travel to South america. Characterized by spotty hepatocyte necrosis with invlammatory cell infiltration

Reactive arthritis

is a spondyloarthropathy assoicated with HLA-B27 that can occur following infeciton with clamydia, campylobacter, salmonella, shigella, or Yersinia

The great saphenous vein

is a superfical vein of the leg that orginiates on the medial side of the foot courses anterior to the medial malleolus and then travels up the medial aspect of the leg and thigh. It drains into the femoral vein within the region of he femoral triangle, just inferolateral to the pubic tubercle.

Malabsorption

is a syndrome of impaired intestinal digestion and absorptoin. Diarrhea, steatorrhea, weight loss, and vitamin and mineral deficiencies are common. Sudan III stain of stool identifies fecal fat and is used to screen for malabsorption.

Gyecomastia

is abnormal development of breat tissue in males commonly seen in males receiving androgen deprivation therapy aka gonadotropin-releasing hormone agonists (GnRH agonist) for prostate cancer. Selective estrogne receptor modulators inhibit the effect of estrogen on breast tissue (like tamoxifen) and can prevent teh development of gyecomastia.

Calcium efflux prior to muscle relaxation

is accomplished by Ca2+-ATPase and the Na+/Ca2+ exchange mechanism.

Stage of colorectal adneocarcinoma

is always more importnat for prognosis than the grade

Diptheria toxin

is an AB toxin that ribosylates and inactivates EF2. This action inhibits protein synthesis and ultimately leads to cell death.

Osler-Weber-Rendu syndrome

is an AD condition characterized by the prescence of telangectasias in the skin as well as mucus membranes (lips, GI tract, respiratory tract and urinary tract). These telangiectasias can rupture and cause epistaxis, GI bleed, and hematuria

Fragile X syndrome

is an X-linked disorder (defect in FMR1 with CGG repeats) that presents with a long, narrow face, a prominent chin and forehead, and large testes. Patients often have developmental delay and neuropsychiatric findings that overlap with anxiety, autism, ADHD

Lesch-Nyhan syndrome

is an X-linked recessive disorder caused by a defect in HGPRT. This results in failure of the purine salvage pathway, leading to increased uric acid. Denovo purine synthesis must increase to replace lost bases (would have to know the pathway)

Acute acalculous cholecystitis

is an acute inflammation of the gallbladder in the absence of gallstones. It typically occurs in critically ill patients. manifests with fever, RUQ pain, leukocytosis. Inflamed and enlarged gallbladder.

Spironolactone

is an aldosterone antagonist commonly used to treat heart failure. It has signifcant antiandrogenic effects (structurally simialr) and can thus cause gyecomastia, decreased libido, and impotence. Eplerenone is a more selectve aldosterone antagonist with fewer side effects.

Mifepristone

is an anti-progestin agent that can be used to terminate early pregnancy (binds to receptors stronger than progesterone). The prostagnlind analogue misoporstol cna also be used in combo.

A-fib

is assoicated with increased risk fo systemic thromboembolism. the left atrial appendage is the most common site of thrombus formation.

Acute Hemolytic Transfusion Reaction

is an antibody-mediated (type II) hypersensitivity reaction caused by preexisting anti-ABO antibodies that bind antigens on the new RBCs. Subsequent complement activation results in erythrocyte lysis, vasodilation, and symptoms of shock. Findings include fever, hypotension, chest and back pain, and hemoglobinuria.

Hyperacute rejection

is an antibody-mediated reaction (type II hypersensivity) cuased by PREFORMED IgG ANTIBODIES within the recipient that are directed against donor antigens. Examples include anti-ABO and anti-HLA antibodies. This form of rejection occurs immediatley upon intial perfusion of the transplanted organ adn is often diagnosed introperatively due to mottling and cyanosis of the organ.

Cyproheptadine

is an antihistamine with anti-serotnergic properties used in the treatment of serotonin syndrome.

Pemphigus Vulgaris

is an autoimmune bullous disease characterized by autoantiboides directed against desmosomal proteins (desmoglein) It presents with painful flaccid bullae and erosions affecting the skin and mucosal membranes (often the mouth- not true of bullous pemphigoid). The bullae spread laterally wiht pressure and new blisters may from with gentle rubbing (Nikolsky sign- not true of bullous pemphigoid- tense blisters that don't rupture)

Myotonic dystrophy

is an autosomal dominant disorder caused by an increased number of trinucleotide repeats on myotonia-protein kinase gene. Sustained muscle contraction (myotonia say from a hand shake), along with weakness and atrophy are common. Cataracts are seen in almost all cases. Frontal balding and gonadal atrophy are other common features

Tay-Sachs

is an autosomal recessive disorder caused by a deficiency in Beta-heoxsamindase A, which results in the accumulation of GM2 ganglioside. It is characterized by progressive neurodegeneration and a cherry red macular spot. Unlike Nieman-Pick, there is no hepatosplenomegaly.

Anorexia nervosa

is an eating disroder characterized by low body weight, intesne fear of becoming fat, and distorted body image. It may appear like bullimia nervosa as there is a bing eating/purg subtype that could see parotid gland enlargment. However, Bulimia individuals maintain weight. Medical complications of anorexia include bradycardia, hypotension, osteoporosis, amenorrhea, and cardiac atrophy.

Telomerase

is an enzyme that posses reverse transcriptase activity and that is normally expressed in stem cells and cancer cells (how they become immortal becuase telomere does not shorten for them). Telomeres add TTAGGG to the 3' end of DNA strands

N-acetylglutamate

is an essential activator carbamoyl phosphate synthase I and is formed by the enzyme N-acetylglutamate synthetase.

H/K ATPase

is an example of active transport requiring ATP. Omeprazole and other PPIs will block this leading ot increase in pH

Akasthisia

is an extrapyramidal side effect of antipsychotic medication characterized by inner restlessness and an inability to sit or stand in one position. Akathisia is frequently misdiagnosed because the restlessness is misinterpreted as worsening psychotic agitation.

Fabry disease

is an inherited deficiency of alpha-glactosidase A that causes accumulation of the globoside ceramide trihexoside in tissues. The earliest manifestations are angiokeratomas, hypohidrosis and acroparesthesia .Without enzyme replacement, patients typically develop progressive renal failure.

Selegiline

is an inhibitor of MAO, type B. Clinically is used to delay the progression of Parkinsons.

Raltegravir

is an integrase inhibitor that disrupts the HIV genomoe integration into host cell's chromosomes, thereby preventing host cell machinery from being used to synthesize mRNA.

The PI3K/Akt/mTOR pathway

is an intracellular signaling pathway importnat for anti-apoptosis, cellular proliferation, and angiogenesis It includes a growth factor binding ot receptor tyrsoine kinase, causing auto-phosphorylation of specific tyrosine residues on the receptor. these phosphotyrosin residues activated phosphoinositide 3-kinase (PI3K) which then phosphorylates PIP2 found in the plasma membrane to PIP3. This leads to activaiton of the protein Akt (protein kinase B), a serine/threonine specific protein kinase, which activated mTOR (the target for rapamycin/sirolimus), which translocates to the nucleus to induce genes involved in cell survival, anti-apoptosis, and angiogenesis (often increased in cancer cells therefore)

Mucormycosis

is an opporunistic infection caused by Rhizopus, Mucor, and Absidia species. The classic clinical picture is paranasal sinus involvement in a diabetic or immunosuppressed patient The fungi form broad nonseptate hyphae that branch at right angles

Rivaroxaban

is an oral anticoagulant that directly inhibits factor Xa. It is used in venous thromboembolism and a-fib. pharm

Pneumococcal polysaccharide vaccine

is an unconjugated vaccine that induces a relatively T-cell independent response. IN contrast, the pneumococcal conjugate vaccine induces a more robust response

The green discolration of pus or sputum noted during bacterial infections

is associated with myeloperoxidase (MPO) from neutrophil azurophilic granules.

PCOS

is assoicated with oligomenorrhea, obesity, hirsutism and polycystic ovaries. These patients have an increased risk for developing endometrial adenocarcinoma (unopposed estrogen and progesterone is low) and type 2 diabetes (insulin resistance) assoicated with increased LH:FSH ratio

Chronic valvular inflammation and scarring

is assoicated with rheumatic herat disease and predispose to infective endocaritits, which is charadcterized by valvular vegetionas wiht destruction of underlying cardiac tissue.

The external branch of the superior laryngeal nerve

is at risk for injury during thyroidectomy due to its proximity to the superior thyroid artery and vein. This nerve innervates the cricothyroid muscle, which tenses the vocal cords (loss may lead to hoarsness)

Smoking cessation

is by far the most effective preventive intervention in almost all patients regardless of disease status.

Typhoid fever

is caused by Salmonella Typhi and usually presents after patient has visited an endemic coutnry. It presents with fever, diarrhea, abdominal pain, formaiton of ROSE SPOTS on chest/abdomen and could even lead to hemorrhagic enteritis.

Maple Syrup Urine disease

is caused by a defect in alpha keto acid dehydrogenase, leading to an inability to degrade branched amino acids (isoleucine, leucine, and valine). This illness classically results in poor feeding and dystonia as well asthe maple syrup scent (burnt sugar) in the patients urine after first couple days of life.

HbC

is caused by a missense mutation that results in a negative gluatmate residue being substituted for positive lysine. Thus HbC moves slower than both HbA and HbS on gel electrophoresis toward the positive node.

Acute allergic contact dermatitis

is caused by a type IV hypersensitivity reaction to an anitgen on the skin surface. Gross findings include erythematous, papulovesicular, weeping lesions (spongiosis). Histology is characterized by spongiosis, an accumulation of edema fluid in the intercellualr spaces of the epidermis

Goodpasture syndrome

is caused by anti-GBM antibodies tha react with a component of the alpha3-chain of collagen type IV in the glomerulus.

Wide pulse pressure

is caused by aortic regurgitation which can explain why symptoms sometimes include palpiations from forceful ventricular contactions ejecting large stroke volumes, and head pounding can be due to unusually high amplitude pulsations of the intracranial arterie with each beat. Involuntary head bobbing can be a sign of widened pulse pressure (peak systolic volume - peak diastolic volume)

diastolic HF

is caused by decreased ventricular compliacne and is characterized by normal left ventriuclar ejection fraciton, normal LV end-diastolic volume, and elevated LV filling pressurs.

Follicular lymphoma

is characterized by aggregates of packed follicles that obscure the normal lymph node architecture. t (14;18), which causes overexpression of BCL-2

Aortic regurgitation

is characterized by an early diastolic murmor (over the left sternal border) and is most commonly caused by aortic root dilation or a bicuspid aortic valve in developed countries.

Serotonin Syndrome

is characterized by confusion, agitation, tremor, tachycardia, hypertension, clonus, hyperreflexia, hyperthermia, and diaphoresis. Combinations of SSRIs and MAO inhibitors can do it or overdose of SSRIs. Tryptophan is a precursor of serotonin

Medullary carcinoma

is characterized by extracellualr deposits of amyloid (stains congo red) formed by calcitonin secreted from neoplastic parafollicular cells.

Giant Cell Arteritis

is characterized by granulomatous inflammation of the media and predominantly invovles the medium to smaller branches of the carotid artery, especially the temporal artery. It is histologically identical to Takayasu's arteritis

Men2B

is characterized by medullary thyorid cancer, pheo, mucosal neuromas, and marfanoid habitus.

Schizophreniform disorder

is characterized by psychotic symptoms (duelusions, hallucinations, disorgazied speech and behavior, negative symptoms- like socially withdrawn or flat affect or lack of motivaiton or lack of speech or thought) lasting > 1 month and < 6 months

panthotheneic acid (B5)

is coenzyme A. it is necessary with oxaloacetate binding to citrate.

Anovulation

is common in the first several years after menachrce and the last few years before menopause. This is due to an immature HPO axis. During this time they may have longer menstrural cycle and irregular bleeding patterns. IN the abscence of ovulation, the ovarain follice does not degnerate to become the copurs luteum and thus no progesterone and estrogen remins high and we stay in the proliferative phase (spotting but no bleeding) and that buidls up until finally an egg is released and then a lot of endometrial ttisue will slough off.

H.flu type b vaccine

is composed of cell wall polysacharide conjgated with protein toxioid from either diptheria or tenatus. This vaccination decreases meningitis and epiglottis dramatically.

A complete hydatidiform mole

is composed of muliple cystic edematous hydropic villi as a result of trophoblast proliferation. Serial measurments of B-hCG should be forme dfollowing evacuation of a hydatidiform mole. Persistently elevated may indicate an invasive mole or choriocarcinoma. Can cause hyperemesis gravidarum from the increased B-HCG

the RER

is convered in ribosomes and is involved with tranfer of proteins to the cell membrane and extracellular surface. The RER is well-developed in protein secreting cells. The smooth ER lacks surface ribosomes and fucntions in lipid syntheisis, carbodydrate metaboslism, and detoxification of drugs.

The ovary

is covered by a simple cuboidal epithelium inolved insurface reapir of defects from ovulation. Endometriosis commonly affects the ovaries and causes infertility.

Aortic stenosis murmor

is crescendo-decrescendo and in a person > 70 is likely caused by degerative calcifcation of the aortic valve leaflets.

Tranforming growth factor (TGF-beta)

is critical to fibroblast migration, proliferation, and connective tissue synthesis in wound healing. Increased TGF-beta activity is responsible for hyertrophic/keloid scarring and the fibrosis that occurs in chronic inflammation.

a preventable adverse event

is defined as injury to a patient due to failure to follow evidence-based best practice guidelines.

Stress urinary incontinence

is defined as involuntary urine loss with increased intrabdominal pressure (laughing, sneezing). Pelvic floor strenthening (eg. Kegel excercise) targets the levator ani (iliococcygeus, pubococcygeus, puborectalis) to improve support around the urethra and bladder. This helps.

Pulsus paradoxus

is defined by a decrease in systolic blood pressure of > 10 mmHg with inspiration. It is most commonly seen in patients with cardiac tamponade. It occurs because with inspiraiton we know there is increased venous return to the right ventricle. This cuase the right ventricle to push a little more on the left ventricle which is no problem usually cuz the left ventricle can just adjust within the pericadial space. When pericardial space is limited though, this leads to a bowing of the interventricular septum decreasing EDV in the left ventricle and thus a decreased systolic pressure

The carpal tunnel

is defined by the carpal bones on the dorsal surface and the transverse carpal ligament (flexor retinaculum) on the volar surface. It contains the tendons of the flexor digitorum profundus and superficialis and flexor policcus longus, in addition to the median nerve.

Hepatitis D

is depedent on Hep B to infect hepatocytes becuase it requires the Hep B surface antigen to coat the hepatitis D antigen before it can enter hepatocytes and multiply

Coronary dominance

is determined by the cornoary artery supplying the posterior descending artery (PDA), whcih also supplies blood to the AV node via the AV nodal artery. The PDA usually orignates form the right coronary artery (70%), but also from both (20%) and the left cirucmflex artery: 10% (left dominant circulation)

Cryptococcal meningitis

is diagnosed by India Ink staining of CSF. The main treatment for this infection is amphotericin B and flucytosine.

Bipolar I disorder

is diagnosed in patients with a lifetime history of > 1 episodes of mania. Manic episodes are characterized by elevated/irriatable mood, hyperactivity, decreased need for sleep, pressured speech, and gradioisty DIG FAST It may occur with pscyhotic features- in this case would have to distiguish from the psychotic disorders, but keep in mind with bipolar, its the mood symptoms that come first and are the prominent features.

Blood flow

is directly proporitonal to radius raised to the fourth power. Resistance is inversely proportional.

Allergic bronchopulmonary asperigllosis

is due to aspergillus where it may complicate asthma causing eosionophilia and result in transient pulmonary infiltrates and eventual proximal bronchiectasis.

Thoracic outlet syndrome

is due to compression of the lower trunk of the brachial plexus in the scalene triangle, the space bordered by the anterior and middle scalene muscles and first rib. Symptoms include upper extremity numbness, tingling, and weakness. TOS often occurs within the scalene triangle, the anterior scalene, middle scalene, and first rib.

Increased incidence of cholelithiais in womenwho are pregnant or using OCPs

is due to estrogen-induce cholesterol hypersecretion and progesterone-incuded gallbladder hypomotility Hence the fat, fertile, female, and 40

Type 2 diabetes

is due to insulin resistance and a relative insulin deficiency. Chornically elevated levels of free fatty acids contribute to insulin resistnace by imparing insulin-depdent glucose uptake and increasing hepatic gluconeogensis and insulin secretion.

obstructive sleep apnea

is due to neuromuscular weakness of the oropharynx. Electrical stimulation of the hypoglossal nerve increases the diamter of the oropharyngeal airway and decreases the frequency of apneic events.

Hemoglobin A2

is elevated in beta-thalassemia as beta-globin chain underproduction leads to decreased hemoglobin A levels.

Minute ventilation

is equal to the product of the tidal volume and respiratory rate and includes dead space ventilation. Alveolar vnetilation is equal to the product of the respiratory rate and the difference between the tidal volume and dead space volume.

The bladder

is extraperitoneal, so in placement of a suprapubic cystostomy, it would pierce the layer of teh abdominal wall but will not enter the periotneum. Layers pieced would be skin, superficial fascia, aponeurosis (of internal and external oblique, tranversalis fascisa, and bladder wall.

Buproprion

is first-line for MDD that does not cause sexual dysfuction.

Myxomatous changes with pooling of proteoglycans in the media layer of large arteries

is found in cystic medial dengeration, which predisposes to the devleopment of aortic dissections and aortic aneursms. Medial dengeration is frequently seen in younger patients with Marfans.

Paraaminohippuric acid (PAH)

is freely filtered from the blood in the glomerular capillaries to the tubular fluid in Bowman's space. It is also secreted from the blood into the tubular fluid by carrier proteins, which can be saturated at high blood levels of PAH

alcohol-induced heaptic steatosis

is primarily related to a decrease in free fatty acid oxidaiton secondary to NADH production.

Recombination

is gene exchange that occurs thorugh the corssin gover of two double stranded DNA molecules (as can occur with the non-segmented adenovirus in host cells). Reassoartment describes the mixing of gneome segments in tow or more segmented viruses that infect the same host cell.

Hep C virus

is genetically unstable because it lacks proofreading in the 3' to 5' direction in its RNA polymerase and its envelope glycoprotein contains a hypervariable region prone to mutation.

Diphenhydramine

is highly anticholinergic and most likely should be discontinued in an older person if they are having issues peeing.

HIV-1

is highly mutabile and can therefore evade host humoral and cellular immune responses and the development of resistance to anti-retroviral drugs. Pol gene mutations are responsible for acquried reistance to HIV reverse trancirbiptase inhibitors and protease inhibitors. Env gene mutations enable escape from host neutralizing antibodies.

The stapedius muscle

is innervated by the facial nerve. Paralasis of this bone can lead to hyperacusis.

NF-kappa B

is involved in cancer pathways and inflammation when messed up. To be activated, IKB must release NF-KB after undergoing phosphorylation.

