Smart Book

How is testicular torsion characterized?

Acute, severe pain with nausea/vomiting, an asymmetrically high-riding testis, and absent cremasteric reflex

How does Parvovirus present in adults?

Acute, symmetric arthralgia/arthritis involving hands, wrists, knees, and/or feet, with or without rash

How does acute rheumatic fever present?

Acute/subacute: Migratory arthritis Pancarditis (mitral regurgitation) Sydenham chorea Chronic Mitral stenosis

What action is impaired with obturator nerve injury (goes through obturator canal)?

Adduction of the thigh

What are tubular, villous, or tubulovillous, depending on their histologic appearance?

Adenomatous polyps Villous tend to be larger, sessile, and more severely dysplastic than tubular adenomas Villous can cause a secretory diarrhea from increased mucin production; patients may develop hypoproteinemia and hypokalemia

What drug is best for SVT?

Adenosine

What is the initial treatment of paroxysmal SVT?

Adenosine

What virus is associated with acute hemorrhagic cystitis?

Adenovirus

What effects does prolonged glucocorticoid therapy have?

Adipose- lipolysis, altered fat distribution Adrenal cortex- atrophy Bone- osteoporosis Immune system- suppression, T-cell apoptosis Liver- increased gluconeogenesis and glycogenesis Skeletal muscle- atrophy (glucocorticoid myopathy) Skin- thinning, stria, and impaired wound healing

What is the Metyrapone test?

Admin of metyrapone will cause a decrease in cortisol synthesis via inhibition of 11-beta-hydroxylase In patients with an intact hypothalamic-pituitary-adrenal axis, this will cause a reactive increase in ACTH, 11-deoxycortisol, and urinary 17-hydroxycorticosteroid levels

What patient characteristic is most likely to indicate a poor long-term prognosis in PSGN?

Adult onset

Where do you commonly see Cheyne-Stokes breathing?

Advanced CHF Cheyne-Strokes breathing is a cyclic breathing pattern in which apnea is followed by gradually increasing then decreasing tidal volumes until the next apneic period

What patients are at an increased risk for VZV reactivation (shingles)?

Advanced age Immunosuppression

How does neisseria meningitidis get into the CNS?

Aerosolized droplets that subsequently colonizes the nasopharyngeal epithelium, then penetrates into the bloodstream and spreads to the meninges via transcellular penetration of the cerebral capillary endothelium

What is the path of the pupillary light reflex?

Affarent= optic nerve Efferent= parasympathetic of occulomotor When an optic nerve is damaged, light in that eye will cause neither pupil to constrict (nerve cant sense light) However, light in the contralateral eye will cause both pupils to constrict (because motor pathways are intact)

What is the MOA of adenosine?

Affect phase 4 of the action potential, reducing the rate of spontaneous depolarization in cardiac pacemaker cells Adenosine interacts with A1 receptors on the surface of cardiac cells, activating potassium channels and increasing potassium conductance, causing the membrane potential to remain negative for a longer period Also inhibits L-type Ca2+ channels, further prolonging the depolarization time These actions result in a transient slowing of the sinus rate and an increase in AV nodal conduction delay

How does Medium chain acyl-CoA Dehydrogenase (MCAD) deficiency present?

Affected individuals may remain asymptomatic for long periods until they experience a significant fast, during which they are unable to oxidize fatty acids to maintain glucose and ketone body production Classic manifestations include hypoketotic hypoglycemia (eg, undetectable acetoacetate level), mild hepatomegaly, and liver dysfunction Because the resulting metabolic crisis can have severe consequences (eg, seizures, sudden infant death), fatty acid oxidation disorders are part of standard newborn screening Tx= avoid fasting and promptly supply glucose during periods of illness

How do T-tubules help with contraction?

Allow the depolarization impulse to rapidly propagate through the interior of the muscle fiber This ensures that caclium release from the Sarcoplasmic reticulum occurs uniformly throughout the fiber, allowing for synchronized contraction of myofibrils in each muscle cell Mutation in a sarcolemma protein that decreases numbers of functional T-tubules lead to uncoordinated contraction of myofibrils, which manifests as muscle weakness

Where does tamsulosin work?

Alpha 1 a/d receptors found on smooth muscles

Liver damage and shortness of breath in young person is associated with what?

Alpha 1 antitrypsin disease

What are the treatments for BPH and HTN?

Alpha 1 blockers (Doxazosin, Prazosin, and Terazosin)

What is the MOA of phentolamine?

Alpha1 blocking drug Necrosis from NE leakage can be prevented with a sodium chloride solution containing phentolamine mesylate, an alpha receptor blocker

Abdominal aortic aneurysm (AAA)

Atherosclerosis and smoking

What hemodynamic changes are associated with chronic aortic stenosis, concentric left ventricular hypertrophy, and atrial fibrillation together?

Atrial contraction contributes significantly to LV filling in chronic aortic stenosis and concentric left ventricular hypertrophy. Loss of atrial contraction due to atrial fibrillation can reduce LV preload and cardiac output sufficiently to cause systemic hypotension Decreased forward filling of the LV can also result in backup of blood in the LA and pulmonary veins, leading to acute pulmonary edema

What type of heart problem can occassionally seen in patients after excessive alcohol consumption?

Atrial fibrillation ("holiday heart syndrome")

What is a risk for acute mesenteric ischemia?

Atrial fibrillation (irregularly irregular heart beat or EKG with absent p waves)

What are the features of a fourth heart sound (S4)?

Atrial gallop sound (before S1) Heard immediately after atrial contraction as blood is forced into a stiff ventricle Normal: Healthy older adults Abnormal/associated conditions: Younger adults, children Diastolic dysfunction (eg, LVH)

What typically causes position dependent obstruction of the mitral valve, leading to a mid diastolic murmur and symptoms of decreased CO and presents with constitutional symptoms?

Atrial myxoma Tumors demonstrate scattered cells within a mucopolysaccharide stroma and abnormal blood vessels

What is secreted by atrial cardiomyocytes in response to atrial stretch?

Atrial natriuretic peptide (ANP) Induced by HTN or hypervolemia ANP causes peripheral vasodilation and increased urinary excretion of sodium and water. Neprilysin inhibitors (eg, sacubitril) prevent the degradation of ANP, enhancing its beneficial hemodynamic effects in heart failure patients

What are the local cutaneous effects of chronic topical corticosteroid administration?

Atrophy/thinning of the dermis that is associated with loss of dermal collagen, drying, cracking, and/or tightening of the skin, telangiectasias, and ecchymoses

How do you treat metoprolol OD?

Atropine Glucagon Saline

How do you treat antimuscarinic/anticholinergic toxicity?

Atropine toxicity is treated with physostigmine "Phyxes atropine OD"

How do bisphosphonates work?

Attach to hydroxyapatite binding sites on bone surfaces Inhibit osteoclast-mediated bone resorption

What are the pili on the capsular surface of N meningitidis primarily responsible for?

Attachment to and colonization of nasopharyngeal epithelium

How is high-grade CIN described?

Atypical cells have invaded beyond the lower 1/3 of the cervical epithelium (eg, to the epithelial surface) High rate of cancer

What is maple syrup urine disease?

Autosomal recessive disorder Defective breakdown of branched-chain amino acids (leucine, isoleucine, and valine) Degradation of these 3 amino acids first involves transamination to their respective alpha-ketoacids, which are subsequently metabolized by several enzymes reffered to as the branched-chain alpha-ketoacid dehydrogenase complex (BCKDC) BCKD needs 5 cofactors: Thiamine, Lipoate, Coenzyme A, FAD, NAD (mnemonic: Tender Loving Care For Nancy)

What is the pathogenesis of hemochromatosis?

Autosomal recessive disorder characterized by excessive intestinal iron absorption and accumulation within parenchymal tissues that result in end-organ damage Frequently caused by a missense mutation in the HFE gene (most common caucasians)

What is MCAD deficiency?

Autosomal recessive disorder characterized by the inability to degrade medium length fatty acids (6-12 carbons) by beta oxidation Affected patients present in early childhood with hypoketotic hypoglycemia and neurologic and hepatic dysfunction following a period of fasting or increased metabolic stress

What is classic galactosemia?

Autosomal recessive disorder leading to complete enzymatic absence of galactose-1-phosphate uridyl transferase Newborns present within days of birth jaundice, vomiting, and hepatomegaly In general, most enzyme deficiency conditions follow an autosomal recessive inheritance pattern whereas diseases due to defective noncatalytic proteins follow an autosomal dominant pattern

What is ataxia telangiectasia?

Autosomal recessive disorder resulting from a defect in DNA-repair genes DNA of these patients is hypersensitive to ionizing radiation Manifestations= cerebellar ataxia, oculocutaneous telangiectasias, repeated sinopulmonary infections, and an increased incidence of malignancy See cerebellar atrophy

What is methylmalonic acidemia?

Autosomal recessive organic acidemia resulting from complete or partial deficiency of the enzyme methylmalonyl-CoA mutase

How do you treat restless leg syndrome?

Avoidance of aggravating factors (eg, alcohol, sleep deprivation) Dopamine agonists (eg, pramipexole)

What nerve innervates the deltoid?

Axillary nerve Also provides sensory over the lateral shoulder

What two drugs are used in organ transplantation?

Azathioprine and 6-MP

What drug is used to prevent MAC infection when CD4 is less than 40>

Azithromycin

What drugs inhibit the synthesis of ergosterol by the fungal cytochrome P450 enzymes?

Azoles Also suppress the human P450 system, resulting in many drug-drug interactions

How is sperm affected in CF?

Azoospermia

What is the only bacteria with a polypeptide capsule?

B anthracis Contains poly-D-glutamic capsule

What are the most prominent organisms isolated in intraabdominal infections?

B. fragilis and E. coli usually polymicrobial infections

What is a necessary lifelong treatment after a total gastrectomy?

B12 This is due to the fact that parietal cells produce Intrinsic factor which is necessary for the absorption of B12

What are the B-cell only immune disorders?

BAC Bruton's X linked Agammaglobulinemia IgA deficiency Combined Variable ImmunoDeficiencies (CVID)

What virus is seen in transplants, usually kidney transplants?

BK virus ("Bad Kidney")

What are the segmented viruses?

BOAR: Bunyavirus Orthomyxovirus Arenavirus Reovirus

What mutation is commonly seen in malignant melanoma?

BRAF v600E mutation Seen in 40-60% of patients with melanoma

What tests should be ordered prior to SGLT2 inhibitor use?

BUN and creatinine Decrease proximal tubular reabsorption of glucose, thereby promoting urinary glucose loss Check these before and during treatment Eg, canagliflozin, dapagliflozin (flozin's)

What bacteria shows large, gram positive rods that form colonies resembling a medusa head?

Bacillus anthracis

Which gram negative bacteria is the only one with a polypeptide capsule and poly-d glucose?

Bacillus anthracis

What are the spore forming bacteria?

Bacillus anthracis (anthrax) Bacillus cereus (food poisoning) Clostridium botulinum (botulism) Clostridium dificile (Pseudomembranous colitis) Clostridium perfringens (Gas gangrene) Clostridium tetani (tetanus)

What are splinter hemorrhages associated with?

Bacterial endocarditis Subungual splinter hemmorhages, splinter- or flame-shaped hemorrhagic streaks in the nail bed that appear as a consequence of microemboli from the valvular vegetations

What condition is commonly seen in Wilson's disease?

Basal ganglia atrophy

What are the clinical signs of cardiac tamponade?

Beck's triad: JVD Hypotension Diminished heart sounds Pulsus paradoxus: Abnormally large inspiratory decrease in systolic blood pressure > 10 mmHg

What do you see in bronchoalveolar carcinoma?

Alveolar growth pattern without invasion

What are the 4 major causes of hypoxemia (low PaO2)?

Alveolar hypoventilation Ventilation-Perfusion mismatch Diffusion impairment Right-to-left shunting A-a gradient is normal with alveolar hypoventilation (between 5-15 mmHg)

Where do proteases in alveolar fluid come from?

Alveolar macrophages and infiltrating neutrophils

What type of placentation is present in dizygotic twins?

Always have 2 amnions and 2 chorions

What are endothelin receptor antagonists?

Ambrisentan, bosentan Endothelin is a potent vasoconstrictor that also promotes smooth muscle cell proliferation Typically found in high concentrations in patients with pulmonary arterial hypertension and is an important target of therapy for the disease

What 4 drugs cause pulmonary fibrosis?

Amiodarone Methotrexate Busulfan Bleomycin

What are class III antiarrhythmic drugs and what is their MOA?

Amiodarone, sotalol, dofetilide Predominantly block K+ channels and inhibit the outward K+ currents during phase 3 of the cardiac action potential, thereby prolonging repolarization and total action potential duration

A patient taking cisplatin develops ototoxicity, what drug can help with the toxicity?

Amiphostene

What drug do you give for patient undergoing dental procedure and is at risk for endocarditis?

Amoxicillin

Mucosal H flu tybe b treatment

Amoxicillin/Clavulonic acid

What antifungals act at the cell membrane?

Amphotericin B and nystatin (bind ergosterol) Azoles (inhibit synthesis of ergosterol)

What are classic histopathologic findings in alzheimer's?

Amyloid plaques (central amyloid beta core surrounded by dystrophic neurites) Neurofibrillary tangles (aggregates of hyperphosphorylated tau protein)

What is phenelzine?

An MAOI that works by irreversibly binding and inhibiting both types of MAO Results in increased presynaptic availability of monamine neurotransmitters, thereby increasing their release into the synaptic cleft May take up to 2 weeks following discontinuation before MAO is resynthesized to a level adequate for normal monoamine degredation

What is erythema multiforme?

An acute inflammatory disorder that can involve the skin of the extremities, face, trunk, and neck Severe cases (EM major) can also affect oral mucous membranes and the tongue Appearance can vary, but patients typically develop erythematous, round papules that evolve into target lesions with a dusky central area, a dark red inflammatory zone surrounded by a pale ring, and an erythematous halo in the lesion's periphery

What is lead time bias?

An apparent increase in survival time among patients undergoing screening when they actually have an unchanged prognosis Patients screened with more sensitive tests may appear to live longer only because the disease was detected earlier than had it been diagnosed clinically

What is Capitation?

An arrangement in which a payor pays a fixed, predetermined fee to provide all the services required by a patient. Payors may negotiate a capitated contract with an insurance company that then pays the providers, or a large medical group may negotiate directly with the payor Payment structure underlying HMO

What is Cystinuria?

An autosomal recessive disorder caused by defective transportation of cystine, ornithine, arginine, and lysine (COLA) across the intestinal and renal tubular epithelium Recurrent nephrolithiasis is the only clinical manifestation Hexagonal cystine crystals

What is tryptase?

An enzyme that is relatively specific to mast cells, and elevated serum levels are often used to support clinical diagnosis of anaphylaxis after the patient has been stabilized

What is ubiquitin ligase?

An enzyme that recognize specific protein substrates and catalyze uniquitin attachment. These tagged proteins are then taken up by the proteasome, where they are broken down into their constituent oligopeptides and, eventually amino acids

What is pulsus paradoxus?

An exaggerated decrease in SBP during inspiration (>10mmHg) Most commonly seen in patients with cardiac tamponade but can also occur in severe asthma, COPD, hypovolemic shock, and constrictive pericarditis

What is hairy cell leukemia?

An indolent B-cell neoplasm predominantly found in middle-aged men and characterized by bone marrow failure and infiltration into the reticuloendothelial system, causing massive splenomegaly Other features include a "dry tap" and the presence of lymphocytes with cytoplasmic projections

What is familial dysbetalipoproteinemia (type III)?

An inherited hyperlipoproteinemia with a protein defect in ApoE Has elevated chylomicrons and VLDL remnants Major manifestations= premature atherosclerosis, tuboeruptive and palmar xanthomas

What is an imperforate hymen?

An obstructive lesion caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina. At birth, vaginal secretions stimulated by the mother's estrogen can cause mucocolpos (accumulation of mucus in the vaginal canal), which may manifest as a bulging introitus If the condition remains undiagnosed, the mucus is reabsorbed and the child will be asymptomatic until menarche

What is a paradoxical embolus?

An thrombus from the venous system crosses into the arterial circulation via an abnormal connection between the right and left cardiac chambers (eg, patent foramen ovale, atrial septal defect, or ventricular septal defect)

What type of organism is Gardnerella vaginalis?

Anaerobic gram-variable rod

What are the histologic findings of epithelial ovarian cancer?

Anaplasia of epithelial cells with invasion into the stroma, along with multiple papillary formations with cellular atypia

What are the clinical features of PCOS?

Androgen excess: Hirsutism, acne, androgenic alopecia Ovarian dysfunction: menstrual irregularity, polycystic ovaries Insulin resistance: acanthosis nigricans, glucose intolerance/diabetes, metabolic syndrome Obesity

What is chronic lymphedema a risk factor for?

Angiosarcoma

What ligament is injured in radial head subluxation (nursemaid's elbow)?

Annular ligament Results from sudden traction on the outstretched and pronated arm of a child Usually in little distress unless attempts are made to move the elbow

What is the defect iin Tetralogy of Fallot?

Anterior and cephalad deviation of the infundibular septum during embryologic development, resulting in a malaligned ventricular septal defect (VSD) with an overriding aorta As a result, the patient has right ventricular outflow obstruction (resulting in a systolic murmur) and squats to increase the peripheral systemic vascular resistance (afterload) and decrease right-to-left shunting across the VSD

What antibodies are highly specific for systemic sclerosis?

Anti-DNA topoisomerase I (Scl-70)

What HB antibody correlates with decreased viral replication and infectivity?

Anti-HBe

Which antibodies provide protective immunity against future infection of HB?

Anti-HBsAg

What are the antibodies in CREST syndrome?

Anti-centromere antibodies

What drugs are most often affected by CYP450 inhibitors and inducers?

Anti-epileptics Theophylline Warfarin

What is Aminoglycoside (eg, gentamicin) resistant most commonly due to?

Antibiotic-modifying enzymes These enzymes add chemical groups to the antibiotic, which diminishes its ability to bind to the 16S ribosomal RNA within the 30S ribosomal subunit

What is Anti-HBc IgM?

Antibody to core protein of HB First sign of acute infection Present during window phase prior to HBsAg and HBeAg

What is Anti-HBc IgG?

Antibody to core protein of HB Present in both acute and chronic infection Not present after vaccination

What is Anti-HBe?

Antibody to envelope protein of HB Develops in cleared infection and later in chronic infection Indicates decreased viral replication and infectivity

What is Anti-HBs?

Antibody to surface antigen of HB Seen with cleared infection or vaccination Confers long-term immunity

What is an acute hemolytic transfusino reaction?

Antibody-mediated (type III) hypersensitivity reaction Anti-ABO antibodies (mainly IgM) in the recipient bind the corresponding antigens on transfused donor erythrocytes, leading to complement activation. Anaphylatoxins cause vasodilation and symptoms of shock, while formation of the membrane attack complex leads to complement-mediated cell lysis. (Hemolytic disease of the newborn ins another example) Presents with fever and chills, hypotension, dyspnea, chest and/or back pain, and hemoglobinuria (red- to brown-colored urine) May also develop DIC and renal failure Occurs within mimutes to hours of starting a blood transfusion and are most often due to ABO incompatibility

What is the MOA of ipratropium?

Anticholinergic agent and derivative of atropine Treats obstructive lung disease by blocking acetylcholine at muscarinic receptors, which prevents bronchoconstriction and reduces mucus secretion from tracheobronchial submucosal glands

What are some adverse effects of Tricyclic antidepressents (such as amitriptyline)?

Anticholinergic properties can lead to confusion, constipation, and acute urinary retention. Elderly at increased risk for side effects due to comorbid conditions, decreased hepatic and renal clearance of meds, and a higher burden of concurent meds that can interact with TCAs and contribute to adverse effects.

What medications are associated with osteoporotic fractures?

Anticonvulsants that include cytochrome P450 (phenobarbital, phenytoin, carbamazepine) Aromatase inhibitors Medroxyprogesterone GnRH agonists PPIs Glucocorticoids

What is caspofungin?

Antifungal that blocks glucan synthesis These echinocandins are unique in that they suppress fungal cell wall synthesis

What do eosinophils phagocytize?

Antigen-antibody complexes

What drugs are given to counteract cholinesterase inhibitor adverse effects when treating myasthenia gravis?

Antimuscarinic agents (eg, glcopyrrolate, hyoscyamine, or propantheline)

What antibodies are associated with polymyositis?

Antinuclear Anti-Jo-1 Biopsy shows endomysial mononuclear inflammatory infiltrate and patchy muscle fiber necrosis Similar to dermatomyositis but lacks the characteristic skin findings

What bacterial virulence factor is important in bacillus anthracis infection?

Antiphagocytic D-glutamate capsule (polypeptide) Also produces a potent exotoxin complex composed of edema factor, lethal factor, and protective antigen, which enter host cells and cause cell death

Where does H pylori like to live in the stomach?

Antrum

What type of ulcers result in H pylori infection of the antrum? body/fundus?

Antrum- duodenal ulcers Body/fundus- gastric ulcers

What valvular diagnosis is associated with bounding femoral pulses and carotid pulsations that are accompanied by head bobbing?

Aortic regurgitation

Where is secondary (reactivation) TB located?

Apical lobe with cavitary lesions

Why cant methimazole be used in 1st trimester?

Aplasia cutis

What are the neurokinin 1 (NK1) receptor antagonists?

Aprepitant Fosaprepitant Used to treat chemotherapy induced emesis

What reaction does 5-Lipoxygenase catalyze?

Arachadonic acid to 5-HPETE

What structures are important in reabsorption of CSF?

Arachnoid granulations

What is needed to make nitric oxide along with endothelial nitric oxide synthase (eNOS)?

Arginine NADPH O2

Breast cancer in postmenopausal woman treatment

Aromatase inhibitor (anastrozole)

What is the MOA of anastrazole?

Aromatase inhibitor which reduces the synthesis of estrogen from adrogens, suprressing estrogen levels in postmenopausal women and slowing progression of ER-positie tumors

What does garlic odor signify in poisoning, and what is the treatment?

Arsenic poisoning Dimercaprol (all heavy metals)

What artery is obstructed from testicular torsion?

Arterial blood flow in the testicular arteries is initially preserved, leading to engorgement and eventual hemorrhagic infarction. spermatic cord is twisted though, so eventually get ischemia due to gonadal artery compression (arises from abdominal aorta) Compresses pampiniform plexus of the testicular vein and reduced venous outflow

What can glucokinase function as in pancreatic beta cells?

As a glucose sensor by controlling the rate of glucose entry into the glycolytic pathway Mutations in the glucokinase gene are a cause of maturity-onset diabetes of the young

When does microsatellite instability occur?

As a result of defective DNA mismatch repair and is the genetic basis for Lynch syndrome (HNPCC)

What are the serious complications of ankylosing spondylitis?

Ascending aortitis Restricting chest wall expansion (d/t involvement of thoracic spine and enthesopathies of costovertebral and costosternal junctions) Anterior uveitis

What is the Charcot Triad?

Ascending cholangitis triad of symptoms RUQ pain, jaundice, and fever Can make it a pentad to include shock- hypovolemia and altered mental status

What part of the nephron is impermeable to water regardless of serum vasopressin levels?

Ascending limb of the loop of Henle

Granulomatous heart nodules

Aschoff bodies (associated w/Rheumatic Fever)

What drug did the patient OD on if he has interstitial nephritis, gastritis, bleeding, and renal failure?

Aspirin

What is familial hypocalciuric hypercalcemia?

Benign autosomal dominant disorder caused by defective calcium-sensing receptors in the Parathyroid gland and kidneys

Alcohol withdrawl

Benzodiazepines

What is the treatment for alcohol withdrawal?

Benzodiazepines Long acting benzos with active metabolites (such as diazepam or chloriadezepoxide) are preffered in the majority of patients due to self-tapering effects, resulting in a smoother course of withdrawal In patients with liver disease, benzos that do not undergo oxidative metabolism in the liver and have no active metabolites (eg, lorazepam, oxazepam, temazepam [LOT]) are preferred

What drug is used to treat status epilepticus?

Benzodiazepines (eg, lorazepam) Enhance the effect of GABA at the GABA-A receptor, leading to increased Cl influx and suppression of action potential firing

What does thiamine deficienc cause?

Beriberi and Wernicke-Korsakoff syndrome Dry beriberi is characterized by symmetrical peripheral neuropathy Wet beriberi includes the addition of high-output congestive heart failure CBS involvement (ie, Wernicke-Korsakoff) occurs primarily in alcoholics

What is dobutamine?

Beta adrenergic agonist with predominant activity onn beta-1 receptors, weaker activity on beta-2 receptors, and minimal activity on alpha-1 receptors Used for management of refractory heart failure associated with severe left ventricular systolic dysfunction and cardiogenic shock Positive inotropy and chronotropy (increases CO and decreases left ventricular filling pressures) Mild vasodilation (avoids increase in afterload seen with other vasopressor/inotropic agents but limits usefulness in severely hypotensive pts)

What is cerebral amyloid angiopathy?

Beta amyloid deposition in the walls of small- to medium-sized cerebral arteries, resulting in vessel wall weakening and predisposition to rupture Not associated with systemic amyloidoses; rather, the amyloidogenic proteins are usually the same as those seen in Alzheimer's Most common cause of spontaneous lobar hemorrhage, particularly in adults age>60 (tend to be recurrent and most often involves the occipital and parietal lobes)

What drugs have been shown to improve long-term survival in patients with HF due to left ventricular systolic dysfunction?

Beta blockers ACE inhibitors Angiotensin II receptor blockers Aldosterone antagonists

Which drugs improve mortality in heart failure?

Beta blockers ACE inhibitors/ARBs Aldosterone antagonists (spironolactone) Hydralazine

What medications have negative chronotropic effects?

Beta-adrenergic blockers (eg, metoprolol, atenolol) Non-dihydropyridine calcium channel blockers (eg, verapamil, diltiazem) Cardiac glycosides (eg, digoxin) Amiodarone and sotalol Cholinergic agonists (eg, pilocarpine, rivastigmine)

What is the most common cause of aortic stenosis in the US?

Bicuspid aortic valve

What is acute respiratory distress syndrome (ARDS) characterized by?

Bilateral pulmonary infiltrates and hypoxemia in the absence of heart failure 3 phases: Exudative (leakage of protein-rich fluid into alveolar space) Proliferative (repair damaged lung, collagen deposition/scarring, and edema is reabsorbed) Fibrotic (excess collagen deposition in a minority of patients that leads to irreversible pulmonary fibrosis and Pulm HTN)

What can cause bleeding in Crohn's disease?

Bile acid malabsorption which may lead to impaired absorption of fat-soluble vitamins (ADEK) Vitamin K deficiency can result in impaired coagulation

What antihyperlipidemic can increase triglycerides if used as monotherapy?

Bile acid-binding resins (eg, cholestyramine) Inhibits enterohepatic circulation of bile acids Leads to diversion of hepatic cholesterol to synthesis of new bile acids, Increased uptake of cholesterol from circulation, Reduced blood LDL However, they increase hepatic production of triglycerides

How do Ladd's fibrous bands and intestinal obstruction present in newborn?

Bilious emesis during first days of life Can have twisting of mesentery around SMA, aka a midgut volvulus This compromises intestinal perfusion and may lead to life-threatening bowel necrosis

What is the MOA of beznodiazepines?

Bind the benzodiazepine binding site, which allosterically modulates the binding of GABA, resulting in an increased frequency of chloride ion channel opening Influx of chloride ions into the neurons causes neuronal hyperpolarization and inhibition of the action potential

How can Mycoplasma pneumoniae cause a mild anemia and an elevated serum lactate dehydrogenase level?

Binds an oligosaccharide on the respiratory epithelium that is also present on erythrocytes, leading to the generation of cross-reacting IgM antibodies (cold agglutinins) Mild, transient hemolytic anemia can be caused which resolves as IgM antibody titers decline (6-8 weeks after infection begins)

How is binge eating disorder different from bulimia?

Binge eating has no compensatory behaviors while bulimia nervosa does due to worry about body shape and weight Bulimia nervosa maintains a normal body weight

How do you diagnose mucormycosis?

Biopsy Histologic exam of the affected tissue is necessary to confirm the diagnosis

What is the difference between bipolar I and bipolar II?

Bipolar I is diagnosed in patients with greater than or equal to 1 episodes of mania Bipolar II involves hypomanic episodes (less severe than mania and without psychotic features) and major depressive episodes

What immunosuppressive can cause drug induced arteriolar vasoconstriction, which results in HTN and a rise in serum BUN and creatinine? (Nephrotoxic) Long term use can result in obliterative vasculopathy

Calcineurin inhibitors (ie, tacrolimus, cyclosporine) Common immunosuppressive agents to prevent rejection of transplanted solid organs

What is phase 0 mediated by in cardiac pacemaker cells?

Calcium influx Differs from phase 0 of cardiomyocytes and purkinje cells, which results from an inward sodium current

What are brown pigment gallstones composed of?

Calcium salts of unconjugated bilirubin and arise secondary to bacterial or helminthic infection of the biliary tract Beta-glucoronidase released by injured hepatocytes and bacteria hydrolyze bilirubin glucoronides to unconjugated bilirubin

Antacid Use

Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying All can cause hypokalemia Overuse can cause problems

How is Niacin (Vit. B3) synthesized?

Can be synthesized endogenously from tryptophan and is an essential component of NAD and NADP Deficiency of this vitamin results in pellagra, which is characterized by dermatitis, diarrhea, and dementia

In DKA, what happens to glycerol produced by the degradation of TGs in adipose?

Can be used by glycerol kinase in the liver and kidney to synthesize glucose during gluconeogenesis

How is incontinence connected with diabetic autonomic neuropathy?

Can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying Postvoid residual volume (PVR) testing with ultrasound or catheterization can confirm inadequate bladder emptying

What nerve can be damaged in sudden upward stretching on the arm at the shoulder?

Can damage the lower trunk of the brachial plexus (carries nerve fibers from C8 to T1 spinal levels) Responsible for innervating all of the intrinsic muscles of the hand- can result in finger clumsiness with total claw hand deformity

What can result in vertebral malalignment (subluxation)?

Can effect atlantoaxial joint Extension of neck (ex. for intubation) can worsen the subluxation, leading to acute compression of spinal cord and/or vertebral arteries Long-standing rheumatoid arthritis can affect the cervical spine and cause vertebral malalignment

What drug type would patients with CAD and HF along with HTN benefit from?

Cardioselective beta-blockers

Where are interstitial myocardial granulomas (Aschoff bodies) found?

Carditis due to acute rheumatic fever Develops after an untreated group A strep pharyngeal infection Contain plump macrophages with abundant cytoplasm and central, slender ribbons of chromatin (Anitschkow, or caterpillar, cells)

What is neurophysin?

Carrier protein for oxytocin and vasopressin (ADH)

How does glucose enter the cell?

Carrier-mediated transport D-glucose is preferred over L-glucose

What surface marker do caseating granulomas of TB have?

Caseating granulomas consist of large epitheloid macrophages with pale pink cytoplasm. CD14 is a surface marker of the monocyte-macrophage cell lineage

What antifungal acts at the cell wall?

Caspofungin

What does bartonella henselae cause?

Cat-scratch disease Bacillary angiomatosis Culture-negative endocarditis

What in the brain is affected in Huntington's?

Caudate nucleus Putamen

What dermatologic effect can Malassezia have?

Cause an erythematous, hyper- or hypopigmented macules and patches

Why cant PTU be used in the 2nd or 3rd trimester?

Cause hepatotoxicity

How do neuraminidase inhibitors work?

Cause the newly synthesized virions to adhere to the host cell surface and form viral aggregates, thereby reducing the spread of virus to other host cells

What is Neuroleptic Malignant syndrome?

Caused by a dopamine antagonist Onset of 1-3 days Altered mental status Sympathetic hyperactivity (eg, hyperthermia, hypertension, tachycardia, diaphoresis) Diffuse rigidity ("lead-pipe") Hyporeflexia High fever too Treat with Dantrolene sodium

What is serotonin syndrome?

Caused by a serotonergic agent Onset <1 day Altered mental status Sympathetic hyperactivity (eg, hyperthermia, hypertension, tachycardia, diaphoresis Clonus Hyperreflexia High fever too Treat with Dantrolene sodiumandcyproheptadine

What are the muscarinic effects and nicotinic effects of cholinergic toxicity?

Cholinergic toxicity (organophosphate toxicity can cause this because it is a cholinesterase inhibitor) Muscarinic- DUMBELS (Diarrhea/diaphoresis, Urination, Miosis, Bronchospasm/bronchorrhea&bradycardia, Emesis, Lacrimation, Salivation) Nicotinic effects- Muscle weakness, paralysis & fasciculations Atropine fixe muscarinic but not nicotinic Pralidoxime fixes the muscarinic and nicotinic effects

increased hCG (human chrionic gonadotropin)

Choriocarcinoma Mole Multiple pregnancies

What type of rejection is characterized by vascular wall thickening and luminal narrowing as well as interstitial fibrosis and parenchymal atrophy?

Chronic Months to years Chronic, low grade immune response refractory to immunosuppressants

Smudge cells

Chronic Lymphocytic Leukemia (CLL)

How does late Lyme disease present?

Chronic asymmetric large joint arthritis and encephalopathy

What is Primary Biliary Cholangitis (PBC)?

Chronic autoimmune liver disease characterized by destruction of small and mid-sized intrahepatic bile ducts with resulting cholestasis Most common in middle-aged women and frequently associated with other autoimmune disorders

What antibiotic would be most appropriate in a middle aged man who has fever, weight loss, and a productive cough that reports drinking 12-18 beers a day? (Poor dentition, foul-smelling sputum)

Clindamycin Alcoholics are more likely than the general population to develop pulmonary infections and abscesses involving combinations of anaerobic oral flora and aerobic bacteria.

What does the presence of hemosiderin-laden macrophages in pulmonary alveoli indicate?

Chronic elevation of pulmonary capillary hydrostatic pressures, most commonly as a result of left-sided heart failure May be described as macrophages containing golden cytoplasmic granules that turn dark blue with Prussian blue staining

Waxy casts

Chronic end-stage renal disease

What is interferon gamma used to treat?

Chronic granulomatous disease (NADPH oxidase deficiency)

What is the diagnosis in a patient with progressive symptoms of hypothyroidism (eg, fatigue, weight gain, constipation) and a diffuse goiter?

Chronic lymphocytic (Hashimoto) thyroiditis Predominantly in women, with a peak incidence at age 45-65, and is the most common cause of hypothyroidism in iodine-sufficient regions such as the US

What treatment best addresses infertility in PCOS?

Clomiphene (selective estrogen receptor modulator that prevents negative feedback inhibition on the hypothalamus and pituitary by cirulating estrogen, resulting in increased gonadotropin production (FSH andLH) and ovulation)

When is the opening snap heard with mitral stenosis?

Close after mitral valve opening Delayed diastolic rumbiling mid-to-late diastolic murmur

What is signified by the S2 heart sound?

Closure of pulmonic and aortic valves Physiologic split heart sound is when the pulmonic closes after the aortic during inspiration Wide splitting can occur with conditions that prolong RV ejection time (eg, right bundle branch block, pulmonary stenosis)

What fungus presents with spherules?

Coccidiodes

What fungi shows spherules packed with endospores?

Coccidioides immitis Endemic to the southwester US (i.e., southern and central California, Arizona, New Mexico, and western Texas), northern Mexico, and some regions of Central and South America

Painful blue fingers/toes, hemolytic anemia

Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis, CLL)

Where along the nephron does lithium cause impairment?

Collecting duct system Lithium-induced diabetes insipidus is the result of lithium's antagonizing effect on the action of vasopressin on principal cells within the collecting duct system.

Which portion of the nephron has the most concentrated fluid in the presence of ADH?

Collecting ducts

What parts of the kidney are from the ureteric bud (metanephric diverticulum)?

Collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters

What are cholesteatomas?

Collections of squamous cell debris that form a round, pearly mass behind the tympanic membrane in the middle ear Congenital or as either an acquired primary lesion or secondary to infection, trauma, or surgery of the middle ear

Cancer metastasis to liver

Colon Stomach Pancreas

What does the third aortic arch form?

Common and proximal internal carotid arteries

What is gilbert syndrome?

Common familial disorder of bilirubin glucuronidation in which the poduction of UDP glucuronyl transferases (enz that mediate glucoronidation of various substances) is reduced Suggested in patients with no apparent liver disease who have mild unconjugated hyperbilirubinemia thought to be provoked by one of the classic triggers (Ex. hemolysis, fasting, physical exertion, febrile illness, stress, and fatigue) Presumptive diagnosis can be made when the unconjugated hyperbilirubinemia persists with repeat testing, but LFTs, CBC, blood smear, and reticulocyte count are normal

What is the clinical presentation of Neurocysticercosis? How is it diagnosed? How is it managed?

Common in Central and South America, sub-saharan Africa, Asia Prolonged incubation (months to years) Seizures, focal neurologic symptoms, intracranial hypertension (CSF obstruction) Diagnosed with CT/MRI- cysts, scolex Eosinophilia, increased ESR Managed with antiparasitic therapy (albendazole)

What nerve is injured with decreased sensation along the lateral right leg and dorsal right foot as well us foot drop?

Common peroneal

What nerve injury commonly results from trauma to the leg near the head of the fibula, causes "foot drop", and has a characteristic steppage gait?

Common peroneal nerve

What nerve provides sensation at the dorsum of the foot?

Common peroneal nerve Vulnerable to injury where it courses around the neck of the fibula Also causes weakness of dorsiflexion (deep peroneal nerve) and eversion (superficial peroneal nerve)

What causes increased afterload (from excessive vasoconstriction), excess fluid retention, and deleterious cardiac remodeling in heart failure?

Compensatory activation of RAAS and sympathetic nervous system

How does carbon monoxide impair hemoglobin function?

Competitively binds to heme (affinity much greater than O2) Remaining binding sites on carboxyhemoglobin have an increased affinity for oxygen that causes the oxygen dissociation curve to shift to the left, impeding oxygen delivery to tissues

What is the vastus medialis?

Component of the quadriceps femoris Arises from proximal femur and ultimately inserts into the tibial tuberosity by means of the patella Functions as a knee extensor

What cardiac change is associated with long standing hypertension?

Concentric hypertrophy of the left ventricle

A lung abscess with infection of bacteria such as peptostreptococcus, prevotella, bacteroides, and fusobacterium species are likely to which conditions?

Conditions that increase aspiration risk, such as alcoholism, drug abuse, seizure disorders, previous stroke, and dementia These bugs are anaerobic oral bacteria

During wound healing, when is there excessive metalloproteinase activity and myofibroblast accumulation in the wound margins?

Contracture formation Contractures produce deformities of the wound and surrounding tissues, most often on the palms, soles, anterior thorax, or at serious burn sites

What conversion will be inhibited by high intracellular concentrations of fructose 2,6-bisphosphate within hepatocytes?

Conversion of alanine--> glucose Fructose 2,6 bisphosphate (F2, 6BP) activates phosphofructokinase-1 (increasing glycolysis) and inhibits fructose 1,6- bisphosphatase (decreasing gluconeogenesis) Fructose 2,6 bisphosphate concentration is regulated by a bifunctional enzyme complex: phosphofructokinase-2 increases F2,6BP levels in response to insulin and fructose 2,6 pisphosphatase decreases F2, 6BP levels in response to glucagon

Which vessel has the largest difference in oxygenated blood compared to the aorta?

Coronary sinus Myocardial oxygen extraction exceeds that of any other tissue or organ Due to the high degree of oxygen extraction, increases in myocardial oxygen demand can only be met by an increase in coronary blood flow

What drug to treat asthma is important in preventing inflammation in asthma?

Corticosteroids

Intranuclear eosinophilic droplet-like bodies

Cowdry type A bodies (HSV or VZV)

Viral myocarditis cause

Coxsackie B

What IBD has Anti-saccharomyces cerevisiae (ASCA) antibodies?

Crohn's

Which IBD is associated with calcium oxalated stones?

Crohn's

String sign on x-ray

Crohn's bowel wall thickening

If a patient presents with abdominal pain, heme- positive stool, and noncaseating granulomas, what is the most likely diagnosis?

Crohn's disease NCGs- accumulation of epithelioid macrophages that frequently form multinucleated giant cells without centers of necrosis, surrounded by a cuff of lymphocytes

What is the MOA of nitrosureas?

Cross link DNA Requires bioactivation Crosses BBB into CNS

Why do first generation antihistamines cause sedation?

Crosses the blood brain barrier

What does celiac histology look like?

Crypt hyperplasia...what else??

Severe diarrhea in AIDs

Cryptosporidium

What is accumulation effect?

Cumulative exposure to a risk factor or risk reducer must sometimes occur for prolonged periods before a clinically significant effect is detected

What is ecthyma gangrenosum?

Cutaneous necrotic disease with a strong association with Pseudomonas aeruginosemia bacteremia From perivascular invasion and release of tissue-destructive exotoxins, causing vascular destruction and insufficient blood flow to patches of skin that become edematous and subsequently necrose

What kind of toxicity can occur with nitroprusside therapy?

Cyanide toxicity Antidotal treatment can be achieved by 3 different strategies: direct binding of cyanide ions (hydroxocabalamin), induction of methemoglobinemia (sodium nitrite), and use of detoxifying sulfur donors (sodium thiosulfate)

What medications can cause SIADH?

Cyclophosphamide SSRIs Carbamazapine

What is the treatment for serotonin syndrome?

Cyproheptadine Functions as a serotonin antagonist First generation antihistamine with nonspecific 5-HT1 and 5-HT2 receptor antagonist properties

How are pro-carinogens metabolized?

Cytochrome P450 monooxygenase, present in hepatic microsomes and ER of varied other tissues Converts pro-carcinogens into carcinogens

Where is transketolase located in the cell?

Cytoplasm Cytoplasm is home to enzymes necessary for glycolysis, fatty acid synthesis, and the pentose phosphate pathway

Where are the enzymes necessary for glycolysis, fatty acid synthesis, and the pentose phosphate pathway located?

Cytosol

Where is carbamoyl phosphate synthetase II, an enzyme that catalyzes the initial step in de novo pyrimidine synthesis, located?

Cytosol Carbamoyl phosphate synthetase I of the urea cycle is located in the mitochondria

What therapy is used to treat Wilson's disease?

D-penicillamine Contains a free sulfhydryl group and functions as a copper chelator

What are the T-cell only immune disorders?

DICE Digeorge syndrome (CATCH 22?) IL-12 Receptor deficiency Chronic mucocutaneous candidiasis hyperIgE syndrome (Job syndrome)--> (FATED)

Which type of diabetes is associated with HLA? Which specific types?

DM type 1 HLA-DR3 and DR4

Which prokaryotic polymerase has 5' to 3' exonuclease activity?

DNA polymerase I Also has 3' to 5' exonuclease activity and 5' to 3' polymerase activity

What do the Homeobox genes encode for?

DNA-binding transcription factors Play a role in the segmental organization of the embryo along the cranio-caudal axis

Where is the lesion in internuclear ophthalmoplegia?

Damage of the MLF in the dorsal pons Disorder of conjugate horizontal gaze in which the affected eye (ipsilateral to the lesion) is unable to adduct and the contralateral eye abducts with nystagmus

What is the location of the damage that causes decorticate (flexor) posturing?

Damage to neural structures above the red nucleus (eg, cerebral hemispheres, internal capsule)

Where is dystrophic calcification seen?

Damaged or necrotic tissue in the setting of normal calcium levels

What is the diagnosis characterized by hypoplasia/absence of the cerebellar vermis and cystic dilation of the fourth ventricle with posterior fossa enlargement?

Dandy-Walker malformation Patients often present during infancy with developmental delay and progressive skull enlargement Cerebellar dysfunction can result in unsteadiness and impaired muscle coordination Non-communicating hydrocephalus may occur due to atresia of the foramina of Luschka and Magendie, resulting insymptoms of elevated intracranial pressure Other features can include agenesis of the corpus callosum and malformations involving the face, heart, or limbs

What is the treatment for Neuroleptic Malignant Syndrome?

Dantrolene Direct acting skeletal muscle relaxant (Inhibition of Ca2+ ion release from sarcoplasmic reticulum of skeletal muscle)

How do you treat malignant hyperthermia?

