uworld

COX2

"Bad" COX; mediates inflammation by IL1 AND TNF alpha, pain perception, mediates fever; inhibition by celecoxib decreases inflammation(IL1) and TNF alpha, pain and fever by inhibiting COX2 production of arachidonoic acid metabolites may stimulate cancer formation and progression

wrist bones mnemonic

"So Long To Pinky, Here Comes The Thumb" Scaphoid Lunate Triquetrum Pisiform Hamate Capitate Trapezoid Trapeium

RRR (relative risk reduction)

(control abs risk- treatment abs risk) / contr absolute risk

Enterobius vermicularis RX

(pinworm) Rx entire family aBendazoles or pyrantel pamoate preffered for pregnant pt

alveolar ventilation

(tidal vol - deadspace) x breath/min is the vol of new air reaching the gas exchange areas ie alveoli and respiratory bronchioles

Vasculitis (inflammation of the vessel wall- arterial/vein wall)

*3 layers: intima(endothelial cells),media, adventitial. *pt will have s/s of organ ischemia as a result of endothelial cell damage=esposure of subendothelial collage and tissue factor= coag cascade= thrombusformation. or bld vessel wall fibrose after inflammation- narrowed lumen=dec bld flow to a organ

Aminoglycosides s/e

- Ototoxic / Nephrotoxic / Neurotoxic - Photosensitivity - Superinfection - Nausea / tremors * Give other antibiotics 1 hour before/after oral aminoglycosides * Gentamycin, Tobramycin, Streptomycin

Hypertensive nephrosclerosis

- seen in patients with chronic hypertension. prolonged elevatn of BP causes renal arterioles to undergo compensatory "medial hypertrophy" and "fibrointimal proliferation". endothelial damage leads to deposition of plasma proteins and BM material in the arteriolar walls (hyaline arteriolosclerosis). lumen will narrow= restrict renal bld flow, glomerular ischemia and fibrosis(glomeruloscerosis) with collapse of the capillary loops and thickening of bowman capsule. affected kidnewy will show mild renal atrophy with finely granular surface

Small vessel vasculitis

- wegener granulomatosis:nasopharynx, lung,.cANCA elevated - churg-strauss syndrome:pANCA.granuloma, asthma, eosinophilia - microscopic polyangiitiss:p ANCA, no granuloma, no asthma, no peripheral eosinophilia

Torsades de pointes causes

--Hypokalemia -Hypomagnesemia hypocalcemia -Prolonged QT interval

Coronary steal syndrome

-Distal to coronary stenosis, vessels are maximally dilated at baseline. Administration of vasodilators (e.g., dipyridamole, regadenoson) dilates normal vessels and shunts blood toward well-perfused areas ➡⬇ flow and ischemia in poststenotic region. -An alteration of circulation patterns lead to a reduction in the blood directed to the coronary circulation caused when there is narrowing of the coronary arteries and a coronary vasodilator is used - "stealing" blood away from those parts of the heart. This happens as a result of the narrowed coronary arteries being always maximally dilated to compensate for the decreased upstream blood supply. = -Thus, dilating the resistance vessels in the coronary circulation causes blood to be shunted away from the coronary vessels supplying the ischemic zones, creating more ischemia -Principle behind pharmacologic stress tests.

Daptomycin

-Lipopeptide antibiotic that disrupts cell membrane of gram-positive cocci including MethicillinResistanceSA), VancomycinResistanceEndocarditis moa: is by disrupting the bacterial mem by crating transmembrane chanel that cause intracellular ioin leakage. it cannot pemeate the outer membrane of gram negative so it is ineffective in treatment of gram-neg infectn. it also binds to and is inactivated by pulm surfactant so it is ineffective rx for pneumonia -s/e: myopathy, rhabdomyolysis.

Liddle syndrome

-Mimics hyperaldosteronism -AD -Decreased degradation of Na channels in collecting tubules called ENaC -Presnts as HTN, hypokalemia, metabolic alkalosis in young -Low aldo and low renin( but in hyperaldo- aldosterone will be high) -Tx: (amiloride or triamterene) to block Na channels that is not degraded; not spironolactone

Parotid Gland Tumor - symptoms? and it can compress

-Non-tender, mass in superficial part of gland -Facial nerve palsy causing facial droop

thigh claudication

-Suggestive of occlusive dz of the ipsilateral distal External Iliac or Common Femoral Artery disease

Eisenmenger syndrome

-Uncorrected left-to-right shunt (VSD, ASD, PDA)= RV hypertrophy/pulm arterial hypertension. RVH occurs to compensate shunt becomes right to left. -Causes late cyanosis, clubbing (see picture), and polycythemia.

Pilocytic astrocytoma

-benign tumor of astrocytes -MC CNS tumors in children -usu arises in cerebellum -PIC - CT - cystic lesion with mural nodule growing on wall -PIC - HISTO - Rosenthal fibers - thick eosinophilic processes -GFAP pos aka: pillow that has rose with hair like process (GFAP)

p value is less than

0.05

0.89 of a test correctly testing neg cos pt dont have the dz, what is the probability that if 8 new pt that are also negative, will be tested negative

0.89x 0.89... all the way for 8 times meaning 0.89 raise to power 8. but the probability that atleast one person will be negative is 1- 0.89 raise to power 8 note: the probability that the test will be positive even tho the 8 ppl are negative for dz is 0.11 raise to power 8.

Koilocytes- sign of HPV

1-4 skin warts(verruca vulgaris) 6-11 - genital warts(condylomata acuminata) 16-18 cervical,vagina, vulvar and anal nepoplasia

Pathophysiology of HF

1. <CO= activation of sym nerv sys and RAAS.= > peripheral vascular resistance(vasoconstriction) and > retention of sodium/water in the kidney >ADH and > total body water 2. ANP release due to stretch in the myocyte wall= constrict eff and dilate aff. it counters RAAS

major risk factors for developing AAA abdominal aortic aneurysm

1. age >65 2. smoking 3. male sex

how to read ECG

1. are p wave present; y: lead 11,11,F. 2. is it regular or irreg: distance btw qrs (R-R interval)- no Pwave and its ireg ireg- atrial fib 3. is QRS wide or narrow. nl is 3 box/120ms. if wide= bundle branch bloc. qrs facing up- RBBB, facing down is LBBB or ventircular tachy 4. check PR interval. nl 1 box . short in symp tone long in vagal tone or AV block 5. QT interval. long is hypocalcemia- tentany short in hypercalcemia- confusion 6. ST segment st elevation: transmural ischemia st depression: subendocardial isch, T WAVE peak in hyperkalemia u wave in hypokalemia

medication and osteoporosis

1. ca & vit d 2.bisphosphonate-alendronate: inhibit osteoclast-mediated bone resorption 3. denosumab: binds RANK-L and inhibits binding to RANK 4. recombinant PTH analog(teriparatide): stimulates maturation of preosteoblast into bone forming osteoblast. incr GI ca absorption and renal tubular ca reabsorption

acute heat failure

1. diet 2. poor medicine compliant diet: >Na intake= > plasma osmo= > adh = > Pulm edema= HF 3. nsaid = inhibit COX= < prostaglandins =which was suppose to maintain renal perfusion = more retention of water/salt in the body

factors that promote edema

1. elevated capillary hydrostatic pres 2. dec plasma oncotic pressure 3. sodium and water retention 4. impaired lymphatic drainage

2 classes of dopamine agonists

1. ergot compound derived from ergot fungi( bromocriptine) 2. nonergot compund( eg prmipexole, ropinirole) they treat parkinson dz bromocriptine also treats hyperprolactinemia

2 types seizure

1. focal: if it orginate from a localized region of one crebral hemisphere 2. generalized: if the involve both hemisphere focal is divided into 2 simple: if pt is conscious thru the seziure complex: if pt is unconscious

cause of pancreatitis

1. gallstone 2. alcohol abuse= ast >alt and incr MCV

A FIB treatment

1. hrt rate control:BB. CCB, digoxin 2. hrt rhythm control: cardioversion: diffilbralator- shock the hrt or ibutilide 3. anticoagulation: warfarin,apixaban, dabigatran, aspirin

effect of hypothyroidism on serum lipid cos this pt has fatigue, weight gain, goiter, elevated TSH, low throxineT4

1. hypothryroid causes decr LDL receptor expression, leading to decreased clearance of LDL, resulting in incr bld LDL level. 2. hypothyroidim also decr LDL receptor activity and biliary excretion of cholesterol. 3. hypertriglyceridemia also occur due to decr expression of lipoprotein lipase

Kimmelstiel-Wilson nodules characteristic

1. located in the peripheral mesangium 2. ovoid or spherical shape 3. lamellated appearance 4. eosinophilic(hematoxylin and eosin stain) 5. periodic acid- schiff positive KWN are diagnostic for nodular glomerulosclerosis, which is characterized by glomerular basement mem thickening and increased mesangial matrix deposition. overtime expansion of the mesangium and KWN formation compress the glomerular capillaries and cause loss of glomerular function. leading to proteinuria- nephrotic syn

Acute HF tx

1. loop diu: Na K 2Cl inhbited = > urine output of Na/water. s/e over diures: remove too much fluid: hypok, renal failure, hypotension 2. metolazone: thiazid like drug: Inhibit Na/cl reabsorption. s/e; hypok 3.nitrate: venous dilate= pull bld away from LV- improve dyspnea. s/e headache(meningeal vasodilation) 4. ACE inhibitor, hydralazine = afterload reduction= CO > 5: beta 1 : incr contractility in systole. no function in diastole 6. milrinone:

platelet plug formation after injury in the vessel to prevent bleeding

1. plate adhesion: via vwf acting as a connector that binds platelet to underlying collage 2: platect ecome activated and secret substance like adenosine diphosphate, ionized calcium, fibrinogen, alpha from alpha and delta granules 3. thromboxane A2 but so there is no too much platelet to the point it blocks the vessel prostacyclin (prostaglandin I2)

distant tumor can metastasis in liver becos

1. presence of fenestrated hepatic sinusoidal epithelium which allow tumor cell to easily pass from bloodstream thru to the parenchyma 2. dual blood supply from the portal and systemic circulation. which incr the likelihood of circulating tumor cells depositing in the liver

VALVE LESION CAUSE

1. rhematic fever: weeks after strep pharyngitis, autoimmunetype 2 hypersensitivity rxn. antibodies to bacterial M PROTEIN cross react to protein of the heart. mitral valve is affected years after infection 2. carcinoid Hrt dz: carcinoid tumor of the intestine secreting serotonin. fibrous deposit in tricuspid/pulm valves

AML translocation

1. t(15,17) trans retinoic acid receptor

maneuvers of heart

1. to incr preload/venous return a. leg raise: blood will fall back toward heart b. squatting: bld in the leg is forced back to the hrt 2. decr preload/VR A. Valsalva: incr intra thoracic pressure- vein compression in the thorax- bld doesnt return to the heart. standing: blood falls toward feet 3. incr afterload: hand grip decr afterload: amyl nitrate/vasodilator

3 nucloside analogs antiviral drugs

1. viral dependent nucleoside: acyclovir, valacyclovir, famciclovir, ganciclovir 2. nucleotides: cidofovir, tenofovir and foscarnet 3. cell dependent nucleoside : zidovudine lamivudine # 1 needs virus kinase to be activated but pt with varicella zoster virus with AIDs tends to be thymidine-kinase deficient making them acyclovir resistant. so # 2 drug is good for such pt.

Skull foramen mnemonic

1.Ant crainal fossa:cleaners mIddleCF only spray smelly stuff right on smelly post. CF:idiot in jail just jump high

medium arteries vasculitis

1.PAN: most organ but lung is spared. ass/w HBsAg. string of pearls appearance on imaging: cos of fibrinoid necrosis after transmural(dilation/pearls) inflammation= heal to be fibrosis(string)- making the node. biopsy: fibrinoid necrosis(pink around the wall).RX: corticosteroid 2.KAWASAKI: coronary a. involve- thrombus- 4Y/O with MI. 3.buerger dz:

diabetic neuropathy pathogenesis

1.accumulation of glycosylationn end products and sorbitol- altered metabolism and incr oxidative stress 2. occlusion of vasa nervorum with nerve ischemia 3. length dependent axonopathy

Rapid Progressive Glomerulonephritis RPGN has 3 types

1.anti-GBM RPGN: linear GBM deposit of ifG and C3. in some pt anti GBM cross react with pulm alveolar BM producing pulm hemorrhage(good pasture synd) 2. immune comples rpgn: lumpy-bumpy granular pattern of staining for both igG, igA and fo complement. 3. pauci-immune rpgn: there are no immunoglobulin or complement deposit on the BM. most pt have elevated antineutophil cytolasmic antibody ANCA

GABA A receptors

1.benzo bind to GABA A receptors, resulting in an incr freq of chloride channel opening. this is why its good for short term treatment of anxiety and alcohol withdrawal synd 2.barbs: incr the duration of of opening of the GABA A recep- cl channel in th epresence of gaba. although it has anxiolytic properties, we dontuse it for anxiety treatment bcos it induces fetal resp depression

testicular cancer types

1.germ cell tumor(95% are seminomatous or nonseminomatous (embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed) 2. sex cord-stromal tumors which are setoli cells, leydig incr AFP, B-HC, LDH age 15-35

3 Vascular Tumors

1.hemangioma: benign tumor of bld vessel, it regress during childhood, blanches 2.angiosarcoma: endothelial cell that line the bld vessel is malignantly proliferation, ass/w PVC, arsenic and thorotrast exposure. dont blanch 3. kaposi sarcoma: low grade malignant proliferation of endothelial cell. ass/w HHV8. purple pathches, plque, nodule on skin. dont blanch AIDS pt, transplant pt.

cervical intraepithelial neoplasia

1.high grade:atypical cell invaded beyond lower one-thrid of the cervical epithelium 2.low grade: cells have not invaded pass the lower one third of the cervical 3.cervical carcinoma: invade basem

common cause of vertigo

1.meniere dz= hear loss 2.BPPV(otoliths in semicircular canals)= head movement 3.vestibular neurits(labyrinthitis)= no hearing loss

cardaic tumor

1.myxoma:mcc in LA, sound of tumor plop risk is emboli causing stroke, MR, HF, MS. Pt dies suddenly and autopsy found myxoma=obstruction of MV. 2. rhabdomyoma: tumor of muscle cell. children, can be seen prenatally, ass/w tuberous sclerosis. TSC1= hamartin TSC2= tuberin 3.metastatic tumor

hypertension

1.salt intake: body secrete adh to have bring water to balance the sodium = > BP= bld vessel become sick= atherosclerosis= lipid/fibrous plaque. pulse pressure > bcos aretery bcome stiff= < in compliance

eating disorder treatment

1.team approach help client regain control and restore nutritional health anorexia nervosa: olanzapine bulimia nervosa: SSRI( Fluoxetine) binge-eating disorder: weignt loss therapy, SSRI, lisdexamfetamine

mother = 1/30 carrier freq father- 1/100 carrier freq what is the probability that baby will have CF

1/4 X 1/30 X 1/100= 1/12000

Subacute sclerosing panencephalitis SSPE

10 y/o recently moved to USA has ataxia, myoclunus and visual problem. his parent says he began acting strangely and difficult walking to school few month ago. lab shows brain biopsy show an RNA virus containing hemgglutinin

ischemic stroke

12-24 red neurons(eosin, pyknotic nuclei. loss of nissl substance) 24-72- neutrophil 3-7 macrophage/microglia 1-2wk reactive gliosis, liquifactive 2wk-mo glial scar- cystic area

non-Hodgkin's follicular lymphoma translocation

14:18; BCL2 is 18 move to immunoglobulin heavy chain promoter region on chrm 14

CFTR

3 base pair deletion in CFTR gene at amino acid position F508; this mutiaon impairs "post translational processing of CFTR, resulting in shunting of CFTR toward the proteasome, with complete absence of the protein on the cell surface. elevated sweat Cl- conc are found in the pt.

MEN1

3p Parathyroid(renalstone-ca), pancreatic endocrine, and pituitary tumors(prolactinoma,bitemporal visual field defect), pt will be clumsy , falling/bumping to stuff due to optic chaism

B-thalassemia

4 y/o male autopsy include bone deformities/ hepatosplenomegaly. clumps of erythroid precursor cells are found in liver and spleen. the presence of erythroid precursors in organs such as liver and spleen is indicative of extamedullary hematopoiesis, which is caused by sever chronic hemolytic anemia such as b thalassemia chipmunk faces bcos maxillary overgrowth and frontal bossing

ADHD should not be dx until age

4-5yr

ANTIDEPRESSANT TAKES

4-6wks to achieve maximal effect

Ventricular free wall rupture happens

5 days to 2wks, autopsy show slitlike tear in the anterior lft ventricular wall consistent with free wall rupture ; a complication of transmural MI. hypotension= shock= cardia arrest

# of vocabulary for age 2

50-200 words and able ot use 2-word phrase or else the pt has an isolated language disorder if her motor and social skillare normal

Burkitt translocation

8:14 c-myc moves to a region near the immunoglobulin promoter site

CML translocation

9; 22 form bcr-abl fusion gene

major depressive disorder

> 2wks and >5 symptom

Valvular A fib

A FIB cause of a pt has rheumatic heart dz= mitral stenosis= very high risk of thrombus= not easy to treat unlike normal A FIB

Hawthorne effect

A change in a subject's behavior caused simply by the awareness of being studied. dr started taking sexual history of pt bcos they know they are being studied

Corynebacterium diphtheriae

ABCDEFG ADP-ribosylation Beta-prophage AB exotoxin Corynebacterium Diphtheria Elongation Factor 2 Granules that stains with aniline dye its a non motile, uncapsulated gram positive rods. v & Y shaped chains S/S sore throat, fever, pharyngeal exudates/coalescing pseudomembrane complication: pseudomembrane aspiration= suffocation and diphetheria toxin can go to the brain and heart- myocarditis, HF and neurologic toxicity. diphteria exotoxin inhiubits host cell protein syntehsis by catalyzing the ADP ribosylation of host cell EF2

macrolides are

ACE arythromycin, clarithromycin, erythromycin

ACE-I side effects

ACE prevent conversion of ANG1 to ANG II, so efferent arteriole is not constricted , thus decr GFR in the pt. doctor are usually not concern about the decr GFR in this case but if creatinine begin to increase then they pay attention. pt also have hyperkalemia and cough

SA node action potential and adenosine

ACH and adenosine reduce the rate of spontaneous depolarizatio in cardiac pacemaker cells by prolonging phase 4

Cushing syndrome symptoms

ACTH is major horm of the zona fasciculata and reticularis, whereas zona glomerulosa is regulated by Ang II exess productn of ACTH will increase cortisol -cushing dz and incr androgen- irregular menstruation,hirsutism in women)

FAP (familial adenomatous polyposis)

AD, caused by germline mutation to tumor suppressor gene. pt have hundred or thousands of colonic polym lifetime risk of colon cancer is 100%

primary adrenal insufficiency PAI

AKA addison dz abdominal pain, weight loss, pt will be salt craving, orthostasis and dizziness on standing, electrolyte disturbance. PAI result from autoimmune destruction of bilatral adrenal cortex - which produce aldosterone, cortisol, androgens

Gaucher disease

AR,lysosomal storage dz, caused by b- glucocerebrosidase β- def. → ↑ glucocerebroside accumlation *aseptic necrosis of femur*, Gaucher cells (lipid-laden Mφ's, crumpled tissue paper), hepatosplenomegaly, spleen liver enlarge

Xeroderma pigmentosum

AR; defect in nucleotide excision repair enzymes; ↑ risk for UVB light cancers

arteriovenous(AV) shunt result in formation of AV fistula

AV fistula is an abnormal communication btw an artery and a vein dat bypasses the arterioles(which is the major source of riesistance in vascular system). because of the bypass total peripheral resistance is reduced, thus decreasing afterload as well. AV shunt incr preload and decr afterload by routing bld directly to venous. high volume AV shunt can everntually result in high output cardiac failure. inc EDV

AP in SA node,AV node

AV node phase 4 is slower. verapamil/diltiazem slows L Type ca channel = slow heart rate AND slow AV node conduction beta blocker: slow phase 4=Na =low HR

Abacavir hypersensitivity reaction is ass with

Abacavir is an NRTI use to treat HIV. It can sometimes have a hypersensitivity which is an allergic reaction that is strongly associated with HLA-B*57:01 allelle. pharm

Neuroleptic Malignant Syndrome

Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes. unlike serotonin synd wehre pt will be hyperreflexia, myoclonus)

bipolar 2 disorder

Alternation of major depressive episodes with hypomanic episodes (not full manic episodes). hypomanic means incr activity, energy and confidence, decreased need for sleep

Class 3 antiarrhythmics

Amiodarone, ibutilide, dofetilide, sotalol; K channel blockers; inc. AP duration and QT interval

Ranolazine

Antianginal Agent: inhibit late sodium current. s/e prolong QT = torsarde de point

widened pulse pressure

Aortic regurgitation rapid distension and collapse of the carotid arteries(corrigan sign) and a "to and fro" bruit seen over the femoral arteries (duroziez sign)

Hairy Cell Leukemia

B-cell neoplasm is seen in males with massive red pulp splenomegaly, produces dry tap, and stains + (TRAP). recent dx is by bone marrow biopsy and flow cytometry and lymphocytes with cytoplasmic projection Tx: 2-CDA (adenosine deaminase inhibitor)

role of beta receptors

B1: in heart and kidney a. inc HR and contractility b: stimulate renin release c. block <CO, <bp b2: found peripherally- dilate bld vessel in muscle liver, bronchodilate the lung. have no effect on HPN

BRAF mutation

BRAF is a protein kinase involved in activating the signaling pathways of melanocyte proliferation. mutation is V600(VALINE TO GLUTAMIC acid) seen in 40-60% of pt with melanoma leads to greatly increased activation of the signaling pathway for melanocyte growth, survival and metastasis.

Thoracic Aneurysm

Balloon-like dilatation of the thoracic aorta.= weakness in the wall= pt has tertiary syphilis= inflammation of the vasav asorum at the advertitial(outer layer of bld vess)= tree bark appearance of aorta( fibrosed) *** aneurysm closer to the aortic root will pull aortic valve causing insufficiency, compression of mediastinal structure, and thrombosis due to loss of lamellar flow- thrombus embolise

Follicular adenoma of thyroid

Benign tumor of thyroid Proliferation of follicles surrounded by capsule NO invasion. but normal follicular tissue is seen on biopsy

osteonecrosis of the jaw is s.e of

Bisphosphonates another adverse effect is medication induced esophagits- pt having trouble swallowing

Abciximab

Blocks glycoprotein IIa/IIIb receptor to decrease platelet binding to fibrinogen. GP2B/3A is either def or defective not with glanzmann thrombasthenia

Absent of bicept reflex

C5-C6 spinal nerves mediate the biceps and brachioradialis reflexes

Fragile X Syndrome

CGG repeat on FMR1 gene on the long arm of X. this leads to "hypermethylation and inactivation of FMR1, preventing transcription and production of frag x mental retardatn protein. thereby impairing neural development

risk of stroke

CHADS Score >2 must start warfarin. >1 must start aspirin CHF(1 point) HTN(1P Age>75(1p) diabetes(1p) h/o stroke(1p)

normocytic normochromic anemia + chronic kidney dz

CKD pt has fatigue, dyspnea as GFR declines and this is due to damaged EPO erythropoietin. EPO is a glycoprotein hormone produced by peritubular gibroblasts in the renal cortex in response to tissue hypoxia. EPO tells bone marrow to stimulate RBC differentiation and survival. RX: synthetic epo: epoetin, darbepoetin

Fick Principle on cardiac output

CO= rate of O2 consumption/ arterio- venous O2 content

CysteineOrnithineLysineArginine amino acid

COLA share a common transporter in the intestinal lumen and kidney. in pt with cystinuria the transporter is defective resulting in impaired renal and intestinal absorption of these AA= cystine kidney stone flat yellow hexagonal

Dystrophic calcification

Calcium deposits on dead tissues in the setting of normal serum calcium and phosphate it is considered a hallmark of cell injury and death and it occur in all kind of "necrosis "eg coag, fat, caseous, liquifactive

first generation antihistamine and s/e

Chlorpheniramine and diphenhydramine fuctions to relieve allergic symptoms caused by histamine from mast cell. s/e: anticholinergic, antiserotonergic, anti-alpha adrenergic anticholinergic effect on the ocular ciliary muscle impair accomodation and cause blurring of vision in close object

dematitis herpetiformis assocw celia dz histology

DH: erythematous pruritic papules, vesicles, and bullae microabscesses containing fibrin and neurtophils at the dermal papillae tip celiac: incr intraepithelial lymphocytes, loss of villus height, and crypt hyperplasia leading to malabsorptn pathogenesis: formationof IgA antibodies against gliadin or a gliadin tissue transglutaminase complex in the intestine

DMARDs

DMARDs are methotrexate(typically first-line), sulfasalazine, hydroxygloroquine, miocycline and TNf-alpha inhibitors. the pt has swelling, pain, and morning stiffness in multiple joints for 6wks or more, consistent with rheumatoid arthritis.