Nucleotide exicision repair

is invovled in the fixing of pyrmidine dimers that are formed as a result of UV light exposure. they are recodngized by a specific endonuclease complex that initates the process of repair by nicking the damaged strand on both sides of the pyrimidine dimer. The damaged segment is then excised, and replacment DNA is synthesized by DNA polymerase.

Gilbert Syndrome

is likely a diagnosis in patients with no apparent liver disease who have mild unconjugated hyperbilirubinemia that appears provoked by one of the classic triggers.

The area postrema

is located on the dorsal medulla near the fourth ventricle. It is the area where the chemoreceptor trigger zone is sitmualted causing acute nausea after systemic chemotherapy. No BBB (allwos it to sample chemicals in the blood) It is D in this picture.

cardiac myocyte contractility

is lost within about 60 seconds of total ischemia. When ischemia is less than 30 minutes, it can be reversible.

6-metacaptopruine

is mainly degraded in the liver by xanthine oxidase. It could also be activated by HGPRT (the nucleotide salvage pathway).

Isoniazid

is metabolized by ACETYLATION. The speed with which a patient is able to acetylate durgs depends on whether they are genetically fast or slow acetylators.

Deep intraparenchymal hemorrhage

is most commonly caused by hypertensive vasculopahty of the small penetrating braches of the cerebral artereis (Charcot-Bourchard aneursm ruputre). This is in contract to the rupture of saccular aneurysms (berry), which typically cuase subarachnoid hemorrhage.

Vitamin C

is necessary for the hydroxylation of proline and lysine residues in collagen in the RER. Without it, it could lead to scurvy characterized by fragile vessles, gingival bleeding, ecchymosis, petechiae and perifollicular hemorrhages and coiled (corkscrew) hairs. Also think superiosteal hematomas, bleeding into joint spaces, impaired wound healing, and weakened immune response

Vitamin C

is necessary for the hydroxylation of proline and lysine residues in pro-collagen. Deficiency results in scurvy, most often seen in malnourished individuals like homeless and drug abusers. It leads to capillary bleeding, poor wound healing, periodontal disease , and hyperkeratosis of hair follicles.

Primaquine

is necessary to destroy hypnozoites of P vivax and P ovale (malria) that are latent in the liver.

Metabolic acidosis

is normally compensated for by respiratory alkalosis. Use the equatouion PaCO2 = 1.5 * HCO3 + 8 +/-2. In DKA, if the brain is affected badly, respiratory failure can occur where the compensatory resppiratory alkalosis (kussmaul respriatoins) is not occuring

The spleen

is of mesodermal orgin (the dorsal mesentery), but its blood supply comes from teh splenic artery (a branch of the major foregut muscle, the celiac trunk). It is the most common intra-abdominal organ injured during blunt trauma.

Beta-endorphin

is one endogenous opioid peptide dervied from the same precursor that ACTH and MSH are, suggesting a link between stress axis and the opiod system

Necrotizing enterocolitis

is one of the most common GI emergencies affecting newborns, often permature newborns who are more immunocompromised. It is characterized by bacterial invasion (not good immune systme) and isehmic necrosis of teh bowel wall. Abdominal x-ray showing pneumatosis interstinalis (ie air in the bowel wall is diagnostic.

Pudendal nerve block

is perfomed by injecting anesthesia intravaginally medial to the ischial spine, through the sacrospinous ligament. This provides anesthesia to most of the perineum.

Monospot test

is positive in most cases of EBV mono. if its negative but appears to be mono, likely CMV (fever, fatigue, splenomeagly, atypical lymphocytes). The monospot test looks to see if the serum agglutinates horse erthrocytes or sheep.

Hematogenous osteomyelitis

is predominantly a disease of children that most frequently affects the long bones. S. Aureus is implicated in most cases. Streptococcus pyogenes is send most common cause of hematogenous osteomyelitis

Effect modification

is present when the effect of the mian exposure on the outcome is modified by the presence of another variable. Effect modification is not a bias but is confused with confounding often.

IgA protease

is produced by N. meningitidids, N gonororrhoeae, streptococcus pneumoniae, and H. flu. This enzyme cleaves secretory IgA, which prevents it from effectively binding and inhibiting the action of pili and other cell surface antigens which normally mediate mucosal adherence and subsequent penetration

Inhibin B

is produced by Sertoli cells and is a physiological inhibitor of FSH secretion. LH is controlled by testosterone feeback from Leydig cells

IL-2

is produced by helper T cells and stimulates growth of CD4, CD8, and B cells. It also activates natural killer cells and monocytes. The increased activity of IL-2 is thought to be responsible for its anti-cancer effect

IL-4

is produced by the Th2 subset of T-helper cells. It facilitates growth of B-cells and Th2 lymphocytes, and stimulates antibody isotype switching to IgE (type I hypersensitivity)

Fructose

is rapidly metabolized because it is able to bypass PFK-1 (major rate-limiting enzyme) in glycolysis

Reliable test

is reproducible and precise. Reliability is maximal when random error is minimal.

Mucocililary clearance

is responsible for removing most inhaled particles that lodge in the bronchial tree. It makes use of mucus trapping particles by mucus-secreting cells to the level of the larger bronciles and then club cells. Mucus is then swept up and out of there.

Thyroid peroxidase

is responsible for the oxidation of iodide to iodine, the iodination of thyroglobulin tyrosine residues, and the iodotyrosine coupling reaction that forms T3 and T4.

The Caudate nucleus

is separated from the globus pallidus and putamen by the internal capsule. The caudate is atrophied in Huntington's disease

Cardiac action potential conduction speed

is slowest in the AV node (allows for ventricle to fill) and fastest in the Purkinje fibers. Atrial muscle is second fastest and ventricles are slightly slower than that. So Purkinje > atrial muscle > ventricle muscle > AV node conduciton

Isoniazid

is structurally similar to pyridoxine and can result in its deficiency (increases its urinary excretion and compretes for binding sites). This can lead to deficiencies of NT's like GABA. Isoniazid-induced neuropathy can be prevented by supplementing with B6.

The common peroneal nerve

is suscepbile to injury at the lateral neck of the fibula cuased by compression of fracture. Patients often have weakness on foot dorsiflexion (foot drop) and eversion as well as extension. Sensory loss typically occurs on the lateral leg and dorsolateral foot.

Hepcidin

is synthesized by liver parenchymal cells acting as a central regulator of iron homeostatis. High iron levels and inflammatory conditions increase its synthesisi. Low hepcidin increase intestinal iron absorption and stimulate iron release by macrophages.

Niacin

is synthesized endogenously from tryptophan and is an essential componet of NAD and NADP. A deficiency of ____ results in pellagra characterized by the 3 D's of dementia, diarrhea, and dermatitis

Nitric oxide

is synthesized from arginine by nitric oxide synthase. This conversion often occurs in vasodilation by acetycholine infusion for example during a cardiac procedure

The resting membrane potential

is the difference in electrical charges across the cell membrane under steady-state conditions. The ions that are most permeable make up the largest contribtuion which happens to be potassium (hence why the membrane potential is so close to its equillibrum potnetial) but sodium also somewhat determines membrane potential as a small number of sodium channels allow sodium to enter the cell. Thus the resting membrane potential is pulled ever so slightly from potassium and toward sodium.

Nondisjuciton

is the failure of chromsome pairs to separate properly during cell division. This could be due to failure of homologous chromsomes to separate in meiosis I (most cases of downs) or failure of sister chromatids (identical) to searpate during meiosis II or mitosis

Filtration fraction

is the fraction of plasma flowing through the glomeruli (RPF) that is filtered across the glomerular cappillaries into Bowma's space (GFR) Calculate GFR using clearance of inulin or creatinine. RPF can be calculated by PAH clearance. C = urine concentratoin x urine flow rate/ plasma concentration FF = GFR/RPF usually about 20% in healthy indivduals

UV-specific endonuclease deficiency

is the most common cause of autosomal recessive disorder xeroderma pigmentosum (remember its a defect in nucleotide excision repair)

Androgenetic alopecia (male pattern baldness)

is the most common cause of hair loss in both males and females, and demonstrates polygenic inheritance with variable penetrance. Circulating androgen levels along with degree of genetic predisposition are thought to play a role in clinical manifestation.

Candida albicans

is the most common cause of opportunistic mycosis. It can affect any organ and cuase generalized candidemia (think of especially with chemotherapy- neutropenia). Yeast and pseudohypahe on light microscopy and a positive germ tube (image) test are diagnostic.

S. Aureus

is the most common cause of tricuspid endocarditis in IV drug users. These patients cna develop multiple septic emboli in the lungs. Pulmonary infarcts are almost always hemorrhagic due to the dual blood supply to the lungs (pulmonary and bronchial arteries0

Down's

is the most common chrosmosomal anomaly. It is associated with low levels of maternal alpha-fetoprotein and estriol and increased levels of beta hcg and inhibin A. Elevated alpha fetobprteins are seen in multiple gestation, open neural tube defects, and abdominal wall defects.

The hypothalamus

it wears TAN HATS Thirst and Water Balance Adenohypophysis control Neurohypophysis releases hormones produced here Hunger Autonomic regulation Temperature regulation Sexual urges

21-hydroxylase deficiency

is the most common form of congenital adrenal hyperplasia. Affected female infants present at birth with ambiguous (virilized) genitalia like cliteromegaly/fusion of the labioscrotal folds. Male infants have normal genitalia and present later with salt-wasting or precocious puberty (just think so many androgens that can't get them all to estradiol so females have increased testosterone). A high serum level of 17-hydroxyprogesterone is diagnostic.

Glioblastoma multiforme

is the most common primary brain tumor in adults. Areas of necrosis and hemorrhage are seen on gross exmaination. Light microscopy showing pseudopalisaidng tumor cells around areas of necrosis is diagnostic

Dipalmitoyl phosphatidylcholine

is the most importnat indicator of pulmonary surfacant in the fetal lung. Lecithin (phosphatidylcholine) to sphingomyelin ratio >2 indicates good to go.

pC02

is the most potent cerebral vasodilatoir. It decreases cerebral vascular resistance leading ot increased cerebral perfusion and increased intracranial prssure. Patients with COPd usually have low PO2 (hypoxia) and high pCO2 (hypercapnia). Thus their cerebral ciruclation is most likely to be increased.

The incidence

is the number of cases of a disease in a year (regardless of who dies from it)/ the total population AT RISK (this doesn't include the people that already have the disease before measurment was taken)

Cryptococcus neoformans

is the only pathogenic fungus that has a polysaccharide capsule, which can be stained red on mucicarmine stain with clear unstained zone on India ink

Power

is the probability of rejecting a null hypothesis when it is in fact false. It is 1-B where beta is type II error which occurs when researches fail to reject the null hypothethis when it is in fact false.

dysthimia

is the same as persistent depressive disorder. It is often milder, lasting at least 2 years.

The carboxy (end) terminal of the FC portion of IgG

is the site that binds to Fc receptors on neutrophils and macrophages for opsonization and phagocytosis.

Reperfusion injury

is thought ot occur secondary to oxygen free radial generation, mitcohindral damge, and inflammmation damaging the cell membrane.

EHEC O157;H7

is thought to cause at least 80% of cases of HUS in North America and is a common cause of bloody diarrhea. It is assoicated with conusmption of udnercooked beef and has a shiga-liek toxin that inhibits protein synthesis by binding to the 60S ribosomal subunit. This strain is unable to ferment sorbitol (sorbitol free)

Heparin induced thromboyctopenia (HIT)

is treated with direct thrombin inhibitiors (DTIs) like agatroban. Avoid heparin and LMWH in these patients.

Western blotting

is used to identify proteins where protiens are separated by gel elctrophoresis and then an antibody is added to see if protein of interest is there. southern = DNA Northern = RNA

Isolated systolic hypertension

is very common in old age due to decrease in compliance of the aorta and its proxmal branches.

The spinal accessory nerve

is vulnerable to injury in the posterior triangle of the neck. Injury results in weakness of the trapezius muscle, which presents with drooping of the shoulder, imparied abduction of the arm above the horizontal (due to weakness in rotating the glenoid upward), and winging of the scapula.

A communicating hydrocele

is when serous fluid accumulated in the tunica vaginalus in the setting of a patent processus vaginalis. It is painless swelling (vs. varicocele is the bag of worms and is distension of the pampinform plexus).

The PCL

it attaches to the psterior part of the intercondylar area of the tibia and the anterior part of the lateral surface of the medial epicondyle (have to recognize this on MRI from the posterior side) The ACL spans from the anterior portion of the intercondylar tibia to teh posterior medial side of the lateral femoral condyle.

Prostacyclin

it inhibits platelet aggreagation in endothelial cells (is produced by them from prostaglandins). It opposes the fuction of thromboxane A2

Rb

its hyperphosphorylation by CDK4 (cyclin dependent kinase) inactivates it which would occur when proliferation signals occur to get cell into the S phase of the cycle for DNA synthesis.

Nephrotic syndrome

its pathogenesis begins with increased permeability of the glomerular capillary wall to plasma proteins, and thus decreased plasma oncotic pressure of the blood, fluid shift into the interstitium, increased aldosterone synthesis and ADH, with resultant sodium and water retention (exacerbating the edema), hyperlipidemia (to counter for losing protein), and eventually lipiuria.

Elastin

its plasticity and ability to recoil upon release of tension is attributable to a unique form of desmosine cross-linking between four different lysine residues on four different elastin chains.

Streptococcus pneumonaie

its primary virulence factor is its capsule (think of the armor) which inhibits phagocytosis. Cannot cause disease without this capsule

Clostridium tentani

its toxin causes all the symptoms, which travels from the wound up the motor axons to the spinal cord where it causes inhibibition of inhibitory interneurons (GABA down) and unregulated firign of primary motor neurons so you get tismus (jaw stiffness) and risus sardonicus.

Posterior hypothlamus

just remember is the opposite of anterior hypothalamus. So heating and sympathetic

Mycoplasma

lacks peptidoglycan cell walls so woudl be resistant to any attack on cell wals liek penicillins, cephalosporins,carbapenesm, and vanc. Anti-ribosomal agents like tetracycline and marcolides could work.

breast milk

lacks significant Vitamins D and K. Vit K is given as shot at delivery. Infants that are exclusivley breastfed should be supplemented with Vit D (often dont see the sun) to prevent rickets

Broad-specturm anticonvulsants

lamotrigine, levetiracetam, topiramate, and valproic acid should be used in either diffuse or parital subtypes of seizures. These should espeically be used in generalized epilepsy syndromes

Heart failure

leads to RAAS activation due to decreased kidney perfusion. Inactive angiotensin I is converted into active angiotensin II by endothelial bound ACE in the lungs.

RHF

leads to a rise in capillary hydro static pressure thus increasing risk for edema. However, lymphatic drainage can increase to compensate. Edema only results once it is overwhelmed

Live attenuated oral Sabin Poliovirus

leads to a stronger mucosal secretory IgA immune response in comparison to the inactivated salk vaccine. This would offer protection at the site of viral entry by inhibiting attachment to intestinal epithelial cells

Cori disease/debranching enzyme deficiency

leads to accumulation of glycogen with abnormally short outer chains (limit dextrins) due to the inability to degrade alpha-1,6-glycosidic branch points. Patients present with hypoglycemia, ketoacidosis, hepatomegaly, and muscle weakness and hypotonia.

PCA occlusion

leads to contralteral homonymous hemianopsia with macular sparing

Esophagus on CT

located between the trachea (air filled) and the vertebral bodies in the superior thorax.

Thiamine (B1) deficiency

leads to diminished ability of cerebral cells to utilize glucose (hence wernicke's encephalopathy where ophtlamoplegia, ataxia, and confusion result). Pyruvate dehydrogenase, alphaketoglutarate dehydrogenase and transketolase all need B1 to function. Thiamine deficiency can be diagnosed by measuring erythrocyte transketolase activity.

Cutaneous Antrax

leads to formation of necrotic skin wound with an erythematous and edematous border. It is most commonly acquired occupationaly in those who handle livestock or due to biological weapon (but this is pulmonary with nearly 100% mortality)

Aldolase B deficiency

leads to fructose intolerance with accumulation of toxic metabolite fructose-1-P. Patients have hypoglycemia when fructose or sucrose is consumed (F-1-P takes up phosphates and gluconeogenesis can't work)

constriction of efferent arteriole

leads to increased GFR due to incresed hydrstatic pressure of the glomerulus and decreased RPF thus causing an increased filtration fraction. Note though, when RPF is low secondary to severe efferent arteriolar constrriction, there is substantially increased oncotic pressure in the capillary which results in an overall decrease in GFR (most impoortnat to understand the first part) Regardless, the filtration fraction will always increase wiht increased efferent arteriole constriction

Vitamin B12 deficiency

leads to subacute "combined" (for both an ascending and descneding tract) degeneration. Degeration of myelin sheaths for both the lateral corticospinal tract and the dorsal columns. Presents as loss of position and vibration sense, ataxia, and spastic paresis.

Macrophage-mediated immunity to TB

led by Th1 helper cells driving granuloma formation through the release of IFN-gamma thus activating macrophages to release TNF-alpha. IL-12 is needed to get the T cells to go to the Th1 type.

Pacemakers

left ventricular leads in biventricular pacemarkers course through the coronary sinus (easiest way to get to that side) which resides in the artrioventricular groove on the posterior aspect of the heart,

Healthcare proxy/power of attorney

legally designated person who can overrule all family members in the event that the person loses decision-making capacity.

The pirform recesses

lie just inferior to teh internal laryngeal nerve a branch of the superior largneal nerve (CN X) and can be injured when trying to get food that is stuck in the piriform reccess which would lead ot problems with the cough reflex.

Gastroduodenal artery

lies along posterior wall of duodenal bulb and likely eroded by posterior duodenal ulcers. Whereas, anterior ulcers are more likely to cause perforation. Erosion of the gastroduodenal artery can cause life-threatening hemmoorage.

descending aorta

lies directly behind the esophagus and can be seen on transesophageal echocardiography

SCID (Severe Combined Immune Deficiency)

life-threatening that presents when mom immunity wears off. It is characterized by combined T and B cell dysfunction. Characterized by severe viral and bacterial infections, mucocutateous Candidiasis, persistent, diarrhea and failure to thrive. Laboratory findings include absent T cells and hypogammaglobulinemia. Thymic shadow usually not present due to T cell deficiency.

Inactivated influenza vaccine

like all innactivated vaccines, predominantly generates a humoral immune response instead of a cell-mediated immune response, thus creating antibodies against HA which bind HA and prevent its from binding the host cell thereby preventing viral entry into cells.

Selective Cox 2 inhibitors

like celecoxib relieve pain and lower the risk of bleeding and gastric ulceration that NSAIDS cause.

Second-generation antihistamines

like fexofenadine have minimal sedative and antimuscarininc effects are so are more ideal for patients with say already blurry vision or frequent falls. Remember this is likely why diphenhydramine is on Beer's list for the older adult

alpha-adenergic agonistis

like phenylephrine and methoxamine. increase systolic and diastolic blood pressure by stimulating alpha 1 adrenorecpetors, casuing vasoconstriction. The elevated blood pressure then causes a reflexive increase in vagal tone, resulting in decreased heart rate and slowed AV node conduction.