Dantrolene sodium (blocks ryanodine receptors and prevents release of Ca into the cytoplasm of skeletal muscle fibers)

What is the most common cause of decreased AFP?

Dating error!

What does uterine curettage show in ectopic pregnancy?

Decidual changes in the endometrium due to progesterone secretion but no embryonic or grophoblastic tissue (eg, no villi) Decidualized endometrium- dilated, coiled endometrial glands and vascularized edematous stroma (changes occur in the luteal phase of the menstrual cycle, under the influence of progesterone, as the endometrium prepares for implantation)

What part of the ECG is affected with beta blockers?

Decrease AV nodal conduction, leading to an increased AV nodal refractory period This correlates to PR interval prolongation on an ECG

What is the most important biochemical abnormality seen in Alzheimer's disease?

Decrease in acetylcholine level Occurs due to a deficiency of choline acetyltransferase The decline in acetylcholine is most notable in the nucleus basalis of Meynert, which participates in memory and cognition This nucleus is located at the base of the forebrain and widely projects to the neocortex Another involved structure is the hippocampus- formation of new memories

How does botulinum toxin effect electromyography?

Decrease in muscle response following stimulation of a motor nerve (decreased CMAP) Repetitive nerve stimulation leads to facilitation of CMAP

What is the mechanism of Thiazolidinediones (TZDs)?

Decrease insulin resistance by activating peroxisome-proliferator activated receptor-gamma, a nuclear receptor that alters the transcription of genes involved in glucose and lipid metabolism

What is the MOA of thiazolidinediones?

Decrease insulin resistance by binding to peroxisome proliferator-activated recetor-gamma (PPAR gamma), a transcriptional regulator of genes involved in glucose and lipid metabolism (glitazones) Since it is dependent on alteration of gene expression and subsequent protein synthesis, there can be a delay in action of several days to a few weeks

How do prostaglandin F2alpha (eg, latanoprost, travoprost) and cholinomimetics (eg, pilocarpine, carbachol) treat glaucoma?

Decrease intraocular pressure by increasing the outflow of aqueous humor

What is the best treatment for drug induced parkinsonism?

Decrease or discontinue offending medication Anticholinergics (trihexyphenidyl, benztropine)

How does insulin affect potassium?

Decrease potassium because causes K+ to move intracellularly

How do glucocorticoids treat conjunctival redness and severe proptosis in Graves?

Decrease the severity of inflammation and reduce excess extraocular volume Can also prevent worsening of ophthalmopathy induced by radioactive iodine treatment

What do the pulmonary function tests of obstructive lung diseases look like?

Decreased Decreased FEV1/FVC Normal to decreased FVC Increased TLC Decreased DLCO

What is the pathophysiology of thrombotic thrombocytopenic purpura?

Decreased ADAMTS13--> uncleaved vWF multimers--> platelet trapping and activation Acquired (autoantibody) or hereditary

What do the pulmonary function tests of restrictive lung diseases look like (including obesity)?

Decreased FEV1 Normal to increased FEV1/FVC Decreased FVC Intrinsic restrictive lung disease- decreased DLCO Extrinsic restrictive lung disease- normal DLCO

How do prolactinomas effect hormones?

Decreased LH secretion (due to suppression of GnRH) Decreased testosterone

What happens to RPF, GFR, and FF in hypovolemia?

Decreased RPF Decreased GFR Increased FF

What do lab values in primary hypothyroidism look like?

Decreased T4 and increased TSH T3 is primarily produced by conversion from T4 in peripheral tissues; serum levels widely fluctuate d/t short half life, and can often be within the normal range in patients with hypothyroidism

What does phenylephrine do to cardiac output?

Decreased because of increased afterload along with decreased venous return (harder for heart to pump against it...?)

What is the pathogenesis of gall stones in crohn's disease?

Decreased bile acid reabsorption by the inflamed terminal ileum promots cholesterol supersaturation of the bile, resulting in gallstone formation

What causes wrinkles?

Decreased collagen fibril production and increased degradation of collagen and elastin in the dermis

What lab abnormalities are seen with HUS?

Decreased hemoglobin and platelet count Increased bleeding time, lactate dehydrogenase, bilirubin, BUN, and creatinine

What are the cardiac changes associated with normal aging?

Decreased left ventricular chamber size- causes ventricular septum to acquire a sigmoid shape, with the basilar portion bulging into the left ventricular outlow tract Atrophy of the myocardium results in increased interstitial CT, often with concomitant extracellular amyloid deposition Within the cardiomyocytes, there is a progressive accumulation of cytoplasmic granules containing brownish lipofuscin pigment

What accounts for dyspnea in left heart failure?

Decreased lung compliance If a large area of myocardium is affected, left ventricular contractility significantly decreases, reducing left ventricular output. The resulting high end-diastolic pressure impairs diastolic return of blood from the pulmonary veins and capillaries. Increased hydrostatic pressure in the pulmonary circulation causes transudation of fluid from the pulmonary capillaries into the lung interstitium. The presence of fluid in the pulmonary interstitium causes distortion (swelling) of the affected tissue, increasing resistance to movement (decreased lung compliance). As a result, the negative pressure generated during normal inspiratory effort is not sufficient to adequately distend the lungs, resulting in poor gas exchange and shortness of breath.

What is congenital long QT syndrome?

Decreased outward potassium flow with prolonged action potential There are several genetic mutations in K+ channel proteins that contribute to the outward-rectifying potassium current

What are some potentially modifiable risk factors for osteoporotic fractures?

Decreased physical activity Low body weight Poor calcium and vitamin D intake Excessive alcohol or tobacco use Premature menopause Glucocorticoid use

What lab finding is most likely seen in a patient with hemolysis due to mechanical damage from an aortic valve prosthesis?

Decreased serum haptoblobin level Schistocytes (helmet cells) are fragmented erythocytes seen from mechanical trauma Intravascular hemolytic anemias are characterized by decreased serum haptoglobin levels as well as increased LDH and bilirubin

What are the laboratory findings in Klinefelter?

Decreased testosterone Increased LH and FSH (due to loss of feedback inhibition) Increased estradiol

What is the cause of diastolic heart failure (DHF)

Decreased ventricular compliance Characterized by normal left ventricular (LV) ejection fraction, normal LV end-diastolic volume, and elevated LV filling pressures Hypertension, obesity, and infiltrative disorders (eg, transthyretin-related amyloidosis, sarcoidosis) are important causes of DHF

What causes diastolic heart failure?

Decreased ventricular compliance and is characterized by normal left ventricular ejection fraction, normal LV end-diastolic volume, and elevated LV filling pressures

How does acute ureteral constriction or obstruction affect GFR and FF?

Decreases GFR and FF

What is the MOA of methimazole?

Decreases the formation of thyroid hormones via inhibition of thyroid peroxidase, the enzyme responsible for both iodine organification and coupling iodotyrosines (Thioamides- methiimazole, propylthiouracil)

Why do we avoid aspirin in gout?

Decreases uric acid clearance

In patients with Mitral regurgitation, what increases the ratio of forward (aortic pressure) to regurgitant blood flow (left atrial pressure) and improves cardiac output?

Decreasing systemic vascular resistance

What type of murmur is seen with aortic regurgitation?

Decrescendo diastolic murmur Best heard when the patient is leaning forward Peak intensity of the murmur occurs just after aortic valve closure when the pressure gradient between the aorta and the left ventricle is maximal

What artery travels with the radial nerve along the midshaft of the humerus?

Deep brachial artery

What infection is common in Chronic Granulomatous Disease?

Defect in NADPH Oxidase Prone to catalase + organism infections

What is homocystinuria?

Defect in cystathionine synthase Resulting in an inability to form cysteine from homocysteine Cysteine becomes essential, and homocysteine buildup leads to elevated methionine Homocysteine is prothrombotic, resulting in premature thromboembolic events

What is Chediak-Higashi Syndrome?

Defect in lysosomal trafficking regulator gene (LYST) that results in microtubule dysfunction in phagosome-lysosome fusion Autosomal recessive Recurrent pyogenic infecctions by staph and strep, partial albinism, peripheral neuropathy, progressive neurodegeneration, infiltrative lymphohistiocytosis Giant granules in granulocytes and platelets, pancytopenia, mild coagulation defects

What is the defect in congenital umbilical hernia?

Defect in the linea alba (incomplete closure of umbilical ring) Present as protrusions at the umbilicus that are soft, reducible, and benign Can occur in isolation or in association with other conditions, such as Down syndrome

What exactly is deficient in Ehlers-Danlos?

Defective collagen synthesis Can be caused by a deficiency in procollagen peptidase, enzyme that cleaves terminal propeptides from procollagen in the extracellular space Impaired propeptide removal on N terminus results in the formation of soluble collagen that does not properly crosslink

What process is impaired in Osteogenesis Imperfecta?

Defective synthesis of type 1 collagen by osteoblasts (osteoid production by osteoblasts)

What is defective in beta-thalassemia?

Defective transcription, processing, and translation of beta-globin mRNA

What are the effects of an occlusion in the anterior cerebral artery?

Defects in sensory and motor function of the contralateral leg and foot while predominantly sparing the contralateral arm/face Bilateral anterior cerebral artery occlusion can also develop significant behavioral symptoms and urinary incontinence if the frontal micturition center is affected

What causes xeroderma pigmentosum?

Defects in the nucleotide excision repair system, which normally corrects ultravoilet light-induced pyrimidine dimers

What vitamins and minerals are affected in gastric bypass surgery resulting in small intestinal bacterial overgrowth (SIBO)?

Deficiency of most vitamins (B12, A, D, and E) and iron Increased production of folic acid and vitamin K

What are auer rods?

Deformed azurophilic granules found in the cytoplasm of myeloblasts that stain positively for myeloperoxidase Found in abundance in AML M3 (acute promyelocytic leukemia)

What is Werdnig-Hoffman syndrome?

Degeneration of anterior horn cells that is caused by mutation in the SMN1 gene Causes symmetric progressive weakness, but the weakness is more prominent proximal>distal and typically occurs in childhood

How does a PDA present in a neonate?

Differential clubbing and cyanosis without blood pressure or pulse discrepancy are pathognomonic for a large PDA complicated by Eisenmenger syndrome (reversal of shunt flow from L-to-R to R-to-L) Severe coarctation of the aorta can cause lower extremity cyanosis

How does thyrotoxicosis appear on biopsy?

Diffuse atrophy of the thyroid follicles with decreased colloid Due to excess T4 supplementation that suppresses TSH which decreases iodine organification and colloid formation

What does the liver look like in cirrhosis?

Diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous-lined regenerative parenchymal nodules

What is the classic histology of Burkitt lymphoma?

Diffuse medium-sized lymphocytes High proliferation index represented by the high Ki-67 fraction "Starry sky" appearance due to presence of benign macrophages

What are the pathologic features of complete moles?

Diffuse trophoblastic proliferation and edematous chorionic villi ("bunch of grapes") No fetal/embryonic tissue

What is most likely diagnosis in Elderly, low fiber diet, bright red blood in stool, and painless?

Diverticulosis Can regress with higher fiber diet

How do you calculate drug concentration?

Divide the drug dose (mg) by the volume of distribution (Vd)

What is echinococcus granulosus?

Dog tapeworm(found in dogs humans & wolves) also sheep Vector: canine feces Hydatid cysts in liver and lung Encapsulated and calcified cyst ("eggshell calcification") containing fluid and budding cells that will eventually become daughter cysts Outerwall is composed of gelatinous sheets surrounded by a thick fibrous capsule Spilling of cyst contents can cause anaphylactic shock (surgical manipulation should be performed with caution)

What is the MOA of pramipexole?

Dopamine agonist that directly stimulates dopamine receptors

What parts of the spinal cord are damaged in subacute combined degeneration?

Dorsal columns (loss of position and vibration sensation, positive Romberg sign) Lateral corticospinal tracts (spastic paresis) Spinocerebellar tract (ataxia)

Where is the chemoreceptor trigger zone located?

Dorsal surface of the medulla at the caudal end of the fourth ventrical in the region known as the are postrema Area postrema receives blood from fenestrated vessels (absent BBB), which allows it to sample chemicals circulating in the blood Systemic chemotherapy can cause acute nausea from stimulation of the CTZ

How does Hepatitis B replicate?

Double-stranded DNA--> +RNA template--> partially double-stranded DNA progeny Although it is a DNA virus, HBV uses reverse transcription to generate new viral DNA from a positive-sense RNA template

What is the treatment for Lyme disease?

Doxycycline or penicillin-type antibiotics (eg, ceftriaxone)

What does binding of oxygen to hemoglobin do in the lungs?

Drives the release of H+ and CO2 from hemoglobin (Haldane effect) In the peripheral tissues, high concentrations of CO2 and H+ facilitate oxygen unloading from hemoglobin (Bohr effect)

What is DRESS syndrome

Drug Reaction with Eosinophilia and Systemic symptoms Typically occurs 2-8 weeks after exposure to high-risk drugs such as anticonvulsants (eg, phenytoin, carbamazepine), allopurinol, sulfonamides (eg, sulfasalazine), and antibiotics (eg, minocycline, vancomycin) Patients typically develop fever, generalized LAD, facial edema, diffuse skin rash, eosinophilia, and internal organ dysfunction

What can cause the variation in susceptibility of various viruses to antivirals?

Drug phosphorylation rate Monophosphorylation of acyclovir by a viral thymidine kinase is the first step in conversion of acyclovir to its active triphosphate form

What causes sideroblastic anemia?

Drugs (isoniazid, chloramphenicol, linezolid) Also X-linked sideroblastic anemia due to sigma-aminolevulinic acid (ALA) synthase mutation Myelodysplastic syndrome Alcohol abuse Copper deficiency Pyridoxine deficiency (vit. B6) is a cofactor for sigma-aminolevulinate synthase, the enzyme that catalyzes the rate-limiting step of heme synthesis. Inhibition of this step can result in sideroblastic anemia

Where are DCIS and LCIS located?

Ducts

How do nitrites treat cyanide poisoning?

Due to ability to induce methemoglobinemia Methemoglobin contains ferric (Fe3+) rather than ferrous iron (Fe2+) Cyanide binds to ferric iron more avidly than to mitochondrial cytochrome enzymes, diminishing cyanide's toxic effect

How can prolonged exposure to loud noises cause hearing loss?

Due to damage to the stereociliated hair cells of the organ of Corti

How does intestinal atresia distal to the duodenum occur?

Due to vascular accidents in utero "Apple-peel" atresia occurs when the SMA is obstructed The result is blind-ending proximal jejunum; a length of absent bowel and mesentery; and, finally, a terminal ileum spiraled around an ileocolic vessel

When is GTP formed in the CAC?

During the conversion of Succinyl-CoA to Succinate with succinate thiokinase (succinyl-CoA synthetase) Uses GDP too The GTP formed is used by PEP carboxykinase to make PEP from oxaloacetate in gluconeogenesis

What would autopsy findings look like in ARDS?

During the initial phase (first 1-6 days), interstitial and intraalveolar edema, inflammation, and fibrin deposition cause the alveoli to become lined with waxy hyaline membranes

How do you differentiate Beckers and Duschennes muscular dystrophy?

Duschennes- complete lack of dystrophin, see earlier Beckers- partial lack/problem with dystrophin, see later

What symptoms can be seen with infarcts involving the anterior portion of the medial pons?

Dysarthria Contralateral hemiparesis/lower facial palsy due to disruption of ipsilateral corticospinal and corticobulbar tracts Trigeminal nerve arises at the level of the middle cerebellar peduncle at the lateral aspect of the mid-pons

Why is there low sodium in legionella?

Dysfunction of JG apparatus- decrease RAS activation- doesnt allow aldosterone to be made- decrease reabsorption of Na

What are the features of trisomy 18 (Edwards syndrome)

Dysmorphic features: micrognathia, low-set ears, prominent occiput, and rocker bottom feet Patients have significant hypertonia, including clenched hands with overlapping fingers Anomalies of cardiac (VSD, PDA), genitourinary (eg, horseshoe kidney), and gastrointestinal (eg, Meckel's diverticulum, malrotation) systems are characteristic Prenatal ultrasound findings include fetal growth restriction Majority of those affected die in utero; half of livebirths die by age 2 weeks Surviving patients have severe intellectual disability

What syndrome manifests with numerous dysplastic nevi in a young person who has a family history of melanoma in more than 3 first degree relatives?

Dysplastic nevus syndrome Associated with mutations in the CDKN2A gene on chromosome 9p21

What is the bacteria in UTI with gram negative rods demonstrating a green metallic sheen on eosin methylene blue (EMB) agar and hemolysis on blood agar?

E coli

What is the diagnosis of UTI with lactose-fermenting, indole-positive gram-negative rods?

E coli

What 3 bugs are seen in urinary catheter infections?

E coli Klebsiella Proteus

What is the cause of a single ring enhancing lesion in brain of an HIV patient?

EBV

What is the heterophile antibody test used for?

EBV Sensitive and highly specific

How do you treat lead poisoning?

EDTA Succimer Penacillamine Dimercaprol

What is Waterhouse-Friderichsen syndrome?

EPIDEMIOLOGY young children PATHOGENESIS Neisseria meningitidis infection --> DIC, endotoxic shock, adrenal hemorrhagic necrosis --> acute PRIMARY adrenal insufficiency --> lack of cortisol --> exacerbation of hypotension --> death Hypovolemia Hyponatremia Hyperkalemia

What are fatty streaks?

Earliest lesions of atherosclerosis and can be seen as early as the second decade of life Appear as a collection of lipid-laden macrophages (foam cells) in the intima that can eventually progress to atherosclerotic plaques

How do nonstenotic bicuspid aortiv valves manifest?

Early systolic, high frequency click over the right second interspace

What teratogenic effects does lithium have?

Ebstein anomaly, nephrogenic diabetes insipidus, hypothyroidism

What changes are seen in aortic regurgitation?

Eccentric hypertrophy, which causes a compensatory increase in stroke volume to maintain cardiac output This compensatory mechanism allows for a relatively long asymptomatic period in most patients; however, left ventricular dysfunction eventually occurs, leading to heart failure

What electrolyte disturbance is seen with CF?

Eccrine sweat with higher-than-normal concentrations of sodium and chloride Exposure to high temp or exercise can lead to hyponatremia and hypochloremia due to excessive sodium chloride loss through sweat, therefore, salt supplementation is recommended

What is the ENDOTOXINS mneumonic?

Edema Nitric Oxide DIC/Death Outer membrane TNF-alpha O-antigen + core polysaccharide+ lipid A eXtremely heat stable IL-1 and IL-6 Neutrophil chemotaxis Shock

What does the murmur for aortic stenosis look like?

Ejection or midsystolic murmur of crescendo-decrescendo configuration with maximum intensity over the right second interspace and radiation to neck and carotid arteries Most common cause of aortic stenosis in elderly patients (age>70) is degenerative calcification of the aortic valve leaflets

When is isoproterenol usually used?

Electrophysiologically to evaluate Ventricular tachyarrhythmias

What happens to gastrin levels in Zollinger-Ellinson syndrome when administering secretin?

Elevate In contrast, secretin inhibits release of gastrin from normal gastric G cells

What do hormone levels look like in Klinefelter syndrome (47, XXY)?

Elevated FSH Elevated LH Low Testosterone

How do gastrin, pH, and parietal cells look in pernicious anemia?

Elevated gastrin High gastric pH Decreased parietal cell mass As parietal cells are destroyed, ability to secrete HCL decreases, resulting in an elevated pH that leads to upregulation of gastrin secretion Also develop vitamin B12 deficiency as a result of decreased intrinsic factor secretion

What do the insulin level and C-peptide level look like with an insulin secretagogue or insulin-secreting tumor?

Elevated insulin Elevated C-peptide

What do the insulin level and C-peptide level look like in hypoglycemia due to exogenous insulin injection?

Elevated insulin Low C-peptide

How are calcium, PTH, 1,25 dihydroxyvitamin D, and PTHrP affected in multiple myeloma?

Elevated serum calcium and reduced PTH (d/t increased osteoclastic activity)- hypercalciuria d/t decreased renal calcium reabsorption Reduced 1,25 dihydroxyvitamin D Normal PTHrP Hypercalcemia and light chain cast nephropathy cause progressive renal failure, leading to the decreased vitamin D synthesis

What lab tests help confirm vitamin B12 deficiency?

Elevated serum methylmalonic acid and homocysteine (due to vit. B12 acting as a cofactor for methylmalonyl-CoA mutase and methionine synthase) These can disrupt myelin synthesis and result in subacute combined degeneration of the dorsal columns and corticospinal tract

How are manic episodes characterized?

Elevated/irritable mood, impulsivity, hyperactivity, decreased need for sleep, pressured speech, and grandiosity and may occur with psychotic features

What are the hemodynamic consequences of mitral stenosis?

Elevates left atrial diastolic pressure and can therefore cause elevated pulmonary capillary wedge pressure, pulmonary hypertension, decreased pulmonary vascular compliance, right ventricular dilatation, and functional tricuspid regurgitation Diastolic pressure in the left ventricle is usually near normal or even decreased with severe mitral stenosis

What should the simultaneous development of stroke, intestinal or foot ischemia, and renal infarction raise suspicion of?

Embolic phenomena May arise from left atrial or ventricular clots or valvular vegetations, among others

How can diabetes mellitus affect the fetus?

Embryopathy Congenital malformations Placental vasculopathy Asphyxia, growth restriction, and polycythemia Increased fetal insulin Macrosomia, hypertrophic cardiomyopathy, and hypoglycemia after delivery Ultimately can see beta cell hyperplasia

Docusate

Emolient MOA: Osmotic draw into lumen--> increase water absorption by stool Adverse Effects: Diarrhea

What is EDV?

End diastolic volume (preload)

When are waxy casts seen?

End stage renal disease/chronic renal failure

What is a beta-endorphin?

Endogenous opioid that is derived from POMC Several different types of opioid receptors have been ID'd and include mu, delta, kappa, and N/OFQ receptors POMC is a polypeptide precursor that goes through enzymatic cleavage and modification to produce not only beta-endorphins, but also ACTH and MSH Beta-endorphin and ACTH are derived from the same precursor- suggests that there may be a close physiological relationship between the stress axis and the opioid system

What is adenomyosis?

Endometrial glandular tissue within myometrium Common in middle aged parous females

What enzyme is responsible for Nucleotide Excision Repair with UV damaged DNA?

Endonuclease (UV specific)

What is Virchow's triad?

Endothelial injury Venous stasis Hypercoagulable state

How is the extrinsic pathway of apoptosis activated?

Engagement of death receptors on the cell surface These receptors are in the tumor necrosis factor receptor family, with the type 1 TNF receptor (TNFR1) and a related protein named Fas (CD95) After cross-linking of Fas with its ligand, multiple molecules of Fas come together to form a binding site for a death-domain containing adapter protein called FADD FADD then binds an inactive form of a caspase, again bringing multiple caspase proteins together that through a cascade effect eventually induce caspace activation

What are the light microscopy findings in PSGN? Immunofluorescence microscopy? Electron microscopy?

Enlarged, diffusely hypercellular glomeruli due to leukocyte infiltration (neutrophils and monocytes) and mesangial and endothelial cell proliferation Granular deposits of IgG, IgM, and C3 in the glomerular basement membrane (GBM) and mesangium, producint the "starry sky" appearance seen in the image above. Subepithelial humps, representing the deposition of antigen-antibody complexes at the epithelial surface

What infection is characterized by abdominal pain, cramping, bloody diarrhea that has cysts that can be transmitted through oral-fecal contact, and trophozoites that are multinucleate and typically possess phagocytosed erythrocytes within their cytoplasm?

Entamoeba histolytica

What bacteria can cause biliary tract infections?

Enterococcus

How does glucose stimulate insulin release?

Enters beta cells by facilitated diffusion via glucose transporter 2 (GLUT-2) and undergoes oxidative metabolism through glycolysis and the CAC, generating ATP ATP then binds to the regulatory subunit of the ATP-sensitive K+ channel K+ channels close, high ATP/ADP ratio therefore leads to decreased K+ efflux and membrane depolarization This results in opening of voltage dependent Ca2+ channels, increased intracellular Ca2+ levels, and subsequent insulin release

What type of virus is CMV?

Enveloped double stranded DNA virus

What type of virus is HSV-1 and other herpesviruses?

Enveloped, double stranded DNA

What is IgE mediated degranulation associated with?

Environmental exposures such as foods or vespid stings or with medications such as beta-lactam and sulfonamide antibiotics Opioids can cause IgE dependent degranulation (very rare), but IgE independent reactions are more common

How do IgA proteases act as virulence factors?

Enzyme cleaves secretory IgA at its hinge region, rendering it inneffective Secretory IgA exists on mucosal surfaces and in secretions and acts to bind and inhibit the action of pili as well as other cell surface antigens that normally mediate mucosal adherence and subsequent penetration

How is parasitic defense mediated?

Eosinophil proliferation and activation during parasitic infection which is stimulated by IL-5 production by TH2 and mast cells. When a parasite invades the mucosa or bloodstream, it is coated by IgG and IgE antibodies that bind Fc receptors on eosinophil surface. This triggers eosinophil degranulation and release of cytotoxic proteins (ex. major basic protein) and ROS. This mechanism is an example of antibody-dependent cell-mediated cytotoxicity, which is also used by macrophages, neutrophils, and NKCs.

How do androgens stimulate acne development?

Epidermal hyperproliferation and excessive sebum production

"Thumb sign" on lateral neck x-ray

Epiglottitis (Haemophilus influenzae)

What are the key features of ovarian serous cystadenocarcinoma?

Epithelial Most common ovarian cancer Often bilateral Histology: Psammoma bodies Malignant

What cancer risk is increased in endometriosis?

Epithelial ovarian cancer NOT endometrial cancer

How do you treat anemia in kidney failure?

Epoeitin alfa

What is the most likely consequence of nerve injury to the prostatic plexus during prostatectomy?

Erectile dysfunction

What is seen with beta blocker overdose?

Erectile dysfunction asthma/COPD flare Bradycardia or AV block Heart Failure Seizures Sedation Sleep changes Dyslipidemia (if metoprolol)

What is dermatitis herpetiformis?

Erythematous pruritic papules, vesicles, and bullae on the extensor surfaces (eg, elbows, knees), upper back, and buttocks It is linked to IgA antibodies against gliadin and is strongly associated with celiac disease

Where does Parvovirus B19 replicate?

Erythrocyte precursors in the bone marrow

What is the treatment for malaria?

Erythrocytic forms are treated with chloroquine and mefloquine Primaquine is required to kill P vivax and P ovale liver hypnozoites

What is the treatment of neonatal conjunctivitis from neisseria gonorrhea?

Erythromycin

How can pregnancy contribute to gallstones?

Estrogen induced cholesterol hypersecretion Progesterone induced gallbladder hypomotility

How do you calculate Absolute risk reduction?

Event rate in the control group- event rate in the treatment group a/(a+b) - c/(c+d)

What is pulsus paradoxus?

Exaggerated drop (>10mmHg) in systolic blood pressure during inspiration It is detected by inflating a blood pressure cuff above systolic pressure and gradually deflating it

What happens in 11 beta-hydroxylase deficiency?

Excessive adrenal androgen and mineralocorticoid (11-deoxycorticosterone) production Genetically female infants are born with ambiguous genitalia, and affected individuals develop HTN and hypokalemia early in life

What are keloids?

Excessive granulation tissue formation during tissue repair in susceptible individuals (particularly African Americans) Histology shows haphazard arrangement of thick, pink collagen bundles

What happens in functional hypothalamic amenorrhea?

Excessive weight loss, strenuous exercise, chronic illness, eating disorder Then decreased adipose tissue/ fat reserves decreased leptin production Hypothalamus- decreases GnRH Pituitary- decreases LH, FSH Ovaries- decreases estrogen Then amenorrhea and bone loss

What are the risk factors for rickets in children?

Exclusive breast feeding Inadequate sun exposure Increased skin pigmentation (dark-skinned individuals) Maternal vitamin D deficiency

what is the toxin produced by pseudomonas?

Exotoxin A

What is acute transplant rejection?

Exposure to donor antigens induces humoral/cellular activation of naive immune cells Usually <6 months Humoral: C4d deposition, neutrophilic infiltrate, necrotizing vasculitis Cellular: lymphocytic interstitial infiltrate and endothelitis (renal vasculature (endothelitis), tubules, and interstitium)

What does cardiovascular dysphagia result from?

External compression of the esophagus by a dilated and posteriorly displaced left atrium in patients with rheumatic heart disease and mitral stenosis/regurgitation

What can GERD be associated with?

Extraesophageal symptoms (eg, nocturnal cough) in the absence of heartburn

What is presence of erythroid precursors in organs such as the liver and spleen indicative of?

Extramedullary hematopoiesis, a condition characterized by EPO stimulated, hyperplastic marrow cell invasion of extramedullary organs Most frequently caused by severe chronic hemolytic anemias, such as beta-thalassemia

What are the side effects of fluphenazine?

Extrapyramidal symptoms: Acute dystonia Akathisia Parkinsonism Shares Side effects with haloperidol High potency (neurological)

What cholesterol drug inhibits cholesterol absorption at the brush border of the small intestine?

Ezetimibe

What is necessary to convert succinate into fumarate?

FAD Riboflavin is a precursor for FAD

How do you calculate Filtration Fraction?

FF= GFR/RPF RPF= RBF x (1-Hematocrit)

What hormone stimulates the release of inhibin B from Sertoli cells in the seminiferous tubules?

FSH

What are neural tube defects due to?

Failure of fusion of the neural plate edges during the 4th week of fetal dev. Failure of the rostral neuropore to close results in anencephaly, whereas impaired closure of the caudal neuropore causes spina bifida If either neuropore does not fuse, an opening persists between the neural tube and the amniotic cavity that allows leakage of AFP and AChE into the amniotic fluid

What happens in defective proline hydroxylation?

Failure of triple helix formation and stabilization by pro alpha chains during collagen synthesis See in vitamin D deficiency

What can PID eventually lead to?

Fallopian tube scarring which in turn can lead to infertility Most frequently caused by N gonorrhoeae and Chlamydia

What is malingering?

Falsification or exaggeration of symptoms to obtain external incentives (secondary gain)

What is characterized by premature atherosclerosis and xanthomas in the skin and tendons?

Familial hypercholesterolemia Most common inherited lipid disorder Most often caused by defective LDL receptors

Short stature, cafe au lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia

Fanconi Anemia

What kind of deficiency can biliary obstruction present with?

Fat soluble vitamin deficiency (vision problems becuase of vit. A deficiency)

What are the clinical features of Primary biliary cholangitis (PBC)?

Fatigue Itching Hepatomegaly Serum alk phos is elevated Antimitochondrial antibody titers are positve in most cases

What defect is in epispadia?

Faulty positioning of the genital tubercle in the 5th week of gestation

Where does complement bind immunoglobulin?

Fc region of the heavy immunoglobulin chain in the region near the hinge point

How does Chikungunya fever present?

Febrile illness with flulike symptoms Prominent polyarthralgias Diffuse macular rash

How is Hepatitis A transmitted?

Fecal-oral route Contaminated water or food, and raw or steamed shellfish

What nerve is injured with weakness of quadriceps muscle, loss of patellar reflex, and loss of sensation over the anterior and medial thigh and medial leg?

Femoral nerve Can occur due to trauma, nerve compression, stretch injury, or ischemia

What drug is given in hypertensive emergency?

Fenoldopam

Iron-containing nodules in alveolar septum

Ferruginous bodies (asbestosis)

What fetal anomalies can cause polyhydramnios?

Fetal gastrointestinal obstruction (esophageal, duodenal, or intestinal atresia)- impaired fetal swallowing High fetal cardiac output (alloimmunization, parvovirus infection, fetomaternal hemorrhage)- increased fetal urination

How does HHV-6 (roseola) infection present?

Fever for 3-5 days followed by a truncal rash Most common cause of febrile seizures

What is the clinical presentation of septic abortion caused by S. aureus?

Fever, chills, lower abdominal pain, bloody or purulent vaginal discharge Boggy and tender uterus with dilated cervix Pelvic ultrasound: retained products of conception, increased vascularity, echogenic material in the cavity, thick endometrial stripe Can have foul smelling tissue (not foul smelling discharge!)

What are the clinical symptoms of SLE?

Fever, fatigue, and weight loss Symmetric, migratory arthritis Butterfly rash and photosensitivity Pleurisy, pericarditis, and peritonitis Thromboembolic events (d/t vasculitis and antiphospholipid antibodies) Cognitive dysfunction and seizures

What happens in aspirin intoxication?

Fever, tinnitus, and tachypnea Initially develop a primary respiratory alkalosis followed by a mixed respiratory alkalosis and anion gap metabolic acidosis When PaCO2 and HCO3 are both outside the normal range, a normal pH suggests a mixed acidosis/alkalosis disorder, as compensatory responses do not correct the pH completelyk

What is the presentation of Invasive pulmonary aspergillosis?

Fevere, Chest pain, cough, dyspnea, and hemoptysis Chest imaging can show consolidation, nodules, or cavitary lesions On light microscopy- septate narrow hyphae that branch at 45 degrees

What drug is responsible for rapid reperfusion in STEMI?

Fibrinolytic agents (eg, alteplase) Indicated if cannot receive percutaneous coronary intervention in a timely manner Aspirin inhibits COX to reduce thromboxane and lead to irreversible inhibition of platelet agg (prevent additional platelet thrombus, but do not lyse existing thrombus)

What benign breast disease is characterized by a solitary round mass, firm with clear borders, nontender, mobile, tan or white on cross section, proliferation of stromal and ductal elements, surrounded by fibrous capsule that is estrogen sensitive, resulting in a size increase in pregnancy or luteal phase of menstruation with a consequent decrease in size postpartum and after menopause?

Fibroadenoma

What benign breast disease is characterized by a solitary mobile cyst or multiple, diffuse nodulocystic masses, cyclic tenderness, flattened epithelial or apocrine metaplasia surrounding brown or blue fluid ("blue dome cyst"), and compressed fibrous stroma?

Fibrocystic changes Often numerous and painful

What is the perineal body?

Fibromuscular tissue between the urogenital and anal triangle

What antibiotic inhibits the sigma subunit of RNA polymerase?

Fidaxomicin Macrocytic antibiotic (related to macrolides) that leads to protein synthesis impairment and cell death (bactericidal activity against C diff.) Admin. orally and has minimal systemic absorption (high fecal concentrations) Narrow spectrum of activity with a lesser effect on normal colonic flora than vancomycin

What is the most important bacterial factor responsible for E coli UTI?

Fimbrial antigen

What drug is used for BPH that can also increase hair growth?

Finasteride

How should you treat rodenticide poisoning?

Fresh frozen plasma (FFP) Rodenticide is like a "superwarfarin"

What is characterized by cerebellar ataxia (spinocerebellar tract degeneration) and loss of position/vibration sensation (dorsal column/dorsal root ganglia degeneration), kyphoscoliosis, and hypertrophic cardiomyopathy?

Friedreich ataxia Foot abnormalities and diabetes mellitus are also common

What is the name of the autosomal recessive condition that presents during childhood/adolescence with progressive gait ataxia and impaired joint and vibration sense?

Friedreich ataxia Other features include hypertrophic cardiomyopathy (most common cause of death), skeletal abnormalities (eg, kyphoscholiosis, pes cavus), and diabetes mellitus Gait ataxia is d/t degen. of spinocerebellar tracts Impaired joint and vibration sense is d/t degen. of posterior columns and DRG

What does gallstone ileus result from?

From passage of a large gallstone through a cholecystenteric fistula into the small bowel, where it ultimately causes obstruction at the ileum Patients typically present with symptoms/signs of small bowel obstruction, and an abdominal x-ray may reveal gas within the gallbladder and biliary tree

What carbohydrates must be avoided in aldolase B deficiency?

Fructose and sucrose

What is sorbitol broken down to in the Polyol pathway?

Fructose via sorbitol dehydrogenase and NAD+

What bugs are seen with silver stain?

Fungi Legionella Cryptococcus H flu

What intracellular pathway is used with hormone receptors for TSH, glucagon, and PTH receptors?

G protein mediated activation of adenylate cyclase which then activates Protein Kinase A

What system do TSH, glucagon, and PTH receptors use?

G protein mediated adenylate cyclase second messenger system Subsequently activates protein Kinase A

What type of receptors are calcium-sensing receptors?

G-protein coupled receptors Regulate secretion of PTH in response to changes in circulating calcium levels

When do antimalarial drugs instigate hemolysis?

G6PD deficiency Peripheral blood smear shows red blood cells with Heinz bodies, dark, intracellular inclusions that stain with supravital stain and represent hemoglobin that has denatured/precipitated from oxidative stress

What marker is increased in Glioblastoma multiforme?

GFAP

What marker is increased in Pilocytic astrocytoma?

GFAP

What is S gallolyticus endocarditis associated with?

GI lesions (colon cancer) in ~25% Workup for colonic malignancy is essential

What are the most common side effects of aspirin?

GI mucosal injury and bleeding Primarily due to COX-1 inhibition, which results in impaired prostaglandin-dependent GI mucosal defense and decreased platelet aggregation

What are the adverse effects of fluoroquinolones

GI upset Tendonitis (tendon rupture) Dont give to pregnant women because cartilage defects to baby

What is the diagnosis in a 5 day old newborn with jaundice, vomiting, hepatomegalym, renal dysfunction, E coli sepsis, cataract, and hemolytic anemia?

Galactose-1-phosphate uridyl transferase Cessation of breastfeeding and switching to soy milk-based formula is recommended

What is acalculous cholecystitis?

Gall bladder appears like it has cholecystitis but does not have any stones Only when in cystic duct?

What is billiary sludge seen in?

Gallbladder hypomotility Causes bile to become concentrated, promoting precipitation and accumulation of particulate material This forms a viscous biliary sludge that can cause transient bile duct obstruction (biliary colic) and promote cholesterol gallstone formation

What is a mechanical bowel obstruction caused when a large gallstone erodes into the intestinal lumen?

Gallstone ileus Pneumobilia (air in the biliary tract) is a common finding

What is a common complication of TPN?

Gallstones In normal individuals, fat and amino acids into duodenum triggers CCK release, leading to contraction of gallbladder Absence of normal enteral stimulation in patients receiving TPN leads to decreased CCK and subsequent biliary stasis In addition, patients with extensive resection of the ileum an have disruption to the normal enterohepatic circculation of bile acids, leading to inadequate solubilization of biliary cholesterol and formation of cholesterol crystals

What are the most common causes of acute pancreatitis?

Gallstones Alcohol abuse

What junctions connect osteocytes?

Gap junctions

Bunch of polyps in colon and soft tissue tumors

Gardener

Superimpacted teeth, colon polyps, soft tissue tumors. Excess tissue. Subtype of FAP.

Gardener's syndrome

What do the cephalic and gastric phases stimulate?

Gastric acid secretion

What ectopic tissues are found with Meckel diverticulum? How is it diagnosed?

Gastric and pancreatic tissue?? Pertectinate study

What can cause a deficiency of most vitamins (B12, A, D, and E) and iron, but increased production of folic acid and vitamin K?

Gastric bypass surgery that causes small intestinal bacterial overgrowth (SIBO) due to excessive bacterial proliferation in the blind-ended gastroduodenal segment Associated with nausea, bloating, abdominal discomfort, and malabsorption

What causes Zollinger-Ellison syndrome?

Gastrinomas located in the small intestine/pancreas Presents with peptic ulcers (especially distal duodenal ulcers), heartburn, and diarrhea

What are the manifestations of nontyphoidal salmonella?

Gastroenteritis Self limited watery diarrhea Rarely invasive (<5%): osteomyelitis, mycotic aneurysm, endocarditis

What determines HIV trophism?

Gene sequence in the variable (V3) region of the env gene, which encodes for the HIV surface glycoprotein 120 This glycoprotein mediates viral attachment to the CD4 receptor and chemokine coreceptor

What HIV genes are translated as polyproteins and subsequently cleaved by host protease? or viral protease?

Host protease- env gene products (gp120 and gp41 on cell surface) Viral protease- gag-pol gene products (RT, integrase, protease) Protease inhibitors block viral protease from cleaving gag-pol polyproteins, which results in formation of immature virions that are noninfectious

What is likely to be increased in astrocytes during hyperammonemia?

Glutamine Hyperammonemia in advanced liver failure occurs as a direct result of the cirrhotic liver's inability to metabolize nitrogenous waste products Ammonia crosses the BBB and causes excess glutamine to accumulate within astrocytes This decreases the amount of glutamine available for conversion to glutamate in the neurons, resulting in disruption of excitatory neurotransmission

Renal metabolism of which amino acid is most important for maximizing acid excretion in acute ischemic colitis?

Glutamine The ischemic bowel undergoes anaerobic metabolism, causing lactate accumulation in the blood that leads to an anion gap metabolic acidosis. Acidosis stimulates renal ammoniagenesis, a process by which renal epithelial cells metabolize glutamine, generating ammonium and bicarbonate. Ammonium ions are transported into the tubular fluid and excreted in the urine while peritubular capillaries absorb bicarb, which functions to buffer acids in the blood.

What enzyme produces gluconeogenic precursors that are subsequently converted to glucose in the liver during insulin deficiency?

Glycerol kinase Diabetic ketoacidosis- glycerol (produced by degradation of triglycerides in adipose) cannot be metabolized by adipocytes, so it is secreted into the circulation and transported to the liver, where it is phosphorylated to glycerol-3-phosphate by glycerol kinase Glycerol-3-kinase is subsequently converted by glycerol-3-phosphate dehydrogenase to dihydroxyacetone phosphate (DHAP), which can be used to produce glucose through gluconeogenesis

What amino acid is in the highest quantity in collagen?

Glycine (every 3rd amino acid)

What accumulates in the clear cells of RCC that is responsible for the abnormal appearance?

Glycogen and lipid accumulation

What is Type II: Pompe disease?

Glycogenolysis disorder- Disorder of Acid alpha-glucosidase Normal glucose levels Severe cardiomegaly Glycogen accumulation in lysosomes

What is Type III: Cori disease?

Glycogenolysis disorder- Disorder of Debranching enzyme Hepatomegaly Ketotic hypoglycemia Hypotonia and weakness Abnormal glycogen with very short outer chains

What is Type I: von Gierke disease?

Glycogenolysis disorder- Disorder of Glucose 6-phosphatase Hepatomegaly and steatosis Fasting hypoglycemia Lactic acidosis Hyperuricemia and hyperlipidemia

What is Type V: McArdle disease?

Glycogenolysis disorder- Disorder of Glycogen phosphorylase Muscle phosphorylase deficiency Weakness and fatigue with exercise No rise in blood lactate levels after exercise

What is leuprolide?

Gonadotropin-releasing hormone (GnRH) analog It has agonist properties when administered in a pulsatile fashion and can cause a transient rise in LH and testosterone production on initial administration

What problem can occur with activating mutations in phosphoribosyl pyrophosphate (PRPP) synthetase?

Gout Due to increased production and degradation of purines

What is enterococcus?

Gram positive cocci in pairs and chains and, when grown on blood agar, they do not cause hemolysis (gamma-hemolytic) Important cause of urinary tract infections

What is seen in Tropheryma whippeli infection?

Gram positive stain Small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase-resistant granules

What does histoplasma capsulatum look like on biopsy?

Granulomas and macrophages with intracellular ovoid/round yeast

What are nasal mucosal ulcerations and glomerulonephritis most characteristic of?

Granulomatosis with Polyangiitis (Wegener's) Have antineutrophilic antibodies (c-ANCA) which are virtually pathognomonic for GPA

What pathologic process is responsible for Giant cell arteritis?

Granulomatous inflammation of the media

What cells in the ovary converts androgens to estradiol?

Granulosa cells

What is characterized by T cell activation and stimulation of orbital fibroblasts by thyrotropin receptor antibodies causing fibroblasts to proliferate and secrete excess amounts of glycosaminoglycans (eg, hyaluronic acid), which leads to expansion of the ground substance of retro-orbital tissues and displaces the globe forward?

Graves ophthalmopathy

How do nondihydropyridines work?

Greater effects on the myocardium than peripheral vasculature Decrease cardiac work mainly through reductions in both cardiac contractility and HR

How long must you have symptoms to be classified as major depressiv disorder?