PNH (paroxysmal nocturnal hemoglobinuria)

DUE to complement - mediated hemolysis. mutated PIGA posphatidylinositol gylcan class A WHICH helps GPI glycosylphosphatidylinositol. this protein help attach DAF, cd59 that inactivate complement. loss of anchor for DAF CD55(decay accelerating factor) along with CD 59 (MAC-inhibitory protein Intrinsic defect, intravascular hemolysis =breakdown of iron containing erythroctes can also lead to iron depositon in the kidney(hemosiderosis).

mc of peripheral polyneuropathy

Diabetes M. pt feel numbness and parestehsias in a stocking- glove distribution and decr proprioception due to degeneration fo large fiber sensory axon

Superior vena cava syndrome

Dyspnea, cough, venous congestion, swelling of head, neck upper extremities,

Neonatal meningitis

E. coli is a frequent cause. second is group B strep. this ecoli strains possess the K1 capsular antigen. which is a virulence factor that allows the bacteria to survive in the bldstream and estab lish meningeal infection.

s/e of EPO treatment

EPO stimulate erythrocyte production. as iron is rapidly consumed to make red bld cell pt must e given iron supplement to prevent the iron def anemia

self limited Travellers diarrhea is caused by:

ETEC, gram negative,motile, enteric rod, it colonizes and adhere tosmall intestine mediated by pilli. the subsequent elaboration of plasmid-encoded heat labile LT and or heat stable ST enterotoxin result in the typical manifestation of abdominal cramping, nausea/vomit and low fever. LT enterotoxin resembles cholera toxin in structure and mode of action, bcos it increases intracellular CAMP in gut mucosal cell by activating the Gs ST is not in- incr CGMPactivated by heat

chronic pancreatitis

Epigastric pain and pancreatic exocrine insufficiency resulting in fat malabsorption/steatorrhea- greasy smelly stool.

Wolff-Chaikoff effect

Excess iodine in our diet temporarily inhibits thyroid peroxidase ➡ ⬇ iodine organification ➡ ⬇ T3/T4 production. this is done to protect us from excess thryoid hormone from salt intake. this si how amiodarone causes hypothytroidism by wolff chaikoff effect

Colchicine side effects

Extremely diarrhea and GI pain. nausea Myelosuppression if long term.

antibiotic follows first order kinetics and has a vd of 70L AND CL OF 0.5L/MIN, how much should be adminishtered every 6hrs to maintain a therapeutic stready state plasma conc of 4mg/l?

F= bioavailability which will be 1 if drg is administered intravenously. 4x0.5/1 =2mg/min when administered at 6hrs = 2x 60min/hr x 6hr =720mg

squatting

FORCES MORE BLOOD INTO THE HEART FROM INCREASED ARTERIAL RESISTANCE AND BP . preload rises- size LV INC- less obstruction- dec murmur sound HELPS IDENTIFY MITRAL VALVE PROLAPS, HYPERTROPHIC CARDIOMYOPATHY, AND AORTIC STENOSIS

PDA (patent ductus arteriosus)

Failure of the ductus arteriosus(sixth aortic arch) to close after birth, allowing blood to flow from the aorta into the pulmonary (lung) artery left to right shunt can cause LV vol overload and symptoms og HF. p.e continous machinery like murmur and palpable thrill OVER the left infraclaviculr region due to turbulent bld flow thrU the PDA Indomethacin drug therapy or heart surgery to prevent CHF, emboli. May have no cyanosis.

Water deprivation test

First stage: deprived of water for 2-3 hrs; body weight and osmolality are measured every hr, if urine continues to be diluted and weight loss occurs DI is suspected. Second stage: patient receives ADH, urine is tested an hour later, if NDI, the kidneys will not respond and urine still dilute. if CDI urine osm will increase.

filteration rate

GFR/RPF RPF= RBF*(1-hematocrit) p- plasma B-blood

Antiemetic Therapy and moa

GI irritatio eg infection, chemo, distention result in incr mucosa serotonin release and activation of 5-HT receptors on vaga and spinal afferent nerves sending impulses to medulary vomiting center causing emesis RX: 5-Ht recept antagonist eg ondansetron

what GI ulcer is not malignant

GI ulcer is a breach that extend through the muscularis mucosa into the submucosa or beyond. duodenal ulcer is not ass with an increased risk of carcinoma but esophagus, stomach(gastric) and colon may be malignant and biopsy is required

Large vessel arteritis

Giant cell arteritis: carotid artery but Takayasu's arteritis: is more proximal to the aortic arch , weak or absent pulse in an upper extremity- pulseless dz. they are both similar so diffrentiating them is important

visual pathway

H. posterior cerebral artery occlusion MCA occlusionis contralateral homonymous hemianopia with macula involvement

cardiorespiratory response to exercise

HR, CO, RR will incr but PaO2 PaCO2 will remain the same cos HR and CO increase to meet the incr tissue oxy demands and the RR incr to eliminate the additional carbon dioxide produced

VSD murmur

Holosystolic, harsh-sounding murmur Loudest at tricuspid area/ at the mid to lower left sternal border. it accentuates during maneuvers that incr afterlaod like handgrip.

Hashimoto's thyroiditis

Hypothyroidism, diffuse goiter histo: consist of an intense lymphocytic/plasma cells infiltrate, often within the germinal centers and residual follicles are often surrounded by hurthle cells (large oxyphilic cells filled with granular cytoplasm) that represent follicular epithelial cells that have undergone metaplastic change in response to inflammation

Acute pulmonary embolism effect on RV

I thought it was RV wall thickening but its RV cavity enlargment. pulm arterial resistane will incr= RV press incr= RV cavity enlargement due to incr RV wall tension and cardiac muscle strentching= demand more o2 for the wall= not enuf leads to ischemia of RV wall. RV failure caused by an icr in pulm vascular resistance is sometimes called cor pulmonale

what increases erythrocyte sedimentation rate

IL6- which stimulate acute phase reactant(eg C-reactive protein, fibrinogen) and IL1

Henoch-Schonlein Purpura

IgA-anti-IgA immune complexes -> palpable purpura bleeding on the skin on buttocks/legs, kidney: heamaturia IgA nephropaty ,, arthritis. ***pt has upper resp tract infection- generate high level of IgA which deposit- causing vasculitis.

Incidence vs. Prevalence

Incidence = new cases Prevalence = all current cases

S3 heart sound

Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles

T3 and T4 synthesis

Iodide is taking up by folicular cell-- oxidized to I2-- added to organic/carbon structure(organification). --clo4= perchlorate or pertechnotate - -TPO(thyroid peroxidase) funcion is to oxidation of iodide, organification of iodine into MIT/DIT, coupling of MIT/DIT into T3,T4. --thats why TPO antibodies common in autoimmune thyroid dz.

Jod-Basedow phenomenon

Iodine-induced hyperthyroidism. many pt are iodine deficient so introducin iodine will cause hyperthyroidism. opposite to wolff chaikoff effect

erythropoietin signal transductionis mediated by

JAK2/STAT which promote erythrocyte precursor survivor

Kussmaul sign? in Konstriction and restriction

Kussmaul's sign suggests *impaired filling of the right ventricle* due to either fluid in the pericardial space or a poorly compliant myocardium . incr JVP with inspiration Constrictive pericarditis, restrictive cardiomyopathy

pt stop taking anticoagulant durg. had stroke, LA enlarge, mild mitral regurge. what caused the thromboembolic and whats the source

LA appendage. atrial fibrillationis ass/w risk of systemic thromboembolism and the LA appendage is teh most common site of thrombus formation

coronary arteries occlusion

LAD occlusion: result in ST elevation in V1-V4 RCA: can result in transmural ischemia of the inf wall of the left ventricle, producing ST elevatkion in leads II, III, and aVF

ovarian follicle

LH: stimulates the theca interna cells of the ovarian follicle to produce androgen then aromatase within the granulosa follicle convert androgen to estradiol under FSH FSH : stimulation. theca external cells serve as a conn tissue support structure for the follicle

fall onto an outstretched hand FOOSH

Lunate dislocation will result in compression of the median nerve eg wrist pain , numbness in the first 3and half digits

brachial plexus

MARMU

Urothelial (Transitional Cell) Carcinoma

MC type of bladder Ca. painless gross heaturia lab: malignant epithelial cells are pleomorphic and have hyperchromatic nuclei. an increased nuclus/ cytoplam ratio major risk factor is smoking and occupational exposure to rubber. plastic. aromatic amine- containing dyes, textiles, leather

systolic HF

MCC : MI: myocyte are replaced by scar tissue leads to ischemic cardiomyopathy

multiple myeloma and calcium

MM is ass/w incr bone resorption due to the production of tumor-related cytokines. this results in elevtd serum calcium levels, which reduce PTH production, low PTH decreases renal calcium reabsorption(hypercalciuria) and in combination with renal insufficeincy - reduces 1,25 dihydroxyvitaminD synthesis

3 causes of holo"systolic"/ pansystolic murmur

MR, TR, VSD

Multiple Endocrine Neoplasia Type

MTC: medullary thyroid cancer MEn2 is caused by RET mutation

mitral regurgitation

MVP: causes systolic click and it leads to MR (holosystolic murmur)

Fibromuscular dysplasia

Most commonly affects renal artery and carotid artery. medial layer fibroplasia, string of beads. cos of aneurysms and stenosis= present young woman with no heart dz

SE of statins

Myositis Hepatitis Increased liver enzymes so check hepatic transaminases AST ALT and liver function test

what microbial component can cause DIC

N meningitidis has an outer cell mem virulence factor called lipo-oligosaccharide LOS(are endotoxin found in gram negative enteric rod). endotoxi bind to toll-like receptor 4 on monocytic and dendritic and trigger the release of inflammatory cytokines eg; IL1 IL6 TNF-alpha which leads to endothelial damage, capillary leakage

PCP (phencyclidine) intoxication

N-methyl-D-aspartate(NMDA) GLUTAMATE RECEPTOR antagonist. pt will be violent, hallucinating, memory loss, nystagmus

pelvic exam and nucleic acid amplification testing is positive, pt has mucopurulent discharge or post coital spotting

N.gonorrhea and chlamydia trachomatis- cause cervicitis which cause pelvic inflammatory dz RX ceftriaxone, azithromycin

Arteriolosclerosis

Narrowing of small arterioles 2 type: hyaline or hyperplastic ***hyaline: benign HTN and diabeties. consequencies: end organ ischemia, clasically produce glomerulus scaring- cos of thicken aff bld vessel wall- dec glomerus bld supply- glom scar- chron kid. failure *** hyperplastic: thickening due to hyperplasia- muscular cell layers, dec blood flow- due to malignant HTN. narrowing- cause end organ ischemia-acute renal failure

sevelamer

Non-absorbable phosphte binding polymer that decreases absoroption of phosphate in GI tract. use in hyperphosphotemia in Chronic kid dz

stable angina is all about

O2 demand. treat pt with drug that will lower heart o2 demand with nitrate and beta blocker,CCB . nitrate: pull blood to the veins BB: dec contractility, slow HR; this will give time for preload/filling time and also dec afterload CCB: verapamil,dialtizem: are negative inotropes and dec HR/contractility

3rd degree AV block

P wave independent of QRS.but nL RR interval ass/w lyme dz

How is pseudomonas resistance to aminoglycoside?

P.AERUGINOSA has multiple mechanisms of Ab resistance but with gentamicin, it uses antiobiotic modifying enzymes which is adding chemical group like acetyl, adenyl, phosphate gentamicin. thus altering the drug so it has reduced ability to bind to 16s ribosomal RNA within 30s ribosomal subunit

posterior cruciate ligament damage

PCL prevent posterior displacement of the tibia relative to the femur. it originates from the anteriolateral surface of the medial femoral condyl and insert into the post intercondylar area of the tibia, its integrity can be tested in the clinical seting by using the posterior drawer test.

physical exam shows toe cyanosis and clubbing in a pt that says he cannot keep up with other student on playground cos he get tired he is 10y/o

PDA eisenmenger synd is reversal of shunt flow from left to right to rt to left if it was tetralogy of fallot it will result in whole body cyanosis

boy, gets tired quickly from playing with friends. P.E shows toe cyanosis and clubbing but no figer abnormalities, all extremities apulse are full and equal . dx

PDA patent ductus art.. differential clubbing and cyanosis without bp or pulse discrepancy are signs of PDA complicated by eisenmenger syn(reversal of shunt flow from left to rt to R-L )

opportunistic infection in HIV

PNEUMOCYSTIC JIROVECCI- 200 toxoplasma gondii- 100 mycobacterium avium comples- 50

5y/o cyanosis with minimal exertion, occasionaly episodesof turning blue that began during infancy but now occuring more frequently. boy assumes a squating position as it make him feel better. prominent rt ventricular impulse and harsh systolic murmur is heard on P.E

PT present with cyanotic spell that imprve with squatting, prominent rt ventricular impulse and systolic murmur = tetralogy of fallot. abnormal neural crest cell migration leads to ant and cephalad deviation of the infundibular septum during embryologic development causing mal-aligned VSD and overriding aorta note: he squatt to incr systemic vascular resistance & dec rt to left shunting-hy

osteoporosis table

PTH and calcium will be normal. the have low bone mass,

proximal muscle weakness affecting upper and lower extremitis without significant pain, trouble walking up stairs, removing object out of overhead cabinet. biopsy:

Polymyositis(anti-Jo-1, anti-histidyl-tRNA biopsy: patchy endomysial inflammatory infiltrate i.e direct invasion of individual muscle fibers. whereas dematomyositis causes perifasicular inflammation( localized around bld vessels and the septa btwn muscle fascicles)

primary vs second TB vs miliary

Primary TB: causes ghon complex in the lower lung secondary TB: reactivation of TB occurs often in immunosuppressed and it is apical cavitary lesion and hemoptysis 3. milary TB: hematogenous spread causing pott dz, TB meningitis

Coxiella burnetii

Q fever is a infection that occurs in farm workers exposed to waste from attle ad sheep. pt will develop nonspecific illness myalgias, fatigue, fever>10 days, retoorbital headache with incr liver enzyme

RBF (renal blood flow)

RBF= RPF/(1-HCT) RPF aka PAH clearance = (urinePAH* urineflowrate)/plasmaPAH

night mares, dreams, muscle atonia

REM

Countertransference

Refers to the nurse's/doc behavioral and emotional response to the client

Renal bruit

Renal artery stenosis cause hypertension. its usally unilateral and the one normal kidney is trying to compensate by reducing renin and <Na. the narrowed one: recieve decr bld flow= secrete renin= inCr BP both kidne y cause euvolumic issue. if aff is narrowed. eff will constrict(ang 2) so bld can back up to glomerulus. thats why pt cant be on ACEI bcos it will decr the ang2 that the need to maintain GFR

Contraction band necrosis

Return bld to damage myocyte- results in calcium influx, leading to hypercontraction of mUSCle fiber- dense pink line

reperfusion injury

Return of blood to ischemic tissues causes oxygen derived free radicals, further damaging tissues = cardiac enzyme continue to rise

NSAIDs(naproxen and indomethacin) MOA for gout

Reversibly inhibit COX-1 & COX-2 Block prostaglandin synthesis and exert a broad anti inflammatory efect that includes inhibiton of neutrophils. if nsaid is contraindicated colchicine is used- will inhibit neutrophil chemotasix and phagocytosis

Tamoxifen, raloxifene

SERM -are comp inhibitor of estrogen binding to est receptors. they can have agonist and antagonist effects depending on the tissue. tamoxifen has an estrogenic effect on the uterus and cause= edometiral hyperplasia and cancer raloxifen: does not have the risk and is good for pt with osteoporosis

woman pt with sharp chest pain that radiate to left shoulder(pericarditis). she had facial rash 6mo ago, she has proteinuria in her last clinic appointment.. dx

SLE

SLE hypersensitivity

SLE is an autoimmune against blood cell antigens(type 2 hypersensitivity) and can cause pancytopenia(ie thrombocytopenia, leukopenia, anemia). in contrast, lupus nephritis is caused by immune complex deposition( type 3 hypersensitivity) in the glomeruli

OCD treatment

SSRI; is the first line of treatment pt need serotonin

Cardinal vein gives rise to

SVC, BE able to identify on pic

IgA protease Who secretes it?

Secreted by S. pneumoniae, H. influenzae, and Neisseria to prevent phagocytosis this enzyme cleaves secretory igA at its hinge region, rendering it ineffective. igA AB usually bind to pili and other membrane proteins involved in bacterial adherence to mucosa thus inhibiting mucosal colonization

Ivabradine

Selectively inhibits funny sodium channels, thereby prolonging the slow depolarization phase (phase 4) and slowing the SA node firing rate (HR). No effect on contractility (inotropy) and/or relaxation. giving to pt who cannot take beta blocker

hypertensive emergency- hy

Severe HTN, elevated BP >180/120 with end-organ damage(eg renal). in the kdney this present as malignant nephrosclerosis, characterized by 1. fribrinoid necrosis and 2. hyperplastic arterioloscleosis( onion skin"_) . a microangiopathic hemolytic anemia can occur due to erythrocyte fragmentation and platelet consumption at the narrowed arteriolar lumen

Hirschsprung disease

Submucosal (Meissner) and Myenteric (Auerbach) autonomic plexi are absent in the affected segment of the bowel *Submucosa of the narrowed area is the most superficial layer where the absence of ganglion cells can be seen

sparse tranverse tubules

T-tubules transmit depolarization signals to the sarcoplasmic reticulum to trigger the release of calcium and induce muscle contraction sparse= fewer t- tubule leads to uncoordinated contraction of myofibrils which manifest as muscle weakness

True Negative (TN) vs FP

TN= specificity * (# of pt without the dz) FP=(1-specificity)*(#of pt without the dz)

insulin resistance is caused by

TNF alpha, is a proinflammatory cytokine that induces insulin resistance thru the activatieon of serine kinases, which then phosphorylate serine residues on the beta subunit of IR and IRS-1. this inhibit tyrosine phosphorylation ofIRS1 by IR and hinders downstream signaling resulting in resistance to normal actions of insulin. IRS: insulin receptor substrate

a pt being treated with RA with adalimumab a TNF alpha inhibitor is infected with histoplasma on a trip to ohio

TNF-alpha inhibitor will increase the risk of infection with intracellular bacteria and granulomatous fugi egi histoplasma. histoplasma replicates within the intracelulluar space of macrophages and can spread to lungs, lymph nodes and reticuloendothelial system (liver, spleen, bone marrow)

True Positive (TP) and false negative

TP= (sensitivity) * (# of pt with the dz) FN: (1-sensitivity) * (# of pt with the dz) sensitivity =75% aka 0.75 specificity is 85 % aka 0.85 600 pt but 200 is confirmed to have the dz

Obesity hypoventilation syndrome

The combination of: 1. obesity (body mass index above 30 kg/m2), 2. hypoxia (Po2 is low;falling oxygen levels in blood) during sleep, and 3. PCO2 is high hypercapnia (increased blood carbon dioxide levels) during the day, resulting from hypoventilation (excessively slow or shallow breathing).

IL4 is produced by

Thelper2 , it facilitates proliferation of B cells and Th2 lymphocytes and stimulates antibody idotype switching to igE which mediates type 1 hypersensitivity allergic reaction

vasculirization of neoplastic tumor is by

VEGF & FGF

loud, blowing holosystolic murmur at the mid to lower left sternal border not detectable at birth but bcos audible days after birth

VSD

Measles treatment

Vitamin A pt will have history of fever, cough, congestion, conjunctivits-red eye followed by maculopapular rash- measles, spread through droplet ,start in the face and spread cephalocaudal and centrifugal pattern. erythematous blanching maculopapular lesions often progress to deep red or brown non blanching rash

Carcinoid tumor

What neuroendocrine tumor produces excess serotonin; is associated with diarrhea, flushing, bronchospasms, wheezing; and is diagnosed by findings of elevated urinary 5-HIAA levels? it is comonly located in GI- small intestine, rectum appendix

Metalloproteinases

ZINC containing enzymes that degrade the extracellular matrix and basement memb for tumor invasion. tumor cell detach from surrounding cell: e-cadherins adhere to bm: laminin invade the bm via proteolytic enzymes eg metalloproteinase

Lipomas

a benign tumors that arise from the subcutaneous fat and present as soft, mobile masses tht are stab le or enlarge slowly overtime, the dx is made clinically, but histopalthology shows well-differentiated, mature adipocytes with a fibrous capsule

glioblastoma

a brain neoplasm, present with headache, seizure and focal neurologic issues. ass/w oncogenic mutation that increase EGFR epidermal growth factor recp. expression on the tumor cells. leading to incr transduction of growth signals that promote cellular survival and proliferation

a tight shirt collar

a carotid sinus is . dilation of the internal carotid artery located just above the bifurcation of the common carotid art. afferent travels to the vagal nucleus and medullary centers via CN 9, eff carries para sympathetic impulse via CN 10

Oppositional Defiant Disorder

a childhood disorder in which children are repeatedly argumentative and defiant, angry and irritable, and in some cases, vindictive

epidural hematoma

a collection of blood in the space between the skull and dura mater its, bone dura, arachinoid, pia mater fracture of the pterion regionof the skull and rupture or tear of the middle meningeal artery- transient loss of conciousness- lucid period. as the hematoma expand pt will have ICP elevated intracranial pressure

othostatic hypotension

a common adverse effect of anti-hypertensive medications alpha 1 blocker and ACEi

ecythema gangrenosum

a cutaneous necrotic dz associated with pseudomonas aerugionosa. it occus from perivascular invasion and release of tissue destrutive exotoxins. causing vascular destruction and insufficeint blood flow to patches of skin that bcome edematous and then necrose

varicose veins

a dilated, tortuous vein, usually in the superficial veins of the leg, caused by chronically incr intraluminal pressure and/or loss of tensile strength in the vessel wall leading to incompetence fo venous valves. complication include stasis dermatitis, skin ulcerations(U.W), poor wound healing and infection. WHILE INTERMITENT CLAUDICATION: is deep artery affected, atheroscleorotic plaque in the artery, cause decr bld flow, which will lead to intermittent claudication aka ischemic muscle pain,-- hair loss at the leg- dec peripheral pulses, cool, dry shiny skin, thick brittle nails, and ultimately gangrene and small deep ulcer

conversion disorder

a disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found

H PYLORI

a motile, spiral shaped, gram negative bacteria foun attached to the gastric mucosa . it protect itsefl form gastric acid by producing urase. which converts urea to ammonia to alkalinize the surrounding PH but injures gasteric epithelial cell.