A single-stranded postive-sense RNA virus

like rhinovirus could be infectious without any other parts since all it needs is host machinery and then boom.

Integral membrane proteins

like those G protein receptors that use cAMP (TSH, FSH, LH, ACTH) contain transmembrane domains composed of several alpha helixes with hydrophobic amino acids such as valine, alanine, isoleucine, methionine, and phenylalanine (because they are in the membrane)

Streptococci

like to grow on the fibrin-palatelet nidus of an already damaged/disputed valve.

0-4 hours post MI

little to no change on light microscopy. Takes about 4 hours for the early sings of coagulative necrosis to kick in.

Candida infection in HIV

localized defense against candida is performed by T cells, whereas systemic infection is prevented by neutrophils. For this reason, localized candidiasis is common in patients who have HIV, but neutropenic patients are more likely to have systemic form of disease.

Cerebral amyloid angiopathy

looking for an older adult with LOBAR hemorrhage

NSAIDS and loop diuretics

loop diuretics work by inhibiting the NA-K-2CL tranpsorter, but they also increase porstaganding synthesis thus increasing renal blodo flow leading to increaesd GFR. Thus concurrent use of NSAIDs will block the direutetic response significantly

Conversion disorder

loss of sensory or motor funciton (paralysis, blindness, mutism), often following an acute stressor. Symptoms are not intentionally produced

Rett sydnrome

loss of speech and motor skills, deceleration of head growth, and the classic stereotypic hand movements after a period of normal devleopment. It mainly affects girls and is assoicated with mutations in the MECP2 gene. X-linked ( boys die in utero)

Health Maintenance Organization (HMO)

low monthly premiums, low copays and deductibles, and low total cost for the patient. They reduce utilization by confinding patients to a limited panel of providers, requiring referral from PCP for specialty care. Point-of-service plans are similar to HMO's in that they require patietns to have a primary care provider and obstain referrals for specialissts. HOwever, unlike HMO, patients may also see out-of-network providers, but these costs are typically high and higher premiums too. Preferred provider organziatoin: offer the most flexible choices of both in and out-of -network providers. typically higher premiums and deductibles here though

Lymph drainage

lymphatic draining of teh rectum proximal to the anal dentate line occurs via the inferior mesentergc and internal illiac lymph nodes. Areas distil to the dentate line drain primarily into the inguinal nodes.

Human rabies

main reservoir is bat and wild carnivores. Agitation and spasms (often painful pharyngeal) progressing to coma with weeks of expsorue is storngly suggesting of rabies encephalitis. Prophylactic innactivate vaccine is give to those at high risk who who have possibly been exposed by a bite (along with IgG against rabies).

Thalamus

major relay for all ascending sensory information except olfaction. has many nuclei to know

Choriocarcinoma

malignant tumor that arise from the trophoblast (cyncytotorphblasts and syncytiotrophoblasts) without villi .It is most commonly preceded by normal pregnancy but can occur following any pregnancy (molar, ectopic, aborted). The tumor causes abnormal vaginal bleeding, uterine enlargment, and signifcantly increased beta hcg levels. It rapidly invades the walls and often spreads hematogenously (an exception) to the lungs! (often presents with dyspnea/hemoptysis

General sensation from anterior 2/3 of the tongue

mandibular division of the trigeminal nerve.

Adrenal crisis

manifested by vomitting abdominal pain, weight loss and HYPERPIGMENTATION (increased ACTH leads to increased MSH cells) ideal treamtment for someone in crisis would be stress dose corticosteroids.

Autosomal dominant polycystic kidney disease

manifests in patients 40-50 years old with enlarged kindeys, hypertesion, and renal failure. In newborns, the kidneys are of normal size and the cysts are too small to visualize on ultrasunography

Chronic renal allograft rejection

manifests months to years afterwards and presents with worsening hypertension (ischemic kidney) and a slow progressive rise in serum creatinine. It occurs due to a chronic, indirect immune response to donor alloantigens and results in obliterative intimal thickening, tubular atrophy, and interstitial fibrosis

HUS

manifests with acute kidney, microangiopathic hemolytic anemia, and thrombocytopenia. E.coli O157: H7 or shigella.

Crest syndrome (limited scleroderma)

manifests with calcinosis, Raynduads, esophageal dysmotility (often GERD), sclerodactylyl, telangiectasis. Anti-centromera antiboides are specific for CREST. Anti-DNA topoisomerase I (SCL-70) are specific for systemic sclerosis.

MS

manifests with various self-limiting symptoms, usually the patient is 20-30 years old. Teh most common initial symptoms are optic neuritis, internuclear opthalmoplegia and sensory deficits. Symptoms usually worsen with heat exposure. Its pathogenesis involves an autoimmune T cell and antibody-mediated response targeting oligodendrocytes and myelin in the cNS, leading to slowed nerve conduction deficits.

Acute transmural MI

marked by ST-elevation and subsequent Q-wave formation and is most likely caused by a fully obstructive thrombus superimposed on a ruptured athersclerotic plaque. Stable angina woudl be a stable atheromatous lesion with no overyling thrombus but occlusion greater than 75%

COPD

markedly reduced expiratory airflow velocity (FEV1/FVC < 80%), increased resiudal volume, and limitaiton of tidal volume due to hyperinflation. Chonic bronchitis and/or emphsematous destruction of interalveolar walls are responsible for airflow limitation

Cromolyn and nedocromil

mast cell stabilizing agents that inbhit mast cell degranulation independent of stimuli present. Are considered second line (first-line is inhaled glucocorticorids) for treamtnet of allergic rhinitis and bronchial asthma.

Causes of Down's

maternal nondisjuction (95%), unbalanced unbalanced Robertsoninan (4%) or mosaicism (1%).

Coronary blood flow

maximum flow occurs during diastole and decreased blood flow with ventricular systole. Shorter duration of diastole during tachycardia becomes the major limiting factor for coronary blood supply to mycoardium.

RVH

may be caused by primary pulmonary hypertesnion, espeically in a young female (20's to 40's)

Use of oxygen therapy in NRDS

may be complicated by retinopathy or prematurity. It can leading to blindness.

serum Amylase

may be increased in patients with suppurative parotitis caused by S. Aureus (but lipase is normal- no pancreatitis)

Enhancers/repressors

may be located anywhere upstream, downstream or even within a transcribed gene. In contrast, promoter regions are typically located 25 to 70 bases upstream from their assoicated genes.

Crest

may cause pulmonary hypertension as it narrows the lumen through increases collagen deposition. Patient woudl rpesent with cor pulmonale and some of teh CREST symptoms.

Femoral neck fracture

may compromise the vulnerable medial fermoral circumflex artery which could lead to osteonecrosis of the femoral head.

HIV patients

may experience a reactivation of latent EBV, with a resulting increased incidence of EBV-induced lymphoproliferative disorders like Burkitt lymphoma.

Anemia in woman of childbearing age

most commonly is iron deficiency anemia due to menstrual blood loss. It is assoiciated with decreased serum ferritin, increased serum transferrin, and increased TIBC

Dissection of the axillary lymph nodes

may injure the long thoracic nerve, presenting with weakness of the serratus anterior with winging of the scapula and impaired abduction of the shoulder past the horizontal position (both serratus anterior (primary) and trapezius are needed to rotate the glenoid cavity of the scapula at this point.

Androgenic steroid abuse

may lead to erythrocytosis (reason why men have higher hematocrit), testicular atrophy, acne, and virilization in women (clitoromegaly, hirsutism)

21-hydroxylase deficiency

may not necessarily present with salt wasting in males but rather at age 2-4 years with early virilizaiotn, increased linear growth, and elevated levels of 17-hydroxprogesterone and androgens. Treatment of congenital adrenal hyperplasia would involve low doses of exogenous corticosteroids to suppress excessive ACTH secretion

Vitamin A

may offer benefit in the treatment of measles (should be given)

Splinter hemorrhages

may signify endocarditis

Caspases

mediate apoptosis through 1. Intrinsic mitochondrial pathway (leakage of cytochrome c when BCL-2 is inactivated), 2. extrinsic receptor-ligand pathway (FAS Ligand in negative selection of T cells in the thymus), 3. Cytotoxic T cell perforin and granzymes that activated caspases.

delayed-type hypersensitivity reactions

mediated by T cells. occurs one to 2 days following exposure to antigen (why you wait 48 hours to read PPD) Antigen taken up by APC, presented to T cell, Th1 response (through IFN-gamma of course) activating macrophages thus walling off the thing. Another example of this is contact dermatitis. Note: other hypersensitivity reactions usually take mintues to occur.

TNF-alpha

mediates cachexia

Down's issues

mental retardation, facial dysmorphisism, single palmar crease, endocardial cushion defects, duodenal atresia, and increased AML and ALL risk.

Smoking and changes in cells in the respiratory tract

metaplasia from chronic irritation. You go from columnar cells with cilia to squamous epithelial cells becuase these are more resistant to smoking damage.

Homocystinuria

most commonly caused by a defect in cyathionine synthase, resulting in an inability to from cysteine from homocysteine. Cysteine therefore becomes essential, adn homocysteine buildup leads to elevated methionine levels. Remember, homocysteine is prothombic, resulting in premature thromboembolic events like Acute coronary syndrome in these patients.

Blotchy red muscle fibers

mitochrondial myopathies. Also known as red ragged fiber diseases. EM shows increased number of large, abnormally shaped mitochondria. Types: Myoclonic epilepsy with ragged red fibers (MERRF), Leber optic nueropathy (blindness), and mitchondrial enceophalopathy with stroke-like episodes and lactic acidosis (MELAS). ONLY MATERNAL MITOCHONDRIA ARE TRANSMITTED TO FETUS.

Diabetic nepropathy

moderaly increased albuminuria is the earliest manifestaiton. This is how we screen.

Riluzole

modestly increases survival by decreasing presynpatic glutamate release in ALS. Lough Gehrig disease, give riLOUzole.

Adrenal Medullary Chromaffin Cells

modified postganglionic sympathetic neurons (neuroendocrine) that release catecholamines into the blood stream in response to acetylcholine release by preganglionic sympathetic neurons.

Hematogenous osteomyelitis

more common in children and usually affects the metaphysis of long bones due to slower blood flow and capillary fenestrate in this region. Without proper treatment, the infection can progress to chronic suppurative osteomyelitis

Asbestos exposure

more commonly assoicated with bronchogenic carcinoma over mesothelioma (they love this) Associated with pleural plaques that may be calcified. Don't forget about asbestos bodies/ferruginous bodies.

Statins

most are metabolized by cytochrome P-450 with the exceptoin of pravastatin. Comconmintant adminstraiton of drugs that inhbit statin metabolims (say like a macrolide like erythromycin) is assoicated with increased incidence of statin-induced myopathy and rhabdomyolysis. Acute renal failure is a possible sequaela of rhabdomyloysis

Hypertrophic cardiomyopathy

most common cause of V-fib in individuals younger than 30 and is the most common cause of sudden cardiac death in a young athlete. A characteristic massive cardiac hypertrophy is seen.

Autosomal dominant polycystic kidney disease

most common hereditary cause of renail failure in adults. A positive family history and numerous kidney and liver cysts (oftne seen by 3rd to 4th decade of life) help makes the diagnosis.

CFTR gene mutation in CF

most common mutatoin is a 3 base pair deltion that removes a phenylalanie at amino acid position 508 (delta F508). This mutation impairs posttranslation processing of CFTR resulting in shunting of CFTR toward the proteasome with complete abscence of the protein in the apical membrane.

Beta thlasemmia

most common thalassemia in patients of mediterannean descent (Italian for example). Asians are more likely to have alpha-thalassemia. Beta is caused by mutations that result in defective transcription, processing, and translation of beta globin mRNa. This leads to defieicny of teh beta-globin chains required for normal hemoglobin synthesis. Hence you have a microcytic anemia with increased HbA2

Ulnar injury

most commonly occurs at the elbow and may cause sensory loss in the medial 1 and 1/2 digits of the hand. Patients can also have the ulnar claw on extension of fingers and weakness on wrist flexion/adduction, and flexion of the 4th/fifth digits.

Hemolytic disease of the newborn (erythroblastosis fetalis)

most commonly occurs due to maternal sensitization to Rh antigens during a prior pregnancy with Rh(D)+ fetus. In subsequent Rh(D)+ pregnancies, maternal anti-Rh(D) IgG antibodies cross the placenta and cause fetal hemolysis. Clinical findings include anemia, jaundice, generalized edema (hydrops fetalis), nucleated erythrocytes, and extramedullary hematopoiesis

CMV

most enveloped nucelocapsid viruses acquire their lipid bilayer envelope by budding through the plasma membrane of the host cell. Exceptions include herpesviruses, which bud through and acquire their envelope from the host cell membrane.

Rhabdomyomas

most frequent primary caridac tumor in childrne. Assoicated with tuberous slcerosis.

Immune memory to Influenza Virus

most importantly to prevent infection are anti-hemagglutinin antibodies.

Pilocytic astrocytoma

most likely a pilocytic astrocytoma or a medulloblastoma in a child in the cerebellum (medulloblastomas are located exlcusively here) These two tumors can be differentated on brain imaging. Pilocytic astrocytomas have both cystic and solid features, while medulloblastomas are always solid.

West Nile Virus

most likely diagnosis in elderly patient who has febrile viral illness with a rash and neurologic manifestations, including encephalitis assoicated with flaccid paralysis. It is a positive-sense, single strand flavivirus tranmissted by mosquitos, most often in the summer

Asymptomatic patient with IgG antibody to Hep A

most likely had prior infection in childhood that was subclinical (or anicteric)- often the case in childhood. It occasionally can present as an acute-self-limited illness characterized by jaundice, malaise, fatigue, anorexia, nausea, vomiting, RUQ pain, or an aversion to smoking.

Congenital defect in lower part of the interatrial septum

most likely the result of failure of the endocaridal cushions of the ateriovenricular canal to fuse, resulting in an ASD (common in Down's)

Gastric ulcers

most occur over the lesser curvature of the stomach, at the border between acid-secreting and gastrin-secreting mucosa. The left and right gastric arteries run along the lesser curvature and are likely to be penetrated by ulcers causing gastric bleeding.

K+ in the renal tubule

most of the K+ filtered is reabsorbed in the proximal tubule (67%) and the ascending loop of Henle (25% through the Na/K+/2CL-). This happens even in states of hyperkalemia. It is in the late distal tubule and the cortical collecting ducts where K+ concentration in the urine is regulated. K+ depletion stimulates alpha-intercalated cells to reabsorb extra potassium (think H+/K+ antiporter) whereas principal cells secrete K+ under conditions of normal to increased K+ load (think the channel there. Remember Aldosterone is activated by hyperkalemia)

The mammilary body

most often affected in Wenicke's encephalopathy from thiamine deficiency and COAT.

Lightning injury

most often death occurs due to fatal arrhythmias.

Microglia

move to the area of ischemic infarct approximately 3-5 hours after the onset of ischemia and phagocytize the fragments of neurons, myelin and necrotic debris. A cystic space replaces the necrosis, and astrocytes form a glial scar around the periphery afterward.

Acute disseminated (post-infectious) encephalomyelitis

multifocal pervientricular inflammation and demyleination after infection (commonly measles or VZV). Or certain vaccinatinos (rabies, smallpox)

Horizontal trasection of the rectus abdominus during a c-section

must be performed with caution as the inferioir epigastric arteries (comming off the iliac artery) enter this msucle at the level of the arcuate line. Below this line (as in where a c-section woudl occur) they are susceptible to injury.

Alport Syndrome

mutation in type IV collagen X-linked leads to glomeruloneprhitis, eye problems, and sensorineural deafness. Can't see, can't pee, can't hear a buzzing bee.

2,3 BPG

mutations that result in loss of 2,3 BPG binding binding with RBCs cause HbA to resemble HbF with increased affinity for oxygen.

BRCA1 and 2

mutations to them are implicated in breast and ovarian cnacer. they are tumor supressor genes that play a role in DNA REPAIR (particularly double stranded DNA breaks.

Radial nerve injury due to midhumoral fracture

needs to raise concern for deep brachial artery injury as well since it runs along with the radial nerve at this point.

Vincristine toxicity

neurotoxicity due to failure of microtubule polymerization in neuronal axons.

How does ischemia kill cells

no 02 so no ATP so Na/K pump doesn't work anymore

Complete hydatidiform mole

no fetal structures, and composed of large, edematous, and diosrreded chorionic villi that appear grossly as a bunch of grapes. Embryonic tissue jsut have paternal chromosomes.

RPGN that is pauci-immune

no immunoglobulin or complement deposits on the BM. This is often assoicated with granulomatosis with polyangitis (Wegner's) but can also be idiopaththic - c-anca- anti-neutrophil cytoplasmic antibodies. RPGN would have crescent formation on LM. Otheriwse, RPGN could be assoicated with good pastures- linear immune depositoin or pretty much any of the other neprhitis things like SLE, PSGN, IGA neropathy but would have granular apperance on IM.

Zero-order kinetics

no matter the concentraiton, a constant amount of drug is metabolized per unit of time.

Insomnia treatment

nonpharmacologic treatments for insomnia include sleep hygeine, stimulus control, relaxation, sleep restriction, and cognitive behavioral therapy. Stimulus control focuses on eliminating stimulating bedroom activities and getting into bed only when sleepy.

Coagulation times

normal bleeding time indicates adequate platelet hemostatic function. A normal activated partial thromboplastin time (aPTT) indicates an intact intrinsic coagulation system. Prolonged prothrombin time in the setting of normal aPTT indicates a defect in the extrinsic (like Factor VII) coagulation system.

IgE receptor on mast cells

normally binds the Fc portion of circulating IgE antibodies. When cross-linking occurs due to an antigen exposure, an aggregation of IgE receptors occurs which leads to an intracellular signal being sent to cause allergic response

duodenal ulcers

not assoicated with incrased risk for carcinoma of the duodenum.

Fat emboslism

occlusion of the pulmonary microvessels by fat globules is early finding. They also can escape and occlude areas of the brain (confusion) and skin (petichiae)

Pringle maneuver

occulsion of the portal triad aka hepatoduodenal ligament. It can help distignuish source of RUQ bleeding. if hepatic bleeding persists, IVC or hepatic veins are likely culprit. If it stops, likely something in the portal triad

The embryonic tesits

occur due to SRY gene on Y chormosome and they secrte testosterone and müllerian ducts that normally give rise to the internal genitalia in the female fetus. Testosterone mediates development of male internal genitalia and DHT mediates development of the external genitalia.

Direct inguinal hernia

occur most commonly in older men are are caused by weakness of the tranversalis fascia in Hesselbach's triangle. They are medial to the inferior epigastric vessels, protude only through the external inguinal ring, and are covered by the external spermatic fascia.

Teratoma

occur most frequently in females aged 10-30 (age is big for these ovarian tumors). They have multiple cell types on histology - hair follicles, skin, teeth, bones, and other tissues.

Acute Cardiac transplant rejection

occurs a couple-few weeks folliwng transplantation and is primarily a cell mediated process. On biopsy, would see a dense mononuclear lymphocytic infiltrate. Treatment with immunosupressive drugs is meant to avoid this rejection

Malignant hyperthermia

occurs after administration of inhalation anesthetics and/or succinylcholine to genetically susceptible individuals. It is treated with dantrolene that blocks ryanodine receptors and prevents the release of oCa into the cytoplasm of skeletal muscle fibers.