Greater than or equal to 5 SIG E CAPS lasting greater than or equal to 2 weeks At least one symptom must be either depressed mood or loss of interest/pleasure Patients with sufficient depressive symptoms are diagnosed with MDD even if there is a clear psychosocial stressor that precipitated the depression

What antifungal affects mitosis?

Griseofulvin

How does Glioblastoma multiforme look on gross exam and light microscopy?

Gross- areas of necrosis and hemorrhage, poorly demarcated from the surrounding tissue LM- pseudopalisading tumor cells around areas of necrosis, new blood vessel formation, and small round cells, bizarre giant cells, large number of mitoses

What part of the sarcomere contains only thick (myosin) filaments?

H band

What is HBeAg?

HBV polypeptide Detectable during acute infection Indicates increased viral replication and infectivity

What is HBsAg?

HBV surface glycoproteins Detectable during acute infection Persistence>6 months= chronic infection

What does HF do to RAAS?

HF results in stimulation of the sympathetic nervous system and the RAAS in an attempt to maintain effective intravascular volume Inactive angiotensin I is converted into active angiotensin II by endothelial-bound ACE in the small vessels of the lungs Therefore, levels of angiotensin II are higher in the pulmonary vein when compared to the pulmonary artery

Which drugs can cause drug-induced lupus?

HIPPE Made Quinoa Hydralazine Isoniazid Procainamide Penacillamine Ethambutol Minocycline Quinidine Methyldopa Etanercept Phenytoin (see new onset lupus symptoms, ANA antibodies, and anti-histone antibodies)

What is the HLA for seronegative spondyloarthropathy?

HLA-B27

Where is condyloma accuminata seen?

HPV 11 and 16

What vaculitis is intusception associated with?

HSP Meckel's diverticulum and tumors in adults can also cause intusception

What are the presenting signs of hyperaldosteronism?

HTN Hypokalemia Metabolic alkalosis Decreased plasma renin activity Alternatively, hypoaldosteronism is the cause of type IV renal tubular acidosis Aldosterone antagonists such as spironolactone or eplerenone can be used as medical therapy for Conn's syndrome

What are the clinical features of primary hyperaldosteronism?

HTN Hypokalemic alkalosis: Muscle weakness and paresthesias

What anesthetics can cause acute hepatitis in the postoperative period?

Halogenated inhaled anesthetics during surgery (halothane hepatitis) Halogenated anesthetics (eg, halothane, enflurane, isoflurane, sevoflurane) modulate various neuronal ion channels, leading to CNS depression. The newer halogenated anesthetics (eg, enflurane, isoflurane, sevoflurane, desflurane) have less extensive hepatic metabolism and a lower incidence of hepatotoxicity They are metabolized by CYP450 system

What should be used for contact precautions in infection control measures?

Hand hygiene Nonsterile gloves Gown Private room preferred

What is the classic auscultatory finding in patients with aortic stenosis?

Harsch, crescendo-decrescendo systolic ejection murmur heard best in the right second intercostal space with radiation to the carotids

What is high-altitude sickness?

Headache, fatigue, nausea, dizziness, and sleep disturbances Hypobaric hypoxia is the primary cause

What are the side effects of amlodipine?

Headache, flushing, dizziness, and peripheral edema

How can pituitary tumors present?

Headaches Bitemporal hemianopsia Hypopituitarism Most common hormonally active (functional) adenomas are prolactin-secreting adenomas (prolactinomas) Prolactinomas can cause galactorrhea and amenorrhea in women. In men, often with hypogonadism

What insurance option has the lowest monthly premiums?

Health Maintenance Organization (Point of Service is second, Preferred Provider Organization is most expensive)

Basophilic nuclear remnants in RBCs

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

What hormone increases maternal insulin resistance during the second and third trimesters?

Human placental lactogen Leads to a rise in serum glucose that helps provide adequate nutrition to the growing fetus Gestational diabetes occurs when the compensatory rise in maternal insulin secretion is inadequate to prevent serum glucose levels from reaching excessively high levels

What is the first line medication for essential HTN?

Hydrochlorothiazide

What is the pathogenesis of Struvite stones?

Hydrolysis of urea to yield ammonia Urea-->2NH3 + CO2 NH3 + H20--> NH4+ + OH- Increased urine pH Precipitation of magnesium ammonium phosphate salts

What is the nonoperative treatment for cholesterol gallstones?

Hydrophilic bile acids This reduces cholesterol secretion and increases biliary bile acid concentration. That improves cholesterol solubility and promotes gallstone dissolution

What can a fetus develop with parvovirus infection?

Hydrops fetalis (severe anemia, heart failure, pleural effusions, pericardial effusions, and ascites)

What are the side effects of thiazides?

HyperGLUC Hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia Hypokalemia Hyponatremia

What type of rejection is characterized by gross mottling and cyanosis as well as arterial fibrinoid necrosis and capillary thrombotic occlusion?

Hyperacute Minutes to hours Preformed antibodies against graft in recipient's circulation

What does laboratory testing show in methylmalonic acidemia?

Hyperamonemia (organic acids directly inhibit the urea cycle) Ketotic hypoglycemia (due to overall increased metabolic rate leading to increased glucose utilization and direct toxic inhibition of gluconeogenesis by the organic acids) Metabolic acidosis (ketone build up as well as methylmalonic and propionic acid build up) Diagnosis is confirmed by elevated urine methylmalonic acid and propionic acid

Calcium Carbonate overuse

Hypercalcemia (milk alkali syndrome), rebound acid increase, can chelate and decrease effectiveness of other drugs

What are the risk factors of calcium kidney stones (oxolate, phosphate)

Hypercalciuria Hyperoxaluria Hypocitraturia Diet: increased Na, increased protein, increased oxalate, decreased Ca

What causes spider angiomata in cirrhosis?

Hyperestrinism likely due to increases in androstenedione production, androgen aromatization, and sex hormone-binding globulin concentration Impaired estrogen etabolism by the liver may also be a contributing factor Decreased free testosterone/estrogen

What are the side effects of Protease inhibitors?

Hyperglycemia Lipodystrophy Drug-Drug interactions (due to inhibition of CYP450)

What is the major side effect of amiloride?

Hyperkalemia (K+ sparing diuretic)

What is keratoderma blennorrhagicum?

Hyperkeratotic vesicles on the palms and soles

What do the CGG trinucleotide repeats in Fragile X syndrome lead to?

Hypermethylation and inactivation of FMR1

"Brown" tumor of bone

Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)

What histopathologic findings of the adrenal glands can be seen with Cushing's syndrome?

Hyperplasia of the zona fasciculata and reticularis

What is a side effect of Risperidone and other antipsychotics?

Hyperprolactinemia by blocking D2 receptors on lactotrophs Elevated prolactin leads to amenorrhea (inhibition of gonadotropin-releasing hormone release), galactorrhea, and breast soreness

What does disruption of the tuberoinfundibular pathway by D2 receptor blocking antipsychotics cause?

Hyperprolactinemia with galactorrhea and amenorrhea

What are the complications of prolactinoma?

Hyperprolactinemia- Premenopausal women: galactorrhea, estrogen deficiency (oligo/amenorrhea, decreased bone density, vaginal atrophy) Men: Infertility, decreased libido, impotence Children/adolescents: Delayed puberty, growth impairment Mass-effect symptoms- Headache Visual field defects Suppression of other pituitary hormones

What do the neutrophils look like in B12 deficiency?

Hypersegmented Also see hypersegmented in folate deficiency

What is the most important risk factor for aortic dissection?

Hypertension

What is characterized by inappropriate hypertrophy of the LV myocardium, LV outlet obstruction and myocardial ischemia that can lead to sudden cardiac death in young patients?

Hypertrophic cardiomyopathy Coronary arteries are normal in this condition

What toxicities are associated with Foscarnet?

Hypocalcemia Hypomagnesemia Due to the analog of pyrophosphate chelating calcium and promoting nephrotoxic renal magnesium wasting These can cause seizures

What neuropeptides produced in the lateral hypothalamus function to promote wakefulness and inhibit REM sleep-related phenomena?

Hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B) Most patients who have narcolepsy with cataplexy demonstrate undetectable levels of hypocretin-1 in their CSF (unlike normal individuals)

Electrical stimulation of which nerve could improve obstructive sleep apnea (OSA)?

Hypoglossal nerve Causes tongue to move forward slightly, increasing the anteroposterior diameter of the airway

What electrolyte abnormalities are common with amphotericin B therapy?

Hypokalemia Hypomagnesemia

What are the adverse effects of amphotericin B?

Hypokalemia, hypomagnesemia which reflect an increase in distal tubular membrane permeability Nephrotoxic, also can cause qeakness and arrhythmias Profound hypokalemia can cause ventricular tachycardia or fibrillation

What are the effects of Beta1 adrenergic blockade?

Heart: Decrease HR, decrease contractility, decrease O2 consumption Adverse effects: Worsening HF, bradycardia/heart block Kidney: Decrease Renin release

What are the symptoms of adenomyosis?

Heavy menstrual bleeding (due to increased endometrial surface) Dysmenorrhea (results from endometrial tissue growth in the confined myometrial space) PE- uniformly enlarged uterus ("boggy")

What cancers are found in von Hipple Lindau Syndrome?

Hemangioblastomas Clear cell renal carcinoma Pheochromocytoma

What enzyme is responsible for the green color of a bruise several days after injury?

Heme oxygenase Converts heme to biliverdin

What structures are attacked by autoantibodies in bullous pemphigus?

Hemidesmosomes

What is the order of speeds in hemoglobin movement during gel electrophoresis from fastest to slowest?

Hemoglobin A > hemoglobin S > hemoglobin C

What are the clinical features of Thrombotic thrombocytopenic purpura?

Hemolytic anemia (increased LDH, decreased haptoglobin) with schistocytes Thrombocytopenia (increased bleeding time, normal PT/PTT) Sometimes with: Renal failure Neurologic manifestations Fever

What electrolyte abnormalities are seen with primary adrenal insufficiency?

Hyponatremia Hyperkalemia Hyperchloremia Non anion gap metabolic acidosis

Physical Exam finding of Excess Mg

Hyporeflexia

How does G6PD deficiency present?

Hemolytic anemia and jaundice in response to oxidant stressors (eg, sulfonamide and antimalarial drugs, infection) Heinz bodies (oxidized hemoglobin conglomerates) precipitate in RBCs and are removed by splenic macrophages, leaving behind characteristic bite cells Absence of glutathione reductase results in a clinical scenario similar to G6PD deficiency (catalyzes reduction of oxidized glutathione--> inability to use NADPH to reduce gllutathione)

What is the most common adverse effect of thrombolysis?

Hemorrhage (eg, gastrointestinal, intracerebral)

What is small vessel leukocytoclastic angiitis associated with IgA and C3 deposition typical of?

Henoch-Schonlein purpura (HSP)

Blood transfusion viral infection

Hep C

What is lichen planus associated with?

Hep C

What does Ribavirin treat?

Hep C and RSV

What does incomplete fusion of the urethral (urogenital) folds result in, in males?

Hypospadias

Damage to what would cause permanent central DI?

Hypothalamus

Why cant PTU be used in the 2nd or 3rd trimester?

Hepatic failure

Which hepatitis infection can cause a serum sickness- like syndrome with joint pain, LAD, and a pruritic urticarial rash?

Hepatitis B Other features may include RUQ pain, hepatomegaly, and elevated hepatic transaminase levels

What liver tumor is associated with OCPs?

Hepatoadenocarcinoma

Where does glucagon enact its effects?

Hepatocytes

How do statins affect LDL receptors?

Hepatocytes increase surface expression of LDL receptors to increase uptake of circulating LDL Treatment generally produces a 20-50% reduction in serum cholesterol and LDL concentration

What is another name for Wilson's disease?

Hepatolenticular degeneration

Damage to which structure, the hypothalamic nuclei or posterior pituitary, results in permanent damage?

Hypothalamus Damage to the posterior pituitary is usually transient

How does hemochromatosis affect hepcidin?

Hepcidin level is abnormally low Iron overload occurs due to increased ferroportin mediated iron efflux from storage and increased gut iron absorption.

How does high altitude exposure affect ABG values?

Hypoxemia with respiratory alkalosis Over a course of a few days, chronic respiratory alkalosis sets in, with a corresponding decrease in serum bicarbonate level reflecting renal compensation Still have lower oxygen though because can't completely compensate

What are the clinical features of acute respiratory distress syndrome (ARDS)

Hypoxia Bilateral pulmonary infiltrates Normal pulmonary capillary wedge pressure (6-12 mmHg)

What is the attachment for rhinovirus?

I-CAM-1

What antiarrythmics cause QT prolongation?

IA and III (eg, quinidine, sotalol)

What drugs cause QT prolongation?

IA and III antiarrhythmics (eg, quinidine, sotalol) Antibiotics (eg, macrolides, fluoroquinolones) Methadone Antipsychotics (eg, haloperidol)

What is responsible for variable severity of mitochondrial diseases?

Heteroplasmy Random distribution of normal and mutated mitochondria between daughter cells during mitosis; as a result, some cells may have completely healthy mitochondria, while other cells contain mitochondria affected by gene mutation (heteroplasmy)

What substance is produced by T-lymphocytes and NKCs that is critical in immunity against viral and intracellular bacterial infections which activates macrophages, increases MHC expression, and promotes Th1 differentiation?

IFN- gamma

What cytokine plays an important anti-inflammatory and immunomodulatory role, especially in the pathogenesis of inflammatory bowel disease?

IL-10 aTENuates the immune response through inhibition of TH1 cytokines, reduction of MHC II expression, and suppression of activated macrophages and dendritic cells

Why is a patient still able to metabolize fructose with a fructokinase deficiency?

Hexokinase Essential fructosuria is a benign disorder of fructose metabolism caused by frutokinase deficiency In patients with essential fructosuria, some of the dietary fructose load is converted by hexokinase to fructose-6-phosphate, which can enter glycolysis; this pathway is not significant in normal individuals

What hernia is GERD associated with?

Hiatal hernia

What are the rubber-like properties of elastin due to?

High content of nonpolar (hydrophobic) amino acids and extensive cross linking between elastin monomers facilitated by lysl oxidase

What is the cause of spider angiomatas in a cirrhotic patient?

High estrogen levels This also causes palmar erythema, gynecomastia, testicular atrophy, Dupuytren's contractures and decreased body hair

Why doesnt mycobacteria stain well?

High lipid content which keeps from staining well

What drug characteristics result in a low Vd (3-5L)?

High molecular weight High plasma protein binding High charge Hydrophilicity

What is the most concerning feature of hepatitis E?

High mortality rate observed in infected pregnant women Unenveloped, single stranded RNA virus spread fecal-orally

What are the two major complications of Paget's disease (aka osteitis deformens)?

High output heart failure (b/c a-v shunts are being formed) Osteogenic sarcoma

What hormone inhibits lactation?

High progesterone Done through negative feedback on prolactin in the anterior pituitary

What cytokine is most likely responsible for reduced inflammation in regions of previously active ileocolitis?

IL-10 Anti-inflammatory- reduces production of proinflammatory TH1 cytokines (IL-2 and interferon gamma) and MHC II expression. Also inhibits activated dendritic cells and macrophages

What are the neutrophil chemoattractants?

IL-8, LTB4, C5a

What is the Hot T Bone stEAK mnemonic?

IL1- fever, increased adhesion of neutrophils IL-2- T-cells/NK, Tx for RCC IL-3- Bone marrow/B cells IL-4- IgE IL-5- IgA/Eosinophils IL-6 aKute phase reactants

What happens to the metabolic state in chronic kidney disease?

High serum phosphorous and decreased calcium absorption--> low serum calcium-->Increased PTH synthesis--> secondary hyperparathyroidism Elevated phosphate and FGF-23 also reduce calcitriol synthesis by inhibiting tubular expression of 1-alpha-hydroxylase, resulting in decreased intestinal calcium and phosphate absorption This worsens hypocalcemia but does not significantly improve hyperphosphatemia due to the low GFR, which is the limiting factor for phosphate excretion in patients with CKD PTH increase stimulates osteoclasts to increase bone turnover- long term increase can eventually lead to friable bones and osteitis fibrosa

What do you see in labs of a newborn with perinatal heptatitis B infection?

High viral load and HBeAg positive

What finding is most suggestive of increased insulin resistance?

High waist circumference

What are the characteristics of an aortic regurgitation murmur?

High-pitched Blowing Diastolic murmur Intensity is maximal right after A2 (sound of aortic valve closure) Proceeds in a decrescendo pattern for part or all of diastole Higher overall intensity and longer duration of murmur correlate with the severity of AR, and A2 may be absent in severe AR

What is the initial treatment for status epilepticus?

IV lorazepam and phenytoin given concurrently

Why is heparin safer in pregnancy compared to warfarin?

Higher water solubility- unable to cross the placenta Warfarin readily crosses General rule: water soluble materials, such as conjugated bilirubin, due not readily cross the placenta while lipophilic materials, such as unconjugated bilirubin, may easilycross the placenta

What anatomical structure is used to locate L4 vertebral body for LP?

Highest points of the iliac crests

When is a result considered statistically significant?

If the 95% confidence interval does not cross the null value, which corresponds to a p-value

Do you want a highly sensitive or a highly specific test when screening for life-threatening diseases?

Highly sensitive test ID of every person with the disease is important (to the left on the 2 bell graph)

What is the first structure damaged during global cerbral ischemia (aka hypoxic-ischemic encephalopathy)?

Hippocampus The cells most susceptible to ischemia are the pyramidal cells of the hippocampus and neocortex and the Purkinje cells of the cerebellum

What do mast cell and basophils release upon widespread degranulation that cause anaphylaxis?

Histamine and Tryptase

What mechanism is responsible for decreased gene expression in huntingon's disease?

Histone deacetylation Prevents transcription of certain genes that code for neurotrophic factors, contributing to neuronal cell death

What infection is associated with Ohio and mississippi river valleys as well as soil contaminated by bird or bat droppings?

Histoplasma capsulatum

What is the most common cause of minimal change disease in adults?

Hodgkin Lymphoma

What disorder presents with marfanoid features, but intellectual disability, hypercoagulability, and downward (rather than upward) lens dislocation?

Homocystinuria Autosomal recessive disorder due to a defect in cystathionine beta synthase, which leads to inability to form cysteine and a buildup of methionine and homocysteine

What is the mechanism causing acute pruritis following administration of morphine?

IgE-independent mast cell activations A number of medications, including opioids, radiocontrast agents, and some antibiotics (eg, vancomycin), can trigger this Common symptoms include diffuse itching and pain, bronchospasm, and localized swelling (urticaria)

Which antibodies can and cannot cross the placenta?

IgM cannot cross IgG can cross Secretory IgA is provided by the mother to her baby, but via breast milk

Where is the gallstone lodged in gallstone ileus with symptoms of small bowel obstruction and an abdominal x-ray revealing gas within the gallbladder and biliary tree?

Ileum Gets here via the formation of a cholecystoenteric fistula between the gallbladder and adjoining gut (most often the duodenum) due to pressure necrosis and erosion of these tissues

What nerve provides sensation to the suprapubic and gluteal regions as well as motor function to the anterolateral abdominal wall muscles?

Iliohypogastric nerve Can be damaged in abdominal surgeries which result in decreased sensation and/or burning pain at the suprapubic region

What is the treatment for panic disorder?

Immediate: Benzodiazepines Long-term: SSRI/SNRI &/or CBT

How is crohn's disease associated with kidney stones?

Impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption Intestinal lipids then bind calcium ions, and the resulting soap complex is excreted Free oxalate (normally bound by Ca2+) is absorbed and forms urinary calculi (enteric oxaluria)

What are some causes of polyhydramnios?

Impaired fetal swallowing Fetal GI obstruction and anencephaly Increased fetal urination High fetal CO (alloimmunization, parvovirus infection, fetormaternal hemorrhage)

How does primary ciliary dyskinesia (aka kartagener syndrome) affect sperm motility?

Impaired flagellar and ciliary function

What is abetalipoproteinemia?

Impaired formation of apolipoprotein B (ApoB)- containing lipoproteins Autosomal recessive, loss-of-function mutation in the MTP gene Presents in the first year of life with symptoms of malabsorption

What happens in a congenital deficiency of dopamine beta hydroxylase?

Impaired synthesis of NE and Epi Lead to impaired sympathetic adrenergic activity May see hypotension, ptosis, and hypothermia in children Adults may present with postural (orthostatic) hypotension, exercise intolerance, nasal congestion, and ejaculatory difficulties

What is Hartnup disease?

Impaired transport of neutral amino acids in the small intestine and proximal tubule of the kidney

How can silicosis increase the risk for TB infection?

Impairs the macrophage effector arm of cell-mediated immunity, which is integral to the immune response against mycobacteria Macrophage phagolysosomes may be disrupted by internalized silica particles, causing release of the particles and viable mycobacteria, thereby inhibiting the immune system's ability to control the infection

How does familial chylomicronemia syndrome present?

In childhood with recurrent episodes of acute pancreatitis] Eruptive zanthomas may be present in hypertriglyceridemia, but tendon xanthomas and xanthelasmas are primarily seen with hypercholesterolemia

When is work of breathing minimized?

In patients with increased elastic resistance (eg, pulmonary fibrosis) when their respiratory rate is high and tidal volyme is low (fast, shallow breaths) In contrast, patients with diseases that increase airflow resistance (eg, asthma and COPD) breathe at a lower rate/higher tidal volume (slow, deep breaths) in order to minimize work of breathing

What is the cause of hepatic encephalopathy?

Increased levels of ammonia and other neurotoxins in the circulation that lead to increased inhibitory neurotransmission and impaired excitatory neurotransmitter release Frequently precipitated by a stressor that increases blood ammonia levels BUN is actually decreased because liver cannot convert ammonia efficiently to urea

Why is there an absence of peripheral edema in chronic heart failure?

Increased lymphatic drainage initially offsets factors favoring edema, whereas acute changes are more likely to produce edema

What can happen with long-term PPI use?

Increased parietal cell proliferation due to Gastrin stimulating the parietal and ECL cells

What are the side effects of Buproprion?

Increased seizure risk at high doses Amphetamine like properties Contraindicated in patients with seizure disorders, anorexia, and bulimia nervosa NOT associated with sexual side effects or weight gain

What are clinical findings of hemochromatosis?

Increased serum ferritin Increased saturation of transferrin

What happens to O2 and CO2 during physical exercise?

Increased skeletal muscle CO2 production that increases the CO2 content of venous blood Arterial O2 and CO2 content remains constat via increases in alveolar ventilation and gas exchange efficiency Venous O2 content remains constant or is decreased d/t increased O2 extraction by the tissues that matches or exceeds the rate of oxygen delivery

How do you diagnose celiac disease?

Increased tissue transglutaminase IgA Increased Antiendomysial antibodies Duodenal biopsy showing increased intraepithelial lymphocytes and flattened villi

S3 heart sound causes

Increased ventricular filling pressure (eg, MR, HF) Common in dilated ventricles Normal in young

When is the risk of thymic carcinoma increased

Increased with age and in certain ethnic groups (primarily Asians and Pacific islanders) No environmental risk factors have been confirmed

What do arteriovenous concentration gradients and blood/gas partition coeffiiencts correspond to with anesthetics?

Increased= slower onset of action

What happens to prolactin with disruption of dopaminergic pathways or blockade of dopamine D2 receptors?

Increases

What does IP3 do?

Increases calcium, induces contraction

`How does glucagon treat beta blocker overdose?

Increases heart rate and contractility independent of adrenergic receptors Glucagon activates G protein coupled receptors on cardiac myocytes, causing activation of adenylate cyclase and raising intracellular cAMP Result is calcium release from intracellular stores and increased SA node firing

How does glucagon increase serum glucose?

Increases hepatic glycogenolysis and gluconeogenesis Also stimulates insulin secretion from pancreas

How does squatting improve a child's symptoms with Tetralogy of Fallot?

Increases systemic vascular resistance Which decreases right-to-left shunting, thereby increasing pulmonary blood flow and improving oxygenation status

What hormone stimulates insulin release following consumption of glucose?

Incretin Two hormones with incretin effects are glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (glucose-dependent insulinotropic peptide, GIP)

What side effect is common with atropine?

Indicated for Tx of bradycardia as it decreases vagal influence on the SA and AV nodes. Common side effect is increased intraocular pressure May precipitate closed-angle glaucoma in susceptible individuals

What kind of damage does ionizing radiation cause to tumor cells?

Induces DNA damage through DNA double-strand fractures and the formation of oxygen free radicals

What do ST elevations or Q waves in leads I and aVL indicate?

Infarct involving lateral aspect of the left ventricle

What are the risk factors for cervical cancer?

Infection with high risk HPV strains Hx of STD Early onset sexual activity Multiple or high risk sexual partners Immunosuppression OCPs Low socioeconomic status Tobacco use

Heterophile antibodies

Infectious mononucleosis (EBV)

What lymph nodes drains proximal to the anal dentate line?

Inferior mesenteric and internal iliac lymph nodes

What is an orthomyxovirus with a segmented, negative sense, ssRNA genome that replicates in the nucleus?

Influenza virus

Which rotator cuff muscle is responsible for external rotation?

Infraspinatus

How is neurocysticercosis transmitted?

Ingestion of Taenia solium (pork tapeworm) eggs excreted im feces of human carriers

How is campylobacter jejuni transmitted?

Ingestion of contaminated food (particularly undercooked poultry) Direct contact with domesticated animals

What is bronchiolitis obliterans?

Ingrowth of granulation tissue into the lumen of snall airways leading to airway obstruction and obliteration

What is another name for alpha-1 antitrypsin deficiency?

Inherited Protease deficiency

What is familial hypercholesterolemia?

Inherited autosomal dominant disorder that is a result of heterozygous or homozygous LDL receptor gene mutations This causes hepatocyte under-expression of functional LDL receptors Can lead to accelerated atherosclerosis and early-onset CAD

What does metformin do to gluconeogenesis?

Inhibit

How does metoprolol act to lower blood pressure?

Inhibit release of renin from renal J-G cells through antagonism of beta-1 receptors Prevents RAAS activation, which results in decreased vasoconstriction and decreased renal sodium and water retention

How do dihydropyridines (nifedipine, amlodipine, felodipine) work?

Inhibit the L-type calcium channel on vascular smooth muscle and cardiac cells Primarily affect arterial smooth muscle, causing vasodilation with little or no effect on cardiac conduction or contractility Used in the treatment of several cardiovascular disorders, including HTN, angina pectoris, and certain cardiac arrhythmias

How does ethanol cause hypoglycemia?

Inhibits gluconeogenesis

How does the diphtheria exotoxin work?

Inhibits host cell protein synthesis by catalyzing the ADP-ribosylation of host cell elongation factor-2

What is the MOA of colchicine?

Inhibits microtubule polymerization through stabilization of tubulin, resulting in decreased chemotaxis and degranulation of neutrophils. (inhibits leukocyte migration and phagocytosis)

What is the MOA of carbamazepine?

Inhibits neuronal high frequency firing by reducing the ability of sodium channels to recover from inactiviation S/E- can cause bone marrow suppression; therefore, complete blood cell counts should be monitored

How does probenecid work in the kidney?

Inhibits organic anion transporters Coadministraction with penicillin causes increased serum penicillin concentrations This can be useful in managing cases of penicillin resistance or in the treatment of gonorrhea and neurosyphilis Similarly, probenecid exerts its uricosuric action through inhibition of urate transporters ( a type of organic anion transporter) resulting in increased uric acid excretion

What is the MOA of terbinafine?

Inhibits synthesis of fungal membrane ergosterol by suppressing the enzyme squalene epoxidase

What are the clinical manifestations of congenital hypothyroidism?

Initially normal at birth Symptoms develop after maternal T4 wanes: Lethargy Enlarged fontanelle Protruding tongue Umbilical hernia Poor feeding Constipation Dry skin Jaundice Diagnosis: Increased TSH and decreased free T4, newborn screening Tx: levothyroxine

What bone changes are seen in osteoporosis?

Initially, rabecular thinning and perforation with loss of interconnecting bridges Over time, cortical bone, which comprises most of the appendicular skeleton, also becomes involved

What causes Acute Respiratory Distress Syndrome?

Injury of the pulmonary epithelium and/or endothelium, and occurs most often due to sepsis or pneumonia Cytokines recruit neutrophils to lung tissue, capillary damage and leakage of protein-rich fluid into alveoli Later, cellular proliferation and collagen deposition occurs, and in some patients, this leads to irreversible pulmonary fibrosis

What activates the PFK-2 domain, which converts fructose-6P to fructose-2,6-bisphosphate (fructose-2,6BP) which then activates PFK1 and inhibits F-1,6-Pase, increasing the production of fructose-1,6BP and driving the cell toward glycolysis?

Insulin (opposite effect of glucagon)

What is GLUT-4?

Insulin sensitive glucose transporter expressed in skeletal muscle cells and adipocytes In the absence of insulin, it is sequestered in the cytoplasm However, as insulin concentrations rise, the receptors translocate to the plasma membrane, facilitating glucose transport into the cell

What are GLUT-1,2,3 and 5?

Insulin sensitive glucose transporters always present on the plasma membrane, regardless of insulin levels, and constitutively transport glucose Brain, kidney, intestine, liver, RBCs

What is gigantism mediated by?

Insulin-like growth factor-1 (IGF-1) Released from the liver following stimulation of hepatic GH receptors (by GH) and subsequent activation of the JAK-STAT signaling pathway Binds to receptor tyrosine kinase on cells throughout body and stimulate growth and proliferation

What is seen on histopathology of Chronic lymphocytic (Hashimoto) thyroiditis?

Intense lymphocytic infiltrate, often with germinal centers Residual follicles may be surrounded by Hurthle cells (large oxyphilic cells filled with granular cytoplasm)

How does poison ivy dermatitis manifest?

Intensely pruritic erythematous papules, vesicles, or bullae that often form linear patterns

What is factitious disorder?

Intentional falsification or inducement of symptoms with goal to assume sick role

Where is the AV node located?

Interatrial septum near the opening of the coronary sinus

What is the arterial pathway that is affected in retinal artery occlusion (RAO)?

Internal carotid artery--> ophthalmic artery--> retinal artery

What does 46 XX DSD look like?

Internal female sex organs Ambiguous genitalia Due to excess steroids/androgens

What does the ureter pass anterior to in the true pelvis?

Internal iliac artery Medial to the ovarian vessels Uterine artery crosses over the anterior surface of the ureter ("Water under the bridge")

What nerve mediates the cough reflex?

Internal laryngeal nerve (above the vocal cords) Foreign bodies (eg, chicken or fish bones) can become lodged in the piriform recess and may cause damage to the nerve, impairing the cough reflex

What does 46 XY DSD look like?

Internal male sex organs Ambiguous genitalia Due to androgen receptor deficiency/insensitivity

What happens in liquefactive necrosis?

Interruption of blood supply to an area of the brain, such as by thrombosis or embolism, induces irreversible ischemic changes in the neurons Lysosomal enzymes from ischemic neurons are released resulting in degradation of the tissue in the ischemic region Phagocytic cells migrate into the area and remove the necrotic tissue leaving a cavity, and astrocytes proliferate around the necrotic area with the formation of a scar (gliosis) Complete digestion of necrotic tissue with the formation of a cavity is known as liquefactive necrosis

What is idiopathic pulmonary fibrosis (IPF)?

Interstitial lung disease characterized by peripherally based, patchy interstitial inflammation with focal fibroblast proliferation and honeycombing intermixed with areas of unaffected lung Injury results in loss of type 1 pneumocytes and hyperplasia of type 2 pneumocytes

"Honeycomb lung" on x-ray or CT

Interstitial pulmonary fibrosis

What cells produce secretin?

Intestinal S cells Increases bicarb secretion from the pancreas

What is the resulting difference from an intramuscular inactivated vaccine and live attenuated oral vaccine against poliomyelitis?

Intestinal exposure with oral vaccine produces secretory IgA that is the major antibody associated with mucosal immunity. Stimulation of local secretory IgA production is best promoted when corresponding mucosal surfaces are directly stimulated by the antigen.

What helps most to down-regulate gastric secretion after a meal?

Intestinal influences The ileum and colon release peptide YY, which binds to receptors on the endocrine, histamine containing cells described as enterochromaffin-like cells (ECLs) Such binding counteracts the cephalic and gastric phases of acid secretion by inhibiting gastrin-stimulated histamine release from ECLs

What are factors that inhibit gastric acid secretion?

Intestinal influences Somatostatin Prostaglandins

Where does lymph drainage from the scrotum go?

Into the superficial inguinal lymph nodes Testis go to para-aortic lymph nodes

Why do myocardial cells increase in size in transient myocardial ischemia?

Intracellular Ca2+ accumulation

What are Lewy bodies?

Intracellular eosinophilic inclusions composed of alpha-synuclein that are typically seen in patients with Parkinson's and Lewy body dementia

What is the biochemical targeet of pioglitazone?

Intracellular nuclear receptor Thiazolidinedione- improve insulin sensitivity by binding PPAR-gamma causing it to form a heterodimer complex with the retinoid X receptor Complex then binds transcriptional regulatory sequences of various genes responsible for glucose and lipid metabolism, altering their expression

What is the PI3K/Akt/mTOR pathway?

Intracellular signaling pathway Typically activated when a growth factor binds to its receptor tyrosine kinase, causing auto-phosphorylation of specific tyrosine residues within the residue These phosphotyrosine residues activate phosphoinositide 3-kinase (PI3K), which then phosphorylates PIO2 found in the plasma membrane to PIP3 This leads to activation of Akt (or protein kinase B), a serine/threonine-specific protein kinase Akt activates mTOR, which translocates to the nucleus to induce genes involved in cell survival, anti-apoptosis, and angiogenesis

What are often seen in patients with ADPKD that can cause subarachnoid hemorrhage presenting with sudden onset of "thunderclap headache" when they rupture?

Intracranial berry aneurysms of the circle of Willis

What type of breast cancer can cause bloody or serosanguineous nipple discharge?

Intraductal papilloma is the most common Affected patients typically have no associated breast mass or skin changes. It is caused by proliferation of papillary cells in a duct or cyst wall with a fibrovascular core and may contain foci of atypia or ductal carcinoma in situ. The bloody discharge results from twisting of the vascular stalk of the papilloma in the duct

What is seen on light microscopy of Herpes zoster (shingles)?

Intranuclear inclusions in keratinocytes and multinucleated giant cells

What is germinal matrix fragility responsible for in premature infants?

Intraventricular hemorrhage Germinal matrix starts involuting around 28 weeks gestation and disappears by full term

What is the pathophysiology of nontyphoidal salmonella?

Invasion of enterocytes, massive neutrophil mediated inflammatory response in lamina propria/Peyer's patches, control of infection (usually)

What is tardive dyskinesia?

Involuntary movements after chronic use (eg, lip smacking, choreoathetoid movements)

What is claudication?

Ischemia in arteries Gives a type of anginal pain

What enzyme is decreased in pellagra (niacin deficienccy)?

Isocitrate dehydrogenase It is a precursor for nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), 2 important cofactors for many dehydrogenase and reductase enzymes

Which hypothalamic nuclei mediates hunger?

Lateral Destruction leads to anorexia

Where are femoral hernias located?

Lateral to the pubic tubercle and lacunar ligament Medial to the femoral artery and vein

How does a patient present with congenital deficiency of propionyl-CoA carboxylase, the enzyme responsible for the conversion of propionyl-CoA to methylmalonyl-CoA?

Leads to development of propionic acidemia Deficiency presents with lethargy, poor feeding, vomiting, and hypotonia 1-2 weeks after birth

Which coronary vessel is known as the widowmaker when it becomes occluded?

Left Anterior Descending

Where is the most common site of thrombus formation in atrial fibrillation?

Left atrial appendage

What artery supplies the left ventricle?

Left circumflex artery

What vessel hemorrhages in variceal bleeds?

Left gastric

What visual field defect is present when there's a mass within the temporal lobe?

Left or Right homonymous superior quadrantanopia ("pie in the sky")

How does the blood flow in an aortocavitary fistula between the aortic root and right ventricle (uncommon comp of bacterial endocarditis)?

Left-to-right cardiac shunt as blood continuously flows from the aortic root (high pressure) to the right ventricle (low pressure)

What does charcoal yeast stain for?

Legionella

Which bacteria has neuro, GI, and pulmonary symptoms?

Legionella

What is a negative effect of Amiodarone?

Lengthens cardiac action potential which manifests as QT interval prolongation on ECG Low risk of torsade de pointes in contrast to other drugs

What are the different lymphocyte counts seen in arthrocentesis of osteoarthritis, pseudogout, gout, RA, and septic arthritis?

Less than 2,000= osteoarthritis 2,000-50,000= pseudogout, gout, and RA >50,000= septic arthritis

What are the phagocytic immune disorders?

Leukocyte Adhesion Deficiency Chronic Granulomatous Disease Chediak- Higashi

Eosinophilic cytoplasmic inclusion in nerve cell

Lewy body (Parkinson's) also lewy body dementia

What can mumps induced orchitis lead to?

Leydig cell atrophy and decreased testosterone production Testosterone therapy may be indicated

Cardiac manifestation of lupus

Libman-Sacks endocarditis (nonbacterial, affecting both sides of mitral valve)

What ligament contributes to spinal stenosis?

Ligamentum flavum

What is the PIP3 pathway?

Ligand binds G protein-coupled receptor, activates Phospholipase C, membrane phospholipids are broken down into DAG and IP3 Protein Kinase C is subsequently activated by DAG and calcium; the latter is released from the endoplasmic reticulum under the influence of IP3

How do nicotinic receptors work?

Ligand gated ion channels that open after binding acetylcholine Results in immediate influx of Na+ and Ca2+ into the cell and an outflux of K+ from the cell

What teratogenic effects does methotrexate have?

Limb and craniofacial abnormalities, neural tube defects, abortion

Enterococci treatment

Linezolid Tigecycline Vancomycin

What virulence factor is primarily responsible for the severity of meningococcal disease with N meningitidis?

Lipooligosaccharide Virulence factor in the pathogens outer membrane Endotoxin that cause toxicity when released into the plasma via shedding of the outer membrane ("blebbing") or bacterial lysis Bind TLR4 on monocytic and dendritic cells and trigger release of inflammatory cytokines (IL-1, IL-6, TNF-alpha), which leads to endothelial damage, capillary leakage, and hemorrhagic necrosis

What is the diagnosis in a soft tissue malignancy that contains numerous lipoblasts, which are cells that produce non membrane bound cytoplasmic lipid, and have well demarcated lipid shifts within the cell, characteristically causing nuclear indentations and scalloping of the nuclear membrane?

Liposarcomas Most common soft tissue sarcomas in adults Typically present in middle aged adults as slow growing masses in the deep connective tissue spaces of the trunk or lower extremities

What organism that commonly causes meningtitis is resistant to cefotaxime?

Listeria Resistant to cephalosporins due to altered penicillin-binding proteins However, it is susceptible to ampicillin

What drug can cause nephrogenic diabetes insipidus?

Lithium Characterized by impairing aquaporin-2 water channels and reducing responsiveness to endogenous and exogenous vasopressin

What drug has the teratogenic effect of apical displaceent of the tricuspid valve leaflets?

Lithium for bipolar disorder Ebstein's anomaly Decreased right ventricular volume, and atrialization of the right ventricle Moderate to severe tricuspid regurg possible

What drugs are used as mood stabilizers in bipolar disorder?

Lithium, valproate, carbamazepine, lamotrigine

Poor receptor expression in which organ can lead to atherosclerosis?

Liver LDL receptors

What underlying metabolic process is most likely underlying drug induced lupus erythematosus?

Liver acetylation

What do central chemoreceptors respond to?

Located in the medulla, more involved in the respiratory response to hypercapnea than to hypoxemia CO2 readily diffuses through the BBB and forms H ions in the cerebrospinal fluid; the resulting decrease in pH is detected by medullary neurons, triggering an increase in respiration. Because the BBB is relatively impermeable to H ions, blood pH itself has little effect on central chemoreceptors

How are Kimmelstiel-Wilson nodules characterized?

Location in the peripheral mesangium Ovoid or spherical shape Lamellated appearance Eosinophilic (hematoxylin and eosin stain) Periodic acid-Schiff-positive

How does follicular lymphoma present?

Long, waxing and waning clinical course Most often presents in middle-aged patients with painless lymph node enlargement or abdominal discomfort from an abdominal mass Histology noteable for a mixture of cleaved and noncleaved follicle center cells in a nodular pattern Majority exhibit t(14,18) translocation, resulting of bcl-2 oncogene that blocks programmed cell death

What is the MOA of phenytoin?

Long-acting anticonvulsant that inhibits neuronal high-frequency firing by reducing the ability of sodium channels to recover from inactivation

What diabetic drug class has a high incidence of hypoglycemia, especially in elderly?

Long-acting sulfonylureas (eg, glyburide, glimepiride) Increase insulin secretion by pancreatic beta cells independent of blood glucose concentration

What diuretic is used to treat acute decompensated heart failure?

Loop diuretics decompensated heart failure- dyspnea, orthopnea, elevated JVP, LE edema, and lung crackles

Glycocalyx

Loose network of polysacharride layer ( except poly-D-glutamate) Mediates adherence to surfaces, especially foreign surfaces (Eg, indwelling catheters)

How does nephrotic syndrome lead to a hypercoagulable state?

Loss of anticoagulant factors, especially antithrombin III

How does placental abruption lead to DIC?

Lot of bleeding, liver tries to control it by clotting via plantes as well as intrinsic and extrinsic pathways, but eventually the bleeding is too severe and run out of clotting factors Now can't stop the bleeding

What does alk phos look like in CML?

Low

What is the medication of choice for delirium?

Low dose antipsychotics (eg, haloperidol)

What are the hemodynamic effects of dopamine?

Low dose dopamine infusion stimulates D1 receptors in renal and mesenteric vasculature -Results in vasodilation and increased blood flow to these sites Increasing doses of dopamine stimulate beta1 and alpha1 receptors, resulting in increased CO and elevated SVR At the higher dose range, the increase in afterload can result in decreased CO

How do you treat congenital adrenal hyperplasia?

Low doses of exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of the adrenal cortex

How is cat scratch disease characterized?

Low fever LAD Self-limited course

What are pilocytic astrocytomas?

Low grade gliomas that occur most frequently in the cerebellum Typically have headaches and cerebellar findings Cystic and solid components on imaging Microscopic exam shows pilocytic astrocytes with bundles of glial fibrillary acidic protein (GFAP)-positive hairlike processes and classic Rosenthal fibers (eosinophilic intracytoplasmic inclusions) D/t slow-growing (benign) nature, majority of patients can be treated with surgical resection and have a favorable prognosis

What drug is used to reduce the risk of venous thromboembolism in hospitalized patients?

Low molecular weight heparin

What murmur characteristics are seen with VSD?

Low-pitched holosystolic murmur at the left sternal border Accentuates during maneuvers that increase afterload (eg, handgrip maneuver) A small VSD is usually asymptomatic and produces a louder murmur due to higher interventricular pressure gradient

What is the MOA of fibrates?

Lower TG levels by activating peroxisome proliferator-activated receptor alpha, which leads to decreased hepatic VLDL production and increased lipoprotein lipase activity

When is Hyaline arteriolosclerosis (homogenous deposition of hyaline material in the intima and media of small arteries and arterioles)seen?

Lower levels of hypertension

Where is primary TB seen?

Lower lobe of the lung See Ghon complex- the inital areas of infection (lower lobe, ipsilateral hilar lymph node) After a few weeks, antigen presenting cells display mycobacterial antigens leading to the stimulation of CD4 cells and subsequent cytokine mediated activation of macrophages Macrophages form mature phagolysosomes to kill intracellular mycobacteria and by differentiating into cells that wall off extacellular mycobacteria within granulomas Over time, granulomas become fibrosed and calcified, which reinforces the structure Allows areas of primary infection to be visualized on CXR or gross path Fibrosed and calcified Ghon complex= Ranke complex Secondary TB is more superior lobe

Where is ACE made?

Lung

In what organ does hypoxia result in a vasoconstrictive response?