Thyroglossal duct cyst

a palpable cystic midline mass in the neck due to persistent remnant of thyroglossal duct. painless, discorver in childhood. move up w. swallowing or tongue protrusion

schizoid personality disorder

a persistent pattern of social detachment, preference for solitary activites and limited emotional expressivity.

deleterious remodelling

a pt that has decr CO in heart failure will triger compensatory activity like activationof the sympathetic nervous sys, and RAAS pathway, resulting in vasoconstriction(incr afterload), whhic will lead to fluid retention(inc preload) and over time this adaptation will maintain CO & BP but after a while adverse consequences occur that will deteriorate the cardiac funtion called deleterious cardiac remodelling= a downward spiral of cardiac deterioration leading to symptomatic decompensated HF

Pure red cell aplasia PRCA

a rare form of bone marrow failure- inhibition of erythropoietic precursor and progenitor by auto-immune or ab or cytotoxic T lymphocytes. A Pt BM biopsy shows absence of erythroid precursors but preserved myeloid and megakaryoctyic

zolpidem

a short acting nonbenzo hypnotic agent. like benzo it bind to GABAa

Clostridium botulinum

a spore-forming gram positive anaerobe bacillus that synthesize botulinum toxin which prevent presynaptic release of ACH from the nerve terminal at the NMJ; commonly inhabits soil and water. it is used to Rx focal dystonia and other abnormal muscle contraction

two sample t test

a statistical method used to compare the "means of 2 groups of subjects" if they are equal. If p <0.05, the null(which assumes that there is no difference btwn 2 group) is rejected and the means are assume to be statistically different.

Cryptogenic stroke. CS. this pt had stroke, couldnt speak, weak, talk

a stroke of unknown origin, it is evaluated with bubble study to identify right to left intra cardiac shunts. normal saline is injected and microbubbles in the left heart is observed. CS is usually ass/w ASD, "patent foramen ovale"-hy - during fetal development the foramen ovale shunts oxygenated fetal bld across from the rt to the left atrium. after delivery/umbilical cord clamping and decr pulm vascular resistance lower rt atrial pressure and raise left atrial pressure. this pushes septum primum agains septum secundum, closing the FO. it remains close as long as LAP remain higher than RAP but condition that raise RAP above LAP eg valsalva produce a transient R-L shunt across the PFO- stroke with pt wit hypecoagulability eg(taking OCP) as they are at incr risk for venous thrombosis and paradoxical brain embolism.

Ethylene glycol poisoning

a toxic alcohol found in antifreeze, engine coolant, brake fluid. pt will initially have ethanol intoxication then have signs of acute renal failure- oliguria, flank pain develop around 24-72 hrs after ingestion. EG itself is not toxic but it is metabolized to glycolic acid and oxalic acid. glycolid acid causes ATN oxalic will crystalize and cause tubular obstruction.

ventricular tachycardia

a very rapid heartbeat that begins within the ventricles

Sciatic Foramen

a; greater SF B;sacrospinous lig D: lesser SF C: sacrotuberous lig. " the PIRIFORMIS passes thru the greater SF and is involved in external hip rotation. this muscle injury or hypertrophy can compress the sciatic nerve i the foramen causing piriformis synd: tingling, pain, nubness in the bottock

Atherosclerosis most likely form in

abdominal aorta and coronary artery

myxomatous degeneration

abnormal accumulation of proteoglycans and alterations in collagen predispose pt to develop aortic aneurysm. can be seen in marfarm synd

diverticulosis

abnormal outpouchings in the intestinal wall of the colon due to icr intraluminal pressure causing herniation, complication include diverticular bleeding(vasa recta penetration) and diverticulitis(trapped food). risk factor include diet high in red meat and fat and low in fiber as well as obesity, physical inactivity and smoking. S/S : abdominal pain(usually in the left lower quad) fever, nausea vomiting diarrhea/constipation alteration

Migrane therapy is 2

abortive medication and preventive medication 1. abortive are triptans(sumatriptan) nsaid ,acetaminophen , antiemetics(metoclopramide, prochlorperazine) and ergotamines preventive: anticonvulsants(topiramate or valporate) beta blocker antidepressands(TCA or venlafaxine)

pt taking clozapine need monitoring of

absolute neutrophil count due to risk of life threatening agranulocytosis

pt taking clozapine shud be monitored due to

absolute neutrophil count due to the risk of life threatening agranulocytosis

cardiovascular manifestation of lupus include

accelerated atherosclerosis, small vessel necrotizing vasculitis, pericarditis, libman-sack endocarditis(small sterile vegetations on both side of the valve)

orthostatic hypotension drug

ace inhibitor also cause it

Aldosterone

act on renal cortical collecting duct tofacilitate the exchange of Na for K and H in the tubular fluid excess productn of aldo cause renal Na retention and excess urinary H and K resulting in hypokalemia, metabolic alkalosis and hypertension(incr Na reabsorptn and bld vol.). the electrolyte abnormalities can cause paresthesias and muscle weakness

kidney response to hypovolemia

activation of renin angiotensin aldosterone system and increased ADH release. this results in icr renal sodium, cl, water and urea reabsorption wit incr potassium excretion

pt with alcohol, IV drug abuse has evidence of alcoholic liver dz. his hematemesis, orthostatic sym, normocytic anemia are due to acute bleeding from

acute bleeding from esophageal varices. iron depleted but pt still ahve normal MCV. thrombocytopenia due to decr platelet production, incr destruction and splenic sequestration. portal hypertension due to fibrosis of intrahepatic vessel obstructing flw thru the liver= splenic vein is affected(splenomegaly)= red pulp will be expanded

pt has fever, anorexia/nausea, dark colored urine and upper quad abdominal tenderness is highly suggestive of

acute viral hepatitis. hep A virus is most likely resoponsible as it is the mcc of this case in a young adult tht just traveled to an endemic region eg mexico. pt will have hepatocyte necrosis and apoptosis with mononuclear infliltration. hepatocyte necrosis is characterized bycellular swelling and cytoplasmic emptying eg ballooning degeneration, caused by ATP depletionand disruption of the intermediate filament network

nonsmoker woman, weight loss cough and pleural effusion has what lung cancer

adenocarcinoma o fthe lung. its the mc l.c in the general population. epidermal growth factor recep. EGFR mutation and ALK gene rearrangement are seen more commonly in nonsmoker

sudden cessation of exogenous corticosteroid can precipitate

adrenal crisis, aderenocortical unsufficiency

Cilostazol

agents that incr intra platelet cAMP levels decrease platelet aggregation by preventing platletlet shape and granule release. cilostazol Inhibits platelet cAMP PDE3(enzyme responsible for breaking down camp)-->increased cAMP-->increased PGI2 synth and decreased TXA2 synth-->vasodilation and decreased platelet agg/thrombi Use - tx of *claudication* in pts with Peripheral Art Dz

pediculus humanus capitis and Rx

aka head lice infestation from school children, homeless adult Rx: topical pediculicides- permethrin, ivermectin

familial chylomicronemia syndrome definition and test

aka type 1 hyperlipoproteinemia: AR, caused by lipoprotien lipase LPL def. LPL is normally bound to heparan sulfate on the vascular endothelium allowing it to interact with chylomicrons and VLDL in the circulation and release free fatty acid into the adjacent tissue TEST: heparin administration releases these endothelium bound lipases, allowing LPL activity to be measured in the lab. if there is no sufficient LPL activity, the body is undable to clear dietary lipid due to defective hydrolysis of serum triglyceride (especially chylomicrons)

what is the earliest manifestationof diabetic nephropathy

albuminuria. screening for db neph is best achieved using an albumin-specific urine assay (regular dipstick urinalysis has low sensisitivity) ace inhibitor will reduce pt progression of DN

Rx for Conn's Syndrome (primary hyperaldosteronism)

aldosterone secreting tumor is a adrenal mass - present with hypertension, hypokalemia, metabolic alkalosis and decreased plasma renin activity Rx is spironolactone and eplerenone which are aldosterone antagonist

orthostatic hypotension medications

alpha 1 adrenergic antagonist(terazosin, doxazosin are used for sypmtomatic BPH), diuretics hypovolemia due to hemorrhage, hyperglycemia moa: volume depletion and autonomic dysfunction are common cause of orthostatic hypo

BPH and HTN tx

alpha1 blocker- doxazosin prazosin

MEDULLOBLASTOMA

also in the cerebellum like pilocytic but it is not cystic like pilocytic astocytoma; children; solid lesion that can compress the 4th ventricle causing hydrocephalus. small round blue cells & Homer-Wright rosettes; poor prognosis, spreads via CSF aka rosset the cleaner is at home

Serotonin Syndrome

altered mental status, autonomic hyperreactivity and neruomuscular excitatio eg hyperreflexia, clonus causes include high dose of SSRI and MAO1 tryptophan is serotonin precursor

dullness on percussion, 99 in normal voice sound has higher clarity and intensity

alveolar "consolidation " occur when alveoli bcom filled with fluid eg inflammatory exudate in bacterial pneumonia. incr tactile fremitus(vibration). unilateral alveolar consolidaton: bacterial pneumonia- exudate bilateral: transudation caused by heart failure

Torsades de pointes causes

amiodarone and other class3 and class1A antiarrhthmic agent manifest as QT interval prolongation

pt overdosed on what. s/s skin is flushed, oral mucosa is dry and pupil aer dilated and poorly responded to light

amitriptyline symptoms are anticholinergic toxicity. fever, delirium, mucosa and axillary dryness, flushing, non reactive mydriasis, urinary retention

multiple myeloma pt have greater risk for amyloidosis explain

amyloid light chain amyloidisis i sass/w myeloma and other monoclonal plasma cell dyscrasias due to the deposition of insoluble immunoglobulin light chain fibrils in major organs eg kidney, heart, neurologic sum

Baclofen

an agonist at the gaba B REceptor, is effetive as monotheraphy for the treatment of spasticity secondary to both brain and spinal cord dz, including multiple sclerosis. tizanidine, an alpha2 adrenergic agonist is also effective and commonly used

Pudendal block

an anesthetic administered to block sensation around the lower vagina and perineum injecting an anthesthtic intravaginally

Hashimoto's thyroiditis

an autoimmune disease in which the body's own antibodies attack and destroy the cells of the thyroid gland. anti TPO, anti-thyroblobulin. HISTOLOGy: massive lymphocytic infiltrate(germianl centers) hurthle cells( enlarged eosinophilic follicular cells)

Paraneoplastic cerebellar degeneration

an autoimmune phenomenon where our own cells attacking small cell cancer of the lung attack the cerebellum. it didnt get to the crebellum thru metastasis

Abetalipoproteinemia

an inherited inability to synthesize apolipoprotien B, an important component of chylomicrons and VLDL. thus lipids absorbed in the small intestine cannot be transported into blood and therefore it accumulates in enterocytes, intestinal epithlium resulting in enterocytes with clear or foamy cytoplasm. the picture shows normal intestinal mucosl architecture but the enterocytes contain lear or famy cytoplasm(arrows) which is prominent at the tips of the villi

HMO (Health Maintenance Organization)

an insurance with a low monthly premiums, low copay and deductibles, and low total cost for the pt. they confine pt to a limited panel of providers , requiring referral from primary care provider prior to specialist consultations and denying payment for service that do not meet established guidelines

Flutamide MOA

androgen receptor antagonist use to treat prostate cancer

Cavernous carotid aneurysm

aneurysm in the cavernous segnent of the internal carotid artery can compress nearby structure causing unilateral, throbbing headache and cranial nerve deficit CN VI compression or stretching results in ipsilateral lateral rectus weakness which cause estropia(inward eye deviation) and horizontal diplopia(double vision)

acute pancreatitis and constriction of the duodenum

annular pancreas; results from abnormal migration of the ventral pancratic bud to fuse to the dorsal bud during 7th and 8th wk of fetal development.

loss of grey-white matter differentiatin with sulcal effacement is

anoxic brain injury . the presence of nonreactive pupil to light stimulation ffg cardiac arrest carries a poor prognosis and indicates anoxic damage of the" brainstem th the level of "upper midbrain" the upper midbrain consist of optic nerve, pretctal nuclei, edinger-westphal nuclei, oculomotor n. that mediate consensual pupillary light reflex

45y.o came cause of fatigue which got worst since 4mo, he had difficulty keeping up with the labor as a construction worker, 2wks ago he is unable to climb pas the 2nd flr of the building,over weight, conjuctival pallor, he has difficulty getting onto the examination table due to shortness of breath, hematocrit is low, MCV is low

ans is lead poisoning n adult, basophilic stippling on bld smear. exposure thru occupational. s/s colicky abdominal pain, constipation, leadlines on the gum, peirpheral neuropathy and anemia. lab will show microcytic anemia wth normal iron studies and basophilic stippling

colorectal adenocarcinoma prognosis is related to grade or stage

ans: stage not grade stage: the extent of tumor expansion(did it go to basem) grade: degree of tumor differentiation

T- ALL often present with

ant. mediastinal mass that can compress the great vessels, causing cause respiratory symp, dysphagia of solid, superior vena cava synd

during ovary removal. the doctor can palpate the ureter, what is in front

anterior to the ureter is internal iliac artery

flumazenil

antidote for benzodiazepines

Vit E deficiency

antioxidant that protects Erythrocytes, deficiency → hemolytic anemia + acanthocytosis + neurologic symptoms similar to B12 def. (but without ↑ homocysteine and methylmalonic acid or hematologic findings)

In PSGN, what do the immune complex deposits consisnt of

antistrep antibodies + strep antigen form immune complex that deposit in the GBM; (Type 3 hypersensitivity) deposit looks like subepithelial hump on EM

s/e of addition of carbidopa to levodopa to treat parkinson

anxiety and agitation bcos more dopamin is available to the brain

the mcc site of injury in aortic injury is

aortic isthmus which is C

bounding femoral pulses, head-bobbing

aortic regurg

bound femoral and carotid pulses and head bobbing

aortic regurg; wide pulse pressure

gluteal claudication

aortoiliac occlusion aka leriche synd) it cause impotence cos of decr bld flow to pudendal and gluteal branches of internal iliac artery

Hepatitis B histology

appearance of a finely granular, diffusely homogenous, pale eosinophillic cytoplasm(ground glass hepatocyte) sexually transmitted or IV drug use. a distinct histopathologic manifestation of chronic hepatitis B infection is the accumulation of hepatitis B surface antigen with infected hepatocyte resulting to top explanation

Patella Fracture

are most common due to a direct blow to the ant aspect of the knee eg landing on a flexed knee in a fall. caused also by excessive force transmitted through the quadriceps tendon eg landing on a feet after falling from a height. patella protects the joint from direct injury. the quadriceps tendon insert at the superior pole of the patella

renal infarction

are mostly caused by cardioembolic dz, atrial fib. S/S flank pain, nausea, vomiting, lowgrade fever, hypertension due to renin release from hypoxic tissue Gross pthology: u will see sharply demarcated, yellow-white, wedge shape dareas withing surrounding hyperemia

Hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B)

are neuropeptides produce in the lateral hypothalamus that promote wakefulness and inhibit REM sleep related phenomena. narcolepsy and cataplexy(emotion triggered sleepiness) pt have low to undetectable levels of hypocretin 1 in the CSF

cavernous hemangiomas

are vascular malformation that occur mostly in the brain parenchyma above the cerebellar tentorium. the consist of cluster of dilated,thin walled capillaries with little or no intervening nervous tissue. clinical manifestation: seizure that may progress to neurologic deficit due to mass effect with interruption of the cerebral microcirculation. the lesion might bleed leading to hyper dense/bright mass on CT

cavernous hemangioma

are vascular malformations composed of abnormally dialted capillaries it involves liver brain. gross examination : "mulberry-like" appearance due to their purple vascular clusters histolog: they are composed of abnormal dilated bld vessel. if it leaks it can cause recurrent hemorrhage, pt can have seizures and neurologic deficit

hyperplastic arteriolosclerosis

arterioles have an onion skin appearance - smooth muscle hyperplasia and basement membrane duplication/replicating cos of inc BP retinal hemmorrhage, papiledema,

Renal manifestations of SLE

as diffuse proliferative glomerulonephritis which is characterized by diffuse thickening of the glomerular capilary wall with wire-loop structures on light microscope

Hypothyroidism

ass/w 1. hyperlipidemia, inc total cholesterol and LDL chol = incr risk of coronary dz dec LDL receptor density making them weak to bind to ldl= incr ldl in d plasma 2. myxedema: hyaluronic acid deposit i dermis= draws water= pitting edema and peritibial myxedema 3. hyponatremia cos of incr secretion of ADH

Lightning injuries

ass/w 25% fatality rate. most pple die within first hour after injury with fatal arrhythmias and respiratory failure as the most common causes

postprandial epigastric pain, weight loss, and FOOD AVERSION with ischemic heart diesase = intestine angina

atherosclerosis of the mesenteric arteries, resulting in diminished bld flow to the intestine after meals. pain few hours after meal

saw tooth pattern

atrial flutter

a pt who had a ECG of atrial flutter(saw tooth) had ablation procedure where is conduction block

atrial flutter demonstrate rapid and regular atrial activity in saw tooth pattern , narrow QRS are usually present. atrial flutter is acaused by a lrge reentrant circuit that traverses the cavotricuspid isthmus; which is the region of rt atrial tissue btwn the IVC and tricuspid valve annulus

what sound makes mitral regurg severe[]

audible S3 gallop which occurs when the LV is unable to accommodate the excess bld flow

AML

auer rods ae deformed azurophilic granules found in the cytoplasm of myeloblast that stain positively for myeloperoxidase

myasthenia gravis

autoimmune against ACH on postsynaptic . degradation and complement mediated damage of the postsynaptic membrane occur. pt present with fluctuating weakness that worsen over the day and involves ptosis, diplopia and bulbar( eg fatigue while chewing, dysphagia) RX; long acting ACHE inhibitors pyridotigmine dx; short acting ACHE inhibitors edrophonium

Graves disease

autoimmune hyperthyroidism, thyroid stimulating antibodies(immunoglobulins igG) stimulates TSH receptor on thyroid. s/s eyes:exopthalmos, chin: pretibial myxedema. t cell lymphocyte activation of fibroblasts which contain tsh receptor that bcome active in the presence of the IgG leading to GAG secretion. Rx: beta blocker, thionamides(PTU, METHIMAZOLE and x/e is skin rash and agranulocytosis)

pericarditis

autoimmune inflammation,. sharp, worst wit deep breath(pleuritic), worse lying flat(supine) better sitting up/leaning foward innervated by phrenic nerve so pain is referred to shoulder. inc ESR, fever etc scratchy sound. viral: coxsackievirus. 1. uremic P: renal failure 2. post MI P: a. fibrinous(days after MI) B. dressler's syn(week after MI) 3. autoimmune dz:( RA, lupus)

Dobutamine Pharmacology

b1 cause Gs protein GTP binding leading to activatio of adenylcytclase and icr production of CAMP

heart murmurs sound

b: crescendo decrescendo/ejectn murmur. pulsus parvus: weak and small carotid pulse cos of slow flow thru it E:opening snap F; machine like continous murmur

congenital adrenal hyperplasia

baby has satlt wasting 21-hydroxylase deficiency have deficient cortisol and aldosterone synthesis combined with adrenergic androgen overproduction. male infant have normal genitalia and present 1-2 wks after birth with vomiting, hypotension, hyponatremia and hyperkalemia. female present at birth with ambiguous genitalia

Beta adrenergic on renin

bb drugs inhibit renin release by blocking beta1 receptor mediated regulation of RAAS

pt with CKD has carpal spasm

bcos CKD cause hypocalcemia induced by decr filtration and excretion of phosphorus- hyperphosphatemia

outbreak of influenza A strain happen last year in a community. this year again similar strain is around but ppl are not getting infected why

bcos they have antibodies against hemagglutinin

intermittent claudication of leg

be able to differentiate it with variocose vein. it is an achy or crampy pain in the leg caused by inadequate arterial bld flow, due to atheroslerosis in the banches of the femoral artery. in copntrast with venous dz in which pain is worsened by prolonged sgtanding or sittle with legs dependent, claudication due to arterial dz is worse with exertion and relieved with rest cos the have an icr risk of ischemic stroke and MI

a pt prescribed aminoglycoside and the pharmacy uses an adjusted body weight that is lower than the pt actual body weight for dosage. explain why

because hydrophillic drug like aminoglycoside do not distribute to the adipose tissue as a a result reducing the dosage improve safety and efficacy

AAA (abdominal aortic aneurysm)

below renal artery but above aortic bifurcation. wall is weak cos of atherosclerosis. o2 cant diffuse the wall,= atrophy due to less o2 at the wall= weakness= dilatation. risk factor is male , smoker, more than 60y/o pulsatile abd mass that grows with time. if it >5cm it can rupture = hypotension, pulsatile abd mass and flank pain

hernia

below the inguinal lig = femoral hernia above the inguinal lig= direct and indirect

Fibroadenoma of breast

benign, arises from 15-35. characterized by nodules that are well-demarcated, painless, mobile, and spherical and can be 1-10cm in size histolog: cellular myxoid stroma that encircles and sometimes compresses epithelium lined glandular and cystic space

Parasagittal meningioma

benign, slow growing, affect adult, arise near dural reflections(flat cerbri, tentorium cerebelli). pt are ofter asymptomatic but may have headache, seizure or focal neurologic deficit depending on tumor size and location

renin and beta blocker

beta blocker inhibit release of renin from renal juxtaglomerular cell thru antagonism of beta 1 receptor o these cell. so RAAS is not activated - resulting in decr vasoconstrictn and decreased sodium and water retention. betablocker lowers BP by 1. reducing myocardial contractility and HR 2. decr renin release from kidney

Propanolol

beta blocker, blocks t4 to t3 conversion excellent drug in thyrotoxicosis

systolic murmur

between S1 and S2 HCM AND VSD is part of the list

a pt that had SLE but is treated with multiple medication recently evaluated for progressive muscle wkness, incr BP, facial plethora, truncal obesity and skin ecchymoses. examination of the adrenal gland will reveal

bilateral cortical atrophy. due to long term use of glucocorticoid used for sle. this will supress the "hypothalamic- pitutary-adrenal axis" = leading to low level of CRH cortico-releasing hormone, ACTH and endogenous cortisol. the pt has s/s of hyper corticotisolism. long term supression lead to adrenocortical atrophy (the zona glomerulosa is spared as ANG2 is its primary hormone) bbut zona fasciculata and reticularis will be atrophied

Amphotericin B moa

binds ergosterol of fungal cell membrane = causes pore formation and fungi lysis. it also binds to human cholesterol which brings its s/e of nephrotoxicity, hypokalemia and hypomagnesemia

pt for 7 days havent slept, spent thousand dollars on a new power tool to do a "task". he feels spectacular and is creating a architectural masterpiece. dx and rx

bipolar disorder pt euphoric mood, decr sleep, hyperactive, grandiosity and pressured/rapid speech- acute manic episode of bipolar disorder Rx is mood stabilizing medicaton

antiarrhythmic drugs

block Na channel : are class 1a 1b 1c and beta blocker block K: class 3 block ca: class 4