Familial Retinoblastoma

occurs as a result of mutations in each of the two Rb genes (two hits). These patients have increased risk of other cancers, especially, osterosarcomas.

Wrinkling in aging

occurs because of decreased collagen fibril synthesis and net loss of dermal collagen and elastin.

Lithium induced diabetes insipidus

occurs becuase lithium cna antagonize the action of vasopressin in the collecting ducts. pharm

Confounding Bias

occurs when the exposure-disease relationship is muddied by the effect of an extraneous factor that has correlations with both the exposure and the disease. Confounding bias can result in the false association of an exposure with a disease.

Peripheral neuropathy

occurs by 2 mechanisms. Non-enzymatic glycosylation: leads to increased thickness, hyalinization, and narrowing of the walls of the arteries. In addition, intracellualr hyperglycemia leads to sorbitol accumulation which facilities water influx into the cell resulting in damaged to axons and Schwann cells.

Glucose transport into cells

occurs by means of facilitated diffusion through the glut transporters. The transporters are stereoselective and have a preference for D-glucose

Extrahepatic biliary atresia

occurs due to complete obstruction of extrahepatic bile ducts. Patients develop persisent jaundice beginning around the 3rd or 4th week of life, accompanied by dark urine, acholic stools, and a conjugated hyperbilirubinemia. Liver biospy would show intrahepatic bile ductular proliferation, portal tract edema and fibrosis, and parenchymal cholestasis

Celiac sprue

occurs due to hypersensitvity to gluten and manifests with symptoms of malabsorption including diarrhea, steatorrhea, flatulence, and nutreint defciencies. It is most often diagnosed with serologic testing showing IgA anti-endomysial and anti-tissue transglutaminase antibodies. Small bowel biopsy shows atrophy of the villi, flatenning of the mucosa, and chronic inflammation of the lamina propria with crypt hyperplasia.

pericarditis 2-4 days after MI

occurs due to inflamamtory reaction to cardiac muscle necrosis. the later onset one (< 4 weeks is autoimmune and Dressler's sydnroem)

A-fib

occurs due to irregular, chatoic electrical activity within the atria and presents with absent P waves, irregularyly irregular R-R intervals, and narrow QRS complexes. The AV node refractory period regulates the number of atrial impulses that reach teh ventricle to cause contraction.

Subarachnoid hemorrhage

occurs due to rupture of saccular (berry) aneursym or ateriovenous malformation. Severe vasopasm 4-12 days after the initial insult is the major cause of death in patients recovering from the SAH. Nimodipine, a selective calcium channel blocker, is often prescibed ot prevent this vasopasm.

APL t(15;17)

occurs due to transloaction of the gene for the retinoic acid receptor alpha from chromosome 17 to chromosome 15. This abnormal fusion gene inhibits the differentiation of myeloblasts, and triggers the development of AML.

Tumor lysis syndrome

occurs during chemotherapy where there is massive cell turnover and destruciton which can lead to hyperuricemia and uric acid crystals. Uric acid is soluble at phsyilogic pH (lost proton) but tends ot precipitate in acidic environments (gains proton and charge) aka in the collecting ducts where urine pH is lowest. Alklanization of the urine and hydration help prevent.

S3

occurs during diastole and is best heard with the bell of the stehoscope over the cardiac apex while the patient is in the left lateral decubitus position at end expiration. In patinets > 40, it suggests ventricular enlargement (chronic mitral regurar, arotic regurg, and heart fialure from dilated or ischemic cardiomyopaty)

Hemorrhagic cystitis

occurs during drug therapy with cyclophosphamide or ifosfamide and is caused by the urinary excretion of the toxic metabolite acrolein. It can be prevented by aggressive hydration, bladder irrigation, and MESNA which binds acrolein in the urine.

Reye syndrome

occurs in children with febrile illness treated with salicyclates (asprin). It consists of hepatic failure and encephalopathy (due to the hyerpammonemia caused by hepatic failure). The characteristic histological finding is microvesicular steatosis of heaptocytes wihtout inflamamtion or cerebral edema.

Dystrophic calcification

occurs in damaged or necrotic tissue in the setting of normal calcium levels; metastatic calcificaiton occurs in the normal tissue in the setting of hypercalcemia, Often seen in aging.

X-inactivation

occurs in females and reuslts in coversion of inactivated X chormosomes into compact heterochromatin that is called a Barr body at the periphery of the nucleus It is heavily methylated and has deacetylated histones. As you know, heterchormatin is inactive and not very well transcribed.

Stapylococcal scalded skin syndrome

occurs in infants and children due to production of the exotoxin exfoliatin. It causes widespread epidermal sloughing, especially with gentle pressure (nikolsky's sign)

Negative selection for T cells

occurs in the thymic medulla. It is necessary to eliminate T cells that bind to self MHC or self antigens with overly high affinity. If they survive can lead to autoimmune disease

Enterobiasis

occurs most frequently in school-aged children and presents with perianal pruritus. Diagnosis is made by the Scotch tape test (the pinworm eggs cause anal itching and are put here by the adult worm). Tx: Albendazole is first line.

Menopause

occurs on average at age 51 and is diagnosable retrospectivley after 12 months of amenorrhea. An elevated serum FSH level confirms the dx. Menopause causes HAVOCS: Hot flahses, atrophy of the Vagina, Osteoporosis, CAD, and sleep disturbance

stable angina

occurs when a plaque occludes at least 75% of the coronary artery. Acute coronary syndrome on the other hand (unstable angina, myocardial infarciton, sudden ardiac death) resutl from the pqlue changing with superimposed infarciton.

Opsonization

occurs when host proteins such as immunoglobulins (IgG) or complement (C3b) bind to foreigns cells such as bacteria, enhancing phagocytosis.

Coagulative necrosis

often seen due to lethal tissue ischemia. Think MI as being prototypical. The exception is ischemic celld eath in the CNS which causes liquefactive necrosis.

Functional mitral regurg

occurs when the murmor disapperas after volume overload is corrected- its transient and not something actually wrong with the valve. Could be due to say transient LV dilation that could separate otherwise normal mitral valve leaflets. Reducing pre-load would totally eliminate the murmur.

Superior Mesenteric Artery Syndrome

occurs when the transverse portion of the duodenum is entrapped between the SMA and aorta, causing symptoms of partial intestinal obstruction.

Phosphorylation of serine and threonine residues

of insulin receptor and insulin receptor substrate by serine kinase leads to insulin resistance, which can be induced by TNF-alpha, catecholamines, glucocorticoids, and glucagon

The common cardinal veins

of the developing embryo ultimately give rise to the superior vena cava which can be seen on CT posterolateral to the ascending aorta and anterior to the right pulmonary artery

Urethritis in a young man

often can be due to co-infection with N. gonorrhoeae and chlamyida trachomatis, both causing dysuria adn mucopurlent urethral discharge. therefore we treat for both with ceftriaxone (for N gonorrhoeae) and doxycycline or azithromycin (macrolide) for C trachomatis

Appendicitis

often caused by obstuction of the lumen of the appendix by a fecotlith.

Traumatic aortic rupture

often caused by rapid declaration that occurs in MVCs. The most common site of injury is the arortic isthmus, which is tethered by the lignmentum arteriosum making it more immobile so more prone to injury.

Secondary Bacterial pneumonia

often caused by strept pneumo, staphylococcus aureus, and H. flu.

Sleep deprivation in physicians

often causes congnitive impairment, resulting in medical errors. Physicians must self-regualte their workloads to promote patient safety.

Herniation of the uncus

often compresses CN III on that side leading to dilated pupil.

Patients with MS

often develop spastic bladder a few weeks after developing an acute lesion of the spinal cord. These patients present clincially with increased urinary frequency and urge incontinence. Urodynamic studies show the prescence of bladder hypertonia due to decreased negative feedback from UMN. If a LMN were to occur flaccid bladder would occur with a large residual volume.

Candida vaginitis

often due to antibitoics supressing the normal gram-positive lucky Lactobacilli that allows for candida overgrowth. Other potential causes include pregnancy, systemic corticosteriod use, diabetes mellitus, and immunosupression. Would see a thick, cottage cheese like discharge in normal pH (3.8-4.5)

Prefrontal lobe injury

often experience behavioral and personality changes, secondary to impairment of organizational, restraint, and motivational systems. Often manifests as disorganized, disinhibited, and apathetic types

Henoch-Schönlein purpura

often follows URI in children Symptoms: Classic triad Skin: palbable purprua on buttocks/legs arthralgias GI: abdominal pain Assoicated wthi IgA nerphropathy (Berger disease)

Anterior shoulder dislocation

often injures the axillary nerve.

Colonic Diverticula

often involve the sigmoid and develop due to increased intralumial pressure (pulsion) created during strained bowel movements (due to chornic constipation) causing outpoucing of the mucosa and submucosa (false diverticula). Typically seen in older adults and be be aysmptomatic or present with hematochezia or diverticulitis

Meckel diverticulum

often manifested by lower gastrointestinal bleeding in baby. It often contains ectopic gastric tissue causing the bleeding and can be detected by a 99mmTc-PERTECHNETATE scan.

Renal calculi

often occure when the wrong factors are present. Increased concentration of calcium, phosphate, oxalate, and uric acid promote salt crystallizaiotn, whereas increased citrate (binds calcium) and high fluid intake help prevent formation.

Intussusception

often occurs in children less than 2 years of age and in the region of the ileocecal valve. It manifests witih intermittent severe colicky abdominal pain, currant jelly stools, and sometimes a palpable mass in the right low abdominal quadrant.

Urethral injury

often occurs in the posterior urethera due to pelvic fractures while in the anterior urethra its due to straddle injuries. Symptoms would be inability to void with a full bladder sensation, a high-riding boggy prostate, and blood at the uretheral meatus. If urethral injury is suspected, don't place foley as could make injury worse. In this case, the answer was C since it was a pelvic fracture (posterior urethra) and the part at the prostate is well protected. D (the bulbous segment) is part of the anterior urethera and susceptible to straddle injury.

Vitamin B12 deficiency

often presents with megaloblastic anemia (impaired DNA synthesis) and neurologic deficits (impaired myelin synthesis). Characteristic neurolgoic findins include subacute combine degneration of teh dorsal columns and lateral corticospinal tract. Elevations in methylmalonic acid and homocystein would be diagnostic.

Hepatitis A

often transmitted by the fecal-oral route and oftne occurs from contaminated food or water, with raw of steamed shellfish a common culprit in the US

Corticosteroids

on WBC acutely, they will lead to an increased neutorphil count due to demmargination or neutrophils previously attached to the vessel wall. However, WBC would have decrease lymphocyte, monocyte, basophil, eosinophil counts

Infectious mono

on blood smear, atypical lymphocytes can be seen which are CD8+ cytotoxic T cells attempting to destroy virally infected B cells.

Bcl-2

on chromosome 18 and what is traslocated in follicular lymphoma. It prevents apoptosis and programed cell death allowing the tumor cells to survive.

Meningioma

on histopathology whorled pattern of cellular growth that forms nest, which may calcify into round, psammoma bodies.

Costochondritis

on the DDX for CP. It is reproducible with palpation adn worsened with changes in position.

K-ras

oncogene that increases sthe size of adnomatous polyps and icnrases risk for adenocarcinoma

Fibrinolytics

one example is tPaA. It works by increasing the formation of plasmin from plasminognen. They are often used in treatment of acute MI. Restoration of blood flow can lead to arrhthmias called reperfusion arrhthmias but these are usually benign.

Jervell and Lange-Nielsen sydnrome

one of the most common cause of congential long-QT syndromes. This is an AR conditons accompanied by neurosenosry deafness. SCD is risk due to torsades.

alpha-fetoprotein

one of the most common reasons for elevated levels is underestrimation of the gestational age (do U/S to confirm)

Ankylosing spondylitis

one of the seronegative spondyloarthopathies along with reactive arthritis, psoriatic arthritis, and arthritis associated with inflammatory bowel disease- individuals expressing HLA B27 are at an increased risk for these boys. Characterized by morning stifness, low back pain,destruction of articular cartilage resultign in fusion of teh axial joints, tender sacroliac joints, narrowing of joints spaces in sacroiliacs and a possible bamboo spine . Seen in young men and middle aged men.

Familial hypercholesterolemia

onfe of the most common AD disorders causing LDL receptor mutations causing unerepression of LDL receptors in the liver. It can lead to accelarated atheroslcerosis and early-onset coronary artery diseaes

Neuroblastoma

opsoclonus-myoclonus (eyes in various directions and hypotonia and myoclonus) is a paraneoplastic syndrome assoicated with medulloblastoma, which often presents as a retroperitoneal mass. Its is associated with an increased number of N-myc gene copies and is the most common extracranial neoplasm in children (neural crest derived- comes from the adrenal medulla)

The pupillary light reflex

optic nerve is afferent limb and oculomotor nerve is the efferent limb.

External hemorrhoids

orginate below the dentate line, are covered by modifed squamous epithelum and have cutaneous (somatic) innervation from the inferior rectal nerve, a branch of the pudendal nerve (hence sensitive to pain, tmperature, and touch). The internal hemorhoids on the other hand are above the dentate line adn are innervated by inferior hypogastric plexus (autonomic only- just senstiive to stretch not pain)

The splenic artery

orginates from the celiac artery and gives off several branches (including the pancreatic, short gastric, and left gastroepilopic artereis0. Due to poor anastomoses, the gastric tissue supplied by the short gastric is most vulnerable to ischmemia following splenic blockage

RCC

orginates from the epithelial cells of tHE PROXIMAL RENAL TUBULES. Clear cell is the most common subtype.

Osteoclasts

originate from macrophages and monocytes. M-CSF and nuclear factor kappa-b ligand (RANK-L) play an importnat role in their formation.

the psoas muscle

originates from the anterior surface of the transverse processes and lateral surface of the vertebral bodies (T11-L5). It serves to flex the hip and also somewhat to lateral rotation and abduction of the thigh. It can becomes infected with abscess espeically in a patient with HIV

Osteocytes

osteocytes have long inctracanalicular processes that extend through the ossified bone matrix. These cytoplasmic processes send signals to and exchange nutrients and waste products with the osteocytes within neighboring lamellae via GAP JUNCTIONS. Osteocytes can also sense mechanicl stress adn send signals to surface osteoblasts to modulate activity.

Pulmonary anthrax

otherwise known as woolsorters disease, is cuased by inhalation of spores most commonly while working with goat haair or hides. Hemorrhagic mediastinits is evident by widened medistinum on chest x ray. Long chains and rods (medusa head) Antiphagocytic capsule is D-glutamate.

A degenerate genetic code

our genetic code is degenerate meaning there are more codons (61) than amino acids (20). Many tRNA anticodons can bind to a couple of different codons for the same amino acid (wobble)

The Hardy weinberg equation

p+q = 1 p^2 + 2pq +q^2 = 1 q^2 would be the rare autosomal disease prevalence

Li-fraummeni syndrome

p53 mutation that predisposed to varioius cancer types at a young age (osteosarcoma, breast, leukemia, and adrenal glands.

Post-herpetic neuralgia

pain after resolution of the seeable varicella zoster virus reoccurence.

S1 compression by vertebral disc herniation

pain/sensory loss down the posteior thigh and calf to the lateral aspect of the foot. Patients may also have weakness on thigh extension (gluteus maximus), knee flexion (hamstrings), and foot plantar flexion (gastrocnemius) with an absent ankle jerk reflex.

Dactylitis

painful swelling of the hands and feet a common presentation of SCD in young children. It is one of the vasoocclusive manifestaions of SCD. Sicking episodes result in hemolysis, thus increasing indirect bilirubin and LDH and decreasing haptoglobin.

Cystic fibrosis

pancreas characteristically shows duct obstruction by mucus plugs leading to pancreatic insufficiency.

VIPomas

pancreatic islet cell tumors that hypersecrete VIP (vasoactive intestinal peptide), which increases intestinal chloride loss in the stool and causes excess losses of accompanying water, sodium, and potassium. VIP also inhibits gastric acid secretion. Somastostatin inhibits the secretion of VIP and is used to treat the symptoms.

Person presents with gastrinoma. What do you do next

pancreatic tumors are assoicted with Men1 so make sure to check for calcium concentraiton becuase parathryoid tumor may be present.

Aplasatic anemia

panctyopenia without hepatosplenomegaly and a hypocellular bone marrow replaced by fat cells and marrow stroma. If the patinet had pancytopenia and splenomgaly, unlike to have aplastic anemia.

SLE

pancytopenia is common. It usually occurs due to formation of autoantibodies (warm agglutinins- IgG) against blood cells (type II hypersensitivity). In contrast, lupus nephritis is caused by immune complex deposition in the glomerulus (type III hypersensitivity)

Riboflavin (B2)

participates in TCA as a coenzyme in the form of FAD for succinate dehydrogenase which converts succinate to fumarate

The ureters

pass posterior to the ovarain (goanal vessles) in the retroperitoneum but_ and anterior to the interal iliac artery in the true pelvis

Piriformis muscle

passes through the great sciatic foramen and is invovled in external hip rotation. Muscle injury or hypertrophy can cusae compression of the sciatic nerve.

Machine-like murmor

patent ductus arteriosus This, septal defect, or patent foramen ovale would be necessary for survival with a TGA.

Nonbacterial thombotic endocarditis (NBTE)

pathogenesis often involves a hypercoagulable state. When the hyper coagulability is the result of the procoagulant effects of circulating products of cancers, vegetaions result. NBTE is similar to Rousseau's syndrome (migatory thrombophlebitis) in that it may be induced by disseminated cancers.

WBC casts in presence of UTI

pathomneumoinc for pyelonephritis.

Caudal Regression Syndrome

patient is born with agenesis of the sacrum and occasionally lumbar spine and experiences flaccid paralysis of the legs and urinary incontinence. Frequently related to poorly controlled maternal diabetes.

SCID

patients suffer from recurrent infections cuased by bacteria (humoral), viruses (T-cell), fungi, and opporutnistic infections and also have failure to thrive and chronic diarrhea within the first year of life.

Folate defiency

patients with chronic hemolytic anemia are predisposed to folic acid deficiency and macroytic changes due to increased erythrocyte turnover. True that extramedullary erthropoeisis could rase the MCV but when its above 115 that is highly suggestive of folate or B12 deficiency (also would expect elevated retic count there)

Diabetes insipidus

patiets with diabetes insipidus are unable to conentrate their urine in response to dehdyration. Following desmopressin administration during the water deprivation test, urine osmolallity increases to nomral levels in central DI but does not change in compelte nephogenic DI

Panic Attack

periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following: Palpaitations, Parestehseias, Abdominal distess, Nausea, Itense fear of dying or losing control, lIght-headedness, Chest Pain, Chills, choking, disConnectedness, Sweating, Shaking, SOB. PANICS. Panic disorder requires an attack followed by 1 month or more of 1 of the following: Persistent concern of additional attacks, worrying about the consequences of attack, and/or behavioral changes related to the attack The symptoms result from manifestations of fear.