Lung Pulmonary vascular bed will vasoconstrict to divert blood away from underventilated regions of the lung toward better-ventilated areas

Cancer metastasis to brain

Lung Breast Prostate Melanoma GI

How can turner syndrome manifest in a neonate?

Lymphedema Cystic hygromas Short stature, primary amenorrhea, and aortic anomalies are other important clinical features (45,X)- Loss of paternal chromosome X

What do the L serovars of Chlamydia cause?

Lymphogranuloma venereum Initial infection is associated with a painless genital ulcer, but patients primarily present after the disease has spread to the regional lymph nodes, which results in painful lymphadenitis This disease is very rare in the US and occurs mostly in tropical and subtropical regions

What syndrome is associated with colorectal cancer, endometrial cancer, and ovarian cancer?

Lynch syndrome Genes: MSH2, MLH1, MSH6, PMS2 Autosomal dominant Caused by inactivating mutation in corresponding tumor suppressor gene Deletion of remaining normal allele (second hit) leads to loss of heterozygosity and malignant transformation

What substance can help patients with pyruvate dehydrogenase deficiency generate energy without further elevating lactate?

Lysine and Leucine In this disease, get buildup of pyruvate which is shunted to lactate via lactate dehydrogenase, generating a potentially life-threatening lactic acidosis Disease management=ketogenic diet Lysine and Leucine are exclusively ketogenic

How do muscarinic receptors work?

M1 and M3- utilize IP3 pathway to increase intracellular calcium concentration and activate protein kinase C M2- act via cAMP second messenger system, and when activated decrease intracellular cAMP

What receptors regulate the vomiting reflex?

M1 muscarinic, D2 dopaminergic, H1 histaminic, 5-HT3 serotonergic, and neurokinin 1 (NK1) receptors

What is characterized by pituitary adenomas, primary hyperparathyroidism, and pancreatic neuroendocrine tumors?

MEN1 (mutation in MEN1)

How are MHC I and MHC II processed differently before being expressed on the cell surface for interaction with T-cells?

MHC I- RER MHC 2- acidified lysosomes/endosomes

Conjugate horizontal gaze palsy, horizontal diplopia

MLF lesion

Odansetron

MOA: 5-HT3 antagonist, decrease vagal stimulation, powerful central-acting antiemetic Use: Control vomiting post-op. and in patients undergoing chemo Adverse Effects: Headache, constipation, QT int. prolongation, serotonin syndrome

Loperamide

MOA: Agonist at mu opioid receptors, slow gut motility, poor CNS penetration (low addictive potential) Use: Diarrhea Adverse Effects: Constipation, nausea

Metaclopramide

MOA: D2 receptor antagonist, increase resting tone, contractility, LES tone, motility, promotes gastric emptying Does not influence colonic transport time Use: Diabetic and postsurgical gastroparesis, antiemetic, persistent GERD Adverse Effects: Increased parkinsonian effects; tardive dyskinesia, restlessness, drowsiness, fatigue, depression, diarrhea Drug interaction with digoxin and diabetic agents Contraindicated in patients with small bowel obstruction or Parkinson's due to D2 receptor blockade

Octreotide

MOA: Long-acting somatostatin analog, inhibits secretion of various splanchnic vasodilatory hormones Use: Acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors

Misoprostol

MOA: PGE2 analog, increase production of gastric mucous barrier, decrease acid production Use: Prevention of NSAID induced peptic ulcers (NSAIDs block PGE1 production), off label for induction of labor (ripens cervix) Adverse Effects: Diarrhea, contraindicated in women of childbearing potential (abortifacient)

Cimetidine, ranitidine, famotidine, nizatidine

MOA: Reversible block of H2 receptors--> decreases H+ secretions by parietal cells Use: Peptic ulcers, gastritis, mild esophageal reflux Adverse Effects: Cimetidine--> potent inhibitor of CYP 450 Antiandrogenic effects--> prolactin release, gynecomastia, impotence, decreased libido in males Can cross BBB and placenta--> confusion, dizziness, headaches Cimetidine and Ranitidine--> decreased renal excretion of creatinine Other H2 blockers are relatively free of side effects

Aprepitant

MOA: Substance P antagonist, Blocks NK1 receptors in brain Use: Antiemetic for chemotherapy induced nausea and vomiting

Bismuth Sucralfate

MOA: bind ulcer base providing physical protection and allowing HCO3 secretion to reestablish pH gradient in mucous layer Require acidic environment; not given with PPIs/H2 blockers Use: Increase ulcer healing, traveler's diarrhea

Sulfasalazine

MOA: combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory), activated by colonic bacteria Use: Ulcerative colitis, Crohn's (colitis component) Adverse Effects: Malaise, nausea, sulfonamide toxicity, reversible oligospermia

Orlistat

MOA: inhibits gastric and pancreatic lipase--> decreases breakdown and absorption of dietary fats Use: Weight loss Adverse Effects: Steatorrhea, decreased absorption of fat soluble vitamins

What does ALS look like macroscopically and microscopically?

Macro- thin anterior roots, mild atrophy of the precentral gyrus Micro- loss of neurons in the anterior horn (LMN lesion), degeneration and atrophy of the lateral corticospinal tracts (UMN lesion), loss of neurons in the motor nuclei of CN V/IX/X/XII, muscle: denervation atrophy (small angular fibers)

What is the MOA of fidoxomicin?

Macrocytic antibiotic that inhibits the sigma subunit of RNA polymerase

What hematologic effect can be seen with alcoholism causing acute pancreatitis?

Macrocytosis

What bacteria that attacks the 50S ribosome can cause QT prolongation?

Macrolides

What antibiotics bind the 23S rRNA of the 50S ribosomal subunit and block translocation of the ribosome on mRNA?

Macrolides and Clindamycin

What are the three main effects of Endotoxins?

Macrophage acitvation (TLR4), complement activation, and tissue factor activation (DIC)

What two factors play an important role in osteoclast differentiation?

Macrophage colony-stimulating factor Receptor for activated nuclear factor kappa-B ligand (RANK-L)

What is responsible for removing fine dust particles that reach the respiratory bronchioles and alveoli?

Macrophages

How are caseating granulomas formed in TB?

Macrophages display antigens on MCH II to stimulate CD4 T-cells, CD4 T-cells then release interferon-gamma that activates macrophages and increase their ability to kill phagocytized organisms. Activated macrophages can also differentiate into epithelioid histiocytes and coalesce into multinucleated Langhans giant cells that wall of extracellular mycobacteria within granulomas. The center of the granuloma is acidic and hypoxic, which causes it to appear acellular, necrotic, and "cheese-like" (caseating).

What type of rash develops with Measles virus (rubeola)?

Maculopapular exanthem that starts on the face and spreads down the trunk and extremities

How do anthracycline chemotherapeutic agents (eg, doxorubicin, daunorubicin) cause cardiotoxicity?

Mainly through the formation of anthracycline-topoisomerase II DNA cleavage complexes that affect healthy cardiomyocytes Cardiotoxicity is dependent on the cumulative dose of anthracycline received, and it manifests as dilated cardiomyopathy

What is schizoaffective disorder?

Major depressive or manic episode concurrent with symptoms of schizophrenia Lifetime story of delusions or hallucinations for greater than or equal to 2 weeks in the absence of major depressive or manic episode Mood episodes are prominent and recur throughout illness Not due to substances or another medical condition

What can result from cholestatic liver disease?

Malabsorption and nutritional deficiencies of fat-soluble vitamins

How does 5-alpha-reductase deficiency present?

Male neonates are born with feminized external genitalia that typically masculinize at puberty Small phalus and hypospadias are common

What does XYY look like?

Male, usually undiagnosed, tall, autism, acne, intellectual disability

When is hyperplastic arteriolosclerosis (onion-like concentric thickening of arteriolar walls) seen?

Malignant hypertension

What are the adverse effects of succinylcholine?

Malignant hyperthermia (especially with halothane) in genetically susceptible patients Severe Hyperkalemia in patients with burns, myopathies, crush injuries, and denervation Bradycardia from parasympathetic stimulation or tachycardia from sympathetic effects

What causes dimpling of overlying skin in breast cancer?

Malignant infiltration of suspensory ligaments of the breast (eg, cooper ligament)

What is gestational choriocarcinoma?

Malignant tumor that arises from the trophoblast Most commonly preceded by a normal pregnancy but can occur following any pregnancy

Intracytoplasmic eosinophilic inclusions, drink alcohol

Mallory bodies Alcoholic hepatitis

Eosinophilic cytoplasmic inclusion in liver cell

Mallory body (alcoholic liver disease)

What is the cause of congenital torticollis?

Malposition of the head in utero or birth trauma Most cases resolve with conservative therapy and stretching exercises

What nerve supplies the middle ear and muscles of mastication?

Mandibular division of the trigeminal nerve

What nerve provides general sensation for the anterior 2/3 of the tongue?

Mandibular division of the trigeminal nerve Gustatory innervation of anterior 2/3 is chorda tympani of facial nerve

What maneuver increases the murmur in hypertrophic cardiomyopathy, more specifically with left ventricular hypertrophy?

Maneuvers that decrease preload (venous return) or afterload reduce LV chamber size, which decreases the separation between the mitral valve and interventricular septum, increasing obstruction -Sudden standing -Valsalva -Nitroglycerin admin Maneuvers that increase preload or afterload will decrease murmur intensity by increasing left ventricular end-diastolic volume and lessening the outflow tract obstruction

What drug is a CCR5 inhibitor?

Maraviroc

What change is common in nephrotic syndrome?

Massive protein loss (eg, albumin) in the urine is caused by increased glomerular capillary permeability. Hypoalbuminemia reduces the plasma oncotic pressure, which causes a fluid shift into the interstitial space, resulting in edema. Low oncotic pressure also triggers increased lipoprotein production in the liver (ie, hyperlipidemia)

What is the mechanism of action of cromolyn and nedocromil?

Mast cell-stabilizing agents that inhibit mast cell degranulation independent of the triggering stimulus Less effective than inhaled glucocorticoids and are considered second-line treatments for allergic rhinitis and bronchial asthma

What artery does the middle meningeal artery branch off of?

Maxillary

What is increased in hereditary spherocytosis?

Mean Corpscular Hemoglobin Concentration (MCHC) Increased due to mild dehydration of the RBC Markers of hemolysis are often evident and include elevated lactate dehydrogenase, reticulocytosis, and decreased haptoglobin

What are the names of the aminoglycosides?

Mean GNATS can't kill anaerobes Gentamycin Neomycin Amikacin Tobramycin Streptomycin

What is formed from an incompletely obliterated omphalomesenteric duct and contains heterotopic gastric tissue that can ulcerate and cause brisk but painless lower GI bleeding?

Meckel's Diverticulum

CF patient and inability to pass stool at birth, what is it?

Meconium ileus

Which artery and its branches supply the femoral head and neck that are at risk in a displaced femoral neck fracture?

Medial circumflex artery

Where can the ulnar nerve be injured?

Medial epicondyle of the humerus ("funny bone") Guyon's canal near the hook of the hamate and pisiform bone in the wrist

What medications are avoided in hypertrophic cardiomyopathy?

Medications that decrease venous return or systemic vascular resistance (dihydropyridine calcium channel blockers, nitroglycerin)

What vessels are involved in PAN?

Medium or small sized arteries Renal artery is often prominent Vessels of kidneys, heart, liver, and GI are most commonly involved in resulting ischemia, infarction, or hemorrhage Cutaneous manifestations occur in up to 1/3rd of patients, and include palpable purpura Lung is very rarely involved

What is MEN2 characterized by?

Medullary thyroid cancer Pheochromocytoma Either parathyroid hyperplasia (2A) or marfinoid habits and mucosal neuromas (2B)

What is MEN 2B characterized by?

Medullary thyroid cancer Pheochromocytomas (can have episodic headaches accompanied by other symptoms associated with catecholamine excess) Mucosal neuromas and marfanoid habitus

Homer-Wright rosettes (circular grouping of dark tumor cells surrounding pale center)

Medulloblastoma and neuroblastoma

What drugs cause drug induced lupus?

Mega SHIPPE Methyldopa Sulfonamindes Hydralazine INH Phenytoin Procainamide Ethosuximide

Hypersegmented neutrophils

Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)

What does complete monosomy in turner syndrome result from?

Meiotic nondisjunction during gametogenesis

What are the inheritance patterns of Down syndrome?

Meiotic nondisjunction- extra copy of chromosome 21 present in every cell, risk based on maternal age Ubalanced translocation- all or part of additional chromosome 21 attached to another chromosome, risk high if balanced translocation is present in one parent Mosaicism- Some (not all) cells have an extra copy of chromosome 21, Nondisjunction event in early embryonic life, risk is similar to normal population

What is Ramelteon?

Melatonin agonist Safe and effective in reducing time to sleep onset in elderly

What is the molecular target of repaglinide?

Membrane ion channels It is a meglitinide- short acting glucose lowering medication that functions similar to sulfonylureas and act by binding and closing the ATP-dependent K+ channel in pancreatic beta cell membranes, inducing depolarization and L-type calcium channel opening Increased Ca2+ influx stimulates beta cell insulin release

What is the most common cause of nephrotic syndrome in adults?

Membranous nephropathy

What is characterized by immune complex deposition in the subepithelial portion of glomerular capillary walls, resulting in nephrotic syndrome?

Membranous nephropathy Often idiopathic but may be associated with solid tumors Diffuse thickening of the glomerular basement membrane is seen on LM; subepithelial immune complex deposits form spikes visible with silver stain and electron microscopy

Tinnitus, Hearing loss, and episodic vertigo

Meniere's disease

What can group B strep cause in a baby after infection through mother?

Meningitis Pneumonia Sepsis

What is the most common presentation of cryptococcus neoformans?

Meningoencephalitis

What are the major dopaminergic pathways in the brain?

Mesolimbic and Mesocortical (regulate cognition and behavior) Nigrostriatal (reg. coordination of voluntary mov.) Tuberoinfundibular (inhibits prolactin secretion)

What is detected in a reverse transcription polymerase chain reaction to diagnose chronic myelogenous leukemia?

Messenger RNA transcript containing BCR and ABL exons

What are the side effects of second-generation antipsychotics?

Metabolic adverse effects (eg, weight gain, dyslipidemia, hyperglycemia, increased risk of diabetes) Within the class, olanzapine and clozapine carry the greatest risk

What needs to be monitored with second-generation antipsychotics?

Metabolic adverse effects- weight gain, dyslipidemia, hyperglycemia, increased risk of diabetes Within the class, onlanzapine and clozapine carry the greatest risk

What is the MOA of Nitroglycerin?

Metabolized within vascular smooth muscle cells to nitric oxide, which activates guanylate cyclase and promotes the conversion of GTP to cGTP Increased levels of cGMP lead to decreased intracellular calcium (reduces activity of myosin light-chain kinase) and activation of myosin light chain phosphatase Promotes myosin light-chain dephosphorylation and vascular smooth muscle relaxation

What do tumor cells increase in order to invade the basement membrane?

Metalloproteinases zinc containing enzymes that degrade the extracellular matrix Participate in normal tissue remodeling and in tumor invasion through the basement membrane and connective tissue

What stage of Meiosis is the oocyte arrested in at ovulation, but before fertilization?

Metaphase of Meiosis II

Where in the bone does hematogenous osteomyelitis in children affect?

Metaphysis of long bones Due to slower blood flow and capillary fenestrae in this region

Where does osteomyelitis typically attack patients?

Metaphysis of the long bone

Which drug can be overcome by N5-formyl-tetrahydrofolate (folinic acid, leucovorin) supplementation?

Methotrexate Methotrexate and 5-FU both effectively inhibit thymidylate formation, but the chemotherapeutic effect of methotrexate is overcome by the supplementation

How do you treat methemogloninemia?

Methylene blue Vitamin C Brings iron back to Fe2+

What drug can exacerbate or cause de novo parkinsonian symptoms and trigger extrapyramidal reactions due to its antagonistic effect on dopamine receptors?

Metoclopramide Rarely, if ever, use in patients with PD

Which beta blockers are cardioselective?

Metoprolol, atenolol, bisoprolol, nebivolol Predominant action on beta 1 receptors and are sfe with stable obstructive lumg disease and are the DOC in these patients Combined beta and alpha receptor blockers (eg, carvedilol, labetalol) are also well tolerated and have been used safely in pts with COPD

Which beta blocker can have liver effects?

Metoprolol- dyslipidemia

C diff treatment

Metro Vancomycin if metro doesn't work Fecal transplant if neither works

What antibiotic can cause a disulfiram-like reaction (flushing, headache, nausea, vomiting, and cramps after drinking alcohol)?

Metronidazol Used to treat trichomonal vaginitis and bacterial vaginosis Disulfiram is used for chronic alcohol use to make you sick after drinking alcohol- inhibits acetaldehyde dehydrogenase

What antibiotic can cause a disulfiram-like reaction?

Metronidazole

What causes the anemia in HUS?

Microangiopathic hemolytic anemia Show schistocytes from traumatic mechanism

What teratogenic effects does isotretinoin have?

Microcephaly, thymic hypoplasia, small ears, hydrocephalus

What does lab testing show in lead poisoning?

Microcytic anemia with normal iron studies, and peripheral blood smear may reveal basophilic stippling Ring sideroblasts are seen in the bone marrow but not in the peripheral blood smear

What cells enter an ischemic infarct 3-5 days after onset of ischemia and phagocytize the fragments of neurons, myelin, and necrotic debris?

Microglia

What are the histopathologic findings in HIV associated dementia?

Microglial nodules (groups of activated microglia/macrophages around small areas of necrosis) and multinucleated giant cells

What damage does Reye's syndrome show on light microscopy?

Microvesicular steatosis

Where is a volvulus most common in an infant or a kid? adults?

Midgut Sigmoid

What does administration of human chorionic gonadotropin (hCG) mimic when treating anovulation?

Mimics LH surge, ovulation is induced Menotropin (human menopausal gonadotropin) is a treatment option that acts like FSH and triggers formation of a dominant ovarian follicle (given before the hCG)

What is important to potency of inhaled anesthetics?

Minimal alveolar concentration (MAC) is inversely related to potency

Anorexia treatment

Mirtazepine

What is Li Fraumeni syndrome due to?

Missense mutation in tumor suppressor gene TP53 Predisposes to sarcomas, breast cancer, leukemia, and adrenal tumors but not ovarian neoplasms

What causes Hemoglobin C?

Missense mutation that results in a glutamate residue being substituted by lysine in the beta globin chain Overall decrease in negative charge for the hemoglobin

Lack of what organelle can lead to mature erythrocytes that are unable to synthesize heme even though they contain detectable levels of cytoplasmic enzymes involved in heme synthesis?

Mitochondria

What organelles in the liver are most commonly affected in Reyes syndrome?

Mitochondria

Most common congenital heart valve defect

Mitral Valve Prolapse

What is the diagnosis in a diastolic thrill palpable over the cardiac apex and a low pitched, rumbling, mid diastolic murmur best heard over the apex when the patient is lying in the left lateral decubitus position?

Mitral stenosis

Why is there a difference in PO2 from the alveolar capillaries to the left atrium?

Mixing of oxygenated blood from the pulmonary veins with deoxygenated blood from the bronchial circulation and thebesian veins

What fails in embryogenesis that causes accessory nipples?

Regression of the mammary ridge in utero Usually asymptomatic but can become tender along with breast tissue during times of hormonal fluctuation

What can decrease adenomatous polyp formation?

Regular aspirin use Studies have linked increased activity of COX-2 to some forms of colon adenocarcinoma

How is prolactin regulated?

Regulated primarily by inhibitory effects of hypothalamic dopaminergic pathways However, prolactin secretion is stimulated by TRH In patients with primary hypothyroidism, the increased production of TRH by the hypothalamus can lead to hyperprolactinemia

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Reinke cells of Leydig tumor

What is alkaptonuria?

Relatively benign childhood disorder that is marked by severe arthritis in adult life Autosomal recessive disorder caused by deficiency of homogentisic acid dioxygenase, which normally metabolizes tissue throughout the body During adulthood, these blue black deposits become apparent in the sclerae and ear cartilage Urine turns black when exposed to air d/t oxidization of homogentisic acid

What is the most common trigger for DIC in pregnancy?

Release of tissue factor (thromboplastin) from injured placenta (eg, placental abruption) into the maternal circulation

Where do spliceosomes act?

Remove introns containing GU at the 5' splice site and AG at the 3' splice site Splice site mutations may result in inappropriate removal of exons and retention of introns, leading to formation of dysfunctional proteins

What should a new-onset left vericocele associated with ipsilateral flank pain and hematuria raise suspicion of?

Renal Vein Thrombosis (RVT) causing impaired left gonadal venous drainage

What artery supplies the proximal ureter? distal ureter?

Renal artery Superior vesical artery

What teratogenic effects do ACE inhibitors have?

Renal dysgenesis and oligohydramnios

What is the diagnosis in a patient presenting with gross hematuria, acute flank pain, and passage of tissue fragments in urine in a patient with sickle cell disease or trait?

Renal papillary necrosis Commonly seen in patients with DM, analgesic nephropathy, or severe obstructive pyelonephritis as well

How do you diagnose schizophrenia?

Requires greater than or equal to 2 of the following symptoms: Delusions Hallucinations Disorganized speech Grossly disorganized behavior Negative symptoms Total impairment duration must be greater than or equal to 6 months

What values are increased in PFTs of COPD?

Residual capacity Residual volume Total lung capacity

How does resistance change throughout the respiratory tract?

Resistance increases from the trachea to the medium sized bronchi and then drops dramatically to the bronchioles and is practically zero in the terminal bronchioles Resistance is maximal in the 2nd to 5th generation airways, including the segmental bronchi In contrast, airways <2 mm in diameter (eg, bronchioles) contribute to <20% of the total airway frictional resistance

What acid base disorder is seen in heroin overdose?

Respiratory acidosis (hypoventilation) Low pH, high pCO2, and a normal to mildly increased HCO3- because renal compensation requires at least 24 hours of persistent respiratory acidosis Chronic respiratory acidosis is characterized by a low normal pH, a high pCO2, and a high HCO3- (>30)

What do blood gas values look like in PE?

Respiratory alkalosis (hypocapnia) due to hyperventilation In acute settings, HCO3- remains normal (compensation occurs after approx. 48 hours) Hyperventilation does not significantly improve arterial oxygenation because, as hemoglobin is nearly fully saturated with O2 in ares of normal V/Q ratio, there is little capacity for high V/Q regions to increase blood O2 content much further

What ABG changes are seen in high altitudes?

Respiratory alkalosis due to hyperventilation Compensated by renal excretion of bicarbonate within 24-48 hours

What are lacunar infarctions?

Result of small vessel occlusion (eg, due to lipohyalinosis and microatheroma formation) in the penetrating vessels supplying the deep brain structures Uncontrolled hypertension and DM are major risk factors for this Most often due to lipohyalinosis, microatheroma formation, and hardening/thickening of the vessel wall (HTN arteriolar sclerosis)

What do PTH and Ca2+ values look like in Chronic Kidney Disease (CKD)?

Resulting Hypocalcemia stimulates release of PTH (causing secondary hyperparathyroidism) Hyperphosphatemia (binds serum Ca2+) and low 1,25-dihydroxyvitamin D (decreases intestinal Ca2+ absorption and Ca2+ release from bone)

What is Gerstmann syndrome?

Results from damage of the angular gyrus of the dominant parietal lobe and is characterized by agraphia, acalculia, finger agnosia, and left-right disorientation

What are some complications of acute MI?

Right ventricular failure Acute Hypotension and clear lungs Kussmaul sign Papillary muscle rupture Within 3-5 days Acute, severe, pulm. edema Severe MR with flail leaflet Interventricular septum rupture/defect Within 3-5 days New holosystolic murmur Stepped-up oxygen level between right atrium & ventricle Free wall rupture Within 5-14 days Pericardial tamponade JVD Distant heart sounds

What is the treatment for ALS?

Riluzole MOA: decreases glutamate release

What are the results of Rinne and Weber in sensorineural versus conductive hearing loss?

Rinne- Normal and sensorineural- AC>BC bilaterally Conductive- BC>AC in affected ear, AC>BC in unaffected ear Weber- Normal- midline Sensorineural- lateralizes to unaffected ear Conductive- lateralizes to affected ear

Which vaccine can cause intusception?

Rotavirus

In a susceptible child, a febrile maculopapular rash that begins on the face and spreads to the trunk and estremities, and postauricular LAD is what diagnosis?

Rubella (German measles) (Typically spreads faster and does not darken or coalesce compared to rubeola) Postauricular and occipital LAD is particularly common in rubella, which is caused by a togavirus

What is the epidemiology of Nontyphoidal salmonella?

S enterica Poultry/eggs, exotic pets Foodbourne (primarily) Industrialized countries

What are the bacteria that produce biofilm in vivo?

S epidermidis Viridans Strep P aeruginosa Nontypeable (unencapsulated) H flu

What are the clinical manifestations of babesiosis?

S/S: fevers, fatigue, myalgias, headache, flulike symptoms (if severe: ARDS, CHF, DIC, splenic rupture) Lab studies: anemia, thrombocytopenia, increased LFTs

What drugs cause gynecomastia

SACKED Spironolactone, Alcohol, Cimetidine, Ketoconazole, Estrogen, Digoxin

Where are ADH and oxytocin produced?

SAD POX Supraoptic nucleus- ADH Paraventricular nucleus- Oxytocin

What are the retroperitoneal structures?

SAD PUCKER Suprarenal (adrenal) glands Aorta and IVC Duodenum (except 1st part) Pancrease (except tail) Ureters and bladder Colo (asc. and desc.) Kidneys Esophagus Rectum (mid-distal)

What are the CYP-450 inhibitors?

SICKFACES.COM Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Acute alcohol abuse Chloramphenicol Erythromycin (macrolides) Sulfonamides Ciprofloxacin Omeprazole Metronidazole

Which muscles compose the rotator cuff?

SITS Supraspinatus Infraspinatus Teres Minor Subscapularis

What skin conditions have a positive nikolsky sign?

SJS SSS pemphigus vulgaris

What is pericarditis commonly associated with?

SLE Presents with sharp pleuritic pain that is relieved by sitting up and leaning forward

What vessel can be damaged with a mass infiltrating beyond the gut wall of the third portion of the duodenum?

SMA Lies anterior to the duodenum at the level of the third lumbar vertebra (where the third part of the duodenum courses horizontally across the abdominal aorta and inferior vena cava)

What ECG findings would you see with Occlusion of the proximal LAD?

ST elevation in leads V1-V4 Anteroseptal transmural ischemia

What ECG findings would be seen in occlusion of the LCX?

ST elevations mainly in V5 and V6, and possibly also in I and aVL Transmural ischemia of the lateral wall of the left ventricle

What is ejection fraction?

SV/EDV

What is seen in cauda equina syndrome?

Saddle anesthesia and loss of anocutaneous reflex Associated with damage to S2 through S4 nerve roots

What do Leydig cells do?

Secrete testosterone, which stimulates the Wolffian (mesonephric) ducts to develop into internal male reproductive organs Testosterone is peripherally converted into dihydrotestosterone, which transforms the genital tubercle, urogenital folds, labioscrotal swelling into the external male reproductive organs

Impairment of which defense mechanisms would most likely predispose somebody to giardia lamblia?

Secretory IgA (which impairs adherence)

What is trazadone?

Sedating antidepressant most often used as a hypnotic to treat insomnia associated with depression or antidepressant treatment Associated with rare but serious side effect of priapism

What fails to happen when the cecum rests in the right upper quadrant and Ladd's (fibrous) bands connect the retroperitoneum in the RLQ to the right colon/cecum?

Seen in first days of life Due to midgut malrotation Fibrous bands cause intestinal obstruction

What is the major cause of morbidity and mortality from theophylline intoxication?

Seizures Tachyarrhythmias are the other major concern

What anti-inflammatory does not impair platelet aggregation?

Selective COX 3 inhibitors Anti-inflammatory effects without the side effects of bleeding and GI ulceration associated with non-selective COX inhibitors Do not impair platelet function because platelets predominantly express COX 1

What is the MOA of Milrinone?

Selective PDE-3 enzyme inhibitor that is occasionally used as an inotropic agent in patients with refractory heart failure due to left ventricular systolic dysfunction Decrease the rate of degradation of cAMP in cardiac tissues Increased cAMP promotes calcium influx into cardiac myocytes, increasing myocardial contractility Also inhibits PDE-3 in vascular smooth muscle cells Increased cAMP in vascular tissues causes systemic arterial and venous dilation, which can lead to decreased BP

What is the MOA of phenylephrine?

Selective alpha-1 agonist that increases peripheral vascular resistance and systolic blood pressure and decreases pulse pressure and heart rate

What cellular changes occur as a direct effect of atenolol?

Selective blockade of the Beta 1 receptor leads to decreased cAMP levels in cardiac and renal tissue without significantly affecting cAMP levels in vascular smooth muscle

What is circinate balanitis?

Serpiginous annular dermatitis of the glans penis

What is the marker of osteoblast activity?

Serum level of bone-specific alkaline phosphatase

What is alpha-1 antitrypsin (AAT)?

Serum protein that, through the inhibition of neutrophil elastase, reduces tissue damage caused by inflammation Histologically, AAT deficiency is associated with reddish-pink, periodic acid-Schiff-positive granules of unsecreted, polymerized AAT in the periportal hepatocytes

What enzymes is biotin (B7) an important cofactor for?

Several carboxylase enzymes Ex. Pyruvate carboxylase (pyruvate to oxaloacetate) Acetyl-CoA carboxylase (acetyl-CoA to malonyl-CoA) Propionyl-CoA carboxylase (propionyl-CoA to methylmalonyl-CoA)

What is pauci immune rapidly progressing glomerulonephritis (RPGN)?

Severe glomerular injury that rapidly progresses to renal failure within weeks to months of onset No immunoglobulin or complement deposits on the basement membrane Most patients have antineutrophil cytoplasmic antibodies (ANCA) in their serum Often associated with granulomatosis with polyangiitis (Wegner's) or microscopic polyangiitis (Churg-Strauss) but can also be idiopathic

How do patients with propionic acidemia present?

Severe metabolic acidosis Hypoglycemia and ketosis frequently develop secondary to the acidosis Affected patients present 1-2 weeks after birth with lethargy, poor feeding, vomitingm and hypotonia Treatment involves starting a low protein diet containing minimal amounts of valine, isoleucine, methionine, and threonine

Where is vitamin C deficiency most often seen?

Severely malnourished individuals and leads to capillary bleeding, poor wound healing, and periodontal disease In children, bony deformities and subperiosteal hemorrhages are also characterisitic

When does lecithin production increase during fetal lung development? phosphatidylglycerol production?

Sharply after 30 weeks Increases at 36 weeks Sphingomyelin level should remain approx. constant during the 3rd trimester An L/S ratio greater than or equal to 2.0 indicates adequate surfactant production to avoid neonatal hyaline membrane disease

What drug is used while starting SSRI treatment for increased agitation and anxiety?

Short or intermediate acting benzodiazepine such as lorazepam Can be used before bedtime with minimization of undesireable daytime side effects- due to there being a significant increase in insomnia or other anxiety related symptoms during the initiation of SSRIs

What are the characteristics of Wolff-Parkinson-White (WPW)?

Shortened OR interval Widening of the QRS complex Slurred initial upstroke of QRS complex (delta wave) Caused by an accessory pathway that bypasses AV node, causing preexcitation of ventricles Can develop symptomatic arrhythmia due to reentry of electrical impulses through accessory conduction pathway

What reaction does myophosphorylase catalyze?

Shortening of glycogen chains by cleaving alpha-1.4-glycosidic linkages between glucose residues, liberating glucose 1-phosphate in the process AKA Glycogen phosphorylase

How does digoxin affect QT?

Shortens it

What are the difference between sickle cell trait and disease with HbA and HbS?

Sickle cell trait- HbA%>HbS% Sickle cell disease- HbS%>HbA%

What is the prominent histological feature of diffuse gastric carcinoma?

Signet ring cells Infiltrative growth within the stomach wall

What symptoms are seen in Brachiocephalic (innominate) vein obstruction?

Similar to those in SVC syndrome, but only on one side of the body

What are the effects of simvastatin and cholestyramine on hepatic cholesterol synthesis?

Simvistatin- decrease Cholestyramine- increase Increase bile acid synthesis too Block the increase of cholesterol by adding a statin Combination therapy results in a synergistic reduction in plasma LDL level

What do simvastatin and cholestyramine do individually? together?

Simvistatin- decreases hepatic cholesterol production Cholestyramine- increases hepatic cholesterol and bile acid synthesis Combination therapy results in a synergistic reduction in plasma LDL level

What type of virus is rhinovirus?

Single stranded Positive sense Naked If it is SS positive sense, more infective- can induce viral protein synthesis and genome replication in the host cell Capable of using host's intracellular machinery

What is west nile virus?

Single-stranded flavivirus transmitted by mosquitoes, most commonly in the summer Most infections are asymptomatic or may present with a flu-like illness (West Nile fever), often with a maculopapular or morbilliform rash Neuroinvasive disease manifests as meningitis, encephalitis, or asymmetric flaccid paralysis; patients may have parkinsonian features

How does Norepinephrine work to increase blood pressure?

Stimulation of alpha1 adrenoreceptors leads to vasoconstriction of skin and viscera, resulting in increased systolic and diastolic blood pressure with devreased renal and hepatic blood flow. Alpha1 mediated vasoconstriction occurs via the IP3 second messenger pathway Stimulation of beta1 adrenoreceptors within the heart increases cAMP concentrations through Gs mediated receptor coupling, which leads to increased cardiac contractility, conduction, and heart rate Overall no change in heart rate due to counteraction by an indirect baroreceptor mediated reflex bradycardia following increase in peripheral resistance. Stimulation of alpha2 adrenoreceptors causes a decrease in cAMP in pancreatic beta cells and in the intestines, resulting in decreased insulin secretion and reduced intestinal motility. Central alpha2 adrenoreceptors are not stimulated by IV admin. of norepinephrine as the molecule does not cross the BBB.

What are the significant adverse effects of Methotrexate?

Stomatitis, bone marrow suppression, and liver function abnormalities

How do you treat TCA overdose?

Sodium bicarbonate Increases serum pH which favors the non-ionized (neutral) form of the drug, making it less accessible to bind to sodium channels Also increases extracellular sodium concentration, which helps overcome the competitive, rapid sodium channel blockade induced by TCAs

What is the treatment of aspirin toxicity?

Sodium bicarbonate- alkalinize the urine

What parts of the nephron are most commonly affected in ATN?

Straight proximal tubules Thick ascending limb of loop of Henle MUDDY BROWN CASTS

What are the histopathologic features of esophageal squamos cell carcinoma?

Solid nests of neoplastic squamos cells with abundant eosinophilic cytoplasm and distinct borders Areas of keratinization and the presence of intercellular bridges are also characterisitic

What are the functions of the glossopharyngeal nerve (CN IX)?

Somatic motor: Stylopharyngeus muscle only (elevates larynx during swallowing) Parasympathetic: Inferior salivatory nucleus--> CN IX--> otic ganglion--> travels along auriculotemporal nerve (CN V)--> parotid gland secretion General sensory: Tympanic membrane (inner surface), eustachian tube, posterior third of tongue, tonsillar region, upper pharynx (afferent portion of gag reflex), carotid body, and carotid sinus Special sensory (taste): Posterior third of the tongue

What hormone is used to treat the symptoms of VIPoma?

Somatostatin

What are the pathologic features of partial moles?

Some enlarged villi with focal trophoblastic proliferation Fetal/embryonic tissue present

How does Diphtheria present?

Sore throat Fever Cervical adenopathy Pharyngeal exudates/coalescing pseudomembrane

What are drugs that cause disulfiram reaction?

Sorry Pals Can't Go Mingle Sulfonylureas Procarbazine Certain cephalosporins Griseofulvin Metronidazole

What is used to treat pseudomonas?

Specific penicillins (eg, ticarcillin, piperacillin) and cephalosporins (eg, ceftazidime, cefepime) Certain aminoglycosides, fluoroquinolones (eg, ciprofloxacin, levofloxacin), and carbapenems (eg, imipenem, meropenem)

How does Clear cell carcinoma, a type of renal cell carcinoma, look on gross pathology?

Sphere-like mass composed of golden-yellow cells (due to high lipid content) with areas of necrotic cells and focal hemorrhage Originates from the epithelium of proximal renal tubules

What is the morphology of coccidioides?

Spherules with endospores

What is the problem in Niemann-Pick disease?

Sphingomyelinase deficiency that causes accumulation of the lipid sphingomyelin Clinical features= HSM, neurologic regression, and a cherry-red macular spot in infancy

What structures travel through the foramen magnum?

Spinal roots of CN XI, brain stem, and vertebral arteries

Hyperaldosteronism treatment

Spironolactone

What portions of the colon are most at risk for ischemic damage?

Splenic flexure and Rectosigmoid junction ("watershed" areas) Susceptible to ischemic damage during hypotensive states, especially in patients with underlying arterial insufficiency

What happens to the spleen in pyruvate kinase deficiency?

Splenic/ red pulp hyperplasia Results from increased work of the splenic parenchyma, which must remove the deformed erythrocytes from circulation

What would skin biopsy show in eczematous dermatitis (eczema)?

Spongiosis (an accumulation of edema fluid in intercellular spaces of the epidermis)

Fever, ascites in setting of cirrhosis, what to rule out?

Spontaneous bacterial peritonitis (SBP)

What does PAS stain for?

Stains for glycogen Used for Treponema Whippeli (Whipples disease)

What type of aortic dissection presents with Aortic regurg?

Stanford Type A

Paralysis of what muscle results in hyperacusis (eg, increased sensitivity to sound)?

Stapedius muscle Innervated by the stapedius nerve (branch of the facial nerve)

What bug do you think of first with pus, empyema, and abscess?

Staph aureus

What bug do you think with empyema, pus, and abscess?

Staph aureus

What is the most common bacterial etiology for acute bacterial parotitis?

Staph aureus

Osteomyelitis in IV drug use

Staph aureus Pseudomonas Candida

What is the rash pattern for rubella?

Starts on your face and spreads to trunk and extremities

After a clavical fracture, what muscle may cause the medial fragment to be pulled superiorly and posteriorly?

Sternocleidomastoid

What is the treatment of autoimmune hepatitis?

Steroids (Anti-smooth muscle antibody in autoimmune hepatitis)

What is a benign vascular tumor of childhood?

Strawberry hemangioma (capillary hemangioma) Appear during first weeks of life, initially grow rapidly, and typically regress by 5-8 years old Composed of capillaries separated by Connective Tissue

Which gram positive cocci most commonly colonizes the colon?

Strep bovis?

What is the leading cause of sepsis?

Strep pneum.

What is the most common cause of bacterial meningitis in adults of all ages?

Streptococcus pneumoniae Lancet-shaped, G + cocci in pairs

What are the key features of ovarian sertoli-leydig tumors?

Stroma (sex cord) tumor Increased androgens (eg, hirsutism, clitoromegaly) Malignant

What are the key features of ovarian granulosa cell tumors?

Stroma (sex cord) tumor Increased estrogen (eg, endometrial hyperplasia, postmenopausal bleeding) Increased inhibin Histology: Call-Exner bodies, cofee bean nuclei Malignant

What is Dermatomyositis associated with?

Strong association with malignancy, particularly lung, colorectal, and ovarian cancers

Vascular birth mark (port wine stain) of the face

Sturge Weber syndrome

What border of the rib do the intercostal vein, artery, and nerve lie?

Subcostal groove on the lower border of the rib

What can you see in abusive head trauma (shaken baby syndrome)?

Subdural hemorrhage (d/t tearing of bridging veins) Retinal hemorrhages Additional red flags- injuries inconsistent wiht history or dev. age

What is akathisia?

Subjective restlessness with inability to sit still

What is a crossover study?

Subjects are randomly allocated to a sequence of 2 or more treatments given consecutively A washout (no treatment) period is often added between treatment intervals to limit the confounding effects of prior treatment

What does Chronic lung transplant rejection pathophys look like?

Submucosal inflammation--> granulation, scarring, and bronchiolitis obliterans Present with slowly worsening dyspnea and dry cough that begins months or years after transplantation Exam may reveal end-expiratory squeaks or pops, and spirometry typically demonstrates airflow limitation (obstructive pattern) with a drop in FEV1

Which rotator cuff muscle is responsible for adduction and internal rotation?

Subscapularis

What is the mechanism of resistance of vancomycin?

Substitution of D-lactate in the place of D-alanine

What is adenocarcinoma in situ?

Subtype of lung adenocarcinoma that accounts for <10% of all lung cancers (formerly known as bronchioloalveolar carcinoma) Consists of well-differentiated, dysplastic columnar cells that line the alveolar septa without vascular or stromal invasion Tumor has a tendency to undergo aerogenous spread and can progress to invasive disease if not resected

When in the CAC is GTP produced?

Succinyl-CoA to succinate reaction via Succinate thiokinase (succinyl-CoA synthetase)

What stain is used to test for fat malabsorption?

Sudan III stain of stool (stool normally does not contain any measurable fat)

What diabetic drug do you see steven johnson syndrome with?

Sulfonylureas

What drugs increase the secretion of insulin (and C-peptide) from pancreatic beta-cells?

Sulfonylureas Meglitinides

Activation of what cells are primarily responsible with Toxic Shock Syndrome?

Superantigens (eg, TSS toxin) interact with major histocompatibility complex molecules on antigen-presenting cells and the variable region of the T-lymphocyte receptor to cause nonspecific, widespread activation of T cells This results in the release of IL-2 from the T cells and IL-1 and tumor necrosis factor from macrophages This immune cascade is responsible for the manifestations of TSS

What structures do emergency cricothyrotomy incisions pass through?

Superficial cervical fascia Pretracheal fascia Cricothyroid membrane

What drains most of the cutaneous lymph from the umbilicus down, including the anus below the dentate line?

Superficial inguinal lymph nodes Exceptions are the glans penis and posterior calf (drain to deep inguinal nodes)

Where are parietal cells located?

Superficial upper glandular layer of the gastric body and fundus

What nerve innervates the gluteus medius, gluteus minimus, and tensor fasciae latae muscles?

Superior gluteal nerve

What artery is most likely compromised with distal duodenal perforations?

Superior mesenteric artery

Where does venous drainage of the rectum above the dentate line go?

Superior rectal vein, which drains into the portal venous system via the inferior mesenteric vein Structures below the dentate line drain into the middle and inferior rectal veins, which drain into the systemic circulation via the internal iliac vein

Where should intragluteal injections be given?

Superolateral quadrant of the buttock is a relatively safe site for intragluteal injections, although the anterolateral gluteal region is preffered Injections into the superomedial, inferomedial, and inferolateral regions of the buttock risk injury to the sciatic nerve Injections in the superomedial part of the buttock risk injury to the superior gluteal nerve (Tendelenburg sign if hit)

What enzyme neutralizes ROS to prevent cell injury?

Superoxide dismutase

What do the sertoli cells do?

Suppress female internal reproductive organ development by producing anti-mullerian hormone (AMH), which causes mullerian duct involution Also produce androgen-binding protein, which concentrates testosterone in the seminiferous tubules to enable spermatogenesis (nothing to do with external)

What hypothalamic nucleus is responsible for circadium rhythym regulation and pineal gland function?

Suprachiasmatic

Which rotator cuff muscle is responsible for abduction?

Supraspinatus

What muscle assists in abduction of the arm and stabilization of the glenohumoral joint?

Supraspinatus Tendon is vulnerable to injury due to impingement between the acromion and the head of the humerus Supraspinatus tendinopathy is the most common cause of rotator cuff syndrome

What embryologic layer does the anterior pituitary originate from?

Surface ectoderm (Rathke's pouch)

What does the foam stability index evaluate?

Surfactant functionality To perform this test, multiple wells containing mixtures of ethanol and amniotic fluid are shaken and then examined to find the highest value well that contains a ring of stable foam

What is seen as the earliest manifestation of diabetic nephropathy?

Moderately increased albuminuria (urine albumin 30-300mg/day) Screening for diabetic nephropathy is best achieved using an albumin-specific urine assay (regular dipstick urinalysis has low sensitivity)

What cells undergo hyperplasia during renal artery stenosis?