Fixed S2 splitting

both insp and expir are both wide/split cause: ASD; cos of incr flow on the rt side of the heart

subdural hematoma

bridging veins

Reid index

bronchial gldn hyperplasia in the submucosa is the major contributor to bronchial wall thickening and the severity is measured by reid index. this is a tool that measures the ratio of the thickness of the submucosal glands to the thickness of the bronchial wall btnw the epithelial basement membrane and the bronchial cartilage. a normal RI is 0.4, higher numbers correlate with incr duratio and severity of chronic bronchitis

gallstone pigment

brown: biliary tract infections by microbes producing b-glucorinidases black: chronic hemolytic anemia- sickle cell and incr enterohepatic cyclin of bilirubin in chrohn dz

thromboangitis obliterans aka

buerger dz is a segmental inflammatory vasculitis that affects the small and medium sized arteries and veins of the distal extremities with inflammatory, intraluminal thrombi and sparing of the vessel wall. young, heavy smoler andcan present with digital ischemia and ulceration, extreme claudication, raynaud phenomenon

psudomonas infection are common in what pt

burns, neutropenic, hospitalize and indwelling catheters its gram negative

Porcelain gallbladder

calcification of the gallbladder wall, pt with firm palpable gallbladder and extensive calcificaltion thru out the gallbladder wall has a finding of porcelain gallbladder. right upper quadrant abdomen with or without pain radiography shows thickened gallbladder wall with a rim of patchy or uniform calcification

silica

calcified hilar lyn=mph nodes and birefringent particles within dense, whorled collagenous nodules surrounded by dust-laden macrophage on biopsy has silicosis. collagen deposision mining, sand blasting

Verapamil doesnt have alot of effect on skeletal muscle why? NOTE SER(sarcoplasmic reticulum)

calcim is important in excitation-contraction coupling in cardiac, smooth and skeletal muscle. myocyte depolarization cause activatn of L-type ca channel. in cardiac and smooth muscle cell, this leads to an influx of extracellular calcium that activates sarcoplasmic RyR channels, inducing the release of Ca from SER(ca induced ca release).ca binds to troponin in cardiac or calmodulin in smooth mus. in contrast L type in skeletal muscle directly interact with RyR calcium channels to release ca from SER. this mechanical coupling btwn the receptors allows sarcoplasmic ca release to occur without influx of ca across the plasma mem. verapamil is a nondihydropyridine calcium channel blocker that acts by blocking Ltype ca channel preventing the initial ca influx into hrt and sm muscle cells. that why it wont work on skeletal mus.

cardiac pacemaker what is phase 2 in the picture

calcium

Inulin at the glomerulus is

can be used to estimate/calculate the GFR because it is freely filtered and not reabsorbed nor substrated by the renal tubules

gastric bypass surgery

can cause small intestinaln bacterial overgrowth SIBO due to excessive bacterial proliferation in the blind ended gastroeduodenal segment. SIBO result in def of most vit B12, A D E and iron but increased production of folic and vit K

allopurinol and azathioprine

cannot give them together because allopurinol inhibits xanthine oxidase leading to more active metabolites of azathioprine

BB for angina are

cardio selective b1 drug like meoprolol, atenolol. do not use pindolol, acebutolol.. they worsen angina

coronary art dz and HF tx

cardioselective beta blocker

TBG (thyroxine-binding globulin)

carrier protein for T4 in blood. --estrogen raises it. pregnant woment or taking OCP can see a rise in TBG level. --liver failure lowers TBg- cos less producion

dx OF HF

catheter: incr LVEDP = LHF incr RVEDP =RHF

Vasopressin (ADH) and desmopressin

cause V2 receptor mediated incr in water and urea permeability at the inner medullary collecting duct. the rise in urea reabsorption will decr urea clearance enhancing the medullary osmotic gradient allowing the production of maximally concentrated urine

subthalamic nucleus damage

cause contralateral hemiballismus by decreasing excitation of the globus pallidus, thereby reducing inhibition of thethalamus

neurocysticercosis

cause seizures in pt from central an south america and if u see pt that had a cystic grain lesion on an imaging ingestionof taenia solium eggs excreted i feces of human carriers

hyperacusis (increase sensitivity to sound)

caused by paralysis of the stapedius muscle . the middle ear cavity have 3 auditory ossicles( malleus, incus and stapes) and 3 skeletal muscle tympani and stapedius)

Erythema Infectiosum (Fifth Disease)

caused by parvofirus B19 and present with fever, slapped cheek facial rash adn a lacy, reticular body rash. parvovirus is highly tropic for "erythroid " precurssor cells and replicates predominantly in the bone marrow

Leiomyomas (uterine fibroids)

caused by proliferaton of myometrial smooth muscle cells. may cause heavy menstrual bleeding and pain and irregularly enlarged uterus

androgenic alopecia

causes hair loss at the ant scalp and vertex. it shows polygenic inheritance with DHT being the reason. Rx 5 alpha reductase inhibitors will decr teh conv of testosterone to DHT

Girdia lamblia

causes injury tp tje duodenal and jejunal mucosa by adhering to the brush border and releasing molecules that induce inflammatory response. secretory IgA which impairs adherence is the immunity against G-Lamblia.

HFE protein mutations

causes primary /hereditary hemochromatosis.this protein normally interact iwth transferrin receptor to form a complex that unciona s a sensor of iron stores. mutation that Inactivaiton of HFE proteins cuases enterocytes and hepatocytes to detect falsely low iron levels while iron accumulates in the body thru 1. ENTEROCYtE respond by increasing apical expression of dialent metal transporter1 (DMT1) increasing iron absorption from the interstinal lumen 2. hepatocyte respond by decreasing hepcidin synthesis; low hepcidin levels eresult in icreased ferroportin expression on the basolateral surface of enterocytes. this allows incr iron secretioninto the circulation. leading to iron overload when body iron leve exceed 20g pt develop triad of micronodular cirrhosis diabets mellitus, and skin pigmentation(bronze diabetes) and have an incr risk of hepatocellular carcinoma, cong heart failure, testicular atrophy/hypogonadism

autoantibodies that react with tissue trasglutaminase is dx is

celiac dz; it is caused by immune-mediated reaction to ingested gluten, the major protein complex is wheat, barley and rye. in healthy pt gluten is broken down into several proteins, like gliadin and absorbed but in this pt gliadin triggers inflammatory rxn that causes small intestinal villus atrophy/flattening and lymphocyte infiltration of the intraepithelial cell. duodenum and jejunum are exposed to the highest conc of gliadin and biopsy of these area is required for dx

skin that is marked by a few days of spreading skin erythema, warmth, and tenderness, fever is what

cellulits. is an acute bacteria infection. the most common nonpurulent cellulitis is beta- hemolyitc strep. GROUPASTREP GAS purulent cellulitis: staph auer.: strains that express the virulence factor panton-valentine leukocidin

High Altitude Illness

characterized by hypobaric hypoxia with potential to develop life theratening Cerebral and pulmonary edema. key adaptive response to hypoxemia include hyperventilation to incr bld oxygenation and increased synth of 2,3 BPG in erythrocytes facilitating oxy offloading into peripheral tissue

strawberry capillary hemangioma

child and it regresses by age 5-9

reactive arthrits can occur following infection with

chlamydia, camplobacter, salmonella, shigella or yersinia

why prescribe primaquine with chloroquine

chloroquine is effective against the plasmodia from bloodstream(erythrocyte forms of plasmodium) but not against the latent hepatic infection established by P vivax P ovale. primaquine added to completely eradicate the hypnozoite

atrial flutter

circute in the RA generating wave. same TX as A fib also atrial flutter ablation which is burning some myocyte in the RA so circuit will be disrupted and electrical activity cant go round the atrium. there by eliminating the current

Amiodarone

class 3 and 1A Antiarrhythmic agent causes lengthening of the cardiac action potentila, which manifest as QT interval prolongation on ECG. qt prolongation caused by this drug compare to other drug is ass/w -hy-"low risk of torsade de point"

Types of shock hemodynamic

cold skin= cardiogenic and hypovolemic as a result of low CO but high SVR cos arterioles are clamp down. Warm skin= high CO, low SVR= distributive. pulm rales: high LA pressure. obstructive shock: fluid around the heart.. low CO eg temponade, embolism, tension pneumothorax

APC tumor suppressor gene

colorectal cancer (ASSO WITH FAP) and sporadic colon cancer

polygenic inheritance medical condition

combined effect of two or more genes on a single character. like androgen and genetic factor

Thoracic Outlet Syndrome

compression of brachial plexus as it passes throught the scalene triangle. pt will have extremity numbness, tingling and weakness that worsen with repetitive overhead arm movement. the presence of an extra rib is clue 2. involvement of subclavian verin and artey can also occur and lead to upper extremity swelling and exertional arm pain

Long QT syndrome

congenital Na or K channel defect if comorbid with sensorineural "deafness" = Jervell and Lange Nielsen syndrome) the child will present with having recurrent seizures

pt has genetic mutation in a K channel protein which cause decrease K flow with prolonged action potential. pt also have recurrent syncope

congenital long QT syndrome

SICH spontaneous intracranial hemorrhage

consider if there isno histrory of head trauma, and a pt dies of intracranial hemorrhage. pt with adult type coarctation of the aorta commonly die of hypertension ass complications, including LV failure, ruptured dissecting aortic aneurysm bcos of the incr incidence of congenital berry aneurysm of the circle of willis as well as aortic arch hypertension

pericarditis constrictive or tamponade

constrictive: rapid filling of the RV cos the myocardium is adherent to the pericardium and abrupt stop of filling cos of the calcified myocardium. so u see a dip and plateau

pathogenesis of crescent formation in Rapidly Progressive GlomerloNephritis

crescent consist of flomerular parietal cells, lymphocytes and macrophages along with abundant fibrin deposit, crescents eventually bcom fibrotic, disrupting glomerular function and causing irreversible renal injury

male, fever, diarrhea, teated with antibiotics but no improvement, several weeks after, the pt develops a skin lesion over the abdomen. P/E shows distended and tender abdomen to palpate. bowel content appear to be draining to the surface of the skin in the right lower abdominal quad. whats the dx

crohn dz. fistula can form btween 2 adjacent loops of bowel and fibrotic strictures causing bowel obstruction. fistulas btwn 2 loop= enteroenteric fistula between the bowel and another organ eg bladder. vagina or btwn bowel and skin of the abdominal all= enterocutaneous fistula

HIV pt, white pacthes on the oropharyngeal mucosa and mild generalized lymphadenopathy. brain image reveals no intracranial mass, india ink staining of CSF via lumbar puncture shows spherical yeast with thick capsule

cryptococcus neoformans: a yeast, with thick polysaccharide capsule. opportunistic infection in pt with advanced immunosuppression found in soul contaminated by bird dropping and in inhaled into the alveoli of the lungs

Crohn's disease pt and gallstone

d pt with crohn dz most likely developed gallstone due to inflammation of the terminal ileum causing decr bile acid reabsorption. bile acid are produced in liver and excreted with bile into the duodenum. there they emulsify fat droplet to form water-soluble micelles that allow pancreatic lipase to efficeintly hydrolyze triglycerides into fatty acid and monglycride. in the jejunum these micelles come in close contact with the gut epithelium which facilitate passive absorption of FA, monoglycerices and chol across the brush border into enterocytes

iron def in women of childbearing age, secondary to menstrual bld loss lab

decr serum ferritin. incr TIBC( transferrin), microcytic, hypochormic rbc

Euthyroid sick syndrome

decrease T3 & T4 with normal or decreased TSH; typically in critically ill patients, it can look like hypothroidism but rT3 is also high. so treating pt critical illness will normalize the level

ACE -I effect

decrease the conversionof ang1 to ang2, and aldosterone levels. renin and ang 1 will be increased. ACE is responsible for the breakdown of bradykinin. inhibitor means incr bradykinin

for pt that test positive for HLA B27, has ankylosing spondylitis what shud be monitored toknow the progression in pt

degree of chest pain expansion. involvement of the thoracic spine and costovertebral and costosternal juction can limit chest wall expansiion leading to hypoventilation

Paradoxical S2 splitting

delayed closure of aortic valve. split is heard in the expiration. left sided heart delay cardiomyopathy, LBBB

Persistent S2 splitting

delayed closure of the pulm valve. splitting occur in inspiraton

Demyelinating neuropathy vs axonal neuropathy

demyelinating cause slowed or blocked nerve conduction velocity while axonal injury cause reduction in signal strength

gout

deposition of monosodium urate crystals . under light urate crystals appear needle shaped and negative birefringent gout arthrits: joint pain, warmth, erythema, swelling

Ichthyosis Vulgaris(Lizard Skin)

dermal xerosis(Dry) and rough skin with scaling over the surfaces of the limb. it is caused by mutation of the filaggrin gene, resulting in epidermal hyprplasia, defective dsquamtion and loss of the normal barrier function Tx is minimizing bathing,

pt have muscle weakness, difficulty with getting out of car and carrying groceries from the store, rah on her face and hand. dx. rx

dermatomyositis. the dermal signs are called: heliotrope rash, gottron papules. lab test will show incr muscle enzyme CK and autoab - antinuclear, anti-Jo-1 Rx: glucocorticoid

Primary biliary cholangitis

destruction of intrahepatic, interlobular bile duct by macrophages, lymphocytes, plasma cells, and eosinophils that results in granulomatous inflammation. fatigue and pruitus (usually worse at night)

hereditary pulmonary artery hypertension

develops in 2 step. an abnormal BMPR2 gene predisposes affected pt to excessive endothelial and smooth muscle cell proliferation. so an insult eg nfection or drug is thought to the n activate the dz process which involves increased level of vasoconstritive, proliferative mediators (eg endothelin) and decr level of vasodilative mediators- NO, prostacyclin

preventing risk of neuropathy in pt with dm give

diabeti nephropathy shows urine albumin loss of 30-300 mg/day. if left untreated albuminuria is followed by progressive worsening of renal funtio leading to end stage renal dz. progressionis slowed by use of ACE inhibitor eg lisnopril or angiotensin II reeptor blocker. early DN cause elevated glomerular filtrationpressure and angiotensinII furthur increases glomerular pressure by vasoconstriction of the efferent arterioles. so blockage of this angII effect lowers glomerular pressure

Syphilis manifestations

diffuse maculopapular skin rash that includes the palms and soles condylomata lata: painless wartlike elevated plaques

amlodipine, nifedipine

dihydropyridine calcium channel blocker. used as a "monotherapy" or in a combination withother drug for HTN, pt ususally come back complainin of peripheral edema

Nondihydropyridine CCBs s/e

diltiazem and verapamil s/e include AV conduction block , consitpation, bradycardia and worsening of heart failure in pt with reduced lv function

Aliskiren

direct renin inhibitor, reduces antiogensin 1 levels no angioedema

Crohn's disease s/s

dirrhea can be bloody if conlon is involved, pt has fever, weightloss, malabsorpton and transmural inflammation of the bowel which may result in the formation of fistulas and fibroctic strictures

acne vulgaris

disorder of pilosebaceous follicle. contributing factor include hyperkertatinization and obstruction of follicles; sebaceous gland enlargement with increased secretion of sebum ; colonization of proliferation in the gland by propionibacterium(cutibacterium) acne

Cauda Equina Syndrome

disruption fo sciatic nerve: lower ext weakness, radicular low back pain) pudendal nerve: saddle anesthesia pelvic splanchnic nerves: parasymp innervation of hindgut, bladder and urinary sphincter that promote emptying peristalsis. pt couldnt urinate, no sensation in the perineal region, right lung mass that metastasis to the lumbosacral nerve roots that formed cauda equina, or trama or dish herniation

medication associated with gout

diuretic- hydrochlorothiazide, furosemide ACE-I eg lisinopril cyclosporin

Valsalva maneuver

doctor can ask a pt to do this if they have paroxysmal supraventricular tachy. it will increase vagal tone which will incr refractory period in AV node and help prevent a reentrant circuit from conducting. if valsalva fails, IV adenosine is recomended

femoral vein catheter placement

done in pt w. unavailable preferred access sites eg subclavian, jugular vein or those w. > risk of complications eg uncoperative pt. the femoral vein is the major deep vein of d lower extremity and passes thru d femoral triangle beneath d inguinal lig b4 entering d pelvis as the external illiac vein. femoral triange- superior: inguinal ligmedially -adductor longus muscle sarorius muscle- laterally

a chronically progressive pre-senile demential with cortical atrophy but no other abnormalities- pt will be having demential and its reversible rx is

donepezil

lower dose dopamine vs higher dose dop

dop is an adrenergic agonis that has varying effects based on the dose lower D: stimulate D1 recep in the renal and tubules = incr in renal bld flow, GFR, sodium excretion and coronary vascular bed vasodilation\ higher dose: stimulate B1 recp in the heart= incr cardiac contractility, HR and systolic BP

Internal hemorrhoids

drains into the sup rectal vein which communicates with the inf mesenteric vein.

pt had hypertension was given a drug that selective direct relaxation of smooth muscle of arterioles but does not affect the veins. what will be the s.e

drugs are hydralazine, minoxidil are selective arteriolar vasodilators. they lower BP by reducing sys vas resistance. s/e they trigger reflex symp activation and stimulate RAAS- Na and fluid retention this result in tachy and edema

adenovirus

dsDNA, naked red eye,cough, sore throat day care center, camp, military barack

Multiple Scelerosis and urge incontinence

due to loss of cns inhibiton of detrusor contraction in the bladder

pt present with substernal chest pain and ST elevation in v2-v5 lead dies "5 days" later due to?

due to profound hypotension due to ruptured left ventricular free wall. she presented with ant wall MI. free wll rupture is a catastrophic complication that usually occur within 5-14 days after a large ant. transmural MI from LAD occlusion .infarcted myocardium is weakend, coagulative necrosis, neutrophilic and mcacrophage infiltration and enzymatic lysis of myocardia conn tiss. abrupt rupture of the LV leads to hemopericardium and cardiac tamponade.= pt sudden onset of chest pain and hypotension= shock= pulseless electrical activity= death

obstructive sleep apnea (OSA)

due to relaxation of the oropharyngeal muscle tone with occlusion of the upper airway

a male with bacterial pneumonia is admitted to the hospital and given ceftriaxone and azithromycin but soon after the first dose he complains of abdomimal cramp and lightheadedness. bp is 70/50 while HR is 120, he has rash. whats the dx and rx

dx is anaphyl.atctic shock which is known for vasodilation, incr vascular permeabiliy and bronchoconstriction. Rx epinephrine which counteracts these physiological mechanisms and is the drug of choice for anaphylaxis

pt nonspecific stomachaches that comes with being anxious of going to school. got worst when her bf moved away.mom said she is very shy and afraid of being embarrashed, or look stupid, pt makes little eye contact and give brief answer to question during interview

dx is socail anxiety disorder; it involves excessive ear of scrutiny or embarrassment in social or performance situation resulting in significant distress and functional impairement

hyperaldosteronism

elevated serum aldosterone levels cause hypertension, hypokalemia, and muscle weakness. primary(conn): just incr aldo secondary: incr aldo and renin- wish can be caused by renovascular dz and renin-secreting tumor

supraspinatus tendon

empty can test: abduction of the humerus in parallel to the axis of the scapula(30 degree forward flexion) while in full internal rotation (thumb pointed to the floor). this tendon is vulnerable to injury due to impingement btwn the acromion and the head of the humerus. supraspinatus tendinopathy is the most common cause of rotator cuff syndr

Tricuspid regurgitation

endocarditis in IV drug user carcinoig ebstein anomaly

endometriosis

endometrial tissue located outside the uterus

goiter

enlarged thyroid bcos pt has high TSH(trying to stimuated the gland) but inability to produce T3/T4,

pt obsessively picking nose is now bleeding what is damaged

epistaxis is caused by irritationof the highly vascular mucosa ant the anterior nasal spetum. the ant nasal septum contain the kiesselbach plexus. where all other arteries anastamose

Diagnosis of metabolic alkalosis

everything is up, PH,PCO2, HCO3. it is bcos of accumulated HCO3 and cl is depleted. vomiting/nasogastric suctioning and thiazide/loop diuretic use cause vol and Chloride depletion resulting in alkolosis the picture shows saline responsive vs saline- unresponsive.

lateral prefrontal cortex is responsible for

executive functionin, which includes motivation organization, planning, and purposeful action.

external hemorrhoids

external hemorrhoids drains inside via the inf rectal vein into the internal pudendal vein

self production of physical or psychological symptoms that obtain attention and medical care from health care personnel is

factitious disorder

decompensated heart failure

failing myocardium is no longer able to propel sufficient blood to meet the needs of the body, even at rest. this can cause secondary MR, becos it leada to an incr in LVEDV, or preload with dilation of MV annulus( the tissue on which mitral valve cusps are mounted) and taut stretching of the chordae tendinae. the dilated annulus and restricted movement of teh chordae tendinae can cause insufficient closure of an intrinsically normal mitral valve, resultin in MR

Motor vehicle collision which pt sustain bilateral femur fractures.. think..

fat embolism syd pt has severe long bone/pelvic fracture who develop acute onset neurologic abnormalities, hypoxemia and peterchial rash. occlusionof the pulm microvessels by fat globules is an early histologic finding of this synd

Hep E transmission

fecal-oral route high mortality rate observed in infected pregnant woman. naked(unenveloped) SSRNA

finofibrate given to pt that has high lipid panel. what is moa

fibrate lower triglyceride levels by activating PPAR-alpha which leads to dec hepatic VLDL production and incr lipoprotein lipase activity. while fish oil works by lowering triglyceride by dec production of VLDL and APO-B

Uterine Leiomyomas aka

fibriod can be located 1. subserosal: located on serosal surface 2. intramural: located within teh uterine wall 3. submucosal: velow the endometrium. subserosal leiomyomas often cause irregular uterine enlargement resulting in pelvic pressure and constipation due to pressure on the colon

sickle cell pt spleen will be

fibrosed and atrphied

gluc, urea,

fillterd by gl omerulus reabsorbed by PCT but not secreted but if glucose is too high like in pt with diabetes mellitus it will cause glucosuria because Na/glucose co transport will be saturated and some glucose will not be reabsorbed leading to gluc in urine

treat overdose of benzodiazepines and zolpidem(nonbenzo hypnotics) with what?

flumazenil (competitive inhibitor at benzodiazepine GABA receptor)

INH use & side effects

for TB pt will have fever, anorexia, nausea. and directly have hepatic dysfunction, characterize by AST/SGOT. ALT/SGPT.

pt experiencing a major depressive episode shud be screened for -- to rule out bipola disorder

for past maniac episode because antidepressant monotherapy shud be aboided inpt with bipolar disorder due to risk of inducing mania

antiviral drug s/e is hypocalcemia andhypomagnesemia which can cause seizures

foscarnet: a pyrophosphate analog that is used for ganciclovir-resistant cmv infections. forscarnet can chelate calcium and it induce renal wasting of magnesium

of all the antiviral drug that bind and inhibit DNa polymerase in Reverse transcriptase HIV or herpes which drug do not require intracellular activation by viral or cellular kinase

foscarnet; a pyrophosphate analog, it directly inhibit both DNA polymerase in heRpes virus and reverse trasncriptse in HIV

Aschoff bodies

found on cardiac myocyte, due to acute rheumatic fever which develops after untreated group A strep pharyngeal infection. aschoff bodies contain plump macrophages with abundant cytoplasm pt has fever, fatigue and anorexia, tachycardia, tachypnea, hypotension and mitral valve regurge

Clavicle Fracture

fractured in children after a fall on an outstretched arm. 1. in a distal clavicle fracture: the deltoid muscle carries 2. the weight of the upper extremity the proximal segment is pulled by sternocleidomastoid and trapezius muscle

Metabolism of Fructose

fructose has the fastest metabolism in the liver compare to other monsaccharides

Hot nodule

functioning nodule; ↑ uptake I131 it means not cancerous. cold= chancer of cancer, often biopsied -fine needle aspiration

lood diuretics and NSAID

furosemide works by inhibiting Na-K-Cl causing increased Na,Cl and fluid excretion. it also stimulate prostaglandin release to increase renal blood flow leading to GFR incr and enhance drug delivery. but If you take loop and NSAID eg ibuprofen together, there will be decrease in loop response/effect

Brunner gland hypertrophy

gastric acid is neutralized by bicarbonate from the submucosal glands of the duodenum(brunner glands) and for pancreatic duct secretions. chronic overproduction of gastric acid(h pylori) can lead to hyperplasia of the submucosal glands.

hypertropic cardiomyopathy is caused by

genetic mutations affecting structural proteins of the cardiac sarcomere eg beta-myosin in heavy chain, myosin binding protein C. and is one of the mcc of SCD sudden cardiac death in young adults histology: cardiomyocyte hypertrophy with haphazard cellular arrangement and interstitial fibrosis

Aminoglycosides injury on kidney

gentamicin are filtered across the glomerulus and concentrate i the renal tubules, leading to proximal tubular injury and acute tubular necrosis ATN.. this is visualized histologically as focal tubular epithelial necrosis often with extensive granular cast that obstruct the tubular lumen and lead to rupture of the bm

2 measles

german measles(rubella) measles(rubeola). in both maculopapular rash begin on the head and neck and spread downward. but postauricular occipital is prominent in rubella adult women develop polyarthritis and poly arthralgia while fetal infection happens during the first trimester can cause sensoriuneural deafness, cataract, cardiac malformations.