Poststreptococcal glomeruloneprhitis

periorbital edema, mild to moderate hypotension, and hematuria in a child 2-4 weeks after streptococcal infection (skin or pharynx). On EM, on the epithelial side of the glomerular basement membrane, sub epithelial humps composed of immune complexes of IgG, IgM, and C3 can be seen.

Kawaksakie disease

persistent fever, bilateral conjuctivitis, cervcial lymphadenopathy, and mucocutaneous invovlement (rash). Also strawberry tongue and edema. beware of cornary artery aneursms.

Etanercept

pharm is a TNF-alpha inhibitor that wors by acting as a decoy receptor.

Ethambutol

pharm the most notable side effect for ethambutol (part of the RIPE regimen used to treat TB) is optic neuropathy, usually manifesting as decreased visual acuity, central scotoma, or color blindness

In cardiac pacemaker cells

phase 0 depolarization is mediated by an inward flux of calcium. This differs from phase 0 cardiomyocytes and Purkinje cells, which results from an inward sodium current.

HIPAA

physicians may disclose patient information to friends and family members when the patient gives explicit permission or does not object when given a reasonable opportunity to do so. In an emergency situation, healthcare providers can also share medical information when it is in the patient's best interest based on their professional judgment.

Hemochromatosis in women

physiologic loss through menstruatino and pregnancy slows progression

Persistent lymphaedema

predisposed patients to development of lymphangiosarcoma- a rare malignant nepalsm of the lymphatic channel. Typical scenario woudl be in a patinet 10 year after radical mastectomy

Eosinophils

play an importnat role during parasitic infection. IgG and IgE are bound to the organism and activate eosinohils via antibody-dependent cell-mediated cytotoxicity to release enzymes to destroy the parasite. They are also involved in type I hypersensitivity

Cytoplasmic P bodies

play an importnat role in mRNA translation regulation and mRNA degradation. mRNA may interact with P bodies if they are not going to ribosome after getting their 5'cap, poly A tail, and intorns in the nucleus (talking about eukaryotes here).

The Kozak sequence

plays a role in the initiation of translation (mRNA binding to ribosomes). A mutation three bases upstream of the start codon is assoicated with thalasemmia.

Asbestos exposure

pleural thickening, calcified lesions (pleural plaques), and occassionaly benign pleural effusions.

IN transplant patient

pneumoina wiht intranuclear and cytopolasmic inclusion bodies points to CMV, an enveloped virus that has double stranded DNA

gliosis

proliferation of astrocytes in an area of neuron degeneration leading to a glial scar.

Selective IgA deficiency

predisposes to sinopulmonary and GI tract infections due to absence of secretory IgA. Its is also assoicated with anaphylactic response to transfused blood products due to an immune response against transfused IgA which the patient's body recognizes as foreign.

HbF

predominant hb type in the second and third trimesters and also for first few months after birth. HbF consists of two alpha and two gamma protein subunits and has a high affinity for oxygen.

Digoxin is

predominantly celared by the kidney, so older patients who have a natural decrease in renal funciton should have lower doses.

Body Dysmorphic Disorder

preoccupation with a perceived defect in appearance and repetitive behaviors in response to preoccupation.

Schwannomas

present histologically with a biphasic pattern of celullarity and S-100 positivity (indicating neural crest origin). They can arise from peripheral nerves, nerve roots, and any cranial nerve except CNII. Acoustic neromas are most common and are often located at the crebellopontine anngle at cN VIII

Fibromylagia

presents in women age 20-55 with diffuse musculskeltal pian, fatigue, and neuropsychiatric features (like depression). It is characterized by abnomral central pocessing of painful stimuli. Not polymyalgia rheumatica because not just the shoulders and hips (person is > 50 too) and not elevated ESR

Congenital Hypothryoidism

presents soon after birth with hypotonia, poor feeding, jaundice, macroglossia, constipation and umbilical hernia. Will progress to mental retardation if not corrected

ruptured ectopic pregnancy

presents with abdonminal pain, vaignal bleeding, hemorrahgic schock, and history of ammenoreah. Endometrail biospy would reveal decidual (pregnancy) changes in the endometrium but NO chorionic villi (sicne the fetus aint there)

Right ventricular MI

presents with cardiogenic shock with hypotension, elevated jugular venous pressure, and clear lungs. Hemodynamics woudl show elevated right atrial and central venous pressures, reduced pulmonary capilalry wedge pressure, and reduced CO

Glucagoma

presents with diabetes, necrolytic migratory erythema (an elevated painful and pruritic rash typically affecting the face, groin, and extremities. Over time, small erythematous papules/plaques coalesce to form large lesions with central clearing and bronze-colored induration)

Post-streptococcal glomerulonephritis

presents with edema, hematuria, and an antecedent history of streptococcal infection (impetigo, cellulitis, pharyngitis). This glomerulonephritis is mediated by a type III (immune complex) hypersensitivity reaction and appears as electron-dense sub epithelial "humps" on EM and as granular depositions within the mesangium and glomerular capillary walls on IgG and C3 immunofluorescence.

Chronic pancreatitis

presents with epigastric pain and pancreatic exocrine insufficiency. On CT, pancreas is very close to the aorta.

Impaired Beta-oxidation

presents with hypokektotic (low ketone bodies) hypoglycemia after prolonged (>24 hours) periods of fasting. This can occur with a defect in Acyl-CoA dehydrogenase or with a problem in the carnitine shuttle

Crohn disease

presents with insidious onset of abdominal pain, diarrhea, and constitutional symtpoms (weight loss, fever). Patients are prone to developing fistulas/abscesses as the lesions affect the entire thickness of the bowel wall.

Congenital hydrocephalus

presents with macrocephaly and poor feeding. Imaging shows enlarged ventricles. Untreated hydrocephalus leads to spasticity (muscle hypertonicity) due to stretching of periventricular pyramidal tracts, developmental delays, and seizures.

Neonatal abstinence syndrome

presents with neurologic, gastrointestinal, and autonomic symptoms. Tremors, irritability, diarrhea, and poor feeding are classic findings. Opiate replacement is the treatment of choice (like methadone)

pulmonary fibrosis

presents with progressive dypsnea and bilateral reticulonodular opacities on chest x ray. Pulmonary function tests reveal a restritive patten and lung biopsy shows insterstial lymphocytic inflmation and fibrosis of the alveolar walls.

Posterior cruciate ligament (PCL)

prevents posterior displacement of the tibia relative to the femur. Look for posterior drawer test.

The strongest risk factor for suicide

previous suicide attempt.

Turner Syndrome

primary amenorrhea, short stature, a high arched palate, widley spaced nipples. Primary amenorrhea occurs in these patients due to in utero degneration of the ovaries (streak ovaries). Normal looking Vag though

Oocytes

primary ooctyes are developed in female embryos by the fifth month of life at which point they arrest in phophase of meiosis I. Ovrain cycle hormones stiumulate primary oocyte to resume differenation at puberty. Prior to fertilization, secondary oocytes are arrested in metaphase of meiosis II

Kleinfelter syndrome (XXY)

primary testicular failure due to hyalniziation and fibrosis of the seminiferous tubules. This reuslts in small, firm testes and azoospermia (infertility) Testosterone deficiency (as a result of Leydig cell dysfunction) results in development of eunuchoid body habitus with tall stature and gynecomastia Mild intellectual disability is seen in some patients. Lack of insight and poor judgment are also common.

Viridans streptococci

produce dextrans that aid in colonizing host surface, such as dental enamel and heart valves. They can cause subacute endocarditis, classically seen in patients with preexisting cardiac valvular defects after dental manipulation.

Patients with CF

produce eccrine sweat that contains high concentrations of sodium and chloride compared to normal individuals (can't reabosrb with CFTR to make the sweat hpotonic). this can result in hypovolemia due to excessive sodium loss and intravascular volume contraction.

Serotli cells

produce inhibin in reponse to FSH from the anterior pituitary. Inhibin supresses FSH production. Sertoli cells also facilitate spermatogenesis within seminferous tubules. Impaired sertoli cell function would lead to decreased inhibin, increased FSH, and impaired fertility

Shiga-like toxins (aka Vero cytotoxins)

produced by Enterohemorrhagic E.Coli (EHEC). Nearly identical to the Shiga toxin produced by Shigella dysenteriae. The toxin is an A-B toxin that inhibits the 60s ribosomal subunit in human cells thereby blocking protein synthesis by preventing the binding of tRNA (adenine replaced). Unlike, diptheria toxin andexotoxin A or Pseudomonas, this toxin does not act on EF2.

Ghrelin

produced by the stomach and makes you hungry. It increases with sleep loss and Prader-willi syndrome

Beta HcG

produced by the syncytiotrophoblast after implantaiton, whcih generally occurs 6-7 days after fertilization at the earliest. beta HCG is typically detectable in the serum 8 days after fertilizaiton and 14 days in the urine.

Leptin

produced in proportion to the quantity of fat stored by adipocytes. It acts on the arcuate nucleus of the hypothalamus to inhibit production of neuropeptide Y (which normally decreases appetite and increases satiety). Mutation in leptin gene or receptor would lead to obesity (fat mice yo)

Maternal rubella

produces a low-grade fever, maculopapular rash from face down, and posteior auricular or suboccipital lymphadenopathy. Most adult women would develop polyarthritis/polyarthralgia too. Congenital rubella though coudl cause sensorinueral deafness, cataracts, and cardiac malformations (like PDA)

Listeria

produces a very narrow zone of beta-hemolysis on blood agar, shows tumbling motitlity at 22 degrees C and can be cultured at temperatures as low as 4 C (hence its prescence in cheese and milk). It survives inside host cells so intact cell-mediated immunity is essential for elimination with macrophages

Coryebacterium diptheriae

produces an AB exotoxin which inhibits protein synthesis by catalyzing the ADP-ribosylation of host cell EF2

Carbon tetrachloride (CCl4)

produces free radical injury and injures hepatocytes. P450 oxidizes it creating CCl3 which is a free radical.

Endoderm

produces the lining of the GI tract. So in the case of esophageal atresia, these cells would fill the lumen.

C. tetani

produces the protein exotoxin tetanospasmin that blocks the release of inhibitory motor interneurons in the CNS (more specifically GABA in glycine in the rickshaw cells of the spinal cord). Tetanus is prevented by immunization with toxoid that triggers production of antitoxin antibodies (active)

ANP

promotes vasodialtion and natriuresis and provides a beneficial counter-regulatory mechanism in patients with heart failure. More specifically, it is released from atrial myocytes in response to volume overload and atrial pressure. It acts via cGMP. It dilates afferent renal arterioles (decreased renin) and constricts efferent arterioles (increased GFR) to promote diuresis and sodium excretion. it is the major part of the aldosterone escape mechanism.

HIPAA

protects health information by requiring verbal or written authorization for release of information (even if its the person's spouse). The ONLY execpton would be if a very dangerous diagnosis like HIV

Paraesophageal hernia

protrusion of the fundus into the chest above the level of T10 (its the rarer form of a hiatal hernia). Vs. sliding hiatal hernia is profusion of the cardia of the stomach through esophagus (hourglass sign on X ray)

The vagus nerve

provides cutaneous sensation to the posterior external auditodr canal via its small auricular branch. Sensation to the rest of the canal is from the mandibular division from the mandibular trigeminal nerve. IN this question, a patient had a vasovagal faint after the otoscope rubbed along the vagus nerve.

Medicare

provides health insurance for those 65 and older. It also covers younger individuals with disailibities, end-stage renal diseaes, and ALS.

Common complications of psoriasis

psoriatic arthritis, nail pitting, and uveitis

Schizoaffective disorder

psychosis must occur in the abscence of major mood episodes, but mood symptoms must be present (mania or depression) for most of the illness. In major depress or bipolar disorder with psychotic features, psychotic symptoms occur exclusivley during mood episodes.

Classic toxicities to know for chemotherapeutic agetns

pulmonary fibrosis and flagellate skin discoloration- bleomycin doxorubicin- congestive heart failure (dilated cardiomyopathy) cyclophosphamide- hemorrhagic cystitis.

Cyanide poisoning

rapid cutaneous flushing, tachypnea, headache, tachycarida with nausea/vomitting, confusion and weakness. Labs show severe lactic acidosis (remember it blocks oxidative phosphorylation)

Creutzfeldt-Jakob disease

rapidly progressive dementia with myoclonic jerks. on microscopy, would see multiple vacuoles in the gray matter of the brain (sponfiform encephalopathy). The pathogenesis of this disease is linked to the abnormal protein prion

H. Flu epiglottis

rapidly progressive fever, severe sore throat, drooling and progressive airway obstruction are presenting symptoms of acute epligolittis. This illness is most commonly caused by H. flu type b, but can still cause disease in unimmunized or improperly immunized patients as well more commonly then those immunized. The vaccine is specific for H. flu type b

Agranulocytosis

rare but serious complication of antithyroid drugs (methimazole, propylthiouracil) that commonly presents with sudden fever and sore throat. WBC with diff should be obtained to confirm diagnosis (neutrophil count < 500) and the drug should be discontinued

Narcolepsy

rare neurolgoic disorder characterized by episodes or irresisitible, refrehsing sleep during the daytime and usually one or more REM Sleep-related phenomena such as cataplexy, hypnogogic/hypnopomipic hallucinations, and sleep paralysis.

Lung infarction

rarely happens as a result of pulmonary infarction due to dual ciruclation from the pulmonary and bronchial systems (collateral ciruclation)

Bartter Syndrome

reabsorbing defect in the thick loop of Henle affecting the Na/K/2CL co-transporter AR (like al loop diuretic) leads to hypokalemia, metabolic alkalosis and hypocalcemia (hypercalciuria)

Anti-glomerular basement membrane antibodies

react with collagen type IV, causing rapidly progressive glomerulonephritis with glomerular crescent formation on light microscopy. Immunofluorescence showing linear deposits (make sure know what looks like) of IgG and C3 along the glomerular basement membrane is characteristic.

Ventral posterior lateral nucleus of the thalamus

receives input from the spinothalamic tract and dorsal columns. damage to this nucleus along with the ventral posterior medial nucleus can result in complete contralateral sensory loss.

the proximal ureter

receives its blood supply from the renal artery whereas the distal ureter is supplied by the superior vesicla artery. Circulation to the middle poritons of the ureter is variable and anastomotic. The distal ureter may become ischemic after transplant causing leakage of urine (a known complication)

NK cells

recognize and kill cels with decreased MHC Class I antigen cell surface expression, such as virus-infected cells and tumor cells. They are large lymphocytes that contain perforins (cut open cell) and granzymes in cytoplasmic granules (induce apoptosis after entering the perforin).

Ubiquitin ligases

recognizes specific protein substrates and attach a ubiquitin tag. The proteins are then degraded to an appropriate size and coupled with the major histocompatibility I protein complex in the ER so they can be presented to CD8+ T cells.

Porcelain gallbladders

recommended for cholecystetomy because increaesed cholecystectomy. May appear as gallbladder calcification on X ray.

Deficiency in MAC

recurrent Neisseria infections (meningitis baby)

ecchymoses

red blood cell extravasation that is > 1 cm in diameter If petechiae (< 5mm) If purpura ( 5mm to 1 cm) None of these lesions would completely blanch under pressure

Neuron reacting to acute irreversible injury

red neuron. The neuronal body becomes shrunken and separated from surrounding tissue, cytoplasm becomes eosinophilic. The uncles becomes pyknotic and the Nissl substance disappears. 12-24 hours after event occurs this will appear.

ACE inhbiitors

reduce angiotensin II levles and cause efferent arteriole dilation, thereby decreasing glomerular pressure and filtration rate. This can preciptate acute renal failure in those with reducne intrarenal perfsuion pressure (renal artery stenosis, congestive heart filaure, hypovolemia, chronic renal disease)

neurocysticercosis

relatively common cause of seizures in patients from central and south america. The organism isa parasite called Taenia Solum, the pork takeworm which is ingested from fecal matter of others.

Merocrine glands

release watery secretory product via exocytosis with no loss of cell membrane. This includes salivary and sweat glands

Secretin

released by duodenal S cells in response to increasing H+ concentrations. It increases pancreatic bicarb secretion

demyelination in MS

reduced salatatory conduction down the axon, resulting in conduction blockade or slowing of the signal.

Antiretroviral therapy during pregnancy

reduces the risk of perinatal transmission of HIV to 1-2% and is recommended for all pregnant women with HIV. An infant with oral thrush, interstiral pnuemonia, and severe lymphopenia during the first year of life is consitent with vertical transmission of HIV-1

Pulsus Paradoxus

refers to an exaggerated drop (> 10 mmHg) in SBP during inspiration. It is usually seen in tamponade.

Phenotypic mixing

refers to co-infection by two viral strains, resulting in progeny virions that contain nucleocapsid proteins from one strain and the genome of the other strain. Since there is no change in the underlying genomes (no genetic exchange), the next generation of virions revert to their original, unmixed phenotypes

HD's anticipation

refers to increased trinucleotide expansion that occurs during paternal transmission for each generation resulting in earlier onset of disease.

Hereditary non-polyposis colon cancer or Lynch syndrome

refers to occurence of colonic adenocarcinomas at a young age, along with predispostion for extraintestinal malignancies (like endometriaal cancer). Mutations of DNA mismatch repair genes are responsible.

Berkson's bias

refers to selection bias created by choosing hospitalized patients as the control group

Sensitivity

refers to the ability to correclty identify those with the disease. You want this to be high in a screening test to catch everyone that might have the disease. Given a highly sensitive test, a negative result would help to rule out a diagnosis.

Lead-time bias

refers to the apparent prolongation of survival after applying a screening test that detects a disease earlier than it would have otherwise been detected without any real effect on prognosis

polyhydramnios

refers to the excessive accumulation of amniotic fluid and presetns with increased abdnominal circumference out of proprotion to gestational age. The etiology is decreased fetal swallowing or increased fetal uriniantion. Fetal anomalies that cause decreased swallowing include GI obstuction (duoedenal, esophageal, or intestinal atresia) and anencephaly.

Bioavailability

refers to the fraction of administered drug that reaches the systemic circulation in a chemically uncharged form. It is always less than 1 if it is not IV. It can be determined by examining a graph of plasma concentration vs. time and then doing area under the curve x dose IV/area under the curve x dose oral

Hyperosmotic Volume Contraction

refers to the loss of free water greater than electrolytes which can be seen in diabetes insipidus and in states of excessive sweating without fluid replacement.

The P (sub 50) for hb

refers to the partial pressure at which hemoglobin is 50}% saturated. High oxygen affinity would result in a leftward shift with increased affinty on teh oxygen-dissociation curve. High oxygen affinity hemoglobins have reduced ability to release oxygen leading to incrased EPO and erythrocytosis

Endometriosis

refers to the prescence of endometrial glands and stroma outside the uterus. It may be asymptomatic or present with dysmenorrhea, dyspareunia (painful sex), and/or inferilitiy.

Hibernating myocardium

refers to the prescence of left ventricular systolic funciotn due to reduced coronary blood flow (ischemia) at rest that is partially or completely reversible by coronary revascularization.