Modified smooth muscle (JG) cells within the afferent glomerular arterioles This is due to decreased GFR causing activation of RAAS leading to increased renin release by these cells Chronic renal hyperplasia causes this

What type of cells are JG cells of the kidney?

Modified smooth muscle cells

What type of cells are the JG cells of the kidney?

Modified smooth muscle cells of the afferent arterioles

What drugs can cause serotonin syndrome when combined with a serotonergic medication?

Monoamine oxidase inhibitor (MAOI) antidepressant or a non-antidepressant with MAOI activity (eg, linezolid)

What is a sign of malignancy in lymph node enlargement?

Monoclonal lymphocytic proliferation This is strong evidence

What are common symptoms of drug induced liver injury?

Most commonly due to inhaled anesthetics (halothane) Cause a hepatocellular pattern of liver injury Can range from mild to AST elevation to fulminant hepatits with a 50% fatality rate Liver can atrophy and appear shrunken Histologically, widespread centrilobular necrosis and inflammation of the portal tracts and parenchyma are observed Typically have fever, anorexia, nausea, myalgias, arthralgias, and rash Tender hepatomegaly and jaundice can be seen on PE Lab findings: Marked elevation of AST, prolonged prothrombin time, leuocytosis, and eosinophilia Prolonged Prothrombin time is due to failure of hepatic synthetic function and deficiency of factor VII

What is pulsus paradoxus seen in?

Most commonly seen in patients with cardiac tamponade but can also occur in severe asthma, COPD, and constrictive pericarditis

What layers of GI are included in diverticuli?

Mucosa, Submucosa, and serosa Lack muscularis False diverticula

What happens in the absence of Sertoli cells or AMH?

Mullerian ducts develop into the internal female reproductive organs

What kind of inheritance does spina bifida have?

Multifactorial

What does thyroid peroxidase do?

Multifunctional enzyme that catalyzes the oxidation of iodide, the iodination of thyroglobulin, and the coupling reaction between 2 iodized tyrosine residues

What is a developmental field defect?

Multiple malformations that occur secondary to an embryonic disturbance in an adjoining group of cells Ex. holoprosencephaly- dev. field defect characterized by a spectrum of fetal anomalies due to imcomplete division of the forebrain (prosencephalon)

What characterizes Tourette disorder?

Multiple motor and at least one vocal tic These typically wax and wane, can be suppressed temporarily, and are preceded by a premonitory urge

How does Cruetzfeldt-Jakob disease appear on microscopy?

Multiple vacuoles are seen in the grey matter of the brain (spongiform encephalopathy) Pathogenesis- linked to abnormal protein (prion), rapidly progressive dementia and myoclonic jerks

How do you calculate the probability of 8 separate events occurring?

Multiply the probability of each of the separate events

What is Polyarteritis Nodosa (PAN)?

Multisystem vasculitis characterized by episodic ischemic symptoms in various organs with sparing of the lungs Biopsy shows segmental, transmural inflammation with fibrinoid necrosis Commonly associated with Hepatitis B

What are the symptoms of cholinergic toxicity?

Muscarinic Effects: DUMBBELLS *D*iarrhea *U*rination *M*iosis *B*ronchospasm *B*radycardia *E*xcitation of skeletal muscle and CNS *L*acrimation *L*ethargy *S*alivation Nicotinic Effects: Muscle weakness Paralysis Fasciculations Result from cholinesterase inhibitors

Where are insulin mediated GLUT4 receptors located?

Muscle cells Adipocytes Increase concentration of receptors with increase in insulin

What are the signs of hypocalcemia?

Muscle cramps, perioral paresthesias, hypotension, and possible laryngospasm Other signs may include Chvostek sign and Trousseau sign (Become clinically apparent with serum calcium <7 mg/dL)

What is intermittent claudication?

Muscle pain that is reproducibly caused by exercise and relieved by rest Due to atherosclerotic stenoses (lipid-filled intimal plaques) in the large arteries that prevent sufficient blood flow to exercising muscle Lower extremities most commonly affected; however, proximal lesions can cause gluteal claudication and/or impotence (Leriche syndrome)

What is hypothyroid myopathy?

Muscle pain, cramps and weakness involving the proximal muscles Delayed tendon reflexes and myoedema Features of hypothyroidism Creatine kinase is elevated

What are the effects of Beta2 adrenergic blockade?

Muscle vasculature: vasospasm Adverse effects: Exacerbation of peripheral artery disease Lungs: Bronchoconstriction Adverse effects: Worsening of obstructive lung disease Liver: Decreased glycogenolysis and gluconeogenesis Adverse effects: Hypoglycemia in diabetic patients Most tissues: Decreased potassium entry into cells Adverse effects: hyperkalemia

What is the most common mutation in polycythemia vera?

Mutation in JAK2, a non-receptor (cytoplasmic) tyrosine kinase associated with the EPO receptor

What is Wiskott-Aldrich syndrome?

Mutation in WASp gene; leukocytes and platelets unable to reorganize actin cytoskeleton--> defective antigen presentation X-linked recessive WATER: Wiskott-Aldrich, Thrombocytopenia, Eczema, Recurrent (pyogenic) infections Increased risk of autoimmune disease and malignancy Decreased to normal IgG, IgM Increased IgE, IgA

What molecular mechanism is responsible for lynch syndrome?

Mutation in mismatch repair gene

What is McCune-Albright syndrome?

Mutation of GNAS gene, constant G protein activation, and hormone overproduction Peripheral precocious puberty, irregular cafe au lait macules, and polyostotic fibrous dysplasia Complications: thyrotoxicosis, acromegaly, and cushing syndrome

What are the genetic criteria for ALS?

Mutation of the gene that codes for copper-zinc superoxide dismutase (SOD1) may be implicated

What is the mutation in congenital QT prolongation syndrome?

Mutations in a K+ channel protein that contributes to the delayed rectifier current (Ik) of the cardiac action potential Romano-Ward syndrome Jervell and Lange-Nielsen syndrome

What mutations underlie hypertrophic cardiomyopathy?

Mutations in cardiac cell sarcomere proteins

What happens within the first week of primary TB infection?

Mycobacterium tuberculosis replication within the alveolar space and alveolar macrophages After a few weeks, CD4 lymphocytes are stimulated to release IFN-gamma, which activates macrophages and leads to control of the infection

What are the characteristics of opioid withdrawal?

Mydriasis Abdominal pain Diarrhea Piloerection Lacrimation Yawning Generally non life threatening, unlike withdrawal from alcohol and benzodiazepines

What is subacute combined degeneration?

Myelopathy associated with vit. B12 deficiency Degeneration of both the ascending (dorsal columns) and descending (corticospinal tract) pathways Loss of position and vibration sensation, ataxia, and spastic paresis are common manifestations

What gives the greenish color to sputum?

Myeloperoxidase

What refers to a state of chronic myocardial ischemia in which both myocardial metabolism and function are reduced to match a concomitant reduction in coronary blood flow (due to moderate/severe flow limiting stenosis)?

Myocardial hibernation The new equilibrium prevents myocardial necrosis Demonstrates decreased expression and disorganization of contractile and cytoskeletal proteins, altered adrenergic control, and reduced calcium responsiveness These changes lead to decreased contractility and LV systolic dysfunction However, coronary revascularization and subsequent restoration of blood flow to hibernating myocardium improves contractility and LV function

What is the most common cause of death in patients with diabetes mellitus?

Myocardial infarction from coronary heart disease

What does ATP attachment to the sarcomere cause?

Myosin head detachment from the actin filament If ATP is not available, the cross-bridge between myosin and actin will persist (rigor mortis)

What is the most common primary cardiac neoplasm and usually arises within the left atrium?

Myxomas

What changes are seen in aortic aneurysms?

Myxomatous changes with pooling of proteoglycans in the media layer of large arteries are found in cystic medial degeneration, which predisposes to the dev. of aortic dissections and aortic aneurysms Medial degeneration is frequently seen in younger individuals with Marfan syndrome

What important molecule is produced in the PPP?

NADPH

What enzyme catalyzes the first step of the oxidative burst pathway, transferring an electron from the reducing equiv. NADPH to molecular oxygen and forming ROS, superoxide?

NADPH oxidase Deficiency results in chronic granulomatous disease, which presents with increased risk of infection with catalase positive organisms

How does acetaminophen cause toxicity in the liver?

NAPQi depletes glutathione and forms toxic biproducts in the liver

What are the buffers of the urine?

NH4+ and H2PO4- In metabolic acidosis, urinary pH decreases due to increased excretion of free H+, NH4+, and H2PO4-. Bicarb is completely reabsorbed from the tubular fluid in acidotic states

Does CO poisoning precipitate methemoglobinemia?

NO

Acute gout treatments

NSAIDs Glucocorticoids Colchicine In this order

What are drugs that can cause pill induced esophagitis?

NSAIDs Iron Potassium chloride Tetracyclines Bisphosphonates

What is responsible for calcium efflux prior to relaxation of skeletal muscle/cardiac muscle?

Na+/Ca2+ exchange pump and sarcoplasmic reticulum Ca2+ ATPase pump (SERCA)

What medication is used to treat alcohol use disorder?

Naltrexone

What drugs are prefered for focal (simple and complex) seizures?

Narrow spectrum (can also treat focal seizures that evolve to bilateral convulsive (tonic-clonic) seizures) Carbamazepine Gabapentin Phenobarbital Phenytoin

What teratogenic effects does warfarin have?

Nasal hypoplasia and stippled epiphyses

Which MS treatment can cause PML?

Natalizumab

MS treatment

Natalizumab -Inhibits adhesive molecules required for T cell extravasation through blood-brain barrier into CNS Recombinant IFNB (Avonex) -Increases ant-iinflammatory cytokine production, decreases pro-inflammatory cytokine production, inhibits infiltration of inflammatory immune cells into CNS

Premature baby, air within bowel wall on abdominal x-ray, bloody stools

Necrotizing enterocolitis

How do you diagnose Polyarteritis Nodosa?

Negative ANCA, ANA Association with Hepatitis B, Hepatitis C Microaneurysms on arteriography Tissue biopsy confirms vasculitis (nongranulomatous)

Which bacteria can cause bead like strings from GI to liver?

Neiserria ghonorea

New born, 3 days old, bilateral purulent discharge from eyes, moderate inflammation- what bacteria is it?

Neisseria gonorrhea If 5 days or more, mucopurulent, watery discharge, a lot less inflammation- usually chlamydia

Osteomyelitis in sexually active

Neisseria gonorrhoeae

What bug can metabolize glucose and is found in neutrophils?

Neisseria gonrrhea

Which bug metabolizes glucose and maltose?

Neisseria meningitidis

What cancers stain positive for GFAP?

Neoplasms of glial origin Astrocytomas Ependymomas Oligodendrogliomas

Mycosis fungoides

Neoplastic proliferation of mature CD4+ T cells that infiltrate the skin, producing localized rash, plaques, and nodules

How does medullary thyroid cancer appear on histology?

Nests of polygonal cells with congo red positive deposits Medullary thyroid cancer is a neuroendocrine tumor that arise from parafollicular calcitonin-secreting C cells Amyloid deposits are derived from calcitonin secreted by the neoplastic C cells and stain with congo red

What are the side effects of ganciclovir?

Netropenia Anemia Thrombocytopenia

What organ is most likely to be affected in Hirschsprung disease?

Neural crest cell migration fails They migrate caudally, so the rectum is always affected

What teratogenic effect does valproate have?

Neural tube defects

What teratogenic effects does phenytoin have?

Neural tube defects, orofacial clefts, microcephaly, nail or digit hypoplasia

What are the clinical manifestations of Neonatal abstinence syndrome? Treatment?

Neuro: irritability, hypertonia, jittery movements, seizures (rare) GI: diarrhea, vomiting, feeding intoleracnce Autonomic: sweating, sneezing, pupillary dilation Treatment= opioid therapy (eg, morphine, methadone)

What is Rett syndrome?

Neurodevelopmental disorder that occurs mainly in girls Most due to de novo mutations in X-linked MECP2 gene Characterized by normal dev. until age 6-18 months, followed by loss of motor and language skills and the dev. of stereotypic hand movements Deceleration of head growth is classic Other features: seizures, intellectual disability, autistic features, and breathing abnormalities

What are loose, disorganized proliferations of Schwann cells, fibroblasts, and neurites?

Neurofibromas In Neurofibromatosis type 1 (Aut. Dom.) these involve nerve trunks within the skin and deeper tissues

What are the signs and symptoms of acute intermittent porphyria (AIP)?

Neurologic symptoms (eg, tingling, difficulty concentrating) Recurrent episodes of nonspecific abdominal pain and vomiting Reddish-brown urine

What are the clinical features of Fabry disease?

Neuropathic pain Angiokeratomas Telangiectasias Glomerular disease (eg, proteinuria) Cerebrovascular disease (eg, TIA, stroke) Cardiac disease (eg, left ventricular hypertrophy

How does diabetic CN III mononeuropathy present?

Neuropathy (unilateral CN III most common) Classically presents with acute onset diplopia On exam, eye assumes down and out position due to the unopposed pull by the superior (CN IV) and lateral rectus (CN VI) muscles because all other extraocular muscles (inferior oblique and superior, inferior, and medial recti) are supplied by CN III Ptosis also occurs due to paralysis of levator palpebrae Pupillary size and reactivity is normal

What is pufferfish poisoning?

Neurotoxin, tetrodotoxin, produced by microorganisms associated with the fish Binds to voltage gated Na+ channels in nerve and cardiac tissue, preventing sodium influx and depolarization

Who are pseudomonas infections common in?

Neutropenic patients Hospitalized patients Burns Indwelling catheters Diabetics? CF

What cells are increased in a cbc after corticosteroid use?

Neutrophil counts increase as a result of demargination of neutrophils previously attached to the vessel wall Neutrophil recruitment to fight infection in tissues is decreased, potentially contributing to increased infection risk

What enzyme is responsible for the green color of sputum in pneumonia?

Neutrophil myeloperoxidase

What is responsible for abscess formation?

Neutrophil recruitment and activation leading to the release of cytotoxic granules that kill bacteria but also cause liquefying necrosis of surrounding tissue

What does hyperacute lung transplant rejectio pathophys look like?

Neutrophilic infiltration with fibrinoid necrosis and thrombosis

To achieve rapid improvement of gout symptoms, which cells should be targeted?

Neutrophils NSAIDs to inhibit COX and exert broad anti-inflammatory effects that include inhibiting neutrophils

What cells play a major role in COPD?

Neutrophils Macrophages CD8+ T cells Secrete enzymes and proteases that cause and pepetuate both the alveolar destruction of emphysema and the mucus hypersecretion found in chronic bronchitis

What are the primary mediators of disease in COPD?

Neutrophils, macrophages, and CD8+ T cells Secrete enzymes and proteases

What is Pre-eclampsia?

New onset elevated BP at greater than or equal to 20 weeks gestation AND proteinuria OR signs of end-organ damage

What cholesterol drug can precipitate acute gouty arthritis?

Niacin Can decrease renal excretion of uric acid which precipitates this Decreases hepatic synthesis of TGs and VLDL and reduces clearance of HDL

Which drugs cause hyperglycemia?

Niacin Thiazide Corticosteroids Protease inhibitors Tacrolimus

What receptor once bound by acetylcholine, has an immediate change in transmembrane calcium, sodium, and potassium flow secondary to the opening of the receptor channel?

Nicotinic cholinergic receptor Results in an immediate influx of Na+ and Ca2+ into the cell and an outflux of K+ from the cell

Are bronchial epithelial cells producing keratin pearls anaplastic?

No

What drug is avoided in diabetes mellitus due to it covering symptoms of hypoglycemia?

Non selective beta blockers Exacerbate hypoglycemia and mask its symptoms mediated by NE and Epinephrine If beta blockers necessary, selective B1 antagonists should be used

What are the identifiers of shigella?

Non-motile, non-lactose fermenting organism that does not produce H2S when grown on triple sugar iron agar Mucosal invasion of the M cells that overlie Peyer's patches is an essential pathogenic mechanism for Shigella infection Shigella then escapes the phagosome and spreads laterally to other epithelial cells via actin polymerization

What are pancoast tumors?

Non-small cell lung cancers that arise near the superior sulcus May develop ipsilateral shoulder pain, upper limb paresthesias, and areflexic arm weakness due to involvement of the brachial plexus Horner's can also occur due to involvement of the cervical sympathetic ganglia

What is the MOA of rifaximin?

Nonabsorbable antibiotic that alters GI flora to decrease intestinal production and absorption of ammonia

What is Buspirone?

Nonbenzodiazepine anxiolytic used in the treatment of GAD (Takes 2 weeks to work) Not useful in treatment of acute anxiety due to its slow onset of action Lacks muscle relaxant or anticonvulsant properties, and carries no risk of dependence

What cardiac drugs can lead to diarrhea and syncopal symptoms?

Nondihydropyridine calcium channel blockers (eg, diltiazem, verapamil) Effects include constipation, bradycardia, AV bock, and worsening HF in patients with reduced left ventricular function

What type of virus is Parvovirus B19?

Nonenveloped ssDNA virus

What is required in order to be referred for hospice?

Survival prognosis of less than or equal to 6 months

What are common findings of seronegative spondyloarthropathies?

Symptoms of ReA generally manifest 1-4 weeks following a primary infection causing urethritis or enteritis and are caused by urethritis or enteritis and are caused by an autoimmune reaction initiated by the infecting pathogen. Skin findings include keratoderma blennorrhagicum and circinate balanitis Axial involvement, including sacroilitis, may occur in about 20% of cases

What is malignant hyperthermia?

Syndrome that occurs due to hypersensitivity of skeletal muscles to inhalation anesthetics (especially halothane) and muscle relaxant succinylcholine Susceptibility is inherited as an autosomal dominant trait In a majority of cases, it is related to a defect in the ryanodine receptors of sarcoplasmic reticulum Abnormally releases large amounts of Ca after exposure to anesthetic, this excess free Ca stimulates ATP dependent reuptake by SR, excessive consumption of ATP generates heat; loss of ATP along with high temp induces muscle damage

What does the combination of fixed segmental loss of upper extremity pain and temp sensations, upper extremity lower motor neuron signs, and/or lower extremity upper motor neuron signs in the setting of scoliosis suggest?

Syringomyelia

What is characterized by the abnormal proliferation of mast cells and increased histamine release?

Systemic mastocytosis Histamine causes hypersecretion of gastric acid by parietal cells in the stomach as well as a variety of other symptoms (eg, hypotension, flushing, pruritis)

What are the clinical features of Polyarteritis Nodosa?

Systemic: Fever, weight loss Skin: Nodules, livedo reticularis, ulcers, purpura Renal: HTN, Renal insufficiency, arterial aneurysms Nervous: Headache, seizures, mononeuritis multiplex GI: Mesenteric ischemia/infarction MSK: Myalgias, arthritis Other: MI, retinal ischemia, orchitis

What is the difference in immmune system components with superficial and disseminated candida infection?

T lymphocytes are important for prevention of superficial candida infection (conditions with low t-cell count like HIV increase the risk of superficial candidiasis) Neutrophils prevent the hematogenous spread of candida (more likely in patients who are neutropenic or otherwise immunocompromised and in those with inherited impairments of phagocytosis)

What is a complication of celiac disease?

T-cell lymphomas

What does Lowenstein Jenson stain for?

TB

What antidepressants have strong anticholinergic properties that can produce anticholinergic toxicity?

TCAs (particularly amitriptyline)

What attenuates the immune response?

TGF-beta IL-10

UTI prophylaxis

TMP-SMX (Bactrim)

What is thought to mediate paraneoplastic cachexia by suppressing appetite and increasing basal metabolic rate?

TNF alpha

What factors mediate sepsis?

TNF-alpha (mediates the shock) IL-1 IL-6 Fever Increased NO Lipid A (component of LPS) from bacteria (Gram negative) binds CD14 on macrophages and initiate sepsis

How do you calculate positive predictive value?

TP/[TP+FP]

What is a potential side effect of clopidogrel?

TTP (thrombotic thrombocytopenic purpura)

What cardiac defect is characterized by pulmonary stenosis, RV hypertrophy, overriding aorta, and VSD?

Tetralogy of Fallot In uncorrected defects- children typically squat during cyanotic episodes ("tet spells") to improve oxygenation It does this by increasing SVR and cardiac afterload, temporarily reducing right to left shunting by forcing more blood through the stenotic pulmonary artery

What type of T cells mediate granuloma formation?

Th1 cells

Why is the H flu serotybe b vaccine conjugated to tetanus toxoid protein or outer membrane protein of neisseria meningitidis?

The H flu part consists of a capsular polysaccharide Protein conjugation causes a T cell-mediated immune response leading to long-term immunity through production of memory B-lymphocytes

What are the 2 major side effects that can be caused by lamotrigine?

Stevens-Johnson sndrome and toxic epidermal necrolysis Characterized by flu-like symptoms followed by widespread mucocutaneous epidermal necrosis

Senna

Stimulant MOA: Enteric nerve stimulation--> colonic contraction Adverse Effects: Diarrhea, melanosis coli

What adverse effects are caused by selective arteriolar vasodilators (eg, hydralazine, minoxidil)?

Stimulate RAAS system resulting in sodium and fluid retention with peripheral edemal Also trigger reflex sympathetic stimulation of increasing heart rate, contractility, and CO (not just symp. stim of RAAS)

What antiretroviral drugs do not require activation via intracellular phosphorylation?

Nonnucleoside Reverse Transcriptase Inhibitors (NRTIs) More common ones include nevirapine and efavirenz

What amino acids compose the transmembrane domain of G protein-coupled receptors?

Nonpolar, hydrophobic amino acids (eg, alanine, valine, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine) These amino acids are arranged in an alpha-helical fashion and project their hydrophobic R groups outwardly, anchoring the transmembrane region of the protein to the hydrophobic core of the phospholipid bilayer May also play an important role in cellular signaling and transport

What is the first line treatment for essential tremmor?

Nonspecific beta-adrenergic antagonist propanolol Often inherited in autosomal dominant fashion

What infection control measures should be used with C diff infection?

Nonsterile gloves and gown

What is flutamide?

Nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors It is used in combination with long-acting gonadotropin-releasing hormone agonists for the treatment of prostate cancer

What tests are done for Treponema pallidum?

Nontreponemal tests (eg, rapid plasma reagin, VDRL) evaluate for anticardiolipin antibodies (nonspecific) Treponemal tests evaluate for antibodies targeted against T pallidum Positive nontreponemal requires diagnostic confirmation with treponemal serologic testing

What does PO2 (dissolved oxygen), % sat. of Hb, and total O2 content (both dissolved and O2 attached to Hb) look like for CO poisoning? Anemia (low Hb)? Polycythemia (high Hb)?

Normal PO2 Decreased % sat (competes with O2) Decreased total O2 Normal PO2 Normal % sat Decreased Total O2 content Normal PO2 Normal % Sat Increased Total O2

What does endometrial biopsy show in adenomyosis?

Normal appearing endometrial tissue

What is albinism?

Normal number of melanocytes but decreased melanin due to absent or defective tyrosinase

How do you distinguish absolute erythrocytosis from relative erythrocytosis?

Normal red blood cell mass indicates plasma volume contraction as the cause of polycythemia Increased RBC mass indicates absolute erythrocytosis

What is the Tx for DKA?

Normal saline and insulin These increase serum bicarb and sodium and decrease serum glucose, osmolality, and potassium

Where is metastatic calcification seen?

Normal tissue in the setting of hypercalcemia

How are intracellular and extracellular K+ levels affected in diabetic ketoacidosis?

Normal to increased serum K+ levels despite a total body potassium deficit (normal or Increased extracellular, decreased intracellular) Replacement of K+ is a cruical step in the management of patients with diabetic ketoacidosis

What lab findings are most likely seen with calcium stones?

Normocalcemia, hypercalciuria Idiopathic hypercalciuria is the most common cause of calcium kidney stone disease

What are some characteristics of multiple myeloma?

Normocytic and normochromic anemia Bone pain, pathologic fractures, and "punched out" lytic lesions on Xray Hypercalcemia Increased susceptibility to infection AL amyloid formation Renal failure

Which antihistamines are okay to use in elderly?

Not first generation Newer generation antihistamines (eg, loratadine, cetirizine) Second-generation too (less lipophilic, do not readily cross BBB and usually nonsedating)

Where is rRNA transcribed?

Nucleolus All ribosomal RNA except 5S rRNA is transcribed in the nucleus

Which group of drugs can cause body fat redistribution?

Nucleoside reverse transcriptase inhibitors (NRTIs) Protease inhibitors

Where is the locus ceruleus located?

Nucleus located in the posterior rostral pons near the lateral floor of the fourth ventricle Functions as the principal site of NE synthesis in the brain and projects to virtually all parts of the CNS

How can tricyclic antidepressants cause death?

OD can result in cardiac arrhythmias and refractory hypotension Inhibition of fast Na channels in cardiac myocytes (and the His-Purkinje system) is thought to be the major underlying cellular event

What are risk factors for gallstone formation?

Obesity, rapid weight loss, female sex, glucose intolerance, and hypomotility of gallbladder

What is the most common cause of acute appendicitis?

Obstruction of the lumen of the appendix Fecaliths (adults), hyperplastic lymphoid follicles (infants), foreign bodies, or tumors may cause the obstruction

How do germinomas present?

Obstructive hydrocephalus Doral midbrain (Parinaud) syndrome Germinomas in the suprasellar region cause endocrinopathies due to pituitary/hypothalamic dysfunction Most common pineal gland tumor

What is bronchiectasis?

Obstructive lung disorder Persistent bronchial dilation (irreversible) Cystic fibrosis is the number one cause of this because mucous plugs Sx: recurrent pulm infections in the same lobe

What are the characteristic manifestations of Wernicke syndrome?

Occulomotor dysfunction (resolves with thiamine) Ataxia (takes longer to resolve) Mental status changes (respond well to treatment) Memory and learning abnormalities usually persist as a condition caused Korsakoff syndrome

What can be seen in uncal herniation?

Occulomotor nerve palsy with a fixed dilated pupil (eg, due to preganglionic parasympathetic fiber damage)

What must you rule out in older men or postmenopausal women that are iron deficient?

Occult blood loss (eg, colon cancer))

What is Diphenoxylate?

Opioid antidiarrheal drug that binds mu opiate receptors in the gut to slow motility

What is the treatment for transient ischemic attack (TIA)?

Optimal blood pressure control Statin Low-dose aspirin- to prevent ischemic stroke

What enzyme deficiency presents with very high ammonia, poor feeding, lethargy, and seizures that results in an accumulation of carbamoyl phosphate, which is converted to orotic acid by the pyrimidine biosynthetic pathway, and low citrulline levels>?

Ornithine transcarbamylase deficiency

What is the deficiency in patients with discrete episodes of vomiting, tachypnea, and confusion/coma secondary to hyperammonemia?

Ornithine transcarbamylase deficiency (most common disorder of the urea cycle): characterized by hyperammonemia and elevated urinary orotic acid UMPS deficiency leads to orotic acid buildup too but NOT hyperammonemia- see megaloblastic anemia and delayed growth

What transport into mitochondria is necessary for proper function of the urea cycle?

Ornithine transport Major disposal pathway for waste nitrogen generated by catabolism of amino acids

painful red lesions on pads of fingers/toes

Osler nodes

What HTN medication can cause pulmonary edema?

Osmotic diuretics (eg, Mannitol) Use cautiously in high-risk patients, such as those with CHF or preexisting pulmonary edema

What is polyethylene glycol?

Osmotic laxative Diarrhea with lactase deficiency has similar pathophysiology

Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose

Osmotic laxatives MOA: Provide osmotic load to draw water into GI lumen Lactulose--> also treats hepatic encephalopathy because gut flora degrade it into metabolites (lactic acid, acetic acid) that promote nitrogen excretion as NH4 Adverse Effects: Diarrhea, dehydration; may be abused by bulimics

What do sclerotic lesions in the bone result from?

Osteoblasts, indicates more indolent course (Osteoblastic)

What do lucent lesions in the bone result from?

Osteoclasts, tend to repressent aggressive cancer (Osteolytic)

Long Term PPI use effects

Osteoporosis Can't absorb Mg, Iron, Ca, B12

Endotoxin Description

Outer cell membrane of most gram negative bacteria Not Secreted Lipid A component of LPS Genes from bacterial chromosomes Low adverse effects Clinical effects: fever, shock, DIC MOA: induce TNF, IL-1, IL-6 Poorly antigenic No toxoid formed and no vaccine Stable at 100 degrees celsius for 1 hour

Where is histoplasma seen on histology?

Oval or round yeasts within macrophages in disseminated infection

What cells are responsible for centriacinar emphysema?

Pathogenesis of smoking-induced emphysema involves oxidative injury to the respiratory bronchioles and activation of resident alveolar macrophages by components of cigarette smoke. This is followed by inflammatory recruitment of neutrophils into the affected airspaces. Activated macrophages and neutrophils release proteases, including elastase and others that degrade the extracellular matrix and also generate oxygen free radicals that impair the function of protease inhibitors (eg, alpha-1 antitrypsin). The resultant protease-antiprotease imbalance leads to acinar wall destruction and irreversible airspace dilation distal to the terminal bronchioles.

When does autosomal dominant polycystic kidney disease usually present?

Patients 40-50 years old Enlarged kidneys, HTN, and renal failure In newborns, kidneys are normal sized and cysts are too small to be detected on ultrasound As cysts enlarge, they compress the renal parenchyma and cause symptoms

When can tyramine-induced hypertensive crisis occur?

Patients taking MAO inhibitors who consume foods containing high amounts of tyramine

What happens in individuals with HLA haplotypes that cannot bind certain polypeptide fragments?

Patients will be unable to mount a T cell dependent (eg, IgG, cell mediated) immune response against these antigens

How can MS affect the bladder?

Patients with MS often develop a spastic bladder a few weeks after developing an acute lesion of the spinal cord Present clinically with increased urinary frequency and urge incontinence Urodynamic studies show the presence of bladder hypertonia

When are MAOIs particularly useful?

Patients with treatment-resistant major depressive disorder with atypical features Increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are hallmarks of the atypical subtype

What are the symptoms of Hartnup disease?

Pellagra-like skin eruptions Cerebellar ataxia (Can occur as a result of niacin deficiency) Diagnosis can be confirmed through detection of excessive amounts of neutral amino acids in the urine

Strep pneumoniae treatment

Penicillin/cephalosporin (systemic infection, pneumonia), vancomycin (meningitis)

How do you treat copper toxicity?

Penicillinamine or trientene

What pathway is G6PD part of?

Pentose Phosphate Pathway

What tissue would be involved in a vertical, midline incision made at the posterior vaginal opening through the vaginal and subvaginal mucosa?

Perineal body

What is Sheehan Syndrome?

Peripartum hypotension--> pituitary infarct-> pituitary dysfunction (panhypopituitarism) Commonly develop failure of lactation due to deficiency of prolactin

What do peripheral carotid bodies respond to?

Peripheral chemoreceptors found in the carotid and aortic bodies are the primary sites for sensing PaO2 and are stimulated by hypoxemia When supplemental oxygen is administered, the rapid increase in PaO2 can reduce peripheral chemoreceptor stimulation and decrease the respiratory rate

What does acute lung transplant rejection pathophys look like?

Perivascular (small lung vessels) and submucosal (bronchiole) lymphocytic infiltrates

What drug is used for lice?

Permethrin cream

What is the buildup of very long chain and branched chain fatty acids due to impaired oxidation a hallmark of?

Peroxismal disorders (eg, Zellweger syndrome, adrenoleukodystrophy) Accumulation of these FAs in the brain results in permanent neurologic dysfunction

Why doesnt axonal regeneration occur in the CNS?

Persistence of myelin debris Secretion of neuronal inhibitory factors Development of dense glial scarring

What is borderline personality disorder characterized by?

Persistent pattern of unstable relationships, mood lability, and impulsivity Patients may exhibit suicidal ideation or behavior in the context of an interpersonal crisis in which they feel rejected or abandoned

Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands and genitalia

Peutz Jegher

How do Corynebacterium diphtheriae acquire virulence to become pathogenic?

Phage conversion permitting exotoxin production

What is the treatment for pheochromocytoma?

Phenoxybenzamine (irreverisible alpha-antagonist)

What enzymes utilize BH4 in phenylalanine metabolism?

Phenylalanine hydroxylase and tyrosine hydroxylase PKU can be caused by BH4 deficiency and phenylalanine hydroxylase deficiency

What enzyme converts Norepinephrine to Epinephrine?

Phenylethanolamine-N-methyltransferase (PNMT) Cortisol increases the conversion of NE to E in the adrenal medulla by increasing PNMT expression

Tonic-clonic seizure treatment

Phenytoin, valproate, carbamazepine, and leviteracetam

What is increased in Lesch-Nyhan syndrome?

Phosphoribosyl pyrophosphate (PRPP) amidotransferase activity Due to purine synthesis increasing to replace lost bases (from failure of purine salvage pathway, leading to increased degradation of hypoxanthine and guanine to uric acid)

Does neostigmine or physostigmine penetrate the CNS?

Physostigmine Both are cholinesterase inhibitors that are used to treat anticholinergic toxicity (ex. atropine toxicity)

What are the complications of hereditary spherocytosis?

Pigmented gallstones Aplastic crises from parvovirus B19 infection

What neoplasm is most likely if it is a cystic tumor in the cerebellum of a child that is well-differentiated, comprised of spindle cells with hair-like glial processes, and are associated with microcysts?

Pilocytic astrocytoma These cells are mixed with Rosenthal fibers and granular eosinophilic bodies

What drugs are used to treat beta-lactamase producing Bacteroides species?

Pipercillin-tazobactam Also effective against most gram-negative enteric rods (including pseudomonas)

What is the management for Thrombotic thrombocytopenic purpura?

Plasma exchange Glucocorticoids Rituximab

How do vanc-resistant enterococcus develop their resistance?

Plasmid

What is the mechanism of resistance to extended-spectrum beta-lactamases?

Plasmid with drug resistance gene

What organism can be visualized using silver stain of respiratory secretions in pneumonia of an HIV patient?

Pneumocystis pneumonia (PCP) Fungal infection due to impaired cell mediated immunity

What 2 disorders affect just the LMN?

Polio Werdnig-Hoffman

What causes damage to anterior horn cells and leads to asymmetric flaccid paralysis and hyporeflexia with preserved sensation?

Poliomyelitis

What are the characteristics of DKA?

Polydipsia Polyuria Fruity odor to the breath and/or urine Associated with elevated anion gap metabolic acidosis that is usually accompanied by compensatory respiratory alkalosis Combination yields a low pH, low serum bicarbonate, and low PaCO2

What is giant cell arthritis often associated with?

Polymyalgia rheumatica Causes achy pain in the shoulder and hip girdles

What is the major virulence factor of H flu type b?

Polyribosylribitol phosphate A capsule component and major virulence factor for Hib

What glycogen storage disease is caused by a defective lysosomal enzyme?

Pompe disease Caused by acid alpha-glucosidase (acid maltase) deficiency and is characterized by hypertrophic cardiomyopathy, diffuse muscular weakness, and macroglossia

What does portal vein thrombosis cause?

Portal HTN, splenomegaly, and varicosities at portocaval anastomoses Does not cause histologic changes to the hepatic parenchyma Ascites is uncommon as the obstruction is presinusoidal

How does hemolytic disease of the newborn (erythroblastosis fetalis) present?

Positive direct Coombs test, profound anemia, jaundice (possibly leading to kernicterus), and generalized edema (hydrops fetalis due to accumulation of interstitial fluid). The severe anemia also stimulates release of immature, nucleated erythrocytes and leads to persistent extramedullary hematopoiesis in the liver, spleen, and other tissues (hepatosplenomegaly).

What coronary artery is compromised in rupture of the posteromedial papillary muscle?

Posterior Descending Artery

What vessel is most likely affected in an inferior MI?

Posterior Descending Artery (from Right Coronary Artery)

What lung region is most likely affected in aspiration while lying supine?

Posterior segment of the right upper lobe or superior segments of the lower lobes

Which muscles contain myoglobin-rich, glycogen-poor fibers with many mitochondria?

Postural skeletal muscles like the soleus and paraspinal Predominantly Type I slow twitch, red muscle fibers that derive ATP primarily from oxidative (aerobic metabolism)

What is given to prevent tissue damage in individuals exposed to radioactive material such as iodine-131 (131 I)?

Potassium iodide Inhibits thyroid uptake of radioactive iodine isotypes

Why are selective COX 2 inhibitors better for treating patients that also have peptic ulcer disease?

Potent anti-inflammatory effects with less risk of bleeding and gastrointestinal ulceration

What do amatoxins inhibit?

Potent inhibitors of RNA polymerase II (halting mRNA synthesis) Found in a variety of poisonous mushrooms (eg, Amanita phalloides, known as death cap)

What is an exaggerated sensitivity drug reaction?

Predictable reaction occurring at lower than expected exposure Eg, tinnitus after single aspirin dose

How do you treat Polyarteritis Nodosa?

Prednisone and cyclophosphamide ACE inhibitors for HTN

Where do nitrates have their effects?

Predominantly affect the large veins, where smooth muscle relaxation leads to venodilation and increased venous capacitance. Cardiac venous return (preload) is reduced, leading to reduction in left ventricular end-diastolic volume and pressure and a consequent decrease in left ventricular wall stress. Decreased myocardial oxygen demand leads to relief of anginal symptoms

What is congenital rubella syndrome?

Predominantly characterized by neonatal defects of the head (microcephaly, mental retardation), eyes (cataracts), ears (deafness), and heart/cardiovascular system (PDA, peripheral pulmonic stenosis)

Why does Amphotericin B have toxic effects?

Preferentially binds ergosterol in fungal membranes than for cholesterol in human cell membranes. However, it binds cholesterol to a degree, which explains a large number of its adverse effects.

What are the neonatal complications of diabetes during pregnancy?

Premature delivery Fetal macrosomia Congenital malformations Neural tube defects Cardiovascular anomalies Caudal regression syndrome Respiratory distress Transient hypoglycemia Polycythemia and hyperviscosity

What are the risks of secondhand smoke exposure?

Prematurity, low birth weight SIDS Middle ear disease (eg, otitis media) Asthma Respiratory tract infections (eg, bronchitis, pneumonia)

What is the best indicator of severity in mitral regurgitation (MR)?

Presence of an audible S3 Patients with severe mitral regurgitation develop left-sided volume overload with an S3 gallop due to the large volume of regurg. flow reentering the ventricle during mid-diastole Abscence of an S3 gallop excludes severe chronic MR

When do you see Anti HBc IgG?

Present in both acute and chronic infection Not present after vaccination

How do subarachnoid hemorrhages present?

Present with a generalized, excruciating headache Classically described by patients as "the worst headache of my life" Occur due to rupture of saccular (berry) aneurysms or arteriovenous malformations

What are a couple specific features of Graves disease?

Pretibial myxedema and graves ophthalmopathy Caused by an autoimmune response directed against TSH receptor that results in accumulation of glycosaminoglycans within the affected tissue

What are the side effects of PDE-5 inhibitors?

Priapism Hypotension Flushing Headache Blue tinted vision (cyanopia)

What is Phencyclidine (PCP)?

Primarily an N-methyl-D-aspartate receptor antagonist, with lesser effects on the reuptake inhibition of biogenic amines and other receptors Can have dissociative and anesthetic effects but may also cause psychosis and sever agitation, leading to violent trauma Ataxia, horizontal and vertical nystagmus, and memory loss can also be present

How does increased bone resorption in primary hyperparathyroidism look?

Primarily involves the cortical bone of the appendicular skeleton The cortical thinning appears radiologically as subperiosteal erosions More advanced disease can present as osteitis fibrosa cystica (ie, granular decalcification of the skull, osteolytic cysts, and brown tumors)

What is the pathogenesis of alcohol-induced hepatic steatosis?

Primarily related to a decrease in free fatty acid oxidation secondary to excess NADH production by the 2 major alcohol metabolism enzymes, alcohol dehydrogenase and aldehyde dehydrogenase

What lymph nodes drain distal to the anal dentate line?

Primarily the inguinal nodes, although some lymph can also reach the inferior mesenteric and internal iliac nodes

Where are the parietal cells located?

Primarily under the upper glandular layer of the gastric body and fundus (below the simple columnar epithelial cells)

Hyperpigmentation, hypotension, and fatigue

Primary adrenal insufficiency Addison's disease

How does an imperforate hymen present?

Primary amenorrhea and normal secondary sex characteristics with cyclic abdominal or pelvic pain due to accumulation of menstrual blood in the vagina and uterus (hematocolpos) The pressure from the resulting collection of blood can also cause back pain and difficulties with defecation

Where are anti-mitochondrial antibodies seen?

Primary biliary cirrhosis Typically presents with cholestatic symptoms (eg, pruritis, jaundice, malabsorption)

Antimitochondrial antibodies

Primary biliary cirrhosis (female, cholestasis, portal hypertension)

What do HFE protein mutations result in?

Primary hemochromatosis Inactivation of HFE protein results in decreased hepcidin synthesis by hepatocytes and increased DMT1 expression by enterocytes, leading to iron overload Increased risk for liver cirrhosis and hepatocellular carcinoma

HTN, hypokalemia, metabolic alkalosis

Primary hyperaldosteronism (Conn syndrome)

What is included in MEN type 1?

Primary hyperparathyroidism (hypercalcemia) Pituitary tumors (prolactin, visual defects) Pancreatic tumors (especially gastrinomas)

What is the diagnosis of a patient with severe fatigue, splenomegaly (often causing early satiety/abdominal discomfort), hepatomegaly, anemia, and bone marrow fibrosis?

Primary myeofibrosis JAK2 mutation

What is frontotemporal dementia associated with?

Pronounced atrophy of the prefrontal cortex with later degeneration of the anterior temporal cortex Manifests initially with changes in personality, social behavior, and language that progresses over time to more global dementia with obvious neurocognitive deficits

What stage of Meiosis is the oocyte arrested in before puberty?

Prophase of Meisosis I

What enzyme is deficient in propionic acidemia?

Propionyl-CoA carboxylase

What is released by vascular endothelial cells to inhibit platelet aggregation?

Prostacyclin

Which cancer metastasizes to bone and causes sclerotic bone lesions?

Prostate cancer

How do you treat heparin overdose?

Protamine sulfate

What are common bacterial virulence factors?

Protein A IgA Protease M Protein

What protein is activated by DAG and calcium in the IP3/DAG pathway?

Protein Kinase C

What cells are positive for synaptophysin?

Protein found in presynaptic vesicles of neurons, neuroendocrine, and neuroectodermal cells CNS tumors of neuronal origin frequently stain positively for synaptophysin on immunohistology

What is leptin?

Protein hormone produced by adipocytes in proportion to the quantity of fat stored Acts on arcuate nucleus of hypothalamus to inhibit production of neuropeptide Y (decreasing appetite) and stimulate production of alpha-MSH (increasing satiety) Mutations in the leptin gene or receptor result in hyperphagia and profound obesity

What test is the best to monitor the anticoagulation effect of warfarin?

Prothrombin time Due to factor VII effects

What type of gene is KRAS?

Proto-oncogene Often activated in tumor cells, thereby increasing the cellular response to mitogenic stimuli

What is the most likely cause of Direct Hernias?

Protrude through Hesselbach's triangle which is formed by the inguinal ligament inferiorly, inferior epigastric vessels laterally, and the rectus abdominus medially. Transversalis fascia forms the floor of the triangle, and defects or weakness involving it can lead to protrusion of abdominal contents through Hesselbach's triangle into the inguinal canal More common in elderly and men

Where does a majority of water get reabsorbed in the nephron?

Proximal tubule

What is the morphology of candida?

Pseudohyphae with blastoconidia?

What do white-yellow plaques composed of fibrin, inflammatory cells, and cellular debris on colonic mucosa signify?

Pseudomembranous colitis

What organism is the most common cause of diabetic osteomyelitis?

Pseudomonas

Patient with red painful eye, photophobia, "sand in eyes" feeling, which gram neg bacteria and what is complication?

Pseudomonas Keratitis

What are the causes of otitis externa causes?

Pseudomonas Swimmers ear or elderly person with hearing aids Can become malignant in diabetes

What infection is the major pathogen in burn patients?