Cyanide poisoning

give pt sulfur

Methlphenidate (Ritalin) s/e

given to pt with ADHD pt will have decreased appetite, weight loss and insomia

Beta Blockers overdose tx

glucagon

polyol pathway

glucose --> sorbitol --> fructose but in pt with diabetes/chronic hyperglycemia overwhelms the pathway causing accumulation of intracellular sorbitol= incr osmotic/oxidative stress= cataract/retinopathy, neuropathy, nephropathy

do u know how AS sound like

go listen to it

men carry weight suddenly his arms involuntarily give way and he drops weight

golgi tendon organ

Cyclosporine is a common cause of

gout exacerbation in pt who have undergone solid organ transplantation particularly renal transplant. this drug impairs renal excretion of uric acid resulting in hyperuricemia

Campylobacter jejuni

gram negative, oxidase positive, curved watery and bloody diarrhea

pt hot climate, training in the military, have weakness muscle ache and noticed darkening of his urine. which cast is present in urine

granular cast pt presentation is consitent with rhabomyolysis- skeletal muscle necrosis and the release of intracellular breakdown product in the circulation and dark urine is myoglobinuria lab shows elevated creatine kinase and kidney injury occurs due to heme pigment-mediated tubular injury leading to ATN- urine microsope will sow granular, muddy brow cast

Subacute thyroiditis (de Quervain's)

granulomatous inflammation of the thyroid, occurs in young female, tender, enlarged gland.

Adenomyosis

growth of endometrium within the myometrium. pt will have bleeding for month= menorrhagia and dysmenorrhea . pt have uniformly enlarged uterus with normal appearing endometrial tissue on biopsy but myomet

Cherry hemangioma

happens in adult, children dont eat cherry

antisocial personality disorder

hate social life so he violate the right of others and engae in unlawful behavior like property destruction without feeling remorse

38 y/o came cos of anterior chest pain that developed 4days ago. pain is sharp and makes it difficult to take a deep breath, ultrasound show pericardial effusion what is the cause

he has acute viral pericarditis; viral infectn is the mcc of pericarditis eg adenovirus, coxsackie, echovirus, inflenza. the viral infection cannot be confirmed that is why it is called idiopathic. the pain is worse when lying flat and improves with sitting up and leaning forward. u will hear pericardial frictn rub during atrial, ventricular systole, and earl diastole. you will see diffuse ST elevation caused by inflammation of the ventricular myocardium

S3 and S4

heard during diastole s3 sound like a naija man saying ken-tucky tennesse- S4

jervell and lage-nielsen syn

hearing loss and prolong QT mutation in genes eg KCNQ1, KCNE1 that encode for the alpha and beta subunit of voltage gated potassium channels

ANP/BNP function

heart: incr GFR, cause diuresis and renin inhibiton kidney: decr aldosteroe bld vessel: vasodilation and incr capillary permeability

renal cell carcinoma

hematuria, abdominal mass, flank pain and weight loss. hypercalcemia and erythrocytosis

pt bleeding after gum extraction, slow oozing blood at the site of dental extraction. maternal uncle sufferd from recurrent bleeding into joint(hemarthrosis)

hemophilia A& B- PTT incr

bleeding after a tooth extraction and history of hemarthrosis are suggestive of

hemophilia- decr level of F8 &9 LEADING to failure to convert prothrombin into thrombin and deficient thrombus formation.

igA and C3 deposition on vessel is ass/w

henoch schonlein purpura. HSP is common in children and is related to recent infection. child will have skin lesion, with or without abdom pain and arthralgias. it is usally self limiting. but pt can have glomerulonephritis and end stage renal dz as complication

pt on thyroid replacement therapy for hypothyroidism now has a suppressed TSH means

her current dose of levothyroxine is too high. and excess thyroid hormone result in beta- adrenergic receptor expression= cardiovascular complicaltion like atrial fibrillateion

syncope, sinus node dysfunction, hepatomegaly, skin hyperpigmentation, and hyperglycemia is suggestinG

hereditary hemochromatosis; AR, abnormally high intestinal iron absorption, which cause excess iron acc within organ; skin hyperpigmentatin, hepatomegaly, cirrhosis, pancreatic islet destrection- DM, impotence and cardiac enlargement -HF

nephrogenic diabetes insipidus CAUSE

hereditary( ADH receptor mutation) secondary to hypercalcemia hypokalemia lithium demeclocycline ( adh antagonist drug)

angioedema; hereditary or ace inhibitor induced

hereditary: pt has low C1 esterase inhibitor activity leading to incr bradykinin activity. normally C1 esterase inhibitor inhibit C1 complement thus stoping classic complement pathway. it also inhibit kallikrein thus conversion of kininogen to bradykinin is stopped. ACE I: blocks the breakdown of bradykinin. so pt with with hereditary angio cant take ACE I

variable clinical expressions in affected family members can occur due to

heteroplasmy each individual have different versions and express differently the same diz. some will be severly affected, mildly and some off spring will be unaffected

panhypopituitarism (sheehan synd)

high estrogen durig pregnancy cause enlargement of the pituitary gland without an incr in bld supply. peripartum hypotension can cause ischemic necrosis of the pituitary leading to pan hypopituitarism pt will develop failure of lactation due to deficiency of prolactin. shehan also cause hypocortisolism, hypothyroidism.

Esophageal squamous cell carcinoma

histopathologic: sq cell with abundant eosinophilic cytoplasm and distint borders. areas of keratinization are easily idnetified(keratin pearls) and in the presence of intercellular bridges . pt will have solid food dysphagia as the tumor gradually obstruct the esophageal lumen which can progress to liquid dysphagia leading to discomfort/burning and weight loss 2 most importnat risk factors in the United states are smoking tobacco and drinking alcohol. Consumption of foods containing N-nitroso compounds

PCA occlusion causes

homonymous hemianopsia

mechanical complication of acute myocardial infarction

hy

Loeffler syndrome

hyper eosinophilic synd. A restrictive cardiomyopathy caused by an endomyocardial (can lead to thrombus)fibrosis with an eosinophilic infiltrate and eosinophilia high eosinophil count, eczema, lung fibrosis

psoriasis

hyperketatosis, parakeratosis of the stratum corneum and epidermal hyperplasia(acanthosis) with enlongated rete ridges. neutrophilic foci in the stratum corneum and epidermis may coalesce to form microabscesses (munro microabscesses)

CKD will cause what to phosphorus

hyperphophatemia due to impareid renal excretion. elevated phos in blood will trigers release of FGF23, which lowers calcitriol production and intestinal calcium absorption = hypocalcemia= hyperphospHatEmia will then lead to hyperPTH

preeclampsia

hypertension onset after 20 wk, plus proteinuria or signs of end organ damage. end organ damage is due to endothelial damage secondary to the release of inflammatory factors from abnormal placenta

pt losing weght and having anxiety, insomnia

hyperthroid drug s/e or hyperthyroidism

panic attack reaction

hyperventilation, leading to decr in arterial PaCO2 hypocapnia- lading to reduced cerebral blood flow and symptom of cerebral hypoperfusion eg dizziness blurred vision, lightheadedness

Rb tumor suppressor gene is activated when

hypophosphorylated so it can prevent damaged cell from passing G1 to S checkpoint

Dandy-Walker syndrome

hypoplasia /absence of the cerebellar vermis and cystic dilation of 4th ventricle with posterior fossa enlargement,

hypovolemia effect on GFR, RPF, FF

hypovolemia result in reduced RPF,GFR. this leads to compensatory efferent arteriolar vasoconstriction, which raises FF and maintains GFR at near to normal levles

Antiandrogen therapy

idea is to inhibit testosterone in prostate cancer 1. pulsatile release of GnRH from hypothalamus stiumlates LH-- leads to inc testo. but, constant will downregulate LH ; leuprolide (GnRH long acting analog) 2. ketoconazole inhibit leydig cell(test synthesis) 3. finesteride; 5 alpha reductatse inhibitors will inhibit conversion of test to HT 4.Flutamide, cyproterone, spironolactone inhibit androgen receptor

Korotkoff sounds

if breath sound are heard thru out the respiratory cycle- it means pulsus paradoxus(which we see in carediac tamponade, constrictive pericarditis, COPD, ASTHMa)

pt comes with new onset atrial fib. whats the first thing to check

if he has hyperthroidism

Internuclear ophthalmoplegia

impaired horizontal gaze caused by lesion of MLF. the affected eye is unable to adduct while the othere eye is able to abduct(look outside)

Nonbullous impetigo

impetigo; a blistering eruption that leads to formation of a golden yellow crust, seen in children. caused by stap. au. and GAS group A strep pyogen. which ae gram positive cocci in chains PSGN can occur 1-2wk after GAS sin infection or pharyngeal infection and may not be preventable despine antibiotic treatment of the initial infection. fecial edema, dark(cola-colored) urine, hypertension, hematureia, nephritic range proteinuria and urinary rbc cast suggest psgn. RENAL damage: is due to immune complex deposition on the glomerular basement mem and to complement activation(causing massive inflamatory response and GBM structureal damage). ARF- acute rehm fever -fatigue and heat murmurs also occur

B1 adrenergic receptors found in

in cardiac tissue and renal juxtaglomerular cells but not in vascular smooth muxcle

FIBROUS CAP

in coronary artery disease, smooth muscle cells and collagen form what over the lipid core?

most deoxygenated blood in the body is found

in coronary sinus

Metaloproteases

in response to myocardial stretching due to vol overload, atrial and ventricle secrete ANP & BNP. these peptides is broken down and inactivated by metalloprotease neprilysin pt with HF is given neprilysin inhibitor eg sacubitirl allowing ANP, BNP to do their job which is to bind to cGMP which stimulates diuresis and peripheral vasodilation tohelp alleviate volume overload

Unilateral Fetal Hydronephrosis

inadequate canalization of the ureteropelvic junction, the connection site btwn kidney and the ureter is the most common site

prevelence

incidence X Durati on of dz. while incidence is the # of new cases. prevelene is the total # of case at a particular point

liver markers and indication

incr AST,ALT= hepatocellular damage 2. incr alk-phos and GGT= biliary injury 3. albumin, bilirubin, PROTHROMIN TIME = CIRRHOSIS

positive symptoms of schizophrenia is caused by

incr activity of dopamin in the mesolimbic pathway. Rx is antipsychotic medication that works to antagonise dopamine and decr dop activity in the mesolimbic pathway

glaucoma

incr intraocular pressure ass/w incr production or decr outflow of aqueous humor. 1. prostaglandin agonist: latanoprost will incr outflow via the uveoscleral pathway- this is preferred rx for open angle glaucoma. 2. muscuranic agonist: incr outflow thru the schlem canal. 3. dec aqueous inflow: beta blockers, alpha 2 agonist and carbonic anyhdrase inhibitors

in Hypoalbuminemia, low oncotic pressure triggers

increased liver protein and lipid synthesis- leading to hyperlipidemia

effect of corticosteroids on wbc count

increased neutrophil resulting form "demargination" of neutrophil previously attached to the vessel wall" and decr lymphocyte, monocyte, basophil and eosinophil count.

what is the strogest risk factor for cervical dysplasia aka cervical intraepithelial neoplasia is

infection with HPV 16, 18. It is transmitted thru sexual intercourse and skin to skin contact

endocarditis

inflammation of the endocardium, regurgitant aortic, mitral, tricuspid. mass can break off stroke, paralysis, blindess, ischemia in the leg, renal etc roth spot in the eye osler node: painful bump on pads of finger and toe. liebman sacs and culture neg bacteria(coxiella burnetii-Q fever) is not in the picture

distal to the anal dentate line drain into

inguinal node

malignant heperthermia occurs after

inhalation of anesthetics esp halothane. pt will complain after surgical procedure it is due to hypersensitivity of skeletal muscle to inhalation of anesthetic and muscle relaxant succinylcholine. in majority of the cases it is related to defect on ryanodine receptors of sarcoplasmic reticulum

Pt had a recent surgery now present with s/s of drug-induced live injury is due to

inhaled anesthetic use. it cause heaptotoxicity especially Halothane which is one of the most commonly used inhaled anesthetics world wide, in the usa halothane has been replaced ewith enflurane, isoflurane, desflurane and sevoflurane. they are safer but still cause hepatotoxicity leading ot aminotransferase level incr, prolonged prothrombin time, eosinophilia.

vwf dz

inherited (grandfather bleeds)bleeding dz. nose bleed for 10 min bleeding time incr-- impaired platelet ptt incr-- due to decr factor 8 activity

Ehlers-Danlos syndrome

inherited disorders. it is caused by procollagen peptidase deficiency, which result ini mpaired cleaveage of terminal propeptidase in extracellular space. primarily your skin, joints and blood vessel walls. flexible joints, hyperextensible skin, duet to soluble collagen that does not properly corsslink and stretchy, fragile skin. This can become a problem if you have a wound that requires stitches, because the skin often isn't strong enough to hold them.

STATIN MOA

inhibit HMG-CoA, the rate limiting enzyme in cholesterol synthesis. This leads to enhanced hepatic LDL receptor recycling and incr LDL clearance from the circulation s/e myopathy

Aminoglycosides MOA

inhibit bacterial protein synthesis and inhibiting genetic code reading by binding to prokaryotic 30s ribosomal subunit

Methimazole

inhibits thyroid peroxidase only PTU and methimazole are both "thioamides"

Trendelenburg gait

injections given in the superomedial quadrant of the butock have a high risk of injuring the sup gluteal nerve(L4-S1) resulting in gluteus medius weakness and trendelenburg giat. the superolateral quad of the buttock is a safte site for intra gluteal injection. TG: hip drop on the contralateral, unaffected side when the foot is raised

preventable adverse event

injury to a patient due to failure to follow an evidence-based best practice guidelines it can result in delay in diagnosis and treatment

DIABETES INSIPIDUS

intense thirst and polyuria, with inability to concentrate urine due to lack of ADH(central) or failure of response to circulating ADH(nephorgenic) urine gravity and osmolality will be low while serum osm will be hig

what enable influenza virus to cause cross species infection in human host cell

interaction with the host cell is dependent upon viral surface glycoprotein called hemagglutinin, which bind to sialic acid receptor on human respiratory epithelial cells swine flu /avian influenza

muscle pain that occur with exercise and remit with rest is

intermittent claudication; smoking is an risk factor. claudication is due to atherosclerosis of the large arteries- stenosis caused by lipid filled intimal plaques that bulge into the arterial lumen( atheromas)

Atherosclerosis

intima plaque that obstruct blood flow, consist of cholesterol, fibrous muscular cap on top, then it undergo calcification. large and Medium arteries involve: abd aorta, coronary, popliteal, internal carotid. risk is 1.atherosclerosis emboli: which will have cholesterol blebs- 2.it can weaken the vesel wall- o2 cant get thru the wall- wall bcom weak- it ballons- aneurysm

IV infusion of saline leads to

intravascular volum expansion with an incr intracardiac vol and filling pressure resulting in incr in myocardial wall stretch leading to the release of endogenous natriureti peptide hormones, including atrial natriuretic peptide ANP and brain natriuretic peptide BNP ANP, BNP respond to wall stretch by activating guanylate cyclase= incr CGMP= Vasodilation of aff & eff glomerular arteriole and incr GFR leading to natriuresis(sodium excretion) and diuresis (fluid excfretion)

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs; this is a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors pt will have movement include lip smacking, facial grimacing, tongue protrusion and choreoatheltoid movemtn of the head limbs and trunk

Concentric left ventricular hypertrophy

involves uniform thickening of the LV walls with reduction in LV cavity size results from prolonged systemic hypertension-HY

phenelzine, tranylcypromine

is a MAOIs . they are antidepressants that works by inhibiting oxidative deamination, thereby increasing the presynaptic availability of serotonin, NE and dopamine

idiopathic pulmonary fibrosis (IPF)

is a chronic progressive lung dz thought to be due to recurrent episode of lung injury and disordered healing. persistent inflammation likely triggers excessive activity of TGF-B, PDGF, FGF, VEGF. this leads to increased fibroblast activity/ myofibroblast formation and collagen production= pulm fibrosis

Krukenberg tumor

is a gastric tumor that has metastasized to the ovary and can present with unintentional weight loss, epigastric pain and adnexal masses. histologically, teh metastatic tumor cell have large amount of mucin with apically displaced nuclei resulting in signet ring appearance

Guillain-Barre syndrome

is a group of immune-mediated polyneuropathies that are caused by molecula.r mimicry. leading to demyelination of the peripheral nerves. it can be preceded by campylobacter jejuni and ass/w immunization

milrinone

is a phosphodiesterase-3 inhibitor that reduces the degradation of CAMP to treat decompensated heart failure. positive ionotropy to improve strove vol and cardiac output venous vasodilation reduces preload, arterial vasodilation reduces afterload to provide a cumulative reduction in cardiac work

Methadone

is a potent, long acting opioid agonist used in the maintenance treatment of opioid use disorder. its prolonged effects suppress withdrawal symptoms and craving. also its a full mu-opioid receptor agonist

synaptophisin

is a protein found in the presynaptic vesicles of neurons, neurocendorine and neuroectodermal cells. CNS tumor of neuronal origin usually stain positive for synaptophysin while neoplasm of glial origin (astrocytoma, ependyomomas, oligodendroglioma) will stains for GFAP

Antiseizure drugs define status epileticus

is a single seizure lasting more than 5min and pt never recover consciousness completely iv lorazepam is given first the phynytoin next cos its long acting anticonvulsant

nucleolus

is a site of ribosomal subunit maturation and assembly. RNA polymerase1 functions exclusively within nucleolus to transcribe the 45s pre-rRNA gene, which codes for most of the rRna components

Eosinophilic granulomatosis with polyangiitis (Churg- Strauss)

is a small to medium vessel vasculitis characterized by asthma, rhinosinusitis, eosinophilia. pt can have asymmetric multifocal neuropath due to vasculitis affecting the "epineural" vessels eg wrist drop to radial nerve involvement. positive PANCA(AB against neutrophil myeloperoxidase

Sertoli-Leydig cell tumor

is a tumor of the ovary arise from the sex cord stroma and secrete testosterone. pt will have large ovarian mass and sign of virilization. note the tubular structures lined by round sertoli cells and surrounded by a fibrous stroma are seen on picture

Procalcitonin

is a unique acute phase reactant that can rise or fall depending on infection; elevated levels means bacterial source low level indicate a viral source

Cyproheptadine (Periactin)

is an antidote for pt that took high dose of SSRI it is an antihistamine with antiserotonergic properties. it i sa first gen anithistamin

Projection

is an immature defense mechanism involving the misatribution of one's unacceptable feeling to another person who does not actually have them pt who is angry that parent is having a divorce, say he thinks his parent is angry with him.. projecting cos he is the one angry

Lipofuscin

is aproduct of lipid peroxidation, accumulating in aging cells especially in pt with malnutrition and cachexia

Membranous nephropathy

is ass. with igG4 antibodies to the phospholipase A2 receptor 1. weight gain, protein in urine and PLA2Receptor ab present

injury to the posterior urethra

is ass/w pelvic fracture and the anterior urethra is most commonly damaged in straddle injuries. inability to void with full bladder sensation, high riding boggy porstate. placement of foley catheter is impossible and painful ancer is C

pupillary light reflex

is assessed by shining light in an eye and observing the response in that eye(direct) as well as the opposite eye (consensual).