Wallerian degneration

refers to the process of axonal degeneration and breakdown of the myelin sheath that occurs distal to a site of injury. Axonal regeneration does not occur in the CNS due to persistence of myelin debris, secretion of neuronal inhibitory factors, and development of the dense glial scar (by the astrocytes).

Renal Blood Flow

refers to the volume of flood that flows through the kidney per unit time and can be calculated by dividing the renal plasma flow by (1- hematocrit) RPF = (urine PAH x urine flow rate)/plasma flow rate RBF = that/1-hematocrit

The surchiasmatic nucleus

regulates the circadian rhythm as it processes light information received from the retina and relays it to other hypothalamic nuclei and the pineal gland to modulate body temperature and the production of hormones such as cortisol and melatonin. Melatonin supplementation is recommended for the treatment of insomnia assoicated with jet lag.

Beta - glucoronidase

released from injured hepatocytes and bacteria casuing increased levels of unconjugated bilirubin to be in the bile increasing pigment stone formation

Somatostatinoma

remember that somatostatin is not just the thing that inhibits growth hormone. it is also secreted by delta cells of the pancreas and decreases the secretion of secretin, cholecystokinin, glucagon, insulin, and gastrin. Reduced gallbladder contractility, due to decreased cholecystokinin secretion, is responsible for biliary stones in patients with somatostatinoma.

Tardive dyskinesia

repetivie, rhythmic, involuntary movemnets of the tongue, lips, face, trunk and extremitites. INcludes things like facial grimacing, tongue movments, lip samking, and puckering. It is due to prolonged exposure to antipsychotics

HBV

replicates by double stranded DNA to RNA template then to double stranded progeny. Although it is a DNA virus, it replicates via reverse transcriptase (partially double stranded).

Osteoporosis

represents loss of total bone mass with trabecular thinning with fewer interconnections . Subperiosteal resorption with cystic degeneration is characteristic of osteitis fibrosa cystica (hyperthyroid). Vitamin D defeciency results in "excessive unmineralized osteoid, resulting in low mineral density. Osteopetrosis is characterized by the persistence of primary, unmineralized spongiosa in the medullary canals.

Schizoprhenia

requires 2 or more of teh folliwng five: delusions, hallucinations, disorganizeed speech, grossly disorganized hbeavior adn negative symptoms over the course of > 6 months and one must be delusions, hallucinaitons, or disorganized speech.

H. flu

requires X (hematin) and V (NAD+). It can grow on sheep agar only in the presence of S. Aureus because it produces the needed X and V factors.

Sitting up from supine position

requires the external abdominal obliques, the rectus abdominus, and the hip flexos (the iliopsoas primarily cosnisting of the psoas major, minor, and illiacus)

branched-chain alpha-ketoacid dehydrogenase

requires the same five cofactors as pyruvate and alpha ketoglutarate dehydrogenase, which is why some patients with maple syrup urine disease (burnt sugar urine) can benefit from high dose thimaine therapy.

Mitochondrial DNA

resembles prokaryotic DNA as a small circular chromosome and is maternally derived. Mutations in this DNA can cause disease (passed on by mom) like MELAS

The medial collateral ligament

resists force that pushes the knee medially. Increaes laxity of the knee with the valgus stress test indicates injury to the medial collateral ligament.

MRSA

resitant to all beta lactam antibiotics becuases it has an altered penicilling binding protein in its peptidoglycan cell wall that does not bind beta lactams effectively pharm.

Fat embolus

respiratory distress, diffuse neurologicla impaiment, uppper body rash wihtin days of severe long bone fractures is characteristc.

Meningococcal Lipooligosaccharide (LOS)

responsible for many of the observed toxic effects in meningitis and meningococcemia for the gram-negative diplococcus Neisseria meningitidis. Blood levels of this endotoxin correlate with morbidity and mortality

Protein Kinase A

responsible for the intracellualr effects of the G-protein/adenylate cyclase second messenger system . Glucagon, PTH, and TSH all use this method.

Hemorrhoids

result from distention of one of the serveral areteriovenous plexuses. The venous component of internal hemorrhoids (painless and above the pectinate line) drains into the middle and superior rectal veins, which communicate with the internal iliac and inferior mesenteric veins respectively.

Keloids

result from excessive collagen formation during tissue repair in susceptible individuals.

NTDs

result from failure of fusion of teh nueral tube during the 4th week of fetal development. Would have increased AFP and ACETYCHOLINEASTERASE in aminiotic fluid.

Dizygotic twins

result from fertilization of 2 oocytes and 2 different sperms and always have 2 amnions and 2 chorions. In contrast monozygotic twins arise from the fertilization of a single oocyte. Monozygotic twinning may occur at different stages of embryogenesis, whichi affects the organization of fetal membranes.; dichorionic/diamniotic (0-4 days), monochorionic diamniotic (4-8 days), monochorionic monoamnitoic (days 8-12), and monochorionic monoamniotic conjoined twins (> 13 days)

Lesions of the glossopharyngeal nerve

result in loss of loss of the gag reflex (afferent limb); loss of sensation in the upper pharanyx, posterior tongue, tonsils, and middle ear cavity; and loss of taste sensation on the posterior 1/3 of the tongue. The glossopharyngeal nerve exits out the jugular foramen (call 911)

ARDS

results form increases pulmonary capillary permeability. This leads to decreased lung compliance, increased work of breathing, and worsened ventilation to perfusion mismatching. The pumonary capillary wedge pressure is typically normal.

Radial Head subluxation (nursemaid's elbow)

results form sudden traction on the outstretched and pronated arm of a child. Affected children are usually in little distress unless attempts are made to move the elbow from their extended and pronated position. The annular ligament is torn and displaced in this injury. Most common elbow injury in children.

Acute promeylocytic luekemia

results form t (15;17) mutation. whereby the gene for retinoic acid receptor is transferred from chromosome 17 to chromosome 15. treatment invovles all-trans-retinoic acid to differentation of myeloblasts into mature granulocytes.

Gout

results form the deposition of monosodium urate crystals in the joints and soft tissues. Under polarized light, urate crystals appear needle-shaped and negatively birefringent. Conations that increase uric acid production or decrease uric acid clearance can increase the risk of gout.

Methylmalonic acidemia

results from a defect in the isomerization of methylmalonyl coA to succinyl CoA (to enter the TCA cycle)

Pompe disease

results from acid alpha-glucosidase deficiency that presents in early infancy with cardiomegaly, macroglossia, and profound muscular hypotonia. Abnormal glycogen accumulation (PAS positive) within lysosomal vesicles is seen on muscle biopsy.

Hereditary Sperocytosis

results from cytoskeleton abnormalities, most commonly from spectrin and anykyrin. Hemolytic anemia, jaundice, and splenomegaly are classic manifestations. Sperocyrtes on blood smear.

Osteogenesis imperfecta

results from defective synthesis of collage type 1-this is needed to even begin bone matrix formation.

Lingual thyroid

results from failure of migration of the thyroid gland. If removed in surgery, would lead to symptoms of hypothyroidism - lethargry, feeding problems, constipation, macroglossia, umbilical hernia, dry skin, hypothermia,

Neural tube defects

results from failure of the neural tube to close during the 4th week of fetal life. They most commonly form in the region of the anterior (anencephaly) or posterior (classic NTD), posterior neuropores. Supplementation with folate can help prevent this

Thrombotic thrombocytopenic purpura (TTP

results from impaired funciton of ADAMTS13, a von-willebrand factor cleaving protease. Thus, large vWF multimers build and cause a prothrombotic state resulting in microvascular thrombosis. Thrombocytopenia and hemoltic anemia with shcistocyte formation occur as erythrocytes are sheared by platelet rich thrombi.

Hyper-IgM syndrome

results from inability of B-lymphocytes to undergo isotype switching from IgM to other immunoglobulin isotypes such as IgD, IgG, etc. Clinically, it most commonly results in lymphoid hyperplasia with recurrent sinopulmonary infections. It occurs due to genetic defect in CD40L which promotes the class switching

Recall bias

results from inaccurate recall of past exposure by people in the study and applies mostly to retrospective studies like case-control studies. People who have suffered an adverse event are more likely to recall risk factors than those who did not.

Leukocyte Adhesion deficiency

results from loss of CD18. This leads to inability to synthesize integrins and thus lekocytes can't get out of blodo stream. Manifestaions: infection without pus formation, delayed detachment of the umbilical cord and poor wound healing.

TTP

results in MAHA and thrombocytopenia, which is essential to the diagnosis. Plasma exchange therapy is life saving. Also it results from reduced ADAMTS13 activtity which leads to large vWF multimers that can't be cleaved and results in microvascular platelet-rich thrombi. Pentad: neurologial symptoms, kidney, fever, MAHA, thrombocytopenia

Normal aging

results in a decrease in left ventricular chamber apex to basedimesnion, development of a sigmoid-shaped ventricular septum, increased collagen depostion, and accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes.

Huntington's disease

results in a gain of function mutation of the huntington's protein where there is increased deacetylation of histones. This prevents the transcription of certain genes that code for neutrophic factors, leading to neuronal cell death.

Nephrotic syndrome

results in a more hypercoagulable state (losing Antithrombin III). Sudden-onset of flank-pain, hematuria, and right-sided varciocele are suggestive of renal vein thrombosis.

Botulinum neurotoxin

results in both nicotinic blockade and muscarinic blockade (dry mouth) . It classically presents as a descending paralysis that first manifests with cranial nerve abnormalities (diploplia, dysphagia, and dysphonia). Then nausea vomiting and abdominal pain can result from food-borne botulism, classically from eating canned goods. The toxin works by prevents fusion of ACh containing synaptic vesicles with the plasma membrane (blocking ACh release)

IFN-gamma defect

results in dissemniated mycobacterial disease in infancy or early adult hood.

Incomplete fusion of the urethral (urogenital) folds

results in hypospadias in males, an abnormal opening of the urethra proximal to the glans penis along the ventral shaft of the penis. Vs. epispadias is an abnormal opening on the dorsal surface due to faulty positioning of the genital tubercle

Vit K def

results in impaired clotting factor carboxylation. (gamma-glutamyl caroxylase needs vitamin K to carboxylate which allows for the creation of calcium-binding sites) Newborns are at risk due to poor transplacental transfer of vitamin K and sterile gut. All newborns should receive vitamin K prophylaxis to prevent bleeding complications (like intracerebral hemorrhage)

Superior gluteal nerve injury

results in weakness and paralysis of the gluteus minimus and medius. This causes the pelvis to tilt downward toward the contralateral side (positie Trendelenbrug sign) when standing on the affected leg. When walking the patient leans toward the affected side.

cleft lip

results when the maxillary prominence fails to fuse with the intermaxillary segment during the fifth-sixth week of embryonic development. Cleft palate occurs when the palatine shelves fail to fuse with one aonter or with the primary palate.

superficial inguinal lymph

scrotum, skin below the umbilicus mostly, including external gentialia and anus below the pectinate line (but not the glans penis- deep inguinal nodes)

Cushing Syndrome

secondary to adrenal adenoma/carcionma would present with low ACTH levels. In contrast, Cushing caused by a pituitary adenoma will have elevated ACTH levels but be suppressed by high-dose, but not low-dose, Dexamethasone. Serum ACTH levels would remain markedly elevated despite dexamethasone in ectopic ACTH production.

Sensitized TH2 cells

secrete IL-4 and IL-13, which together promote B cell lymphocyte class switching to IgE. They also secrete IL-5, which activates eosinophils and promotes IgA synthesis. An excess of TH2 lymphokines may contribute to allergic asthma. Remember, the Hot T-Bone stEAK mneumonic

Don't forget about the Cytochrome-p-450 interactions

see pharm

Pyruvate Kinase deficiency

see pharm

Theophylline toxicity

seizures and tachyarrhthmias are a major cause of death in toxicity pharm

Prospective cohort study

select a group of individuals, determine their exposure status, and then follow them over time to see if they develop the disease of interest.

case-control studies

selection of control subjects woudl be to pick those who are not cases- aka don't have the disease of interest without knowing expsoure status. Then you go back retrospectively and see if incidence of exposure is increased in the case group compared to the control group (who does ot have the disease)

Straph epi

should be treated with vancomycin pharm

Patients with suspected giant cell arteritis

should check ESR or CRP

aortic dissection

sever retrosternal pain that raidates to the back. Due to aorting intima teraming with blood dissecting through the aortic media.

Trisomy 13 (Patau Syndrome)

severe cleft lip and/or palate, microphthlamia, severe mental retardation, microcephaly, holoprosencephaly, NTDs, polydactyly, rocker-bottom feet,

Mitral stenosis

severity is given by the length of time between S2 and the opening snap. the shorter the time interval, the more severe it is (because higher atrial pressures lead to more force behind the opening during diastole)

Okazaki fragments

short streches of newly synthesized DNA that are separated by RNA primers. They are formed by producing the discontinuous lagging strand during replication.

Synovial fluid analysis of pseudogout

shos rhomboid-shpaed calicum pyrophsophate crystals that are positively birefringent under polarized light (blue in parallel). The knee joint is invovled in >50% of cases.

Ampicillin

shoudl always be added in meningitis of infants and older adults to cover empiracally for listeria as listeria is not sensitive to cephalosporins. Cephalosporins don't cover LAME: listeria, atypicals (chlamydia, mycoplasma), MRSA, enterococccus

Medical errors

should always be disclosed and given with an apology regardless of whether harm has occurred.

Active TB

should always be treated with full RIPE therapy or risk selection for mutant strains that become resistnat.

IPV

should be assesed for safety and approached in a supportive, open-ended manner. Physician's priority should be ensuring the patient's safety through the use of referrals and developing an emergency plan.

Pertussis

should be considered in any adult who has not had updated vaccination boosters. The clinical presentation would be a paroxysmal cough lasting > 2 weeks that is assoicated with post-tussive emesis or inspiratory whoop after a severe coughing episode. It is caused by Bordetella pertussis which is a gram-negative coccobacillus

Babesiosis

should be considered in patients with febrile illness who reside in geographic areas where they are exposed to the Ixodes tick (northeastern United States). Blood smear would show intraerythrocytic organisms.

moderately elevated alkaline phosphatase of unclear etiology

should be followed up by gamma-glutamyl transpeptidase which would not increase for the bone unlike ALP

Advance care planning of end-of-life issues

should be initated whenever a person is sick in the hospital. The medical team needs to know what the patient would want shoudl they beocme really sick.

Informed consents

should be obtained by a provider who has sufficient knowledge to give an accurate descirption of the itervention.

Thoracentesis

should be perfomed above the 7th rib in midclaviular line, the 9th rib along the midaxillary line and the 11th rib along the posterior scapular line. inInseriton of a needle lower than this point risks injury of say the liver. Insertion of the needle on the inferior margin of the rib (remember VAN) risks striking the subcostal neurovascular bundle.

Inhaled glucocorticoids

should be risnesd out afterwards to avoid oral candidiasis

HIV-assoicated dementia

should be suspected in AIDS patients with progressive congnitive decline. The charactersitic histopathologic pattern is microglial nodules aka groups of activated macrophages/microglial cells formed around small areas of necrosis that may fuse to form multinucleated giant cells.

Patients that are temporarily incapacitated (drunk)

should not be allowed to make importnat healthcare decisions (keep them in hospital until sober)

Adenoma-carcinoma sequence

since increased COX-2 is requried, aspirin can protect against.

Candida albicans

single-celled budding yeast with pseudohyphae (also germ tubes at certain rich serum)

Primary cilliarly dyskinesia

situs inversus, chronic sinusisits, bronchiectasis, and infertility

Chronic pyelonephritis

small assymetric kidneys with broad scars and blunted calysces. Associated with vesicureteral reflux or chronic kidneys stones.

Lacunar infarcts

small ischemic infarcts involving the deep brain structures (basal ganglia and pons) and subcortical white matter (internal capsule, corona radiata).k They are most often due to hypertensive aterioslclerosis of small, penetrating arterioles. May sound very similar to a Charcot-Bouchard aneursm with hemorrhage but this would appear hyperdense on CT whereas lacunar infarct would be dark and cavitary (lacuna)

Pancreatic adenocarcinoma risk factors

smoking, age, chronic pancreatitis, diabetes mellitus, genes (like MEN and HNPCC)

Pasterurella multocida

soft-tissue infeciton that develops 24 hours after a dog or cat bite. May smell like a mouse. (the wound)

ACA

supplies the medial 2 hemispheres (frontal and parietal). Occlusion can cause contralateral motor and sensory deficits of the lower extremities, behavioral changes, and urinary incontinence

Silicosis

specific for silica are calcification on the rim of hilar nodes and birefringent silica particles surrounded by fibrous tissue.

C5-C6

spinal nerve mediates the biceps and brachioradialis. A weaker reflex than normal indicates a LMN problem whereas a stronger reflex would indicate an UMN problem

Whipple disease

stains PAS positive due to its glycoprotein in its cell wall.

The standard deviation and standard erro

standard deviation reflects the spread of individuals values in a normal distribution. The standard error of the mean reflects the variablity of menas nad helps estimate the true mean of the underyling population (a population mean, not just a sample mean) to give a 95% CI for the whole population mean. mean +/- 1.96*SD/square root of n gives 95% CI for the population mean. As n increaes, the CI gets smaller, thus more precise. mean +/- 2.58 *SD/square root of N gives the 99% CI

Intracellular receptors

steroids VETTT CAP Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone.

Androgens (including anabolic steroids like methyltestosterone)

stimulate epidermal hyperproliferation and excessive sebum production, thereby promoting acne development. Anabolic steroid misuse is a known cause of acne, especially in competitive athletes.

Pulsatile GnRH

stimulates FSH and LH release and is useful for the treatment of infertility.

IL-12

stimulates the differentiation of naive T-helper cells into the Th1 population. Patients defecient would suffer from severe mycobacterial infections due to inability to mount a strong cell-mediated granulomatous immune response (can't activate macrophages). They would be treated with IFN-gamma (released from Th1 cells)

Lamellar bodies of type II pneumocytes

store and release pulm surfactant. In NRDS, surfactant deficiency leading to atelectasis due to increased surface tension.

Turner Syndrome

streak ovaries, amenorrhea, and infertility. Also assoicated with short stautre, webbed neck, shield chest and bicuspid aortic valve. Coarcation of the aorta

HPV 16 and 18

strongly associated with anal and cervical squamous carcinomas and risk increased in HIV and men who have sex with men.

Small Cell Carcinoma

strongly assoicated with smoking and is centrally located. This tumor arises from the primitive cells of the basal layer of the bronchial epithelium forming sheets or clusters of round or oval cells. Immunohistochemical stains are frequently postiive for neuroendrocrine markers like chromogranin and synaptophysin

The Limbic system

structtures invovled in long-term memroy, olfaction, behavior modification, olfaction, emotion, and ANS function. They include the hippocampus, amygdala, fornix, mammilary bodies, and cingulate gyrus Responsible for the famous 5 F's Feeding, fleeing, fighting, feeling, and sex

crossover study

subjects are randomly allocated to a sequence of 2 or more treatments given consecutively. A washout no treat ment period is often added between to limit confounding effects of prior treatment

TCAs

such as imipramine, doexpin, amitrptyline, and clomipramine have stronger anticholinergic properties than heterocyclics or SSRIs and should be used with caution in patients with BPH, as they could cause urinary retetnion

Schistocytes

suggest microangiopathic hemolytic anemia (HUS, TTP, DIC, or mechanical damage - say a prosthetic valve). IN childhood, HUS is often accompanied by bloddy diarrhea. Coagulation studies are normal in HUS and TTP (unlike in DIC)

wet beriberi (thiamine0 B1 deficiency)

suggested in a homeless man who has high-output congestive HF with neurological symptoms as well.