Pseudomonas Aeruginosa

What is a common cause of urinary tract infections with indwelling bladder catheters that is oxidase-positive, non-lactose-fermenting, G-?

Pseudomonas aeruginosa`

What are the key features of ovarian mucinous cystadenocarcinoma?

Pseudomyxoma peritonei Mucin-producing epithelial cells Malignant

What is characterized by hyperparakeratosis, acanthosis, rete ridge elongation, mitotic acctivity above the epidermal basal cell layer, and a reduced or absent stratum granulosum?

Psoriasis Neutrophils may form spongiotic clusters in the superficial dermis and the parakeratotic stratum corneum (Munro microabscesses)

What are the common complications of psoriasis?

Psoriatic arthritis Nail pitting Uveitis

What are the causes of erectile dysfunction?

Psychogenic stressors Performance anxiety or depression Medications (SSRIs, sympathetic blockers) Vascular or neurologic impairment Genitourinary trauma (eg, prostatectomy)

What is the first line treatment for narcolepsy?

Psychostimulants (eg, modafinil) for daytime sleepiness

What nerve injury leads to weakness of the perineal musculature causing fecal and urinary incontinence, perineal pain, and sexual dysfunction?

Pudendal nerve Stretch injury of this nerve may occur due to stress placed on the pelvic floor during labor

What can develop with prolonged, untreated obstructive sleep apnea?

Pulmonary HTN RHF

What can cause an accentuated pulmonary component of the second heart sound and signs of right sided heart failure due to cor pulmonale in CREST syndrome?

Pulmonary HTN from damage to the pulmonary arterioles Get intimal thickening of pulmonary arterioles

What can sildenafil be used for in the lungs?

Pulmonary hypertension

What cofactor is commonly used in transamination and decarboxylation reactions?

Pyridoxal phosphate (vitamin B6) Transamination reactions typically occur between an amino acid and an alpha-keto acid The amino group from the amino acid is transferred to the alpha-keto acid, and the alpha-keto acid in turn becomes an amino acid

What vitamin is necessary for transamination and decarboxylation reactions of amino acids, for gluconeogenesis, and for other essential biochemical processes?

Pyridoxine (vitamin B6)

What test has largely replaced bacitracin sensitivity with Strep pyogenes?

Pyrrolidonyl arylamidase (PYR) test Is PYR positive

During hypoxic conditions, intracellular accumulation NADH inhibits what?

Pyruvate dehydrogenase As a result, increased pyruvate are converted to lactate by lactate dehydrogenase Ex. with acute mesenteric ischemia

What are the side effects of fluoroquinolones?

QT prolongation GI upset Tendon rupture

What is abnormal bleeding in a patient with uremia due to?

Qualitative platelet disorder that causes prolonged bleeding time with normal platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT)

How do you treat Buerger's?

Quit smoking

What are the different cardiac pressures?

RA- <5 RV- 25/5 Pulm arteries- 25/10 LA- <12 LV- 130/10 Aorta- 130/90

How do you calculate renal blood flow (RBF)?

RBF= RPF/(1-Hct) RPF= PAH clearance= (urine[PAH] x urine flow rate)/ plasma [PAH]

What vessel is most likely infarcted in an MI with ST elevations in II, III, and aVF?

RCA Ischemic injury to inferior wall of the heart- posteroinferior wall of left ventricle is supplied by the Posterior descending branch of RCA

What is the mutation for MEN2A/2B?

RET

What mutation is found in medullary thyroid cancer and pheochromocytoma?

RET

What mutation causes Hirschsprung?

RET mutation

"Tram-track" appearance of capillary loops of glomerular basement membranes on light microscopy

RPGN

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

Rabies (Negri bodies)

What nerve is responsible for sensory innervation of the posterior arm, forearm, and dorsal lateral hand as well as motor innervation to all of the extensor muscles of the upper limb below the shoulder?

Radial nerve Damage to the proximal radial nerve (eg, at the axilla or midshaft humerus) may result in wrist drop

What nerve can be injured with repetitive pressure/trauma at the axilla?

Radial nerve Findings: weakness of forearm, hand and finger extensors Sensory loss over posterior arm and forearm, dorsolateral hand, and dorsal thumb More distal lesions spare the triceps brachii

What nerve can be damaged with repetitive pressure/trauma at the axilla (eg, improperly fitted crutches)?

Radial nerve Findings: weakness of the forearm, hand, and fingers extensors (eg, wrist drop, absent triceps reflex), and sensory loss over the posterior arm and forearm, dorsolateral hand, and dorsal thumb More distal lesions spare the triceps brachii

An increase in what causes increased expiratory flow rates in interstitial lung disease?

Radial traction (outward pulling) on the airways, leading to increased expiratory flow rates when corrected for the low lung volume Fibrosis causes the high radial traction

Where are serotonergic neurons found?

Raphe nuclei of the brainstem

What is subacute sclerosing panencephalitis?

Rare complication of measles infection that occurs several years after apparent recovery from initial infection Oligoclonal bands of measles virus antibodies are found in the cerebrospinal fluid of these patients

What is pure red cell aplasia?

Rare form of marrow failure characterized by severe hypoplasia of marrow erythroid elements in the setting of normal granulopoiesis and thrombopoiesis Associated with thymoma, lymphocytic leukemias, and parvovirus B19 infection

What is Whipple disease?

Rare systemic illness that involves the small intestine, joints, and CNS Caused by G+ actinomycete Tropheryma whippelii Classic histo: small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase-resistant granules

What are the symptoms of hypoglycemia?

Whipple's triad Symptoms of hypoglycemia (eg, tremor, diaphoresis, confusion) Low blood glucose level Relief of hypoglycemic symptoms when the blood glucose level is increased

What happens to ACTH and Cortisol after a high-dose dexamethazone test with an ectopic source of ACTH?

There is no change

What supplementation can help improve maple syrup urine disease (MSUD)?

Thiamine

What diuretics are indicated in patients with nephrolithiasis secondary to hypeercalciuria and contraindicated in hypercalcemia?

Thiazide diuretics

What drug interactions are there with lithium?

Thiazide diuretics NSAIDs (not aspirin) ACE inhibitors Tetracyclines, metronidazole

Which portions of the nephron contain the most dilute fluid?

Thick ascending loop of henle Distal convoluted tubule

What does the major virulence factor of strep pneumoniae do?

Thick polysaccharide capsule that encases the organism and prevents phagocytosis and complement binding

How do you diagnose babesiosis?

Thin blood smear (Wright/Giemsa stains): intraerythrocytic pleomorphic ring forms (occassional "maltese crosses")

How do you prevent cyanide toxicity with nitroprussides?

Thiosulfate If gets it, treat with methylene blue

What is the diagnosis in compression of the lower trunk of the brachial plexus in the scalene triangle, the space bordered by the anterior and middle scalene muscels and the first rib that presents with upper extremity numbness, tingling, and weakness?

Thoracic outlet syndrome

The administration of what substance can bypass thymidylate synthase to inhibit apoptosis in folate-deficient cells?

Thymidine

Which hormone has a zinc-finger structure?

Thyroid hormone

What junctions form the blood brain barrier?

Tight junctions between nonfenestrated capillary endothelial cells that prevent the paracellular passage of fluid and solutes

What mechanism is responsible for rapid recovery from anesthesia with highly lipophilic anesthetics?

Tissue redistribution of the drug (subsequently to organs receiving less blood flow- explaining their short duration of action) Quickly accumulates in tissues receiving high blood flow; this accounts for their rapid onset of action

What is the topical treatment of psoriasis?

Topical vitamin D analogs (calcipotriene, calcitriol, and tacalcitol) Bind vit D receptor and inhibit keratinocyte proliferation and stimulate keratinocyte differentiation

What do Irinotecan and topotecan inhibit?

Topoisomerase I (an enzyme that induces single strand breaks in DNA to relieve negative supercoiling during replication)

What is the target of Etoposide?

Topoisomerase II

How do you calculate the total filtration rate of a substance and the net excretion rate of a substance?

Total Filtration Rate= (inulin clearance)(plasma concentration of substance) Net Excretion Rate= (Inulin clearance)(plasma concentration)-(tubular reabsorption of substance)

What is decreased at peak stress during exercise?

Total systemic vascular resistence

What infections do you see blueberry muffin rash in?

Toxo Rubella CMV

What is the cause of multiple ring enhancing lesions in brain of an HIV patient?

Toxoplasma

What molecule contains chemically modified bases (eg, dihydrouridine, ribothymidine, pseudouridine) and has a CCA sequence at its 3' end?

Transfer RNA (tRNA) CCA sequence is used as a recognition sequence by proteins- 3' terminal hydroxyl group of the CCA tail serves as the amino acid binding site

What is the name of the unconscious shifting of emotions or desires associated with a person from the past to another person in the present?

Transference

What substance is critical for fibroblast migration, proliferation, and connective tissue synthesis?

Transforming growth factor-beta (TGF-beta) Increased TGF-beta is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver, and kidney that occur with chronic inflammation

What enzyme is responsible for the conversion of fructose-6-phosphate to ribose-5-phosphate?

Transketolase and Transaldolase

What genes are affected in Acute Promyelocytic Leukemia (APML)?

Translocation involving the retinoic acid receptor alpha (RARA) gene from chromosome 17 and the promyelocytic leukemia (PML) gene on chromosome 15 Leads to a fusion gene whose product inhibits differentiation of myeloblasts and triggers the development of APML

Absent expression of platelet endothelial cell adhesion molecule 1 (PECAM-1) gene will most likely affect which neutrophil function?

Transmigration

What is congenital toxoplasmosis?

Transplacental infection (acquired in utero) Classic triad includes hydrocephalus, intracranial calcifications and chorioretinitis Expecting mother should avoid cat feces to help prevent exposure to Toxoplasma

Porin function

Transport across outer membrane

What can expanding space occupying lesions within the temporal lbe cause?

Transtentorial herniation of the uncus due to elevated intracranial pressure

Incision of what structure improves carpal tunnel symptoms?

Transverse carpal ligament (aka flexor retinaculum)

What is ethacrynic acid good for?

Treat hypertension in patients with sulfa allergies

What are the indications of Clozapine treatment?

Treatment resistant schizophrenia Schizophrenia associated with suicidality

What treatment of vitamin B12 deficiency can actually worsen neruologic dysfunction?

Treatment with folate alone!

What is serotonin syndrome?

Triad: Autonomic instability (eg, hyperthermia, HTN, tachycardia) Altered mental status (eg, agitation, confusion) Neuromuscular hyperactivity (eg, tremor, hyperreflexia, myoclonus) As well as GI symptoms and diaphoresis Due to increased serotonergic effect in the central nervous system, possibly through increased serotonin effect on 5-HT1A and 5-HT2A receptors

What depression medication has anticholinergic, antihistaminic, and alpha adrenergic antagonist effects that can also affect cardiac conduction?

Tricyclic antidepressants (ex. amitriptyline)

migratory thrombophlebitis

Trousseau's sign of Pancreatic adenocarcinoma

Where in the respiratory tract is stratified squamous epithelium found?

True vocal cords Undergo near constant friction and abrasion due to speech Stratified squamous is protective, as deeper cells can replace surface cells that are damaged

What urinary level can be measured to diagnose pancreatitis?

Trypsinogen

What amino acid is the precursor of the neurotransmitter causing serotonin syndrome?

Tryptophan

How does the lepromin skin test appear in tuberculoid and lepromatous leprosy?

Tuberculoid- indurated nodule Lepromatous- nonreactive

What do most patients with ATN show on histology after time?

Tubular re-epithelialization and regain renal function When ATN is associated with multiorgan failure, renal function may be permanently impaired (foci of interstitial scarring can be seen on light microscopy)

What type of gene is TP53?

Tumor suppressor gene Produces p53, which inhibits proliferation of cells with genetic abnormalities

Streak ovaries

Turner's syndrome

What statistical method can be used to compare the mean of two different groups?

Twp sample t test

What type of collagen is found in mature scars?

Type 1 collagen

What interferons are produced by most human cells in response to viral infections?

Type I interferons (alpha and beta) These cause decreased protein synthesis by infected cells

What is acute serum sickness?

Type III hypersensitivity caused by tissue deposition of circulating immune complexes The most common manifestations include fever, pruritic skin rash, and arthralgias that begin 7-14 days after exposure to an antigen Lymphadenopathy and proteinuria may also occur in some patients

How does Zollinger-Ellison Syndrome present?

Typically experience abdominal pain and acid reflux May also have diarrhea Ulcers are often refractory to therapy

How does acute hepatitis A present?

Typically presents acutely with prodromal symptoms (eg, fever, malaise, anorexia, nausea/vomiting, right upper quadrant pain) followed by signs of cholestasis (eg, jaundice, pruritus, dark-colored urine, clay-colored stool) shows spotty hepatocyte necrosis and inflammatory cell infiltration on biopsy

How are PTH, phosphorous, and calcium affected in osteoporosis?

Typically unaffected!

What amino acid is essential in Phenylketonuria?

Tyrosine

What enzyme is involved in degradation and attachment of viral proteins on MHCI that are then expressed on the cell surface for presentation to cytotoxic CD8+ lymphocytes?

Ubiquitin ligase This is done through the ubiquitin proteasome pathway which is essential for breakdown of intracellular proteins, both native and foreign, and helps recycle them into the amino acid building blocks.

How does haemophilus ducrei?

Ulcer with grey base and raised edges

What is the diagnosis with an endoscopy revealing erythematous, edematous, friable, and granular mucosa that begins at the anal verge and extends proximally?

Ulcerative colitis Characterized by loose and bloody stools Neutrophils accumulate in the crypt lumina causing crypt abscesses microscopically Inflammation is classically limited to the mucosa

What does clinical improvement after edrophonium administration indicate in patients with myasthenia gravis?

Undertreatment Increase dose of long-acting acetylcholinesterase inhibitors (eg, pyridostigmine)

What is the histopathology of a carcinoid tumor?

Uniform cells in shape and size of cells that comprise islands Eosinophilic cytoplasm and oval-to-round stippled nuclei Neuroendocrine cells Dense core granules seen on electron microscopy

What is an idiosyncratic drug reaction?

Unpredictable reaction in certain patients Eg, Nonimmune hemolytic anemia with primaquine in G6PD deficiency

What is an immunologic (drug allergy) drug reaction?

Unpredictable, specific immunologic reaction Eg, Rapid urticaria/anaphylaxis (Type 1), Drug-induced hemlysis (Type II), serum sickness (Type III), and contact dermatitis (Type IV)

What are common findings of acute cholecystitis caused by gall stones?

Upper abdominal pain Fever Murphy's sign Serum Alk Phos. Elevated **Failed gallbladder visualization on radionuclide biliary scan

What is the triad for reactive arthritis?

Urethritis, conjunctivitis, and mono- or oligoarticular arthritis See this and think of chlamydia

What substance is measured in carcinoid syndrome?

Urinary 5-hydroxyindoleacetic acid (5-HIAA) Product of serotonin metabolism

What side effects are seen in SGLT2 inhibitors?

Urinary tract and genital mycotic infetions due to glucosuria Increased osmotic diuresis can also cause symptomatic hypotension in some patients (particularly the elderly and individuals on diuretics) Should be avoided in patients with moderate-to-severe renal impairment due to lack of efficacy and increased risk of adverse effects (renal function should be assessed before and after therapy)

How do vasopressin and desmopressin affect urine output?

Urine output decreases and urine osmolality increases ADH Analog- cause a V2 receptor mediated increase in water and urea permeability at the inner medullary collecting duct The resulting rise in urea reabsorption (decreased urea clearance) enhances the medullary osmotic gradient, allowing the production of maximally concentrated urine

What cells are directly responsible for synthesizing the fibrous cap in atheromas?

Vascular Smooth Muscle Cells (VSMCs) Only cells in atherosclerotic plaque capable of synthesizing structurally important collagen isoforms and other matriz components

What is a cavernous hemangioma?

Vascular malformations that most commonly occur within the brain parenchyma above the cerebellar tentorium. They consist of clusters of dilated, thin-walled capillaries with little or no intervening nervous tissue. Patients with cavernous hemangiomas often have seizures and may develop progressive neurologic defects due to mass effect with interruption of the cerebral microcirculation. These lesions also have a tendency to bleed, which can contribute to neuro symptoms and appear as an irregular hyperdense/bright mass on head CT. At risk for intracerebral hemorrhage

What does loss of nocturnal erections indicate?

Vascular or neurologic disease (not seen with psychogenic impotence)

How does chronic transplant rejection look on biopsy?

Vascular wall thickening and luminal narrowing (Obliterative vascular necrosis) Interstitial fibrosis and parenchyma atrophy

What is Kawasaki disease?

Vasculitis of medium-sized arteries that affects young children (usually <5 y.o.) Most commonly in patients of Asian ethnicity Diagnosis based on a fever for > or equal to 5 days plus 4 of the following: Bilat. non-exudative conjunctival injection Cervical LAD Mucositis: erythemia of palatine mucosa, fissured erythematous lips, strawberry tongue Extremity changes: edema of hands and feet, erythema of palms and soles, desquamation of fingertips Rash: polymorphous (usually urticarial) erythematous rash on extremities that spreads centripetally to the trunk Serious complication= coronary artery inflammation leading to dev. of coronary artery aneurysms (give low dose aspirin to prevent rupture)

What is cutaneous small vessel vasculitis?

Vasculitis that only affects the skin and typically arises due to drug or pathogen exposure (eg, hepatitis B or C virus) Drugs known to cause this include penicillins, cephalosporins, sulfonamides, phenytoin, and allopurinol On skin exam- nonblanching palpable purpura is usally present and often involves lower extremities Biopsy- skin lesions histologically demonstrate markedly inflamed small blood vessels with fibrinoid necrosis and a predominance of neutrophils and fragmented neutrophilic nuclei (leukocytoclastic vasculitis), with mononuclear cells predominating in older lesions

Why is epoprostenol sometimes used in the treatment of pulmonary hypertension?

Vasodilates and inhibits platelet aggregation Works on PGI2

What can neoplastic lesions of the CNS promote by disrupting the BBB?

Vasogenic edema Increased vascular leakage into the cerebral interstitium contributes to elevated intracranial pressure, which typically presents with headache, nausea/vomiting, and papilledema

What is a major cause of morbidity and mortality in patients recovering from subarachnoid hemorrhage (SAH)?

Vasospasm 4-12 days after the initial insult Nimodipine, a selective calcium channel blocker, is often prescribed to prevent this vasospasm

What are the 3 major apertures of the diaphragm?

Vena caval foramen (caval opening): contains IVC Aortic hiatus: contains aorta, thoracic duct, and azygos vein Esophageal hiatus: contains esophagus and anterior and posterior trunks of the vagus nerve

What hemodynamics changes are seen with nitroglycerin use?

Venodilation with a decreas in left ventricular end diastolic volume and wall stress, resulting in decreased myocardial oxygen demand and relief of angina symptoms

Damage to what nuclei leads to complete contralateral sensory loss (eg, touch, pain/temp, vibration/proprioception)?

Ventral posterior lateral nucleus (receives input from the spinothalamic tract and dorsal columns) Ventral posterior medial nucleus (receives input from the trigeminal pathway) of the thalamus send somatosensory projections to the cortex via thalamocortical fibers

Where is dopamine produced?

Ventral tegmental area dns ubstantia nigra pars compacta located in the midbrain

What is the number one cause of death in 24 hrs post MI?

Ventricular arrhythmia

What is the most common COD after acute MI?

Ventricular fibrillation Related to electrical instability in the ischemic myocardium

What are the features of a third heart sound (S3)?

Ventricular gallop sound (after S2) Heard during rapid passive filling of ventricles in diastole Sudden cessation of filling as ventricle reaches its elastic limit Normal: Age <40 Pregnancy Abnormal/associated conditions: Systolic HF Mitral regurg. High-output states

Which hypothalamic nuclei mediates satiety?

Ventromedial Destruction leads to hyperphagia

What abnormalities are associated with VACTERL Syndrome?

Vertebral anomalies Anorectal anomalies Cardiac anomalies TEF Esophageal atresia Renal issues (dev.) Limb defects

What is the most likely predisposing factor for pyelonephritis?

Vesicoureteral urine reflux

How does the sympathetic nervous system regulate visceral function?

Via 2-neuron signal transmission involving cholinergic preganglionic neurons and adrenergic postganglionic neurons Eccrine sweat glands and the adrenal medullae are exceptions to this rule as they are both innervated by cholinergic neurons Parasympathetic uses both pre and post ganglionic cholinergic

What are the clinical features of PCP (phencyclidine)?

Violent behavior Dissociation Hallucinations Amnesia Nystagmus (horizontal or vertical) Ataxia

What infections are commonly seen in patients with profound and prolonged neutropenia?

Viral and Fungal infections Most common fungal causes= Aspergillus and Candida

What is the number one cause of pericarditis?

Viral infection

What do the parallel chains (serpentine cords) under microscopy of Mycobacterium tuberculosis correlate with?

Virulence Serpentine cords due to the presence of cord factor, a surface glycolipid, on the cell wall

What type of viruses are capable of genetic shifts through reassortment?

Viruses with segmented genomes (eg, BOAR= Bunyavirus, Orthamyxovirus, Arenavirus, and Reovirus)

Which vitamin excess can cause pseudotumor cerebri?

Vitamin A

What vitamin deficiency can be beneficial in the treatment of measles?

Vitamin A Reduces comorbidities, recovery time, and length of hospital stay

How is Vitamin A related to squamos metaplasia?

Vitamin A normally maintains orderly differentiation of specialized epithelia, including the mucus-secreting columnar epithelia of the ocular conjunctiva, respiratory and urinary tracts, and pancreatic and other exocrine ducts Avitaminosis A can cause squamos metaplasia of such epithelia to a keratinizing epithelium

What vitamin problem is associated with intracranial hypertension, skin changes, and hepatosplenomegaly?

Vitamin A overuse

What vitamin deficiency shows hypersegmented neutrophils?

Vitamin B12

In malabsorption caused by celiac disease, what lab findings are seen?

Vitamin D deficiency Decreased serum phosphorous Increased serum PTH (secondary hyperparathyroidism), and low (or normal) serum calcium

How can neural tube defects be prevented in pregnancy?

Vitamin supplementation (folate (B9))

What condition is characterized by partial or complete loss of epidermal melanocytes?

Vitiligo Age of onset varies, but most afflicted individuals will have developed lesions by the second or third decade of life Pathogenesis of unclear

What is the diagnosis in patients presenting with hepatomegaly, lactic acidosis, and fasting hypoglycemia that does not improve with fructose or galactose administration?

Von Gierke disease Glucose 6 phosphatase deficiency which impairs the release of free glucose generated through glycogenolysis and gluconeogenesis

What is angiodysplasia associated with?

Von Wildebrand disease, aortic stenosis Ex. older patient with systolic murmor, crescendo decrescendo, right second intercostal space as well as bloody stools

What are the B and T-cell immune disorders?

WASH Wiskott aldrich (WATER) Ataxia telangectasia SCID Hyper-IgM

What is the mnemonic for CYP450 dependent drugs?

WEPTD Warfarin Estrogen (OCPs) Phenytoin Theophylline Digoxin

"Delta wave" on EKG, short PR interval, supraventricular tachycardia

WPW (Bundle of Kent)

How do you treat psychogenic polydipsia?

Water restriction

How does an injury to the radial nerve present?

Weakness during finger and thumb extension ("finger drop") without wrist drop or sensory deficits Injury during passage through the supinator canal may occur due to repetitive pronation/supination of the forearm, direct trauma, or subluxation of the radius

What does an injury to the spinal accessory nerve result in?

Weakness of the trapezius muscle, which presents with drooping of the shoulder, impaired abduction of the arm above horizontal (due to weakness in rotating the glenoid upward), and winging of the scapula

What are the clinical manifestations of typhoid fever?

Week 1: rising fever, bacteremia, relative bradycardia (pulse-temp dissociation) Week 2: Abdominal pain, rose spots on trunk and abdomen Week 3: HSM, intestinal bleeding and perforation

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Wegner's and Goodpasture's

Common causes of viral meningitis?

West Nile HIV HSV2 Coxackie (enterovirus)

How are GFR and creatinine related?

When GFR is normal, relatively large decreases in GFR result in only small increases in serum creatinine Conversely, when the GFR is significantly decreased, small decrements in GFR produce relatively large changes in serum creatinine Good rule of thumb is that every time GFR halves, serum creatinine doubles

What is linkage disequilibrium?

When a pair of alleles are inherited together in the same gamete (haplotype) more often or less often than would be expected given random pairing Often occurs when the genes are in close physical proximity on the same chromosome

What is a gall stone ileus?

When a stone is stuck in a fistula between the gall bladder and the GI tract?

When is Ras active?

When bound to GTP

What is permissiveness?

When one hormone allows another to exert its maximal effect Ex. cortisol exerts its potentiating effect in part through upregulation of alpha-1 adrenergic receptors on vascular smooth muscle cells

What is the description of the osmotic fragility on acidified glycerol lysis test with HS?

When the RBCs are incubated in a hypotonic solution with glycerol, hemoglobin is released

When can intestinal carcinoid tumors cause carcinoid syndrome?

When the metastasize to the liver If they don't, the secretory products will be metabolized by the liver before entering the systemic circulation

What is atopic dermatitis?

aka eczema, is a chronic inflammatory skin disorder common in children Typically presents in infants and young children as erythematous papules and plaques involving the face, scalp, trunk, and extensor surfaces. Diaper area is usually spared In older children and adults, it often manifests as lichenification in a flexural distribution Chronic course marked by exacerbations and remissions, severity tends to lessen with age Intense pruritus is a hallmark Associated with a family history of atopy and at risk of dev. other atopic diseases, such as allergic rhinitis and asthma (allergic triad)

Ejection click

aortic stenosis

What are the receptors for Gs?

betas D1 H1 B2

What is temperomandibular disorder (TMD) characterized by?

characterized by a constellation of symptoms that may include unilateral facial pain that worsens with jaw movement, headache, and ear discomfort Can originate from TMJ derangement, pathologic contraction of the muscles of mastication, and/or hypersensitivity of the nerves that supply the jaw

What are 3 different methods to detect legionella?

charcoal yeast with cysteine and iron silver stain presence of antigen in urine (most accurate method)

What bug is associated with parrots and birds?

chlamydia psitaccii

Strep bovis bacteremia- check for?

colon cancer

Peyronie's disease

curvature of the penis due to fibrous tissue deposits around the corpora cavernosa

What drugs are used for olid tumors and leukemias?

cyclophosphamide Vincristine/Vinblastine Etoposide/teniposide

What are the symptoms of hemochromatosis?

diabetes cirrhosis bronzing of the skin dilated cardiomyopathy pseudogout

Chlamydia treatment

doxycycline or azithromycin

What type of virus is adenovirus?

dsDNA Utilize DNA dependent DNA polymerase to replicate their genomes

Umbilical pain, 16 y.o. F, what should be ruled out first?

ectopic pregnancy

What can PCOS lead to?

endometrial hyperplasia, endometrial carcinoma, infertility and early pregnancy loss

What is sarcoidosis associated with?

eruthema nodosum, anterior uveitis, myositis, arthritis, constitutional symptoms

What causes Zollinger-Ellison syndrome?

gastrinoma either in duodenum or pancreas

What is the name of the feeling of something in your throat?

globus sensation

What type of protein is fibrillin?

glycoprotein

What polyprotein is cleaved in the golgi in viral HIV infection?

gp160--> gp120 (mediates viral attachment) gp41 (mediates viral fusion)

Why can there be hypothyroid symptoms with testicular germ cell tumors or gestational trophoblastic disease?

hCG has a similar structure to TSH These diseases may develop very high serum hCG concentrations, which can stimulate TSH receptors and cause paraneoplastic hyperthyroidism

What are the side effects of isoniazid?

hepatotoxicity, peripheral neuropathy (d/t B12 deficiency)

Why is tazobactam added to piperacillin?

inhibit beta lactamase (prevent inactivation of penicillin class drugs)

How does probenecid work?

inhibits the reabsorbtion of urate from the PCT → ↑ uric acid excretion

What four organs can be affected by coccidiomycoses?

lungs brain skin bone

What process do tetracyclines directly affect?

mRNA genetic code reading Target 30S ribosomal subunit

Which malaria has neuro symptoms (brain occlusions specifically)?

malaria falcipirum

How do you treat methemoglobinemia?

methylene blue and vitamin C

Opening snap

mitral stenosis

What is the MOA of naltrexone?

mu-opioid receptor antagonist Blocks the rewarding and reinforcing effects of alcohol Has been shown to reduce the craving for alcohol

What is interferon beta used to treat?

multiple sclerosis

What effects does significant hypokalemia have?

muscle weakness cramps possible rhabdomyolysis

What is c-myc?

nuclear regulator that activates multiple genes necessary for promotion of growth (Transcription activator)

What are howell jolly bodies?

nuclear remnants of the RBCs which are generally removed by a functional spleen; therefore, presence in a peripheral smear suggests functional asplenia in sickle cell pts

What are c-Jun and c-Fos?

nuclear transcription factors Directly bind DNA via a leucine zipper motif Identify using Southwestern blots

What kind of damage is common with urea cycle defects?

nuerologic damage due to accumulation of ammonia

What are Heinz bodies?

oxidized hemoglobin precipiated within RBCs

ANCA

p-ANCA - Churg Strauss + microscopic polyangiitis, - anti-*myeloperoxidase / MPO* p-ANCA - primary sclerosing cholangitis (ulc colitis) c-ANCA - Wegener granulomatosis - anti*proteinase-3 / AP3*

What gene has decreased activity in many tumors?

p53 (tumor suppressor gene that controls cell division and apoptosis)

What is the immunochemistry for complete moles?

p57-negative

What is the immunochemistry for partial moles?

p57-positive

What are some drugs that can cause a serum sickness like reaction?

penicillin cefaclor TMP-SMX

Strep bovis treatment

penicillin for prophylaxis

What is sevelamer?

phosphate-binding medication Prevents absorption of phosphate in the GI tract Use for hyperphosphatemia due to kidney failure

What are the side effects of amiodarone?

pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism, corneal deposits, photosensitivity, neurologic effects, constipation, cardiovascular effects, blye/grey skin deposits resulting in photodermatitis

Call-Exner bodies

small follicles filled with eosinophilic secretion diagnostic feature of granulosa cell tumor

How does octreotide treat variceal bleeding?

splanchnic vasodilation

What 3 bugs do you think with IV catheters?

staph aureus and epidermidis Enterobacter

What does FTA-ABS stain for?

syphilis

What translocation is seen in the M3 variant of AML, or APML?

t(15,17) See Auer rods here

How do you calculate half life?

t1/2 = (0.7 x Vd) / CL

What can be found on physical exam with atrial left-to-right shunts?

Wide and fixed splitting of S2 Can facilitate paradoxical embolism due to periods of transient shunt reversal (eg, during straining or coughing)

Low serum ceruloplasmin

Wilson disease (hepatolenticular degeneration)

How do you check to see if there is correct compensation in metabolic acidosis?

Winter's formula PaCO2= [1.5*HCO3-]+8+/-2

Recurrent infections, eczema, thrombocytopenia

Wiskott-Aldrich syndrome - mutation in WAS gene (X-linked recessive)

How can crohn's disease affect coagulation?

With ileal resection or extensive ileal involvement, can cause bile acid malabsorption which may lead to impaired absorption of fat-soluble vitamins Vitamin K deficiency can result in impaired coagulation with easy bruising, large hematoma formation in deep tissues and joints after minor trauma, and prolonged bleeding after surgery

Where are left ventricular gallops (S3 and/or S4) best heard?

With the bell of the stethoscope over the cardiac apex while the patient is in the left lateral decubitus position Listening at end expiration makes the sound even more audible by decreasing lung volume and bringing the heart closer to the chest wall

How to diagnose c diff?

toxin in stool

What is von Willebrand factor deficiency?

vWF binds glycoprotein Ib receptors on platelets after endothelial damage and carries factor VIII vWF deficiency results in mucocutaneous bleeding due to defects in platelet aggregation and coagulation pathway abnormalities Ristocetin aggregation test will show decreased aggregation of platelets

What do alpha granules of platelets contain?

vWF, fibrinogen, and fibrinectin

MRSA treatment

vancomycin, linezolid, ceftaroline, daptomycin

When does free wall rupture after MI usually occur?

Within the first 5-14 days It is a mechanical comp. of transmural MI

Where does fluid accumulate in a communicating hydrocele?

Within the tunica vaginalis in the setting of a patent processus vaginalis Presents as a painless swelling that transilluminates on examination

What is the clinical presentation of pancreatic adenocarcinoma?

Wt loss, anorexia Abdominal/back pain or painless obstructive jaundice Migratory thrombophlebitis Hepatomegaly and ascites (with metastasis)

Alport syndrome

X-linked defect in Type IV collagen. Results in thinning/splitting of basement membrane. Clinical symptoms are: Isolated hematuria, sensory hearing loss and ocular disturbances.

What type of genetic inheritance does G6PD deficiency have?

X-linked recessive

What type of inheritance does hemophilia A and B have?

X-linked recessive

What is Lesch-Nyhan syndrome?

X-linked recessive disorder characterized by the dev. of dystonia, choreoathetosis, self-mutilation, and hyperuricemia within the first few years of life This condition is caused by deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT) This causes an increase in PRPP amidotransferase in order to supply a sufficient quantity of purine nucleotides

What is Fabry disease?

X-linked recessive lipid storage disorder characterized by alpha-galactosidase A deficiency that results in accumulation of globotriaosylceramide

How does candida look on light microscopy?

Yeasts and pseudohyphae

Which virus has councilman bodies?

Yellow fever Eosinophilic apoptotic bodies on liver biopsy= description of councilman bodies

Are brain tumor cells forming giant cells anaplastic?

Yes

Can a ureter be damaged during surgery but still be able to urinate without any difficulty?

Yes, because other ureter can take over

Where are actin (thin) filaments bound to structural proteins?

Z line

What is late regurgitation of undigested food in elderly pathognomonic for?

Zenker Diverticulum

What viral infection is associated with GBS?

Zika

What metal is in metalloprotease?

Zinc

How do you calculate Odds Ratio?

a*d/b*c also known as a 2x2 table, is calculated by dividing the true results by the false results. It is a measure of the odds of disease in the experimental group vs the control group.

What does choriocarcinoma look like on histology?

abnormal proliferation of mononuclear cytotrophoblasts and multinuclear syncytiotrophoblasts No villi are present

What are the aerobic organisms?

" Nagging Pests Must Breathe" Nocardia Pseudomonas MycoBacterium Tuberculosis

What enzymes in the Citric Acid Cycle require thiamine?

"ATP" Alpha-ketoglutarate dehydrogenase Transketolase Pyruvate dehydrogenase

What are the anaerobic organisms?

"Anaerobes Can't Breathe Fresh Air" Clostridium Bacteroides Fusobacterium Actinomyces

What is the mnemonic for CYP450 inhibitors?

"CRACK AMIGOS" Cimetidine Ritonavir (protease inhibitors) Amiodarone Clarithromycin Ketoconazole (azole antifungals) Acute alcohol Metronidazole/Macrolides Isoniazid Grapefruit juice Omeprazole Sulfonamides

What are the catalase positive organisms?

"Cats Need PLACESS to Belch their Hairballs" Catalase positive Nocardia Pseudomonas Listeria Aspergillus Candida E. coli Staphylococci Serratia B cepacia H pylori

What are the receptors for Gq?

"HAVe 1 M&M" H1 A1 V1 M1 and M3 Uses "Cute Cs" Phospholipase C

What are the receptors for Gi?

"MAD 2s" A2 M2 D2

What is the mnemonic for the CYP450 inducers?

"Monika is a Chronic Alcoholic who drinks Guinnes, Corona, and PBRS" Modafinil Chronic Alcoholism Griseofulvin Carbamazepine Cyclophosphamide Phenytoin Barbiturates Rifampin St. John's Wort

What are the urease positive organisms?

"Pee CHUNKSS" Proteus Cryptococcus H pylori Ureaplasma Nocardia Klebsiella S epidermidis S saprophyticus

What are the encapsulated bugs?

"Please SHINE my SKiS" Pseudomonas Strep pneum H flu type B Influenza type B Neisseria meningitidis E. coli Salmonella Klebsiella pneum group B Strep

What are the facultatively intracellular bugs?

"Some Nasty Bugs May Live FacultativeLY" Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia pestis

What are the oblicate intracellular bugs?

"stay inside (cells) when it is Really CHilly and COld" Rickettsia Chlamydia Coxiella

What is the equation for maintenance dose?

(Cpss x CL)/ Bioavailability fraction Bioavailability=1 with IV Cpss= desired steady state plasma concentration

Rash on palms and soles

(K CARS) Kawasaki Coxacki A Rocky mountain fever Secondary syphilis

What is the calculation for half life?

(Vd x 0.7)/ CL

What is the calculation for loading dose?

(Vd x Cpss)/ Bioavailability fraction

Culture negative endocarditis

*HACEK* Haemophilus Aggregatibacter (actinobacillus) Cardionacterium Eikenekka Kingella Coxiella, bartonella

What is the MOA of Bortezomib?

*Protease inhibitor* that binds to 20S core of 26S proteasome, reversible inhibitor of *chymotrypsin*, and disrupts signaling cascades and leads to cell death

How does Digoxin work?

- Inhibits Na+/K+ ATPase mainly in the myocardiun. - This increases intracelular Na+, reversing the action of the Na+/Ca2+ exchanger. - This causes an increase in intracellular calcium. - Positive inotrope and negative chronotrope (harder and slower).

What is a leukamoid reaction?

A benign leukocytosis (>50,000) that occurs in response to an underlying condition such as severe infection/hemorrhage, malignancy (eg, leukemia), or acute hemolysis Leukocyte alkaline phosphatase levels are normal or increased Peripheral smear can show increased bands, early mature neutrophil precursors (eg, myelocytes), and granules (eg, Dohle bodies) in the neutrophils

What is bortezomib?

A boronic acid-containing dipeptide proteosome inhibitor Plasma cells are particularly susceptible in mltiple myeloma due to the synthesis of large amounts of monoclonal immunoglobulin The resulting accumulation of toxic intracellular and proapoptotic proteins increases cellular apoptosis

What is tetrahydrobiopterin?

A cofactor used by hydroxylase enzymes in the synthesis of tyrosine, dopamine, and serotonin Phenylketonuria can result from BH4 deficiency due to dihydropteridine reductaase deficiency Intellectual disability is the hallmark of this condition and results in neurotransmitter deficiency and hyperphenylalanemia Tx= low phenylalanine diet and BH4 supplementation

What is BRAF?

A protein kinase involved in activation of signaling pathways for melanocyte proliferation

What is the nasal transepithelial potential difference test for CF?

A saline solution is applied to the nose, and because pts with CF have increased Na absorption via ENaC, sodium is absorbed intracellularly but chloride in the saline solution is retained in the lumen The higher relative amounts of negatively charged chloride on the epithelial surface result in a more negative transepithelial voltage difference CFTR channel functioning is reversed in sweat ducts

What is fenoldopam?

A selective peripheral dopamine-1 receptor agonsit Given IV to lower BP in HTN emergency, especially in patients with renal insufficiency Causes arteriolar dilation, increases renal perfusion, and promotes diuresis and anatriuresis

What is the immune response in tuberculoid leprosy?

A strong TH1 mediated- IL-2, IFN-gamma, and IL-12 in affected tissues, leading to activation of macrophages that kill M leprae organisms, thereby limiting disease extent However, this localized inflammation damages the skin and cutaneous nerves, leading to the development of a small number of hypopigmented, well-demarcated plaques with decreased sensation

What is akathisia?

A type of extrapyramidal side effect Ranges from mild subjective feelings of tension to marked physical restlessness Associated with antipsychotic treatment

What are the different serotypes of chlamydia? (look up!!!)

A-C= african blindness D-K= STI, PID, L types= lymphogranuloma venerum

What are the proto-oncogenes/tumor promoters?

ABL, BRAF, HER1, HER2, MYC, RAS, SIS, and TGFA

What do dense granules of platelets contain?

ADP and Calcium

What tumor marker is monitored in hepatocellular carcinoma and germ cell tumors?

AFP Also moderately elevated in patients with chronic viral hepatitis

Burger's disease

AKA Thromboangiitis Obliterans Inflammatory disease of the small and medium sized arteries and veins of extremities Seen in men Related to smoking Ulcers Pain

What is emphysematous cholecystitis?

AKA clostridium cholecystits Air in wall of gallbladder Increased risk with diabetics Caused by c perfringens alpha toxin (gas gangrene)

What are superficial hemangiomas?

AKA infantile, capillary, or strawberry Appear during the first weeks of life Initially grow rapidly and then frequently regress spontaneously by late childhood Bright red when near the epidermis and more violaceous when deeper

What is associated with multiple myeloma and other monoclonal plasma cell dyscrasias?

AL amyloidosis Amyloid is derived from monoclonal immunoglobulin light chains, and often forms deposits in the kidneys, heart, tongue, and nervous system

What disorder affects both the UMN and LMN?

ALS (Lou Gehrig's)

What is analysis of variance?

ANOVA Compares means of 3 or more groups

What are the anti-oncogenes/tumor suppressors?

APC/beta-catenin, BRCA1, BRCA2, DCC, NF1, RB, TP53, VHL, WT1

What is characterized by hypoxic respiratory failure and bilateral pulmonary edema that is often associated with pneumonia and sepsis?

ARDS Widespread inflammation of the pulmonary endothelium leads to leakage of fluid into the alveoli Continued perfusion of fluid filled alveoli causes a ventilation perfusion mismatch with right to left physiologic shunting and hypoxemia

How do you calculate the attributable risk percent (ARP) in exposed patients?

ARPexposed= 100 x [(RR-1)/RR] Represents the excess risk in the exposed population that can be attributed to the risk factor

Problems with parenteral polymixins

ATN Nephrotoxicity

What enzymes are affected by thiamine deficiency?

ATP Alpha ketoglutarate dehydrogenase Transketolase Pyruvate dehydrogenase

Tumor cells resistant after exposure to various anticancer agents express a specific cell glycoprotein that has what function?

ATP dependent transporter Efflux pump that can both reduce the influx of drugs into the cytosol and can increase efflux from the cytosol

How does the second stage of Lyme disease present?

AV block and facial palsy

What medication for antiretroviral therapy is contraindicated with the HLA-B*57:01 allele?

Abacavir Results in a delayed hypersensitivity reaction (type IV)

What is the triad for HSP (Henoch Schlenin Purpura)?

Abdominal pain, arthralgia, pale purpura

What is the best diagnostic imaging study for toxic megacolon?

Abdominal x-ray Complication of Ulcerative colitis. Patients typically present with abdominal pain/distension, bloody diarrhea, fever, and signs of shock. Barium contrast studies are contraindicated due to the risk of perforation

What condition shows fat globules on jejunal biopsy?

Abetalipoproteinemia

What is Guillain-Barre syndrome?

Acute demyelinating polyneuropathy thought to be caused by molecular miimicry Antibodies formed against infectious agents cross-react with myelin and Schwann cells, leading to immune mediated demyelination Light microscopy shows segmental demyelination and an endoneurial inflammatory infiltrate composed of lymphocytes and macrophages

How does classic dengue fever present?

Acute febrile illness with headache, retro-orbital pain, and joint and muscle pain

What is the Jarisch-Herxheimer reaction?

Acute inflammatory reaction that occurs within hours of treatment of spirochetal (eg, syphilis) infections Rapid lysis of spirochetes releases inflammatory bacterial lipoproteins into the circulation and causes acute fevers, rigors, and myalgias

Patient with history of a-fib and develop acute abdominal pain with bright red blood in stool, PE out of proportion to pain, what is most likely diagnosis?

Acute mesenteric ischemia

What is the difference between presentation of acute versus chronic mesenteric ischemia?

Acute mesenteric- a fib/clot risk Chronic mesenteric- eating very painful, atherosclerosis

What leukemia do you see Auer rods in?

Acute myelogenous leukemia (AML)

What is the diagnosis with chalky white lesions in the mesentary that show fat cell destruction and calcium deposition on histology?

Acute pancreatitis

What leukemia is characterized by azurophilic needle-shaped cytoplasmic granules in immature myeloid cells? What is the chromosomal abnormality?