Zollinger-Ellison syndrome

is caused bu gastrin-secreting neuroendocrine tumors(gastrinomas) involving small intestine or pancreas. pt have peptic ulcer(often beyond the duodenatl bulb), abdominal pain/acid reflux, and diarrhea. usually ass/w MET1

Chronic lymphadema(pt had right leg swelling and thickened skin)

is caused by an acquired disruption of lymphatic drainage (eg due to malignancy or lymphadenectomy) and typically present with swelling and thickened skin in one or more extremities RX: compression badages adphysiotherapy. diuretics are ineffective and contraindicated

stress induced cardiomyopathy (takotsubo)

is characterized by hypokinesis of the mid and apical segment and hyperkinesis of the basal segment of the LV resulting in systolic dysfunction. this condition is caused by a surge of catecholamines in the setting of physical or emotional stress and it actually affect postmenopausal women and resolves on its own within several weeks aka broken heart syndrom

white coat hypertension

is classical conditioning:

mcc of liver metastases

is colorectal cancer, which spread directly form the colon or superior rectum through the portal venous system to the liver. gastric and pancreatic cancer also spread thru the portal system of the liver

acne vulgaris

is due to adrenarche-associated enlargement in sebaceous gland with subsequent increases in sebum production. follicles clogged with sebum provide the anaerobic, lipid-rich environment necessary for the proliferation of propionibacterium acnes,

capsaicin

is found in chilli pepper; it cause excessive TRPV1 activation causing buildup on intracellular calcium that result in long lasting dysfunctionof nociceptive never fiber also HY depletion of substance P. so pt feel no pain

PAH and Creatinine

is freely filterd and secreted into urine not reabsorbed

6-Mecaptopurine metabolism

is mainly degraded in the liver by xanthine oxidase. allopurinol, an XO inhibitor can increase the concentration of 6MP

PAN (polyarteritis nodosa)

is segmental, transmural, necrotizing inflammationof medium tosmall sized ateries. no lung dz necrotizing vasculitis renal usu involved, liver, heart kidney are involved PULM ART is NEVER involved

Clear cell carcinoma

is the mcc type of renal cell carcinoma and it originates from the epithelial cells of the PCT gross pathology: sphere like mass composed of golden yellow cell due to high lipid content with areas of necrotic cells an focal hemorrhage

bicuspid aortic valve sound

is the most common cause of aortic stenosis you hear harsh crescendo- decrescendo

Rhabdomyolysis

is the release of intracellular muscle content eg myoglobin, electrolytes due to myocyte injury hy: it is common iwth crush injuries, seizure or drug use(eg statin). pt can have acute kidney injury, hyperkalemia and 3+ blood in urine but no RBC has rhabdomyolysis and its likely induced by seizure. myoglobin is degraded within the glomeruli, heme pigment is released, which destroys the tubular cells- acute tubular necrosis

digoxin

is used for ventricular rate control in atrial fibrillation as it decreases AV node conduction by incr parasympathetic vagal tone. digoxin in used in HF due to its positive inotropic effect and this effects are accomplished via inhibition of Na-k ATPase pump

ventilation-perfusion scan

is useful for dx pulmonary embolism PE should be suspected in pt with recent extended travel(prolong immobilization) who now as acute-onset dyspnea and tachpnea- [pt will have nl lung exam and sinus tachy on ECG. CT angiography is the dx test of choice but shud be avoided in pt with chronic kid dz CKD due to incr risk of contrast-induced nephropathy so in this pt do V/Q scan

in response to progressive occlusion of coronary artery by atherosclerosis

ischemic myocardium may release growth factor eg VEGF to stimulate formation of maturationof collateral vessel. in this pt the slow development of a stable atheroscleortic plaque in the LAD likely allowed collateral vessel from the et coronary artery to supply the ischemic myocardium located distal to the LAD occlusion

sublingual nitroglycerine vs oral nitrate

isosorbide dinitrate has a low bioavailability due to extensive first-pass "liver" metabolism prior to release in circulation sublingual nitroglycerine is abosrbed directly from oral mucosa into the venous circulation and has a high bioavailability

HCM worsen with what drug

isosorbide dinitrate, bos it will decr LV volume which can be caused by reduction in cardiac preload. therefore medication that decr venous return or systemi vascular resistance(dihydropyridine calcium channel blockers, nitroglycerin should be avoided

Necrotizing enterocolitis

it affect newborns. it is bacterial invasion and ischemic necrosis of the bowel wall xray: air in the bowel wall/ curvilinear areas of lucency(red arrow) physical: abdominal distension and bloody stool

Sulfonoureas (Glyburide) moa

it bind to a receptor on pancreatic beta cell and inhibit the ATP-sensitive potassium channel. this alters the cell resting potentioal and allows ca influx leading to exocytosis of insulin. this result in incr insulin secretion "independent of bld glucose level" which lead to risk of hypoglycemia /confusion

Osteoprotegerin

it blocks binding of RANK-L to RANK and reduces formation of mature osteoclast

secretion of a parathyroid hormone related protein PTHrP

it closely resembles PTH , the serum calcium level will be high which will lead to weakness, neuropsychiatric symptoms, constipation nausea or kidney stones. severe hypercalcemia results in impairement of the concentrating capacity of the distal tubule, leading to polyuria and vol depletion. it can also be said that the pt has symptomatic hypercalcemia bcos she had a mass on her lung with enlarged mediastinal lymph node- humoral hypercal of malignancy

Inactivated killed viral vaccines moa vs live attenuated

it generate a humoral immune response agains extracellular viral antigens preventing "viral entry" into the cell Life att viralvaccine can generate a strong cell mediated immune that can kill virally infected cell in addition to providing humoral immunity

cortisol as immnosuppresor

it inactivate NF-KB which mediates response to TNF alpha control synthesis infflammatory mediator like COXQ, LIPOOXygenase

Third degree AV block (complete heart block)

it involves dysfunction of AV node resulting in total lack of communication betw the atria and ventricles. on ECG, there is dissociation of P waves and QRS, with P waves marching out at the intrinsic rate of the SA node and QRS at the intrinsic rate of the his bundle or ventricle(escape rhythm)

Kaposi Sarcoma (HHV-8) in HIV pt

it involves skin and GI tract. endoscopy reveals lesion which range from reddish/violet flat maculopapular lesion to raised hemorrhagic nodules . biopxy can show spindle cells neovasculirization, and extravasated rbc

alteplase moa, it was given to a pt who came in withmidsternal chest pain diaphoresis

it is a fibrinolytic. it binds fibrin in the thrombus(clot) and converts entrapped plasminogen to plasmin. plasmin hydrolyzes key bonds in the fibrin matrix causing clot lysis and restoration of coronary arterial bld flow. the most common adverse effect of fibrinolytic therapy is hemorrhage. intracerebral hemorrhage s/s are decr level of consciousness, asymmetric pupils and irregular breathing.

bupropio

it is a norepinephrien-dopamin reuptake inhibitor. it treat depression, hypersomnia and low energy. it is preferred cause it . auses less weight gain

urticaria

it is caused by IgE-mediated degranulation of mast cells leading to incr permeability of the microvasculature with edema of superficial dermis

digoxin

it is cleared in kidney so dont chose P450 OR liver

Phenoxybenzamine

it is non competitive inhibitor of NE IT IS AN IRREVERSIBLE ALPHA 1&2 adrenergic antagonist that reduces the vasoconstriction induced by NE. B COS PHENOXYBENzammine is irreversible antagonist even very high conc of NE such as thosee seen in pheochromocytoma cannot overcome its effect

Thiazide diuretics function and s/e

it lower BP by decreasing intravascular volume, reducing cardiac output and lowering systemic vascular resistance. it inhibit Na/Cl in the DCT thereby decr reabsorptionof Na and CL it activate RAAS, so aldosterone can excrete potassium and hydrogen resulting to hypokalemia and metabolic alkalosis

Atheroembolic disease

it occurs after a pt undergo an invasive vascular procedure eg coronary angiography, aortic surgery in which atherosclerotic plaque on large vessels eg aorta are mechanically dislodged. this lead to showering of cholesterol rich microemboli into the circulation with resultant obstruction of distal arterioles and tissue ischemia. clinical manifestion is dependent on where the emboli stops but pt frequently develop acute kidney injury. histology will show a needle shaped intravascular cholesterol cleft

Sarcoidosis

it often present on young african american women with onset of resp symp eg cough dyspnea chest pain then weight loss fatigue. histo: noncaseating granulomas which consist of aggregates of epitheliod macrophages and multinucleated giant cell. it is also incidentally detected in asymptomatic pt with typical chest x-ray showing bilateral hilar lymphadenopathy

medial circumflex femoral artery

it provide majority of the bld to the femoral head and neck.injury to these vessel due to displaced femoral neck fracture can cause osteonecrosis of the femoral had

NNH (number needed to harm)

it represent the # of ppl who must be treated b4 one additional adverse event occurs. to calc Absolute risk increase, first calculate the adverse event rate(eg death. diseased) 1/ARI

Inferior epigastric artery on contrast

it runs superiorly and medially up the abdomen, it provides bld supply to the lower ant abdominal wall.

bronchial circuit

it supples oxygen and nutrient to the pulm parenchyma from the systemic circulation but drains mostly to the LA instead of the RA where everything drains. this will creat a rt to left shunt that acts as a partially independed cirucut. howerever this typically accounts for <5% of the systemic cardiac output.

Thiazide diuretics

it use is ass/w higher bone mineral density and reduced fracture risk. good for pt with hypertension and osteoporosis. with the metabolites it will raise serum calcium, uric acid, gluc, chol, and TG levels and lower serum sodium, K, magnesium

Beta Blockers for MI why

it used in a ute MI to reduce morbidity and mortality by decreasing cardiac output and myocardia oxygen demand NON-cardioselective BB(propranolol,nodolol) can trigger bronchospasm in pt with asthma or COPD- DONT GIVE. so give CARDIOSELECTIVE BB(eg metoprolol) it affect beta-1 receptor and are prefered

Normal pressure hydrocephalus

its a communicatinghydrocephalus ass/w decr CSF resorption by arachnoid granulations

Suborrheic Keratosis

its age related, appears "stuck-on" rapid onset of numerous SK(leser-trelat sign) is often ass/w an internal malignancy- gastric adenocarcinoma)

Trastuzumb effect on cardiomyocyte

its used to treat breast cancer by inhibiting HER2. but HER2 plays a role in preserving cardiomyocyte function and minimizing oxidative stress. trastuzumab can cause cardiotoxicity that manifest as a decrease in myocardial contractility without the muscle being destroyed

congenital synd that causes QT prolongation

jervell and lange-nielsen synd(AR, with neurosensory deafness) romano-ward synd(AD, no deafness)

pt has x lined mutation affecting the phosphoribosyl pyrophosphate PRpp synthetase gene. what organ will be affected

joint. gout is caused by tissue deposition of monosodium urate crystals. elevated uric acid levels are risk and can be due to incr purine metabolism= hyperuricemia and gout. PRPPsynthase is responsible for production of ribose used for de novo synthesis of purine and pyrimidine= failure= incr purine due to other pathway for purine to be made= purine undergo degradation=hyperuricemia

evaluation of hypoglycemia

just like insulinoma, pt that is taking sulfunourea will also have inc insulin and c-peptide

Autism Spectrum Disorder

lack of friends, social isolation, fixated interest, and trouble taking turns in conversation . they have difficulty interpreting and responding approprately to nonverbal aspect of communication.

temporal arteritis

large arteries inflammation. polymyalgia rheumatica(fever, weight loss, torso, neck, shoulder, pelvic girdle pain and morning stiffness )occur im more tha half of pt with this dx

staghorn calculus

large renal stone, takes up the space of renal calyces. composed of struvite(magnesium ammonium phoaphate) ass/w upper UTI by hy- klebsiella and proteus- urease producing organism

Type of vasculitis

large vessel: involve aorta temporal(giant cell) arteritis: female, branches of carotid art. headache(temporal), blind(opthalmic) etc. biopsy: granulomatous inflammation and intimal fibrosis

IP3 and DAG

lead to smooth muscle contraction

carotid sinus massage moa this pt present with sudden onset of palpitation and rapid regular tachy is consistent with paroxysmal supraventricular tachy PSVT(which is often due to re-entrant impulse traveling circularly btwn the slowly and rapidly segment of AV node)

leads to incr afferent firing from the carotid sinus which in turn incr vagal parasympathetic tone causing temporary inhibition of SA node activity, slowing of conduction thru the AV node, and prolongation of the AV node refractory period. it is a useful vagal maneuver fro termination of paroxysmal supraventricular tachycardia

Hyaline arteriolosclerosis

leakage of protein out of the vessel wall, aging and diabeties

pt with fever, diarrhea, confusion, cough. sputum gram staining reveals numerous neutrophils but no bacteria dz is?

legionella pneumophila

in multipy myeloma what do u see in urine

light chain cast nephropathy

avoidant personality disorder

limited social interaction but they eanna make friends and be accepted. they avoid social gathering for fear of rejection

Serotonin Syndrome is ass/w what antibiotic

linezolid. maoi antidepressant also causes it

bacteria that produces a very narrow zone of beta hemolysis on bld agar, grows well in refrigirator temp and shows tumbling motilityin the fridge is

listeria monocytogenes: gram positive

specific phobia treatment( stairs, dog, height, plane)

longterm: exposure based cognitive behavioral therapy, in which pt are systematically confronted wit their feared object. shortterm: benzodiazepines

pt wants a benzo for her anxiety but wants one that is short acting so she can sleep and wake up alert and refresh in the morning

lorazepam

Achalasia rx

loss of inhibitory ganglion cell in the distal esophagus. so absence of esophageal peristasis and incomplete relaxation. RX: botulinum toxin prevents acetylcholine release into the neruomuscular synapse resulting in inhibiton of cholinergic neurons- weakness and paralysis. so in this pt injection of botulinum toxin into the LES will relax the sphincter

Dysplasia grade

low grade dysplasia: involves only a small portion of the epithelium it usually spontaneously regresses and needs no treatment high grade; involves most or allof the epithelium but does not penetrate the bm; it is ass with high risk of progression to invasive cancer and is typically referred to as carcinoma in situ invasive carcinoma- involves the full thickness of the epithelium and penetrat3es the basement membrane. the malignant cell may be similar (well differentiated) or may lack the characteristic features of cell found in the tissue of origin(poorly differentiated)

Enoxaparin

low molecular weight heparin that function by "binding and activating antithrombin 111. (AT111) when activated it binds to factor Xa and stops it from converting prothrombin to thrombin.

X-linked agammaglobulinemia

low or absent circulating CD19 CD20 B cells and infections after 6 months pt will be susceptible to pyogenic bacteria, enterovirus and gardia lambia due to absence of opsonizing and neutilizing antibodies . in this condition a mutatin in the bruton tyr kinase gene causes failure of bone marrow preB cell(cd19,20) to develop into mature circulating b lymphocytes(cd 19,20, 21)

Hypovolemia Lab Values

low urine Na ↑ Specific Gravity ↑ BUN/Cr(prerenal azotemia) ↑ Hct ↑ Osmolality (ICF volume, ↓ ECF volume) ↓ K

chlorthalidone: Thiazide diuretics moa

lowers BP by decreasing intravascular volume, reducing cardiac output and lowering systemic vascular resistance. it inhibit Na/Cl co transporters in DCT, thereby decr Na/Cl reabsorption hypona, hypok, hypeca, hypergly, hypechol, hyperuricemia

pt takin monoclonal antibodies(mabs) drug to treat(eg crohn, RA, lukemia/lymphoma) is not eliminated by CYP450 like other drugs but by

mabs are not eliminated by heapti c or renal clearance but are removed from the body in 2 ways 1. target mediated drug clearance: mab direced against cell surface antigen undergo internalization (receptor mediated endocytosis) upon binding to their targets, removing them from the circulation 2. nonspecific clearance: immunoglobulins are constituitively taken up by the reticuloendothelial macrophages (via binding to Fc receptors and vascular endothelial cell( via pinocytosis))

MCV greater than 100

macrocytic- megaloblastic anemia such as VIT B12, folic acid def. pt with chronic hemolytic anemia eg SS DZ have inr folic acid requirement due to incr erythrocyte turnover and are predisposed to macrocytosis

adjusted parameter of drug

many drug are dosed based on total body weight to improve safety and efficacy. in obese pt, use of lean body weight or an adjusted body weight may be necessary when dosing hydrophilic drugs(eg aminoglycosides) that do not distribute into adipose tissue

researcher is taking pt with colon cancer and person without but with similar characteristics and the researcher is comparing the result of the pairs of individual this techinque is called

matching, is used in case-control studies in order to control confounding

neonatal tetanus is prevented by

maternal immunization will proved IgG transplacental protect child till 2mo, hygienic delivery and umbilical cord care. clenched hands, dorsiflexed feet

enhancers and silencers location

may be located upstream, downstream, or within a transcribed gene; these gene sequence function to incr and decr the rate of transcription, respectively. in . contrast, promoter regions are typically located 25 or 75 bases upstream from their associated genes and function to initiate transcription.

Lusitropy on heart muscle and its regulation

means relaxation. regulated by phospholamban serca takes calcium from the cytosol into the sr so that the muscle can relax and increase preload but phospholamban inhibit serca there by having ca stays in the cell. but beta adrenergic inhibit phospholamban so SERC can do its job and heart muscle relax= incr preload

MMR vaccine

measles, mumps, rubella and its live attenuated cong rubella: microcephaly, cataract, deafness, PDA, pulm stenosis, mental retard

Kawasaki disease

medium sized arteries vasculitis. child will have 1. 5days of fever 2. bilateral non exudative conjuctiva injection(erythema) 3. cervical lymphadenopathy(looks like swollen neck) 4. edema of hands feet erythema of palms and soles, 5. rash

Ramelteon

melatonin receptor agonist. used for insomnia. it has low s/e benzo, antihistamines, and sedating antidepressant shud be avoided in the treatment of insomnia in pt tht are elderly due to adverse effect

Spike and dome appearance

membranous nephropathy- nephrotic syndr in adult ass/w solid malignancy, viral hepatitis and SLE

t sample t test

method used to compare the means of 2 group of subject

drug that both inhibit thymidylate formation

methotrexate and 5FU methotrexate is a folic acid analog

pt was prescibed a drug a week ago, he went to party this friday drank alcohol now has facial flushing, headache, nausea vomiting, stomach ache after drinking the alcohol. the pt is sexually active. what pill was prescribed

metronidazole- pt develop a disulfiram-like reaction shortly after ethanol consumption. this drug is used to treat trichomonas vaginitis and gardenella bacteria vaginosis pt should not take alcohol while o this drug

deep brachial artery is affected in what injury

midshaft injury of the humerus

pediatric pt present with generalized edema, massive proteinuria following an upper respiratory infection has

minimal change dz

pt swallowed handful of opiod as the officer approach what is the finding in this pt

miosis, decreased bowel sign, hypotension, dec resp rate, depressed mental status

Hereditary Hemochromatosis

missense mutation in the HFE gene resulting in excessive intestinal iron absorption and organ damage- cirrhosis, DM, cardipmyopathy due to iron accuumlation within parenchymal tissue

opening snap after s2 and a low pitched diastolic rumble

mitral stenosis

Pro-carcinogens are metabolized by...

monooxygenase aka cytochrome P450 moooxygenase it metabolises steroid, alcohol. toxins. forein substances by rendering them soluble and easier to excrete. unfortunately it converts pro-carcinogens into carcinogens capable of causing mutations

D-xylose

monosaccharide absorbed from gut, excreted in kidneys. d-xylose test used to measure GI mucosal damage. measure blood/urine levels after admin its absorption is not affected by pancreatic insufficiency

Hematogenous osteomyelitis

more common in children and usually affects the metaphysis of long bones due to slower blood flow and capillary fenestrate in this region. Without proper treatment, the infection can progress to chronic suppurative osteomyelitis. Q said the 3y/o was limping , dont wanna bear weight with his rt lower extremity, passive range of motiion does not elicit pain and no joint effusion is seen.

carvallo's sign

most right sided murmur is louder during inspiration. bcos it draws more blood vol to lung. so pull bld thru the right side of the heart

women in 2nd/3rd trimester drink solution of glucose and serum glucose level checked an hour later

mother gluc should be elevated becos of human placental lactogen that incrases maternal insulin resistance leading ot rise in serum gluc so as to provide adequate nutrition to the fetus. when the gluc bcome too high it lead to gestational DM

Trichomonas vaginalis

motile, protozoan, can be seen on wet mount . yellow green vagina discharge, burning. saline microscopy is Dx metronidazole is Rx

Essential tremor

movement disorder and is treated with beta blocker. propanolol will prevent E, NE tobind to its receptors Beta 1 beta 2 at adrenergic synapse; in pt with astham beta 2 inhibition will cause bronchoconstriction and pt with ET will start having asthma symp

Tuberous sclerosis

multiple organ child present with seizures facial skin spot mental retard ash leaf spot

young woman has diplopia with internuclear opthalmoplegia(impaired adduction on the left with rt lateral gaze)- . she had prior episode of blurred vision and eye pain with movement dx is

multiple sclerosis- a demyelinating dz of the CNS caused by an autoimmune response directed at oligodendrocyte. leading t reduced saltatory conduction

pt felt muscle cramp while walkin a block, he felt better with rest, h/o hypercholesterol and a smoker

muscle pain occurs with intermittent claudication; smoking is a risk factor. it is usually due to atheroscleosis of the large arteries. resulting from fixed stenoses causedby lipid filled intimal plaque that bulge into the arterila lumen(atheromas). the Lower Extr are most commonly affected,. howerver proximal lesion(aorto-illiac occlusion aka leriche synd) can cause gluteal claudication leading to this man impotence

Hypokalemia causes

muscle weakness, cramps and rhabdomyolysis eg a pt given hypertension drug- chlorthalidone/ hydrochlorothiazide and amlodipine has muscle pain

toxic adenoma

mutated TSH receptor that do not respond to TSH. one nodule: toix adenoma multiple: toxic multiple goiter. pt wil have hyperthyroidism

mutation in MLH1 & MSH2

mutation in dna mismatch repair genes that result inmicrosatellite instability and accumulation of genetic errors causes hereditary nonpolyposis colorectal cancer- lynch synd

TTN gene

mutationin this gene which encodes for the sarcomere protein titin are the mcc of familial dilated cardiomyopathy

Opiod withdrawal

mydriasis/dilated, abdominal pain, diarrhea, piloerection, lacrimation and yawning

Coronary Autoregulation

myocardium extracts 75% of the O2 delivered by coronary BF beta-receptor activation increases rate and contractility producing hyperemia physiological local metabolic control involves several mechanisms including adenosine, ATP-dependent K channels, NO, prostagladins or inhibition of endothelin

muscle atrophy involving difficulties in releasing the door knob

myotonic dystrophy; an AD. it is cause by increased number of trinucleotide repeat on myotonia-proteinkinase gene. sustained muscle contraction(myotonia) along with weakness and atrophy

renal artery stenosis

narrowing of the renal artery caused by artherosclerosis or fibromuscular dysplasia(younger women), can impede blood flow, hypertension and atrophy of the kidney. significant renal hypoperfusion will result in a decr GFR and activation of the RAAS. this leads to incr renin release by modified smooth muscle(juxtaglomerular) cells in the walls of afferent glomerular arterioles. chronic hyperperfusion can cause hypoplasia of the juxtaglomerular apparatus

digoxin toxicity

nausea, vomiting, confusion, and fatigue and visual symptoms. elevated potassium because digoxin inhibit Na-K-ATPase pump

what are the chances that i really do not have thyroid cancer

negative predictive value

Membranous nephropathy

nephrotic in adult, EM of the capillary demonstrates irregular, subepithelial, electron dense immune deposit on the glomerular BM with moderate effacement of the podocyte foot processes spikes and domes

Minimal change disease

nephrotic, caused by immune dysregulation and overproduction of a glomerular permeability factor(IL 13) which damages podocytes and decr the anionic properties of the glomerular basement mem. this result in loss of just albumin in the urine and not all protein unlike other nephrotic syn

cyanide toxicity can occur in pt treated with

nitoprusside. pt willhave altred mental status, seizures, lactica acidosis, bright red venous bld. antidote rx is hydroxocbalamin, inductionof methemoglobinemia(sodium nitrite) and use of detoxifying sulfur donors( sodium thiosulfate)-hy

atrial fibrillation

no p wave, iregularly iregular heart beat = RR interval= decr Left vent ejectn fraction LVEF= heart failure thrombus can form in LV appendage= cardiac embolism= to the brain is stroke. to the GI is mesenteric ischemia to the spleen is splenic infarct. hyperthyroidism can cause A FIB.

inulin and mannitol

no tubular reabsorption or secretion -filtered amount = excreted amount

sleep walking and night terrors

non REM parasomnia of childhood, occurs during slow wave sleep N3= delta wave on EEG

Crohn Disease: Histology

non caseating granuloma, transmural inflammation

Shigella

non-lactose fermenting, watery, bloody diarrhea that produce acid(not gas) during gluc fermentation mucosa invasion is the patogenic mechanism for shigella infection. it invades the M cells that overlie peyer patches. after cell entry, it lyse containment vacuole and enter the cytosolic compartment. it then can induce apoptosis o fth ehost cell and spread to adjacet cell via protusion created thru host cell actin polymerization.

a child speaking to an empty chair said she is speaking to her dead grandma that passed 2mo ago

normal behavior, the child is hallucinating which is part of a norma grief rxn

pulsus paradoxus

normal inspiration, incr vol to the right side. cos the RV is restricted via tamponade. RV wall bulges, decr the LV= dec CO. like the picture. asthma and COPD EXACERBATION ARE THE MOST FREQUENT CAUSES OF PULSUS PARADOXUS IN the absence of significant pericardia dz. beta adrenergic agonist control acute asthma and COPD exacerbations by causing bronchial smooth muscle relaxation via incr intracellular cAMP

watery diarrhea w/o bld or mucus outbreak

norovirus; SSRNA. mcc of viral gastroenteritis in developed countires. resolves in 2-3 days, vomitting and diarrhea

Charcot-Bouchard microaneurysm

notice it is white(hyperdense) lacunar infart would have been dark

VIT E def

occur i pt with fat malabsorption. deficiency of this fat-soluble vit is ass with increased susceptibility of neuronal and erythrocyte membrane to oxidative stress. pt can have ataxia, impaired proprioception and vibratory sensation and hemolytic anemia

Rouleaux formation

occurs due to elevated levels of circulating proteins causing erythrocyte to stack and aggregate. it is found in multiple myeloma and waldenstrom macroglobulinemia which generate high leves of monoclonal "paraprotein (immunoglobulins)

CMV esophagitis

occurs in transplant pt and usually present with odynophagia or dysphagia tht can be accompanied by fever, chest burning pain. endosoocpy typically show linear and shallow ulceration in the lower esophagus and histology usually shows enlarged cells with intranuclear inclusion

Dyssynergic defecation

occurs when puborectalis muscle or the internal or external anal sphincter fails to felax during defecation, leading to chronic constipation.