Insulin

suppresses glucagon release.

Cranioipharygiomas

suprasellar tumors found in children and are composed of calcified cysts containing cholesterol crystals.

hyperprolactinemia

suprresses estrogen so increases risk of osteoporosis in women.

Bitemporal heminanopsia

suspect pituitary tumor. A prolactinoma depresses the entire GnRH, LH, FSH, sex homrones axis, causing impotence in men adn amenorrhea in women of reproductie age.

snRNPs

synthesized by RNA polymerase II in the nucleus. They help to remove introns from the RNA transcript and are thus necessary for synthesis of mRNA (polyadenylaton at 3' end and capping at 5' end are also necessary

Succinyl-CoA synthetase of the TCA cycle

synthesizes GTP as it converts succinyl-CoA to succinate. PEP carboxykinase in gluconeogenesis can make use of this GTP

Follicular lymphoma

t 14;18 cuasing BCL-2 overexpression- prevents apoptosis (remember through the prevention of cytochrome c release from mitochondria)

half life

t = 0.7 x Vd/CL

RNA pol III

tRNA

Advance directives

take precedence over family wishes. Physicians should respect autonomy and adhere to patients' wishes as outlined by the advance directive.

Mallory-Weiss tear

tear in the gastric mucosa near the gastroesopahgeal junction that typically occurs due to forceful vomitting, which can also cause metabolic alkalosis

Villous adenomas

tend to be large, sessile, and more severely dysplastic than tubularadenomas. Villous adnemoas can cause bleeding, sedcretory diarrhea (from increased mucus production) and partial intestinal obstruction.

mode

tend to be the most resistant to outliers.

Para-aortic lymph

testes

Hypertrophic cadiomyopthay

the LVOT obscruction worsesn with decreased LV volume through either decreased afterolad or preload preload (the murmor gets louder when you stand up). Therefore, medications that decrease venous return or systmeic vascular resistance (like dihydropyridine calcium channel blockers and nitroglycerin) should be avoided.

Fas

the ____ receptor acts to initiate the exctrinsic pathway of apoptosis. Mutations involving the ___ receptor or ____ ligand can prevent the apoptosis of autoreactive lymphocytes, thereby increasing risk for autoimmune disease like SLE.

Protamine sulfate

the antidote to bleeding cause by hepaine It is a psecific antagonist that binds to heparin forming a compelx so that it cannot work. pharm

Physiologic dead space

the apex is the largest contriubter of alveolar dead space It is the alveolar dead space plus the anatomic dead space An equatin would be VD (physiologic dead space) = VT (Tidal volume) * (PaCO2-PECO2)/PaCO2 Taco Paco, Peco, Paco Where Pe is the expired air CO2.

Somatic Symptom Disorder

the best approach would be to shedule regular medical vistis that focus on the goal of functional improvement. Referral to a psychiatrist, at least right away, might piss the patient off.

Congenital Torticollis

the child prefers to hold the head to one side and is commonly due to malposition of the head in utero or birth trauma. May see a swelling where the affected SCD is.

At age 2

the child should have a vocabullary of 200-300 words and be able to use 2-word phrases.

TTP

the classic pentad is : fever, neurologic sympatoms renal failure, anemia, and thrombocytoopenia. Also schistocytes due to MAHA (platelet rich thrombi). The PT and aPTT should be normal with the bleeding time prolonged (unlike DIC)

Valproate

the drug of choice for patients with absence and assoicated tonic-clonic seizures. Ethosuximide is also effective against absence seizures but does not suppress tonic-clonic seizures.

Intravenous Benzodiazepines (eg. lorazepam)

the drug of choice for status epilepticus. They work by enhancing the effect of GABA and GABA receptor, leading to increased chloride influx (how GABA works at its receptor) and suppression of action potential firing.

Clozapine

the drug of choice for treatment-resistnat shizophrenia. Can cause increased weight gain and agranulocytosis rarely so must monitor the absolute neutrophil count.

Fatty streaks

the earliest lesion of athersclerosis and can be seen as early as the second decade of life. They appear as a collection of lipid-laden macrophages (foam cells) in the intima that can eventually progress to athersclerotic plaques

Ischemic strokes

the first microscopic findings are seen at 12-24 hours (red, dead neurons- eosinophillic cytoplasm and loss of Nissl substance)

Jugular Venous pressure tracing

the first peak - the a wave, is generated by atrial contraction. This is absent in patients with a-fib.

APC tumor supressor gene

the first step in the classic adenoma to carcinoma sequence is mutaiton of this big guy. It is found in most cases of sporadic colon cancer and in all patients with familial adenomatous polyposis.

RA

the foundation of management is disease-modifying antirheumatic drugs like methotrexate, sulfasalzazine etc. However, for immediate relief (this response takes several weeks). NSAIDS and glucocorticoids may be used.

Oral bioavailability

the fraction of administered drug that reaches the systemic circulation in a chemically uncharged form. From the GI tract, it must first enter the portal circulatino (aka the liver) and can thus be metabolized, decreasing bioavailabiliy. This is called first-pass metabolism and some drugs that have high first pass metabolism are adminstered other ways to avoid this. Rectal suppositories partially bypass first-pass metabolism. The superior rectal veins still drians to portal circulation but the middle and inferior veins go straight to the IVC

Koliocytes

the hallmakr of HPV infeciton. They are pyknotic, superfical or immature squamous cells with a dense, irregularly staining cytoplasm and perinuclear halo-like clearing

Rickets

the histological hallmark is unmineralized osteoid matrix. Clincally, they have bowed legs, a rachitic rosary (of the ribs), and growth retardation.

Atherosclerosis

the lower abdominal aorta and coronary arteries develop the highest burden followed by the popliteal artery and then cartotid artery.

The celiac trunk

the main branch of the abdominal aorta: it provides oxygenated blood to the spleen, stomach, liver, abdominal esophagus, and parts of the duodenum and pancreas. The proper hepatic artery supplies blood to the liver

ACTH

the major trophic hormone of the zona fasciculata and reticularis. Prolonged ACTH stimulation causes hyperplasia (not hypertrophy) of the zona fasiculata and reticularis, resulting in excessive cortisol production (Cushing Syndrome)

Bladder cancer

the majority are transitonal cell carcinomas. Painless hematuria is the common presenting symptom. Tumor stage is most importnat for prognosis

suicides

the majority occur with the use of a firearm. Must evaluate their axis to guns,

In hereditary spherocytosis

the mean corpuscular hemoglobin concentration (MCHC) is increased due to mild dehydration of the red blood cell. Markers for hemolysis are often evident and include elevated lactate dehydrogenase, reticulocytosis, and decreased haptoglobin.

Glycine

the most abundant amino acid in collagen (Gly-X-Y). This repetition allows for the triple helical conformation of collagen molecules.

Adenocarcinoma of the lung

the most common cancer of the general population, especially in women who are non-smokers. It is located periphery with tumor cells forming gland-like structures.

Pericarditis

the most common cardiovascular manifestatoin assoicated with systemic lupus. It presents with sharp pleuritic (on inspiration) chest pain that is relieved by sitting up and leaning forward Pericardial friction rub heard on ausculation. Other cardiac manifestations of lupus = pericardial effusion, Libman-sacks endocarditis, and increased risk of coronary artery disease

Strept pneumo

the most common cause of community acquired pneumonia in adults.

S. pneumoniae

the most common cause of community acquired pneumonia in immunocopentent hosts HIV+ too unless CD4 count < 200 (Pneumocystitis jiroveci)

TCA's

the most common cause of death in TCA overdose are refractory hypotension and cardiac arrthymias. Their MOA is blocking reuptake of NE and 5-HT. But the reason for teh cardiongenic shock has to do with inhibiton of sodium channels in cardiac myoctes. pharm

S. Epidermidis

the most common cause of foreign body infections due to its ability to produce biofilms (polysaccharide)

A-fib

the most common cause of irregualrly irregular rhythm and is detected by absence of oragnized P waves and varying R-R intervals. It can sometimes occur in excessive alcohol consumption (the holidary heart syndrome)

CMV retinitis

the most common cause of retinits in HIV-positive patietns. Uusally affects patients with CD4 counts less than 50. It is best treated with ganciclovir.

Ornithine transcabamoylase deficiency

the most common disorder of the urea cycle (X-linked), resulting in severe neurolgical abnormalities due to high blood and tissue ammonia. Increased urine orotic acid excretion is typical (carbamoyl phosphate is shuttled to the pyrimidine pathway)

CAD

the most common etiology in most cases of SCD. V-fib woudl typically be the cause of death if it happens acutely (during the prehospital phase)

Follicular lymphoma

the most common indolent lymphoma - has a waxing and waning course. Due to bcl-2 overexpresion.

vWD

the most common inherited bleeding disorder. It is a functional factor VIII and platelet defect thus causing prolonged bleeding time and aPTT

Essential tremor

the most common movement disorder. Patinets experience a slowly progressive, symmetric postural and/or kinetic tremor most often affecting the upper extremitites that gets worse when doing things It is often inherited in an autosomal dominant fashion (familial tremor). It often gets a little better with alcohol. First-line treatment is nonspecific B-adrenergic antagonist propranolol.

CF

the most common muation of the CFTR gene is deltaF508 wich deletes the three nucleotides that code for phenyalanie at postion 508. This leads to abnormal protein folding and failure to glycosylate, thus the transmembrane receptor is degraded before it can even be put in the epithelium.

E. Coli

the most common pathogen causing cystitis and pyelonephritis. UTI commonly affects women due to a shorter urethra. In UTI, symptoms are asymptomatic or subrapubic pain with tenderness, frequent urination. If fever, flank pain, hematuria with casts accompanied- think more pyelonephritis.

Prolactinoma

the most common pitutiary adenoma causing galactorrhea and menstrual irregularities in premonopausal women. Large pitutiary adenomas can cause headaches from mass effect and bitemporal hemianopsia due to copmression of the optic chiasm. The Lactotroph is the cell that becomes the tumor.

Cryptococcus neoformans

the most common presentation is menigoencephalitits in immunocompromised patients. Budding yeasts with thick capsules is diagnostic

Glioblastoma

the most common primary cerebral neoplasm of adults typically located within cerebral hemispheres and may lead to mid-line shift or cross the midline forming a "butterfly glioma". These tumors are highly malignant and grossly contain areas of necrosis and hemorrhage.

Henoch-Schönlein purpura

the most common systemic vasculitis in children. It is an IgA-mediated type III hypersensitivity reaction in children that generally follows infection. Depositions of circulating IGA-containing immune complexes in small vessels results in systemic vasculitis. Common manifestations include palpable lower-extremity purpura, abdominal pain, arthralgias, and hematuria.

Hamartomas

the most common type of benign lung tumors. They are composed of disorganized cartilage, fibrous and adipose tissue

Papillary thyroid cancer

the most common type of thryoid cancer. The diagnosis is made by fine-needle aspiration by characteristic cell morphology showing large cells with nuceli contained finely dispersed chromatin wiht a ground-glass appreance (Oprphan Annie eye) t They also may have psammoma bodies.

Clavicle fracture

the most commonly fractured bone. The sternocleidomastoid muscle causes superior displacement of the medial fragment. The weight of the arm and the pec major causes inferior displacement of the lateral fragment.

Statins

the most effective lipid-lowering durgs for primary and secondary prevention of CV events, REGARDLESS of baseline lipid levels.

Amphotericin B

the most notorious side effect is renal toxicity. Severe hypokalemia and hypomagnesemia are commonly seen during therapy and often require daily supplemenation pharm

left atrium

the most posterior part of the heart. The esophagus lies directly posterior to it.

Mitral regurg

the most reliable ausucultatory finding indicating a severe MR and left ventriuclar volume overload is left-side S3 gallop. The intensity of the holosytolic murmor does not correlate well with regurigtant volume.

Enoxaparin

the name gives it away. Its a LMWH that fuctions like heparin by binding and activating antithrombin III. Activated AT III then binds to factor Xa and prevents it form converting prothrombin to thrombin.

Respiratory tract epithelium

the nose, paranasal sinuses, nasopharyxx, most of the larynx, and the tracheobronchial tree are lined witih pseudostratified colunmnar, mucinous secreting cells. Stratified squamous epithelum is only found in the oropharyx, larygopharyx, anterior epiglottis, upper half of the posterior epiglottis, and vocal folds (true vocal cords)

Raphe nuclei

the only serotonin secreting neruons in the CNS are found here.

Malleus, incus, stapes

the ossicles of the inner ear.

Trochlear nerve injury

the patient may tuck the chin (less looking down) and turn head away from the affected eye (not medial so superior oblique not affected)

Hospice

the patient needs to have a metastatic cancer with a prognosis of < 6 months.

Methotrexate

the preferred disease-modifying treatment for patients with moderate to severe rheumatoid arthritis. Significant adverse effects include stomatitis (inflammation invovling the mouth or lips like an ulcer) , bone marrow suppressions, and liver function abnormalities.

Group B strep

the pregnant lady is screened at 35-37 weeeks and if postiive is given INTRAPARTUM antibiotics either with penicllin or ampicillin to prevent GBS sepsis, pneumonia and meningitis

Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap?

the prescence of an internal ribosome entry site (this virus has a long area here that is called the internal ribosome entry site and directs translation)

Adenomyosis

the prescence of endometrial glandular tissue within the myometrium. Symptoms include heavy menstrual bleeding, dysnmenorrhea. Physical exam shows a uniformly enlarged uterus.

Neutrophils

the primary cell responsible for Gout symptoms. NSAIDs are first line with broad anti-inflammatory effects that include inhibition of neutrophils. Colchicine is second line that directly inhibits neutrophil chemotaxis and phagocytosis by preventing microtubule formation.

NPV

the probability of being disease free if the test result is negative

Negative predictive value

the probablity of not having a diseae given a negative test result.

Prostatectomy nerve injury

the prostatic plexus lies within the fascia of the prostate(THROUGH THE LESSER AND GREATER CAVERNOUS NERVES) and innervates the corpus cavernosa of the penis, which facilitates penile ecretion. Injury during prostatectomy can cause erectile dysfuciton

Glucose-6-phosphate dehydrogenase

the rate-limiting enzyme in the pentose phosphate pathway, the major source of NADPH, which is necessary to reduce glutathione but also the biosynthesis of cholesterol, fatty acids, and steroids.

Reid index

the ratio of the thickness of the mucous gland layer in the bronchial wall submucosa to the thickness of teh bronchial wall BETWEEN THE RESPIRATORY EPITHELIUM AND BRONCHIAL CARTILAGE. progressive mucous gland enlargment is the major contributer to this thickness increase in bronchitis.

H-band

the region of the sarcomere where myosin does not overlap with actin.

Athersclerosis

the releaseof PDGF by locally adherent platelets (endothelial cell injury), endothelial cells, and macrophages promote the migration of smooth muscle cells from the media into the intima and their subsequent proliferation

Chest X ray

the right atrium represents most of the cardiac silloette at the right middle lobe of the lung. Consolidaiton with lobar pneumonia here can obscure it.

Reliability

the same as precision

Hydroxy-halide radicals

the same thing as bleach and therefore created by MPO in destruction of microbes

Hypertension

the single most importnat firsk factor for the development of intimal tears leading to dissection.

Nontypable strains of H. flu

the strains that do not form an antiphagocytic capsule and are part of the noraml upper respiratory flora but can cause otitis media, sinusitis, and bronchitis. Immunity is not conferred then by the type B capsular strain vaccine.

Lower extremity superficial lymphatic system

the superficial lymphatic system is divided into medial and lateral tracts. The medial tract (medial foot) runs up to the superfical inguinal lymph nodes with the saphenous vein, bypassing the popliteal nodes. Consequently, lesions of themedial foot cause inguinal lymphadenopathy, whereas lateral lesions are more likely to cause lymphadenopathy in both the popliteal and inguinal areas.

Anaphylaxis

the systemic version of a local allergic response. Systemic vasodilation and increased vascular permeability as well as airway constriction are mediate by agents such as histamine, heparin, and other things released from mast cells and basophils after cross-linking of at least two molecules of surface IgE with antgen delivers the degranulation signal

Pericardial Tamponade Post-MI

the triad of muffled heart sounds, elevated jugular venous pressure, and profound hypotension indicated pericardial tamponade. Rupture of the ventricular free wall as a consequence of an acute transmural MI can cause tamponade. Rupture typically occurs 3-7 days after onset of total ischemia, when coag necrosis, neutrophil infiltration, and enzymatic lysis of connective tissue may have sufficiently weakened the infarcted myocardium.

Transference

the unconcious shifting of emotions assoicated with a signficant person from one's past to a person in the present. Often the patient to the doctor

Atherosclerotic plaque

the vascualr smooth muscle cells are resposnible for synthesizing structurally imporatnt collagen isoforms and extracellula rmatrix that form the fibrous cap covering the plaque. Progressive remodeling leads to their death with icnreased propensity for rupture

Kallmann syndrome

there is an absecne of GnRH secretory neurons in the hypothalamus due to defective migration of olfactory neurons. Teh patients have central hypogonadism, delayed pubertry, and DO NOT HAVE THE ABILITY TO SMELL.

Silicosis

there may be a disruption of macrophage phagolysosomes by internalized silica particles, which increases the patient's susceptibility to TB

Insulin (rapid acting lispro, aspart, and glulisine)

these are taken with meals as they have a very rapid onset of action with peak effects coinciding with peak postprandial hyperglycemia.

Blunt trauma to the globe can cause orbital blowout fractures

these fractures most commonly invovle the medial or inferior orbital walls die to the thin bone bordering the ethomiod and maxillary sinuses.

Chronic Myeloproliferative Disorders

these include P. vera, ET, and primary myelofibrosis. They often has a mutation in the cytoplasmic tyrosine kinase Jak2. This leads to constant activity and activation of STAT transcription factors.

K+ sparing diuretics

these include amiloride, triamterene and spinronolactone. They can cause hyperkalemia, espeically in a patient already on ACE inhibitors (blocking aldosterone)

hypoxia in renal cortical cells

they respond by producing more EPO

Reid index

thickness of gland layer/total thickness of bronchial wall is > 50 in chronic bronchitis (blue bloater) due to hyperplasia of mucus-secreting glands in the bronchi.

Sarcoidosis

think African Amercian female with hilar adenopathy, pulmonary infiltrates, and non-caseating lung granulomas. Granuloma formation is a manifestation of cell-mediated immunity driven by Th1 CD4+ helper T cells through IL-2 and IFN-gamma which stimulates more T cell production and macrophage activation respsectively

First arch

think issues with something in the face- mandibular cleft, and short palate for instance.

ragged red fiber

think mitochondria disease

retinal ganglion cells

think of those as like the extension of the optic nerve onto the eye. When those are wiped out say in blindness, then you won't get construction with illumination.