Acute promyelocytic leukemia (APL) t(15,17) Causes fusion of the retinoic acid receptor-alpha (RARA) gene to the promyelocyte leukemia (PML) gene

What are some findings of biliary atresia?

Pale stool (not enough bile) Dark urine (bile in urine) Icterus Jaundace Enlarged livr Increased total bilirubin Increased direct bilirubin

Cardiomegaly with apical atrophy

Chagas disease (Trypanosoma cruzi)

What does Haemophilus ducreyi cause?

Chancroid Multiple and deep ulcers Base may have grey to yellow exudate Organisms often clump in long parallel strands ("school of fish") PAINFUL

What is obesity hypoventilation syndrome?

Characterized by chronic fatigue, dyspnea, difficulty concentrating, and evidence of hypoventilation (partial pressure of carbon dioxide [PaCO2] >45 mm Hg while awake) One of the important causes of hypoxemia with a normal alveolar to arterial oxygen gradient

What is lateral medullary (Wallenberg) syndrome?

Characterized by vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temp sensation in the ipsilateral face and contralateral body, bulbar weakness, and ipsilateral Horner syndrome Can occur in the setting of cervical spine trama with dissection of the vertebral artery as well as in posterior inferior cerebellar artery occlusion

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

Charcot-Leydin crystals In bronchial asthma

Large granules in phagocytes, immunodeficiency

Chédiak-Higashi disease (congenital failure of phagolysosome formation)

What bug cannot make its own ATP?

Chlamydia

Which bug does not stain well because low muramic acid?

Chlamydia

What is the diagnosis in a gram stain of urethral discharge specimens revealing neutrophils but no organisms?

Chlamydia trachomatis

What is a common cause of nongonococcal urethritis and epididymitis?

Chlamydia trachomatis Azithromycin is the treatment of choice (a bacterial protein synthesis inhibitor)

What conditions are associated with xanthelasma?

Cholestatic conditions such as primary biliary cirrhosis- potential cause for hypercholesterolemia leading to xanthelasma

What enzyme do fibrates inhibit that favor the formation of cholesterol gallstones?

Cholesterol 7alpha-hydroxylase Fibrates inhibit this enzyme which catalyzes the rate-limiting step in synthesis of bile acids The reduced bile acid production results in decreased cholesterol solubility in bile and favors formation of cholesterol gallstones

What enzyme is inhibited by fibrates that can cause cholesterol gallstones?

Cholesterol 7alpha-hydroxylase This enzyme catalyzes the rate limiting step in the synthesis of bile acids Reduced bile acid production results in decreased cholesterol solubility in bile and favors the formation of cholesterol gallstones

What are the motor and sensory functions of the tibial nerve?

Foot plantar flexion and inversion, toe flexcion Plantar surface of the foot May be injured at the level of the popliteal fossa due to deep penetrating trauma or knee surgery Patients typically have weakness on foot plantarflexion, foot inversion, and toe flexion, with sensory loss over the sole

How long can somebody have viable sperm after vasectomy?

For 3 months or at least 20 ejaculations

What is 21-hydroxylase deficiency

Form of congenital adrenal hyperplasia caused by an autosomal recessive inherited defect in the 21-hydroxylase gene Can present as 3 distinct syndromes depending on the residual activity of the 21-hydroxylase enzyme

What are Langerhans cells?

Form of dendritic cell most commonly found in the skin and mucous membranes

What is nonbacterial thrombotic endocarditis?

Form of noninfectious endocarditis characterized by valvular deposition of sterile platelet-rich thrombi Likely from valvular damage d/t inflammatory cytokines in the setting of underlying hypercoagulable state Often with advanced malignancy or SLE

How can you tell if an infection is anaerobic?

Foul smelling ( c diff is also foul smelling but is not anaerobic)

Where does neonatal intraventricular hemorrhage occur?

Fragile germinal matrix Increases in frequency with decreasing age and birth weight Common complication of prematurity that can lead to long-term neurodevelopmental impairment

What substance is increased in the blood type 2 diabetes mellitus besides the glucose?

Free floating Fatty acids Insulin initially

Where does proinsulin get cleaved?

Pancreatic beta-cell secretory granules Stored here until they are secreted

What is a VIPoma?

Pancreatic islet cell tumors that hypersecrete vasoactive intestinal peptide (VIP), which increases intestinal chloride loss into the stool and causes excess of the accompanying water, sodium, and potassium VIP also inhibits gastric acid secretion

What are well circumscribed fluid collections that typically develop following acute pancreatitis due to walling off of necrotic pancreatic tissue/peripancreatic fat?

Pancreatic pseudocysts Usually resolve on their own but may become infected or expand, causing abdominal pain, small bowel/biliary obstruction, or fistula formation into neighboring structures May see radiopaque calcifications situated around the pseudocyst are indicative of chronic pancreatitis

How does rocky mountain spotted fever present?

Papular or petechial rash that begins on the ankles and wrists and spreads to the trunk, palms, and soles Tick transmitted

Where are T cells located?

Paracortex

What can pineal tumors cause?

Parinaud syndrome due to mass effect on the dorsal midbrain in the superior colliculus region Typical findings include upward gaze palsy, absent pupillary light reflex, and impaired convergence

What is the order of conduction speed from fastest to slowest?

Park At Venture Avenue Purkinje system Atrial muscle Ventricular muscle AV node

What are some PE findings of bulimia nervosa?

Parotid gland enlargement Erosion of dental enamel May also develop electrolyte abnormalities (eg, hypokalemia, hypochloremia, metabolic alkalosis) and increased salivary amylase Calluses on dorsum of hands as well (Russell sign)

What is the diagnosis in uncontrolled complement mediated hemolysis that has a triad of hemolytic anemia (hemoglobinuria), pancytopenia, and thrombosis at atypical sites?

Paroxysmal nocturnal hemoglobinuria (PNH)

What is buprenorphine?

Partial opioid agonist that has low intrinsic activity (efficacy) for opioid mu-receptors However, it binds with high affinity (potency) and can prevent binding of other opioid medications Therefore, buprenorphine acts as an opioid receptor antagonist in the presence of full opioid agonists and can precipitate withdrawal in opioid-tolerant patients with chronic pain

What infections are associated with hydrops fetalis?

Parvovirus B19 Syphilis

How is Crohn 's characterized in the GI tract?

Patchy, transmural inflammation Can affect any part of the tract from the mouth to the anus Complications include strictures (d/t bowel wall edema, fibrosis, and thickening of the muscularis mucosa), fistulas (due to penetration of ulcers through the intestinal wall), and abscesses Noncaseating granulomas

What is lipofuscin?

Product of lipid peroxidation, accumulating in aging cells (especially in patients with malnutrition and cachexia)

What is the mediator of giant cell arteritis?

Production of cytokines, in particular, interleukin-6 These are produced in the tunica media

What is ischemic-hypoxic encephalopathy?

Profound cerebral hypoperfusion that can lead to global cerebral ischemia

What is the MOA of mifepristone?

Progesterone antagonist Results in apoptosis and necrosis of the uterine decidua and prevents further development of a 1st trimester pregnancy Glucocorticoid antagonist

What is PD-1?

Programmed death receptor 1 is a cell surface receptor expressed on activated T cells that functions to negatively regulate the immune response The receptor is stimulated by ligands found on a variety of cells, facilitating development of self tolerance and preventing autoimmune disease. Many typesd of cancers increase expression of PD-1 to help them evade the immune response by inhibiting cytotoxic T cells.

Pick's disease

Progressive dementia, similar to Alzheimer's

What is subacute sclerosing panencephalitis?

Progressive dementia, spasticity and seizures Linked to abnormal measles virus that persists in the CNS of these patients for years after recovering from measles infection Microscopy shows myelin degeneration and viral inclusions

What causes more severe somatic pain shifting from the umbilicus to McBurney's point in appendicitis?

Progressive inflammation in the appendix that irritates the parietal peritoneum and abdominal wall

Disruption of the hypothalamus and pituitary stalk by a sarcoid mass can lead to an increase in which hormone?

Prolactin Disruption of dopaminergic pathways in the pituitary stalk leads to loss of inhibition and a subsequent increase in prolactin

What are regenerative nodules seen in liver cirrhosis composed of?

Proliferating hepatocytes

What clinical finding is associated with poor prognosis in alcoholic cirrhosis?

Prolonged Prothrombin Time Serum albumin levels are also a good indicator of the liver's biosynthetic funcction, and its ability to transport and metabolize organic anions is reflected by the serum bilirubin level

What lab abnormailities are there in von Willebrand disease?

Prolonged bleeding time (impaired platelet function) Prolonged Partial Thromboplastin time (PTT)- due to decreased factor VIII activity

What is tardive dyskinesia due to?

Prolonged exposure to dopamine blocking agents causing the upregulation and supersensitivity of dopamine receptors

What is seen in infarcted myocardium during the second week after MI?

Prominent granulation tissue and neovascularization

How does estrogen affect bone?

Promote bown growth and epiphyseal plate closure; hence, precocious puberty may result in a shorter stature, despite an initial growth spurt.

What promotes uric acid kidney stone formation?

Promoted by low urine pH, which favors formation of insoluble uric acid over soluble urate ion GI bicarb loss due to chronic diarrhea leads to chronic metabolic acidosis and production of acidic urine, promoting formation of uric acid stones

How does IL-2 treatment help RCC regress?

Promotes growth of B cells and activates NK cells and monocytes. Increased activity of T cells and NK cells is thought to be responsible for IK-2s anti-tumor effects Ex. Aldesleukin (used for metastatic melanoma and RCC)

How do right sided colon lesions most commonly present? Left sided?

Right sided- more likely to bleed and cause iron deficiency anemia Left sided- obstructing symptoms (eg, altered bowel habits, constipation, abdominal distension, nausea and vomiting)

How do inflammatory macrophages in the intima reduce plaque stability?

Secrete metalloproteinases, which degrade extracellular matrix proteins (eg, collagen)

What is the karyotype for partial moles?

69, XXX or XXY Maternal and paternal DNA

What is the location of the right lobe, pleura, and right hepatic lobe on the midclavicular line?

6th rib= right lobe 8th rib= right lung pleura 10th rib= right hepatic lobe

How long can troponin be elevated in MI?

7-10 days

What is the risk of gestational trophoblastic neoplasia with partial moles?

<5%

What is Protein A?

A bacterial virulence factor that binds Fc region of IgG Prevents opsonization and phagocytosis S. aureus

What is IgA Protease?

A bacterial virulence factor that cleaves IgA and allows bacteria to adhere and colonize mucous membrane "SHiN" Strep pneum H influenza Neisseria

What is M Protein?

A bacterial virulence factor that prevents phagocytosis Similar epitopes to human (molecular mimicry) Possibly underlies autoimmune response seen in acute rheumatic fever Group A strep

What do hemodynamic measurements look like in Obstructive shock?

CVP (right sided preload) increased PCWP (left sided preload) decreased (increased in tamponade) Cardiac index decreased SVR (afterload) increased MvO2 decreased

What do hemodynamic measurements look like in Cardiogeneic shock>

CVP (right sided preload) increased PCWP (left sided preload) increased Cardiac index decreased SVR (afterload) increased MvO2 decreased

What changes are seen in central venous pressure, CO, and SVR in PE?

CVP- increased CO-decreased SVR- increased

What does the X4 virus of HIV use for viral entry?

CXCR4 Considered T lymphotropic because CXCR4 is expressed primarily on T lymphocytes but only minimally on macrophages

What substance is responsible for increasing the reaction rate of glycogenolysis during active contraction?

Ca2+ Muscle Phosphorylase kinase (PK) is activated by intracellular Ca2+ more powerfully than cAMP

What drugs cause PR prolongation?

Ca2+ channel blockers Beta blockers

What is an ecological study?

Frequency of a given characteristic are studied using population data Useful to generate hypotheses but should not be used to make conclusions regarding individuals within these populations (ecological fallacy)

What happens in cough syncope?

Increased intrathoracic pressure during a coughing episode decreases venous return to the heart, thereby transiently decreasing CO and cerebral perfusion

Activating mutations in what gene lead to constitutive activation of epidermal growth factor receptor (EGFR) pathway, promoting increased cell proliferation and growth?

KRAS

Cherry red tongue

Kawasaki Rheumatic fever

What type of rejection is characterized by- Humoral: C4d deposition, neutrophilic infiltrate, necrotixing vasculitis or Cellular: Lymphocytic interstitial infiltrate and endothelitis?

Acute Usually less than 6 months Exposure to donor antigens induces humoral/cellular activation of naive immune cells

What are the symptoms of Parvovirus B19 in adults?

Acute arthropathy This is symmetric polyarthritis involving the proximal interphalangeal, metacarpal, knee, and ankle joints This is self-limited and nondestructive

Where is a femoral nerve block injected?

At the inguinal crease It will anesthetize the skin and muscles of the anterior thigh (eg, quadriceps), femur, and knee

How does vitamin E deficiency present?

Ataxia Impaired proprioception and vibratory sensation Hemolytic anemia

What are the cutaneous findings of reactive arthritis

Keratoderma blennorrhagica (hyperkeratotic lesions on soles or palms) Balanitis circinata (Ulcerative lesions on glans penis)

What cancer syndrome results from disruption of the nonhomologous end joining repair mechanism?

Ataxia telangiectasia ATM gene is mutated and leads to inactivation of tumor suppressor protein p53 Predisposition to CNS lumphoma and leukemia

What is the mutation in ataxia telangiectasia?

Autosomal recessive condition from mutation of ATM gene Responsible for DNA break repair

What is familial chylomicronemia syndrome (type 1 hyperlipoproteinemia)?

Autosomal recessive condition most often caused by lipoprotein lipase (LPL) deficiency

What is alkaptonuria?

Autosomal recessive disorder Lack homogentisic acid dioxygenase which blocks the metabolism of tyrosine, leading to an accumulation of homogentisic acid Clinical features= black urine when exposed to air, blue black pigmentation of face, and ochronotic arthropathy

How does acute hepatitis A present?

Prodromal symptoms (eg, fever, malaise, anorexia, nausea/vomiting, RUQ pain) followed by signs of cholestasis (eg, jaundice, pruritus, dark-colored urine, clay-colored stool) Self limited infection

What artery supplies the AV node in a right dominant heart? left dominant heart? codominant heart?

Right dominant- RCA Left dominant- Left circumflex Codominant- RCA and left circumflex

Obstruction of what vein causes right sided face and arm swelling and engorgement of subcutaneous veins on the same side of the neck?

Right sided brachiocephalic vein

What is the triad of ataxia telangiectasia?

Cerebellar ataxia Telangiectasias Increased risk of sinopulmonary infections Increased risk of hematologic malignancies and causes an immune deficiency consisting of both cell-mediated and humoral dysfunction

What is the name of the location which acoustic schwannomas are found?

Cerebellopontine angle (Between the cerebellum and lateral pons)

What causes diarrhea from Bacillus cereus?

Cereulide (preformed toxin)

What deficiency causes increased cleavage of C2 and C4 that results in inappropriate activation of the complement cascade?

C1 inhibitor (C1INH) deficiency (C1 esterase inhibitor) C1 inhibitor normally blocks conversion of kininogen to bradykinin, so in this deficiency, bradykinin can be increased

What complement does Protein A like to block?

C3b

What do epithelial ovarian tumors produce?

CA-125

What does the R5 virus of HIV use for viral entry?

CCR5 Considered macrophage-tropic because CCR5 is expressed in high concentrations on both macrophages and lymphocytes R5 is the predominant HIV type

What are lymphoblasts in precursor T-ALL positive for?

CD2, CD3, CD4, CD5, CD7, CD8, TdT, and CD1a

What is the mechanism of liver injury in hepatitis B infection?

CD8+ T lymphocyte responds to viral antigens on the cell surface resulting in hepatocyte damage

What is the mechanism of liver injury in hepatitis B infection?

CD8+ T lymphocytes respond to viral antigens on the cell surface resulting in hepatocyte damage

What is the mechanism of action of Triptans?

Serotonin 5-HT1B/5-HT1D agonists used as abortive therapy during an acute migraine Affects postsynaptic serotonin receptor stimulation

What is the antidote for amitryptiline?

Sodium bicarbonate

What is characterized by cyanosis that worsens with feeding, crying or exercise?

Tetralogy of Fallot

What atypical lymphocytes are seen in EBV?

CD8+ T-lymphocytes Appear as cells much larger than quiescent lymphocyte with abundant cytoplasm, an eccentrically placed nucleus, and a cell membrane that appears to conform to the borders of neighboring cells

Tumor marker for colon cancer

CEA

What are the 3 most common infective causes of esophagitis?

CMV (linear ulcers) HSV (punched out lesions) RSV

What structures travel through the jugular foramen?

CN IX, X, XI, and jugular vein

What complications do you worry about in recovery phase after ATN?

Continued impairment of renal tubular function, resulting in electrolyte wasting (hypokalemia, hypomagnesemia, hypophosphatemia, and hypocalcemia) Protein loss is unexpected with ATN

What is the MOA of Thiazolidinediones?

Activate peroxisome-proliferator activated receptor- gamma (PPAR gamma), a nuclear receptor that alters the transcription of genes involved in glucose and lipid metabolism Effects: Increased FA uptake, Increased adiponectin production, increased insulin sensitivity (muscle, liver), decreased TNF-alpha production, decreased leptin production

During dev. of atherosclerotic plaques (atheromas), what cells release growth factors that stimulate recruitment of smooth muscle cells from the arterial wall media and their subsequent proliferation in the intima?

Activated macrophages Platelets Endothelial cells

Why does sarcoidosis have hypercalcemia?

Activated macrophages express 1-alpha-hydroxylase that leads to the production of excess 1,25-dihydroxyvitamin D and hypercalcemia

What does Gs activate?

Activates adenylate cyclase Then converts ATP to cAMP Then activates protein kinase A Increases calcium in heart (increase contractility) Inhibits myosin light chain kinase in smooth muscle (relaxation)

How does TNF-alpha induce insulin resistance?

Activates serine kinases, which then phosphorylate serine residues on the beta subunits of IR and IRS-1 This inhibits tyrosine phosphorylation of IRS-1 by IR and subsequently hinders downstream signaling, resulting in resistance to normal actions of insulin

How do you calculate the number needed to treat?

1/(control rate-treatment rate)

How do you calculate number needed to treat?

1/ARR= 1/((a/a+b)-(c/c+d))

What HPVs are associated with condyloma accuminata?

11 and 16

When does ischemic stroke show neurons with eosinophilic cytoplasm and loss of Nissle substance?

12-24 hours post ischemia "Red neurons"

What temp to kill spores?

121 degrees C

What genes are translocated in Trisomy 21 via Robertsonian translocation?

14 and 21

What is the risk of gestational trophoblastic neoplasia with complete moles?

15-30%

What enzyme deficiency causes congenital adrenal hyperplasia characterized by mineralocorticoid excess and deficiencies of cortisol and sex steroids with typical findings including HTN and hypokalemia with amenorrhea and lack of secondary sex characteristics in female patients, and feminization in male patients?

17 alpha hydroxylase deficiency

What enzyme do spirinolactone and ketoconazole inhibit in steroid synthesis that causes gynecomastia?

17,20 Desmolase (17 alpha hydroxylase)

What classes of antiarrhythmics prolong QT?

1A and III

What are the derivatives of the 5 aortic arches?

1st- part of maxillary artery 2nd- hyoid and stapedial arteries 3rd- common carotid and proximal internal carotid arteries 4th- on left--> aortic arch, on right--> proximal right subclavian artery 6th- proximal pulmonary arteries, on left--> ductus arteriosus

What BMI is considered overweight?

25-29.9

In what direction is the DNA template read?

3' to 5' direction

What is Turner's?

45XO Short stature, webbed neck, cystic hygroma, Bicuspid aorta, coarctation (femoral pulse < brachial pulse) Tx: growth hormone Fertility: IVF

What is the diagnosis in a patient with classic, salt wasting, deficient cortisol and aldosterone synthesis combined with adrenal androgen overproduction?

21 hydroxylase deficiency Male infants have normal genitalia and present 1-2 weeks after birth with vomiting, hypotension, hyponatremia, and hyperkalemia Females present at birth with ambiguous genitalia

What is the most common form of congenital adrenal hyperplasia?

21-hydroxylase deficiency Genetically F infants typically have ambiguous genitalia (virilization) at birth, whereas males have phenotypically normal genitalia, with salt wasting or precocious puberty appearing later Elevated 17-hydroxyprogesterone is diagnostic

When does ischemic stroke show neutrophilic infiltration?

24-72 hours post ischemia

What karyotype do complete moles usually show?

46, XX Results when an empty ovum is fertilized by a haploid sperm Subsequent duplication of the paternal genetic complement (23X) results in the characteristic 46, XX genotype 46, YY are not seen because duplication resulting in this is not viable- cannot survive

What is the karyotype for complete moles?

46,XX or XY Paternal DNA only

What is ototesticular disorder of sex development?

46,XX>46,YY Both ovarian and testicular tissue present Ambiguous genitalia True hermaphroditism

What is Kleinfelter's?

47 XXY Dysgenesis of seminiferous tubules Decrease inhibin B, Increased FSH Dysfuntion of leydig cells Decreased testosterone, Increased LH, Increased estrogen (gynecomastia) Primary hypogonadism, eunichoid body shape, mild intellectual disability, tall/long extremities

In what direction is DNA synthesized?

5' to 3'

Metabolism of 1g of protein or Carb produces how many calories of energy?

4 1g of fat produces 9 Calories

What is DNA polymerase III's function in prokaryotic DNA replication?

5' to 3' DNA synthesis and 3' to 5' exonuclease ("proofreading") activity

What is a normal A-a gradient?

5-15 mmHg

Which drugs are used for which types of nausea?

5-HT3 receptor antagonists for visceral nausea due to gastrointestinal insults, such as gastroenteritis, chemo, and general anesthesia Antihistamines and anticholinergics for vestibular nausea Dopamine antagonists for nausea associated with migraine

How large of a vocabulary should 2 year old children have?

50-200 words and be using 2-word phrases

How does chronic pancreatitis present?

Diarrhea, weight loss, and epigastric calcifications in a patient with chronic alcoholism Resulting in pancreatic exocrine insufficiency and malabsorption

What is alcohol induced cardiomyopathy?

A dilated cardiomyopathy that can occur with chronic, excessive ethanol intake Characterized by contractile dysfunction, cardiomyocyte hypertrophy, myocardial fibrosis, and biventricular enlargement leading to heart failure

What is succinylcholine?

A fast-acting, depolarizing neuromuscular blocking agent used for rapid-sequence intubation that causes equal reduction of all 4 twitches during train-of-four stimulation (phase I blockade) Prolonged admin or use in patients with abnormal plasma cholinesterase activity causes transition to a phase II (nondepolarizing) block, seen as a progressive reduction in each of the 4 twitches

What type of reaction is poison ivy dermatitis?

A form of allergic contact dermatitis, which is a type IV hypersensitivity reaction mediated primarily by T lymphocytes

What is neprilysin?

A metalloprotease that cleaves and inactivates endogenous peptides including natriuretic peptides (eg, BNP), glucagon, oxytocin, and bradykinin Inhibition leads to increased levels of endogenous natriuretic peptides, which promote beneficial effects in heart failure

What is nevirapine?

A nonnucleoside reverse transcriptase inhibitor (NNRTI) that directly binds to reverse transcriptase and inhibits its function Point mutations that onfer resistance against one NNRTI can sometimes confer cross resistance against other NNRTIs (eg, efavirenz and nevirapine)

What type of mechanism does H/K ATPase use?

Active transport mechanism Targeted with PPIs

What are the clinical findings in aortic regurgitation?

Diastolic decrescendo murmur Widened pulse pressure (increased SBP and decreased DBP) Rapid rise-fall ("water hammer") pulsation Abrupt carotid distention and collapse, "pistol-shot" femoral pusles

What can postpartum hemorrhage result from?

Abnormal placentation Prior uterine surgery can impair decidualization, resulting in myometrial invasion by villous tissue and a placenta that is abnormally adherent to the myometrium (placenta accreta)

What causes left ventricular outflow tract obstruction in hypertrophic cardiomyopathy?

Abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied interventricular septum

How does choriocarcinoma present?

Abnormal vaginal bleeding Uterine enlargement Significantly increased beta-hCG

Migraine headache treatment- abortive and prophylaxis

Abortive-NSAIDs and Sumatriptan Prophylaxis- Calcium channel blockers, amitryptiline, topiramate, and propanalol

What are acute intermittent porphyria attacks due to?

Accumulation of ALA and poorphobilinogen (PBG), resulting from inherited PBG deaminase deficiency combined with ALA synthase induction (typically due to certain medications, alcohol use, or a low calorie diet) Management with glucose or hemin inhibits ALA synthase activity

What does cystic medial necrosis of the aorta in Marfan's?

Accumulation of basophilic ground substance in the media with cyst like lesions

What is myxedema?

Accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues See in hypothyroidism

What does the area under a receiver operating characteristic (ROC) curve represent?

Accuracy of the test Plots the sensitivity (true positive rate) against 1-specificity (false positive rate)

How is isoniazid metabolized?

Acetylation Speed the patient is able to acetylate drugs depends on if they are genetically fast or slow acetylators Presence of fast and slow acetylators within the same population results in a bimodal distribution of the speed of isoniazid metabolism Slow acetylators are at an increased risk of adverse side effects

When does Anti-HBsAg (IgG) appear?

After either successful HBV vaccination or HBsAg clearance and remains detectable for life (indicator of non-infectivity and immunity)

What are the risk factors for thyroid cancer?

Age <30 (papillary cancer) or >60 (anaplastic cancer) Female Radiation exposure (papillary and follicular) Iodine deficiency MEN2, RET mutations (medullary thyroid cancer) Familial polposis coli, Cowden syndrome (papillary cancer)

What are the risk factors of pancreatic adenocarcinoma?

Age > or equal to 65 Smoking Chronic pancreatitis Genetic predisposition Hereditary pancreatitis Peutz-Jeghers syndrome MEN syndromes Hereditary nonpolyposis colon cancer

What is the epidemiology of babesiosis?

Agent: babesia microti Vector: ixodes scapularis tick Geographic distribution: NE US

What is baclofen?

Agonist at the GABA-B receptor Effective as monotherapy for the treatment of spasticity secondary to both brain and spinal cord disease, including multiple sclerosis Tizanidine, an alpha-2 adrenergic agonist, is also effective and commonly used

What is the MOA of isoproterenol?

Agonist to b1=b2 >>>>>>>a increased inotropy and chronotropy, vasodilation (lowers PVR)

What is a serious complication of antithyroid drugs?

Agranulocytosis Results from drug induced granulocyte destruction and consequent neutropenia

What are the adverse effects of clozapine?

Agranulocytosis Seizures Myocarditis Metabolic syndrome

What side effect in the blood do PTU and Methimazole cause?

Agranulocytosis and aplastic anemia

What are the hydrophobic amino acids

Alanine, Valine, Leucine, Isoleucine, Phenylalanine, tryptophan, methionine, proline, and glycine

What syndrome is characterized by cerebellar vermis atrophy that presents with gait ataxia, truncal instability, and a rhythmic , postural tremor of the fingers and hands?

Alcoholic cerebellar degeneration Long-term, heavy alcohol use may be associated with this

What drugs are all organisms in the mycoplasma genus resistant to?

All drugs that target the cell wall since they lack peptidoglycan cell walls Penicillins, cephalosporins, carbapenems, and vancomycin Can be treated with antiribosomal agents (eg, tetracyclines, macrolides)

What does a Stanford type B aortic dissection refer to?

All other dissections involving the descending aorta Typically originate close to the origin of the left subclavian artery

What are saccular (berry) aneurysms?

Associated with ADPKD, Ehlers-Danlos syndrome, HTN Located in the circle of willis Size is variable (2-25mm) Result of rupture is subarachnoid hemorrhage Symptoms of rupture are sudden severe headache Focal neurologic deficits uncommon

What are major features of Meconium ileus?

Associated with CF Level of obstruction is the ileum Meconium consistency is inspissated (dehydrated) Squirt sign is negative

What are Charcot-Bouchard aneurysms?

Associated with HTN Located in basal ganglia, cerebellum, thalamus, and pons <1mm in size Result of rupture is intracerebral hemorrhage Symptoms of rupture are progressive neurologic deficits and headaches may follow

What are the 3 major types of glial cells?

Astrocytes Oligodendrocytes Microglia

What happens in irreversible neuronal damage and neuronal death?

Astrocytes proliferate at the site of injury (gliosis)- it a universal response of the CNS to severe damage Proliferating astrocytes are enlarged and contain a large number of fibrils and glycogen granules Their nuclei are large, vesicular, and display prominent nucleoli Proliferated astrocytes replace lost neurons and compensate for their volume Later, after the neuronal death, astrocytic processes form a closely connected firm meshwork called a gliotic scar

What does sickle cell anemia usually present?

Asymptomatic in the fetus/neonate due to high levels of fetal hemoglobin that are not replaced by hemoglobin S until age 3-12 months

What are the names of the reversible NSAIDs?

Diclofenac Ibuprofen Ketorolac Naproxen Indomethacin

What kind of reaction is Myasthenia Gravis?

Autoimmune Type II (antibody-mediated) hypersensitivity reaction against skeletal muscle myocyte surface acetylcholine receptors

What type of inheritance does MEN 2 have?

Autosomal dominant Germ-line activating mutations of RET proto-oncogene

What is myotonic dystrophy?

Autosomal dominant disorder caused by an increased number of trinucleotide repeats on myotonia-protein kinase gene Sustained muscle contraction (myotonia), along with weakness and atrophy, is common Cataracts seen in almost all patients Frontal balding and gonadal atrophy are other common features

What is the epidemiology and clinical presentation of hereditary spherocytosis?

Autosomal dominant inheritance Northern European decent Hemolytic anemia, jaundice, and splenomegaly Lab= increased MCHC, spherocytes on blood smear, negative coombs test, increased osmotic fragility on acidified glycerol lysis test Tx= splenectomy

What gene mutation is the cause of Li-Fraumeni syndrome?

Autosomal dominant mutation in the tumor suppressor gene TP53 Predisposed to cancer dev. at a young age History of sarcoma, leukemia, adrenal, and breast cancer Cancers of the brain are also common

What mutation is responsible for a majority of HCM cases?

Autosomal dominant mutations affecting the cardiac sarcomere genes (eg, cardiac beta-myosin heavy chain gene and myosin-binding protein C gene)

What inheritance does Neurofibromatosis Type 1 have?

Autosomal dominant- single gene (17)

What inheritance does classic galactosemia?

Autosomal recessive

What is the inheritence of PKU?

Autosomal recessive

What kind of inheritance is sicke cell?

Autosomal recessive

What enzyme can interleukin-1 and TNF-alpha upregulate during inflammation?

COX-2 Selective COX-2 inhibitors (eg, celecoxib) decrease inflammation by inhibiting COX-2 production of pro-inflammatory arachidonic acid metabolites Minimal gastroduodenal toxicity since they do not affect COX-1

What are the treatments for acromegaly that agonize the dopamine receptor?

Bromocriptine and cabergoline

What is seen on biopsy of hamartoma lung cancer?

CT, cartilage, and fat cells Cartilage is most important...

Where is mucociliary transport the primary means of eliminating medium particles?

Bronchi and proximal bronchioles Cilia stops at terminal bronchioles

Psyllium, methylcellulose

Bulk forming laxatives MOA- soluble fibers; draw water into gut lumen, forming a viscous liquid that promotes peristalsis Adverse Effects: Bloating

How is PAH secreted from the blood into the tubular fluid?

By cells of the proximal tubule by a carrier protein-mediated process Secretion of PAH can be saturated at high blood concentrations

What is the MOA of entacapone?

COMT inhibitor that increases the bioavailability of levodopa by inhibiting its peripheral methylation

What do hemodynamic measurements look like in septic shock?

CVP (right sided preload) decreased PCWP (left sided preload) decreased Cardiac index (LV output) increased SVR (afterload) decreased MvO2 increased

What are the 2 c diff toxins?

C- enterotoxin that binds brush border B- cytotoxin that disrupts cytoskeleton via actin depolymerization

What drug is used in pulmonary hypertension?

Bosentan (endothelin-receptor antagonist) Blocks effects of endothelin (potent vasoconstrictor that also stimulates endothelial proliferation)

Cushing versus Conn Syndrome

Both have metabolic alkalosis and high aldosterone symptoms ...?

What are the best treatments for focal seizures?

Both simple and complex Narrow spectrum: Carbamazepine Gabapentin Phenobarbital Phenytoin

What are the best treatments for generalized seizures?

Both tonic-clonic and myoclonic Broad spectrum: Lamotrigine Levetiracetam Topiramate Valproic acid Abscence Ethosuximide

What are risk factors for Pyloric stenosis?

Bottle feeding Scandinavian descent Blood types B and O Diagnose with ultrasound

What do hemodynamic measurements look like in Hypovolemic shock?

CVP (right sided preload) decreased PCWP (left sided preload) decreased Cardiac index decreased SVR (afterload) increased MvO2 decreased

What does an interscalene nerve block anesthetize?

Brachial plexus as it passes through the scalene triangle Nearly all patients develop transient ipsilateral diaphragmatic paralysis due to involvement of the phrenic nerve roots as they pass through the interscalene sheath

What are the major side effects of sotalol?

Bradycardia Proarrhythmia Most commonly torsades de pointes due to QT prolongation

Where are insulin-independent GlUT-1,2,3,&5 located?

Brain Kidney Intestine Liver RBCS Do not respond to increased insulin levels Always expressed

What are nitrosureas used for?

Brain tumors (including glioblastoma multiforme) Toxicity= CNS toxicity (convulsions, dizziness, ataxia)

What is the location of the damage that causes decerebrate (extensor) posturing?

Brainstem at or below the level of the red nucleus (eg, midbrain tegmentum, pons)

What is 5-hydroxyindoleacetic acid?

Breakdown product of serotonin that is used to screen for carcinoid syndrome

What PE exam finding in children may suggest intusception?

Bring legs up- fetal position because pain

What drugs are prefered for generalized (tonic-clonic, myoclonic, and absence) seizures?

Broad spectrum Lamotrigine Levetiracetam Topiramate Valproic acid

How do ACE inhibitors work?

Block angiotensin-mediated vasoconstriction, particularly of the efferent renal arterioles This leads to a reduction in renal perfusion, glomerular filtration rates, and renal filtration fraction For patients with bilateral renal artery stenosis, use of ACE inhibitors should be closely monitored as they can precipitate acute renal failure (decreased RBF, decreased Interglomerular filtration pressure, reduced GFR and FF)

How do beta-adrenergic blockers affect renin, AT I, AT II, Aldosterone, and Bradykinin

Block beta-1 receptor mediated regulation of the RAAS Renin decreased AT I decreased AT II decreased Aldosterone decreased

How do class I antiarrhythmics work?

Block voltage gated Na channels Binding strength varies between the different subclasses: Strength is IC>IA>IB Use dependence describes the phenomenon in which higher heart rates lead to increased sodium channel blockade due to cumulative blocking effects over multiple cardiac cycles Class IC antiarrythmics demonstrate the most use dependence due to their slow dissociation from the receptor, and class IB drugs have the least use dependence as they rapidly dissociate

What is the MOA of Ethosuximide?

Blocks thalamic T-type Ca2+ channels that trigger and sustain rhythmical burst discharges in thalamic neurons First line for absence seizures

What is the murmur heart in mitral regurgitation?

Blowing, holosystolic murmur best heard over the cardiac apex with radiation to the axilla Rheumatic heart disease is a very common cause of mitral regurg. in underdeveloped countries

How does Kaposi sarcoma present?

Blue-violet or brownish skin plaques on the extremities and mucous membranes of HIV-positive patients Tumor arises from primitive mesenchymal cells and is strongly associated with HHV-8

How do beta blockers work to help treat hyperthyroidism?

Blunt the adrenergic manifestations of hyperthyroidism (hyperthyroidism causes upregulation of beta-adrenergic receptor expression, leading to increased catecholamine effect) In addition, lipid-soluble beta blockers reduce conversion of T4 to T3 by inhibiting 5'-monodeiodinase in peripheral tissues

Why can their be a clinical decline when administering O2 to a patient with COPD?

Can lead to increased CO2 retention (oxygen-induced hypercapnea), resulting in confusion and depressed consciousness Major cause is reversal of hypoxic pulmonary vasoconstriction, which increases physiologic dead space as blood is shunted away from well-ventilated alveoli

What type of placentation is present in monozygotic twins?

Can occur at different stages of embryogenesis, which affects the organization of the fetal membranes: dichorionic/diamnionic (days 0-4) monochorionic/diamniotic (days 4-8) monochorionic/monoamniotic (days 8-12) monochorionic/monoamniotic conjoined twins (>13 days)

When does serum sickness occur?

Can occur following admin. of antigenic heterologous proteins such as chimeric monoclonal antibodies or nonhuman immunoglobulins A serum sickness-like reaction is also associated with the use of certain nonprotein drugs

What does adding carbidopa to levodopa do?

Can reduce most of the peripheral side effects However, behavioral changes from levodopa can actually worsen with addition of carbidopa because more dopamine becomes available in the brain

What can ACE inhibitors cause if used in pregnant women?

Can result in fetal anuria, oligohydramnios, pulmonary hypoplasia, limb contractures, and calvarium defects

What vaginal infection has a normal pH?

Candida

What is the most significant advantage of the inactivated polio vaccine compared to the oral polio vaccine?

Cannot revert to a virulent form However, live vaccine (OPV) produces more durable cell mediated immunity

What is the drug of choice for trigeminal neuralgia?

Carbamazepine Inhibits neuronal high-frequency firing by reducing the ability of sodium channels to recover from inactivation

What drugs are CYP450 Inducers?

Carbamazepine Phenobarbital (barbiturates) Phenytoin Rifampin Griseofulvin Alcohol (chronic use) Modafinil St. John's wart

What is responsible for the decreased chloride content of erythrocytes in arterial blood compared to venous blood?

Carbonic anhydrase Hemoglobin is responsible for carrying 15% of carbon dioxide as carbanate and the remainder of CO2 as bicarb ion within RBCs. CO2 produced by tissue respiration enters RBCs and is hydrated by carbonic anhydrase to form carbonic acid. Carbonic acid then undergoes spontaneous conversion to HCO3- and H+. Many of the bicarb ions diffuse out of the RBC into the plasma. To maintain the electrical neutrality chloride ions diffuse into the RBC to take their place. This process is called "chloride shift" and it is the principle cause of high RBC chloride content in venous blood.

What can present with flushing, telangiectasias, cyanosis, watery diarrhea, cramping, bronchospasm, dyspnea, wheezing, and valvular fibrous plaques?

Carcinoid syndrome Tx= Octreotide

What are the symptoms of digoxin toxicity?>

Cardiac: life-threatening arrhythmias GI: anorexia, nausea & vomiting, abdominal pain Neurologic: fatigue, confusion, weakness, color vision alterations

Exotoxin Description

Certain gram positive and gram negative organisms Secreted from cell Polypeptide Genes in plasmid or bacteriophage High adverse effects Various clinical effects and modes Induces high-titer ABs= antitoxins Toxoids as vaccines Destroyed rapidly at 60 degrees celsius Except staph enterotoxin and E. coli heat stable toxin

Why can't methimazole be used in the first trimester?

Causes aplasia cutis Baby will be born with absent scalp in certain areas...

What is the MOA of topical capsaicin?

Causes defunctionalization of afferent pain fibers and depletion of substance P Initial application results in a burning and stinging sensation, but chronic exposure leads to reduced pain transmission

How does primary mineralocorticoid excess (hyperaldosteronism) effect electrolytes?

Causes increased renal sodium reabsorption, leading to hypertension, hypokalemia, and metabolic alkalosis Primary hyperaldosteronism is frequently caused by adrenal adenoma or bilateral hyperplasia

How does decreasing PaCO2 affect the brain in mechanical ventilation?

Causes vasoconstriction Reduces cerebral blood volume leading to decreased ICP and cerebral vascular resistance

What is the diagnose of a mass composed of abnormally dilated capillaries separated by thin connective tissue septa?

Cavernous hemangioma "Mulberry-like" appearance due to their purple vascular clusters Reduced structural support gives them the tendency to leak, causing recurrent hemorrhage

What is the treatment for lyme disease?

Ceftriaxone

What is the treatment for gonorrhea?

Ceftriaxone and azithromycin

What are HLA-DQ2 and DQ8 associated with?

Celiac disease

What disease is positive for anti-tissue transglutaminase IgA antibodies?

Celiac disease

What does the bcl-2 gene normally inhibit?

Cell death cascade Overexpression of bcl-2 leads to increased secretion of Bcl-2 protein, which inhibits apoptosis and promotes survival of tumor cells Occurs in follicular lymphoma secondary to translocation of the bcl-2 oncogene from chromosome 18 to the Ig heavy chain locus on chromosome 14 [t(14,18)]

What is seen on biopsy of mature teratomas?

Cell lines of > 1 germ layer, commonly including hair, teeth, and skin

How is low-grade CIN described?

Cells have not invaded past the lower 1/3 of the cervical epithelium Most cases, these regress spontaneously

What is brown adipose?

Cells that contain several intracytoplasmic fat droplets and many more mitochondria than white adipose cells Function to produce heat by uncoupling oxidative phosphorylation with the protein thermogenin Found in newborns and in hibernating mammals

How do fibroadenomas look histologically?

Cellular or myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces

What is the order of organ susceptibility to infarction after occlusion of a feeding artery?

Central nervous system, myocardium, kidney, spleen, and liver The presence of a dual and/or collateral blood supply enables an organ to tolerate arterial occlusion better than those with end-arterial circulations

What would you expect on visual field exam with lesions of the macula?

Central scotoma

Thyroidization of kidney

Chronic pyelonephritis Eosinophilic proteinaceous material resembling colloid in the thyroid follicles

What causes bronchiolitis obliterans?

Chronic transplant rejection Characterized by lymphocytic inflammation, fibrosis, and, ultimately, destruction of the bronchioles

What can trigger prinzmetal (variant) angina?

Cigarette smoking Cocaine/amphetamines Dihydroergotamine/triptans Treatment= tobacco/drug cessation and vasodilator therapy (eg, nitrates, calcium channel blockers)

What feature in the respiratory epithelium dissappears last?

Cilia

What drugs are CYP450 Inhibitors?

Cimetidine Ciprofloxacin Erythromycin Azole antifungals Grapefruit juice Isoniazid Ritonavir (protease inhibitors) Macrolides (except azithro) Quinolones Diltiazem, verapamil Amiodarone SSRIs Alcohol (acute use)

What can chelate calcium and magnesium in transfusions that can reduce plasma levels and cause paresthesias?

Citrate

What lab study is important for identifying the cause of metabolic alkalosis?

Cl-

What medications that have increased effect at faster heart rates which makes them more effective at treating tachyarrhythmias, but can also cause prolonged QRS duration (a proarrhythmic effect) at higher heart rates?

Class 1C antiarrhythmics (eg, flecainide)- typically used to treat SVTs such as those caused by a-fib Bind to fast sodium channels responsible for phase 0 depolarization of cardiac myocytes, blocking the inward sodium current This prolongs the QRS duration with little effect on total action potential or QT interval duration

What antiarrhythmics are sodium channel blocking agents that depress phase 0 depolarization and also prolong repolarization due to moderate potassium channel blocking activity, increasing action potential duration in cardiac myocytes?

Class IA antiarrhythmics (disopyramide, quinidine, and procainamide)

What type of antiarrhythmic is dofetilide?

Class III Blocks potassium channels and inhibits outward potassium currents during phase 3, thereby prolonging repolarization and total action potential duration

What are basic leucine zippers?

Class of eukaryotic transcription factors composed of 2 alpha helical proteins that combine to form a dimer Each dimer has a DNA binding region composed of basic amino acids and a leucine zipper dimerization domain that contains repeated leucine residues at every 7th position

Which viruses can the Aedes aegypti mosquitos transmit?

Classic dengue fever Chikungunya

Ethylene glycol/methanol intoxication treatment

Fomepizole (alcohol dehydrogenase inhibitor) "FOMEpizole- For Overdoses of Methanol and Ethylene glycol"

What are the most characteristic physiologic signs of marijuana intoxication?