Paradoxical embolism

occurs when venous clot that lodges into systemic/arterial circ (brain), via abnormal connection btwn the right and left cardiac chambers eg foramen ovale, ASD, VSD) eg pt develop stroke from DVT dislodging to middle cerebral artery. HY: Atrial left to right shunts cause wide and fixed splitting of S2 and can facilitate paradoxical embolism due to periods of transient shunt reversal eg during straining or coughing

odds ratio

odds of developing arrhythmia in exposed divided by odd of developing arrythmia in unexposed group

Paget disease of bone (osteitis deformans) s/s

older pt will have bone pain, enlarged veterbral bodies with cortical thickening onimaging . PD is characterized by excessive and disorderedbone formation. it affect the skull, long bones of the extremites and vertebral column the icr formation of new bone is PD is ass with an elevated serum alkaline phosphate level while calcium and phosphorus are normal

Ethambutol side effects

optic neuropathy- blurring vision

viral replication cycle and antiviral therapy

oseltamivir is a neuraminidase inhibitor useful in the treatment of both influenza A and B virus infections. neuraminidase is requred for the release of virus from infected cells and for the spread of virus withing the respiratory tract. so therefore it can be used to treat or prevent influenza

child has white pupillary reflex (leukocoria) is at risk of

osteosarcoma. retinoblastoma is the most common ocular tumor of childhood familial RBlastoma: rb supressor gene on chrom 13 is affected

tumor in the adrenal cortex are

outer; aldosterone/conn synd middle; cortisol/cushing synd inner; androgens/hirsutism and virilization

Malignant ovarian neoplasms

ovarian cancer has 3 histologic type: epithelial, germ cell, and sex cord stroma. epithelial is the most common and is ass with (cancer antigen)CA 125. pt with ovarian cancer present with pelvic mass, ascites, and peritoneal metastasis that result in decr appetite, abdominal distension and bowel orbladder changes constipation, urinary frequencies

Vibro cholerae

oxidase positive, gram neg, comma shaped organism that require salt for growth and exist in aquatic environments. transmission by ingestion of contaminated food or water shellfish diarrhea by invading the intestinal epithelium or releasing enterotoxin. it clumps togetehr in colonies along the surface of the small intestine . it also activates adenylate cyclase leading to incr cl- efflux reduced Na reabsorption

Osler's nodes

painful, fingertims and . toes

testicular cancer

painless, solid testicular mass should always be considered testicular cancer until proven otherwise. types: 1. germ cell tumors(95%): seminomatous or nonseminomatous(embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed) 2. sex cord- stromal tumors: sertoli and leydig cells

Janeway lesions

palms and sole, nontender. pt has acute infective endocarditis and are the result of septic embolization from valvular vegetation

retroperitoneal hematoma due to an accident

pancreas is mostly injured then other organ at the back not spleen

hyperacusis nerve innervation

paralysis of stapedius muscle which is innervated by the stapedius nerve( which is branch of facial nerve)

contralateral Hemineglect

parietal lobe lesions

Urachal abnormalities

patent: pt present with straw colored urine discharge from the umbilicus which is exacerbated by crying, straining. sinus: failure to close the distal part, adjacent to the umbilicus . it present with periumbilical tenderness and purulent umbilical discharge due to persistent and recurrent infection

burnt pt will be affected with pseudomonas what antibiotic shud be given

penicillin 3rd and 4th cephalosporin

male organ drainage penis scotrum testis

penis- deep inguinal scotrum- superficial inguinal testes- paraortic node

Vincristine SE

peripheral neuropathy and neurotoxicity eg finger numbness and tingling.

Vincristine s/e

peripheral neuropathy. finger numbness tingling

Action Potential (AP) of myocyte

phase 0: class 1 antiarrhythmic drug phase 2: L type ca-verapamil/diltiazem phase 3: class 3 antirarrhythmic drg

Milrinone

phosphodiesterase 3 inhibitor. PDE3 breaks down cAMP in myocytes. so the inhibitor incr cAMP - incr contraction of myocyte by activating b1 receptor. dobutamine works same way

photoaging: uv contribute to aging how

photoaging is caused by UV light penetrate into skin causing epidermal atrophy and decr collagen fibril production and incr degradation of collagen and elastin in the dermis

IPF (idiopathic pulmonary fibrosis) RX

pirfenidone - it inhibits TGF-B nintedanib- a tyr kin inhibitor that inhibits PDGF, FGF, VEGF. aka perfect nine

Central Diabetes Insipidus cause

pituitary tumor aut. immune accident/trauma surgery ischemic encephalopathy

female, headache, sudden onset of blindness in rt eye . recently has neck, torso, shoulder, pelvic girdle pain and morning stifness dx

polymyalgia rheumatica(neck, shoulder, mornining stiffness,: occurs in half pt with temporal arteritis(inflammation of medium, large size arteries and on microscopic exam granulomas are seen in the media of the arteries

Pseudogout

positive birefringent, CPPD

I HR BOY, flattened nose, bilateral club feet dies in 1 hr after birth dx

potter seqeunce- renal agenesis

gallbladder hypomotility

ppl develop SLUDGE! gallbladder is not emptying in response to CCK. gallbladder function is to actively absorb water from bile. so hypomotility causes the bile to become concentrated, promoting precipitation and accumulation of particular material. this cause bililary sludge that can cause bile duct obstruction(biliary colic) and promote cholesteorl gallstone formation

myocardial hibernation

presence of LV systolic dysfunctio due to reduced coronary bld flow at rest that is partially or completely reversible by coronary revascularization.

s/s of pt with familial chylomicronemia

present in childhood with marked hypertriglyceridemia , reccurent acue pancreatitis, lipemia retinalis(milky appearing retinal vasculature) and eruptive xanthomas(small yellow papules on the extensor surface)

Atopic Dermatitis (Eczema)

present with pruritus and erythematous papule and plaques and is ass/w other atopic dz such as allergic rhinitis and asthma

Sydenham's chorea and with a pt with sore throat 3mo ago

presents with involuntary, rapid, irregular, jerking movement involving the face, arms and legs, it occurs months after group A strep infection and is one fo the major clinical manifestations . of acute . rheumatic fever, so pt with this condition has a high risk of chronic valvular dz. it is caused by delayed onset autoimmune rxn involving antistrep antibodies that cross react with the basal ganglia

middle age women with generalized pruritis and signs of VIT A def, likely has

primary biliar cholangitis PBC. auto immune destruction of small bile ducts in the liver- bile acid is important for solibilization and absorptioN of fat; pt will develop malabsorption of fat soluble vit ADEK

elevated liver enzymes and antimitochondrial antibody

primary biliary cholangitis: destruction of small and mid-sized intrahepatic bile duct with resulting cholestasis. biopsy show patchy lymphocytic inflammation with destruction of intrahepatic bile ducts and necrosis and micronudular regeneration of periportal tissue. which is similar to graft versus host dz biopsy finding

pt sperm count is ok but it is immobile dx

primary ciliary dyskinesia- AR mutation in protein responsible for normal flagellar and ciliary structure and fuction eg dynein, assembly proteins- situs inversus, chronic inusitis, bronchiectasis andinfertility

Dengue virus(by aedes mosquito). SSRNA

primary/ pt first infection: asymptomatic and self limited secondary infection: due to infection with a different viral serotype and usually cause severe illness

nipple discharge in both breast and cessation of menstration

prolactinoma- active pituitary adenoma later stage; pt can have headache and bitemporal hemianopsia due to compression of optic chiasm

histopathologic of syphilitic lesions at all stage is

proliferative endarteritis of small vessels with a surrounding plasma cell- rich infiltrate. in the initial stage pt ill be testing neg for rapid plasma reagin(RPR)

First degree AV block

prolonged PR interval almost up to 2 box or more. usually it within 1 box. it is always followed by a qrs

the TATA box

promoter region in which RNA polymerase 2 binds during initiation of transription

prostatectomy or injury to the prostatic plexus can cause

prostactic plexus originates from inferior hypogastric plexus innervates teh corpus cavernosa of the penis, which facilitates penile erection. ans: erectile dysfunction

niacin s/e is mediated by

prostaglandin flushing warmth itching andits use to teat hyperlipidemia and to raise HDL. to lower TRIglycride and LDL

sclerotic bony metastases in an older man is suggesting

prostate cancer. imagine of bone metastases assist in cancer diagnosis osteolytic(lucent): due to osteoclast stimulation tend to represent aggressive cancer. osteoblastic(sclerotic): due to osteoblast, indicates a more indolent course prostate cancer commonly has osteoblastic bone lesion

DNA binding proteins

proteins that bind to regions of nuclear DNA near genes and directly switch these genes on or off. they are diverse group that include 1. Transcription factors(Myc. CREB) 2. Steroid receptors(cortisol, aldosterone, progesterone), 3.thyroid hormone reeptor, 4.fat soluble vitamin receptors(vit D, retinoic acid), and 5. dna transcription and replication proteins

pelvic splanchnic nerves (s2-s4)

provide paraynpathetic innervation to the bowel and bladder, it is impaired in cauda equina synd

Idiopathic Intracranial Hypertension aka

pseudotumor cerebri, optic disc roundness will be blurry that is a sign of papilledema. incr intracranial press compresses the optic nerve resulting in impaired axoplasmic flow and optic disc edema

Sitting up from supine position without using hands. what muscle

psoas major

Placenta accreta

pt after delivery started continue bleeding non stop acreta has direct myometrium attachment

Valsalva maneuver

pt bears down as if having a bowel movement. or blows against closed glottis resulting in increased intrathoracic pressure= compress of veins in the chest- dec venous return to the heart- less preload= smaller LV cavity= incr murmur intesity

Herpes Simplex Virus

pt came with rash(erythema multiforme) but had 2weeks ago a recurrent genital lesion which began with small papules and then became vesicular with ulceration, crusting and eventual healing

pt had a severe accident now have difficulty tasting food

pt has ageusia(loss of taste). which occus in setting of anosmia(loss of smell). a common complication of tramatic brain injury leading ot avulsion of the olfactory nerve rooflet

Congenital long QT syndrome

pt has an ion channel defect, causing cardiac cell to show dec outward pottasium flow resulting in prolong action potential- K channel defect- decr in the outward K current leads to prolong AP & QT interval = live threatening ventricular arrythmia= syncope , seizure, death etc

young girl coplain of pain in the leg during sport, P.E shows pulsatile vessel within the intercostal spaces and diminished femoral pulses relative to brachial pulse.

pt has aortic coarctation ass/w tuner synd

34y/o with a h/o infective endo carditis complain of excercise tolerance decr for 6mo, partial compression of the femoral arteries by the stethoscope elicits a systolic- diastolic bruit. both carotid arteries demonstrate a rapid rise and fall of the arterial pulse

pt has aortic regurg which can be a complicatio of his h/o infective endocarditis. rapid loss of aortic pressure during diastole due to backflow of bld into the LV= LV will dilate= incr LVEDV= eccentric hypertrophy that allows a compensatory incr in SV & CO

pt taking risperidone stop menstration and has breast tenderness for 3mo why

pt has drug induced hyperprolacteinemia due to risperidone, an antipsychotic drug. it inhibit D2

anorexia nervosa

pt has low body weiht but still dieting, purging, binge eating, caloric restriction. intense excercise cos they fear of bcoming fat and distorted body image. amenorrhea, fine downy body hair

Neuroleptic Malignant Syndrome

pt is taking haloperidol and sertraline for schizo. now he is obtunded and diffusely rigid without clonus. NMS: muscle rigidity, hyperthermia, . pt shud stop the antipsychotic in this case haloperidol and shud take supportive care ; dantrolene, a ryanodine receptor blocker that inhibits calcium release from the sarcoplasmic reticulum- this is an effective antidote- hy

pt h/o hep C infection, vomiting bright red blood, p/e shows abdominal distention and gynecomastia, repetitive flicking motion of the hands are seen when pt is asked to outstretch his arm and dorsifles his wrist

pt is with cirrhosis(hep C, gynecomastia, abd distenition) recent Gi blding = hepatic encephalopathy- which is revercible decline in neuro function due to liver failure to metabolize wate product such as AMMONIA. GI bleeding cause incr nitrogen delivery to the gut in form of hemoglobin which is converted inot NH3 -- absorbed to the bldstream--enters the portal vein and is detoxified to urea. in CLF, hepatocyte cant detoxify so NH3 accumulates= results in incr inhibitory NT( eg gaba) and impaired excitatory NT release(glutamate,)

rotator cuff

pt landed on posterior shoulder now can abduct but cant external rotate against resistance = infraspinatus subscapularis: helps with adduction and internal rotation of the arm

2nd generation antipsychotics

pt taking haloperidol(1st gen) has acute dystonia/muscle spasm in his neck (extrapyramidal sym) so doctor switched to 2nd gen - quietiapine. moa of 2nd gen is block 5HT2A receptor-HY

Digoxin toxicity

pt was treated for CHF weeks ago now have disturbed color percepiton, GI problem: diarrhea, nausea, vomit, anorexia. and neurologic : fatigue, confusion, weakness life threatening ventricular arrhythmias are the most serious complication changes in color vision

Arbovirus outbreak and how to control dz

pt will have flu like illness, meningitis, encephalitis(confusion, tremor, focal neurologica deficit) and acute asymmetric falccid paralysis(west nile virus) control: is to eliminate vector arthropod breeding ground like stagnant water and early identification of infected birds( they are the host) and use insecticide spray for the mosquitos who transmit it

Primary Genital Herpes Rx and moa

pt will have genital rash and positive tzanck smear. antiviral drugs for the treatment is acyclovir, valcyclovir(acyclovir produrg with better oral bioavailablility) and famciclovir acyclovir are incorporated into newly replicating viral DNA and ultimately terminate viral DNA chain syntheisis

orbitofrontal cortex injury

pt will have personality changes, disinhibition, and irritability secondary to impairment of the behavioral and emotional

responsible for greenish color of sputum

pus in sputum seen during common bacterial infection due to the presence of myeloperoxidase, a blue-green heme based enzyme that is released from neutrophil azurophilic granules and forms hypochlorus acid bleach

manic episode consistent with bipolar 1 disorder

quit job, he sure to make million on placing large bets, he wants to spread understanding to the world is his new mission. he is talkative, racing thought

finger drop without wrist drop

radia nerve damage while passing supinator canal.

correlation coefficient

ranges from -1 to +1 and describe the strength and polarity of a linear association.

Tachyphylaxis

rapid decrease in response to the drug. "Acute tolerance"

influenza virus(swine/avian) pandemic is caused by

rassortment of RNA segments coding for heamgglutinin or neuraminidase protein

pt has burning chest when laying down. she has recurrent nonpitting edema of the hands she wears warm gloves indoor bcos her fingers turn blue when the are cold

raynaud phenomenon and esophageal dysmotility causing gerd the dx is CREST synd Calcinosis Raynaud Esophag. Sclerodactyly Telangiectasis

given drug thru anal vs oral

rectal administration will bypass first pass metabolism by the liver. it goes thru rectal bld direct to the systemic circulation, drug thru oral route has low bioavailability bcos it first pass the liver b4 getting to the systemic ciruclation

Berkson's bias

refers to selection bias created by choosing hospitalized patients as the control group

During skeletal muscle contraction ATP binding to myosin causes

release of the myosin head from its binding site on the actin filament so myosin head can reset to "contract" again

Cardiac looping

requires cilia and dynien leads to dextrocardia seen in kartagener synd or primary cilliary dyskinesia

Pygmalion effect

research believing the efficacy of treatment can potentially affect the outcome

High altitude

resp alkalosis because decr oxygen up tehre leads to hypoxemia resulting into hyperventilation and excessive expirateion of CO2 lead to resp alkalosis

8 y/o for one week has had rapid and irregular movements, he is also making funny faces, trouble controlling the volume of his voice. physical exam shows boy moving his hand erratically. he has new murmur, and several circular, erythematous lesionon his abdomen. whats the dx

rheumatic fever ffg untreated GAS ab against GAS cross react with host tissue due to molecular mimicry - M protein and N-acetyl beta D glucosamine attack myosin

person exposed/in close contact to a pt a pt with meningococal dz shud be given

rifampin as a prophylaxis

Riedel thyroiditis

rock hard thyroid- fibroblast activateion/proliferation= fibrous tissue(collagen) deposition in thyroid. parathyroid can be affected, hoarsness, trachea compressed. igG4 related

scattered non caseating granuloma in multiple tissue, liver, lymph nodes(bilateral hilar adenopathy). lung(interstitial lung dz), joint, uveitis, skin

sarcoidosis

anatomic snuffbox

scaphoid fractures have a high risk of avascular necrosis

Bupropion S/E

seizures. it is used for antidepressant , it inhibit the reuptake of NE, DOP. dont give to pt with h/o seizure, bulimia or anorexia nervosa

Phenylephrine

selective alpha 1 agonist that incr peripheral vascular resistance and systolic blood pressure and decrease pulse pressure and heart rate. its infusion will incr sympathetic tone resulting in vasocinstriction and icr in TPR. this leads to decr cardiac output due to incr afterload along with decr venous return

Rotavirus

self limited childhood < age5 diarrhea in unvaccinated kids. it invade the villous enterocytes of the duodenum and proximal jejunum and results in villous blunting, proliferation of secretory crypt cells and a loss of brush border enzymes; this result in watery diarrhea without fecal leukocytes.

Acute Hepatitis A

self limiting, fever, malaise, anorexia, vomit , rt upper quad pain,jaundice pruritus dark colored urine (due to increased conjugatd bilirubin levels) and acholic stool (lacks bilirubin pigment)

undescended testes

seminiferous tubules will atrophy if uncorrected due to higher body temp, resulting in decreased fertility and incr risk of malignancy orchiopexy (surgical placement of the testes in the scrotal sac) can minimize damage and decr risk of testicular cancer

a lower cut off mark will incr

sensitivity

Lactated Ringer's Solution

septic shock is charaterized by incr permeability of the vascular endothelium with leakage of intravascular fluid into the extravascular space. in managment of septic shock, rapid restoration of intravascular volume is critical. it is best to administer bolus of isotonic crystalloid in th form of 0.9% normal saline or lactated ringer solution thru large catheters

patent foramen ovale

septum primum and secundum fail to fuse. should close at birthe when pulm resistance fall allowing rush of blood to travel from RV, pulm artery to the lung.- pushing the septum together prostaglandin= fall = closure

carpal tunnel syndrome

seretary has difficulty typing and holding phone, hand weakness, weakness of thumb opposition and atrophy of the thenar eminence

female with incr androgen ( hair in chin, deep voice and "clitoromegaly" with a large adnexal mass has and large cyst in ovary

sertoli-leydig tumor

renal artery stenosis

severe hypertension, abdominal bruits RAS causes decreased renal artery perfusion WHICH ACTIVATES RAAS.incr aldo secretion causes increased Na reabsorption and K, H excretion

angina vs pericarditis

sharp pain and pleuritic and may be exacerbted by swallowing or coughing

A gurl sick with pharyngitis weeks ago not has joint pain and sick is at risk of dieing cos of

she has migratory arthritis, a positive anti streptolysin O titer, . she can die acutely of pancarditis(infflamation of the endocardium, myocardium and epicardium). she can eventually have new holosystolic murmur which lead to MR- cardiac dilation= HF= death as a result of chronic complication yrs later

WPW syndrome

short PR interval, delta waves and wide QRS. IT is caused by accessory pathway that bypasses the AVnode causing preexcitationof the ventricles. pt will feel arrhythmia due to reentry of electrical impulses thru the accessory conductn pathway

statins and macrolide

should not be given together bcos most statin except for pravastatin are metabolized by cytochrom p450 3A4. concomitant administratio of drughs that inhibit statin metabolism eg macrolide- erythromycin is ass with incr statin induce myopathy bcos erythromycin is partof CYP450 inhibitors

simple and facilitated diffusion

simple moves through a membrane without the help of carrier proteins facilitated requires carrier protein

conduction velocity

slowest conduction is thru AV node: speed with which electricity move thru the heart. slow so heart have more time to fill purkinje fiber is the fastest

Follicular thyroid carcinoma

slowly growing, painless, cold nodule and fine needle aspiration result shows follicular neoplasm eg numerous follicular cell and microfollicles benign vs malignant is differentiated thru histology of the entire tumor- thyroidectomy. benign: follicular adenoma- follicular cell are encapsulated malignant: follicular thyroid carcinomas: invasion of the tumor capsule and surrounding bld vessel- HY

Lacunar infarcts

small ischemic infarcts involving the deep brain structures (basal ganglia and pons) and subcortical white matter (hy- internal capsule, corona radiata).k They are most often due to hypertensive aterioslclerosis of small, penetrating arterioles. May sound very similar to a Charcot-Bouchard aneursm with hemorrhage but this would appear hyperdense on CT whereas lacunar infarct would be dark and cavitary (lacuna)

Aortic dissection

small lumen is the true lumen large lumen is the false lumen. tear in the intima layer type A:ascending tpe b: descending s/s tearing chest pain that radiate to the back. 1.if it propagate to the root of the aorta can cause aortic regurge 2. it can enter the pericardial space- effusion/tamponade 3. rt coronary artery come off the aorta it can lead to myocardia ischemia 4.propagation to the aortic arch= stroke(carotid), horner synd(sympathtic chain), vocal cord paralysis(rec. laryng. n compression which run underneath the arch) picture: widen midiasternum

risk factor for AAA abdominal aortic aneurysm

smokig male sex and age greater than 65

calmodulin, MLCK are seen in

smooth mus calmodulin:calcium binding protein

TCA overdose treatment

sodium bicarb NaHCO3 if QRS>100 agitaiton/seizure: benzo

Octreotide

somatostatin analog

Osteosarcoma

spindle shaped tumor cells mixed with bone and osteoid. pt has pain and soft tissue swelling

rib spleen and kidney

spleen 9, 10,11 left rib kidney is 12th left

pt said doctor is the best and brillant and for next appointment cos doctor was late she said he is terrible and doesnt care about pt,,

splitting

Dobutamine for pharmacologic stress testing

stable angina results from fixed coronary artery stenosis that limits bld flow to downstream myocardium preventin the myocardial o2 supply frm incr during exertion. dobutamin mimics the effects of exercise and increases myocardial oxy demand. it can be used during stress testing to provoke areas of ischemic myocardium which can be seen on imaging as a localized and transient decr in contractility (ie wall motion defect)

prolong exposure to loud noise damage

stereociliated hair cells of the organ of corti

ANP and BNP

stimulate salt and water excretion by the kidneys to facilitate diuresis clinically BNP has diagnostic utility in patients with shortness of breath of unknown cause