Pardoxical embolism

think patent foramen ovale, atrial septal defect, or ventricular septal defect. Atrial septal defect causes wide and fixed splitting of S2 and can facilitate pardoxical embolism during periods of transient reversal from left to right to right to left (like coughing or straining)

Crohn's disease

think transmural inflammation.

Integrin-mediated adhesion of cells

to basement membrane and the extracellular matrix involves the binding of fibronectin, collagen, and laminin.

Nitrates and phosphodiesterase inhibitors

together they are a biG NO NO NO Nitrates are converted to NO by vascualr smooth muslce which increases cGMP. cGMP is normally metabolized by phosphodiesterase in cells but when you ahve these inhibitors for erectile dysfuction (tadalafil, sildenafil, and vardenafil) you have accumulation of cGMP which can cause massive hypotension.

Opioid

tolerance to most side effects is expected ot occur with chronic opioid use except in constipation- the most common and persistent effect.

Arsenic poisoning

toxicity can result fromexposure to pesticides/insecticides (so can Ach overexposure so keep that in mind too). Presents witih abdominal pain, vomitting, diarrhea, hypotension (from volume loss), and a garlic breath odor. Tx: Dimercaprol (pharm)

HBV

transmitted by sex, intravenous drug use Risk of sexual transmission of hep c is very low

The Dengue virus

travel to endemic area, mosquito, hemorragic fever, multiple subtypes (can get reinfected with a different subtype after getting one - 4 total)), Secondary infection (second infection with different serotype) usually causes worse infection. Symptoms: break bone fever (joint pain), bleeding (thrombocytopenia- possible petichiae), leukopenia.

duodenal peptic ulcer

treat with antibiotics against H. pylori because the usual cause.

Postpartum hemorrahage

treat with oxytocin.

Wernicke syndreom

triad of oculomotor dysfuction, ataxia, and confusion. Korsakoff syndrome is a complication of this where the hallmark is permanent memory loss (won't come back) and confabulation.

p53

tumor suppressor gene that controls cell division and apoptosis

Recombination

two DNA viruses that are non-segmented

Right-sided colon cancers

typcially present with signs of iron deficiency anemia due to occult blood loss (can't visibly see) that would manifest as fatigue, pallor and weight loss (just that its cancer)

Acute cerebellar vermis lesion

typically causes truncal ataxia and gait.

GFR

typically measured by inulin which is freely filtered but then neither reabsorbed nor secreted.

IgA nepropathy

typically occurs in children/young adults within 5 adays of an URT illness (PSGN usually is seen 1-3 weeks after). Painless hematuria with mesangial IgA deposits on immunofluresence.

LV free wall rupture

typically occurs in the first 3-7 days after onset of MI if its going to occur (<10% of cases) where coag necrosis and neurtophil infiltration have suffcienctly weakened the infarcted myocardium.

Kaposi's sarcoma

typically presents as blue-violet or brownish skin plaques on the extremities and mucous membranes of HIV-positive patients. It is assoicated with human hyperes virus type 8

Transitional cell carcinoma of the bladder

typically presents as gross hematuria in an elderly male. A history of smoking or occupation exposure to rubber, palstics, aromatic amine containing dyes, textiels, or leather increases risk.

Crohn disease

typically presents with prolonged diarrhea and abdominal pain. fever, malabsorption and weight loss are also common. Trasnmural inflammation can resutl in fistulas, abscesses and fibrotic strictures

The sympathetic nervous system

typically regulates visceral function via 2-neuron signal transmission invovling cholinergic preganglionic neurons and adrenergic postganglionic neurons. Eccrine sweat glands and the adrenal medulla re the exceptions to the rule as they are both innervated by cholinergic neurons .The parasympathetic system (starts at cranial nerve nuceli and the sacral spinal cord) uses both pregangliionic and postganglionic cholinergic neurons.

11-hydroxylase deficiency

typically results in excessive adrenal androgen and mineral corticorid (11-dexoycroticosterone).

Predicatable drug rxn

typically the case due to known properties of the drug. Ex. NSAIDS causing gastric ulcers. Unprredictable reactions would be due to genetic differences immune reacitons, or other mecahnisms

Insulin like growth factor

tyrosine kinase activity

the most highly oxygenated blood in the fetus

umbilical vein

Endometrial cells

undergo apoptosis upon withdrawal of endocrine stimulation by progesterone.

Lactase deficiency

undigested lactose causes osmotic diarrhea with acidification of stool (can test pH of stool in dx) and increased hydrogen gas causing flatulence

DNA pol 1

unique in that it has 5' to 3' exonuclease activity.

Hepatitis B

unlike hepatitis C (usually asymptomatic acutely), is associated with a serum-sickness like syndrome in the prodromal period with malaise, fever, skin rash, pruritus, lymphadenopathy and joint pain. AST and ALT (ALT >AST) are likely to be elevated and possiblity for anorexia, nausea, jaundice, and RUQ pain are also possible.

Essential fructosuria

unlike hereditary fructose intolerance and classic galactosemia, this condition (fructokinase) is relatively benign. Although asymptomatic, their urine will test postitive for a reducing sugar that is not glucose due to unmetabolized fructos (copper reduction test would test for reducing sugar)

Helicase

unwinds DNA at the replication fork and separates dsDNA into ssDNA during the replication process

BPH

urinary retention results in increased pressure in the urianry tract leading to hydronephrosis and renal interstitial atrophy and scarring. BPH must be treated as it can eventually lead to renal failure.

Warfarin toxicity

use Vitamin K if nonacute and fresh frozen plasma for acute reversal.

Case-control study

use to compare the exposure of people with the disease (cases) to the exposure of people without the disease (controls). The main measure of association is the exposure odds ratio. (odds of exposure of people with disease/odds of exposure of people without disease) ex. healthy patients (control) and diseased patients (cases) are asked about acetaminophen use.

Ethosuximide

used for absence seizures.

Colchicine

used for the treatment of gouty arthritis in patients who cannot take NSAIDS. it inhibits leukocytes migration and phagocytosis by blocking tubulin polymerization (the cytoskeleton). Significant side effects include nausea and diarrhea.

Terbinafine

used for treatment of dermatophytosis. It inhibits the synthesis of fungal membrane ergosterol by supressing the enzyme squalane epoxidase.

orlistat

used to aid in weight loss. Is notorious for causing fatty bowel movments (steatorrea).

Polymerase Chain Reaction (PCR)

used to amplify small fragments of DNA. It requires primers that are complimentary to the regions of DNA flanking the segment of interest.

Chi-square test

used to test association between 2 categorical variables

Ethosuximide

used to treat abscence seizures. It works by blocking T-type CaS+ channenls in the thalamus that trigger burst dishcharges Phenytoin, carbamazepine, and voalproic acid on the other hand work by decreasing sodium current (inactivate sodium channels) in cortical neurons reducing the ability to fire.

Stains and fibrates

using both increases the risk of myopathy.

Juvenile Pilocytic astrocytomas

usually arise in the cerebellum, brainstem, hypothalamic region or optic pathways. Microscopically, pilocystic astrocytomas are well-differentiated neoplasms comprised of spindle cells with hair-like glial processes known as microcysts. These cells are mixed with Rosenthal fibers and granular eosinophilic bodies. A cystic tumor in the cerebellum of a child is most likely a pilocytic astrocytoma.

ACL tears

usually damaged by sudden decelerations and pivots on an extended knee

Chronic Granulomatous disease

usually due to X-linked mutation in NADPH oxidase. Deficiency results in an inability to form the oxidative burst in neutorphils results in infection with Catalase positive organisms Dx can occur by either ntiroblue tetrazolium test negativity or dihydrorhodamine flow cytometry

Chemical carcinogens

usually enter body in a pro-carcinogen state and converted into active metabolites by teh cytochrome p450 oxidase system (microsomal monooxygenase).

Kaposi's sarcoma

usually involves the skin and GI tract in HIV patients not on antiretroviral therapy. Endoscopy revelas reddish/violet flat maculopapular lesions to raised hemorrhagic nodules or polypoid masses. Biopsy can show spindle cells, neovascularizaiton, and extravasted red blood cells.

Cardiac pacemaker cells

usually it is controlled by the SA node becuase this has the fastest firing rate of all conductive cells. The cells in other areas of the conduction system (AV node, bundle of His, and Purkinje fibers) may serve as pacemakers if normal impulse conduction is impaired

Pathologic atrophy

usually occurs due to decreased physical workload; loss of innervation; decreased blood suppply; inadequate nurtion; absent endocrine stimulation; aging; or pressure

SAH

usually occurs due to rupture of beery ansuersms or ateriovenous malformations. The worst headache of my life (acute). CT woudl show fluid and CSF xanthochromia assoicated with ADPKD and Ehlers-Danlos

Minimal change disease

usually occurs in kids and often after an inciting event such as an URT, immunization, or insect bite.

Neonatal intraventricular hemorrhage

usually occurs in the fragile germinal matrix and increasing in frequency in premature infants.

V. cholerae

usually requires a massive infectious dose to cause disease because sensitive to gastric acidity. However, in patients taking omeprazole or any other condition that reduces acidity, the minimum infectious dose is lowered significantly.

PKU

usually results from deficiency of phenylalanie hydroxylase but could also be due to its cofactor BH4. Infants gradually develop severe intellectual disability and seizures. Hypopigementation of the skin, eyes, and catecholaminergic brain nuclei are also seen (decreased melanin production)

Incontinence and MS

usually these patients develop urge incontinence due to a loss of system inhibition on detrusor contraction in the bladder. As disease progresses, the bladder can become atonic and dilated, leading to overflow incontinence.

Listeriosis (listeria meningitis)

usually transmitted through food ingestions and can cause meningitis in immunocompromised hosts (transplants/HIV). Listeria is gram-positive with tumbling motility. It grows well in cold temperatures and can therefore contaminate refrigerated food (like unpasteurized cheese)

BV

vaginal infection diagnosed by the prescence of clue cells and a positive amine "whiff" test with KOH. The pathogenisis invovles a loss of lactobacilli in the normal vaginal flora and overgrowth of Garnerella vaginalis. It is treated with CLINDAMYICN or metronidazole

Tropical sprue

very similar pathology to celiac disease, except more present in the jejunum and ileum and responds to antibitoics

Protein A

virulence factor of S. Aureus (Gram positive clusters on GS) that binds Fc portion of IgG and prevents complement activation, opsonization, and phagocytosis

Pernicious Anemia

vitamin B 12 deficiency mediated by autoimmune destruction of parietal cells in the upper (superfical) glandular layer of the stomach. IF can't be released then.

Impaired colleagues

we are ethically and legally obligated to report them if patient safety is at risk.

Golgi tendon system

when a muscle exerts too much force (creates too much tension), the GTOs inhibit contraction of the muscle, causing sudden muscle relaxation to prevent damage to the MSK system

equilibrium potential

when a specific ion channel opens, the respective ions will flow across the membrane in a direction that brings the resting membrane potential closer to that ion's equilibrium potential. Remember, Sodium is primarily extracellular with a equilibrium potential of +60mv, Potassium is primarily intracellular with an equilibrium potential of -90 mv, and chloride is priamrily extracellular with a membrane potential of -75 mv.

Thoracentesis

when doing a thoracentesis do it above the rib (to avoid the neurovascualr bundle-vein artery nerve) and in teh midascapular line. You go two ribs below the effusion as well.

Congestive heart failure

when due to dilated cardiomyopathy or chronic ischemic disease is characterized by dilatation of 1 or both ventricles and contractile (systolic) dysfunction.

Factitious disorders

when the patient consciously creates physical and/or psychological symtpoms in order to assume "sick role" Munchausen syndrome: chronic factitious disorder with predominantly physical signs and symptoms. Characterized by multipel hospital admissions with willingness for invasive procedures Munchausen syndrome by proxy: Illness in a child or elderly patients is caused by the caregiver (form of child abuse/elder abuse), but they want to be the sick role by proxy.

End of life

when the patient is unable to make their wishes known and there is no written documentation of these wishes, the responsibility for medical decision making falls to their designated health care proxy. If patient never designated a surrogate decision-maker, medical decisions default to next of kin which is spouse in a married person.

linkage disequilibrium

when two allele loci are inherited in the same gamete more or less than would be expected given random chance. This can occur even if the genes are on different chromosomes. Essentially they don't follow Hardy Weinberg equillibrium

General cancer rule

when you see multiple tumors- think mets. The most common malignant hepatic leison is a mets from brest, lung, colon, not HCC

embolic phenomena

when you see stroke and renal infarction, think about a-fib that predisposes patients to these emboli.

The nucleolus

where RNA pol I synthesizes rRNA and i tis also invovled in the maturation of the ribosome with the 60S and 40S subunits

An increase in estrogen activity

whether from pregnancy, OCPs, post-menopausal estrogen repalcment increases levels of thyroxine-binding globulin. This leads to an increase in total thryoid hormone levels, but feedback control maintins normal levels of free thyroid hormone.

Bacterial mRNA can be polycistronic

which means that one mRNA codes for several proteins such as with the lac operon (necessary proteins for lactose metabolism in E. coli)

An increase in stroke volume on left ventricular pressure-volume loops

widening of the horizontal points showing increased or decreased EDV or ESV respectively.

The lepromin skin test

will be positive in patients with tuberculoid leprosy as they exhibit a strong CD4+ TH1 cell-mediated immune response to Mycobacterium leprae. Tuberculoid leprosy with the strong response damages the skin and surroudnig nerves- loss of sesnsation at the spot and hypopigmented patch.

Precocious puberty in a male

will be tall for age group at first because will hit growth spurt early, but then will be short as an adult since epiphyseal plates close early

Metyrapone

will cause a decrease in cortisol synthesis by inhbitng 11-beta-hydroxylase. IN patietns with intact HPA, it will cause a reactive increase in ACTH, 11-deoxycortisol and urinary 17-hydroxycorticosteroid.

Mycobacteria tuberculosis

will grow as "serpentine" cords on enriched media secondary to the presence of cord factor, a mycoside. Cord factor establishes virulence through neutrophil inhibition, mitochondrial destruction, and the induced release of TNF.

Cornyebacterium

will grow on cysteine-tellurite agar. It can also be cultured on Loffler's media.

Retic count

will increase dramatically once B12 deficiency is ocrrected and then will decrease overtime as the anemia is corrected.

Type 1 diabetes

will present acutely with polyuria, polydipsia, and polyphagia accompanied by fatigue and weight loss. The diagnosis can be confirmed with a fasting blood glucose (>126) or HbA1c measurement

Hashimoto's thryoiditis

will show mononuclear, parenchymal infiltration with well developed germinal centers. They also will show characteristic Hurthle cells

Antimuscarinics and antihistmaines

with antimuscarinc action are most effective in treating motion sickness. can have side effects like dry mouth.

Romance with patients

with current patients, its always unethical. Relationships with formal non-psychiatric patients may be acceptable on a case-by case patient provided the physician-patient relationship is terminated beforehand (and can't ask the patient to do it either because then you are influencing that decision).

Prevent PE's in hospitalized patients

with heparin (especially after hip replacement)

Anesthetics

with high tissue solubility are characterized by large arteriovenous concentration gradients and slower onsets of action.

Posteroperative hypoparathyroidism

with resultant hypocalemia is common post-thyroiddectomy. Supplement patients with calcitriol and calcium.

Atypical PKU

with tyrosine supplementation, may still have neurological abnormalities such as an increased prolactin level (remember that dopamine decreases prolactin)

2,3-BPG

within erythrocytes, these babies allow increased oxygen delivery because of lower Hb affinity. 2,3 bis phos is produced from 1,3 bis phos by the enzyme bisphosphoglycerate mutase. This reaction consumes the energy that would have otherwise been used to make ATP

Regiona airway resistance

within the first 10 generations of bronchi contributes to most of the total airway resistance of the lower respiratory tract. Resitance is maximal in the 2nd to 5th generation pathways (medium sized bronchi) but then decreases signifcantly due to increased surfaced area in the terminal bronchioles (<2mm)

Anti-HBc and anti-HBs

without detection of viral antigens would indicate recovery from acute hepatitis B infection (if it was just vaccination, patient would only have anti-HBs). Chronic hepatitis B would be indicated by persistnet levels of HBsAg and HBV DNA in the serum

Mild or brief sadness

without signficant interference in pscyhosocial functioning is consistent with normal sadness and not a disorder

macrolides like erythromycin

work by blocking translocation (macroslides) on the ribosome for the t-TRNA sliding along- thus inhibits protein synthesis

Aminoglycosides

work by interfering with the 30S ribosomal subunit (rRNA invovled) and causing the cell to misread mRNA, thereby halting protein synthesis. An importnat mech of resistance is the methylation of the aminoglycoside-binding portion of the ribosome. pharm

HIV protease inhibitors

work by preventing the formation of a mature viral core.

Sumatriptan

works as a serotonin agonist and is used for migraines. May inhbit the trigeminal nerve, prevent vasoactive peptide release and induce vasoconstriction.

Micafungin

works by inhibiting cell wall synthesis by inhbiting beta glucan.

A chronic arteriovenous shunt

woudl increase cardiac output becuase of increased sympathetic stimulation to the heart, decreased total peripheral resistnace, and increased venous return. It would also cause the venous return curve to shift ot the right becuase ciruclating lbood volume is increased through renal retention of fluids and becuase venous pulling is reduced by increasing sympathetic tone.

An abnormal atrial v wave that is way to high

would be indicative of mitral regurgitation.

GFAP

would be positive in astrocytomas- think glioblastoma in adults of pilocytic astrocytoma in kids

A monomeric subunit of hb

would be very similar to that of myoglboin and thus woudl have the similar hyperbolic oxygen-dissocation curve (lack of cooperative binding and also P50 would be reached at just 1 mmHG- super tightly bound)

Saline infusion

would cause a rightward widening of the pressure volume loop due to increased preload causing increase in EDV

A drug that binds to GABA-A receptors

would increase the conductase of chloride ions ,leading to increased passive transport of chloride into teh cell interior. This causes the membrane potential to become more negative and hyperpolarized than the resting membrane potential as it approaches the equillibrium potential of chloride (-75 mV)

Ciprofloxacin resistance

would likely be due to a mutation in DNA gyrase.

a penetrating injury at the left sternal border in the fourth intercostal space

would puncture the right ventricle

Xanthelasma

yellowish eyelid papule or plaque containing lipid laden macrophages. It is often associated with either primary or secondary hyperlipidemia. Cholestatic conditions such as PBC are a potential cause

MEN

you must memorize their cancers. Both chromaffin cels of the adrenal medulla and parafollicular cells (C-cells) of the thyroid originate from neural crest. The germ-line mutation in Men is why they both get cancers in that area.

Polyarteritis nodosa

young adutls Heb B assoication Fever, weight loss, malaise, headache GI:adominal pain, melnaa Hypertesnion, nuerologtical dysftion, cutaneous eruptions, renal damage (multiple microanerusms) spares the lungs Transumural inflammation of the arterial wall with fibrinoid necrosis Tx: corticosteroids + cyclophosphamide