Conjunctival injection (red eyes), tachycardia, increased appetite, and dry mouth

What does glucoronidation rate look like in zero order kinetics?

Constant amount of drug is metabolized per unit of time, independent of serum levels

What does glucoronidation rate look like in 1st order kinetics?

Constant fraction (or proportion) of drug is metabolized per unit time, so the amount of metabolized changes based on the serum concentration

Aluminum Hydroxide overuse

Constipation and hypophosphatemia, proximal muscle weakneds, osteodystrophy, seizures "minimum" amount of feces

What cardiac complication is common with chest radiation therapy?

Constrictive pericarditis

Why do you get increased WBCs after given steroids?

Demargination

What is the treatment for SIADH?

Demiclocycline

What osteoporosis drug binds RANK-L and inhibits binding to RANK therefore reducing differentiation and survival of osteoclasts?

Denosumab

What histologic findings are consistent with acute graft rejection?

Dense interstitial lymphocytic infiltrate

What skin problem can present with celiac?

Dermatitis Herpetiformis Characterized by erythematous pruritic papules, vesicles, and bullae that appear bilaterally and symmetrically on the extensor surfaces, upper back, and buttocks

What dermatologic condition is celiac associated with?

Dermatitis herpetiformis

What skin condition is associated with celiac disease?

Dermatitis herpetiformis

What are anti-Jo1 antibodies associated with?

Dermato and Polymyositis AKA anti-histidyl-Trna-synthetase

Where are Keiser Fischer rings in Wilson's disease located?

Descemet membrane at corneoscleral junction Copper is deposited here

Where is copper deposition in Kayser-Fleischer rings?

Descemet's membrane of the cornea

What is the treatment for central diabetes insipidus?

Desmopressin

What treats nocturnal eneuresis?

Desmopressin

What structures are attacked by autoantibodies in pemphigus vulgaris?

Desmosomes "Des men are vulgar"

What are the adverse effects of lithium?

Diabetes insipidus Hypothyroidism Tremor Ebstein anomaly (teratogenic)

Why is the urease breath test used with ulcers?

Diagnose H pulori H pylori can split gastric urea to form CO2 and ammonia; the urease breath test relies on this reaction False negative test results can occur in patients using PPIs, bismuth, or antibiotics due to suppression of bacterial growth

Magnesium hydroxide overuse

Diarrhea, hyporeflexia, hypotension, cardiac arrest "Mg= Must Go To bathroom"

What enzyme is deficient with hyperphenylalanemia and elevated prolactin>

Dihydrobiopterin reductase Accounts for 2% of PKU cases

What is the MOA of Leflunomide?

Dihydroorotate dehydrogenase inhibitor (reversible)

What is the drug of choice in lowering bp without worsening ECG in HTN and sinus bradycardia with first-degree AV block (PR int >200)?

Dihydropyridines (Nifedipine) Minimal effect on cardiac conduction Can cause reflex tachycardia in response to peripheral vasodilation and are therefore useful in HTN patients with resting bradycardia

What cardiomyopathy does pregnancy predispose a patient to?

Dilated cardiomyopathy

How do you treat mercury and arsenic OD?

Dimercaprol Succimer

Where do timolol and other nonselective beta blockers work when treating open-angle glaucoma?

Diminish the secretion of aqueous humor by the ciliary epithelium

What is the cause of Zenker (false) diverticulum?

Diminished relaxation of cricopharyngeal muscles during swallowing results in increased intraluminal pressure in the oropharynx This may eventually cause the mucosa to herniate through a zone of muscle weakness in the posterior hypopharynx

How does minoxidil work?

Direct arteriolar vasodilator

What drug increases the prothrombin and activated partial thromboplastin times but do not affect the thrombin time?

Direct factor Xa inhibitors (eg, apixaban, rivaroxaban) Unfractionated heparin and direct thrombin inhibitors (eg, dabigatran) prolong the thrombin time

What is Meniere disease?

Disorder of inner ear characterized by increased volume and pressure of endolymph (endolymphatic hydrops) that is thought to be due to defective resorption of endolymph Damage to vestibular and cochlear components of the inner ear Characterized by triad: low-frequency tinnitus, vertigo, sensorineural hearing loss

What is the initiating step in infective endocarditis?

Disruption of normal endocardial surface Most commonly in areas of maximal turbulence, typically the atrial surface of incompetent AV valves or the ventricular surface of incompetent semilunar valves This is followed by focal adherence of fibrin and platelets, forming a sterile fibrin-platelet nidus

How does clostridium toxin B (cytotoxin) work?

Disrupts the actin cytoskeletal structure and intracellular signaling More cytotoxic

What does a Stanford type A aortic dissection refer to?

Dissections involving any part of the ascening aorta Typically originate in the sinotubular junction

Why is there a triad of ataxic gait, urinary incontinence, and dementia in normal pressure hydrocephalus?

Distortion of periventricular white matter Bladder control is influenced by descending cortical fibers that run in the distended paraventricular area Later, loss of cortical inhibition on the sacral micturition center causes the dev. of urge incontinence (occurs in elderly)

Alcohol abuse treatment

Disulfiram, acamprosate, naltrexone, supportive care

Mutations in colon to produce cancer?

First APC-->causes proliferation-->KRAS-->adenoma-->p53,DKCC,COX--> adenocarcinoma Aspirin to reduce COX

Which pharyngeal arches can be disrupted in genetic disorders that result in hypoplasia of the mandibular and zygomatic bones?

First and second 1st: trigeminal nerve, mandible, maxilla, zygoma, incus, malleus 2nd: facial nerve, stapes, styloid process, lesser horn of hyoid

When giving a benzodiazepine, what drugs should be avoided?

First generation H1-histamine receptor antagonists, including diphenhydramine and chlorpheniramine Can cause significant sedation, especially when used with other meds that cause CNS depression (such as benzos)

How is naltrexone used in moderate to severe alcohol use disorder?

First line pharmacologic treatment Binds mu opioid receptor and blocks the rewarding and reinforcing effects of alcohol Has been shown to reduce the craving for it- can be initiated while individual is still drinking Disulfiram inhibits aldehyde dehydrogenase and has an aversive MOA but does not reduce craving!- can only be used in patients with strong motivation to maintain abstinence

What are the 3 phases of ARDS?

First theres an insult Then:

What antihistamines can also cause anticholinergic effects?

First-generation antihistamines (eg, diphenhydramine) They are nonspecific and act as antagonists to multiple receptors, including muscarinic acetylcholine receptors

What are some intestinal complications of Crohn's disease?

Fistulas Strictures (bowel obstruction) Abscesses

How does anterior dislocation appear physically?

Flattening of the deltoid prominence Protrusion of the acromion Anterior axillary fullness (d/t humeral head's movement into this location) Axillary nerve is most commonly injured by anterior should dislocations (innervates deltoid and teres minor muscles, sensory innervation to skin overlying lateral shoulder) Classically follow a blow to an externally rotated and abducted arm

What is the equation to calculate flow?

Flow (Q)= [(P1-P2)x r^4]/viscosity of blood x L r=radius of blood vessel L=length of blood vessel

How does early Lime disease present?

Flu like symptoms Erythema chronicum migrans

What antifungals affect DNA and RNA synthesis?

Flucytosine

How do you treat SIADH?

Fluid restriction, demeclocycline

What is a common side effect of pioglitazone?

Fluid retention, with resultant weight gain and edema pioglitazone is a thiazolidinedione Can exacerbate underlying congestive heart failure

What is the MOA of methotrexate?

Folic acid antagonist that competitively inhibits DHF reductase, which catalyzes the synthesis of tetrahydrofolate DHF reductase inhibition causes the intermediate DHF to accumulate intracellularly (Dihydrofolate polyglutamate accumulates)

How can chemotherapy affect ovarian follicles?

Follicular depletion through accelerated atresia, an apoptotic process

What is the treatment for antifreeze poisoning?

Fomepizole Dialysis Ethanol

What are the key features of ovarian dysgerminoma?

Germ cell tumor Adolescents Increased beta-hCG, increased LDH Histology: "fried egg cells" Malignant

What are the key features of ovarian endodermal sinus (yolk sac) tumors?

Germ cell tumor Increased AFP Aggressive Schiller-Duval bodies resemble glomeruli Malignant

Where is primary TB located?

Ghon foci in the lower lungs

"Soap bubble" in femur or tibia on x-ray

Giant cell tumor of bone (generally benign)

Which protozoa can cause watery diarrhea?

Giardia Cryptosporidium

How does Vitamin C deficiency (scurvy) present?

Gingival swelling/bleeding, petechiae, ecchymoses, and poor wound healing Perifolicular hemorrhages and coiled (corkscrew) hairs are also commonly seen

How is HSV-1 infection characterized?

Gingivostomatitis (vesicles on the lips and hard palate, fever, LAD) Recurrent infection causes lip lesions that are typically less severe due to existing cellular and humoral immunity from prior infection

What forms a scar in ischemic stroke of the brain?

Glial cells (astrocytes)

Pseudopallisading tumor cells on brain biopsy

Glioblastoma

What kidney findings are there in SLE?

Glomerular capillary basement membrane thickening with wire-loop changes

What parts of the kidney are from metanephric mesoderm?

Glomeruli, bowman's space, proximal tubules, loop of henle, and distal convoluted tubule

What activates the F-2,6-BPase domain, which degrades fructose-2,6BP to fructose-6P and driving the cell toward gluconeogenesis?

Glucagon (opposite effect of insulin)

During severe hypoglycemia, what is the best to use for rapid correction of hypoglycemia?

Glucagon- intramuscularly or subcutaneously

What enzyme is preferentially expressed in the liver and pancreatic beta cells, where it plays an important regulatory role in glycogen synthesis and insulin secretion, respectively?

Glucokinase Mutations that impair expression raise the glucose threshold required for insulin release, leading to maturity onset diabetes of the young

What mutation is seen in sickle cell disease?

Glutamic acid (Glu) to Valine (Val) See in DNA and RNA

What are the electrolyte changes in tissue ischemia?

Increased extracellular K+ (via reduced functionality of membrane Na-K-ATPase) Subsequent K leakage from affected cells May reduce extracellular Na, Ca, HCO3 Cytoplasmic Ca accumulation is a hallmark of ischemic injury

What is phenylketonuria?

Inability to convert phenylalanine to tyrosine by the phenylalanine hydroxylase system Classic clinical features= intellectual disability, seizures, light pigmentation, and a "musty" odor

What kind of vaccine is given with human rabies infection?

Inactivated vaccine (postexposure prophylaxis)

What fails in a bicornate uterus?

Incomplete lateral fusion of the paramesonephric ducts

What are communicating hydroceles and indirect inguinal hernias caused by?

Incomplete obliteration of the processus vaginalis Resultant connection between the scrotum and abdominal cavity can allow for fluid leakage (hydrocele) or the passage of abdominal contents (indirect inguinal hernia)

What happens when a tRNA is mischarged with the incorrect amino acid (and not corrected by aminoacyl-tRNA synthetase proofreading)?

Incoporate the wrong amino acid into the growing polypeptide chain

What do IV fludes due to intravascular and LV EDV?

Increase Increase in preload stretches the myocardium and increases the end-diastolic sarcomere length, leading to an increase in SV and CO

What is the mechanism of metabolic syndrome?

Increase in fat increases insulin resistance

How do alpha-adrenergic agonists work?

Increase systolic and diastolic blood pressure by stimulating alpha1-adrenoreceptors in the vascular walls, causing vasoconstriction The elevated systemic blood pressure then causes a reflexive increase in vagal tone, resulting in decreased heart rate and slowed atrioventricular node conduction

What is the MOA of stimulants for ADHD?

Increase the availability of norepinephrine and dopamine in the prefrontal cortex (block reuptake at synapses)

What is the MOA of benzodiazepines?

Increase the frequencing of opening of the CNS GABAa receptor-chloride channels and have anxiolytic, anticonvulsant, and muscle relaxant effects as well as sedative-hypnotic effects

How do IV fluids work to treat hypovolemic shock?

Increase the intravascular and left ventricular end-diastolic volumes The increase in preload stretches the myocardium and increases the end-diastolic sarcomere length, leading to an increase in stroke volume and CO by the Frank-Starling mechanism

How do topical prostaglandins help treat open-angle glaucoma?

Increase the outflow of aqueous humor via the uveoscleral pathway Preferred treatment for open-angle glaucoma

What hemodynamic changes are seen in acute mitral regurgitation?

Increased (very increased) preload Decreased afterload No change in contractile function Increased (very increased) Ejection Fraction Decreased Forward Stroke Volume

How does primary biliary cirrhosis present?

Increased ALP Increased Direct bilirubin (suggests obstruction) Pruritis Fatigue Abdominal pain Hepatomegaly

What does PE show in constrictive pericarditis?

Increased JVD Pericardial knock Pulsus paradoxus Kussmaul sign (due to a paradoxical rise in JVP with inspiration)

What are the symptoms of stimulant withdrawl? (eg, cocaine, amphetamines)

Increased appetite Hypersomnia Intense psychomotor retardation Severe depression ("crash")

How is cerebral blood flow affected with volatile anesthetics?

Increased cerebral blood flow It is an undesirable effect as it results in increased ICP Other important effects of inhalation anesthetics are myocardial depression, hypotension, respiratory depression, and decreased renal function

How are the levels of cholesterol, bile acids, and phosphatidylcholine with gall stones?

Increased cholesterol Decreased bile acids Decreased phosphatidylcholine High bile salts and phosphatidylcholine increase cholesterol solubility and decrease the risk of gallstones

What hematologic finding can be seen in COPD?

Increased erythropoietin production Can cause hypoxia sufficient to stimulate increased erythropoietin production by the cortical cells of the kidney

What ions make the largest contribution to the resting membrane potential?

Ions that are the most permeable to the cell membrane In general, high potassium efflux and some sodium influx are responsible for the value of the resting potential, which is typically about -70mV

What do cerebellar hemisphere lesions typically result in?

Ipsilateral dysdiadochokinesia, limb dysmetria, and intention tremor

What can chronic hemolysis cause?

Iron deposition in the kidney (hemosiderosis)

How do you treat Plummer Vinson?

Iron supplements Surgical resection of webs if iron doesn't work

What is seen in EM of membranouse nephropathy? Immunofluorescence?

Irregular, subepithelial, electron-dense immune deposits of the GBM with moderate effacement of the podocyte foot processes Immunofluorescence demonstrates a diffuse granular pattern of IgG along the capillary

What is the MOA of phenoxybenzamine?

Irreversible alpha1 and alpha2 adrenergic antagonist that effectively reduces the arterial vasoconstriction induced by NE Because it is an irreversible antagonist, even very high concentrations of NE, such as those seen in pheochromocytoma, cannot overcome its effects

How do penicillins and cephalosporins work?

Irreversibly bind penicillin-binding proteins such as transpeptidases

How does Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss) present?

Late-onset asthma Rhinosinusitis Eosinophilia Mononeuritis multiplex due to involvement of the epineural vessels of peripheral nerves is common (asymmetric multifocal neuropathy) p-ANCA positive

How does acetazolamide treat glaucoma?

It decreases aqueous humor synthesis by inhibiting carbonic anhydrase

What is hyperacute rejection?

It is a form of transplant rejection that is usually diagnosed by the surgeon in the operating room when the organ becomes cyanotic and mottled after anastamosis of the donor and recipient blood vessels. Perfusion through the transplanted organ ceases immediately due to antibody and complement-mediated injury to the vascular endothelium with formation of extensive thromboses. Hyperacute rejection is an antibody-mediated reaction (Type II hypersensitivity reaction) caused by preformed IgG antibodies within the recipient that are directed against donor antigens.

What is Zidovudine's MOA?

It is a nucleoside reverse transcriptase inhibitor used to prevent maternal to fetal transmission of HIV during labor (when the mother is not virally suppressed) It is a thymidine analogue that does not have the normal 3'-hydroxyl group found on thymidine. Because new nucleotides are added to growing DNA chains only at the 3'-hydroxyl group, the addition of ZDT into DNA results in chain termination

What HLA is reactive arthritis associated with?

It is a spondyloarthropathy associated with HLA-B27 Can occur following infection with Chlamydia, Campylobacter, Salmonella, Shigella, or Yersinia Presents with sterile arthritis due to deposition of immune complexes

How does morphine work?

It is an opiate analgesic that have a high affinity for the mu receptor, exerting the strongest analgesic effects Bind mu receptors on the postsynaptic membrane, which opens potassium channels and leads to membrane hyperpolarization due to potassium efflux

What is Acute Compartment Syndrome (ACS)?

It is caused by increased pressure within fascial compartments of the limbs, leading to impaired perfusion. ACS can cause severe pain, myonecrosis, and nerve injury. The anterior compartment of the leg, which contains the deep peroneal (fibular) nerve, is the most common site of ACS

What is the function of primaquine in malaria treatment?

It is used to prevent disease relapse by completely eradicating the hypnozoites that are responsible for latent hepatic infection.

What is a common hint in the history for polycythemia vera?

Itchy after hot shower

What is xerosis?

Itchy rash and dry cracked skin Common in older patients during the winter Extracellular ceramides, fatty acids, and sterols in the stratum corneum normally provide a permeability barrier that prevents excessive transepidermal water loss and hinders skin penetration by chemicals and other irritants Patients with xerosis have defects in the stratum corneum permeability barrier

How are babesiosis and Lyme disease transmitted?

Ixodes tick

What pathway is used in GH cell surface receptors?

JAK-STAT pathway Cytokines (eg, interferon) and hematopoietic growth factors (eg, EPO, G-CSF) also use this pathway

What causes polycythemia vera?

JAK2 V617F mutation Renders hematopoietic stem cells more sensitive to growth factors

What virus causes PML?

JC virus

A mutation in what causes polycythemia vera?

Jak 2 mutation

What is the diagnosis with a profound bilateral sensorineural hearing loss and congenital long QT syndrome, which predisposes to ventricular arrhythmias and sudden cardiac death?

Jervell and Lange-Nielsen syndrome (autosomal recessive) Occurs secondary to mutations in genes that encode voltage gated potassium channels

What joints are most likely to develop pathology secondary to an x-linked mutation affecting the PRPP synthetase gene?

Joints

Where in the circle of willis can an aneurysm push on CN III?

Junction of the posterior communicating artery with the internal carotid artery

What is an immature squamos cell with dense, irregularly staining cytoplasm and perinuclear clearing, resulting in a halo? Also has a large pyknotic nucleus where the chromatin has condensed as part of the apoptosis process (giving it a raisinoid appearance

Koilocyte Hallmark sign of HPV infection

What are macrophages in the liver known as?

Kupffer cells

What drugs arent covered by cephalosporins?

LAME Listeria Atypicals (chlamydia and mycoplasma) MRSA Enterococci

What hormone stimulates release of testosterone from Leydic cells of the testes?

LH

How are LH, ACTH, and renin levels affected in 17 alpha hydroxylase deficiency?

LH and ACTH are increased Renin is decreased

What are the clinical criteria for ALS?

LMN symptoms: muscle weakness, atrophy, and fasciculation UMN symptoms: spasticity, hyperreflexia, and pathologic reflexes

What is the preffered treatment of VTE in pregnancy?

LMWH (eg, enoxaparin, dalteparin)

How does abetalipoproteinemia present?

Lab studies show- very low plasma TG and cholestrol levels Chylomicrons, VLDLs, and apoB are completely absent from the blood Fat soluble vitamin deficiency (particularly vit. E) Essential fatty acid deficiency RBCs with abnormal membranes and thorny projections called acanthocytes as well as multiple neruologic abnormalities

Why is it okay to give labetolol instead of metopralol in cocaine OD?

Labetolol is an alpha and beta antagonist If gave metopralol, will cause unnopposed alpha effects- already vasospasming, so very bad!

What is a significant factor in predisposing patients to cervical abnormalities?

Lack of barrier contraception Important in preventing HPV infection

What is the most dominant bacteria of the vagina?

Lactobacillus

What is the treatment for hepatic encephalopathy?

Lactulose Rifaximib- RNA polymerase inhibitor Neomycin

what is the treatment for hepatic encephalopathy?

Lactulose, neomycin, and rifaximin (RNA pol. inhibitor- like rifampin but no CYP450 effects)

What cells of the epidermis have tennis racket shape intracytoplasmic granules?`

Langerhans cells These granules are known as Birbeck granules which are only visible on electron microscopy and have no known function yet

Where do atherosclerotic plaques predominantly develop?

Large elastic arteries (eg, aorta, carotid, and iliac arteries), and in large or medium sized arteries (eg, coronary and popliteal) In humans, the most heavily involved vessel is the abdominal aorta, followed by the coronary arteries, popliteal arteries, internal carotid arteries, and the circle of Willis

What is tabes dorsalis?

Late form of neurosyphilis that causes progressive degeneration of the dorsal columns and dorsal roots of the spinal cord Manifestations= loss of proprioception and vibratory sensation, severe lancinating pains, and sensory ataxia (eg, wide-based gait, positive Romberg sign) Many patients also have Argyll Robertson pupils Increased incidence of syphilis in MSM and HIV infected patients HIV positive patients develop neurosyphilis more rapidly

What is the immune response in lepromatous leprosy?

More disseminated Affected tissues show extensive accumulation of acid-fast bacilli within macrophages and often a TH2 cytokine profile (IL-4, IL-5, IL-10) Patients with lepromatous leprosy develop more numerous, poorly demarcated plaques that are widespread across the body

What is porphyria cutanea tarda (PCT)?

Most common disorder of porphyrin synthesis Late step derangements cause photosensitivity, which is thought to be due to the acccumulation of porphyrinogens that react with oxygen on excitation by UV light Caused by uroporphyrinogen decarboxylase (UROD) deficiency, which is either inherited or acquired, manifesting in presence of iron and of susceptibility factors (alcohol, smoking, halogenated hydrocarbons, hep C, HIV)

What are prolactinomas?

Most common pituitary adenoma and can cause galactorrhea, menstrual irregularities, and infertility in premenopausal women Large ones can cause headaches from mass effect and bitemporal hemianopsia from compression of the optic chiasm

What are hydaditiform moles?

Most common type of gestational trophoblastic disease (GTD) Complete mole is composed of multiple cystic edematous hydropic villi and "bunch of grapes" macroscopic appearance as a result of trophoblastic proliferation

What is Klinefelter syndrome?

Most commonly caused by a meiotic nondisjunction event during parental gametogenesis that results in a 47, XXY karyotype

What is aplastic anemia?

Most commonly due to a toxic effect or autimmune response causing apoptosis of pluripotent stem cells (pancytopenia) Bone marrow biopsy reveals hypocellularity with an abundance of fat cells

What characterizes chronic tic disorder?

One or more motor or verbal tics (but not both) for greater than or equal to 1 year

What happens in carbon tetrachloride poisoning?

Produces free radicals that start a vicious cycle of hepatic injury It is oxidized by P450 oxidase system in liver, forming free radical, which reacts with structural lipids of cell membranes The result is lipid degradation and hydrogen peroxide formation (this is called lipid peroxidation) Peroxides go on to form new radicals, continuing the cycle

What is the medication for acromegaly?

Octreotide

What is the treatment of carcinoid syndrome?

Octreotide

What medication can be given to control symptoms of carcinoid syndrom?

Octreotide (somatostatin analog) Acts on somatostatin receptors and inhibits secretion of many hormones and hormone-like substances

What enters the orbit via the superior orbital fissure?

Oculomotor nerve (CN III), ophthalmic nerve (CN V1) branches, trochlear nerve (CN IV), abducens nerve (CN VI), and superior ophthalmic vein

When do you get an S4 heart sound?

Often in older adults d/t age-related decrease in left ventricular compliance Louder the sound, more likely due to a pathologically stiff left ventricle, which occurs in restrictve cardiomyopathy and in left ventricular hypertrophy following prolonged hypertension Always pathologic in younger patients

What causes necrotizing fasciitis?

Often polymicrobial, but if monomicrobial, Streptococcus pyogenous (group A strep) S pyogenes is a pyrrolidonyl arylamidase (PYR)-positive, beta-hemolytic, G positive cocci that grows in chains

What does HER2 encode for?

Oncogene for a transmembrane glycoprotein with intrinsic tyrosine kinase activity Member of the family of epidermal growth factor receptors

What is associated with HLA-B27?

PAIR Psoriatic arthritis Ankylosing spondylitis IBD Reactive arthritis

What cardiac problem is associated with congenital Rubella?

PDA

What is the MOA of Cilostazol?

PDE inhibitor that inhibits platelet aggregation and acts as a direct arterial vasodilator

What initiates the formation of an atherosclerotic plaque?

PDGF FGF Cause smooth muscle proliferation, get a fibrous atheroma, can rupture and become an embolus

What prostaglandins increase uterine tone?

PGE2 (Dinoprost works here) and PGF2alpha (Carboprost works here) Deliver baby at 9mo. etc. Abortifacent early in pregnancy

How do growth factors stimulate cell proliferation?

PI3K/Akt/mTOR pathway Important for anti-apoptosis, cellular proliferation, and angiogenesis

Omeprazole, lansoprazole, esmoprazole, pantoprazole, dexlansoprazole

PPI inhibitors MOA: Irreversible inhibition of H/K ATPase in stomach parietal cells Use: Peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellinson syndrome, component of therapy for H pylori, stress ulcer prophylaxis Adverse Effects: Increased risk of C diff infection, Increased pneumonia risk, Decreased serum Mg with long-term use

H pylori treatment?

PPI, clarithromycin, and amoxicillin (tetracycline or metronidazole if penicillin allergy/doesn't work) If quadruple therapy- add bismuth sucralfate

What is the most helpful in preventing the systemic complications of corynebacterium diphtheriae?

Primary treatment= antitoxin (passive immunization), which inactivates circulating toxin Antibiotics should also be administered to reduce continued production of toxin

What are the absolute contraindications to the use of OCPs?

Prior history of thromboembolic event or stroke History of an estrogen-dependent tumor Women over age 35 years who smoke heavily Hypertriglyceridemia Decompensated or active liver disease (would impair steroid metabolism) Pregnancy

What does Anti HBS indicate?

Prior immunization or revovery from an earlier HBV infection (distinguish from immunization by a positive anti HBc IgG)

How is ODD different from conduct disorder?

Problematic behaviors are more severe and aggressive in conduct disorder Conduct disorder may exhibit destruction of property, physical aggression, or cruelty toward people or animals, stealing or deceit ODD is more argumentative and defiant toward authority figures

What impairment would occur with a homozygous mutation in methylene tetrahydrofolate reductase?

Problems converting homocysteine to methionine

What drugs can cause drug induced Lupus?

Procainamide Hydralazine Isoniazid Minocycline TNF-alpha inhibitors (eg, etanercept)

What is the major determinant of whether or not a coronary artery plaque will cause ischemic myocardial injury?

Rate at which it occludes the involved artery (slower allows for formation of collaterals) A thin fibrous cap, a rich lipid core, and active inflammation in the atheroma would all decrease plaque stability and thus potentially promote rapid coronary occlusion via superimposed thrombosis if the plaque were to rupture

Where do craniopharyngioma's come from?

Rathke pouch remnants, which is an evagination of the surface ectoder, that lines the fetal oral cavity. This protrusion of the roof of the mouth forms the anterior pituitary gland The posterior lobe of the pituitary forms from an outpouching of the diencephalon (infundibulum) and is derived from neuroectoderm

How is K+ in the tubular fluid normally affected in the thick ascending limb of the loop of Henle?

Reabsorbes K+ via the Na/K/2Cl Approx. 2/3rds of the filtered K+ load is reabsorbed in the PCT Thick asc. limb of loop of Henle further resorbs about 25-30%

What receptor does insulin work on?

Receptor tyrosine kinase Signals to increase the synthesis of glycogen, proteins, fatty acids, and nucleic acids Activates protein phosphatase, an enzyme that dephosphorylates (activates) glycogen synthase

What is Teriparatide?

Recombinant PTH analog that stimulates maturation of pre-osteoblasts into bone-forming osteoblasts Increases GI calcium absorption and renal tubular calcium reabsorption

How do nonsegmented double stranded DNA viruses exchange genetic information?

Recombination Exchange of genes between 2 chromosomes via crossing over within homologous regions Continues to progeny virions

What are the clinical features of panic disorder?

Recurrent and unexpected panic attacks with greater than or equal to 4 of the following: Chest pain, palpitations, SOB, choking Trembling, sweating, nausea, chills Dizziness, paresthesias Derealization, depersonalization Fear of losing control or dying Worry about additional attacks, avoidance behavior

What problems does HIV cause if the neonate is infected?

Recurrent infections Diarrhea

What are the diagnostic criteria for narcolepsy?

Recurrent lapses into sleep or naps (> or equal to 3 times/week for 3 months) Greater than or equal to 1 of the following: Cataplexy: brief loss of muscle tone precip. by strong emotion (eg, laughter, excitement) Low CSF levels of hypocretin-1 Shortened REM sleep latency Associated features: Hypnagogic or hypnopompic hallucinations Sleep paralysis

What nerve travels in close proximity to the inferior thyroid artery and can be injured during thyroid surgery?

Recurrent laryngeal nerve

What are the risk factors of struvite stone formation?

Recurrent upper UTIs Urease-producing organisms (eg, Klebsiella, Proteus)

What is the purpose of cytostatic drugs (eg, mTOR inhibitors) on drug eluting stents?

Reduce smooth muscle cell proliferation Helps prevent neointimal hyperplasia and luminal restenosis following intracoronary stent placement

What change occurs in the postsynaptic muscle cell in myasthenia gravis?

Reduced amplitude of motor end plate potential

What is NADPH necessary for?

Reducing glutathione Biosynthesis of cholesterol, fatty acids, and steroids

What is wet age-related macular degeneration characterixed by?

Retinal neovascularization due to increased vascular endothelial growth factor (VEGF) levels Patients typically have acute vision loss and metamorphopsia with fundoscopy showing grayish-green subretinal membrane and/or subretinal hemorrhage Tx= smoking cessation and VEGF inhibitor therapy

What is subclavian steal syndrome?

Reversal in blood flow from the contralateral vertebral artery to the ipsilateral vertebral artery due to severe stenosis of the proximal subclavian artery May have symptoms related to arm ischemia in the affected extremity (eg, exercise-induced fatigue, pain, paresthesias) or vertebrobasilar insufficiency (eg, dizziness, vertigo)

What type of drugs are used to prevent vertical transmssion of HIV-1?

Reverse transcriptase inhibitors

What finding is most suggestive of strongyloides stercoralis infection?

Rhabditiform larvae in the stool

What is mitral stenosis almost always caused by?

Rheumatic fever

What is the most common cause of mitral stenosis?

Rheumatic fever Characterized by diffuse fibrous thickening and distortion of mitral valve leaflets along with commissural fusion at the leaflet edges

What antibodies are positive in rheumatoid arthritis?

Rheumatoid Factor Anti-CCP antibodies

What embryologic structure is the cerebellum from?

Rhombencephalon

What does synovial fluid look like in psudogout?

Rhomboid shaped pyrophosphate crystals is diagnostic These crystals are positively birefringent under polarized light

What is the diagnosis in an alcoholic or severely malnourished patient with angular stomatits, cheilitis, glossitis, seborrheic dermatitis, eye changes, and anemia?

Riboflavin deficiency

What is characterized by an excess of unmineralized osteoid matrix and epiphyseal cartilage due to vitamin D deficiency?

Rickets Clinical manifestations include frontal bossing, craniotabes, costochondral junction deformity ("rachitic rosary"), and bowed legs

Osteomyelitis in sickle cell

Salmonella

How can salmonella be differentiated from shigella?

Salmonella produces hydrogen sulfide

Why would a patient with pancreatitis have low calcium?

Saponification

Bilateral LAD, uveitis

Sarcoidosis

Glomerulous like structures surrounding vessels in germ cells

Schiller Duval bodies Yolk sac tumor

What is seen on peripheral smear in gram-negative sepsis leading to DIC?

Schistocytes and thrombocytopenia

How do you diagnose Schizoaffective disorder?

Schizoaffective disorder requires that the patient meet the criteria for major depressive or manic episode concurrent with active-phase symptoms of schizophrenia Also requires that delusions or hallucinations occur in the absence of mood symptoms for greater than or equal to 2 weeks at some point during the illness

What neoplasm shows a biphasic pattern of cellularity and S-100 positivity?

Schwannoma Can arise from peripheral nerves, nerve roots, and cranial nerves Acoustic neuromas most common type of intracranial schwannoma and are located at the cerebellopontine angle at CN VIII

Anti-centromere

Scleroderma (CREST)

What is important to assess prior to initiating pharmacologic treatment in a major depressive episode?

Screen for past history of manic episodes to differentiate MDD from bipolar disorder

What is CMV colitis?

Second most common reactivation syndrome after CMV retinitis Patients have fever, anorexia, weight loss, and abdominal pain. Pain may be vague initially but becomes more localized as the disease progresses Colonoscopy shows mucosal erythema, erosions, and ulcerations Biopsy reveals acute and chronic inflammatory changes, vasculitis, and giant cells with large, ovoid nuclei containing centralized intranuclear basophilic inclusions Herpesvirus family

What can unilateral renal artery stenosis cause?

Secondary hypertension in 2-5% of HTN patients Kidney affected by the stenosis may become atrophied d/t oxygen and nutrient deprivation

What phase of syphilis is condyloma lata seen in?

Secondary syphilis Smooth, painless, wart like lesion

What type of neoplasms are people with familial retinoblastoma at risk for developing?

Secondary tumors, especially osteosarcomas, later in life

How do Dihydropyridine calcium channel blockers (eg, amlodipine, nifedipine, felodipine) work?

Selective for the smooth muscle of the peripheral vasculature rather than the myocardium, making them excellent arteriolar vasodilators that have minimal effect on ventricular contractility or heart rate Major effect: lower systemic blood pressure and decrease afterload- net effect on cardiac work is an overall reduction

What is Ivabridine?

Selective inhibitor of funny sodium channels (If), prolonging slow depolarization phase (phase 4) Decrease SA node firing, negative chronotropic effect without inotropy Reduces cardiac O2 requirement

What drugs are used to treat cholinergic toxicity (DUMBELS)?

Selective muscarinic antagonists (eg, glycopyrrolate, hyoscyamine, propantheline) Used to reduce side effects of cholinesterase inhibitors in sites where Ach action is mediated by muscarinic receptors

How do opioids work?

Selectively bind G protein-coupled receptors, mimicking the actions of endogenous opioid peptides However, long-term activation of mu-opioid receptors on nociceptio-trasmitting neurons is associated with increased pain sensitivity (central sensitization)

What can staph aureus cause after terminating a pregnancy?

Septic abortion Risks= pregnancy termination with retained products of conception

Which medication inhibits lymphocyte proliferation by blocking interleukin-2 signal transduction?

Sirolimus Targets the mTOR signaling pathway, an important stimulator of cell growth and proliferation Binds to the immunophilin FK-506 binding protein (FKBP), forming a complex that inhibits mTOR This leads to interruption of IL-2 signal transduction, preventing G1 to S phase progression and lymphocyte proliferation

How is skeletal muscle not affected by verapamil?

Skeletal muscle is resistant to calcium channel blockers Calcium release by the sarcoplasmic reticulum is triggered by a mechanical interaction between L-type and RyR calcium channels

What does presbyopia share its etiology with?

Skin wrinkles Both are age-related changes Occur 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 development of skin wrinkles

What diagnostic study helps diagnose Wilson disease?

Slit lamp exam

What is the morphology of histoplasma?

Small oval yeast within macrophages

What are the histologic exam findings of serum sickness?

Small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration Deposition of IgG and/or IgM complement-fixing antibodies results in localized complement consumption and hypocomplementemia

What are cherry hemangiomas?

Small, red, cutaneous papules common in aging adults Do not regress spontaneously and typically increase in number with age LM shows proliferation of capillaries and post-capillary venules in the papillary dermis

What are actinic keratoses (AKs)?

Small, scaly, erythematous lesions with a sandpaper texture occurring on sun-exposed areas Show hyperkeratosis (hyperplasia of the stratum corneum) Parakeratosis (retention of nuclei in the stratum corneum) Atypical keratinocytes with pleomorphic nuclei and multiple mitoses Small percentage of AKs progress to invasive squamous cell carcinoma; therfore, frequent monitoring is necessary

What is the most important intervention to lower risk of MI?

Smoking cessation

What cells are responsible for biliary colic after administration of mu opioid analgesics, such as morphine?

Smooth muscle cells in the sphincter of Oddi, leading to spasm and an increase in common bile duct pressures

In vaso previa, what does the heart rate look like?

Tachy/bradycardia- alternates

What is characterized by chronic, large artery vasculitis that primarily involves the aorta and its branches which presents with constitutional symptoms and arterio occlusive findings in patients age <40?

Takayasu arteritis Histo shows granulomatous inflammation of the vascular media

What is the clinical presentation of Klinefelter's?

Tall stature, small and firm testes, azoospermia, and gynecomastia Mild intellectual disability is seen in some patients, and the severity generally increases with each additional X chromosome

How is gynecomastia treated?

Tamoxifen Inhibits effect of estrogen on breast tissue

What is first line for BPH?

Tamsulosin

What does finasteride do?

Targets peripheral conversion of testosterone to DHT by inhibiting 5-alpha-reductase

What are lymphoblasts in precursor B-ALL positive for?

TdT, CD10, and CD19

What do stressful situations like infection, pain, and sleep deprivation do to glucose levels?

Tend to increase them and cause hyperglycemia

What do you want to check when giving magnesium sulfate for Pre-eclampsia/eclampsia?

Tendon reflexes- could be hyporeflexive

Which rotator cuff muscle is responsible for adduction and external rotation?

Teres minor

What drug can increase the risk of osteosarcoma?

Teriparatide

What do the embryonic testis secrete?

Testosterone and Mullerian inhibiting factor (MIF) MIF is responsible for regression of the paramesonephric (mullerian) ducts that normally give rise to the internal genitalia of the female fetus

What neurotransmitters are affected from tetanus toxin?

Tetanus toxin is a potent metalloprotease exotoxin that first binds to receptors on the presynaptic membranes of peripheral motor neurons. From there, it migrates by retrograde axonal transport to central inhibitory neurons in the spinal cord and brain stem and prevents release of inhibitory neurotransmitters glycine and gamma-aminobutyric acid (GABA).

What is the difference between the pneumococcal conjugste vaccine and the pneumococcal polysaccharide vaccine?

The conjugate vaccine induces a more robust immune response through B and T cell activation

What is impaired in vitamin D synthesis in chronic kidney disease?

The conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D Phosphate retention and hypocalcemia also results due to failure of glomerular and tubular function Leads to a compensatory rise in PTH

What are the histopathologic findings of Primary biliary cholangitis (PBC)?

Variable but typically show patchy lymphocytic inflammation with destruction of intrahepatic bile ducts, and necrosis and micronodular regeneration of periportal tissues Granulomas and bile staining of hepatocytes are common findings

What nerve can be damaged in an orbital blowout fracture?

The infraorbital nerve Damage can result in paresthesia of the upper cheek, upper lip, and upper gingiva

What amino acid is the last one translated?

The last codon before the stop codon Stop codons do not add amino acids Translation of the template proceeds in the 5" to 3' direction (Read template in 5' to 3') Makes protein in 3' to 5'

What does the musculocutaneous nerve innervate?

The major forearm flexors (eg, biceps brachii, brachialis) Coracobrachialis (flexes and adducts the arm) Provides sensory innervation to the lateral forearm Derived from the upper trunk of the brachial plexus (C5-C7) and can be injured by trauma or strenuous upper extremity exercise

How is the intrinsic pathway of apoptosis activated?

The mitochondria becomes more permeable and pro-apoptotic substances are released into the cytoplasm in response to stress or the cessation of survival signals Once the cell is exposed to stress or cessation of survival signals, the anti-apoptotic proteins Bcl-2 and Bcl-x that reside in the mitochondrial membranes and cytoplasm are replaced with pro=apoptotic proteins such as Bak, Bax, and Bim The pro-apoptotic proteins allow for the increased permeability of the mitochondria, which results in the release of caspase-activating substances like cytochrome c

What is a glioblastoma?

The most common primary cerebral neoplasm of adults that is typically located within the cerebral hemispheres and may cross the midline ("butterfly glioma") These tumors are highly malignant and grossly contain areas of necrosis and hemorrhage

What are G protine coupled receptors that stimulate hydrolysis of membrane bound phospholipids via phospholipase C a part of?

The phosphatidylinositol second messenger system Increases cytoplasmic free calcium through IP3 mediated calcium efflux from the ER

How can congenital long QT syndrome progress?

The prolongation predisposes to the development of life-threatening ventricular arrhythmias (eg, torsades de pointes) that can cause palpitations, syncope, seizures, or sudden cardiac death

What is ornithine transport into mitochondria necessary for?

The proper function of the urea cycle Major disposal pathway for waste nitrogen generated by catabolism of amino acids

What drugs cause cutaneous flushing (Van Cen)?

Vancomycin Adenosine Niacin Calcium channel blockers Echinocandins Nitrates

What drug is a partial agonist of nicotinic acetylcholine receptors that can assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewarding effects of nicotine?

Varenicline

What happens to E-cadherin levels in tumor cells?

Usually decrease

What is thromboangiitis obliterans (Buerger's)?

Usually seen among heavy cigarette smokers with onset before age 35 Associated with hypersensitivity to intradermal injections of tobacco extracts This segmental thrombosing vasculitis often extends into contiguous veins and nerves, encasing them in fibrous tissue

How does Progressive Multifocal Leukoencephalopathy present?

Usually seen in immunocompromised HIV, lymphoma or leukemia) patients Caused by JC polyoma virus Patches of demyelination due to the preferential infection of oligodendrocytes is the primary pathologic effect

What causes chronic non-atrophic gastritis affecting the gastric antrum?

Usually the result of H pylori infection Associated with increased risk of peptic ulcer Involvement of the gastric body in longstanding infection is associated with an increased risk of gastric adenocarcinoma and mucosa- associated lymphoid tissue (MALT) lymphoma

What age do patients present with cystine stones?

Usually young children due to it being an inherited problem Problem reabsorbing COLA (Cystine, Ornithine, Lysine, and Arginine)

What is the most common cause of post partum bleeding?

Uterine atony (lacking tone)

What is the triad of reactive arthritis?

Uveitis Urethritis Arthritis Triggered by urogenital and gastrointestinal infections "ChiC puSSY" Chlamydia Campylobacter Shigella Salmonella Yersinia

What substances drive angiogenesis?

VEGF and FGF VEGF increases endothelial cell motility and proliferation, new capillaries begin to sprout FGF2 is involved in the promotion of endothelial cell proliferation, migration, and differentiation

Adrenoleukodystrophy

VLC fatty acid accumulation. enlarged adrenals. no calcifications Damage to myelin sheath- can lead to seizures (peroxisome disorder)

Most common cardiac anomaly

VSD

Holosystolic murmur

VSD, tricuspid regurgitation, mitral regurgitation

How do you decrease the incidence of congenital rubella syndrome?

Vaccination of children and non-pregnant females of childbearing age with live, attenuated rubella virus vaccine

What is Mullerian aplasia?

Vaginal agenesis or Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome Variable uterine development and no upper vagina (eg, short vagina) Patient cannot menstruate Normal ovaries so regular development of secondary sexual characteristics due to normal estrogen secretion

What are the clinical features of partial moles?

Vaginal bleeding Crampy abdominal pain Normal uterine size Normal to high beta-hCG levels

What are the clinical features of complete moles?

Vaginal bleeding Enlarged uterus inconsistent with dates Extremely high beta-hCG levels that can cause: Hyperemesis gravidarum Pre-eclampsia Hyperthyroidism Theca-lutein cysts

Metabolism of what produces propionyl-CoA?

Valine Isoleucine Methionine Threonine Odd chain fatty acids

What amino acid change is seen in sickle cell disease?

Valine substitution for glutamic acid

What medication is an effective maintenance treatment of bipolar disorder?

Valproate

What cardiac findings can be seen in carcinoid syndrome?

Valvular fibrous plaques (right>left) Description= endocardial thickening with dense fibrous deposits around the tricuspid and pulmonary valves as well as moderate pulmonary valve stenosis- left heart is normal