Norepinephrine (NE)

stimulates cardiac B1 adrenoreceptors, which incr CAMP conc, incr HR, ocntractility, incr renin, conduction note:alpha 1- vasoconstrictn alpha 2- vasodilation beta 1- HR inc beta 2- vasodilation

saddle pulmonary embolus

straddles the bifurcationof the main pulm artery. DVT or pulm embolism arises due to the virchow tirad of endothelial injury, venous stasis and a hypercoagulable state

moldy grain in china contain a substance tht cause G to T mutationin P53 GENE

strains of fungi aspergillus flavus and aspergillus parasiticus grow on food like corn, soybeans, peanuts producing aflatoxin as a byproduct.

takotsubo non ischemic cardiomyopathy/apical balooning

stress induced, depressed EF, S/S HF, inc CK, MB, troponin but no coronary dz and resolve 4-6wk base contract but apex dont contract

Hawthrone Effect/ Observer effect

study subject change their behavior as a result of their awareness that they are being studied

restrictive HRT DZ

substant infiltrating the heart- granuloma, sarcoid, amyloid protein(amyloidosis) severe diastolic dysfuncion, ventricle cant relax to fill the bld. dyspnea: cos rv is not pumping well to the LV= edema= liver congestion= >JVP Kussmaul sign: when they inspire there is arise in JVP. nl it is suppose to fall bcos ventricle accept the blood volume but their ventricle cannot accept cos RV is not stretchy low voltage of EKG. Fabry, hemochromatosis

central retinal artery occlusion

sudden, Acute, PAINLESS, permanent monocular vision loss Retina CLOUDY with attenuated vessels and CHERRY RED spot on fovea [Center of macula]. CRA is a branch of the opthalmic artery which arises from the internal carotid artery. athero- and thromboembolism are the most common cause of CRAO

actinic keratosis

sun exposed ares, lesion consis of erythematous papule with central scale and a rough sadpaper like texture. it considered premalignant and have the potential to progress to sq. cell carcinoma

scrotum drains to

superficial inguinal nodes

common cardinal vein give rise to

superior vena cava

s.s HF

supine: more bld role back t the heart= worsen pulm congestion and breathing LHF:pt can breath, sleep upright with pillow RHF: inc JVP, edema, liver congestion. seen in pulm hypertension or cor pulmonale or LHF rales and congesion(seen on X RAY) biopssy: heart failure cells/ hemosiderin(iron) laden macrophages/ brown pigment in macrophages

suprapubic abdominal wall

suprapubic cystosomy ; the tocar and annula pierces the aponeurosis , along with layers of the superficial fascia, trasversalis fascia and extraperitoneal fat

common peroneal nerve

susceptible to injury at the lateral neck of the fibula caused by compression or fracture- cause foot drop

to avoid blleding during oophorectomy, ligate

suspensory ligament of the ovary. it contain the ovarian artery, vein, lymphatics and nerves

small nuclear RNA is

sythesized by RNA plymerase 2 in the nucleus and complexes with specific proteins to form small nuclear ribonucleoprteins (snRNPs). snRNPs are component of spliceosomes which remove introns from pre-mrna to form mature mRna

Rotator Cuff Syndrome is caused by

tear of supraspinatus muscle

orchiopexy/ picture shows spermatic cord layers

testicles btwn 8wks and full term slowly descend into the scrotum by PASSING from abdomen thru deep inguinal ring to enter the inguinal canal. the testis then exit the canal via superficial inguinal ring which is formed by an opening in the external oblique muscle aponeurosis

Gonorrhea diagnosis is confirmed by

thayer martin media, chocolate agar infused with anitibiotic

mitral stenosis

the LA pressure has to rise higher than normal to open the valve. LA can compress the esophagus- dysphagia compress recurrent laryngeal nerve= hoarseness 1. h/o Rheumatic fever. opening snap sound

transcatheter aortic valve implantation (TAVI)

the catheter is advanced thru the aorta to the aortic valve. common complication of TAVI is paravalvular aortic regurge; thereby decrasing diastolic bld pressure and increasing LVEDP

cephalic, gastric, and intestinal phase

the cephalic and gastric phase stimulate gastric acid secretion while intestinal influences tend to reduce gastric acid secretion

Congenital Torticollis

the child prefers to hold the head to one side and is commonly due to intrauterine malposition of the head in utero while in the womb or birth trauma. May see a swelling where the affected Sternocleidomastoid muscle.

what is being palpated along the inner side of the Sternocleiodomastoid muscle and what its origin

the common carotid artery and the proximal portion of the internal carotid artery are derived from the third aortic arch. which gives rise to the glassopharygngeal nerve

aortic stenosis

the diagram depict crescendo-decresendo systolic murmur. the mcc in elderly pt age >70 is "degnerative calcification" of aortic valve leaflets. calcific AS is a caused by chronic hemodynamic stress or atherosclerotic inflammation that eventually leads to progressive aortic valve leaflet thickening, calcification and stenosis. murmur is best heard over the rt second interspace

Homeobox genes

the genes code for "transcription "factors that activate other genes that are important in cell development and differentiation; organization of the embryo along the cranio- caudal axis

human tumor cell develop the ability to resis chemotherapy by

the human multi drug resistance(MDR1) gene codes for (high yield) P-glycoprotein, a transmembrane ATP-dependent efflux pump

lymphatic proximal to the anal dentate line drain into

the inferior mesemteric and interanal iliac lymph node

HPV (human papilloma virus) oncologenicity relies on

the inhibitory effect of viral proteins E6 E7 on cell cycle regulatory proteins p53 and Rb. this allow cells infected with HPV to undergo unchecked cellular proliferation and evasion of apoptosis

plaque rupture

the likelihood of plaque rupture is related to plaque stability and not plaque size or degree of luminal narrowing. stability depends on the mechanical strength of the fibrous cap. inflammatory macrophages in the intima may reduce plaque stability by secreting metalloproteinases, which degrade extracellular matrix proteins eg collagen

Gas Partition Coefficient

the onset of action of a gas anesthetic depend on its solubility in the bld(bld/gas partition coef). drug with high b/g pc are more soluble in the bld and therefor demonstrate slower equilibration with the brain and have longer onset time like drug A(halothane)

shining light on the rt eye cause constritn of her right eye but not left eye shining light on her left eye cause constriction of only her right eye.

the optic nerve CN2 is responsible for the afferent limb of this reflex; CN3 occulomotor is responsible for efferent limb. in this pt the rt CN2 &CN3 is functional as there was direct response seen when light was shown the left CN2 is also functional bcos the rt eye consensual response occured when light was shined on the left eye BUT CN3 has lesion bcos constrictionof the left pupil was not seen in response to light

mechanism of liver injury in HBsAg

the presence of HBsAg and HBcAg on the cell surface stimulate the host cytotoxic CD8 T lymphocytes to destroy infected hepatocytes

cervical dysplasia

the presence of precancerous (HPV) changes in the cells that make up the inner lining of the cervix. inside the infected cells, viral proteins eg E6 E7 binds to tumor suppressing host proteins (P53) resulting in their destruction by the proteasome. this eliminate a crucial check point on cellular growth and can lead to dysplasia

Power (1-beta)

the probability of rejecting the null hypothesis when the null hypothesis is indeed false

pt had an inferior wall myocardial infarction(IWMI) what will happen to CO, PCWP, central venous pressure

the pt is in cardiogenic shock after suffering from inf. wall MI which is suppled by PDA. RCA also gives rise to marginal branches that supply most of RV, IWMI is often ass/w RV infarction. rt sided heart failure presents with hypotension and distended JV, but the lungs are clear, no lung crackle, no pulm edema unless significant left side heat failure is also present. pt will have hypotension(<CO), distended JV(elevated central venous pressure) . bcos lft sided filling pressure are reduce, PCWP will also decr as it reflects LApressure.

myelination and axon/ length vs time constant

the speed of conduction down an axon depend on 2 constant. myelination increases the length constant and decr the time constant both which improve axonal conduction speed. demyelination is multiple sclorosis thus impairs this

hysterectomy wht can be injured

the ureter due to its close proximity to the urterine structures.the urer passes inferior to the uterine vesses- water under bridge

lady present with small bluish lesion under the nail, it is extremly tender to touch. if it is atumor, the cell of origin willhave what

thermoregulation; a bluish neoplasm underneath the nail bed may be either a glomus tumor(glomangioma) or a subungual melanoma. melanoma contain melanocyte while glomangima is a tumor of modified smoothmuscle cells of a glomus body; which are numerous small, encapsulated neurovascular organs found in the dermis of the nail bed, pads of the finger and toes and ears

paranoid personality disorder

they dont have trust, doubt about others intentions and concern that personal information will be used against them and always suspicious, they threaten ppl

first generation antipsychotics

they treat schizo and psychosis. FGA are classified according to potency, . low potency FGA; cause antihistaminergic(sedation), anticolinergiccholinergic, noradrenergic blockade(orthostatic hypotension) s/e high potency: cause extrapyramidal sym like dystonia, akathisia, parkinsonism s/e

Endocardial fibroelastosis

thickening of the endocardial seen in infant in 1st year of life, proliferationof fibrous(collagen) and elastic fiber) cause of restrictive heart dz in baby

Chlorthalidone s/e

this drug ismore potent in lowering BP than others TZD (eg hydroclorothiazide) butit is ass/w metabolic abnormalities " it incr LDL cholesterol. TG level,

Variant(Prinzmetal's) Angina

this is not caused by atherosclerotic plaque narrowing, often the artery is clean but it as a result of vasospasm of artery = vasoconstriction- it happens spontneously. = ischemia= STelevation on ECG. Often happen at rest/midnight/early morning. h/o pt Dx: provoke the vasospasm by giving pt ergonovine ACH in nl pt will vasodilate the vessel but in this pt ach will vasoconstrict thier vessel so u can visualise on an angiogram RX: pt quit smoking, nitrate, CCB

new born has small, bright red, slightly elvated lesion over buttock

this is strawberry capillary hemagioma(juvenile). it consist of unencapsulated aggregates of closely packed, thin walled capillaries, they are benign. tell the parents that these will "initially grow" in proportion to the child "then regress" at or b4 puberty. so not to worry

Clear cell carcinoma

this is the histology of the kidney. pt will come with painless heamturia in an older adult is a sign of urinary tract cancer (urothelial or renal cell carcinoma). the renal biopsy show rounded/polygonal cells with abundant clear cytopalsm

dual chamber pacemaker s/e

this pacemaker leads stops in the RA and RV, so this can cause tricuspid regurg because the RV lead passes thru the TV orifice and can disrupt valve clousure

pt had femur fracture, had surgery now sudden onset shortness of breath and chest pain

this pt has 2 risk factors for pulm embolism- 1. immobilization(causes venous stasis) 2. recent surgery( inflammationinduces a hypercoagulable state) thrombotic occlusion of pulm circulation lead V/Q mismatch. 1. well ventilated alveoli cant get blood flow(dead space ventilation) 2. the remaining accessible alveoli are unable to fully oxygenate the vol of bld that continues to flow thru the pulm= result in hypoxemia

Internal Capsule Stroke

this pt has contralateral wekness w. clasp-knife spasticity, which is initial resistance to passive flexion followed by a sudden release of resistance. this is seen in upper motor neuron lesion, rigidity, hyperreflexia, and positive babinski sign. these lesions damage the pyramidal motor sys(eg CST tract) which runs from the precentral gyrus (primary motor cortes) thru the internal capsule to the brainstem and spinal cord.

pt woke up lightheadedness, he felt unsteady and almost passed out getting out of bed. he has history of aortic stenosis, coronary art. dz requirring percutaneous coronary intervention. ECG was given

this pt is experiencing a 3rd degree AV block. it involves a total lack of communication btwn the atrial and ventricles due to AV node dysfunction. it can result from ischemia, 1. infiltrative dz(eg. sarcoidosis), 2.lyme dz or 3. age related fibrosis with cellular degeneration

right lower quad tenderness with rebound as well as palpable mass, abdomen and pelvis ct scan shows periappendiceal fluid collection.

this pt is suffering from perforated appendicitis that has evolved into an intraabdominal abscess. bacteroides fragilis is mcc anaerobic gram negative bacillus that is frequently isolated in the abscess

teniae coli

three bands of longitudinal smooth muscle in muscularis that travel longitudinally on the outside of the colon and converge at the root of the vermiform appendix

PTU (propylthiouracil)

thyroid hormone antagonist. Given to those with hyperthyroidism. it inhibit TPO: dec T3 T4 inhibit 5' deiodinase: which convert t4 to t3(active)

ectopic thyroid tissue

thyroid tissue staying on base of the tongue and not migrate down= mass in the tongue. -only detected during increased demand for hormones like puberty and pregnancy. it will get bigger but not enough and pt will still have hypothyroidims. the TSH will incr in response to the hypothyroidism making the mass on the tongue grow bigger- it needs to be removed and pt will be on synthetic thyroid

a pt fell from the roof, now the right foot is dorsiflexed and everted and he is unable to tip toe. what is wrong

tibial nerve. this pt will also have sensory loss over the sole (plantar foot.) tibial nerve many be injured at the level of popliteal fossa

minute ventilation

tidal vol x breath/min is the total vol of new air that enters the resp pathway per min

damage to radial nerve while passing thru the supinator canal may occur due

to repetitive pronation/supination of the forearm, direct trauma or subluxation of the radius. pt will have wekness during finger and thumb extension- finger drop without wrist drop or sensory deficit

first treatment for psoriasis(scraping lead to bleeding) is

topical corticosteroid and vit D analog vit D analog will inhibit T-CELL and keratinocyte proliferation and stimulate keratinocyte differentiation.

Hookworm (Necator americanus and ancylostoma duodenale

transmitted: skin comes in contact with soil contaminated with human feces and larvae penetrate the skin-- lung-- coughed up-- swallowed-- small intestine-- feed on host bld-- iron def anemia- microcytic anemia as complication

TAP proteins

transporter associated with antigen processing. are necessary for loading a cytoplasmic(eg viral) proteins onto MHC1 molecule. so it can activate CD8 T cells thru interaction with the TCR

holosystolic murmur that increases intensity during inspirtation

tricuspid regurg. MR or VSD does not incr in intensity during inspiration

skeletal muscle mechanism depends on myosin, actin, tropomyosin and troponin and ca) explain

tropomyosin is the long green covering the myosin binding site of actin when muscle is at rest. troponin is the small grey globular protein sitting alongside the tropomyosin. troponin T bind the other troponin component to topomyosin. troponin I binds the troponin-tropomyosin complex to actin. troponin C contain the binding sites for Ca. during excitation-contraction: Ca is released from sarcoplasmic reticulum. Ca binds troponin C, tropomyosin shifts to expose the actin binding site for myosin, allowing contraction to occur

the probablility of concluding that there is no difference when there is is called

type 2 error which is B power is 1-b

2nd degree AV block

type1:wenckebach: progressive PR prolongateion then a drop beat. RR interval is irreg type 2: no progressive pr interval. it comes along with RBBB OR LBBB

transference

unconscious shifting of emotions associated with a significant person from one's past to a person in the present. like a person who never have a father figure growing up

Heparin mechanism of action

unfractioned and LMWH can bind to antithrombi to incr its activity against factor 10a. but only unfractioned heparin is able to bind to both antitrhormbin and thrombin together to from ternary complex to "inactivate" thrombin. only unfractioned is long enough .

Stable angina & unstable angina

unstable: due to rupture of plaque with thrombosis and incomplete occlusion of coronary A. MI: irreversible, complete thrombus. death of myocardium after 20 min without flow,

pt has abdominalpain, vomit, hematuria, hypercalcemia and hypophosphatemia, and hyperparathyroid

ureterolithiasis.. kidney stone

myxoma

usually arise in the LA, obstruct the mitral valve, leading to mid diastolic murmur and symptoms of dedr CO, syncope. IT CONTAIN SCATTERD CELLS WITHIN A MUCOPOLYSACCHARIDE STROMA AND ABnormal bld vessels wiht hemorrhaging

Enterococcus endocarditis

usually occur in men wh have recently undergone manipulationof areas colonized by this organism. the genitourinary tract eg cytoscopy. GI colonoscopy they are gamma hemolytic (no hemolysis on agar) catalase neg, pyrrolidonyl arylamidase-positive, lancefield group D gram + cocci that can grow in hypertonic 6.5% saline and bile

ekg boards and beyond

v1 & 11 are the reading script

maneuver summary

valsalva; inc murmur standing- inc squatting- dec leg raise-dec

ab use for invasive MRSA infection and moa

vancomycin: blocks glycopeptide polymerization by binding to D-alanyl D-alanine s/e red man syn and nephrotoxicity daptomycin: disrupt cellular membrane by creating transmembrane channels causing leakage s/e CPK elevation, myopathy linezolid: inhibits bacterial protein synthesis by binding to 50S subunit s/e thrombocytopenia. optic neuritis, high risk for serotonin synd

the cardiovascular response to exercise is

vasoconstriction in the splanchnic circulation and vasodilation in the skeletal muscle, shunting blood toward exercising muscle. the vasodilation is predominantly resulting in overall decr systemic vascular resistance. there is also incr HR, SV that increases cardiac output and O2 delivery to the tissues.

Nitroprusside

vasodilator of veins and arteries to decrease both LV preload and afterload doing this will allow pt with HF to be able to maintain cardiac out and stroke volume at a lower LV pressure (lower cardiac work)

HCM PT shud avoid drug that would decrease preload/ reduced sys vascular resistance

vasodilators eg dihydropyridine CCB, nitroglycerine, and ACEi 2. diuretic decr LV venous filling(preload) and also result in greater outflow obstruction

during physical exercise/running what is expected to peak

venous blood mean CO2 content. bcos in the skeletal muscle physical exercise cause incr oxidative metabolism of gluc and FA, this incr the rate of O2 consumed and CO2 produced which then must be balanced by incr in sk. muscle perfusion and alveolar ventilation.

what causes sudden death in MI pt

ventricular fibrillation; it results from arrhythmogenic foci triggered by electrical instability in the ischemic myocaredium

cancer of the pelvis including the prostate spread to the lumbosacral spine via

vertebral venous plexus VVP. VVP communicate with # of venous networks, including the "prostatic venous plexus"

a baby that has oral thrush, interstitial pneumonia,lymoopenia during first year has

vertical transmission of HIV 1 thru mom. mom who received no prenatal ART antiretroviral therapy which is 2 reverse transcriptase inhibitor and one protease inhibitor or NNRTI- which are enzyme inhibitor

Reflux nephropathy

vesicoureteral relux is caused by rterograde urine flow from the bladder int the ureter. the hydrostatic pressure of refluxing urine along with infection due to ascending bacterialcauses inflammtion. the upper and lower poles of the kidney are most susceptible to relux-induced damage which appears as dilated calyces with overlying renal cortical scarring.

coronary sinus

vessel that run on the left atrioventricular groove of the posterior aspect of the heart that empties deoxxygenated blood into the right atrium btwn the IVC and tricuspid valve at the CS orifice. bcos it communicate freely with RA, it bcome dilated by any factor that causes dilation of the RA. "d mcc of coronary sinus dilation evident on ECG is elevated rt sided heart pressure secondary to pulm HTN" adenosine and nitric oxide are drug that vasodilate it so myocardial can take more oxygen it needs.

MCC of pericarditis

viral infection is the mcc eg adenovirus, coxsackievirus, echovirus influeza virus s/s pt will feel substernal pluritic chest pain that radiate to the scapula posteriourly. they cant breath deep down and its worse when lying flat and pain improves with sitting up and leaning foward- pericardial friction rub

Non-ischemic cardiomyopathy

viral: coxsakie, influenza, adenovirus etc 2. peri-partum: pregnant woman, cause is multifactoral 3. chemo: after treating with anthracycline: doxorubicin and daunorubicin 4. gene mutation: beta myosin heavy chain, alpha myosin heavy chain, troponin 5: alcohol

pt cannot read what is an alternate way to communicate for understanding the surgical procedure

visual resources

Aortic steonosis

walken and suddenly faint, crescendo decrescendo. angina due to decr coronary bld flow. 1. senile AS: wear and tar, age, calcium deposot 2.bicuspid AVS: young 3. supravalvular AS: narrowing of the ascending aorta above AV. seen in william synd

PT undergo gastrectomy must be on lifelong

water vit B12; intrinsic factor that isnormally secreted by parietal cells in the stomach and is neccessary for the absorption of b12 in the ileum

child fever headache vomit confusion, they have recently noticed several dead birds aroun the neighborhood dx

west nile virus; is harbored in birds and transmitted into humans by mosquitos. most pt are asymptomatic the virus can cause an influenza-like illness or neroinvasive dz with meningitis, encephalits and flaccid paralysis

heart failure

when bld is not being push forward; pressure will be on the wall: blood leaks from lungs and vein LV failure- inc LV wall pressure- incr LVEDP causing mitral valve to close b4 LA empty= incr LA pressure= icr pul capillary pressure= edema cos RVP RAP incr= high JVP, and capillary leak

Hook worm transmission necator americanus and ancylostoma duodenale

when human skin comes in contact with soil contaminated with human feces. the larvae penetrate the skin, travel to lungs are coughed up and then subsequently swallowed. adult hookworm live in small intestine and feed on human bld- chronic iron def anemia

observer bias

when observations may be skewed to align with observer expectations. thi bias can be reduced by conducting a blinded study in which observers ae unaware of study detail and pt so they wont be influenced

Primitive heart

while cardinal vein forms SVC and IVC not from the cardiac tube

aortic regurgitation

wide pulse pressure, water hammer pulse, head bobbing

Fibromyalgia

widespread musculoskeletal pain ass/w fatigue, and neuropsyc disturbance. common in women. symp>3mo pt has absence of lab findings everything seems normal ESR, CRP

pt with Chronic kidney dz and phosphate

will have decr in GFR, which decr the filtered phosphate load and cause elevated serum phosphate levels- hyperphosphatemia; this will reduce serum free calcium and stimulates osteocyte and clast to release FGF-23 fibroblast growth factor, which will decr pRoximal tubule phosphae reabsoption. it also inhibit 1 alpha hydroxylase in the PCT, so calcitriol is not synthesis - causing even more hypocalcemia but at least phosphate is not been absorb which is the goal to reduce hyperphosphatemia

lesion at jugular foramen

will lead to vernet synd: which is dysfunction of crainal nerv 9, 10, 11- symptoms include dysphagia, hoarseness, loss of gag reflex on the ipsilateral side and deviation of the uvular toward the normal side

pt auditory hallucination, mood and personality change, slurred speech, tremor, gait instability and abnormal liver function test- transaminases suggest

wilson dz AR - copper accumulation in liver, brain, cornea. evaluation include obtaining ceruloplasmin level, 24 hrs urinary copper excretion, and slit lamp exam for copper deoposition in the cornea(kayser-fleischer rings)

first generation antipsychotics vs second gen

work by blocking dopamine receptors eg haloperidol- s/e high risk of extrpyramidal symp- acute dystonic rxn, drug induced parkinson, akathisia(inner reslessness, cant sit still), tardive dyskinesia. 2nd gen: metabolic adverse effect: weight gain, diabeties

Stimulant for ADHD MOA

works by increasing the availability of NE and dop in the prefrontal cortex. amphetamine incr the release of NE and dop FROM PRESYNAPTIC STORAGE VESICLES AND INHIBIT Monoamine oxidase.

radial never injury

wrist drop nl: it extend arm, wrist and supinate the wrist and abduction the thumb

SSRI cause sexual dysfunction y/n

yes. SSRI used for major depressive disorder pt s/e include decr libido, arousal, anorgasmia and incr ejaculation latency BUPROPION is a drug pt can switch to. it also an antidepressant but no sex dysfuction.

clues to Hrt murmur questn b4 listening to the sound

young female, healthy: MVP healthy, yong athlete, syncope: HCM immigrant or pregnant- MS IV dru abuser: TR turner synd or aortic coarctation: bicuspid AV=early stenosis= AR marfan- MVP